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Muscle Disease Flashcards

(54 cards)

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1
Q

What are some inflammatory causes of muscle disease

A

Polymyositis
Dermatomyositis
Inclusion body myositis
Polymyalgia Rheumatica

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2
Q

How do muscle diseases commonly present

A

Muscle pain (myalgia)
Muscle weakness/ tiredness
Stiffness

Occasionally abnormal bloods,
organ involvement and skin rashes

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3
Q

What is the difference between polymyositis and dermatomyositis

A

Exactly the same but dermatomyositis also has skin involvement

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4
Q

At what age do polymyositis and dermatomyositis often appear

A

Between 40 and 50 years

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5
Q

There is an increased malignancy with both polymyositis and dermatomyositis. In one there is a particularly increased risk. What one of these 2 is this

A

Dermatomyositis

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6
Q

How can we describe polymyositis and dermatomyositis

A

Idiopathic inflammatory myopathies that appear in a symmetrical pattern

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7
Q

What are some of the clinical features of polymyositis and dermatomyositis

A

Muscle weakness
Insidious onset, worsening over months
Proximal muscles

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8
Q

What happens to the muscle cells in polymyositis and dermatomyositis

A

The muscle cells are lost and therefore muscle bulk

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9
Q

What is a key feature of dermatomyositis

A

Gottrons sign or gottrons papules

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10
Q

Where is there evidence of Gottrons sign

A

Over the PIP and the metapharyngeal joints

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11
Q

Describe the appearance of the Heliotrope rash that can appear in dermatomyositis

A

Purple rash around the eyes

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12
Q

Describe the appearance of the Shawl sign that can be appear in dermatomyositis

A

purple colour rash over the back of the neck or a v shaped rash down the front of the chest

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13
Q

What is the most common organ involved in polymyositis or dermatomyositis

A

Lung (interstitial lung disease and respiratory muscle weakness
Respiratory muscle weakness can lead to breathlessness

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14
Q

What organs can be involved in polymyositis or dermatomyositis

A

Oesophageal (dysphagia)
Cardiac (myocarditis)
Other (fever, weight loss, Raynauds phenomenon, non-erosive polyarthritis)

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15
Q

What kind of malignancies can develop from polymyositis or dermatomyositis

A

Ovarian, breast, stomach, lung, bladder and colon (hollow organs)

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16
Q

Who is the malignancy risk greatest in in patients who have either polymyositis or dermatomyositis

A

men over the age of 45

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17
Q

What types of drug can cause muscle pain and muscle inflammation

A

Statins

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18
Q

What other medical conditions are important to know about when taking a history for suspected polymyositis or dermatomyositis

A

Diabetes mellitus and thyroid disease

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19
Q

On examination of a patient with either polymyositis or dermatomyositis, what can be scene

A

Wasting of the muscles usually the big proximal ones

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20
Q

What should be tested in examining a patient with polymyositis or dermatomyositis

A

Confrontational - muscle power

Isotonic testing - 30 seconds sitting to standing test (repeated muscle strength

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21
Q

Why is it useful to do confrontational testing and isotonic testing

A

It is easy to compare results - to see if medication is helping and how poor they are during a flare etc.

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22
Q

What should be tested in suspected polymyositis or dermatomyositis

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A

Muscle enzymes (CREATINE KINASE CK)
inflammatory markers
electrolytes, calcium, PTH, TSH
Autoantibodies: ANA and Anti-Jo-1

Electromyography (EMG)

  • increased fibrillations
  • abnormal motor potentials
  • complex repetitive discharges

Muscle Biopsy

  • definitive test
  • perivascular inflammation and muscle necrosis

MRI
-muscle inflammation
-oedema
fibrosis and calcification

23
Q

Why is CK likely to be high in polymyositis or dermatomyositis

Study These Flashcards
A

The muscle itself is inflamed which causes the breakdown of the muscle cells which release CK

