Muscle Disease (Myopathy)

Question 1

what three conditions are muscles diseases?

Answer 1

1. inflammatory myopathies (polymyositis and dermatomyositis)
2. polymyalgia rheumatica
3. fibromyalgia

Question 2

define polymyositis and dermatomyositis

Answer 2

autoimmune conditions with peak incidence in 40-50s

Question 3

describe the risk of malignancy in polymyositis and dermatomyositis

Answer 3

15% in D

9% in P

Question 4

presentation of polymyositis and dermatomyositis

Answer 4

• muscle weakness (usually symmetrical, proximal)
• insidious onset, worsening over months
• Gottron’s sign (finger joints)
• heliotrope rash (upper eyelids)
• shawl sign for dermatomyositis

Question 5

other organ involvement in polymyositis and dermatomyositis

Answer 5

• interstitial lung disease
• muscle weakness= dysphagia and weakened respiration
• myocarditis
• fever
• Raynauds
• inflammatory arthritis

Question 6

diagnosis of polymyositis and dermatomyositis

Answer 6

• muscle testing e.g. confrontation (push on elbow) and isotonic test (sit to stand)
• bloods (CK high due to muscle breakdown) and inflammatory markers
• autoantibodies e.g. ANA, anti-jo-1
• muscle biopsy is definitive (perivascular inflammation and muscle necrosis)
• EMG
• MRI

Question 7

management of polymyositis and dermatomyositis

Answer 7

corticosteroids

immunosuppression e.g. azathioprine, methotrexate, ciclosbrin, IVIg and rituximab

Question 8

define polymyalgia rheumatica

Answer 8

this is inflammation in the muscles surrounding the shoulders and hips

Question 9

who is polymyalgia rheumatica seen in?

Answer 9

over 50s

associated with temporal arteritis/giant cell arteritis

Question 10

presentation of polymyalgia rheumatica

Answer 10

• ache in shoulder and hip girdle, usually symmetrical
• morning stiffness
• reduced movement
• systemic= fatigue, anorexia, etc.
• arteritis associated= headache, visual loss, scalp tenderness and jaw claudication

Question 11

diagnosis of polymyalgia rheumatica

Answer 11

• raised ESR, plasma viscosity and CRP

- temporal artery biopsy and USS

Question 12

management of polymyalgia rheumatica

Answer 12

• lose dose steroids 15mg (gradual reduction over 18 months to 2 years), should feel better within 24 hours
• calcium and vitamin D supplements reduce side effects of steroids (watch diabetes)
• increased CVS risk
• high dose steroids should be given if giant cell arteritis is risking vision loss

Question 13

define fibromyalgia

Answer 13

chronic muscle pain associated with no physical inflammation of muscles, may be post emotional or physical trauma

Question 14

presentation of fibromyalgia

Answer 14

• MSK pain and fatigue
• morning stiffness
• anxiety associations e.g. difficulty urinating, IBS, headaches, memory, sleep disturbance

Question 15

diagnosis of fibromyalgia

Answer 15

• tender points

ACR 2010 criteria

Question 16

management of fibromyalgia

Answer 16

patient education, CBT, physiotherapy, OT

antidepressants e.g. tricycles, analgesia and gabapentin