Dermatomyositis: Difference between revisions
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*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
- Neuromuscular weakness
- Upper motor neuron:
- CVA
- Hemorrhagic stroke
- Multiple sclerosis
- Amyotrophic Lateral Sclerosis (ALS) (upper and lower motor neuron)
- Lower motor neuron:
- Spinal and bulbar muscular atrophy (Kennedy's syndrome)
- Spinal cord disease:
- Infection (Epidural abscess)
- Infarction/ischemia
- Trauma (Spinal Cord Syndromes)
- Inflammation (Transverse Myelitis)
- Degenerative (Spinal muscular atrophy)
- Tumor
- Peripheral nerve disease:
- Neuromuscular junction disease:
- Muscle disease:
- Rhabdomyolysis
- Dermatomyositis
- Polymyositis
- Alcoholic myopathy
- Upper motor neuron:
- Non-neuromuscular weakness
- Can't miss diagnoses:
- ACS
- Arrhythmia/Syncope
- Severe infection/Sepsis
- Hypoglycemia
- Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
- Respiratory failure
- Emergent Diagnoses:
- Symptomatic Anemia
- Severe dehydration
- Hypothyroidism
- Polypharmacy
- Malignancy
- Aortic disease - occlusion, stenosis, dissection
- Other causes of weakness and paralysis
- Acute intermittent porphyria (ascending weakness)
- Can't miss diagnoses:
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
- ↑ 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.