Dermatomyositis

Revision as of 13:22, 20 July 2015 by Rossdonaldson1 (talk | contribs) (Management)

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

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