Difference between revisions of "Dermatomyositis"

(Clinical Features)
(Clinical Features)
Line 7: Line 7:
 
==Clinical Features==
 
==Clinical Features==
 
'''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
  
 
'''Dermatologic'''
 
'''Dermatologic'''
#Heliotrope rash on face scalp
+
*Heliotrope rash on face scalp
#Gottron's papules (rash on MCP, PIP, and DIP joints)
+
*Gottron's papules (rash on MCP, PIP, and DIP joints)
#Shawl sign (rash above shoulders)
+
*Shawl sign (rash above shoulders)
  
 
'''Other'''
 
'''Other'''
#Cardiac (cardiomyopathy)
+
*Cardiac (cardiomyopathy)
#High association with malignancy
+
*High association with malignancy
#Interstial lung disease
+
*Interstial lung disease
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==

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

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

References