DrVirgo
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Whats a good way to differentiate between:
-Fibromyalgia
-Polymyalgia Rheumatica
-Polymyositis
???
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| sprint123
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Have a look at the ESR----> nORMAL--->Fibromyalgia
Increased ESR---> Could be PMR or Polymyositis
Look for stiffness in PMR in different areas
Look for weakness in Polymyositis in proximal muscles
Hope this helps!
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| usmlestud
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agree with sprint
also, in fibromyalgia
1....no consitutional symptoms
2....normal labs
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| dr in trouble
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FIBROMYALGIA most of the time affects young women where as PMR affects older women.
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| DrVirgo
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is it ok to say:
Fibromyalgia: DIFFUSE MUSCULOSKELETAL PAIN
Polymyalgia Rheumatica: STIFFNESS > pain
Polymyositis: PROX. Muscle WEAKNESS.
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| tolito
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also, i think muscle biopsy is MAT for diagnosing polymyositis
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| ssrpk
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which one is associated with an underlying malignancy, is it dermatomyositis or polymyositis
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| Aashi
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Dermatomyositis is the one associated with malignancies
commonly seen malignancies are ovarian , gastric cancer, and lymphoma. Others include lung, male genital organs, nonmelanoma skin, Kaposi's sarcoma, mycosis fungoides and melanoma.
Therefore, investigations and follow ups for malignancy should be initiated at the time dermatomyositis is diagnosed..
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| ssrpk
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thanks 
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| dr in trouble
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What are the musle groups involved in both polymyositis and dermatomyositis???????
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| virgola82
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Also in polymyalgia there is increased ESR with normal aldolase and othe markers of muscular necrosis while in polymyositis/dermatomysitis there is increased ESR w increased aldolase and oher muscular necrosis markers
In polymyositis you have mostly weaknesss of prox muscles impairing functioning while in PMR there is pain of proximal muscles preventing normal functioning.
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| young_doc
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Don't forget about other possible clues in -myositis like Gottron's papules or Anti-Jo Ab's...
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| DrVirgo
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Thanks everyone... For some reason I used to get these confused on questions...
Here are my notes for differentiating them:
FIBROMYALGIA:
-MC in females 35-55
-NOT inflammatory, so nsaids, naproxen, steroids won't work
-diffuse MUSCULOSKELETAL PAIN
-Fatigue and Poor sleep
-Multiple TENDER JOINTS (trigger points)
-NO joint swelling or pain
-Cause unknown but sleep disorders, depression, and viral infections all contribute
-LAB STUDIES NORMAL (w/u: CBC, ESR, TFTs, and CK)
-Treatment: TCAs (Amitriptyline) and Exercise
POLYMYALGIA RHEUMATICA
-MC in females >50
-INFLAMMATORY.
-STIFFNESS > Pain
-Morning Stiffness> 1 Month
-Everything is STIFF (shoulders, neck, hips, torso all stiff!)
-Assoc. with Temporal Arteritis
-ESR: >40mm/hr and increased CRP
-Treatment: Low dose prednisone (or high dose prednisone if temporal arteritis present also), ASA and NSAIDS provide less relief.
POLYMYOSITIS AND DERMATOMYOSITIS
-PROXIMAL MUSCLE WEAKNESS
-Dermatomyositis: malar rash like SLE, Heliotrope rash (purple periorbital edema), Gottron's Sign: scaly patches over the dorsum of prox. interphalangeal joints.
-Can be associated with dysphagia due to involvement of the striated muscle of the upper pharynx.
-Dx: MUSCLE BIOPSY shows endomyseal infiltrates, also CK and Aldolase.
Metastatic w/u: to r/o malignancy (PAP, Mammo, CT chest/abdomen/pelvis.
-Treatment: Steroids
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| dr in trouble
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Good work Dr Virgo
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| hanwin
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