Monday, April 6, 2015

Study group discussion: Polymyalgia rheumatica and polymyositis

Question: Which inflammatory condition is associated with temporal arteritis?

Answer: Polymyalgia rheumatica!

Question: A patient comes with pain and weakness in the proximal muscles with not much of stiffness! What would it be? Polymyositis or PR?

Answer: Polymyositis.

Stiffness is a present in both but more of a feature of PR.

Pain in proximal muscles along with stiffness is PR, there will be no weakness of muscles in PR.

On the other hand, in case of Polymyositis, there is weakness of the muscles that is the main difference!

There might be little tenderness in this case.. But whether weakness is present or not that differentiates the two!

Rest we can further elaborate based on the enzymes!

So to summarize:
Muscle weakness is more of feature of polymyositis.
Stiffness, pain goes with Polymyalgia rheumatica.

Question: Which enzymes will be raised in PM?

Answer:
Creatine kinase.
Aldolase.

Question: What would be elevated in PR?

Answer: ESR.

Question: How does one differentiate between PM and DM?

Answer: In dermatomyositis, you will be see above symptoms plus skin manifestations - Gottron papules, Heliotrope rash, Shawl sign.

Question: What is the most common serious complication of PM/DM?

Answer: Malignancy!

Which malignancy?

Ovaries are most common. Others are cervix, breast, lungs, pancreas.
Testing for malignancy which CA is helpful?

CA-125 - That's for ovarian cancer.
19-9 for pancreas!

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