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肌肉痛 + 近端肌肉無力 (依器官系統區分 (內分泌 (hypothyroid myopahty(79%) (lab (CK ⬆️, TSH ⬆️)…

- - - - Diagnosis: X-ray, CT
      - History: Falling, Trauma
      - Pathological fracture
    - - Specific point
  - - - Excercise-related
  - - - lesions along with dermatome
      - PE : Straight leg raising, Spurling's test
      - C spine/L2-L4
    - - vesicular lesion?
      - PCR testing
    - - risk factor
        
        diabetes
        
        dyslipidemia
    - - Diagnosis: CSF examination (+Electrodiagnostic studies, MRI)
      - Acute/Subacute: Reach maximum disability in 2 weeks
      - Distal sensory loss followed by weakness that starts in the legs and progresses to the arms and cranial muscles
      - Treatment: IVIg or plasma change
  - - - History taking
        
        diet?
        
        travel history?
        
        leukocytosis
        
        以上有符合再做肌肉biopsy
    - - Influenza
        
        Fever, Soar muscle
        
        快篩
      - poliovirus
      - HHV
    - - Less likely
  - - - SLE
        
        LAB data
        
        ANA
        
        anti-dsDNA (70%)
        
        anti-Sm (30%)
        
        PE
        
        myalgia (70%)
        
        Arthritis and arthralgias (90%)
        
        Mucocutaneous involvement
        
        renal involvement(50%)
        
        2012 SLICC criteria
        
        Link Title
      - 懷疑是MG
        
        問一天當中無力感有無變化
        
        edrophonium test
  - - - 低血鈣?
      - 低血鉀?
        
        看抽血報告
        
        問medication history
    - - ref
      - lab
        
        CK ⬆️
        
        TSH ⬆️
      - pathogenesis
        
        T4 deficiency ➡️ abnormal glycogenolysis ➡️type2 muscle atrophy ➡️ type 1 (compensatory) hypertophy ➡️oxidative damage ➡️ rhabdomyolysis
    - - pathogenesis
        
        catabolic effect on skeletal muscle for gluconeogenesis
        
        interfere IGF-1 signaling ➡️ myocyte apoptosis
        
        ref
      - diagnosis
        
        減少glcocorticoid dose 然後觀察muscle strength, 如果有肌力有改善可能好是Glucocorticoid-induced myopathy, 惡化則可能是 inflammatory myopathy
        
        前提是有用glucocorticoid習慣
- - - - cause of statin discontinuation
- - - - proximal skeletal muscle weakness and inflammation
    - - immune-mediated necrotizing myopathy (IMNM)
      - inclusion body myositis (IBM)
    - - muscle biopsy
        
        scattered necrotic muscle fibers
        
        In patients with autoimmune necrotizing myopathy
        
        Myofiber injury appears to be mediated directly by CD8+ cytotoxic T lymphocytes
        
        regenerating muscle fibers are scattered throughout the fascicle
        
        cellular infiltrate is predominantly within the fascicle
        
        abnormal necrotic
        
        Muscle fiber size is variable
        
        Macrophages and myeloid dendritic cells are usually present
      - Electromyography
        
        Increased insertional activity and spontaneous fibrillations
        
        Abnormal myopathic low-amplitude, short-duration polyphasic motor unit potential
        
        Complex repetitive discharges
      - MRI
      - Ultrasound
    - - Corticosteroids
        
        Prednisone
      - Corticosteroid-sparing agents
        
        Methotrexate
        
        Azathioprine