inflammatory myopathies

Question 1

what are inflammatory myopathies characterised by?

Answer 1

weakness

Question 2

what is polymyalgia rheumatica characterised by

Answer 2

pain and stiffness

Question 3

what is fibromyalgia characterised by

Answer 3

pain and fatigue

Question 4

what is myopathy

Answer 4

disease of the muscle in which the muscle fibres do not function properly
causes weakness

Question 5

clinical features of polymyositis and dermatomyositis

Answer 5

muscle weakness

• insidious onset, worsening over months
• usually symmetrical, proximal muscles
• often specific problems

Question 6

what is the skin involvement in dermatomyositis

Answer 6

• Gottron’s sign
• heliotrope rash
• shawl sign

Question 7

what other organ involvement in dermatomyositis and polymyositis

Answer 7

• ILD
• resp muscle weakness
• dysphagia
• myocarditis
• fever
• weight loss
• Raynauds
• inflammatory arthritis

Question 8

what malignancy is it associated with

Answer 8

• ovarian
• breast
• stomach
• lung
• bladder

Question 9

examinations for myositis

Answer 9

-test muscle power (confrontational and isotonic testing)

Question 10

diagnosis of myositis

Answer 10

blood tests

• raised CK
• CRP
• autoantibodies
• electrolytes, calcium, PTH

electromyography

• increased fibrillations
• abnormal motor potentials

muscle biopsy
MRI

Question 11

what autoantibody is specific to myositis

Answer 11

Anti-Jo-1

Question 12

is myositis ANA positive or negative

Answer 12

positive

Question 13

how is myositis treated

Answer 13

corticosteroids
immunosuppression:
-azathioprine
-methotrexate
-ciclosporin
if no response:
-IV immunoglobin
-Rituximab

Question 14

what is the most definitive diagnostic test for polymyositis

Answer 14

muscle biopsy

Question 15

age group for polymyalgia rheumatica

Answer 15

over 50

Question 16

clinical signs of polymyalgia

Answer 16

• ache in shoulder and hip girdle
• morning stiffness
• usually symmetrical
• fatigue, anorexia, weight loss and fever
• reduced movement
• normal muscle strength

Question 17

what are the key features of temporal arteritis

Answer 17

• headache
• scalp tenderness
• jaw claudication
• visual loss
• tender, enlarged, non-pulsatile temporal arteries

Question 18

how is temporal arteritis diagnosed

Answer 18

• raised ESR, plasma viscosity, CRP

- temporal artery biopsy or USS

Question 19

how do you treat polymyalgia rheumatica

Answer 19

start at prednisolone 15mg daily

-gradual reduction in dose over 18 months to 2 years

Question 20

how is temporal arteritis treated

Answer 20

prednisolone 40-60mg daily

-steroid reduced over 18 months to 2 years

Question 21

is fibromyalgia inflammatory

Answer 21

no

Question 22

symptoms of fibromyalgia

Answer 22

muscle pain!
fatigue!
-headaches
-poor sleep pattern
-cognitive impairment 
-anxiety
-msk chest pain

Question 23

criteria for diagnosis of fibromyalgia

Answer 23

• patient experiences widespread pain and associated symptoms
• symptoms have been present at same level for 3 or more months
• no other condition otherwise explains the pain

Question 24

treatment for fibromyalgia

Answer 24

• education
• graded exercise programme
• CBT
• anti-depressants
• analgesia
• gabapentin and pregabalin

Question 25

is ILD associated with fibromyalgia

Answer 25

no