Differentiating Polymyalgia rheumatica from other diseases: Difference between revisions

Latest revision as of 21:23, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Polymyalgia rheumatica (PMR) must be differentiated from other conditions such as late onset rheumatoid arthritis, polymyositis, dermatomyositis, fibromyalgia, and remitting seronegative symmetrical synovitis with pitting edema.

Differentiating Polymyalgia Rheumatica from other Diseases

Polymyalgia rheumatica (PMR) must be differentiated from other conditions such as late onset rheumatoid arthritis, polymyositis, dermatomyositis, fibromyalgia, and remitting seronegative symmetrical synovitis with pitting edema.^[1]^[2]^[3]^[4]

Differentiating polymyalgia rheumatica on the basis of fatigue and chronic pain

Disease	Differentiating signs and symptoms	Diagnostic findings
Polymyalgia rheumatica	Older at onset Generalized stiffness	Elevated ESR or CRP Response to corticosteroids
Fibromyalgia	Symptoms have been present at a similar level for at least 3 months. Chronic musculoskeletal pain with multiple tender points Stiffness, numbness, and fatigue Headaches Sleep disorder	All lab tests are normal
Rheumatoid arthritis	Multiple joint swelling Morning stiffness Rheumatoid nodules	Positive RF or anti-cyclic citrullinated protein (CCP) antibody Elevated ESR or CRP
SLE	Maculopapular rash Multi-system involvement	Positive anti-Smith antibodies
Chronic fatigue syndrome	Fatigue plus 4 of the following symptoms: Short-term memory loss Sore throat Tender lymph nodes in the neck or armpit Muscle pain Joint pain without swelling or redness Headaches Insomnia Malaise	Diagnosis of exclusions Symptoms must present for more than 6 months
Spondyloarthritis	Axial skeletal pain and stiffness Restricted spinal motion	Elevated ESR or CRP Negative RF Bamboo spine on x-ray
Osteoarthritis	Localized joint pain Restricted to affect joints Older at onset	Degenerative joint changes on x-ray
Hypothyroidism	Systemic symptoms such as weight gain, constipation, dry skin Muscular aching Prominent fatigue	Elevated TSH Low free T4
Polymyositis and dermatomyositis	Pelvic and shoulder girdle muscle weakness Rash	Muscle biopsy confirms the diagnosis Elevated CPK enzyme
Neuropathy	Numbness and tingling Paresthesia	Abnormal EMG

Differentiating polymyalgia rheumatica from other causes of inflammatory myopathy

Organ system	Disease	Symptoms												History	Physical Examination	Diagnosis
Organ system	Disease	Age of onset	Muscle weakness	Fever	Myalgia	Contractures	Gait abnormality	Neuropathy	Atrophy	Stiffness	Myoglobinuria	Other features	Laboratory Findings	History	Physical Examination	Creatine Kinase	Muscle Biopsy	Electromyogram
Inflammatory/ Rheumatologic	Polymyalgia Rheumatica^[5]	50s	Diffuse	+	+	−	−	−	−	+	−	Weight loss	History of joints stiffness, worse in the morning	Restricted shoulder motion	↑↑ ESR ↑↑ CRP	Normal	Normal	Normal
	Dermatomyositis^[6]	40s−50s Can affect children	Proximal	+	+	−	−	−	−	+	−	Rash Dyspnea Weight loss Cough	Viral infections Cancer	Heliotrope rash on face and hands Telangiectasia Erythema Mechanic's hands Gottron's sign ( violaceous scaly eruption )	↑↑ ESR ↑↑ CRP	↑↑	Perimysial mononuclear infiltrate	Myopathic
	Polymyositis^[7]	> 18 years	Proximal	+	+	−	−	−	−	+	−	Similar to dermatomyositis without mucous and skin involvement	N/A	N/A	↑↑ ESR ↑↑ CRP	↑↑	Endomysial mononuclear infiltrate Patchy necrosis	Myopathic
	Inclusion body myositis^[8]	50s	Proximal & distal	−	−	−	−	−	−	−	−	Dysphagia Asymmetric weakness	Retrovirus (most common)	N/A	Antibodies to cytoplasmic 5'−nucleotidase	↑↑	Inflammatory cells Invading muscle cells Vacuolar degeneration Inclusions or plaques	Neurogenic
	Fibromyalgia^[9]	40−50s	Generalized	−	−	−	−	+	−	−	−	Anxiety or depression features Fatigue Sleep disturbance Numbness Muscle spasms	History of depression	Tenderness in the soft tissue anatomical location	Normal	Normal	Normal	Normal
Organ system	Disease	Age of onset	Muscle weakness	Fever	Myalgia	Contractures	Gait abnormality	Neuropathy	Atrophy	Stiffness	Myoglobinuria	Other features	History	Physical Examination	Laboratory Findings	Creatine Kinase	Muscle Biopsy	Electromyogram

