7: Muscle disease Flashcards Preview

MSK Week 2 2017/18 > 7: Muscle disease > Flashcards

Flashcards in 7: Muscle disease Deck (73)
1

What does myopathy mean?

Any pathology involving muscle

2

What are some symptoms of muscle disease?

Myalgia (muscle pain)

Muscle weakness (often described as tired, heavy)

Stiffness

3

What is the generic name for inflammatory muscle disease?

Myositis

4

What are two idiopathic inflammatory myopathies?

Polymyositis

Dermatomyositis (+ skin)

5

Myositis is more common in (men / women).

women

as with all autoimmune disease

6

People with myositis are at increased risk of ___.

malignancy

7

What can be seen under the microscope in someone with myositis?

Necrosis

Regeneration

Inflammatory cell infiltrate

8

Which muscles are commonly affected by myositis?

Shoulder muscles

Hip muscles

9

What is the main symptom of myositis?

Muscle weakness

i.e difficulty performing everyday tasks

10

Myositis has an (acute / insidious) onset.

insidious

over a period of months

11

Is myositis symmetrical or asymmetrical?

Symmetrical

(Inclusion body myositis can be asymmetrical)

12

What are typical skin features of dermatomyositis?

Gottron's papules - violet patches over PIP and MCP joints

Heliotrope rash - characteristic rash around eyes

Shawl sign - rash on back, as if patient has been wrapped up in a blanket (made of acid???)

13

10% of myositis patients also have lung disease - which type?

Interstitial lung disease

pulmonary fibrosis

14

What is a GI symptom associated with myositis?

Dysphagia

15

Which type of cardiac muscle may be affected by myositis?

What is this condition called?

Myocardium

Myocarditis

16

People with muscle disease may have apparent (hypertrophy / atrophy).

atrophy

17

What is confrontational testing?

Patient attempts to resist your power, gives an indication of muscle strength

18

What is isotonic testing?

Gives indication of muscle stamina

e.g 30s sit to stand test

19

What are some blood tests which can be carried out to identify muscle disease?

Creatine kinase - released when muscles break down, first-line test

Inflammatory markers - CRP and ESR will be raised in inflammatory myopathies

U&Es - for other causes e.g hypocalcaemia, hyperkalaemia

Autoantibody tests - for anti Jo-1 antibody in particular

20

Which non-specific autoantibody may be raised in inflammatory myositis?

ANA

21

What is a specific autoantibody for inflammatory myositis?

Anti-Jo-1

22

Which test involves putting two needles into muscle and passing a current through them to track action potentials?

Electromyography (EMG)

23

What is the definitive test to diagnose inflammatory myositis?

Muscle biopsy - loads of signs of inflammation

24

How is inflammatory myositis treated?

Steroids

Immunosuppressants as steroid-sparers: azathioprine, methotrexate, ciclosporin

be aware that methotrexate causes pneumonitis

Biologic agents

25

Why are steroids started before immunosuppressants despite the fact that they may cause muscle pain as a side effect?

Immunosuppressants take 4-6 weeks to start working

26

Apart from steroids and immunosuppressants, what else may be given to patients with severe inflammatory myositis?

IV immunoglobulin

Rituximab (inhibit B cells)

but expensive and lots of side effects so be careful

27

(Poly)myositis and dermatomyositis are examples of ___ diseases.

autoimmune

28

Polymyositis and dermatomyositis affect (proximal / distal) muscles.

proximal

29

Which myositis is more common in menaffects distal muscles and is often misdiagnosed as polymyositis?

Inclusion body myositis

30

If you're treating a patient for inflammatory myositis and they aren't responding to treatment, what should be considered?

Inclusion body myositis

31

Is inclusion body myositis an autoimmune disease?

No

32

Which class of drug may cause symptoms similar to myositis?

Statins

33

Are polymyositis and polymyalgia the same thing?

Noooo

34

Do people under the age of 50 get polymyalgia rheumatica?

No

35

Which type of vasculitis is polymyalgia rheumatica associated with?

