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The Musculoskeletal System > Muscle Diseases > Flashcards

Flashcards in Muscle Diseases Deck (45):
1

What is polymyalgia rheumatica?

A relatively common chronic inflammatory condition causing myalgia at the hip and shoulder girdles

2

How is polymyalgia rheumatic characterised?

  • Proximal myalgia of the hip and shoulder girdles
  • Mornign stiffness lasting > 1 hour

3

Polymyalgia rheumatica is strongly related to which other condition?

Giant cell arteritis

4

In what age is polymyalgia rheumatica most common?

> 50

5

Which blood tests can be done for polymyalgia rheumatica?

There are no specific tests

  • CRP (will be raised)
  • PV/ESR (will be raised)

6

Symptoms of polymyalgia rheumatic respond very well to which treatment?

Low dose steroids

(prenisolone 15mg)

The response is so dramatic that this can be used as a diagnostic tool

7

What is the treatment oplan for polymyalgia rheumatica involving low dosease steroids?

The steroid dose is gradually reduced over around 18 months

By this time the condition will have resolved in most patients

8

What is the most common form of systemic vasculitis?

Giant cell arteritis

9

Giant cell arteritis commony affects older/younger patients?

Older

10

How is giant cell arteritis characterised histologically?

  1. Transmural inflammation of the intima, media and adventitia
  2. Patchy infiltration by lymphocytes, macrophages and multinucleated giant cells (granulomas)

11

Vessel wall thickening in giant cell arteritis can result in what?

Subsequent distal ischaemia

12

What are the common signs and symptoms of giant cell arteritis?

  • Visual disturbaces
  • Headaches
  • Jaw claudication
  • Scalp tenderness
  • Fatigue, malaise and fever may be present

13

Which condition should always be considered in the differential diagnosis of new-onset headaches in patients >50 with raised inflammatory markers?

Giant cell arteritis

14

Describe the headache patients may experience in giant cell arteritis

Continuous

Located in the temporal or occipital areas

15

Why does jaw cladication occur in giant cell arteritis?

There is temporal arteritis which causes subsequent ischaemia of the maxillary artery

16

Diplopia may be experienced in patients with giant cell arteritis, what is this?

Double vision

17

What is the most definitive test for giant cell arteritis?

Temporal artery biopsy

18

When should a temporal artery biopsy be done for a patient?

As soon as giant cell arteritis is suspected

19

Why is a positive temporal artery biopsy 100% specific, but only 15-40% sensitive for giant cell arteritis?

Giant cell arteritis is a diffuse condition and has patchy involvement

This means some segments of the artery will be normal

20

What are the typical biopsy findings in an artery with giant cell arteritis?

  1. Mononuclear infiltration
  2. Granulomatous inflammation (multinucleated giant cells)

21

What is the treatment for giant cell arteritis?

Corticosteroids

  • Prednisolone 40mg (no visual impairment)
  • Prednisolone 60mg (visual impairment)

 

22

When should treatment be started for giant cell arteritis?

As soon as the condition is clincially suspected

23

Describe the treatment program involving corticosteroids for giant cell arteritis

The prednisolone dose is gradually tapered over 2 years

After this time, the condition will have resolved for most patients

24

What is polymyositis?

An idiopathic inflammatory myopathy that caused symmetrical proximal muscle weakness

25

How is dermatomyositis different from polymyositis?

It has typical cutaneous manifestations as well as the other symptoms

26

Both polymyositis and dermatomyositis are more common in which sex, and which age group?

Females

Adults > 20, especially 45-60

27

What is the basic pathogenesis of polymyositis?

It is thought that CD8 T cells and macrophages surround healthy muscle tissue and initiate a cytotoxic response

(an autoimmune response to both nuclear and cytoplasmic antibodies in seen in most patients)

28

Which antibodies are associated with polymyositis and which of these are specific for polymositis/dermatomyositis?

  1. ANA
  2. Anti-RNP
  3. ANti-Jo-1 (specific)
  4. Anti-SRP (specific)

29

How do patients with polymyositis present and what is the onset of the condition?

Symmetrical, proximal muscle weakness in the upper and lower extremities

Some patients also have myalgia

(insidious in onset)

30

Why may dysphagia occur in polymyositis?

Secondary to oropharyngeal and oesphageal involvement

(a poor prognostic sign)

31

Which lung condition is commonly found in those with polymyositis that are postive for anti-Jo-1 antibody?

Interstitial lung disease

32

Which investigations are suitable for polymyositis/dermatomyositis?

  • Inflammatory markers
  • Serum creatinine kinase
  • Autoantibodies
  • MRI
  • Electromyography
  • Muscle biopsy

33

Why is muscle biopsy crucial in polymyositis/dermatomyositis?

It can exclude other rare muscle diseases

34

What does a muscle biopsy classically show in polymyositis/dermatomyositis?

Muscle fibres in varying stages of inflammation, necrosis and regeneration

35

What is the management of polymyositis/dermatomyositis?

Prednisolone (40mg)

Immunosuppressive drugs e.g. azathioprine or methotrexate

36

What are the classical cutaneous features of dermatomyositis?

  1. V-shaped rash over chest
  2. Gottron's papules
  3. Heliotrope rash

37

There is an associated risk of malignancy with dermatomyositis patients, which types of cancer are most common?

  • Breast
  • Ovarian
  • Lung
  • Colon
  • Oesophagus
  • Bladder

38

What is fibromyalgia?

An unexplained condition causing widespread muscle pain and fatigue

39

Fibromylagia is most common in which sex and age?

Females

Young and middle aged

40

What is fibromyalgia thought to be?

Disorder of central pain processing

or

Syndrome of central sensitivity

41

Patients with fibromyalgia tend to have a lower threshold of which things?

  • Pain
  • Heat
  • Noise
  • Strong odours

42

Fibromyalgia can occur as a primary or secondary condition. When it occurs as a secondary condition, which conditions is it associated with?

  1. RA
  2. SLE

43

How does fibromyalgia clinically present?

  1. Persistant widespread pain (> 3 months) on bopth sides of the body, above and below the waist and including the axial spine
  2. Fatigue and unrefreshing sleep
  3. Cognitive difficulties
  4. Anxiety, depression, IBS and migraine

44

Which conditions may present similiarly to fibromyalgia?

  • Hypothyroidism
  • RA
  • SLE
  • Polymyalgia rheumatica
  • Other inflammatory autoimmune conditions

45

What is the management of fibromyalgia like?

  1. Education of self-management techniques
  2. Graded exercise
  3. Atypical analgesia (amitriptyline)
  4. Gapapentin
  5. Pregabalin
  6. Cognitive behavioural therapy

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