Inflammatory muscle disorders

· Polymyalgia rheumatica (or "muscle rheumatism") (to be) _____ an inflammatory condition that mainly (to occur) ________ in the elderly; it (to associate) __________________ with giant-cell arteritis. It often (to respond) _______ dramatically to glucocorticoids (e.g. prednisolone).

· Polymyositis, dermatomyositis and inclusion body myositis (to be) _____ autoimmune conditions in which the muscle (to affect) ________________.

Rhabdomyolysis (to be) ______ the breakdown of muscular tissue due to any cause. While it may not (to lead) _____________ to any muscular symptoms at all, the myoglobin thus released may (to cause) ____________ acute renal failure.

Tumors

Tumors of muscle (to include) _________________:

· Smooth muscle: leiomyoma (benign, very common in the uterus), leiomyosarcoma (malignant, very rare)

· Striated muscle: rhabdomyoma (benign) and rhabdomyosarcoma (malignant) - both very rare

· Metastasis from elsewhere (e.g. lung cancer)

Injuries of muscles (to include) _________________ wounds and strains.

Polymyalgia Rheumatica (PMR) – (to be) ______ a disorder associated with pain in the shoulder and hip. It (to consider) ____________________ a seronegative rheumatic disease but the etiology (cause) (not to establish) _________________. It (to respond) ________ well to steroids (prednisone).

It (to associate) ________________ with temporal arteritis (aka giant cell arteritis), which (to be) _______ a more serious condition.

Polymyositis (to be) ______ a type of inflammatory myopathy, related to dermatomyositis and inclusion body myositis. Polymyositis (to mean) ___________ 'many muscle inflammation'.

Polymyositis (to tend) __________ to become evident in adulthood, presenting with bilateral proximal muscle weakness, often noted in the upper legs due to early fatigue while walking. Sometimes the weakness (to present) ______________ itself by the person being unable to rise from a seated position without help, or inability to raise their arms above their head. The weakness (to be)______ generally progressive, accompanied by lymphocytic inflammation (mainly cytotoxic T8 lymphocytes). The cause (to be) _____ unknown, but (to seem) ________ to be related to autoimmune factors, genetics, and perhaps viruses. In rare cases, the cause (to know) _______________ to be infectious, associated with the pathogens that (to cause) _____________ Lyme disease, toxoplasmosis, and others.

Polymyositis, like dermatomyositis, (to strike) ______________ females with greater frequency than males. The skin involvement of dermatomyositis (to be) ______ absent in polymyositis.

Diagnosis (to be) ______ fourfold, including elevation of creatine kinase, signs and symptoms, electromyograph (EMG) alteration, and a positive muscle biopsy. Treatment generally (to involve) ________________ glucocorticoids, especially prednisone. At present, a number of studies (to be) _______ underway to determine whether patients diagnosed with polymyositis (to benefit) ___________ from newer drugs inhibiting the biologic effects of TNF alpha, such as Infliximab ("Remicade").

Sporadic inclusion body myositis (sIBM): IBM _____often (to confuse) ________________ with (misdiagnosed as) polymyositis and polymyositis that (not to respond) ______________ to treatment (to be) _______ likely IBM. sIBM (to come) ________ on over months to years, polymyositis (to come) _________ on over weeks to months. It (to appear) __________ that sIBM and polymyositis (to share) _____________ some common features, especially the initial sequence of immune system activation, however, polmyositis (not to display) _______________________ the subsequent muscle degeneration and protein abnormalities as seen in IBM. As well, polymyositis (to tend) ___________ to respond well to treatments, IBM does not. IBM and polymyositis apparently (to involve) ______________ different disease mechanisms than (to see) ____________ in dermatomyositis.

Dermatomyositis (to be) ______ connective-tissue disease that (to characterize) _________________ by inflammation of the muscles and the skin. Its cause (to be) _____ unknown, but it may (to result) ____________ from either a viral infection or an autoimmune reaction. Up to 50% of the cases may (to be) _______ a paraneoplastic phenomenon, indicating the presence of cancer.

X-ray findings (to include) ________________ dystrophic calcifications in the muscles.

There (to be) ______ a form of this disorder that (to strike) _________ children, known as juvenile dermatomyositis.