Dermatomyositis: Difference between revisions
| Line 47: | Line 47: | ||
==Management== | ==Management== | ||
*Severe disease | ===Mild disease=== | ||
*Prednisone 1mg/kg/day (up to 80mg/day) | |||
**Taper after 6-8 weeks | |||
===Severe disease=== | |||
*Respiratory muscle symptoms of CHF | |||
**Methylprednisolone 1000mg/day x 3 days | **Methylprednisolone 1000mg/day x 3 days | ||
==Disposition== | ==Disposition== | ||
Revision as of 13:22, 20 July 2015
Background
- Inflammatory myopathy
- Affects proximal muscles > distal
- Female:Male; 2:1
- Peak incidence 40-50s
Clinical Features
Muscular
- Proximal greater than distal weakness
- Deltoid and hip flexors
- difficulty standing from a chair
- Onset over months
- Mild myalgias
Dermatologic
- Heliotrope rash on face scalp
- Gottron's papules (rash on MCP, PIP, and DIP joints)
- Shawl sign (rash above shoulders)
Other
- Cardiac (cardiomyopathy)
- High association with malignancy
- Interstial lung disease
Differential Diagnosis
- Polymyositis
- SLE
- Guillain-Barre Syndrome
- Drug Induced Myopathies (Statins)
- Hypothyroidism
- Limb Girdle Muscular Dystrophy
- Rhabdomyolysis
- Myasthenia Gravis
- Pyomyositis
- Viral myositis
- Botulism
Diagnosis
- CK
- ANA
- Chem for creatinine
- Troponin, can involve myocardium
- EKG
- Bedside PFTs (FEV1 and FVC)
- UA for myoglobin
- Consider malignancies
Management
Mild disease
- Prednisone 1mg/kg/day (up to 80mg/day)
- Taper after 6-8 weeks
Severe disease
- Respiratory muscle symptoms of CHF
- Methylprednisolone 1000mg/day x 3 days
Disposition
- Admit to monitored bed for CHF symptoms, respiratory muscle weakness
- Admit for dysphagia/aspiration risk
- Out patient follow up with muscle biopsy for others
See Also
- Weakness
- Polymyositis
- SLE
- Rheumatoid arthritis