50 MYALGIAS General Discussion Muscle pain may be the result of muscle disease, but joint and bone disease also may produce complaints of muscle pain. Pain from disease of overlying tissue, fascia, or tendons also may be referred to muscle. In addition, disease of major peripheral nerves or of their smaller intramuscular branches may produce both muscle pain and muscle weakness. Muscle pain may be a major symptom in inflammatory, metabolic, endocrine, and toxic myopathies. Metabolic myopathies is a term applied to a heterogeneous group of disorders that result from the inability of skeletal muscle to produce or maintain adequate levels of energy in the form of adenosyl triphosphate (ATP). The metabolic myopathies are classified according to the altered area of metabolism as muscle glycogenoses, disorders of lipid metabolism, and mitochondrial myopathies. The symptoms of patients with the metabolic myopathies vary widely but include premature fatigue, episodic aches, cramps and pains occasionally accompanied by extensive rhabdomyolysis with myoglobinuria, and fixed, progressive muscle weakness. The diagnosis of a metabolic myopathy usually requires muscle biopsy with a combination of analyses, including histology, histochemistry, electron microscopy, and biochemistry. Multiple drugs and toxins can cause myopathy. Patients at risk for developing adverse reactions typically are those who have reduced abilities to metabolize or excrete the drug and its metabolites, which include infants, children, elderly patients, and those who have liver or renal failure. There are several recognized mechanisms whereby toxins can produce muscle damage. Toxins may cause a direct toxic or biochemical effect. Secondary effects of toxins resulting in muscle damage include immune activation with inflammation, vascular insufficiency, ischemia, hypokalemia, muscle overactivity, compression, or direct injury resulting from repeated injections. Since toxin-related muscle damage can be readily reversible once exposure stops, toxic myopathies should be considered early in the differential diagnosis of myalgias. The idiopathic inflammatory myopathies are a group of disorders characterized by proximal muscle weakness and nonsuppurative inflammation of skeletal muscle, often accompanied by extramuscular manifestations. Dermatomyositis, polymyositis, inclusion body myositis, and cancer-associated myositis are idiopathic inflammatory myopathies. Patients with idiopathic inflammatory myopathy may present with a variety of nonspecific symptoms such as fatigue, myalgias, arthralgias, malaise, and weight loss. Medications Associated with Myalgias Albuterol Amiodarone Amphotericin B Chloroquine Cimetidine Clofibrate Corticosteroids (chronic use) Cyclosporine Diuretics L-Dopa Emetine Enalapril Epsilon-aminocaproic acid Finasteride Gemfibrozil Halothane HMG-CoA reductase inhibitors (statins) Hydroxychloroquine Interferon-alfa Isoretinoin Lamotrigine Labetalol Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on MYALGIAS Full access? Get Clinical Tree
50 MYALGIAS General Discussion Muscle pain may be the result of muscle disease, but joint and bone disease also may produce complaints of muscle pain. Pain from disease of overlying tissue, fascia, or tendons also may be referred to muscle. In addition, disease of major peripheral nerves or of their smaller intramuscular branches may produce both muscle pain and muscle weakness. Muscle pain may be a major symptom in inflammatory, metabolic, endocrine, and toxic myopathies. Metabolic myopathies is a term applied to a heterogeneous group of disorders that result from the inability of skeletal muscle to produce or maintain adequate levels of energy in the form of adenosyl triphosphate (ATP). The metabolic myopathies are classified according to the altered area of metabolism as muscle glycogenoses, disorders of lipid metabolism, and mitochondrial myopathies. The symptoms of patients with the metabolic myopathies vary widely but include premature fatigue, episodic aches, cramps and pains occasionally accompanied by extensive rhabdomyolysis with myoglobinuria, and fixed, progressive muscle weakness. The diagnosis of a metabolic myopathy usually requires muscle biopsy with a combination of analyses, including histology, histochemistry, electron microscopy, and biochemistry. Multiple drugs and toxins can cause myopathy. Patients at risk for developing adverse reactions typically are those who have reduced abilities to metabolize or excrete the drug and its metabolites, which include infants, children, elderly patients, and those who have liver or renal failure. There are several recognized mechanisms whereby toxins can produce muscle damage. Toxins may cause a direct toxic or biochemical effect. Secondary effects of toxins resulting in muscle damage include immune activation with inflammation, vascular insufficiency, ischemia, hypokalemia, muscle overactivity, compression, or direct injury resulting from repeated injections. Since toxin-related muscle damage can be readily reversible once exposure stops, toxic myopathies should be considered early in the differential diagnosis of myalgias. The idiopathic inflammatory myopathies are a group of disorders characterized by proximal muscle weakness and nonsuppurative inflammation of skeletal muscle, often accompanied by extramuscular manifestations. Dermatomyositis, polymyositis, inclusion body myositis, and cancer-associated myositis are idiopathic inflammatory myopathies. Patients with idiopathic inflammatory myopathy may present with a variety of nonspecific symptoms such as fatigue, myalgias, arthralgias, malaise, and weight loss. Medications Associated with Myalgias Albuterol Amiodarone Amphotericin B Chloroquine Cimetidine Clofibrate Corticosteroids (chronic use) Cyclosporine Diuretics L-Dopa Emetine Enalapril Epsilon-aminocaproic acid Finasteride Gemfibrozil Halothane HMG-CoA reductase inhibitors (statins) Hydroxychloroquine Interferon-alfa Isoretinoin Lamotrigine Labetalol Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on MYALGIAS Full access? Get Clinical Tree
