Muscle Diseases Flashcards
What makes inclusion body myositis different to poly/dermatomyositis?
It is more common in men, and affects distal muscles in an asymmetrical pattern
What are the main features of fibromyalgia?
Persistent widespread pain, fatigue, cognitive difficulties and multiple other unexplained symptoms
Who does polymyalgia rheumatica occur in?
Individuals aged > 50
Which antibodies may be seen in myositis but are not specific?
ANA and anti-RNP
A trial of what medication can be used as a diagnostic tool in polymyalgia rheumatica?
Prednisolone (there will be a very dramatic and rapid response)
How long is the course of treatment for polymyalgia rheumatica?
Usually around 18 months
How is fibromyalgia treated?
Graded exercise, atypical analgesics, CBT
Fibromyalgia is often seen in association with which other rheumatological conditions?
SLE and rheumatoid arthritis
How is fibromyalgia diagnosed?
It is a diagnosis of exclusion if no other cause for the symptoms can be found
As well as antibodies, what else can be raised in the blood of someone with myositis?
Inflammatory markers and creatinine kinase
Which antibody is specific to myositis?
Anti-Jo-1
Who does myositis most commonly affect?
Adults (more commonly women) aged 45-60
What is the characteristic finding of polymyositis and dermatomyositis?
Symmetrical, proximal muscle weakness
What dose of prednisolone is given to patients with polymyalgia rheumatica in each of the following situations: a) no evidence of GCA? b) GCA with headaches only? c) GCA with visual changes?
a) 15mg daily b) 40mg daily c) 60 mg daily
With which type of myositis is the risk of malignancy greatest?
Dermatomyositis (around 25%)
If there are signs of GCA when a patient presents with polymyalgia rheumatica, what investigation must be performed?
Temporal artery biopsy
What are the main features of polymyalgia rheumatica?
Proximal myalgia of the hip and shoulder girdle, with associated morning stiffness typically lasting > 1 hour
What condition is commonly associated with polymyalgia rheumatica?
Giant cell arteritis
What is the gold standard investigation for myositis?
Muscle biopsy
How is myositis managed?
Prednisolone and a DMARD (methotrexate/azathioprine)
Who is fibromyalgia most likely to occur in?
Young and middle aged women (often after a trauma of some sort)
When is the risk of malignancy associated with myositis highest?
In the first 5 years following diagnosis
What is the most important blood test for the diagnosis of polymyalgia rheumatica?
Inflammatory markers will be raised
What are some systemic features which may occur in patients with myositis?
Dysphagia, and interstitial lung disease
What are the cutaneous features of dermatomyositis?
Heliotrope rash, Gottron’s papules and a V shaped rash over the chest/shawl sign over the back
Dermatomyositis is most likely to be paraneoplastic in which group of patients?
Males aged > 50
