Dermatomyositis: Difference between revisions
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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
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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