Myopathies
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Fibromyalgia should be differentiated from known muscle diseases, or myopathies, that have a genetic or other known cause.
Below is a list outlining different conditions that may result in a muscle disease or myopathy. This list has been prepared largely (not completely) from the following article: Reardon K, Collins C, Byrne E, Muscle Pain and Cramps, Medicine Today, Vol. 2, No. 6, June 2001, p 20-28, Sydney, Australia. Many of these conditions are rare or uncommon.
Below is a list outlining different conditions that may result in a muscle disease or myopathy. This list has been prepared largely (not completely) from the following article: Reardon K, Collins C, Byrne E, Muscle Pain and Cramps, Medicine Today, Vol. 2, No. 6, June 2001, p 20-28, Sydney, Australia. Many of these conditions are rare or uncommon.
Condition: Polymyositis, Dermatomyositis, Inclusion Body Myositis.
Disorder type: Idiopathic Inflammatory Myopathy
Features: Proximal weakness. Typical rash in dermatomyositis. Creatine kinase blood test value usually high.
Condition: Sarcoid Myopathy
Disorder type: Idiopathic Inflammatory Myopathy
Features: Rash may be present (erythema nodosum).
Condition: Connective Tissue Diseases
Disorder type: Idiopathic Inflammatory Myopathy
Features: Blood tests show high ESR, ANA, DNA antibodies, etc.
Condition: Polymyalgia Rheumatica
Disorder type: Idiopathic Inflammatory Myopathy
Features: Proximal, limb girdle tiredness and pain. Occurs especially in elderly.High ESR. Prednisone is often used to treat this.
Condition: HMA-CoA reductase inhibitors, e.g. Simvastatin, Pravastatin (anti-cholesterol agents).
Disorder type: Prescription Drugs/Alcohol.
Many prescription drugs (and alcohol) are associated with muscle pain and/or cramps.
Features: Elevated creatine kinase
Condition: Diuretics ("fluid pills").
Disorder type: Prescription Drugs/Alcohol.
Many prescription drugs (and alcohol) are associated with muscle pain and/or cramps.
Features: May be low potassium, sodium or magnesium on blood tests.May exacerbate dehydration.Treatment is by supplementing and/or stopping the pill. Dietary changes may be of assistance.
Note: The herb licorice when taken long term can also lower potassium.
Condition: Alcohol
Disorder type: Prescription Drugs/Alcohol.
Many prescription drugs (and alcohol) are associated with muscle pain and/or cramps.
Features: Chronic alcohol-related myopathy is usually painless. But acute painful myopathy may occur after a binge.
Condition: Hypothyroidism
Disorder type: Endocrine disorder
Features: Usually high creatine kinase. A simple TSH blood test will confirm.
Condition: Osteomalacea
Disorder type: Endocrine disorder
Features: May get severe proximal myalgia. Loosers zones (on x-ray) around femoral neck, pelvis, scapular, fibula or metatarsals. Vitamin D deficiency is the primary cause.
Condition: Myophosphorylase deficiency (McArdle's Disease)
Disorder type: Metabolic Myopathies: Carbohydrate Disorders - Disorders of glycogen breakdown.
Features: Pain rapidly develops in the exercising muscles, and increases with continued movement. Muscle contractures may develop. Pain after exercise may last a long time.Resting creatine kinase usually raised. creatine kinase always raised after exercise. Inherited (usually autosomal recessive).
Condition: Phosphorylase b kinase deficiency.
Disorder type: Metabolic Myopathies: Carbohydrate Disorders - Disorders of glycogen breakdown.
Features: As for McArdle's Disease (above)
Condition: Phosphofructokinase deficiency.
Disorder type: Metabolic Myopathies: Carbohydrate Disorders - Disorders of glycolysis.
Features: As for McArdle's Disease (above)
Condition: Primary muscle carnitine deficiency.
Disorder type: Metabolic Myopathies: Lipid Metabolism.
Features: Very rare - secondary deficiency is a lot more common. Typically painless. Manifests as progressive proximal weakness.Lots of lipid accumulation occurs in the muscle and a low muscle carnitine level is found on testing. Carnitine supplementation is used as part
of the treatment.
Condition: Carnitine palmitoyl transferase deficiency.
Disorder type: Metabolic Myopathies: Lipid Metabolism.
Features: Muscle pain during or after prolonged activity. Often present with post-exercise muscle swelling and pain. There may be a family history. A muscle specimen needs to be checked for the enzyme level to confirm the diagnosis.
Condition: Cytochrome b deficiency.
Disorder type: Metabolic Myopathies: Purine Metabolism
Features: Exercise intolerance and muscle pain.Creatine kinase usually normal. Resting serum lactate may be raised. Electromyography often not very abnormal. Muscle biopsy needed to confirm.Coenzyme Q10 may be helpful in treatment.
Condition: Depressive/Psychiatric Somatisation.
Disorder type: Mental health.
Features: Probably uncommon. CFS/ME sufferers are too often put in this category without justification. Depression/frustration is a natural side-effect of chronic pain and tiredness. Complaints of muscle pain may uncommonly be part of a mental "defense" mechanism in a person (subconsciously) wanting attention and sympathy. May be associated with low self worth.
