Muscular Conditions Flashcards
What is fibromyalgia?
Neurosensory disorder characterised by chronic MSK pain
Who gets fibromyalgia?
What can it occur alongside?
6x more common in women, most common cause of MSK pain in women age 22-50
May start after emotional or physical trauma
Approx 25% of RA patients and 50% of SLE patients
Pathophysiology of fibromyalgia
Central pain processing disorder- patient will have lower threshold to pain and other stimuli
not inflammatory
how does fibromyalgia present?
Chronic widespread pain
Fatigue and disrupted sleep
Headaches
Cognitive impairment
Non cardiac chest pain
Anxiety
How is fibromyalgia investigated?
Clinical diagnosis- widespread pain and associated symptoms, at a chronic level
Rule out other differentials ie RA SLE etc
How is fibromyalgia managed?
Analgesia
Antidepressants
Complementary medicine like acupuncture
What is polymyalgia rheumatica?
Inflammatory condition that causes pain and stiffness in the shoulders, pelvic girdle, and neck
What does it have a strong association to?
GCA- the 2 conditions often occur together
Who gets polymyalgia rheumatica?
Mostly old white ppl
What causes polymyalgia rheumatica?
Nobody knows lol
How does polymyalgia rheumatica present?
pain and stiffness in shoulders, pelvic girdle, and neck, worst in morning/after inactivity
Rapid onset over days-weeks
Other symptoms:
Systemic
Muscle tenderness
Carpal tunnel
Peripheral oedema
Differential diagnosis of polymyalgia rheumatica
OA + RA
SLE
Statin-induced myopathy
Myositis (e.g., polymyositis)
Cervical spondylosis
Adhesive capsulitis (frozen shoulder)
Hyperthyroidism or hypothyroidism
Osteomalacia
Fibromyalgia
Lymphoma or leukaemia
Myeloma
How is polymyalgia rheumatica diagnosed?
Clinical diagnosis, usually made after 2 weeks of symptoms, plus response to steroids and excluding differentials
(Steroid response should be very good to point toward diagnosis)
In polymyalgia rheumatica, what do you test for before commencing steroids?
FBC, UE, LFT
Calcium -> hyperparathyroid and osteomalacia
Serum protein electrophoresis -> myeloma
thyroid function
creatinine kinase -> myositis
RF -> RA
For ruling out differentials:
ANA -> SLE
aCCP -> RA
CXR -> lung cancer
How is polymyalgia rheumatica treated?
15mg prednisolone daily
Symptoms are usually fully controlled after a week, so then taper off the steroids for minimising sidefx
What are inflammatory myopathies?
autoimmune diseases characterized by chronic muscle inflammation, leading to muscle weakness and (sometimes) pain
Common in hips and shoulders
What are the 2 main types?
Polymyositis and dermatmyositis
What is the key presentation for both?
Symmetrical proximal muscle weakness of gradual onset
Who gets inflammatory myopathies?
Women 2x more likely than men
Age 40-50
What can cause an inflammatory myopathy?
Underlying cancer
Viral infection
Certain HLA genes
How does dermatomyositis present?
gottron papules/lesions- scaly lesions over knuckles
Heliotrope rash- discoloration on eyelid
Periorbital oedema
Photosensitive rash on back and shoulders
How is myositis tested for?
creatinine kinase blood test
Normal value is 300 ish but in myositis it’ll be 1000s
May also be raised in:
- Rhabdomyolysis
- Acute kidney injury
- Myocardial infarction
- Statins
- Strenuous exercise
How are inflammatory myopathies diagnosed?
Clinical features, CK, MRI, muscle biopsy
What is the associated antibody of myositis?
Anti Jo 1
How are inflammatory myopathies managed?
Assess for possible underlying cancer, then first line is corticosteroids
When steroids not good enough:
Methotrexate, azathioprine, or biological therapies
