Muscle Diseases

Question 1

What makes inclusion body myositis different to poly/dermatomyositis?

Answer 1

It is more common in men, and affects distal muscles in an asymmetrical pattern

Question 2

What are the main features of fibromyalgia?

Answer 2

Persistent widespread pain, fatigue, cognitive difficulties and multiple other unexplained symptoms

Question 3

Who does polymyalgia rheumatica occur in?

Answer 3

Individuals aged > 50

Question 4

Which antibodies may be seen in myositis but are not specific?

Answer 4

ANA and anti-RNP

Question 5

A trial of what medication can be used as a diagnostic tool in polymyalgia rheumatica?

Answer 5

Prednisolone (there will be a very dramatic and rapid response)

Question 6

How long is the course of treatment for polymyalgia rheumatica?

Answer 6

Usually around 18 months

Question 7

How is fibromyalgia treated?

Answer 7

Graded exercise, atypical analgesics, CBT

Question 8

Fibromyalgia is often seen in association with which other rheumatological conditions?

Answer 8

SLE and rheumatoid arthritis

Question 9

How is fibromyalgia diagnosed?

Answer 9

It is a diagnosis of exclusion if no other cause for the symptoms can be found

Question 10

As well as antibodies, what else can be raised in the blood of someone with myositis?

Answer 10

Inflammatory markers and creatinine kinase

Question 11

Which antibody is specific to myositis?

Answer 11

Anti-Jo-1

Question 12

Who does myositis most commonly affect?

Answer 12

Adults (more commonly women) aged 45-60

Question 13

What is the characteristic finding of polymyositis and dermatomyositis?

Answer 13

Symmetrical, proximal muscle weakness

Question 14

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?

Answer 14

a) 15mg daily b) 40mg daily c) 60 mg daily

Question 15

With which type of myositis is the risk of malignancy greatest?

Answer 15

Dermatomyositis (around 25%)

Question 16

If there are signs of GCA when a patient presents with polymyalgia rheumatica, what investigation must be performed?

Answer 16

Temporal artery biopsy

Question 17

What are the main features of polymyalgia rheumatica?

Answer 17

Proximal myalgia of the hip and shoulder girdle, with associated morning stiffness typically lasting > 1 hour

Question 18

What condition is commonly associated with polymyalgia rheumatica?

Answer 18

Giant cell arteritis

Question 19

What is the gold standard investigation for myositis?

Answer 19

Muscle biopsy

Question 20

How is myositis managed?

Answer 20

Prednisolone and a DMARD (methotrexate/azathioprine)

Question 21

Who is fibromyalgia most likely to occur in?

Answer 21

Young and middle aged women (often after a trauma of some sort)

Question 22

When is the risk of malignancy associated with myositis highest?

Answer 22

In the first 5 years following diagnosis

Question 23

What is the most important blood test for the diagnosis of polymyalgia rheumatica?

Answer 23

Inflammatory markers will be raised

Question 24

What are some systemic features which may occur in patients with myositis?

Answer 24

Dysphagia, and interstitial lung disease

Question 25

What are the cutaneous features of dermatomyositis?

Answer 25

Heliotrope rash, Gottron’s papules and a V shaped rash over the chest/shawl sign over the back

Question 26

Dermatomyositis is most likely to be paraneoplastic in which group of patients?

Answer 26

Males aged > 50