24
Q

What are the 5 different types of treatment for polymyositis or dermatomyositis

Study These Flashcards
A 
Glucocorticoids (40mg/day, fast acting)
Azathioprine (take 6-8 weeks to work)
Methotrexate
Ciclosporin
IVIG
25
The steroid treatment for polymyositis or dermatomyositis should gradually be increased. True or False
False - it should be gradually decreased until the patient is only on immunosuppressive therapy
26
Patients with Inclusion body myositis are often misdiagnosed as having what
Polymyositis
27
What age group and sex are more likely to develop Inclusion body myositis
over 50s | More common in men
28
What muscles are typically affected in Inclusion body myositis
Distal muscles - weakness in wrist and finger flexors in upper limbs and quadriceps and anterior tibial muscles in legs
29
What is the main different between Inclusion body myositis and Polymyositis or dermatomyositis
Inclusion body myositis is assymetrical and Polymyositis or dermatomyositis is symmetrical
30
What does a muscle biopsy of Inclusion Body Myositis show
Inclusional bodies
31
Patients with Inclusion Body Myositis tend to have a fairly poor response to treatment. True or False
True
32
What age of patients are likely to develop Polymyalgia Rheumatica
Those over 50 years
33
Where is there a higher incidence of Polymyalgia Rheumatica
Northern regions - iceland and scandinavia (near the equator it is rare)
34
What conditions is Polymyalgia Rheumatica associated with
Temporal arteritis and giant cell arteritis
35
What muscles does Polymyalgia Rheumatica affect
Proximal muscles
36
What is the problem with muscle biopsies in Polymyalgia Rheumatica
The muscles look normal as the problem does not arise at the level of the muscle
37
What are some of the clinical manifestations of Polymyalgia Rheumatica
``` Ache in shoulder and hip girdle Morning stiffness Symmetrical Fatigue, anorexia, weight loss, fever Reduced movement of shoulders, neck and hips Muscle strength is normal ```
38
What is a common presenting complaint in a patient with Polymyalgia Rheumatica
I could not get up in the morning but over the course of the day things improved If they lift their arms they really struggle but if you do it for them it is normal as the underlying muscle is normal
39
What is Temporal arteritis / Giant cell arteritis
Granulomatous arteritis of large vessels
40
What are some of the presenting complaints with Temporal arteritis / Giant cell arteritis
``` Headache Scalp tenderness Jaw claudication - when chewing Visual loss Tender, enlarged, non-pulsatile temporal arteries ```
41
How can we make a diagnosis of Temporal Arteritis
Raised ESR Plasma viscosity CRP Temporal artery biopsy - you may see thickening of the vessel wall
42
What is the problem with temporal artery biopsies?
They are not reliable due to having skipped lesions - you get patches of normal areas and affected areas
43
What is the treatment for Polymyalgia Rheumatica
Low dose steroids (15mg) - very rapid and dramatic response to these
44
Can polymalgia rheumatica be cured
Yes - within 18months to 2 year
45
What is the commonest cause of chronic MSK pain
Fibromyalgia
46
Is fibromyalgia associated with inflammation
No
47
Who is most likely to get fibromyalgia
Women often between 22-50
48
When might fibromyalgia begin
After emotional or physical trauma
49
What are some of the factors in the fibromyalgia cycle
Stress, limited activity, fatigue, depression, muscle stiffness, pain, muscle tension
50
Describe the sleep pattern is a patient with fibromyalgia
Often disturbed and they often wake up and feel as if they haven't had a good sleep which ultimately causes more pain
51
What are some regional symptoms and syndromes related to fibromyalgia
``` Headache IBS Cognitive difficulties (concentrating and remembering things properly) - brain fog Non cardiac chest pain Numbness that moves from area to area Excessive sweating ```
52
What are some of the clinical manifestations of fibromyalgia
``` Pain in neck, shoulders, lower back and chest wall Varies in intensity Symptoms are worse with exertion, fatigue and stress Sensation of swelling Unrefreshing sleep Pins and needles/ tingling Headaches Depression Abdominal pain Poor concentration and memory ``` Excessive tenderness on palpation of soft tissue (even cap refill)
53
How can we establish a diagnosis of fibromyalgia
No diagnostic test inflammatory markers are normal Absence of other explanation of symptoms
54
What is the treatment for a patient with fibromyalgia
``` Patient education MDT Graded exercise programme CBT Complementary medicine - acupuncture Anti-depressants Analgesia Gabapentin and pregabalin AMATRYPTOLINE ```

MSK SM (42 decks)

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