Muscle diseases

Question 1

Symptoms of PMR?

Answer 1

Proximal myalgia of hip and shoulder girdle muscles

Morning stiffness that lasts less than an hour and improves with movement

Question 2

What is PMR associated with?

Answer 2

GCA

Question 3

Diagnosis of PMR?

Answer 3

No specific investigations but treatment is often diagnostic

Question 4

PMR treatment?

Answer 4

15mg of prednisoone

Symptoms respond dramatically, often diagnostic

Question 5

Pathology of GCA?

Answer 5

Transmural inflammation of intima, media and adventitia of affected arteries
Vessel thickening > lumen narrowing > distal ischaemia

Question 6

Symptoms of GCA?

Answer 6

Visual disturbances
Headache
Jaw claudication
Scalp tenderness

Question 7

Symptoms of polymyositis?

Answer 7

Proximal muscle weakness

Question 8

Pathology of polymyositis?

Answer 8

T cells and macrophages surround, invade and destroy healthy muscle fibres

Question 9

Which antibody is associated with polymyositis?

Answer 9

Anti-Jo-1 antibody

Question 10

Investigations for polymyositis?

Answer 10

EMG - abnormal

Muscle biopsy - shows fibres in various stages of inflammation, necrosis and regeneration

Question 11

Treatment of polymyositis?

Answer 11

40mg prednisolone, responds but slowly

Some patients are left with residual weakness

Question 12

If oesophagus or oropharynx are involved in polymyositis, which complication may arise?

Answer 12

Dysphagia

Question 13

Which disease is associated with polymyositis?

Answer 13

Interstitial lung disease

Question 14

Symptoms of dermatomyositis?

Answer 14

Clinically similar to polymyositis but with cutaneous features
Associated risk of malignancy

Question 15

Cutaneous features of dermatomyositis?

Answer 15

V-shaped rash across the chest
Heliotrope rash
Gottron’s papules

Question 16

Investigations and management of dermatomyositis?

Answer 16

Same as polymyositis

Question 17

Symptoms of fibromyalgia?

Answer 17

Widespread pain
Fatigue
Anxirty and/or depression
Cognitive difficulties
Lower threshold of stimuli:
- pain
- heat
- noise
- strong odour

Question 18

Which conditions are associated with fibromyalgia?

Answer 18

RA

SLE

Question 19

Investigations for fibromyalgia?

Answer 19

No specific investigations
Diagnosis made clinically, excluding other conditions
- SLE
- RA
- Hypothyroidism

Question 20

Treatment of fibromyalgia

Answer 20

CBT
Graded exercise
Tricyclics - gabapentin, amitryptiline