inflamm myopathies

Question 1

what are the types of inflammatory myopathies ?

Answer 1

dermatomyositis
polymyositis
inclusion body myositis

Question 2

common and important risk factor for dermatomyositis ?

Answer 2

UV rays

Question 3

clinical picture of dermatomyositis and polymyositis ?

Answer 3

develop over weeks to months
fever and weight loss
non-erosive inflammatory polyarthritis
raynaud’s phenomenon
calcifications in childhood DM

Question 4

what are the patterns of muscle weakness in PM and DM

Answer 4

proximal muscle weakness of the upper limb - unable to comb their hair, can’t take things from a height
proximal muscle weakness of the lower limbs - difficulty getting up from a chair, difficulty climbing up the stairs
pharyngeal and respiratory muscle weakness - dysphagia, breathing problems

Question 5

what are the skin manifestations of dermatomyositis ?

Answer 5

heliotrope rash on eyelids
rash on thee face, neck and chest ( V sign, diffuse and photosensitive )
rash on the back ( shawl sign )
Gottron’s papules - papules and rashes on MCP and IP joints
rough cracked hands - mechanic’s hand
dilated nail bed capillary loops

Question 6

what is pathognomonic for DM ?

Answer 6

gottron’s papules

Question 7

difference between dermatomyositis and polymyositis ?

Answer 7

polymyositis exhibits proximal muscle weakness but no skin manifestations , and is also commonly associated with AV conduction defects and interstitial Lung disease

Question 8

what malignancies are commonly associated with dermatomyositis ?

Answer 8

lung
breast
ovaries
GI
Non-hodgkins

Question 9

polymyositis may show features of what 2 diseases ?

Answer 9

scleroderma and mixed connective tissue disease
so a diagnosis of exclusion

Question 10

most important method of diagnosis of DM and PM ?

Answer 10

muscle biopsy

Question 11

what are the steps or algorithm that a patient must go for a diagnosis of DDM or PM ?

Answer 11

patient presented with proximal muscle weakness
heliotrope rash , v sign, shawl sign ( in DM)
perform CK , AST , ALT LDH , aldolase
abnormal EMG

Question 12

treatment for PM and DM ?

Answer 12

prednisone 0.5-1 mg/kg
- muscle enzymes may improve but muscle strength takes longer
give biphosphonates

Question 13

patient diagnosed with PM or DM , but not responding to steroids and has developed distal muscle weakness as well as proximal - what is the most likely diagnosis ?

Answer 13

inclusion body myositis

Question 14

in what group of patients in inclusion body myositis seen in ?

Answer 14

males abovee thee age of 50

Question 15

what is the pattern of muscle weakness in inclusion body myositis ?

Answer 15

bilateral
asymmetrical distal and proximal muscle weakness

Question 16

what aree thee medicatioins that can cause muscle weakness ?

Answer 16

amiodarone
antithyroid agents
antiretroviral - HIV patients

Question 17

which patients should we think twice in before diagnosing an inflammatory myopathy ?

Answer 17

thyroid patients
patients with arrythmia
HIV positive patients

Question 18

what are the differential metabolic causes of muscle weakness ?

Answer 18

glycogen and lipid storage disease
mitochondrial disease
hypokalaemia
hypercalcaemia