Muscle Diseases

Question 1

What are two signs of polymyalgia rheumatic?

Answer 1

Pain and stiffness.

Question 2

Where does polymyalgia rheumatica present?

Answer 2

Shoulder and hip girdles.

Question 3

How long does morning stiffness present for in polymyalgia rheumatic?

Answer 3

Lasts for over an hour.

Question 4

What condition is strongly associated with polymylagia rheumatic?

Answer 4

Giant Cell Arteritis

Question 5

What is base line treatment for PMR with no giant cell arteritis?

Answer 5

15mg prednisolone daily

responds very rapidly <24 hours

Question 6

PMR What is the length of the prednisolone course.

Answer 6

18 months and the dosage is gradually reduced over that period.

Question 7

Giant cell arteritis pathology

Answer 7

Inflammation of vessel walls with immune infiltration.

Thickening results I luminal narrowing and subsequent distal ischaemia.

Question 8

Giant Cell Arteritis

Presentation

Answer 8

Unilateral acute temporal headaches.
Scalp tenderness
Visual disturbances
Jaw claudication
Prominent non pulsatile temporal artery.

Question 9

Main risk of GCA

Answer 9

Blindness due to ischaemia of optic nerve.

Question 10

What artery results in jaw claudication?

Answer 10

Maxillary Artery

Question 11

GCA Diagnosis

Answer 11

Raised plasma viscosity and CRP
MR/CT angiogram
Temporal artery biopsy is gold standard.

Question 12

What cells on biopsy are seen to have infiltrated the vessel walls.

Answer 12

Lymphocytes macrophages and multinucleate giant cells

Question 13

Treatment for GCA with no visual impairment?

Answer 13

40mg of prednisolone

Question 14

Treatment of GCA with visual impairment?

Answer 14

60mg of prednisolone

Question 15

Period of prednisolone treatment in GCA?

Answer 15

Over 2 years gradually decreasing.

Treatment started as soon as diagnosis suspected DON’T wait for biopsy result.

Question 16

Muscle tone is polymyalgia reumatica?

Answer 16

Reduced muscle movement but strength is normal.

Question 17

In polymyalgia rheumatica what is commonly used as a diagnostic tool?

Answer 17

15mg dose of prednisolone due to rapid response.

Question 18

Other symptoms related to polymyalgia rheumatic?

Answer 18

Systemic

Fatigue, anorexia, weight loss and fever

Question 19

What is Polymyositis?

Answer 19

Idiopathic inflammatory myopathy.

2:1 F:M 40-50 years usually

Question 20

What is dermatopolymyositis?

Answer 20

Clinically very similar to polymyositis but with skin involvement.

Question 21

Pathogenesis behind polymyositis?

Answer 21

T-cell mediated necrosis of muscle fibres.

Question 22

What antibodies are associated with polymyositis?

Answer 22

anti-Jo-1

anti-SRP

Question 23

Presentation of polymyositis

Answer 23

Symmetrical and proximal gradual muscle weakness.
Often described by inability to perform actions which were once easy.
Up to half of patients will have myalgia.

Question 24

Systemic symptoms of polymyositis

Answer 24

Lung- Interstitial lung disease, generally pulmonary fibrosis
- respiratory muscle weakness
Oesophageal- dysphagia
Cardiac- Myocarditis
Systemic - Fever weight loss, raynauds, inflammatory arthritis.

Question 25

What is there an increased risk of in dermatomyositis?

Answer 25

Malignancy specifically ovarian breast and bowel.

Question 26

Who are at most risk of malignancy in dermatomyositis?

Answer 26

Men over 50 years old.

Question 27

Investigations for polymyositis

Answer 27

MRI- shows oedema and scarring FBC Electromyograph- abnormal finding low voltage short duration. Biopsy- gold standard - shows varying degrees of inflammation and necrosis

Question 28

Full blood count and immunology findings in polymyositis?

Answer 28

Raised CRP and plasma viscosity. Serum creatinine kinase levels increased showing muscle breakdown. ANA, anti-JO-1 and anti-SRP

Question 29

Polymyositis treatment

Answer 29

Prednisolone usually 40mg combined with methotrexate azathioprine etc

Question 30

What other features are typical of dermatomyositis?

Answer 30

Shawl sign - V-shaped rash over chest Gottrons papules- rash over MCP joints and back of hands. Heliotrope Rash- Rash around the eyes.

Question 31

Fibromyalgia

Answer 31

Chronic widespread muscle pain and fatigue. Common in young and middle aged women.

Question 32

Name some triggers for fibromyalgia

Answer 32

IBS emotional or physical trauma , lights sounds heat etc

Question 33

Pathogenesis of fibromyalgia

Answer 33

Unknow, but thought to be an abnormality in pain processing and sensitivity due to biochemical metabolic or immunological reasons.

Question 34

What conditions are often linked to fibromyalgia?

Answer 34

Systemic Lupus Erythematosis | Rheumatoid arthritis

Question 35

Presentation of fibromyalgia

Answer 35

Persistant and widespread pain >3 months. Fatigue with disrupted and unrefreshing sleep. Cognitive impairment 'fuzzy brain' Anxiety depression

Question 36

Are there any investigations in fibromyalgia?

Answer 36

No its based entirely of clinical bases however tests must be conducted to outrule clinically similar conditions.

Question 37

What conditions can present like fibromyalgia?

Answer 37

Hypothyroidism, rheumatoid arthritis, systemic lupus erythematosus.

Question 38

Management of fibromyalgia

Answer 38

Education in self management and exercise. Validating concerns and acknowledgment of patients pain. Counselling and behavioural therapy. Analgesia

Question 39

What analgesics are used in fibromyalgia?

Answer 39

Gabapentin Pregabalin and amitriptyline.