References

↑ Pease CT, Haugeberg G, Montague B; et al. (2009). "Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study". Rheumatology (Oxford). 48 (2): 123–7. doi:10.1093/rheumatology/ken343. PMID 18980958. Unknown parameter |month= ignored (help)
↑ Pease CT, Haugeberg G, Morgan AW, Montague B, Hensor EM, Bhakta BB (2005). "Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arteritis in patients presenting with polymyalgic symptoms. A prospective longterm evaluation". J. Rheumatol. 32 (6): 1043–6. PMID 15940765. Unknown parameter |month= ignored (help)
↑ Sørensen CD, Hansen LH, Hørslev-Petersen K (2010). "[Myositis as differential diagnosis in polymyalgia rheumatica]". Ugeskr. Laeg. (in Danish). 172 (42): 2899–900. PMID 21040663. Unknown parameter |month= ignored (help)
↑ Hopkinson ND, Shawe DJ, Gumpel JM (1991). "Polymyositis, not polymyalgia rheumatica". Ann. Rheum. Dis. 50 (5): 321–2. PMC 1004419. PMID 2042988. Unknown parameter |month= ignored (help)
↑ Myklebust G, Gran JT (1996). "A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis". Br J Rheumatol. 35 (11): 1161–8. PMID 8948307.
↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
↑ Ohara N, Katada S, Yamada T, Mezaki N, Suzuki H, Suzuki A, Hanyu O, Yoneoka Y, Kawachi I, Shimohata T, Kakita A, Nishizawa M, Sone H (2016). "Fibromyalgia in a Patient with Cushing's Disease Accompanied by Central Hypothyroidism". Intern. Med. 55 (21): 3185–3190. doi:10.2169/internalmedicine.55.5926. PMC 5140872. PMID 27803417.

[pmid18980958-1] Pease CT, Haugeberg G, Montague B; et al. (2009). "Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study". Rheumatology (Oxford). 48 (2): 123–7. doi:10.1093/rheumatology/ken343. PMID 18980958. Unknown parameter |month= ignored (help)

[pmid15940765-2] Pease CT, Haugeberg G, Morgan AW, Montague B, Hensor EM, Bhakta BB (2005). "Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arteritis in patients presenting with polymyalgic symptoms. A prospective longterm evaluation". J. Rheumatol. 32 (6): 1043–6. PMID 15940765. Unknown parameter |month= ignored (help)

[pmid21040663-3] Sørensen CD, Hansen LH, Hørslev-Petersen K (2010). "[Myositis as differential diagnosis in polymyalgia rheumatica]". Ugeskr. Laeg. (in Danish). 172 (42): 2899–900. PMID 21040663. Unknown parameter |month= ignored (help)

[pmid2042988-4] Hopkinson ND, Shawe DJ, Gumpel JM (1991). "Polymyositis, not polymyalgia rheumatica". Ann. Rheum. Dis. 50 (5): 321–2. PMC 1004419. PMID 2042988. Unknown parameter |month= ignored (help)

[pmid8948307-5] Myklebust G, Gran JT (1996). "A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis". Br J Rheumatol. 35 (11): 1161–8. PMID 8948307.

[pmid1658649-6] Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.

[pmid16586492-7] Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.

[pmid16586493-8] Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.