Giant cell arteritis

36

Which muscles are affected by polymyalgia rheumatica?

Proximals - shoulders, hips

37

Do people with polymyalgia rheumatica have muscle weakness?

No

38

What are the symptoms of polymyalgia rheumatica?

Muscle PAIN

Muscle STIFFNESS

39

Polymyalgia rheumatica has a (rapid / insidious) onset.

rapid onset - weeks

40

People with polymyalgia rheumatica often feel quite unwell systemically - what symptoms may they have?

Fatigue

Anorexia

Weight loss

Fever

41

What does a muscle biopsy of someone with polymyalgia rheumatica look like?

Normal

42

What is vasculitis?

Inflammation of endothelium

43

Which artery is affected by giant cell arteritis?

Which nerve does it supply?

Temporal artery

Optic nerve

44

Which symptoms are associated with giant cell arteritis?

Pain, tenderness in the temporal region

Achey scalp

Jaw claudication

45

Why do people with giant cell arteritis get jaw claudication?

Increased oxygen demand of mastication muscles

but vasculitis reduces blood flow

46

People with giant cell arteritis often experience visual ___.

loss

47

Why must visual loss associated with giant cell arteritis be treated seriously?

Permanent blindness may result

48

In giant cell arteritis, the temporal arteries may become ___ and (palpable / unpalpable).

unpalpable

49

How is polymyalgia rheumatica diagnosed?

Can only be diagnosed clinically

+/- Raised inflammatory markers

+/- Apparent giant cell arteritis

50

How is polymyalgia rheumatica treated?

Steroids

51

How long does polymyalgia rheumatica tend to last?

18-20 months

52

The steroid dose for polymyalgia rheumatica is gradually (increased / reduced).

reduced

53

Polymyalgia rheumatica shows a ___ response to steroids.

dramatic

54

What is a very common non-inflammatory myopathy?

Fibromyalgia

55

What is the prevalence of fibromyalgia?

2-5%

56

Fibromyalgia is more common in (men / women).

women

57

What may trigger fibromyalgia?

Emotional or physical stress

58

Fibromyalgia is sort of cyclical because it is associated with a lot of other illness. What are some examples?

Depression

IBS

leading to poor sleep patterns and stress, fibromyalgia...

59

What are the symptoms of fibromyalgia?

Myalgia - particularly neck, shoulders, hips

Pins and needles

Headaches

"Brain fog" - poor concentration and memory

60

How do fibromyalgia patients describe their pain?

Diffuse

Exacerbated by exertion, fatigue, stress

61

Fibromyalgia often ___ sleep.

disturbs

described as 'unrefreshing'

62

Similar to polymyalgia rheumatica, how is fibromyalgia diagnosed?

Literally by excluding everything else

All tests are normal but should be done to exclude inflammation, muscle damage

63

How is fibromyalgia treated?

Medications - analgesia (inc. atyptical antidepressants like amitryptiline) -- val medication???

Behavioural therapy

Complementary therapy

64

What happens to nociceptors in fibromyalgia?

Hypersensitive

65

Why do some people treat fibromyalgia as a made-up disease?

No reason for pain receptors to react the way they do

66

Is medication effective in fibromyalgia?

Tends not to be

67

What kind of exercise programme may people with fibromyalgia try?

Graded

increasing amounts of light exercise

68

Is there any organ pathology in fibromyalgia?

No

69

What questions should be asked to someone with suspected polymyalgia rheumatica?

Better/worse on exercise?

Headaches, vision problems?

70

What examinations should be performed on someone with suspected polymyalgia rheumatica?

Test muscle power - should be normal

Examine and palpate temporal arteries

71

What tests should be performed for suspected polymyalgia rheumatica?

Blood test - inflam markers, CK etc.

72

What dose of prednisolone should be given to a patient with suspected polymyalgia rheumatica?

15mg

they'll come back and call it a miracle cure

73

What are some side effects of steroids which should be considered before putting patients on them?

Weight gain

Osteoporosis (give vit d and calcium supplements, biphosphonates)