Muscle Diseases

Question 1

What is the difference between polymyositis and dermatomyositis?

Answer 1

Dermatomyositis = polymyositis + skin changes

Question 2

The risk of malignancy increases with polymyositis and dermatomyositis. True/False?

Answer 2

True

Question 3

List the classic presenting MSK features of poly/dermato -myositis

Answer 3

Proximal muscle weakness that worsens over months
Symmetrically affected
Myalgia
Difficulty with daily tasks

Question 4

List investigations for poly/dermato -myositis

Answer 4

Inflammatory markers
Muscle enzyme (CK)
Autoantibodies
Electrolytes
Electromyography

Question 5

Which antibodies are associated with poly/dermato -myositis?

Answer 5

ANA

Anti-Jo-1

Question 6

What is the definitive test for poly/dermato -myositis?

Answer 6

Muscle biopsy

Question 7

List the main treatment for poly/dermato -myositis

Answer 7

Steroids
Immunosuppression (methotrexate, azathioprine)
Ciclosporin
Rituximab

Question 8

What is the steroid usually used for poly/dermato -myositis?

Answer 8

Prednisolone 40mg daily

Question 9

Inclusion body myositis is more common in males. True/False?

Answer 9

True

Question 10

How would the msucle weakness be described in inclusion body myositis?

Answer 10

Asymmetrical distal muscle weakness

Question 11

CK levels in inclusion body myositis are increased to a lesser fold compared to poly/dermato -myositis. True/False?

Answer 11

True

Question 12

Inclusion body myositis is associated with anti-Jo-1 antibody. True/False?

Answer 12

False

Question 13

Polymyalgia rheumatica is associated with which arteritic disease?

Answer 13

Giant cell arteritis

Question 14

Muscle weakness if a feature of polymyalgia rheumatica. True/False?

Answer 14

False

Muscle pain and stiffness

Question 15

List the common features of polymyalgia rheumatica

Answer 15

Morning stiffness - can’t get out of bed (>1 hour)
Improvement with movement/throughout the day
Hip and shoulder pain
Fatigue
Anorexia
Reduced movement

Question 16

What is the mainstay of treatment for polymyalgia rheumatica?

Answer 16

Low dose steroid - usually rapid/dramatic response

Question 17

What is the commonest cause of chronic MSK pain?

Answer 17

Fibromyalgia

Question 18

Is fibromyalgia inflammatory?

Answer 18

No

Question 19

List some clinical features of fibromyalgia

Answer 19

Broken sleep
Pain all over body (> 3 months)
Pins and needles
Headaches
Depression
Tenderness on soft tissues
Fatigue

Question 20

The aetiology of polymyalgia rheumatica (PMR) is unknown. True/False?

Answer 20

True

Question 21

What is the most common form of systemic vasculitis in adults?

Answer 21

Giant cell arteritis

Question 22

List clinical features of GCA

Answer 22

Jaw claudication
Visual disturbance
Headache
Tender scalp
Non-pulsatile arteries
Systemic features

Question 23

What is the definitive test for diagnosing GCA?

Answer 23

Temporal artery biopsy

Question 24

Polymyositis is more common in men. True/False?

Answer 24

False

Women 2:1 men

Question 25

By how much is CK usually raised in polymyositis?

Answer 25

10x

Question 26

What is the definitive diagnostic test for polymyositis?

Answer 26

Muscle biopsy

Question 27

List some cutaneous features of dermatomyositis

Answer 27

``` Heliotrope rash (puffy eyes) Gottron's papules (violet patches on hands) Shawl sign (V-shaped violet rash over chest) ```

Question 28

In which group of people is fibromyalgia most common in?

Answer 28

Young and middle-aged women

Question 29

What drugs may be given in fibromyalgia?

Answer 29

Amitryptilline (TCAD) Gabapentin/ pregabalin (anticonvulsants) Simple analgesia

Question 30

List the two main multi-organ features seen in polymyositis, and are indicators of poor prognosis?

Answer 30

ILD | Dysphagia

Question 31

What investigations are used in PMR?

Answer 31

ESR, PV, CRP (increased) | Temporal artery biopsy

Question 32

What is the steroid usually used for PMR? How does the dose change if GCA is suspected?

Answer 32

15mg Prednisolone | 40mg if GCA

Question 33

What is the mainstay of treatment in fibromyalgia?

Answer 33

The mainstay of treatment for fibromyalgia is education and CBT, and graded exercise

Question 34

What are the features found on examination in fibromyalgia?

Answer 34

Excessive tenderness on palpation of soft tissues (11/18 points)

Question 35

What investigations are used in fibromyalgia?

Answer 35

No tests - diagnosis of exclusion | Inflammatory markers normal