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MSK SM > Muscle Disease > Flashcards

Muscle Disease Flashcards

1
Q

What are some inflammatory causes of muscle disease

A

Polymyositis
Dermatomyositis
Inclusion body myositis
Polymyalgia Rheumatica

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2
Q

How do muscle diseases commonly present

A

Muscle pain (myalgia)
Muscle weakness/ tiredness
Stiffness

Occasionally abnormal bloods,
organ involvement and skin rashes

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3
Q

What is the difference between polymyositis and dermatomyositis

A

Exactly the same but dermatomyositis also has skin involvement

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4
Q

At what age do polymyositis and dermatomyositis often appear

A

Between 40 and 50 years

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5
Q

There is an increased malignancy with both polymyositis and dermatomyositis. In one there is a particularly increased risk. What one of these 2 is this

A

Dermatomyositis

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6
Q

How can we describe polymyositis and dermatomyositis

A

Idiopathic inflammatory myopathies that appear in a symmetrical pattern

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7
Q

What are some of the clinical features of polymyositis and dermatomyositis

A

Muscle weakness
Insidious onset, worsening over months
Proximal muscles

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8
Q

What happens to the muscle cells in polymyositis and dermatomyositis

A

The muscle cells are lost and therefore muscle bulk

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9
Q

What is a key feature of dermatomyositis

A

Gottrons sign or gottrons papules

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10
Q

Where is there evidence of Gottrons sign

A

Over the PIP and the metapharyngeal joints

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11
Q

Describe the appearance of the Heliotrope rash that can appear in dermatomyositis

A

Purple rash around the eyes

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12
Q

Describe the appearance of the Shawl sign that can be appear in dermatomyositis

A

purple colour rash over the back of the neck or a v shaped rash down the front of the chest

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13
Q

What is the most common organ involved in polymyositis or dermatomyositis

A

Lung (interstitial lung disease and respiratory muscle weakness
Respiratory muscle weakness can lead to breathlessness

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14
Q

What organs can be involved in polymyositis or dermatomyositis

A

Oesophageal (dysphagia)
Cardiac (myocarditis)
Other (fever, weight loss, Raynauds phenomenon, non-erosive polyarthritis)

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15
Q

What kind of malignancies can develop from polymyositis or dermatomyositis

A

Ovarian, breast, stomach, lung, bladder and colon (hollow organs)

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16
Q

Who is the malignancy risk greatest in in patients who have either polymyositis or dermatomyositis

A

men over the age of 45

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17
Q

What types of drug can cause muscle pain and muscle inflammation

A

Statins

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18
Q

What other medical conditions are important to know about when taking a history for suspected polymyositis or dermatomyositis

A

Diabetes mellitus and thyroid disease

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19
Q

On examination of a patient with either polymyositis or dermatomyositis, what can be scene

A

Wasting of the muscles usually the big proximal ones

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20
Q

What should be tested in examining a patient with polymyositis or dermatomyositis

A

Confrontational - muscle power

Isotonic testing - 30 seconds sitting to standing test (repeated muscle strength

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21
Q

Why is it useful to do confrontational testing and isotonic testing

A

It is easy to compare results - to see if medication is helping and how poor they are during a flare etc.

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22
Q

What should be tested in suspected polymyositis or dermatomyositis

A

Muscle enzymes (CREATINE KINASE CK)
inflammatory markers
electrolytes, calcium, PTH, TSH
Autoantibodies: ANA and Anti-Jo-1

Electromyography (EMG)

  • increased fibrillations
  • abnormal motor potentials
  • complex repetitive discharges

Muscle Biopsy

  • definitive test
  • perivascular inflammation and muscle necrosis

MRI
-muscle inflammation
-oedema
fibrosis and calcification

23
Q

Why is CK likely to be high in polymyositis or dermatomyositis

A

The muscle itself is inflamed which causes the breakdown of the muscle cells which release CK

24
Q

What are the 5 different types of treatment for polymyositis or dermatomyositis

A 
Glucocorticoids (40mg/day, fast acting)
Azathioprine (take 6-8 weeks to work)
Methotrexate
Ciclosporin
IVIG
25
Q

The steroid treatment for polymyositis or dermatomyositis should gradually be increased. True or False

A

False - it should be gradually decreased until the patient is only on immunosuppressive therapy