[pmid27803417-9] Ohara N, Katada S, Yamada T, Mezaki N, Suzuki H, Suzuki A, Hanyu O, Yoneoka Y, Kawachi I, Shimohata T, Kakita A, Nishizawa M, Sone H (2016). "Fibromyalgia in a Patient with Cushing's Disease Accompanied by Central Hypothyroidism". Intern. Med. 55 (21): 3185–3190. doi:10.2169/internalmedicine.55.5926. PMC 5140872. PMID 27803417.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Polymyalgia rheumatica}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Polymyalgia_rheumatica]]
 {{CMG}}; {{AE}} {{AEL}}
@@ Line 7: / Line 7: @@
 ==Differentiating Polymyalgia Rheumatica from other Diseases==
-PMR must be differentiated from the following conditions:
+Polymyalgia rheumatica (PMR) must be differentiated from other conditions such as late onset [[rheumatoid arthritis]], [[polymyositis]], [[dermatomyositis]], [[fibromyalgia]], and [[remitting seronegative symmetrical synovitis with pitting edema]].<ref name="pmid18980958">{{cite journal |author=Pease CT, Haugeberg G, Montague B, ''et al.'' |title=Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study |journal=Rheumatology (Oxford) |volume=48 |issue=2 |pages=123–7 |year=2009 |month=February |pmid=18980958 |doi=10.1093/rheumatology/ken343 |url=}}</ref><ref name="pmid15940765">{{cite journal |author=Pease CT, Haugeberg G, Morgan AW, Montague B, Hensor EM, Bhakta BB |title=Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arteritis in patients presenting with polymyalgic symptoms. A prospective longterm evaluation |journal=J. Rheumatol. |volume=32 |issue=6 |pages=1043–6 |year=2005 |month=June |pmid=15940765 |doi= |url=}}</ref><ref name="pmid21040663">{{cite journal |author=Sørensen CD, Hansen LH, Hørslev-Petersen K |title=[Myositis as differential diagnosis in polymyalgia rheumatica] |language=Danish |journal=Ugeskr. Laeg. |volume=172 |issue=42 |pages=2899–900 |year=2010 |month=October |pmid=21040663 |doi= |url=}}</ref><ref name="pmid2042988">{{cite journal |author=Hopkinson ND, Shawe DJ, Gumpel JM |title=Polymyositis, not polymyalgia rheumatica |journal=Ann. Rheum. Dis. |volume=50 |issue=5 |pages=321–2 |year=1991 |month=May |pmid=2042988 |pmc=1004419 |doi= |url=}}</ref>
-* [[Rheumatoid arthritis]]: PMR and late onset [[rheumatoid arthritis]] (RA) can initially present with similar clinical features like [[synovitis]].  These patients are treated initially as PMR with [[glucocorticoids]].  RA treatment is started when there is no improvement or when it evolves into characteristic RA or when there is a persistently raised plasma viscosity.<ref name="pmid18980958">{{cite journal |author=Pease CT, Haugeberg G, Montague B, ''et al.'' |title=Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study |journal=Rheumatology (Oxford) |volume=48 |issue=2 |pages=123–7 |year=2009 |month=February |pmid=18980958 |doi=10.1093/rheumatology/ken343 |url=}}</ref> <ref name="pmid15940765">{{cite journal |author=Pease CT, Haugeberg G, Morgan AW, Montague B, Hensor EM, Bhakta BB |title=Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arteritis in patients presenting with polymyalgic symptoms. A prospective longterm evaluation |journal=J. Rheumatol. |volume=32 |issue=6 |pages=1043–6 |year=2005 |month=June |pmid=15940765 |doi= |url=}}</ref>
-* [[Polymyositis]] and [[dermatomyositis]]: Patients with [[dermatomyositis]] or [[polymyositis]] present with tenderness and weakness of proximal muscles, while PMR patients present with pain and stiffness. This differentiation between these entities may be difficult in elderly patients. Proper history, complete physical examination, [[ESR]], [[creatine kinase]] levels and [[muscle biopsy]] help in establishing the proper diagnosis.<ref name="pmid21040663">{{cite journal |author=Sørensen CD, Hansen LH, Hørslev-Petersen K |title=[Myositis as differential diagnosis in polymyalgia rheumatica] |language=Danish |journal=Ugeskr. Laeg. |volume=172 |issue=42 |pages=2899–900 |year=2010 |month=October |pmid=21040663 |doi= |url=}}</ref> <ref name="pmid2042988">{{cite journal |author=Hopkinson ND, Shawe DJ, Gumpel JM |title=Polymyositis, not polymyalgia rheumatica |journal=Ann. Rheum. Dis. |volume=50 |issue=5 |pages=321–2 |year=1991 |month=May |pmid=2042988 |pmc=1004419 |doi= |url=}}</ref>
-* [[Malignancy]] (such as [[myeloma]]): Patients with [[malignancy]] sometimes present with PMR like symptoms and have  poor response to [[steroid]] therapy.<ref name="pmid3774196">{{cite journal |author=Manganelli P, Borghi L, Coruzzi P, Novarini A, Ambanelli U |title=[Paraneoplastic polymyalgia rheumatica. Case contribution] |language=Italian |journal=Minerva Med. |volume=77 |issue=38 |pages=1739–41 |year=1986 |month=October |pmid=3774196 |doi= |url=}}</ref> This is in fact paraneoplastic syndrome presenting as PMR.<ref name="pmid19562970">{{cite journal |author=Kwiatkowska B, Filipowicz-Sosnowska A |title=[Polymyalgia rheumatica mimicking neoplastic disease--significant problem in elderly patients] |language=Polish |journal=Pol. Arch. Med. Wewn. |volume=118 Suppl |issue= |pages=47–9 |year=2008 |pmid=19562970 |doi= |url=}}</ref>
