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41 Cards in this Set
- Front
- Back
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What muscle enzymes do we look at for myositis?
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Creatine Kinase
Aldolase ALT/AST |
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Most patients with myositis present with what symptom?
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weakness
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What is myalgia?
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Muscle pain
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Criteria for PM/DM diagnosis?
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Weakness
Enzymes Electromyography Muscle Biopsy Dermatologic Findings |
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What is DM?
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Dermatomyositis
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What is PM?
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Polymyositis
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What are the dermatologic findings of DM?
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Gottron's papules
Heliotrope |
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What additional diagnostic criteria are used for DM/PM diagnosis?
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Autoantibodies
MRI/Spectroscopy Evidence of Inflammatory/Rheumatic Disease |
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Muscle weakness of myopathies generally involves what kind of muscle?
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Skeletal muscle, most often proximal
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What is one major complication you need to be aware of with myopathy patients?
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Dysphagia (due to weakness of muscles used when swallowing)
Respiratory muscle can also cause problems |
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Problems with dysphagia and respiratory muscle weakness can lead to...
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aspiration pneumonia
or respiratory failure |
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What is one way you can test patients in the office for muscle weakness?
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Manual muscle testing
applying resistance against contraction |
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What is the scale used to record your findings for the manual muscle test?
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0=No Contraction
1=Contraction, No Movement 2=Movement, but not against Gravity 3=Gravity but not Resistance 4=Resistance but not Normal 5=Normal |
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What are some activities that test strength?
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Stand from chair w/o hands
Squatting or standing from floor Sitting from Supine Standing on heels and toes |
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Is there a correlation b/t levels of enzyme markers and disease activity in myopathies?
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Yes, thus levels of enzymes can be used to measure disease activity as well as for diagnosis.
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What is the most sensitive muscle enzyme for inflammatory myopathy?
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Creatine Kinase
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Which muscle enzyme is relatively organ specific?
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Creatine Kinase
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You will expect to see what with myopathic potentials in EMG?
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Low amplitude
Short duration Polyphasic |
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Increased spontaneous activity in EMG's will appear as...
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Fibrillations
Positive Sharp Waves Complex Repetitive Discharges |
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What are the advantages of an open muscle biopsy?
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Better sample
Easier interpretation Can get larger amount of muscle |
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What are advantages of needle muscle biopsy?
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Less scar
Less risk Smaller procedure Easier to repeat |
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What kind of mononuclear cell infiltration do you see with PM and IBM?
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Endomysial
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What kind of mononuclear cell infiltration do you see with DM?
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Perimysium
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Is perifascicular atrophy seen in DM or PM?
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DM
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In what myopathy do you see rimmed vacuoles and inclusions?
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IBM
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What are histologic features of dermatomyositis?
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Perimysial infiltration
Perifascicular atrophy Capillary depletion Deposition of complement in muscle |
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What are some vascular features of dermatomyositis?
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Reduced muscle capillary density
Ischemic muscle damage Cutaneous ulcerations Intestinal perforations |
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What are some cutaneous features of dermatomyositis?
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Gottron's papules
Heliotrope sign Erythematous rash Scalp involvement Photosensitivity Nailfold Changes |
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Where do you commonly see cutaneous involvement in DM?
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Extensor surfaces
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How do we best see active disease in MRI?
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T2-weighted images that reflect increased water/edema
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What part of the body is most often looked at when using an MRI to diagnose myopathies?
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The thigh
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What is the most common autoantibody seen in both PM and DM?
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Positive ANA
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What are some of the Myositis-Specific Autoantibodies?
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Anti-synthetases (anti-Jo-1 & Non-Jo-1)
Anti-Mi-2 Anti-SRP Anti-PM-Scl |
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Which anti-synthetase is more common? (Anti-Jo-1 or Non-Jo-1)
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Anti-Jo-1 is far more common than Non-Jo-1
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What clinical features are common in patients with any anti-synthetase?
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interstitial lung disease or arthritis
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What disease is Anti-Mi-2 typically associated with?
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Dermatomyositis
--rash often prominent |
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What disease are signal recognition particle (SRP) autoantibodies typically associated with?
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Polymyositis
--no skin involvement --acute onset, severe disease |
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What disease do we commonly associate Anti-PM-Scl autoantibodies with?
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Both PM and DM
--inflammatory arthritis is also common |
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The myositis autoantibodies have _____ specificity and _____ sensitivity
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high specificity, low sensitivity
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Rank DM, IBM and PM from greatest to least in their rate of progression of muscle weakness
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DM>PM>IBM
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With which myositis are you most likely to see malignancy and when is the risk greatest?
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Dermatomyositis
Risk greatest in the first year |
