muscle diseases

Question 1

how do muscle diseases present

Answer 1

Muscle pain (myalgia)
Muscle weakness/tiredness
Stiffness
Abnormal blood tests
Other organ features

Question 2

what is myopathy

Answer 2

disease of the muscle in which the muscle fibres do not function properly resulting in muscular weakness

Question 3

inflammatory myositis overview

Answer 3

autoimmune condition
females more than males
40-50 age peak
inflammation of muscle and weakness of muscle

Question 4

dermatomyositis

Answer 4

qrare condition that causes muscle inflammation. It presents with symmetric proximal muscle weakness, skin rash, and extramacular manifestations

Question 5

which investigations help with diagnosis

Answer 5

Muscle enzymes eg. creatine kinase (CK)
Inflammatory markers
Electrolytes, calcium, PTH, TSH (to exclude other causes)
Autoantibodies: ANA, Anti-Jo-1, Myositis specific antibodies

Question 6

what is shown on an EMG with myositis

Answer 6

increased fibrillations, abnormal motor potentials, complex repetitive discharges

Question 7

diagnosis for myositis

Answer 7

muscle biopsy ; Definitive test. Perivascular inflammation and muscle necrosis
MRI: muscle inflammation, oedema, fibrosis and calcification

Question 8

treatment for myositis

Answer 8

Corticosteroids
Immunosuppression:
Mycophenolate Mofetil
Methotrexate
IV immunoglobulin
Rituximab

Question 9

what age group does polymyalgia rheumatica occur in

Answer 9

over 50s

Question 10

clinical manifestations of polymyalgia rheumatica

Answer 10

Ache in shoulder and hip girdle
Morning stiffness
Usually symmetrical
Fatigue, anorexia, weight loss and fever may occur
Reduced movement of shoulders, neck and hips
Muscle strength is normal

Question 11

diagnosis of polymyalgia rheumatica

Answer 11

Raised ESR, plasma viscosity, CRP
Temporal artery biopsy
Temporal artery USS

Question 12

treatment for polymyalgia rheumatica

Answer 12

Rapid and dramatic response to low dose steroids
Steroid dose:
PMR - start at prednisolone 15mg daily
GCA - start at prednisolone 40-60mg daily

Gradual reduction in steroid dose over 18 months to 2 years

Question 13

what is polymyalgia rheumatica associate with

Answer 13

giant cell arteritis

Question 14

what is fibromyalgia

Answer 14

neurosensory disorder characterised by chronic MSK pain

Question 15

when might fibromyalgia come on

Answer 15

after physical/ emotional trauma

Question 16

treatment for fibromyalgia

Answer 16

Patient education
Multi-disciplinary response
Graded exercise programme
Cognitive behavioural therapy
Anti-depressants eg. Tricyclics, SSRIs
Analgesia
Gabapentin and pregabalin