-*[[Fibromyalgia]]: [[Fibromyalgia]] occurs in age groups 20-50 years.  Patients have characteristic tender points. Unlike PMR, the active phase proteins and [[ESR]] are normal.
-*[[Hyperparathyroidism]]: [[Hyperparathyroidism]] presents with proximal stiffness and bone pain with elevated [[parathyroid hormone]] levels and often raised [[calcium]] levels without elevation of [[ESR]] levels.
-* Chronic infection ([[subacute bacterial endocarditis]] ([[SBE]])): Rheumatologic symptoms seen in [[infective endocarditis]] can present as a clinical picture suggestive of [[polymyalgia rheumatica]] hindering the correct diagnosis.<ref name="pmid16859595">{{cite journal |author=Auzary C, Le Thi Huong D, Delarbre X, ''et al.'' |title=Subacute bacterial endocarditis presenting as polymyalgia rheumatica or giant cell arteritis |journal=Clin. Exp. Rheumatol. |volume=24 |issue=2 Suppl 41 |pages=S38–40 |year=2006 |pmid=16859595 |doi= |url=}}</ref>
-* [[Hypothyroidism]]: Patients with hypothyroidism muscle and joint pain and weakness similar to [[PMR]]. Delayed relaxation of deep tendon reflexes is seen in [[hypothyroidism]] with elevated [[TSH]] levels and low [[T4]] levels.
-*[[Remitting seronegative symmetrical synovitis with pitting edema]] ([[RS3PE]]): [[RS3PE]] presents with symmetrical [[synovitis]] and [[pitting edema]], usually in patients over 50 years of age and lack [[rheumatoid factor]]. Unlike PMR, the symptoms commonly manifest distally.
 ===Differentiating polymyalgia rheumatica on the basis of fatigue and chronic pain===
 {|
@@ Line 31: / Line 15: @@
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Polymyalgia rheumatica]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * Older at onset
 * Generalized [[stiffness]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * Elevated [[ESR]] or [[CRP]]
 * Response to [[corticosteroids]]
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Fibromyalgia]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * Symptoms have been present at a similar level for at least 3 months.
 * Chronic [[musculoskeletal pain]] with multiple tender points
@@ Line 45: / Line 29: @@
 * [[Headaches]]
 * [[Sleep disorder]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *All lab tests are normal
 |-
-|[[Rheumatoid arthritis]]
+! align="center" style="background:#DCDCDC;" + |[[Rheumatoid arthritis]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * Multiple [[joint swelling]]
 * Morning [[stiffness]]
 * [[Rheumatoid nodules]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * Positive [[Rheumatoid factor|RF]] or [[Anti-citrullinated protein antibody|anti-cyclic citrullinated protein (CCP) antibody]]
@@ Line 59: / Line 43: @@
 |-
 ! align="center" style="background:#DCDCDC;" + |[[SLE]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * [[Maculopapular rash]]
 * Multi-system involvement
-|
+| align="left" style="background:#F5F5F5;" + |
 *Positive anti-Smith [[antibodies]]
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Chronic fatigue syndrome]]
-|[[Fatigue]] plus 4 of the following symptoms:
+| align="left" style="background:#F5F5F5;" + |[[Fatigue]] plus 4 of the following symptoms:
 *Short-term [[memory loss]]
 *[[Sore throat]]
@@ Line 75: / Line 59: @@
 *[[Insomnia]]
 *[[Malaise]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *Diagnosis of exclusions
 *Symptoms must present for more than 6 months
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Spondyloarthritis]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * [[Axial skeleton|Axial skeletal]] pain and [[stiffness]]
 * Restricted spinal motion
-|
+| align="left" style="background:#F5F5F5;" + |
 * Elevated [[ESR]] or [[CRP]]
 * Negative [[RF]]
 * [[Bamboo spine]] on [[x-ray]]
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Osteoarthritis]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * Localized [[joint pain]]
 * Restricted to affect [[Joint|joints]]
 * Older at onset
-|
+| align="left" style="background:#F5F5F5;" + |
 * Degenerative joint changes on [[X-rays|x-ray]]
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Hypothyroidism]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *Systemic symptoms such as [[weight gain]], [[constipation]], [[dry skin]]
 *[[Myalgia|Muscular aching]]
 *Prominent [[fatigue]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *Elevated [[TSH]]
 *Low free [[T4]]
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Polymyositis and dermatomyositis]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *Pelvic and shoulder girdle [[muscle weakness]]
 *[[Rash]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *[[Muscle biopsy]] confirms the diagnosis