Condition: Cerebral palsy. Cerebrovascular accident (CVA or stoke).
Disorder type: Central nervous system problems associated with increased muscle tone (spasticity or rigidity).
Features:
Condition: Isaac's syndrome.
Disorder type: Central nervous system problems associated with excessive motor unit activity.
Features: An unusual cause of muscle pain and cramps. Electromyography helpful. Anticonvulsants may help.
Disorder type: Idiopathic Inflammatory Myopathy
Features: Proximal weakness. Typical rash in dermatomyositis. Creatine kinase blood test value usually high.
Condition: Sarcoid Myopathy
Disorder type: Idiopathic Inflammatory Myopathy
Features: Rash may be present (erythema nodosum).
Condition: Connective Tissue Diseases
Disorder type: Idiopathic Inflammatory Myopathy
Features: Blood tests show high ESR, ANA, DNA antibodies, etc.
Condition: Polymyalgia Rheumatica
Disorder type: Idiopathic Inflammatory Myopathy
Features: Proximal, limb girdle tiredness and pain. Occurs especially in elderly.High ESR. Prednisone is often used to treat this.
Condition: HMA-CoA reductase inhibitors, e.g. Simvastatin, Pravastatin (anti-cholesterol agents).
Disorder type: Prescription Drugs/Alcohol.
Many prescription drugs (and alcohol) are associated with muscle pain and/or cramps.
Features: Elevated creatine kinase
Condition: Diuretics ("fluid pills").
Disorder type: Prescription Drugs/Alcohol.
Many prescription drugs (and alcohol) are associated with muscle pain and/or cramps.
Features: May be low potassium, sodium or magnesium on blood tests.May exacerbate dehydration.Treatment is by supplementing and/or stopping the pill. Dietary changes may be of assistance.
Note: The herb licorice when taken long term can also lower potassium.
Condition: Alcohol
Disorder type: Prescription Drugs/Alcohol.
Many prescription drugs (and alcohol) are associated with muscle pain and/or cramps.
Features: Chronic alcohol-related myopathy is usually painless. But acute painful myopathy may occur after a binge.
Condition: Hypothyroidism
Disorder type: Endocrine disorder
Features: Usually high creatine kinase. A simple TSH blood test will confirm.
Condition: Osteomalacea
Disorder type: Endocrine disorder
Features: May get severe proximal myalgia. Loosers zones (on x-ray) around femoral neck, pelvis, scapular, fibula or metatarsals. Vitamin D deficiency is the primary cause.
Condition: Myophosphorylase deficiency (McArdle's Disease)
Disorder type: Metabolic Myopathies: Carbohydrate Disorders - Disorders of glycogen breakdown.
Features: Pain rapidly develops in the exercising muscles, and increases with continued movement. Muscle contractures may develop. Pain after exercise may last a long time.Resting creatine kinase usually raised. creatine kinase always raised after exercise. Inherited (usually autosomal recessive).
Condition: Phosphorylase b kinase deficiency.
Disorder type: Metabolic Myopathies: Carbohydrate Disorders - Disorders of glycogen breakdown.
Features: As for McArdle's Disease (above)
Condition: Phosphofructokinase deficiency.
Disorder type: Metabolic Myopathies: Carbohydrate Disorders - Disorders of glycolysis.
Features: As for McArdle's Disease (above)
Condition: Primary muscle carnitine deficiency.
Disorder type: Metabolic Myopathies: Lipid Metabolism.
Features: Very rare - secondary deficiency is a lot more common. Typically painless. Manifests as progressive proximal weakness.Lots of lipid accumulation occurs in the muscle and a low muscle carnitine level is found on testing. Carnitine supplementation is used as part
of the treatment.
Condition: Carnitine palmitoyl transferase deficiency.
Disorder type: Metabolic Myopathies: Lipid Metabolism.
Features: Muscle pain during or after prolonged activity. Often present with post-exercise muscle swelling and pain. There may be a family history. A muscle specimen needs to be checked for the enzyme level to confirm the diagnosis.
Condition: Cytochrome b deficiency.
Disorder type: Metabolic Myopathies: Purine Metabolism
Features: Exercise intolerance and muscle pain.Creatine kinase usually normal. Resting serum lactate may be raised. Electromyography often not very abnormal. Muscle biopsy needed to confirm.Coenzyme Q10 may be helpful in treatment.
Condition: Depressive/Psychiatric Somatisation.
Disorder type: Mental health.
Features: Probably uncommon. CFS/ME sufferers are too often put in this category without justification. Depression/frustration is a natural side-effect of chronic pain and tiredness. Complaints of muscle pain may uncommonly be part of a mental "defense" mechanism in a person (subconsciously) wanting attention and sympathy. May be associated with low self worth.
Condition: Cerebral palsy. Cerebrovascular accident (CVA or stoke).
Disorder type: Central nervous system problems associated with increased muscle tone (spasticity or rigidity).
Features:
Condition: Isaac's syndrome.
Disorder type: Central nervous system problems associated with excessive motor unit activity.
Features: An unusual cause of muscle pain and cramps. Electromyography helpful. Anticonvulsants may help.
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