Muscle Diseases

Question 1

how do muscle diseases present

Answer 1

myalgia (muscle pain)
muscle weakness/tiredness
stiffness
abnormal blood tests

Question 2

what type of myopathy are polymyositis and dermatomyositis

Answer 2

idiopathic inflammatory myopathies

Question 3

who is more likely to get polymyositis and dermatomyositis

Answer 3

females 2 : males 1

40-50 years

Question 4

what there an increased incidence of in patients with polymositis and dermatomyositis

Answer 4

malignancy

Question 5

what is seen histologically in polymyositis and dermatomyositis

Answer 5

muscle biopsy: muscle fibre necrosis, degeneration, regeneration and an inflammatory cell infiltrate.
perivascular necrosis

Question 6

what are the clinical features of idiopathic inflammatory myopathy (polymyositis and dermatomyositis)

Answer 6

MUSCLE WEAKNESS

insidious onset, worsening over months
usually symmetrical, proximal muscles

myalgia in 25-50%

Question 7

what extra features distinguish the clinical presentation of dermatomyositis from polymyositis

Answer 7

cutaneous signs

• gottrons sign
• heliotrope rash
• shawl sign

Question 8

what other organs can be involved in inflammatory myositis

Answer 8

lung (ILD, resp muscle weakness)

oesophagus (dysphagia

cardiac (myocarditis)

also:
fever, weight loss, raynauds, non-erosive polyarthritis)

Question 9

what cancers are associated with inflammatory myositis

Answer 9

ovarian, breast, stomach, lung, bladder and colon cancer

Question 10

in a history of a patient with an inflammatory myositis, what are other common medical problems

Answer 10

Dermatomyositis, thyroid disease, raynauds

Question 11

what is isotonic testing

Answer 11

30 second sit to stand test

Question 12

what tests can be included to test muscle function

Answer 12

confrontational testing- tests direct power

isotonic testing

Question 13

what blood tests can be done into inflammatory myositis

Answer 13

muscle enzymes- creatine kinase (CK)
inflammatory markers
electrolytes, calcium, PTH, TSH (to exclude other causes)
autoantibodies (ANA, Anti-Jo-1)

Question 14

what is seen in electromyography in inflammatory myositis

Answer 14

increased fibrillations
abnormal motor potentials
complex repetitive discharges

Question 15

what is the definitive test for inflammatory myositis

Answer 15

muscle biopsy

Question 16

what is seen in biopsy of inflammatory myositis

Answer 16

muscle inflammation,
oedema,
fibrosis,
calcification

Question 17

what is the treatment for idiopathic inflammatory myosisitis (polymyositis and dermatomyositis)

Answer 17

glucocorticoids
azathioprine 
methotrexate
ciclosporin 
IV immunoglobulin 
rituximab

Question 18

what medication might cause a similar presentation to myositis

Answer 18

atorvastatin

Question 19

what is polymyalgia rheumatica

Answer 19

idiopathic inflammatory condition associated with temporal arteritis/ giant cell arteritis

Question 20

who gets polymyalgia rheumatica

Answer 20

over 50s

Question 21

what is the clinical presentation of polymyalgia rheumatica

Answer 21

ache in shoulder and hip girdle

morning stiffness

usually symmetrical

fatigue, anorexia, weight loss, fever

reduced movement of shoulders, neck and hips

Question 22

what is muscle strength like in polymyalgia rheumatica

Answer 22

normal

Question 23

what is temporal arteritis/ giant cell artheritis

Answer 23

granulomatous arteritis of large vessels

Question 24

what are the symptoms of temporal arteritis/ giant cell arteritis

Answer 24

headache, scalp tenderness, jaw claudication, visual loss, tender, enlarged, non pulsatile temporal arteries

Question 25

how do you diagnose temporal arteritis/ (GCA)

Answer 25

raised ESR, plama viscosity, CRP temporal artery biopsy

Question 26

how do you treat temporal arteritis/ GCA

Answer 26

steroids (prednisolone 40mg, 60mg if visual impairment)- gradually reduced over around 18 months to 2 years steroids as a diagnostic tool- Symptoms respond very dramatically to low dose steroids (prednisolone 15mg daily)

Question 27

what is fibromyalgia

Answer 27

idiopathic chronic (MSK) pain disorder

Question 28

is fibromyalgia associated with inflammation

Answer 28

no

Question 29

who gets fibromyalgia

Answer 29

females 6 : males 1 | 22-50 y/o

Question 30

when does fibromyalgia pain sometimes begin

Answer 30

after emotional or physical trauma

Question 31

what is the pathology of fibromyalgia

Answer 31

dorsal horn neurones become hyperresponsive to nociceptive and nonnociceptive somatic senation due to extracellular Ca+ and nitric acid diffusing into neurones resulting in exaggerated release of sustance P and glutamate = hyperalgesia

Question 32

what are the clinical manifestations of fibromyalgia

Answer 32

pain; neck, shoulders, lower back, chest wall diffuse and chronic, varies in intensity symptoms worse with exertion, fatigue and stress sensation of swelling, fatigue, poor, unrefreshing sleep pins and needles/ tingling, headaches, depression, abdominal pain (IBS), poor concentration and memory

Question 33

what are the clinical findings in fibromyalgia

Answer 33

excessive tenderness on palpation of soft tissues 11/18 tender points no abnormalities of MSK system

Question 34

what is the treatment for fibromyalgia

Answer 34

education exercise programme congitive behavioural therapy complemetary medicine (acupuncture) anti depressants (tricylics- amitriptyline) analgesia gabapentin and pregabalin

Question 35

does morphine help in fibromyalgia

Answer 35

no

Question 36

what is pain of the shoulder and hips without weakness in in 70s

Answer 36

polymyalgia rheumatica

Question 37

what condition commonly co exists with PMR

Answer 37

giant cell vacsulitis

Question 38

what responds rapidly to steroids

Answer 38

PMR

Question 39

what is CK raised in

Answer 39

polymyositis only (and dermomyositis

Question 40

what anti body for polymyositis

Answer 40

anti jo 1

Question 41

what palpation can show firbomyalgia

Answer 41

excessive tenderness of palpation of soft tissue in 11 out of 18 sites

Question 42

what is difficulty climbing the stairs a sign of

Answer 42

polymyositis