Muscle Disease Flashcards
Dr J Golla
name 2 types of inflammatory myopathies
polymyositis
dermatomyositis
Polymyositis and Dermatomyositis are __________ ____________ myopathies
idiopathic inflammatory
the female to male ratio in polymyositis and dermatomyositis is 1:2
true or false?
false
F:M
2:1
what is the peak incidence age in polymyositis and dermatomyositis?
40-50 years
what is there an increased incidence of in polymyositis and dermatomyositis?
malignancy
what are the histological features of polymyositis and dermatomyositis?
muscle biopsy include muscle fibre necrosis, degeneration, regeneration and an inflammatory cell infiltrate.
Underlying cause is not clear
what is the most common clinical feature in polymyositis and dermatomyositis?
muscle weakness
what cutaneous sign is seen in dermatomyositis in the hands?
gottrons sign
what cutaneous rash is seen in dermatomyositis on the face?
heliotrope rash
what cutaneous sign is seen in dermatomyositis on the back?
shawl sign
what other organs are involved in dermatomyositis?
lung - ILD
oesophageal - dysphagia
cardiac - myocarditis
other - Raynaulds
there is a __% incidence of malignancy in dermatomyositis and _% incidence of malignancy in polymyositis
15% - dermatomyositis
9% - polymyositis
outline the typical history in dermatomyositis and polymyositis?
tired muscles and pain DM and thyroid disease steroids and statins alcohol, drug use weight loss, cough, breathlessness, Raynaulds
what 2 tests are performed in dermatomyositis and polymyositis?
confrontational (power) and isotonic (30 sec sit and stand)
what is seen in the blood of someone with dermatomyositis and polymyositis?
CK
inflammatory markers
ANA
Anti Jo-1
what other investigations can help diagnose in dermatomyositis and polymyositis?
electromyography - EMG
muscle biopsy
MRI
what is seen on biopsy of the muscle of someone with dermatomyositis and polymyositis?
Perivascular inflammation and muscle necrosis
what is the treatment in dermatomyositis and polymyositis?
Glucocorticoids Azathioprine Methotrexate Ciclosporin IV immunoglobulin Rituximab
Polymyalgia Rheumatica is seen in people over the age of what?
50 years old
Incidence of Polymyalgia Rheumatica is higher in southern regions
true or false?
false
northern
what conditions is Polymyalgia Rheumatica associated with
Associated with temporal arteritis/giant cell arteritis (15%)
what are the clinical manifestations seen in Polymyalgia Rheumatica?
ache is shoulder and hip
morning stiffness
strength is normal
what does temporal arteritis cause?
headache
scalp tenderness
jaw claudication
visual loss
how do you diagnose Polymyalgia Rheumatica?
raised ESR, PV, CRP
temporal artery biopsy
what is the treatment in Polymyalgia Rheumatica?
low dose steroids
fibromyalgia is associated with inflammation
true or false?
false!
Not associated with inflammation
in what sex and age is fibromyalgia most common?
female (6:1)
22-50 years old
what are the clinical manifestations in fibromyalgia?
pain in neck, shoulder and lower back chronic worse with exception swelling fatigue pins and needles general unwellness
what are the clinical findings in fibromyalgia?
excessive tenderness on palpitation
what is the diagnosis criteria in fibromyalgia?
widespread pain >/= 3 months
unrefreshing sleep, fatigue
no other condition explains pain
what is the treatment in fibromyalgia?
exercise acupuncture anti-depressants analgesia gabapentin and pregablin
diagnose:
63 year old male pain in shoulders and hips raised PV and CRP normal CK
Polymyalgia Rheumatica
what is the treatment in Polymyalgia Rheumatica? drug? mg? duration?
Prednisolone 15mg reducing course over 6 months
diagnose:
64 year old man heavy arm for 6 months tiring climbing stairs EMG suggests myositic change in the proximal muscles raised CK and CRP
dermatomyositis
how does Alan Muldoon make his boyfriend scream during sex?
he calls him and tells him about it