 *Elevated [[CPK|CPK enzyme]]
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Neuropathy]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *[[Numbness]] and [[tingling]]
 *[[Paresthesia]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *Abnormal [[EMG]]
 |}
-=== Differentiating polymyalgia rheumatica from other causes of myopathy ===
+=== Differentiating polymyalgia rheumatica from other causes of inflammatory myopathy ===
 {|
 ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
@@ Line 137: / Line 119: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myalgia
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Contractures'''
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Contractures
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gait abnormality
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Neuropathy
@@ Line 149: / Line 131: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
 |-
-! rowspan="3" style="background:#DCDCDC;" align="center" + |Medication−induced
+! rowspan="5" style="background:#DCDCDC;" align="center" + |Inflammatory/ Rheumatologic
-! style="background:#DCDCDC;" align="center" + |[[Corticosteroids]]<ref name="pmid24083177">{{cite journal |vauthors=Gupta A, Gupta Y |title=Glucocorticoid-induced myopathy: Pathophysiology, diagnosis, and treatment |journal=Indian J Endocrinol Metab |volume=17 |issue=5 |pages=913–6 |date=September 2013 |pmid=24083177 |pmc=3784879 |doi=10.4103/2230-8210.117215 |url=}}</ref>
+! style="background:#DCDCDC;" align="center" + |[[Polymyalgia rheumatica|Polymyalgia Rheumatica]]<ref name="pmid8948307">{{cite journal| author=Myklebust G, Gran JT| title=A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis. | journal=Br J Rheumatol | year= 1996 | volume= 35 | issue= 11 | pages= 1161-8 | pmid=8948307 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8948307  }}</ref>
-| style="background:#F5F5F5;" align="center" + |Variable
+| style="background:#F5F5F5;" align="center" + |50s
-| style="background:#F5F5F5;" align="center" + |Proximal
+| style="background:#F5F5F5;" align="center" + |Diffuse
-| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
+| style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* [[Central obesity]]
-* Excessive [[sweating]]
-* [[Insomnia]]
-* Reduced [[libido]]
-* [[Amenorrhoea|Amenorrhea]]
-* [[Infertility]]
-* Psychological disturbances
-| style="background:#F5F5F5;" align="left" + |
-*Positive h/o medications
-| style="background:#F5F5F5;" align="left" + |
-* Facial and sphincter [[Muscle|muscles]] are usually spared
-| style="background:#F5F5F5;" align="left" + |
-* Positive [[ACTH stimulation test]]
-* 24-hour urine [[cortisol]]
-* Low dose [[dexamethasone suppression test]]
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-|-
-! style="background:#DCDCDC;" align="center" + |[[Statins]]<ref name="pmid22001973">{{cite journal |vauthors=Tomaszewski M, Stępień KM, Tomaszewska J, Czuczwar SJ |title=Statin-induced myopathies |journal=Pharmacol Rep |volume=63 |issue=4 |pages=859–66 |date=2011 |pmid=22001973 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |60+
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
 | style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−/+([[Rhabdomyolysis]])
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-*Positive h/o medications
-*H/o other medication use
-| style="background:#F5F5F5;" align="left" + |
-* [[Tenderness]]
-* Muscle aches
-| style="background:#F5F5F5;" align="left" + |
-* '''↑↑''' Liver enzymes
-| style="background:#F5F5F5;" align="left" + |
-* '''↑↑'''
-| style="background:#F5F5F5;" align="left" + |
-* [[Necrosis]]
-* Degeneration, and regeneration of fibers
-* Phagocytic infiltration
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-|-
-! style="background:#DCDCDC;" align="center" + |[[Alcohol]]<ref name="pmid11784353">{{cite journal |vauthors=Preedy VR, Adachi J, Ueno Y, Ahmed S, Mantle D, Mullatti N, Rajendram R, Peters TJ |title=Alcoholic skeletal muscle myopathy: definitions, features, contribution of neuropathy, impact and diagnosis |journal=Eur. J. Neurol. |volume=8 |issue=6 |pages=677–87 |date=November 2001 |pmid=11784353 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Variable
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + | +/−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* [[Swelling]]
-* Tender
-* [[Erythema]] and induration
-| style="background:#F5F5F5;" align="left" + |
-* [[Alcohol]] intoxication
-| style="background:#F5F5F5;" align="left" + |
-* Change in [[mental status]]
-* [[Telangiectasias|Telangiectasia]]
-* [[Peripheral neuropathy]]
-| style="background:#F5F5F5;" align="left" + |
-* Monspecific and are normal in many patients
-| style="background:#F5F5F5;" align="left" + |
-* Normal or '''↑↑'''
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-|-
