MUSCLE DISORDERS Flashcards
Polymyalgia rheumatica is characterised by what main symptom? This is commonly occurs with which other condition?
Muscle pain and stiffness, particularly in shoulders and hips (BILATERAL)
Commonly occurs with temporal arteritis
Polymyalgia rheumatica affects proximal or distal muscles more? During which time of the day are symptoms worse?
- Proximal muscles
- Morning
What do you expect strength testing and creatinine kinase levels to be in polymyalgia rheumatica?
NORMAL
How do you diagnose polymyalgia rheumatica? What is the treatment?
- Clinical findings
- Raised CRP and ESR
- Responds very well to glucocorticoids
A 35-year-old woman with a history of depression and anxiety presents with widespread musculoskeletal pain for the past five months. Muscle biopsy is normal and lab tests are normal. What is the most likely diagnosis?
How would you treat this condition?
Fibromyalgia: unknown cause
patients often have point tenderness
- Exercise is one of the most important treatments
- Tricyclic
- SSRI
What should you consider in someone with muscle pain and slow onset symmetrical** muscle weakness that started **proximally?
Inflammatory myopathy:
- polymyositis
- dermatomyositis
PROXIMAL MUSCLE WEAKNESS IS A HALLMARK SYMPTOM
How can you distinguish clinically between PMR and an inflammatory myopathy (myosotis)?
how can you distinguish based on blood results?
Both start with proximal muscle symptoms but PMR is characterised by pain and stiffness with an absence of muscle weakness whereas myopathies will cause pain and weakness
CK elevated in myositis
What antibodies are positive in 80 to 90% of patients with inflammatory myopathies?
Antinuclear antibodies (ANA)
Anti-Jo1 is an ANA associated with inflammatory myopathies such as polymyositis and dermatomyositis
Which type of inflammatory myopathy is associated with endomysial Inflammation?
Polymyositis
Which type of myositis is associated Perimysial Inflammation? How is this differentiated from the other main type of myositis clinically?
Dermatomyositis
Involves the skin
Patient presents with symmetrical proximal muscle weakness of arms as well as this finding on back of hands, what is the diagnosis?
- What might you expect to see around their eyes?
- What is the name of the finding on the hands?
Dermatomyositis
- Heliotrope rash around eyes: purple discolouration of upper eyelid
- Gottron papules: symmetrical red, scaly papules on hand/finger joints
Both pathognomonic for dermatomyositis
What serious condition is associated with inflammatory myopathy?
Malignancy
Mainly adenocarcinomas, can occur in many organs of body including cervix, lungs, ovaries, pancreas, bladder, stomach
Stronger evidence for DM vs PM
