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MSK SOH > Muscle diseases > Flashcards

Muscle diseases Flashcards

1
Q

Polymyalgia rheumatica - Definition

A

Common chronic inflammatory condition

Associated with temporal arteritis and giant cell arteritis

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2
Q

Polymyalgia rheumatica - epidemiology

age

A

Over 50 year olds

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3
Q

Polymyalgia rheumatica - clinical features

A

Ache in the shoulder / hip girdle
Usually symmetrical
Morning stiffness - “struggle to get out of bed”
Symptoms improve as the day goes on
Reduced movement of the shoulders, neck and hips
Muscle strength is normal

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4
Q

Polymyalgia rheumatica - investigations

A

No specific diagnostic test

Bloods
- raised inflammatory markers

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5
Q

Polymyalgia rheumatica - management

A

Low dose steroids

  • 15mg prednisolone
  • patient should have a very rapid and dramatic response
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6
Q

Polymyalgia rheumatica - Giant cell arteritis (GCA) Definition

A

Most common form of systemic vasculitis in adults

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7
Q

Polymyalgia rheumatica - GCA epidemiology

age

A

Older patients

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8
Q

Polymyalgia rheumatica - GCA pathogenesis

A

Transmural inflammation of the affected arteries
Patchy inflammation of lymphocytes, macrophages and giant nucleated cells
Vessel wall thickening can cause narrowing of the lumen of the artery. This leads to ischaemia

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9
Q

Polymyalgia rheumatica - GCA commonly affected areas

A

Head - temporal artery
vertebral artery,
Ophthalmic artery

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10
Q

Polymyalgia rheumatica - GCA clinical features

A 
Visual disturbances 
Continuous headache
Jaw claudication 
Scalp tenderness 
Tender enlarged non-pulsatile temporal arteries
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11
Q

Polymyalgia rheumatica - GCA examination

A

Can’t feel temporal pulse as the wall of the artery has become thickened

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12
Q

Polymyalgia rheumatica - GCA investigations

A

Bloods
- raised inflammatory markers
Temporal artery biopsy
- mononuclear infiltration of granulomatous inflammation usually with multi-nucleated giant cells

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13
Q

Polymyalgia rheumatica - GCA management

A

High dose steroids

- 40-60mg prednisolone

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14
Q

Polymyositis - definition

A

Idiopathic inflammatory myopoathy that causes symmetrical proximal muscle weakness

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15
Q

Polymyositis - epidemiology

M/F, malignancy

A

More common in females

increased incidence of malignancy

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16
Q

Polymyositis - pathogenesis

A

CD8+ T cells and macrophages initially surround the healthy muscle fibres and eventually invade and destroy them

17
Q

Polymyositis - Histology

A

Muscle fibre necrosis
Degeneration
Loss of inflammatory cells

18
Q

Polymyositis - clinical features

A

Muscle weakness
Muscles feel tired and heavy
Difficulty with particular activities (climbing stairs)
Other organ involvement (i.e. ILD, dysphagia)

19
Q

Polymyositis - associated medical conditions

A

Diabetes

Thyroid disease

20
Q

Polymyositis - associated medication

A

Statins

Steroids

21
Q

Polymyositis - examination

A

Look for muscle wasting

22
Q

Dermatomyositis - definition

A

Clinically similar to polymyositis but also has typical skin manifestations

23
Q

Dermatomyositis - clinical features

A

Muscle weakness
Heliotrope rash - violet coloured rash around the eye
Shawl sign
V shaped rash over chest
Grottos sign - pink/purple colour, affects hand joints

24
Q

Polymyositis & dermatomyositis - investigations

A 
Bloods
- raised inflammatory markers 
- raised creatinine kinase (indication of muscle b/d)
Auto-antibodies 
- ANA raised 
- +ve anti-Jo-1 (specific) 
MRI 
- shows extent of muscle involvement 
EMG
- Looks at muscle function by assessing conduction 
Biopsy 
- gold standard
25
Q

Fibromyalgia - definition

A

Unexplained condition causing widespread muscle pain and fatigue

26
Q

Fibromyalgia - epidemiology

M/F, age

A

More common in females

Age: 22-50

27
Q

Fibromyalgia - risk factors

A

Stress
Physical trauma
IBS

28
Q

Fibromyalgia - pathology

A

Disorder of central pain processing or a syndrome of central sensitivity
Patients have a lower pain threshold

29
Q

Fibromyalgia - clinical features

A 
Widespread pain 
Persistent pain (>3 months)
Fatigue 
Cognitive difficulties 
Symptoms worsen on exertion 
Pins and needles sensation
Headache 
Depression
30
Q

Fibromyalgia - examination

A

Excessive tenderness on palpation of soft tissues

31
Q

Fibromyalgia - commonly affected areas

A

Neck
Shoulders
Lower back

32
Q

Fibromyalgia - investigations

A

No diagnostic tests

Multiple normal investigations

33
Q

Fibromyalgia - management

A

Anti-depressants (amitryptiline)
Analgesia
Gabapentin

MSK SOH (24 decks)

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