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Age of onset
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle weakness
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myalgia
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Contractures'''
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gait abnormality
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Neuropathy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Atrophy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stiffness
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myoglobinuria
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |History
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical
-Examination
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Laboratory Findings
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Creatine Kinase
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle Biopsy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
-|-
-! rowspan="6" style="background:#DCDCDC;" align="center" + |Endocrine
-! style="background:#DCDCDC;" align="center" + |[[Cushing's disease]]<ref name="pmid25221399">{{cite journal |vauthors=Sharma V, Borah P, Basumatary LJ, Das M, Goswami M, Kayal AK |title=Myopathies of endocrine disorders: A prospective clinical and biochemical study |journal=Ann Indian Acad Neurol |volume=17 |issue=3 |pages=298–302 |date=July 2014 |pmid=25221399 |pmc=4162016 |doi=10.4103/0972-2327.138505 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |25 −45
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* [[Decreased libido]]
-* [[Obesity]]/[[weight gain]]
-* [[Plethora]]
-* Round face
-* Menstrual changes
-* [[Hirsutism]]
-* [[Hypertension]]
-* [[Ecchymoses]]
-* [[Lethargy]]
-* [[Depression]]
-* Dorsal fat pad
-* Abnormal glucose tolerance
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* Facial and sphincter [[muscles]] are usually spared
-* [[Overweight]]
-* Straie
-* [[Moon face]]
-* [[Hypertension|HTN]]
-* [[Hyperpigmentation]]
-| style="background:#F5F5F5;" align="left" + |
-* Positive [[ACTH stimulation test]]
-* 24-hour urine [[cortisol]]
-* Low dose [[Dexamethasone suppression test|dexamethasone <nowiki/>suppression test]]
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Atrophy of type 2 muscle fibers, especially type 2B
-| style="background:#F5F5F5;" align="left" + |Normal
-|-
-! style="background:#DCDCDC;" align="center" + |[[Adrenal insufficiency]]<ref name="pmid30656022">{{cite journal |vauthors=Ruff RL, Weissmann J |title=Endocrine myopathies |journal=Neurol Clin |volume=6 |issue=3 |pages=575–92 |date=August 1988 |pmid=3065602 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |30−50 years
-| style="background:#F5F5F5;" align="center" + |Proximal
 | style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="left" + |
-* Signs of [[glucocorticoid]], [[mineralocorticoid]], and, [[androgen]] deficiency
+* [[Weight loss]]
 | style="background:#F5F5F5;" align="left" + |
-* Signs of [[postural hypotension]]
+* History of joints stiffness, worse in the morning
-* History of [[tuberculosis]]
-* History of [[malignancy]]
-* History of other [[autoimmune disease]]
 | style="background:#F5F5F5;" align="left" + |
-* [[Hypotension]]
+* Restricted shoulder motion
-* [[Hyperpigmentation]]
-* Auricular−cartilage calcification
-* [[Vitiligo]]
 | style="background:#F5F5F5;" align="left" + |
-* [[Electrolyte abnormalities]]
+* '''↑↑''' [[Erythrocyte sedimentation rate|ESR]]
-* [[Hypoglycemia]]
+* '''↑↑''' [[C-reactive protein|CRP]]
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-|-
-! style="background:#DCDCDC;" align="center" + |[[Hyperaldosteronism]] with myopathy<ref name="pmid5037033">{{cite journal |vauthors=Sambrook MA, Heron JR, Aber GM |title=Myopathy in association with primary hyperaldosteronism |journal=J. Neurol. Neurosurg. Psychiatry |volume=35 |issue=2 |pages=202–7 |date=April 1972 |pmid=5037033 |pmc=494037 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |50
-| style="background:#F5F5F5;" align="center" + |Proximal<br>&<br>distal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-[[Rhabdomyolysis]]
-| style="background:#F5F5F5;" align="left" + |
-* [[Palpitations]]
-* [[Hypertension]]
-| style="background:#F5F5F5;" align="left" + |
-* Episodes of [[Palpation|increased heart beats]]
-| style="background:#F5F5F5;" align="left" + |
-* [[Hyperpigmentation]]
-| style="background:#F5F5F5;" align="left" + |
-* [[Hypokalemia]]
 | style="background:#F5F5F5;" align="left" + |
 * Normal
@@ Line 371: / Line 159: @@
 * Normal
 |-
-! style="background:#DCDCDC;" align="center" + |[[Hyperthyroidism]]<ref name="pmid28746208">{{cite journal |vauthors=Li Q, Liu Y, Zhang Q, Tian H, Li J, Li S |title=Myopathy in hyperthyroidism as a consequence of rapid reduction of thyroid hormone: A case report |journal=Medicine (Baltimore) |volume=96 |issue=30 |pages=e7591 |date=July 2017 |pmid=28746208 |pmc=5627834 |doi=10.1097/MD.0000000000007591 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |40
