Muscle Disease Flashcards
How do muscle diseases usually present?
Muscle pain Muscle weakness Stiffness Abnormal blood tests
Polymyositis and Dermatomyositis are _______ Myopathies
Idiopathic inflammatory myopathies
Who gets polymyositis and Dermatomyositis?
40-50yr olds
What does Polymositis and Dermatomyositis increase the risk of?
Malignancy
What would you see histologically in idiopathic inflammatory myopathies?
muscle fibre necrosis Degeneration Inflammatory cell infiltrate
What is the most common presenting feature for idiopathic inflammatory myopathies?
Muscle weakness cant brush hair, climb stairs, get dressed etc
what would the onset of idiopathic inflammatory myopathie’s symptoms be like?
Insidious onset Worsening over time
Name some two idiopathic inflammatory disorders?
Dermatomyositis
Polymyositis
Inclusion body myositis
What are the cutaneous signs of Dermatomyositis ?
Gottrons sign Heliotrope rash Shawl sign
What is this sign called and who gets it ?
Gottrons sign
Dermatomyositis
What is this sign called and who gets it ?
Helicoid rash
Dermatomyositis
What is this sign called and who gets it ?
Shall sign
Dermatomyositis
What is the percentage increased risk of malignancy in dermatomyositis?
15%
What is the percentage increased risk of malignancy in polymyositis?
9%
What two examinations would you like to preform on the patient in the GP setting in a patient with idiopathic inflammatory myopathy?
Confrontational testing- direct testing of power
Isotonic testing - 30 seconds sit to stand
What blood tests would you look at in a patient with suspected idiopathic inflammatory myopathy?
CK
Inflammatory markers
autoantibodies- ANA, Anti-Jo-1
What would you expect to see in the CK levels in a patient with idiopathic inflammatory myopathy
10x the norm
What other investigations would you do to make a diagnosis in idiopathic inflammatory myopathy
MRI muscle
Muscle Biopsy
the MRI will allow you to identify suitable muscles for biopsy
What drug treatment would you consider for idiopathic inflammatory myopathy?
Steroids
DMARDs
Biologics- Rituximab
What is Inclusion Body myositis?
Its abit like polymyositis but it affects distal mucles more often.
CK levels are lower than in polymyositis
Responds poorly to therapy
Study this image
Who gets Polymyalgia Rheumatica ?
People over the age of 50
What important condition sohuld you look out for in patients with Polymyalgia Rheumatica?
Temporal arteritis/giant cell arteritis
What are the clinical manifestations of Polymyalgia Rheumatica?
Ache in the shoulder and hip girdle
Morning stiffness
Constitutional symptoms
What is important to remember about the muscles in patients with Polymyalgia Rheumatica ?
They wil be of normal strength
What would you find in this test in a patient with Polymalgia Rheumatica?
Normal Muscle Strength
What symptoms does Tempoisral Arteritis present with?
Headache
Scalp tenderness
Jaw claudication
How do you treat Polymyalgia Rheumatica?
Prednisolone - 15mg
40-60mg if temporal arteritis
Steriods for 1.5 to 2 years
what is Fibromyalgia ?
Common cause of chronic MSK pain and fatigue
not associated with inflammation
Who gets fribromyalgia?
Prime working life woman
What is the fibromyalgia cycle?
What are the clincial manifestations of fribromyalgia?
Diffuse chronic pain
Unrefeshing sleep
symptoms worsen with excersion
Pins and needles and sensation of swelling
Associated with irritable bowel syndrome
What special examination can you preform to diagnose Fibromyalgia?
Tender points - 11/18 required
What blood test results would you see?
Blood tests would be normal
How do you treat Fibromyalgia?
Education and reasurrance
Anti depressants
Analgesia
Gabapentin and pregabalin
