Muscle disease Flashcards
Who is polymyositis/dermatomyositis most common in?
Females 40-50
What are the main symptoms with the myositis?
Symmetrical muscle weakness in proximal muscles.
What cutaneous signs does dermatomyositis have?
Gottron’s sign- dark red papules and patches on the hands on the MCP joints and DIP joints.
Shawl sign - purple/red around the posterior neckline and also in a V on front of chest
What is a heliotrope rash?
Red, flat rash around the eyelids. Sometimes swelling.
What other organ involvement does myositis cause?
ILD, dysphagia, myocarditis, Raynauds
Dermatomyositis has a increased risk of malignancy. Where is this most common?
Ovarian, breast and then hollow organs.
Always give GI scope and a CT scan.
What other medical problems are a common presentation with dermatomyositis?
DM, thyroid disease
What drugs are linked to dermatomyositis?
Steroids
Statins - can cause myalgia and muscular inflammation
Where does the rash commonly appear in dermatomyositis?
Hands, back of neck, v line of chest, on breasts
How should muscle power be tested in myositis?
Direct testing of muscle power by force and isotonic testing- 30 second sit to stand test.
What blood tests are needed to diagnose myositis?
Creatinine kinase
CRP, ESR
PTH, TSH to exclude
ANA and anti- Jo 1 antibodies
What other tests can be done to diagnose myositis?
Electromyography
What is the definitive test for myositis?
Muscle biopsy.
Muscle necrosis and especially CD8+ cells,
What treatments can be given for myositis?
Steroids
Azathioprine or methotrexate
Ciclosporin
Rituximab
What is inclusion body myositis?
Asymmetrical distal muscle weakness especially in wrist and finger flexors in hands and quads and anterior tibials in legs.
Who is more at risk of inclusion body myositis?
Men over 50
How is inclusion body myositis different to dermatomyositis?
Lower CK levels.
Biopsy shows inclusion bodies
Responds poorly to therapy
Develops over years
What are the clinical manifestations of polymyalgia rheumatica?
Symmetrical ache in shoulder and hip girdle with morning stiffness (>1hr)
Muscle strength is normal but with reduced movement.
How does giant cell arteritis present?
Headache, scalp tenderness, jaw claudication, visual loss,
tender, enlarged non-pulsatile temporal arteries
True or false
Polymyalgia rheumatica has a link with giant cell arteritis
True
15% of pts with PR develop GCA
What is the treatment for GCA?
Low dose steroids
What is fibromyalgia?
Literally dunno.
May begin after emotional or physical trauma
Who is most likely to get fibromyalgia?
Women 22-50
50% more likely in SLE sufferers
What other conditions are linked to fibromyalgia?
Headaches, IBS, cysitis, constitutional symptoms, multiple allergies, depression
Where does fibromyalgia affect on the body?
Neck, shoulders, lower back, chest wall
What treatment can we give for fibromyalgia?
tramadol
Gabapentin
Tricyclic anti-depressants
What antibody is present in patients with myositis?
Anti-Jo 1
Which drug can be given to patients with fibromyalgia to aid their sleep?
Amitryptiline
