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
Contents
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
- Myesthenia Gravis
- Pyomyositis
- Viral myositis
- Botulism
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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