26
Q

Patients with Inclusion body myositis are often misdiagnosed as having what

A

Polymyositis

27
Q

What age group and sex are more likely to develop Inclusion body myositis

A

over 50s

More common in men

28
Q

What muscles are typically affected in Inclusion body myositis

A

Distal muscles - weakness in wrist and finger flexors in upper limbs and quadriceps and anterior tibial muscles in legs

29
Q

What is the main different between Inclusion body myositis and Polymyositis or dermatomyositis

A

Inclusion body myositis is assymetrical and Polymyositis or dermatomyositis is symmetrical

30
Q

What does a muscle biopsy of Inclusion Body Myositis show

A

Inclusional bodies

31
Q

Patients with Inclusion Body Myositis tend to have a fairly poor response to treatment. True or False

A

True

32
Q

What age of patients are likely to develop Polymyalgia Rheumatica

A

Those over 50 years

33
Q

Where is there a higher incidence of Polymyalgia Rheumatica

A

Northern regions - iceland and scandinavia (near the equator it is rare)

34
Q

What conditions is Polymyalgia Rheumatica associated with

A

Temporal arteritis and giant cell arteritis

35
Q

What muscles does Polymyalgia Rheumatica affect

A

Proximal muscles

36
Q

What is the problem with muscle biopsies in Polymyalgia Rheumatica

A

The muscles look normal as the problem does not arise at the level of the muscle

37
Q

What are some of the clinical manifestations of Polymyalgia Rheumatica

A 
Ache in shoulder and hip girdle 
Morning stiffness 
Symmetrical 
Fatigue, anorexia, weight loss, fever 
Reduced movement of shoulders, neck and hips
Muscle strength is normal
38
Q

What is a common presenting complaint in a patient with Polymyalgia Rheumatica

A

I could not get up in the morning but over the course of the day things improved

If they lift their arms they really struggle but if you do it for them it is normal as the underlying muscle is normal

39
Q

What is Temporal arteritis / Giant cell arteritis

A

Granulomatous arteritis of large vessels

40
Q

What are some of the presenting complaints with Temporal arteritis / Giant cell arteritis

A 
Headache 
Scalp tenderness
Jaw claudication - when chewing
Visual loss 
Tender, enlarged, non-pulsatile temporal arteries
41
Q

How can we make a diagnosis of Temporal Arteritis

A

Raised ESR
Plasma viscosity
CRP
Temporal artery biopsy - you may see thickening of the vessel wall

42
Q

What is the problem with temporal artery biopsies?

A

They are not reliable due to having skipped lesions - you get patches of normal areas and affected areas

43
Q

What is the treatment for Polymyalgia Rheumatica

A

Low dose steroids (15mg) - very rapid and dramatic response to these

44
Q

Can polymalgia rheumatica be cured

A

Yes - within 18months to 2 year

45
Q

What is the commonest cause of chronic MSK pain

A

Fibromyalgia

46
Q

Is fibromyalgia associated with inflammation

A

No

47
Q

Who is most likely to get fibromyalgia

A

Women often between 22-50

48
Q

When might fibromyalgia begin

A

After emotional or physical trauma

49
Q

What are some of the factors in the fibromyalgia cycle

A

Stress, limited activity, fatigue, depression, muscle stiffness, pain, muscle tension

50
Q

Describe the sleep pattern is a patient with fibromyalgia

A

Often disturbed and they often wake up and feel as if they haven’t had a good sleep which ultimately causes more pain

51
Q

What are some regional symptoms and syndromes related to fibromyalgia

A 
Headache
IBS 
Cognitive difficulties (concentrating and remembering things properly) - brain fog 
Non cardiac chest pain
Numbness that moves from area to area 
Excessive sweating
52
Q

What are some of the clinical manifestations of fibromyalgia

A 
Pain in neck, shoulders, lower back and chest wall
Varies in intensity 
Symptoms are worse with exertion, fatigue and stress 
Sensation of swelling 
Unrefreshing sleep 
Pins and needles/ tingling
Headaches
Depression
Abdominal pain
Poor concentration and memory

Excessive tenderness on palpation of soft tissue (even cap refill)

53
Q

How can we establish a diagnosis of fibromyalgia

A

No diagnostic test
inflammatory markers are normal
Absence of other explanation of symptoms

54
Q

What is the treatment for a patient with fibromyalgia

A 
Patient education
MDT 
Graded exercise programme
CBT 
Complementary medicine - acupuncture 
Anti-depressants 
Analgesia
Gabapentin and pregabalin
AMATRYPTOLINE

MSK SM (42 decks)

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