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MSK > Muscle Disease > Flashcards

Muscle Disease Flashcards

1
Q

List main muscle diseases (6)

A 
Polymyalgia rheumatica
giant cell arteritis
polymositis
dermatomyositis
inclusion body myositis
fibromyalgia
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2
Q

Polymyalgia Rheumatica

A

Common inflammatory condition causing myalgia at the hip and shoulder girdles

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3
Q

Polymyalgia Reumatica Characteristics

A

Proximal myalgia of the shoulder and hip girdles
Morning stiffness >1hr
Strong relation to giant cell arteritis

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4
Q

Polymyalgia Rheumatica: Epidemiology

A

Women

Over 50s

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5
Q

Polymyalgia Reumatica Symptoms

A

Dramatic muscle stiffness
Shoulder and hip pain
No muscle weakness

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6
Q

Polymyalgia Reumatica Investigation

A

Raised CRP

Raised ESR/PV

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7
Q

Polymyalgia Reumatica Treatment

A

15mg prednisolone

Reduced over 18 months

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8
Q

Giant Cell Arteritis

A

Commonest form of systemic vasculitis

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9
Q

Giant Cell Arteritis Epidemiology

A

Older patients

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10
Q

Giant Cell Arteritis Characteristics

A

Transmural inflammation of the intima, media and adventitia

Patchy infiltration by lymphocytes, macrophages and granulomas

Vessel wall thickening
- subsequent distal ischaemia

Patchy involvement

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11
Q

Giant Cell Arteritis Symptoms

A

Visual Disturbances

  • Diplopia
  • As temporal artery supplies optic nerve
  • Amaurosis fugal (painless or temporary loss of vision in one or both eyes)

Headaches
-continuous in occipital or temporal region

Jaw claudication
- due to maxillary artery ischaemia

Scalp tenderness
Fatigue
Malaise
Fever

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12
Q

Giant Cell Arteritis investigations

A

Temporal artery biopsy

  • mononuclear infiltration
  • granulomatous inflammation

Raised ESR, CRP and PV

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13
Q

Giant Cell Arteritis Treatment

A

If visual impairment
- 60mg prednisolone

No visual impairment
- 40mg prednisolone

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14
Q

Polymyositis

A

Idiopathic weakness myopathy that causes symmetrical proximal muscle weakness

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15
Q

Polymyositis Risk factors

A

High alcohol consumption

Illicit drug use

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16
Q

Polymyositis Pathogenesis

A

CD8+ T cells and macrophages surround healthy muscle tissue and initiate a cytotoxic response

17
Q

Polymyositis Epidemiology

A

Females
>20
Age 45-60

18
Q

Polymyositis Symptoms

A 
Symmetrical proximal muscle weakness in the upper and lower limbs
May have myalgia
Insidious onset
Dysphagia
- Oropharyngeal/ oesophageal involvement
ILD
Gradual onset
Fever
Weight loss
Raynaud's
Polyarthritis 
SOB
Cough
19
Q

Polymyositis Investigations

A 
Inflammatory markers
Serum creatinine kinase
Auto-antibodies
- ANA
-Anti-Jo-1 (specific) 
-Anti-SRP (specific)

MRI

  • Muscle inflammation
  • Oedema
  • fibrosis
  • calcification

Electromyography

Muscle Biopsy

Muscle strength testing

  • confrontational
  • isotonic
20
Q

Polymyositis Treatment

A

40mg prednisolone
Immunosuppressive drugs
- azathioprine
-methotrexate

IV immunoglobulin
Rituximab

21
Q

Dermatomyositis

A

Idiopathic weakness myopathy that causes symmetrical proximal muscle weakness with cutaneous manifestations

22
Q

Dermatomyositis Cutaneous Manifestations

A

V-shaped rash over chest

Gottron’s Papules

  • Purple colouring of the skin over MCP and PIP joints
  • Can be painful
  • may bleed
  • Often worsens in sunlight

Heliotrope rash

23
Q

Dermatomyositis: Main malignancy risks

A 
Breast
Ovarian
Lung
Colon
Oesophageal
Bladder
24
Q

Inclusion body myositis

A

Type of inflammatory myopathy. Progressive muscle disorder.

NOT autoimmune

25
Q

Inclusion body myositis epidemiology

A

Commoner in men

26
Q

Inclusion body myositis Characteristics

A 
Asymmnetrical. 
Generally affects the distal muscles. 
Slower onset than polymyositis. 
Responds poorly to therapy .
CK levels are lower that polymyositis
27
Q

Fibromyalgia

A

Unexplained muscle condition causing widespread muscle pain and fatigue

28
Q

Fibromyalgia epidemiology

A

Females.

Young and Middle Age

29
Q

Fibromyalgia Aetiology

A

Unknown
Disorder of cental pain processing
Syndrome of central sensitivity

30
Q

Fibromyalgia sites

A

Neck
Shoulders
Lower back
Chest wall

31
Q

Fibromyalgia symptoms

A 
Persistent widespread pain >3 months on both sides of the body. Above and below the waist including axial skeleton 
Fatigue and unrefreshing sleep
Cognitive difficulties 
Anxiety
Depression
IBS
Migraines
worse on exercise
32
Q

Fibromyalgia secondary to..

A

Rheumatoid Arthritis

Systemic Lupus Erythematous

33
Q

Fibromyalgia have lower threshold to…

A

Pain
heat
Noise
Strong odours

34
Q

Fibromyalgia clinical signs

A

Excessive tenderness on palpitation

No other abnormalities

35
Q

Fibromyalgia Treatment

A 
Education of self-management
Graded exercise
Atypical analgesia
Gabapentin
Pregabalin
CBT

MSK (35 decks)

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