Muscle Disease Flashcards
How do muscle diseases present
Muscle pain (myalgia) Muscle weakness/tiredness Wasting if prolonged No stiffness Abnormal blood tests
Name 2 inflammatory myopathies
Polymyositis
Dermatomyositis
Which sex is inflammatory myopathy more common in
Women
What age has the peak incidence of inflammatory myopathy
40-50
How does inflammatory myopathy present histologically
Muscle fibre necrosis
Degeneration
Regeneration
Inflammatory cell infiltrate.
List the cutaneous signs of dermatomyositis
Gottron’s sign - papules on finger joints
Heliotrope rash - around eye
Shawl sign - rash across the back of shoulders
What organ systems can be involved in inflammatory myopathy
Lungs = ILD and muscle weakness Oesophagus = dysphagia Heart = myocarditis
Which cancers are associated with inflammatory myopathy
Ovarian, breast, stomach, lung, bladder and colon
What symptoms do people with inflammatory myopathies present with
Tired muscles Functional difficulty Muscle pain Weight loss Cough &/or SOB Raynaud's
Which drugs might be associated with inflammatory myopathy
Steroids
Statins
Which social factors might be associated with inflammatory myopathy
Alcohol
Illicit drug use
What signs of inflammatory myopathy would show up on electromyography
Increased fibrillations
Abnormal motor potentials
Complex repetitive discharges
Which age group does polymyalgia rheumatica occur in
Almost exclusively in the over 50s
Typically present 60-70
Symptoms of polymyalgia are usually symmetrical - true or false
True
Get bilateral shoulder and hip pain
Which areas are usually affected by polymyalgia rheumatica
Pain in shoulder and hip girdle - bilateral
Reduced movement in shoulders neck and hips due to joint issue
Trauma can trigger fibromyalgia - true or false
True
Both emotional or physical
Describe the pain in fibromyalgia
Pain occurs in the neck, shoulders, lower back and chest wall It's diffuse and chronic Varies in intensity Worse with exertion, fatigue and stress But no weakness or reduced movement
List some symptoms of fibromyalgia
Pain - widespread Fatigue and poor sleep pattern Pins and needles/tingling Headaches Depression and anxiety - poor coping IBS Poor concentration and memory No weakness or reduced movement
List the diagnostic criteria for fibromyalgia
Patient experiences widespread pain and other associated symptoms
Symptoms present at same level for more than 3 months
No condition can otherwise explain it
List some treatments for fibromyalgia
Patient education Graded exercise programme Anti-depressants CBT Complementary medicine - e.g. acupuncture Analgesia Gabapentin & pregabalin
What is dermatomyositis
polymyositis + skin changes
Polymyalgia rheumatica is associated with which other inflammatory disease
GCA
Seen in 10% of cases
Must check for symptoms
How does polymyalgia rheumatica present
Bilateral shoulder and hip pain lasting over 2 weeks
Acute onset but last for over 6 weeks
Early morning stiffness lasting more than 45 mins- gets better as day goes on
Normal muscle strength
Evidence of an acute-phase response (raised ESR/CRP)
How do you diagnose polymyalgia rheumatica
Inflammatory markers will be raised - ESR/CRP
CK normal - not actually a muscle disease
Dramatic response to steroids is diagnostic
How do you treat polymyalgia rheumatica
Steroids - start on 15mg prednisolone
Wean down slowly over 18-24 months
How do you ask about muscle weakness
Are you able to get up from a chair without support or climb stairs-inability to do these indicate proximal muscle weakness
Can also ask them to crouch and get up unaided
Always do thorough systemic enquiry-are muscles of
swallowing or breathing involved? Is there dysphagia,
regurgitation of food/liquids, SOB on exertion etc?
Muscles are weakened in polymyalgia rheumatica - true or false
False
- muscle power is normal and there is no wasting
Which sex is more affected by polymyalgia rheumatica
Women - 3x more common
List some systemic symptoms of polymyalgia rheumatica
Systemic symptoms such as weight loss, night sweats, fatigue
and poor appetite are not uncommon
Lung tumours can sometimes cause polymyositis - true or false
True
Can get a paraneoplastic polymyositis driven by the tumour
A raised CK indicates which type of pathology
Muscle pathology
Therefore, you
would expect it to be significantly raised in poly and dermatomyositis
How is FBC affected in polymyositis and PMR
May see anaemia of chronic disease
Polymyalgia rheumatica is a muscle disease - true or false
False
PMR is predominantly a joint diseases and muscle fibres are not involved
How does statin induced myositis present in blood tests
CRP/ESR/PV are usually normal
CK would be mildly raised in statin associated
necrotising myositis
PMR with GCA requires a higehr steroid dose than just PMR - true or false
True
PMR alone = 15mg
PMR + GCA = 1 mg/kg/day of prednisolone (maximum 80 mg/day)
