Difference between revisions of "Dermatomyositis"

(Differential Diagnosis)
Line 51: Line 51:
 
*Admit for dysphagia/aspiration risk
 
*Admit for dysphagia/aspiration risk
 
*Out patient follow up with muscle biopsy for others
 
*Out patient follow up with muscle biopsy for others
 +
*Very strongly associated with malignancy (~30%), especially:<ref>Hill CL et al. Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet. 2001 Jan 13;357(9250):96-100.</ref>
 +
**Ovarian
 +
**Lung
 +
**Pancreatic
 +
**Stomach
 +
**Colorectal
 +
**Lymphoma
 +
**Bladder
  
 
==See Also==
 
==See Also==

Revision as of 05:23, 17 February 2016

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

  • Drug Induced Myopathies (Statins)

Weakness

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
  • Very strongly associated with malignancy (~30%), especially:[1]
    • Ovarian
    • Lung
    • Pancreatic
    • Stomach
    • Colorectal
    • Lymphoma
    • Bladder

See Also

References

  1. Hill CL et al. Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet. 2001 Jan 13;357(9250):96-100.