Muscle Diseases and Vasculitis Flashcards
what is polymyalgia rheumatica
chronic inflammatory condition characterised by pain and stiffness
who typically gets polymyalgia rheumatica
over 50s
how does polymyalgia rheumatica present
myalgia in proximal limb girdles - symmetrical
morning stiffness lasting >1 hour
fatigue, weight loss
muscle strength is reduced in polymalgia rheumatica true/false
false - no weakness just pain and stiffness
how is polymalgia rheumatica diagnosed
clinical diagnosis - CRP and ESR will be raised
which condition is associated with polymalgia rheumatica
giant cell arteritis, 50% of patients will develop it
what is the treatment for polymyalgia rheumatica
responds rapidly to low dose steroids - 15mg prednisolone daily and gradually reduce dose and symptoms improve
describe the pathogenesis of giant cell arteritis
transmural inflammation of blood vessel layers with patchy infiltration by lymphocytes and macrophages - thickens wall and narrows the lumen of vessel
how does giant cell arteritis present
visual disturbances headache - in temporal lobes jaw claudication scalp tenderness fatigue visible tortuous temporal artery possible
what are the investigations for giant cell arteritis
temporal artery biopsy - may show patchy inflammation
inflammatory markers raised
how is giant cell arteritis treated
corticosteroids, 40mg if no visual disturbances and 60mg if visual disturbances – usually resolves within 2 years
how does polymyositis present
symmetrical proximal muscle weakness
insidious onset
obvious atrophy
describe the cutaneous features of dermatomyositis
v-shaped rash over chest
heliotrope rash - erythema and swelling around eyes
Gottrons papules - violorosaceous rash on hands at MCP and PIPs
list some extra-articular manifestations of polymyositis
interstitial lung disease
oesophageal muscle involvement causing dysphagia
myocarditis
dermatomyositis increases risk greatly of what disease
solid organ cancers such as breast, bladder and prostate
which antibodies are present in polymyositis and dermatomyositis
anti-jo-1
what is the diagnostic investigation for polymyositis
muscle biopsy - showing perivascular inflammation and necrosis
other than muscle biopsy what other investigations are useful for polymyositis
creatinine kinase raised
electromyography
how is polymyositis treated
corticosteroids in short term with immunosuppression
is fibromyalgia an inflammatory condition
no - presents with muscle pain and fatigue
who typically gets fibromyalgia
middle aged women
list the clinical features of fibromyalgia
myofascial pain and twitching lasting >3 months
poor sleep
cognitive difficulties
skin hyper-reactivity
how is fibromyalgia diagnosed
no definitive diagnosis - must rule out similar conditions eg SLE, hypothyroidism and RA
how is fibromyalgia managed
no cure, patient education and atypical analgesics such as gabapentin and pregabalin
