Dermatomyositis: Difference between revisions
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'''Muscular''' | '''Muscular''' | ||
#Proximal greater than distal weakness | #Proximal greater than distal weakness | ||
*Deltoid and hip flexors | #*Deltoid and hip flexors | ||
*difficulty standing from a chair | #*difficulty standing from a chair | ||
#Onset over months | #Onset over months | ||
#Mild myalgias | #Mild myalgias | ||
Revision as of 13:47, 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