Flashcards in Muscle Disease Deck (40):
What does "Myalgia" mean?
What does "My arms feel heavy and tired, i struggle to do things" imply about the muscle?
What does "My muscle are stiff when i first wake up and then get a bit better when I've walked about for a bit" imply about the muscle?
Which muscle disease(s) have an increased risk of malignancy associated?
What type of disease are Polymyositis and Dermatomyositis?
Idiopathic Inflammatory Myopathies
Who's more like to get polymyositis? (male/female) (ages 10-20/ 20-30/30-40/40-50/50-60/60-70/65+)
40-50 years peak
What is seen on biopsy of Polymyosits?
Muscle fibre necrosis
An inflammatory cell infiltrate
What is the most common presenting complaint of a patient with polymyosits?
List some clinical features of Myositis:
Insidious onset, worsening over months.
Usually symmetrical, proximal muscles
Mild myalgia in some patients (25-50%)
Was cutaneous signs are seen in dermatomyositis?
Gottron's sign (hands)
Heliotrope rash (face/eyes) (purple/pink discoloration and swelling)
Shawl Sign (Back)
Which drugs are known to cause proximal muscle weakness?
What other presentations can be important to pick up in a history of tired muscles and functional difficulty?
What is the difference between Confrontational Testing and Isotonic Testing?
Confrontational = Direct testing of power (pushing)
Isotonic = Repeated movement (e.g. 30 second sit to stand)
Which is a better test of muscle power? (Confrontational, Isotonic)
Why are Creatine Kinase enzymes raised in Myositis?
Muscle inflammtion and breakdown of muscle causes release of muscle enzymes during break down. Creatine Kinase is a muscle enzyme so levels of this rise (up into thousands) in myositis
What is a specific antibody of polymyositis and drmatomyositis?
What is an EMG?
Shows pattern of how muscle conducts electricity
What is seen on an EMG of a patient with polymyositis?
Increased fibrillations, abnormal motor potentials, complex repetitive discharges
Treatment for Myositis:
Prednisolone daily - decrease dose over time
Use immunosuppression at same time as steroid
(steroids - short term)
What is typical of Inclusion body myositis?
Distal muscle weakness
Weakness wrist and finger flexors in upper limbs and quadriceps and anterior tibial muscles in legs
Weakness often asymmetrical
CK levels lower than polymyositis
Muscle biopsy shows inclusion bodies
Responds poorly to therapy
How high are the CK levels in IBM and PM?
(Not up into thousands in IBM)
(Into thousands in PM, much higher)
What is the best test for myositis?
What are the main symptom of myositis?
Which drugs may cause a presentation similar to myositis?
Who gets Polymyalgia Rheumatica?
Over 50 year olds
What condition is associated with Polymyalgia Rheumatica?
Temporal Arteritis/ Giant Cell Arteritis (15%)
What are the clinical manifestations of Polymyalgia Rheumatica?
Ache in shoulder and hip girdle
Fatigue, anorexia, weight loss and fever may occur
Reduced movement of shoulders, neck and hips due to pain and stiffness
Comes on quite quickly (within a few weeks)
Worst first thing in the mornign
Struggle to get out of bed
Better after walking about a bit
MUSCLE STRENGTH NORMAL
Whats "the fear" with GCA (temporal arteritis)?
What would be raised in polymyalgia rheumatica?
ESR, plasma viscosity, CRP
Is polymyalgia rheumatica autoimmune?
Treatment for polymyalgia rheumatica:
(no temporal arteritis)
(feel dramatically better)
Treatment for polymyalgia rheumatica:
(WITH temporal arteritis)
(to prevent visual loss)
Is fibromyalgia an inflammatory or non-inflammatory problem?
Main symptoms of Fibromyalgia:
Poor sleep pattern
Does exercise make symptoms of fibromyalgia better or worse?
Where is the pain in fibromyalgia?
What is fibromyalgia pain like?
Varies in intensity
Worse with exertion, fatigue, stress
Sensation of swelling
How many tender points need to be present to make a diagnosis of fibromyalgia?
11 out of 18
Are the inflammatory markers raised in fibromyalgia?
They are normal
It is a non-inflammatory