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Myositis (Clinical presentation (Weakness
Site: proximal (DM/PM), or…
Myositis
Clinical presentation
Weakness
Site: proximal (DM/PM), or distal (IBM)
Onset: acute/subacute (DM), insidious (PM)
Character: weakness and wasting, asymmetric
Radiation: other sites e.g. bulbar muscles
Associations: skin signs (DM), general signs
Timing: can be progressive
Skin signs
Heliotrope rash (eyes)
Erythematous rash (cheeks, chest, upper back; shawl sign)
Erythematous knuckles (Gottron's papules)
Dry cracked hands
SC calcifications
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Other organ involvement
Respiratory: Interstitial lung disease
Cardiovascular: myocarditis, conduction issues
Musculoskeletal: arthralgia, Raynaud's
Diagnosis
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Investigations
Bloods
CRP/ESR (raised)
Muscle enzymes (CK, LDH, ALT/AST) raised
Immunology (Jo-1 +ve, also ANA anti-RNP, anti Mi2)
ABG (resp failure)
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History
PC/HPC
Proximal: difficulty standing from
seated or lifting arms over head
Distal: difficulty with fine movements
Dysphagia, dysphonia
Skin problems
Signs of malignancy
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Types
Dermatomyositis
Proximal muscle weakness plus skin involvement
Onset any age, F>M
Associated with CT diseases and malignancy
Inclusion body myositis
Distal muscle weakness, more atrophy
Onset >50y, M>F
No association with CT/systemic disease/malignancy
Polymyositis
Proximal muscle weakness, no skin involvement
Onset >18y, F>M
Associated with CT/systemic autoimmune diseases
Management
Conservative
Monitoring
Muscle markers, ECG, EMG
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Medical
PM and DM
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Acute
Steroids
Early aggressive treatment
E.g. methylprednisolone or prednisolone
IV then oral, once CK normal and
clinically better can titrate down
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