Muscle Disease

Question 1

name 7 possible causes of myopathy

Answer 1

inflammatory
Endocrine disroders
Electrolyte disorders
metabolis myopathies
drugs and toxins
infection
rhabdomylysis

Question 2

general presentation of muscle disease?

Answer 2

muscle pain (myalgia)
muscle weakness/tiredness
stiffness
abnormal blood tests

Question 3

name 2 idiopathic inflammatory myopathies

Answer 3

polymyositis

dermatomyolitis

Question 4

who gets idiopathic inflammatory myopathy?

Answer 4

more females than men

onset usually 40-50 y/o

Question 5

does inflammatory myopathy increase cancer risk?

Answer 5

yes

greatest risk in men >45

Question 6

histological features of inflammatory myopathy (IM)?

Answer 6

muscle fibre necrosis
degeneration
regeneration
inflammatory infiltrate

Question 7

clinical features of IM?

Answer 7

muscle weakness = main feature
incidious onset - worsening over months
symmetrical, proximal muscles
often specific problems - i.e cant brush hair etc
myalgia in 25-50%

Question 8

what is dermatomyositis?

Answer 8

inflammatory myopathy which affects the skin
Gottrons sign = inflammation on the knuckles
heliotrope rash
shawl sign

Question 9

what organs can IM affect?

Answer 9

lungs - ILD, resp muscle weakness
oesophagus - dysphagia
cardiac - myocarditis
systemic - fever, weight loss, raynauds, non-erosive polyarthritis

Question 10

IM history?

Answer 10

muscle symptoms
PMH - DM, thyroid
DH - steroids, statins
FH 
SH - alcohol/drug use
Other - weight loss, cough, breathless, raynauds

Question 11

how can IM affect muscles?

Answer 11

can cause atrophy and loss of muscle power

Question 12

2 types of testing for muscle power?

Answer 12

conformational - direct test (push against)

isotonic - 30 secs to stand and sit

Question 13

how can IM be diagnosed?

Answer 13

History
Bloods
electromyography
muscle biopsy
MRI

Question 14

muscle biopsy features?

Answer 14

perivascular inflammation

muscle necrosis

Question 15

MRI features?

Answer 15

muscle inflammation
oedema
fibrosis
calcification

Question 16

blood test features?

Answer 16

CK enzyme
inflammatory markers
Autoantibodies - ANA, anti-Jo-1
electrolytes, calcium, PTH, TSH (to exclude other things)

Question 17

EMG features?

Answer 17

increased fibrillations
abnormal motor potentials
complex repetitive discharges

Question 18

how is IM treated?

Answer 18

steroids
azathioprine/methotrexate/ciclosporin?
IV immunoglobulin
Rituximab

Question 19

what is a heliotrope rash associated with?

Answer 19

dermatomyositis

Question 20

what is the definitive test for polymyositis?

Answer 20

muscle biopsy

Question 21

main symptoms in inflammatory myositis?

Answer 21

muscle weakness

Question 22

what drug might cause a presentation similar to myositis?

Answer 22

statins

Question 23

who gets polymyalgia rheumatica?

Answer 23

over 50s

associated with giant cell arteritis and temporal arteritis

Question 24

clinical features of PR?

Answer 24

aching in shoulder and hip
morning stiffness
usually symmetrical
fatigue, weight loss, fever sometimes
reduced movement
normal muscle strength

Question 25

how is PR diagnosed?

Answer 25

mainly focused on clinical features and examination exclude other diagnosis bloods - raised inflammatory markers temporal artery biopsy

Question 26

how is PR treated?

Answer 26

steroids higher dose if temporal arteritis gradually reduce dose over 18 months to 2 years

Question 27

what is fibromyalgia?

Answer 27

non-inflammatory cause of chronic MSK pain | more common in women 22-50

Question 28

what can trigger fibromyalgia?

Answer 28

physical or emotional trauma

Question 29

what causes the sensation of pain in fibromyalgia?

Answer 29

central sensitization

Question 30

fibromyalgia cycle?

Answer 30

emotional and physical pain etc lead to less movement leads to worse symptoms etc

Question 31

can fibromyalgia affect other systems?

Answer 31

yes | almost all

Question 32

clinical features of fibromyalgia?

Answer 32

``` widespread pain diffuse and chronic symptoms worsen with exertion, fatigue and stress sensation of swelling poor sleep pins and needles headaches depression abdo pain (IBS) poor cognition ```

Question 33

clinical finding of fibromyalgia?

Answer 33

excessive tenderness on palpation of soft tissues (11/18 points) no actual abnormality

Question 34

how is fibromyalgia diagnosed?

Answer 34

clinically widespread pain with associated symptoms present 3 or more months no other explanation

Question 35

associated symptoms?

Answer 35

bad sleep cognitive symptoms fatigue other somatic symptoms

Question 36

how is fibromyalgia medically treated?

Answer 36

analgesia (usually not opiates) anti-depression gabapentin and pregabalin

Question 37

non medical fibromyalgia treatment?

Answer 37

education graded exercise programme CBT complementary medicine (e.g acupuncture)