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="left" + |
-* Signs of [[hyperthyroidism]]
-| style="background:#F5F5F5;" align="left" + |
-* H/o of [[weight loss]]
-| style="background:#F5F5F5;" align="left" + |
-* [[Sweating]]
-* [[Tremor]]
-* Neck swelling
-| style="background:#F5F5F5;" align="left" + |
-* Decreased [[TSH]]
-| style="background:#F5F5F5;" align="left" + |
-* '''↑↑'''
-| style="background:#F5F5F5;" align="left" + |
-* Non specific
-| style="background:#F5F5F5;" align="left" + |
-* [[Myotonic]]
-|-
-! style="background:#DCDCDC;" align="center" + |[[Hypothyroidism]]<ref name="pmid6627693">{{cite journal |vauthors=Khaleeli AA, Griffith DG, Edwards RH |title=The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle |journal=Clin. Endocrinol. (Oxf) |volume=19 |issue=3 |pages=365–76 |date=September 1983 |pmid=6627693 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |55
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | + [[Rhabdomyolysis MRI|Rhabdomyolysis]]
-| style="background:#F5F5F5;" align="left" + |
-*  Signs of [[hypothyroidism]]
-| style="background:#F5F5F5;" align="left" + |
-* H/o [[weight gain]]
-| style="background:#F5F5F5;" align="left" + |
-* [[Myxedema|Myxoedema]]
-* Muscle pseudohypertrophy
-| style="background:#F5F5F5;" align="left" + |
-* Increased [[TSH]]
-| style="background:#F5F5F5;" align="left" + |
-* '''↑↑'''
-| style="background:#F5F5F5;" align="left" + |
-* Nonspecific
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-|-
-! style="background:#DCDCDC;" align="center" + |Diabetic infraction<ref name="pmid25932331">{{cite journal |vauthors=Horton WB, Taylor JS, Ragland TJ, Subauste AR |title=Diabetic muscle infarction: a systematic review |journal=BMJ Open Diabetes Res Care |volume=3 |issue=1 |pages=e000082 |date=2015 |pmid=25932331 |pmc=4410119 |doi=10.1136/bmjdrc-2015-000082 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |45
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="left" + |
-* [[Cramps]]
-* Sudden onset of [[pain]]
-* Anterior thigh [[muscles]] are most commonly involved
-| style="background:#F5F5F5;" align="left" + |
-* H/O long standing [[diabetes]]
-| style="background:#F5F5F5;" align="left" + |
-* [[Swelling]]
-* [[Tenderness]]
-| style="background:#F5F5F5;" align="left" + |
-* Elevated [[ESR]]
-* [[Leukocytosis]]
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* [[Necrosis]]
-* [[Edema]]
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-|-
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Age of onset
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle weakness
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myalgia
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Contractures'''
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gait abnormality
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Neuropathy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Atrophy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stiffness
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myoglobinuria
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |History
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical
-Examination
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Laboratory Findings
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Creatine Kinase
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle Biopsy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
-|-
-! rowspan="5" style="background:#DCDCDC;" align="center" + |Inflammatory/ Rheumatologic
 ! style="background:#DCDCDC;" align="center" + |[[Dermatomyositis]]<ref name="pmid1658649">{{cite journal| author=Dalakas MC| title=Polymyositis, dermatomyositis and inclusion-body myositis. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 21 | pages= 1487-98 | pmid=1658649 | doi=10.1056/NEJM199111213252107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1658649  }}</ref>
 | style="background:#F5F5F5;" align="center" + |40s−50s<br>Can affect children
@@ Line 599: / Line 279: @@
 | style="background:#F5F5F5;" align="left" + |
 * Normal
-|-
-! style="background:#DCDCDC;" align="center" + |[[Polymyalgia rheumatica|Polymyalgia Rheumatica]]<ref name="pmid8948307">{{cite journal| author=Myklebust G, Gran JT| title=A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis. | journal=Br J Rheumatol | year= 1996 | volume= 35 | issue= 11 | pages= 1161-8 | pmid=8948307 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8948307  }}</ref>
-| style="background:#F5F5F5;" align="center" + |50s
-| style="background:#F5F5F5;" align="center" + |Diffuse
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="left" + |
-* [[Weight loss]]
