Muscle Disease

Question 1

What does “Myalgia” mean?

Answer 1

Muscle Pain

Question 2

What does “My arms feel heavy and tired, i struggle to do things” imply about the muscle?

Answer 2

Muscle Weakness

Question 3

What does “My muscle are stiff when i first wake up and then get a bit better when I’ve walked about for a bit” imply about the muscle?

Answer 3

Inflammation

Question 4

Which muscle disease(s) have an increased risk of malignancy associated?

Answer 4

Myositis

especially dermatomyositis

Question 5

What type of disease are Polymyositis and Dermatomyositis?

Answer 5

Idiopathic Inflammatory Myopathies

Autoimmune

Question 6

Who’s more like to get polymyositis? (male/female) (ages 10-20/ 20-30/30-40/40-50/50-60/60-70/65+)

Answer 6

Females (2:1)

40-50 years peak

Question 7

What is seen on biopsy of Polymyosits?

Answer 7

Muscle fibre necrosis
Degeneration
Regeneration
An inflammatory cell infiltrate

Question 8

What is the most common presenting complaint of a patient with polymyosits?

Answer 8

Muscle weakness

Question 9

List some clinical features of Myositis:

Answer 9

Muscle weakness
Insidious onset, worsening over months.
Usually symmetrical, proximal muscles
Mild myalgia in some patients (25-50%)

Question 10

Was cutaneous signs are seen in dermatomyositis?

Answer 10

Gottron's sign (hands)
Heliotrope rash (face/eyes) (purple/pink discoloration and swelling)
Shawl Sign (Back)

Question 11

Which drugs are known to cause proximal muscle weakness?

Answer 11

Steroids

Question 12

What other presentations can be important to pick up in a history of tired muscles and functional difficulty?

Answer 12

Raynauds Phenomenon
Weight loss
Cough
Breathlessness
Dysphagia
Fever
Non-erosive Polyarthritis

Question 13

What is the difference between Confrontational Testing and Isotonic Testing?

Answer 13

Confrontational = Direct testing of power (pushing)
Isotonic = Repeated movement (e.g. 30 second sit to stand)

Question 14

Which is a better test of muscle power? (Confrontational, Isotonic)

Answer 14

Isotonic testing

Question 15

Why are Creatine Kinase enzymes raised in Myositis?

Answer 15

Muscle inflammtion and breakdown of muscle causes release of muscle enzymes during break down. Creatine Kinase is a muscle enzyme so levels of this rise (up into thousands) in myositis

Question 16

What is a specific antibody of polymyositis and drmatomyositis?

Answer 16

Anti-Jo-1

Question 17

What is an EMG?

Answer 17

Electromyography

Shows pattern of how muscle conducts electricity

Question 18

What is seen on an EMG of a patient with polymyositis?

Answer 18

Increased fibrillations, abnormal motor potentials, complex repetitive discharges

Question 19

Treatment for Myositis:

Answer 19

Prednisolone daily - decrease dose over time
Use immunosuppression at same time as steroid
(steroids - short term)

Question 20

What is typical of Inclusion body myositis?

Answer 20

Distal muscle weakness
Weakness wrist and finger flexors in upper limbs and quadriceps and anterior tibial muscles in legs
Weakness often asymmetrical
Patients >50

CK levels lower than polymyositis
Muscle biopsy shows inclusion bodies
Responds poorly to therapy

Question 21

How high are the CK levels in IBM and PM?

Answer 21

High
(Not up into thousands in IBM)
(Into thousands in PM, much higher)

Question 22

What is the best test for myositis?

Answer 22

Biopsy

Question 23

What are the main symptom of myositis?

Answer 23

Muscle Weakness

Question 24

Which drugs may cause a presentation similar to myositis?

Answer 24

Statins

Question 25

Who gets Polymyalgia Rheumatica?
(age)
(Almost exclusively)

Answer 25

Over 50 year olds

Question 26

What condition is associated with Polymyalgia Rheumatica?

Answer 26

Temporal Arteritis/ Giant Cell Arteritis (15%)

Question 27

What are the clinical manifestations of Polymyalgia Rheumatica?

Answer 27

Ache in shoulder and hip girdle
Morning stiffness
Usually symmetrical
Fatigue, anorexia, weight loss and fever may occur
Reduced movement of shoulders, neck and hips due to pain and stiffness
Comes on quite quickly (within a few weeks)
Worst first thing in the mornign
Struggle to get out of bed
Better after walking about a bit
MUSCLE STRENGTH NORMAL

Question 28

Whats “the fear” with GCA (temporal arteritis)?

Answer 28

Blindness

Question 29

What would be raised in polymyalgia rheumatica?

Answer 29

ESR, plasma viscosity, CRP

Question 30

Is polymyalgia rheumatica autoimmune?

Answer 30

NO

INFLAMMATORY CONDITION

Question 31

Treatment for polymyalgia rheumatica:

no temporal arteritis

Answer 31

15mg Prednisolone

feel dramatically better

Question 32

Treatment for polymyalgia rheumatica:

WITH temporal arteritis

Answer 32

40-60mg Prednisolone

to prevent visual loss

Question 33

Is fibromyalgia an inflammatory or non-inflammatory problem?

Answer 33

Non-inflammatory

Question 34

Main symptoms of Fibromyalgia:

Answer 34

Pain
Extreme fatigue
Poor sleep pattern

Question 35

Does exercise make symptoms of fibromyalgia better or worse?

Answer 35

Worse

Question 36

Where is the pain in fibromyalgia?

Answer 36

Neck
Shoulder
Lower back
Chest wall

Question 37

What is fibromyalgia pain like?

Answer 37

Diffuse
Chronic
Varies in intensity
Worse with exertion, fatigue, stress
Sensation of swelling

Question 38

How many tender points need to be present to make a diagnosis of fibromyalgia?

Answer 38

11 out of 18

Question 39

Are the inflammatory markers raised in fibromyalgia?

Answer 39

No
They are normal
It is a non-inflammatory

Question 40

Treatment for Fibromyalgia:

Answer 40

Better to not give medication initially
Try to minimise drugs
Use non-drug therapies, e.g. CBT, graded exercise
Start with Paracetamol, then Amitrptyline