Muscle disease

Question 1

Who is polymyositis/dermatomyositis most common in?

Answer 1

Females 40-50

Question 2

What are the main symptoms with the myositis?

Answer 2

Symmetrical muscle weakness in proximal muscles.

Question 3

What cutaneous signs does dermatomyositis have?

Answer 3

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

Question 4

What is a heliotrope rash?

Answer 4

Red, flat rash around the eyelids. Sometimes swelling.

Question 5

What other organ involvement does myositis cause?

Answer 5

ILD, dysphagia, myocarditis, Raynauds

Question 6

Dermatomyositis has a increased risk of malignancy. Where is this most common?

Answer 6

Ovarian, breast and then hollow organs.

Always give GI scope and a CT scan.

Question 7

What other medical problems are a common presentation with dermatomyositis?

Answer 7

DM, thyroid disease

Question 8

What drugs are linked to dermatomyositis?

Answer 8

Steroids

Statins - can cause myalgia and muscular inflammation

Question 9

Where does the rash commonly appear in dermatomyositis?

Answer 9

Hands, back of neck, v line of chest, on breasts

Question 10

How should muscle power be tested in myositis?

Answer 10

Direct testing of muscle power by force and isotonic testing- 30 second sit to stand test.

Question 11

What blood tests are needed to diagnose myositis?

Answer 11

Creatinine kinase
CRP, ESR
PTH, TSH to exclude
ANA and anti- Jo 1 antibodies

Question 12

What other tests can be done to diagnose myositis?

Answer 12

Electromyography

Question 13

What is the definitive test for myositis?

Answer 13

Muscle biopsy.

Muscle necrosis and especially CD8+ cells,

Question 14

What treatments can be given for myositis?

Answer 14

Steroids
Azathioprine or methotrexate
Ciclosporin
Rituximab

Question 15

What is inclusion body myositis?

Answer 15

Asymmetrical distal muscle weakness especially in wrist and finger flexors in hands and quads and anterior tibials in legs.

Question 16

Who is more at risk of inclusion body myositis?

Answer 16

Men over 50

Question 17

How is inclusion body myositis different to dermatomyositis?

Answer 17

Lower CK levels.
Biopsy shows inclusion bodies
Responds poorly to therapy
Develops over years

Question 18

What are the clinical manifestations of polymyalgia rheumatica?

Answer 18

Symmetrical ache in shoulder and hip girdle with morning stiffness (>1hr)
Muscle strength is normal but with reduced movement.

Question 19

How does giant cell arteritis present?

Answer 19

Headache, scalp tenderness, jaw claudication, visual loss,

tender, enlarged non-pulsatile temporal arteries

Question 20

True or false

Polymyalgia rheumatica has a link with giant cell arteritis

Answer 20

True

15% of pts with PR develop GCA

Question 21

What is the treatment for GCA?

Answer 21

Low dose steroids

Question 22

What is fibromyalgia?

Answer 22

Literally dunno.

May begin after emotional or physical trauma

Question 23

Who is most likely to get fibromyalgia?

Answer 23

Women 22-50

50% more likely in SLE sufferers

Question 24

What other conditions are linked to fibromyalgia?

Answer 24

Headaches, IBS, cysitis, constitutional symptoms, multiple allergies, depression

Question 25

Where does fibromyalgia affect on the body?

Answer 25

Neck, shoulders, lower back, chest wall

Question 26

What treatment can we give for fibromyalgia?

Answer 26

tramadol
Gabapentin
Tricyclic anti-depressants

Question 27

What antibody is present in patients with myositis?

Answer 27

Anti-Jo 1

Question 28

Which drug can be given to patients with fibromyalgia to aid their sleep?

Answer 28

Amitryptiline