Muscle Disease / Myopathies

Question 1

What are inflammatory myopathies characterised by?

Answer 1

Weakness

Question 2

What are the two inflammatory myopathies

Answer 2

Polymyositis and dermatomyositis

Question 3

What is there an increased risk of with inflammatory myopathies

Answer 3

Malignancy, which is screened for at presentation

Question 4

How do inflammatory myopathies usually present

Answer 4

Worsening over months, usually symmetrical, proximial muscles

Question 5

What 3 signs can be seen in dermatomyositis

Answer 5

Gottron’s sign, heliotrope rash and shawl sign

Question 6

What are 2 exam tests to do on inflammatory myositis

Answer 6

Confrontational testing (direct testing of power) and isotonic testing (30 second sit to stand test - to see tiring in muscles)

Question 7

What muscle enzyme can be looked for

Answer 7

CK

Question 8

What are the autoantibodies screened for in inflammatory myositis

Answer 8

ANA, Anti Jo 1, myositis specific antibodies

Question 9

Why are patients screened for electrolytes/ calicum/ PTH/ TSH

Answer 9

to exclude other causes of weakness

Question 10

What are the changes seen in electromyography

Answer 10

increased fibrillations, abnormal motor potentials, complex repetitive discharges

Question 11

What is the definitive test of inflammatory myositis

Answer 11

Muscle biopsy

Question 12

What does the muscle biopsy show

Answer 12

perivascular inflammation and muscle necrosis

Question 13

What is the treatment for inflammatory myositis

Answer 13

Steroids to start off with (not good long term) and immunosuppression

Question 14

What is the main symptom in inflammatory myositis

Answer 14

Muscle weakness

Question 15

What is the most definitive diagnostic test for polymyositis?

Answer 15

Muscle biopsy

Question 16

What age group does polymyalgia rheumatica affect

Answer 16

Elderly people - definitely over 50/60

Question 17

What condition is polymyalgia rheumatica associated with in 15% of patients

Answer 17

Temporal arteritis/ giant cell arteritis

Question 18

What is the main symptom of polymyalgia rheumatica

Answer 18

Muscle pain and stiffness

Question 19

What are the areas of pain in polymyalgia rheumatica

Answer 19

Ache in shoulder and hip girdle, usually symmetrical

Question 20

What are the features of giant cell arteritis

Answer 20

Headache, scalp tenderness, jaw claudication, visual loss (amaurosis fugax - blackout) and tender, enlarged non pulsatile temporal arteries

Question 21

How is the diagnosis of polymyalgia rheumatica

Answer 21

Raised inflammatory markers (may do temporal artery USS or biopsy) - will show thickened artery wall

Question 22

How should polymyalgia rheumatica be managed without giant cell arteritis

Answer 22

Prednisolone 15mg reducing course over 18 months

Question 23

How should polymyalgia rheumatica be managed with giant cell arteritis

Answer 23

Prednisolone 40mg reducing course over 18 months

Question 24

How common is fibromyalgia

Answer 24

Commonest cause of musculoskeletal pain in women 22-50 years

Question 25

What is fibromyalgia not associated with

Answer 25

Inflammation

Question 26

What may bring on fibromyalgia

Answer 26

Emotional or physical trauma

Question 27

What are the predominant symptoms of fibromyalgia

Answer 27

Fatigue, headaches, muscle pain, poor sleep pattern, MSK chest pain, anxiety, depression, some tender points

Question 28

How can fibromyalgia be diagnosed

Answer 28

Of exclusion

Question 29

How can fibromyalgia be treated

Answer 29

Patient education, gabapentin, pregabalin, anti depressants, MDT approach, graded exercise