What does myopathy mean?
Any pathology involving muscle
What are some symptoms of muscle disease?
Myalgia (muscle pain)
Muscle weakness (often described as tired, heavy)
What is the generic name for inflammatory muscle disease?
What are two idiopathic inflammatory myopathies?
Dermatomyositis (+ skin)
Myositis is more common in (men / women).
as with all autoimmune disease
People with myositis are at increased risk of ___.
What can be seen under the microscope in someone with myositis?
Inflammatory cell infiltrate
Which muscles are commonly affected by myositis?
What is the main symptom of myositis?
i.e difficulty performing everyday tasks
Myositis has an (acute / insidious) onset.
over a period of months
Is myositis symmetrical or asymmetrical?
(Inclusion body myositis can be asymmetrical)
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???)
10% of myositis patients also have lung disease - which type?
Interstitial lung disease
What is a GI symptom associated with myositis?
Which type of cardiac muscle may be affected by myositis?
What is this condition called?
People with muscle disease may have apparent (hypertrophy / atrophy).
What is confrontational testing?
Patient attempts to resist your power, gives an indication of muscle strength
What is isotonic testing?
Gives indication of muscle stamina
e.g 30s sit to stand test
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
Which non-specific autoantibody may be raised in inflammatory myositis?
What is a specific autoantibody for inflammatory myositis?
Which test involves putting two needles into muscle and passing a current through them to track action potentials?
What is the definitive test to diagnose inflammatory myositis?
Muscle biopsy - loads of signs of inflammation
How is inflammatory myositis treated?
Immunosuppressants as steroid-sparers: azathioprine, methotrexate, ciclosporin
be aware that methotrexate causes pneumonitis
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
Apart from steroids and immunosuppressants, what else may be given to patients with severe inflammatory myositis?
Rituximab (inhibit B cells)
but expensive and lots of side effects so be careful
(Poly)myositis and dermatomyositis are examples of ___ diseases.
Polymyositis and dermatomyositis affect (proximal / distal) muscles.
Which myositis is more common in men, affects distal muscles and is often misdiagnosed as polymyositis?
Inclusion body myositis
If you're treating a patient for inflammatory myositis and they aren't responding to treatment, what should be considered?
Inclusion body myositis
Is inclusion body myositis an autoimmune disease?
Which class of drug may cause symptoms similar to myositis?
Are polymyositis and polymyalgia the same thing?
Do people under the age of 50 get polymyalgia rheumatica?
Which type of vasculitis is polymyalgia rheumatica associated with?
Giant cell arteritis
Which muscles are affected by polymyalgia rheumatica?
Proximals - shoulders, hips
Do people with polymyalgia rheumatica have muscle weakness?
What are the symptoms of polymyalgia rheumatica?
Polymyalgia rheumatica has a (rapid / insidious) onset.
rapid onset - weeks
People with polymyalgia rheumatica often feel quite unwell systemically - what symptoms may they have?
What does a muscle biopsy of someone with polymyalgia rheumatica look like?
What is vasculitis?
Inflammation of endothelium
Which artery is affected by giant cell arteritis?
Which nerve does it supply?
Which symptoms are associated with giant cell arteritis?
Pain, tenderness in the temporal region
Why do people with giant cell arteritis get jaw claudication?
Increased oxygen demand of mastication muscles
but vasculitis reduces blood flow
People with giant cell arteritis often experience visual ___.
Why must visual loss associated with giant cell arteritis be treated seriously?
Permanent blindness may result
In giant cell arteritis, the temporal arteries may become ___ and (palpable / unpalpable).
How is polymyalgia rheumatica diagnosed?
Can only be diagnosed clinically
+/- Raised inflammatory markers
+/- Apparent giant cell arteritis
How is polymyalgia rheumatica treated?
How long does polymyalgia rheumatica tend to last?
The steroid dose for polymyalgia rheumatica is gradually (increased / reduced).
Polymyalgia rheumatica shows a ___ response to steroids.
What is a very common non-inflammatory myopathy?
What is the prevalence of fibromyalgia?
Fibromyalgia is more common in (men / women).
What may trigger fibromyalgia?
Emotional or physical stress
Fibromyalgia is sort of cyclical because it is associated with a lot of other illness. What are some examples?
leading to poor sleep patterns and stress, fibromyalgia...
What are the symptoms of fibromyalgia?
Myalgia - particularly neck, shoulders, hips
Pins and needles
"Brain fog" - poor concentration and memory
How do fibromyalgia patients describe their pain?
Exacerbated by exertion, fatigue, stress
Fibromyalgia often ___ sleep.
described as 'unrefreshing'
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
How is fibromyalgia treated?
Medications - analgesia (inc. atyptical antidepressants like amitryptiline) -- val medication???
What happens to nociceptors in fibromyalgia?
Why do some people treat fibromyalgia as a made-up disease?
No reason for pain receptors to react the way they do
Is medication effective in fibromyalgia?
Tends not to be
What kind of exercise programme may people with fibromyalgia try?
increasing amounts of light exercise
Is there any organ pathology in fibromyalgia?
What questions should be asked to someone with suspected polymyalgia rheumatica?
Better/worse on exercise?
Headaches, vision problems?
What examinations should be performed on someone with suspected polymyalgia rheumatica?
Test muscle power - should be normal
Examine and palpate temporal arteries
What tests should be performed for suspected polymyalgia rheumatica?
Blood test - inflam markers, CK etc.
What dose of prednisolone should be given to a patient with suspected polymyalgia rheumatica?
they'll come back and call it a miracle cure
What are some side effects of steroids which should be considered before putting patients on them?
Osteoporosis (give vit d and calcium supplements, biphosphonates)