muscle disease Flashcards
what is the difference between polymyositis and dermatomyositis?
same condition, dermatomyositis involves skin too
what is the presentation of polymyositis?
slow onset, symmetrical, proximal muscle weakness
girdle muscles - hip and shoulders
mild myalgia
what is Gotton’s sign?
scaly, red/purple papule on PIP and MCP joints
what is heliotrope rash?
lilac rash over eyes
what is shawl’s sign?
macular rash over back and shoulders
what systemic features are seen with polymyositis?
interstitial lung disease (SOB) dysphagia myocarditis fever weight loss raynauds
what does polymyositis increase your risk of?
malignancy
increased risk of breast, ovarian, lung, bladder and bowel
what test are done to diagnose polymyositis? what are the findings?
confrontational testings
isotonic testing (30 secs sit to stand)
muscle power reduced
what is seen on bloods in polymyositis?
very elevated CK
anti-jo1
what test is diagnostic in polymyositis?
muscle biopsy
what other rest can be done in polymyositis?
EMG - increased fibrillations
what is the management for polymyositis?
malignancy screening
steroids - then reduced
DMARDS - methotrexate/azathioprine (take 4-6 weeks to start working)
if not responding to treatment, what should you consider?
inclusion body myositis
what differences are seen in inclusion body myositis?
more common in men >50
asymmetrical weakness affecting distal muscles
inclusion bodies on biopsy
CK elevated but not as high as in polymyositis
what are the symptoms of polymyalgia rheumatia?
muscle pain and stiffness
quick onset - few weeks
usually symmetrical
muscle pain in shoulders and hips, not weakness
what does PR have an association with? how does it present?
giant cell arteritis unilateral headache scalp tenderness (sore to brush hair) TMJ claudication tender, enlarged temporal artery visual loss
what is seen on bloods in PR?
raised inflammatory markers - CRP and ESR
CK normal
what other tests can be done for PR?
temporal artery biopsy if GCA suspected
what is the management for PR?
15mg ( low dose) prednisolone
(big response in few days)
temporal arteritis without visual loss 40mg pred
temporal arteritis with vision loss 60mg pred
how long is the steroid treatment for PR?
18 months - 2 years
gradual reduction
