Muscle Disease Flashcards
What is polymyalgia rheumatica?
Chronic inflammatory condition characterised by proximal muscle pain and morning stiffness
How does polymyalgia rheumatica present?
In over 50s
Ache of shoulder girdle and hip girdle (normal strength)
Prolonged morning stiffness which improves with movement
Constitutional symptoms
What muscle disease is closely associated with giant cell arteritis (GCA)?
Polymyalgia rheumatica
Which symptoms must you ask about in a patient presenting with shoulder/hip ache and morning stiffness?
Headache, jaw claudication, scalp tenderness, visual disturbance
What is the treatment of polymyalgia rheumatica?
Low dose steroids (15mg/day)
symptoms improve dramatically
What blood tests would you order in suspected polymyalgia rheumatica and what would they show?
Inflammatory markers
Raised
What is polymyositis?
Idiopathic inflammatory condition causing symmetrical proximal muscle weakness
How does polymyositis present?
More common in women
Insidious onset proximal muscle weakness
May be associated with dysphagia and interstitial lung disease
What autoantibodies are associated with polymyositis?
Anti-Jo-1 (particularly associated with interstitial lung disease)
Anti-SRP
What blood tests would you order in a patient with suspected polymyositis and what would they show?
Inflammatory markers - raised
Creatinine kinase - dramatically raised
Autoantibodies - Anti-Jo-1, anti-SRP
What tests are diagnostic of polymyositis and what do they show?
Electromyography - abnormal
Muscle biopsy - show muscle inflammation, necrosis and regeneration
What is the treatment of polymyosisits?
Prednisolone (40mg, responds slowly)
What is associated with polymyositis?
Malignancy (should be screened for at diagnosis)
What factors would make inclusion body myositis a more likely diagnosis than polymyositis?
Male
Distal limb weakness
CK raised but not as dramatically as in polymyositis
Poor response to steroids
What does muscle biopsy show in inclusion body myositis?
Inculsion bodies (white spaces within myocyte)
What condition is dermatomyositis clinically very similar to? How does this condition present?
Polymyositis
Proximal muscle weakness
What are the names and appearances of the cutaneous signs seen in dermatomyositis?
Gottron’s papules - purple discolouration of knuckles
Heliotrope rash - purple discolouration around eyelids
Shawl sign - rash over superior back and posterior neck
_____ - V-shaped rash over chest
What is fibromyalgia?
Idiopathic inflammatory condition characterised by widespread muscle pain and fatigue
How does fibromyalgia present?
Widespread muscle pain
Fatigue
Low pain threshold
Sensitivity to noise, smell, heat
Association with depression, emotional trauma, IBS, chronic fatigue syndrome
How do you diagnose fibromyalgia?
No specific diagnostic criteria largely a diagnosis of exclusion
What must be ruled out before diagnosing fibromyalgia?
Hypothyroidism
Rheumatoid arthriris
Systemic lupus erythematosus
How do you manage fibromyalgia?
Mainstay is helping patients to self-manage
Adjuvant analgesia (amitryptiline, gapapentin, pregabalin)
Cognitive behavioural therapy
