Inflammatory Myopathy/Myositis Flashcards Preview

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Flashcards in Inflammatory Myopathy/Myositis Deck (17):
1

Inflammatory myopathy/Myositis: Definition

Autoimmune disease causing inflammation and degeneration of muscle (unknown cause)

2

5 types of Myopathy

1. Adult polymyositis (PM)
2. Peddermatomyositis
3. Adult dermatomyositis (DM)- muscle + skin issues
4. Overlap syndrome- PM or DM + 1 other autoimmune dis.
5. Inclusion body myositis- early distal muscle weakness

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Who makes the diagnosis

Neurologist and rheumatologist

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Items involved in making the diagnosis

1. CPK- elevated (in the 1000s) --> degradation of muscle
2. Troponin levels (breakdown of heart muscle)
3. Muscle biopsy- seeing inflammatory cells (WBC) and muscle degradation
4. EMG- nerve conduction velocity is fine, but no muscle response (cannot recruit)
5. type specific antibodies (ANA in PM)

5

Medical management

1. IVIG
2. high dose steroids
3. clinical drug trials: remicade
4. respiratory care
5. speech and swallowing

6

PT impairments

1. strength
2. muscle pain (fatigued and broken down)
3. fatigue (unable to recruit all muscle fibers)
4. ROM limitations (hip + knee flexor tightness if non-ambulatory)
5. endurance

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Muscle fiber regeneration

the muscles do regenerate, but it ends up having a lot of scar tissue; loss of some muscles you cannot get back

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Particular Activity limitation

1. bed mobility
2. transfers
3. ambulation
*all have to do with proximal weakness

9

Clinical Features

1. symmetrical, proximal muscle weakness (myopathic, may include respiratory muscles)
2. Distal muscle weakness occurs late in dx (except in IBM)
* if hand weakness within a couple weeks of dx, thinking IBM
3. Distinctive rashes (DM)
4. Cardiac involvement (CHF)- look at troponin levels

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Labs to check before seeing the Myositis pt

1. Troponin- make sure there is no cardiac ischemia
2. CPK- want these to be declining; if levels are elevating do not see them
3. WBC- clueing you in to if there is a new infection
4. PFTs- what is their respiratory status?

11

Recovery rate (PM)

only 30% achieve full recovery (most have lingering functional deficits)

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5yr survival rate (PM and DM)

90% (other 10% die from respiratory issues)

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Long term complications of Corticosteroids

1. osteoporosis
2. avascular necrosis of the hip
3. Steroid myopathy

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Problems with the literature

Groups all neuromuscular dx together
comes from MD population
small number of pts included

15

Strengthening: evidence from the literature

small numbers of sets and reps (3 sets of 10 at 5 R)
Rotate the muscles you're working- avoid CPK elevations

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Aerobic Conditioning: evidence from the literature

exercise at 60% HRmax
no on had increased CPK levels
5 min bouts up to 30min 3x/wk
don't do specific aerobics with pt in crisis (everything will be aerobic for them)

17

Clinical suggestions for this population

1. Positioning devices/PROM exercises (maintain resting muscle length)
2. monitor blood markers for injury/inflammation
3. Target proximal musculature and respiration
4. Keep pts on program forever (lifestyle change)