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Inflammatory joint or muscle disease

Features suggestive of inflammatory joint or muscle disease include:

  • Loss of skills (e.g., handwriting), or regression of achieved motor milestones.
  • Pain at rest, improving with activity.
  • Pain or stiffness after periods of reduced activity (e.g., in the morning, after a long car journey, or after sitting still at school, sometimes called 'gelling').
  • Joint contractures: can be due to chronic and / or untreated, joint or muscle disease.
  • Toe walking: can be a sign of joint or neurological or muscle disease.
  • Muscle cramps with activity and muscle weakness (which may manifest as fatigue).
  • Difficulty climbing stairs or difficulty rising from the floor – Gower’s sign (proximal muscle weakness).
  • Frequent falling (stumbling), slow eating or drinking with difficulty swallowing or chewing, or a change in voice (e.g., new nasal voice), may be a sign of muscle weakness.
  • Muscle tenderness: suggests inflammatory muscle disease.
  • Growth faltering more likely consistent with chronic inflammatory conditions.

Features particularly suggestive of inherited myopathies include: 

  • Delayed milestones (motor and development including speech, feeding).
  • Pseudohypertrophy, which classically involves calf muscles (some muscle dystrophies).
  • Cardiac disease and/or arrhythmias, which can be associated with muscular dystrophies.
  • Family history (of muscle or cardiac diseases) – explore inheritance patterns (in muscular dystrophy and atrophy).
  • Muscle wasting or atrophy, which suggests chronicity, can be seen in muscular dystrophy and spinal muscle atrophy.
  • Myotonia – which is delayed relaxation of muscles after contraction (e.g., on shaking hands), associated with myotonic dystrophy.

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