Difference between revisions of "Dermatomyositis"

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==Differential Diagnosis==
 
==Differential Diagnosis==
Polymyositis
+
*Polymyositis
SLE
+
*SLE
[[Guillain-Barre Syndrome]]
+
*[[Guillain-Barre Syndrome]]
Drug Induced Myopathies (Statins)
+
*Drug Induced Myopathies (Statins)
[[Hypothyroidism]]
+
*[[Hypothyroidism]]
Limb Girdle Muscular Dystrophy
+
*Limb Girdle Muscular Dystrophy
[[Rhabdomyolysis]]
+
*[[Rhabdomyolysis]]
[[Myesthenia Gravis]]
+
*[[Myesthenia Gravis]]
Pyomyositis
+
*Pyomyositis
Viral myositis
+
*Viral myositis
[[Botulism]]
+
*[[Botulism]]
  
 
==Workup==
 
==Workup==

Revision as of 18:13, 25 March 2014

Background

  • Inflammatory myopathy
  • Affects proximal muscles > distal
  • Female:Male; 2:1
  • Peak incidence 40-50s

Clinical Features

Muscular

  1. Proximal greater than distal weakness
  • Deltoid and hip flexors
  • difficulty standing from a chair
  1. Onset over months
  2. Mild myalgias

Dermatologic

  1. Heliotrope rash on face scalp
  2. Gottron's papules (rash on MCP, PIP, and DIP joints)
  3. Shawl sign (rash above shoulders)

Other

  1. Cardiac (cardiomyopathy)
  2. High association with malignancy
  3. Interstial lung disease

Differential Diagnosis

Workup

  • CK
  • ANA
  • Chem for creatinine
  • Troponin, can involve myocardium
  • EKG
  • Bedside PFTs (FEV1 and FVC)
  • UA for myoglobin
  • Consider malignancies

Management

  • Severe disease: Respiratory muscle symptoms of CHF
    • Methylprednisolone 1000mg/day x 3 days
  • Mild disease: Prednisone 1mg/kg/day (up to 80mg/day)
    • Taper after 6-8 weeks

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

Sources

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