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Rheumatology SB > Muscle Disease > Flashcards

Muscle Disease Flashcards

1
Q

what are causes of muscle disease

A 
inflammatory
endocrine
metabolic myopathies
electrolytes disorders
infection
drugs and toxins
rhabdomyolysis
fibromyalgia
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2
Q

what is Polymyositis and Dermatomyositis

A

idiopathic inflammatory myopathies

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3
Q

which one is more linked with malignancy between Polymyositis and Dermatomyositis

A

dermatomyositis

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4
Q

what are the clinical features of Polymyositis and Dermatomyositis

A

Muscle weakness - most common presenting feature
Insidious onset - worsening over months
Symmetrical, proximal muscles
Mild myalgia (muscle pain) in some

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5
Q

what do people with Polymyositis and Dermatomyositis often present with

A

specific problems with muscle weakness

difficulty brushing hair, climbing stairs

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6
Q

how are Polymyositis and Dermatomyositis different

A

dermatomyositis has cutaneous features

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7
Q

what are cutaneous features of Dermatomyositis

A

Gottrons sign - red-purple areas over PIP and MCP joints
Heliotrope rash - purple-red rash around the eyes
Shawl sign - rash around shoulders and in v shape down the chest

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8
Q

what can be other organ manifestations in Polymyositis and Dermatomyositis

A

Lung:
Interstitial lung disease
Respiratory muscle weakness

Oesophageal:
Dysphagia

Cardiac:
Myocarditis

Other:
Fever, weight loss, Raynauds phenomenon, non-erosive polyarthritis

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9
Q

what cancers are linked with Polymyositis and Dermatomyositis

A

ovarian, breast, stomach, lung, bladder and colon

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10
Q

what can be features of the history that can make you suspect Polymyositis and Dermatomyositis

A

PC - tired muscle, functional difficulty, muscle pain
PMH - DM, thyroid disease
Dx - steroids, statins
Sx - alcohol, cocaine
Systemic - Weight loss, cough, SOB, Raynauds

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11
Q

what might be seen on examination of Polymyositis and Dermatomyositis

A

loss of muscle bulk

muscle wasting

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12
Q

what tests can be done for Polymyositis and Dermatomyositis

A

confrontation testing - direct testing of power

isotonic testing - 30 second sit to stand test

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13
Q

what investigations can be done for Polymyositis and Dermatomyositis

A

Serum CK levels - will be elevated
Inflammatory markers
EMG - electromyography
Muscle biopsy - the definitive test for diagnosis

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14
Q

what autoantibodies are associated with Polymyositis and Dermatomyositis

A

ANA

Anti-Jo-1

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15
Q

what would be seen in a muscle biopsy of Polymyositis and Dermatomyositis

A

Perivascular inflammation and muscle necrosis

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16
Q

treatment of Polymyositis and Dermatomyositis

A

1 - Oral steroids; 40mg daily Prednisolone
2 - Immunosuppression; Methotrexate, Azathioprine or Ciclosporin
3 - IV immunoglobulin; used in people who have failed standard therapy

17
Q

how does inclusion body myositis (IBD) differ from polymyositis and Dermatomyositis

A 
weakness often ASYMMETRICAL
commoner in men
diagnosed at much older age> 50
more insidious onset 
distal muscle weakness - tends to start with lower legs and hands
18
Q

what muscles are commonly affected in IBD

A

wrist and finger flexors in upper limbs

quadriceps and anterior tibial muscles in legs

19
Q

Ix of IBD

A

CK levels - lower than in PM ad DM

Muscle biopsy - inclusion bodies seen

20
Q

treatment of IBD

A

responds very poorly to treatment

21
Q

who gets Polymyalgia Rheumatica (PMR) and what is it associated with

A

> 50 years old

Temporal arteritis/Giant cell arteritis

22
Q

features of PMR

A 
NO MUSCLE WEAKNESS
ache in shoulder and hip girdle
morning stiffness and pain
symmetrical
Fatigue, anorexia, weight loss, fever
23
Q

what are the findings of clinical examination in PMR

A

reduced movements of shoulders, neck and hips

muscle strength is NORMAL

24
Q

symptoms/signs of Temporal arteritis/Giant cell arteritis

A 
headache
scalp tenderness
jaw claudication
visual loss (amaurosis fugax)
tender, enlarged, non-pulsatile temporal arteries
25
Q

what is Temporal arteritis/Giant cell arteritis

A

Granulomatous arteritis of large vessels

26
Q

Ix of PMR

A 
ESR - raised 
Plasma viscosity
CRP - elevated
US 
Temporal artery biopsy
27
Q

Tx of PMR

A

Low dose steroids - have rapid and dramatic response to low dose

28
Q

if temporal arteritis present in PMR what is the steroid dose

A

40mg if visual impairment

60mg if none

29
Q

if temporal arteritis is NOT present in PMR what is the steroid dose

A

10mg to 20mg

30
Q

what is fibromyalgia

A

common cause of chronic MSK pain

not associated with inflammation

31
Q

who gets fibromyalgia

A

commoner in women
Commonest cause of musculoskeletal pain in women 22-50 years
may begin after emotional/physical trauma

32
Q

symptoms/signs of fibromyalgia

A 
chronic pain
diffuse tenderness on examination
sleep disturbances/fatigue
mood changes
cognitive difficulties 
headaches
numbness/stiffness
TMJ disorder
'allergic symptoms'/hypersensitivity to light,allergens
33
Q

clinical manifestations of fibromyalgia

A

Pain in neck, shoulders, lower back, chest wall - but can also feel general.
Varies in intensity - gets worse on exercise, doesn’t have to be a lot
Symptoms worse with exertion, fatigue and stress
Sensation of swelling
Fatigue and poor, unrefreshing sleep
Pins and needles/tingling, headaches, depression, abdominal pain (IBS), poor concentration and memory

34
Q

clinical findings of fibromyalgia

A

Excessive tenderness on palpation of soft tissues

No other abnormality of musculoskeletal system

35
Q

Ix for fibromyalgia

A

no diagnostic test
inflammatory markers normal
Absence of other explanation of symptoms

36
Q

Tx for fibromyalgia

A

patient education
self management
anti-depressants
analgesia

Rheumatology SB (7 decks)

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