Dermatomyositis - Revision history

Rossdonaldson1: /* Background */

2024-12-11T16:20:55Z

Background

← Older revision		Revision as of 16:20, 11 December 2024
Line 1:		Line 1:
	==Background==		==Background==
			{{Skin anatomy background images}}
	*Inflammatory myopathy with skin manifestations		*Inflammatory myopathy with skin manifestations
	*Affects proximal muscles > distal		*Affects proximal muscles > distal

Rossdonaldson1: /* Evaluation */

2022-09-07T17:53:36Z

Evaluation

← Older revision		Revision as of 17:53, 7 September 2022
Line 52:		Line 52:

	==Evaluation==		==Evaluation==
			===Workup===
	*Evaluate for emergent complications (e.g. [[respiratory distress]], [[cardiomyopathy]], [[arrhythmia]])		*Evaluate for emergent complications (e.g. [[respiratory distress]], [[cardiomyopathy]], [[arrhythmia]])
	*BMP		*BMP

Kfarzam: /* Non-ED Evaluation */

2022-08-17T03:37:26Z

Non-ED Evaluation

← Older revision		Revision as of 03:37, 17 August 2022
Line 61:		Line 61:

	===Non-ED Evaluation===		===Non-ED Evaluation===
	*ANA, Anti-Jo-1		*ANA, Anti-Jo-1, myositis antibody panel
	*Bedside PFTs (FEV1 and FVC)		*Bedside PFTs (FEV1 and FVC)
	*EMG or muscle biopsy showing myositis		*EMG or muscle biopsy showing myositis

Elcatracho: /* Clinical Features */

2021-02-13T18:30:18Z

Clinical Features

← Older revision		Revision as of 18:30, 13 February 2021
Line 8:		Line 8:
	==Clinical Features==		==Clinical Features==
	[[File:Heliotrope.png\|thumb\|Heliotrope rash]]		[[File:Heliotrope.png\|thumb\|Heliotrope rash]]
			[[File:Dermatomyositis.png\|thumb\|Various dermatologic manifestations of dermatomyositis. Gottron's papules are seen in image A. Shawl sign is seen in image D.]]
	===Muscular===		===Muscular===
	*Symmetric [[weakness]]		*Symmetric [[weakness]]

ClaireLewis at 20:48, 27 September 2019

2019-09-27T20:48:59Z

← Older revision		Revision as of 20:48, 27 September 2019
Line 14:		Line 14:
	**difficulty standing from a chair		**difficulty standing from a chair
	*Onset over months		*Onset over months
	*Mild ~~myalgias~~		*Mild [[myalgia]]s
	*[[Dysphagia]] due to esophageal muscle dysfunction		*[[Dysphagia]] due to esophageal muscle dysfunction
	*[[GERD]] due to smooth muscle inflammation, [[gastric ulcer disease]]		*[[GERD]] due to smooth muscle inflammation, [[gastric ulcer disease]]
Line 32:		Line 32:
	**Increased risk of aspiration, which is a leading cause of death in patients with restricted mobility<ref>Fujisawa T, Hozumi H, Kono M, Enomoto N, Hashimoto D, Nakamura Y, Inui N, Yokomura K, Koshimizu N, Toyoshima M, Shirai T, Yasuda K, Hayakawa H, Suda T. Prognostic factors for myositis-associated interstitial lung disease. PLoS One [serial on the internet] 2014 Jun [cited 2014 Oct 20]; Available from: http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4048238/?report=classic</ref>		**Increased risk of aspiration, which is a leading cause of death in patients with restricted mobility<ref>Fujisawa T, Hozumi H, Kono M, Enomoto N, Hashimoto D, Nakamura Y, Inui N, Yokomura K, Koshimizu N, Toyoshima M, Shirai T, Yasuda K, Hayakawa H, Suda T. Prognostic factors for myositis-associated interstitial lung disease. PLoS One [serial on the internet] 2014 Jun [cited 2014 Oct 20]; Available from: http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4048238/?report=classic</ref>
	*Poor prognosis		*Poor prognosis
	*~~interstitial~~ lung disease		*[[Interstitial lung disease]]
	*Thoracic muscle weakness		*Thoracic muscle weakness

