muscle diseases

Question 1

what are inflammatory myopathies characterised by?

Answer 1

weakness

Question 2

what is poly myalgia rheumatic characterised by?

Answer 2

pain and stiffness

Question 3

what is fibromyalgia characterised by?

Answer 3

pain and fatigue

Question 4

what is myopathy?

Answer 4

a disease of the muscle in which the muscle fibres do not function properly resulting in muscle weakness over time

Question 5

who is at high risk or polymyositis and dermamyositis?

Answer 5

• people with autoimmune conditions
• females (females:male 2:1)
• age 40-50

Question 6

how does myositis present?

Answer 6

gradual onset of muscle weakness, usually affecting proximal muscles (hip, shoulder) and is usually symmetrical

Question 7

how does dermatomyositis present?

Answer 7

gradual onset of muscle weakness, usually affecting proximal muscles (hip, shoulder) and is usually symmetrical
AND
skin involvement
-Gottron’s sign (red/purple colour behind PIP joint)
-Heliotrope rash (red/purple rash around eyes)
-Shawl sign (red/purple rash on back of shoulder area/chest)

Question 8

what other organ involvement is associated with polymyositis and dermatomyositis?

Answer 8

Other organ involvement:
LUNG- ILD, resp muscle weakness

OESOPHAGEAL- dysphagia

CARDIAC- myocarditis

OTHER- fever, weight loss, Raynauds phenomenon, inflammatory arthritis

Question 9

what are some examples of most common associated risks of malignancy in polymyositis and dermatomyositis?

Answer 9

Associated risk of malignancy (in 25%)

common = breast, ovarian, lung, colon, oesophagus and bladder

Question 10

what investigations would be done for polymyositis and dermatomyositis?

Answer 10

Blood test and EMG

Question 11

what could be found on a blood test of someone with polymyositis and dermatomyositis?

Answer 11

• raised inflammatory markers (CRP)
• ANA or anti-RNP (antibodies shared with other autoimmune diseases)
• Anti-jo-1 and anti-SRP (antibodies unique for polymyositis and dermatomyositis)

Question 12

what medication is given to someone with polymyositis and dermatomyositis

Answer 12

Prednisolone (40mg)

Combined with methotrexate or azathioprine

Question 13

who is usually affected by polymyalgia rheumatic?

Answer 13

> 50 years

• northern regions
• patients with temporal arteritis/giant cell arteritis

Question 14

how is polymyalgia rheumatic diagnosed?

Answer 14

Raised ESR, plasma viscosity, CRP

Temporal artery biopsy

Temporal artery USS

Question 15

what is the treatment for polymyalgia rheumatica in a patient without giant cell arteritis?

Answer 15

start at prednisolone 15mg daily, gradually decrease over 18 months to 2 years

Question 16

what is the treatment for polymyalgia rheumatica in a patient without giant cell arteritis?

Answer 16

start at prednisolone 15mg daily, gradually decrease over 18 months to 2 years

Question 17

what is the treatment for someone with polymyalgia rheumatic with giant cell arteritis?

Answer 17

50-60mg prednisolone daily, gradually decrease steroid over 18 years to 2 years

Question 18

what is fibromyalgia?

Answer 18

Unexplained condition causing widespread muscle and chronic pain

Question 19

what is the commonest cause of MSK pain in women ages 22-50?

Answer 19

Fibromyalgia

Question 20

what are the symptoms of fibromyalgia?

Answer 20

Persistent widespread pain > 3 months

Fatigue= disrupted and unrefreshing sleep

Low threshold of pain, heat, noise and odours

headaches and IBS

Question 21

how is fibromyalgia diagnosed?

Answer 21

its a clinical diagnosis

diagnosis of exclusion= rule out hypothyroidism, RA, SLE, polymyalgia and rheumatic

Question 22

what is the treatment for fibromyalgia?

Answer 22

no real cure

• advice regarding graded exercise and activity pacing
• antidepressants e.g. tricyclics (amitriptyline), gabapentin and pregabalin may be of use
• CBT may help