	===Cardiac===		===Cardiac===
	*~~Dilated~~ [[cardiomyopathy		*[[Dilated cardiomyopathy]]
	*Cardiac myositis		*Cardiac myositis
	**Suspect in known dermatomyositis with mild rhythm disturbances, [[CHF]] or myocardial fibrosis		**Suspect in known dermatomyositis with mild rhythm disturbances, [[CHF]] or myocardial fibrosis
Line 53:		Line 53:
	*Evaluate for emergent complications (e.g. [[respiratory distress]], [[cardiomyopathy]], [[arrhythmia]])		*Evaluate for emergent complications (e.g. [[respiratory distress]], [[cardiomyopathy]], [[arrhythmia]])
	*BMP		*BMP
	*[[ECG]], ~~Troponin~~ to screen for myocardial involvement		*[[ECG]], [[troponin]] to screen for myocardial involvement
	*CK, [[Urinalysis]] for myoglobin		*CK, [[Urinalysis]] for myoglobin
	*Signs of systemic inflammation<ref>Koler RA and Montemarano A. Dermatomyositis. Am Fam Physician. 2001 Nov 1;64(9):1565-1573.</ref>		*Signs of systemic inflammation<ref>Koler RA and Montemarano A. Dermatomyositis. Am Fam Physician. 2001 Nov 1;64(9):1565-1573.</ref>
Line 73:		Line 73:

	===Severe disease===		===Severe disease===
	*Interstitial ~~Fibrosis~~ or weakness of respiratory muscles		*Interstitial fibrosis or weakness of respiratory muscles
	**[[Methylprednisolone]] 1000mg/day x 3 days		**[[Methylprednisolone]] 1000mg/day x 3 days
	*[[Methotrexate]] or ~~Azathioprine~~ for cases refractory to steroids		*[[Methotrexate]] or [[azathioprine]] for cases refractory to steroids

	===Outpatient===		===Outpatient===
	*Sunscreen!		*Sunscreen!
	*[[Hydroxychloroquine]]		*[[Hydroxychloroquine]]
	*Other immunosuppressive meds (e.g. methotrexate, rituximab, azathioprine]]		*Other immunosuppressive meds (e.g. [[methotrexate]], [[rituximab]], [[azathioprine]])
	*[[Calcium channel blockers]] for calcinosis		*[[Calcium channel blockers]] for calcinosis

Rossdonaldson1: /* Severe disease */

2019-04-02T01:04:45Z

Severe disease

← Older revision		Revision as of 01:04, 2 April 2019
Line 75:		Line 75:
	*Interstitial Fibrosis or weakness of respiratory muscles		*Interstitial Fibrosis or weakness of respiratory muscles
	**[[Methylprednisolone]] 1000mg/day x 3 days		**[[Methylprednisolone]] 1000mg/day x 3 days
	*Methotrexate or Azathioprine for cases refractory to steroids		*[[Methotrexate]] or Azathioprine for cases refractory to steroids

	===Outpatient===		===Outpatient===

Rossdonaldson1: /* Differential Diagnosis */

2019-04-02T01:03:44Z

Differential Diagnosis

← Older revision		Revision as of 01:03, 2 April 2019
Line 46:		Line 46:

	==Differential Diagnosis==		==Differential Diagnosis==
	*Drug Induced Myopathies (Statins)		{{Myalgia DDX}}

	{{Weakness DDX}}		{{Weakness DDX}}

DrKarb: /* Management */

2018-02-25T20:58:04Z

Management

← Older revision		Revision as of 20:58, 25 February 2018
Line 75:		Line 75:
	*Interstitial Fibrosis or weakness of respiratory muscles		*Interstitial Fibrosis or weakness of respiratory muscles
	**[[Methylprednisolone]] 1000mg/day x 3 days		**[[Methylprednisolone]] 1000mg/day x 3 days
			*Methotrexate or Azathioprine for cases refractory to steroids

	===Outpatient===		===Outpatient===

DrKarb: /* Background */

2018-02-25T20:57:06Z

Background

← Older revision		Revision as of 20:57, 25 February 2018
Line 4:		Line 4:
	*Female:Male; 2:1		*Female:Male; 2:1
	*Peak incidence 40-50s		*Peak incidence 40-50s
			*Juvenille dermatomyositis: 5-10 years of age

	==Clinical Features==		==Clinical Features==

ClaireLewis: /* Management */

2017-08-22T13:17:20Z

Management

← Older revision		Revision as of 13:17, 22 August 2017
Line 68:		Line 68:
	==Management==		==Management==
	===Mild disease===		===Mild disease===
	*Prednisone 1mg/kg/day (up to 80mg/day)		*[[Prednisone]] 1mg/kg/day (up to 80mg/day)
	**Taper after 6-8 weeks		**Taper after 6-8 weeks

	===Severe disease===		===Severe disease===
	*Interstitial Fibrosis or weakness of respiratory muscles		*Interstitial Fibrosis or weakness of respiratory muscles
	**Methylprednisolone 1000mg/day x 3 days		**[[Methylprednisolone]] 1000mg/day x 3 days

	===Outpatient===		===Outpatient===