-| style="background:#F5F5F5;" align="left" + |
-* History of joints stiffness, worse in the morning
-| style="background:#F5F5F5;" align="left" + |
-* Restricted shoulder motion
-| style="background:#F5F5F5;" align="left" + |
-* '''↑↑''' [[Erythrocyte sedimentation rate|ESR]]
-* '''↑↑''' [[C-reactive protein|CRP]]
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-|-
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Age of onset
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle weakness
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myalgia
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Contractures'''
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gait abnormality
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Neuropathy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Atrophy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stiffness
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myoglobinuria
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |History
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical
-Examination
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Laboratory Findings
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Creatine Kinase
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle Biopsy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
-|-
-! rowspan="5" style="background:#DCDCDC;" align="center" + |Genetic
-! style="background:#DCDCDC;" align="center" + |[[Becker's muscular dystrophy|Becker muscular dystrophy]]<ref name="pmid25037084">{{cite journal |vauthors=Flanigan KM |title=Duchenne and Becker muscular dystrophies |journal=Neurol Clin |volume=32 |issue=3 |pages=671–88, viii |date=August 2014 |pmid=25037084 |doi=10.1016/j.ncl.2014.05.002 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |<13yrs
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* Milder form of [[Duchenne muscular dystrophy|Duchenne]]
-| style="background:#F5F5F5;" align="left" + |
-* [[Growth delay]]
-* Age of onset of symptoms is much delayed than [[Duchenne muscular dystrophy|duchenne]]
-| style="background:#F5F5F5;" align="left" + |
-* Positive Grower sign
-| style="background:#F5F5F5;" align="left" + |
-* Decreased amount of [[dystrophin]].
-| style="background:#F5F5F5;" align="left" + |
-* ↑↑
-| rowspan="2" style="background:#F5F5F5;" align="left" + |
-** Muscle fibril degeneration, regeneration
-** Isolated fiber hypertrophy
-** Muscle replacement with fat and connective tissue
-| rowspan="2" style="background:#F5F5F5;" align="left" + |
-* [[Myopathic]]
-|-
-! style="background:#DCDCDC;" align="center" + |[[Duchenne muscular dystrophy]]<ref name="pmid250370842">{{cite journal |vauthors=Flanigan KM |title=Duchenne and Becker muscular dystrophies |journal=Neurol Clin |volume=32 |issue=3 |pages=671–88, viii |date=August 2014 |pmid=25037084 |doi=10.1016/j.ncl.2014.05.002 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |<13 yrs
-| style="background:#F5F5F5;" align="center" + | Proximal
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="left" + |
-* Calf psedohypertrophy
-* [[Cardiomyopathy]]
-* [[Kyphoscoliosis]]
-* [[Cognitive impairment]]
-| style="background:#F5F5F5;" align="left" + |
-* Early onset
-| style="background:#F5F5F5;" align="left" + |
-* Positive Grower sign
-| style="background:#F5F5F5;" align="left" + |
-* Errors in the Xp21 gene.
-* Absence of [[dystrophin]].
-| style="background:#F5F5F5;" align="left" + |
-* '''↑↑'''
-|-
-! style="background:#DCDCDC;" align="center" + |[[Limb-girdle muscular dystrophy|Limb−girdle muscular]] dystrophies<ref name="pmid18769252">{{cite journal |vauthors=Guglieri M, Straub V, Bushby K, Lochmüller H |title=Limb-girdle muscular dystrophies |journal=Curr. Opin. Neurol. |volume=21 |issue=5 |pages=576–84 |date=October 2008 |pmid=18769252 |doi=10.1097/WCO.0b013e32830efdc2 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |<15 yrs
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* Calf hypertrophy
-* Scapular winging
-* [[Cardiomyopathy]]
-* [[Cardiac arrhythmia|Cardiac arrhythmias]]
-* Respiratory muscle weakness
-| style="background:#F5F5F5;" align="left" + |
-* [[Autosomal dominant]]
-* Deterioration of ability to run/walk
-| style="background:#F5F5F5;" align="left" + |
-*[[Muscle weakness]] is generally symmetric
-| style="background:#F5F5F5;" align="left" + |
-* [[LMNA]] gene
-* CAV3 gene
-| style="background:#F5F5F5;" align="left" + |
-* '''↑↑'''
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* [[Myopathic]]
-|-
-| style="background:#DCDCDC;" align="center" + |[[Myotonic dystrophy]]<ref name="pmid22995693">{{cite journal |vauthors=Udd B, Krahe R |title=The myotonic dystrophies: molecular, clinical, and therapeutic challenges |journal=Lancet Neurol |volume=11 |issue=10 |pages=891–905 |date=October 2012 |pmid=22995693 |doi=10.1016/S1474-4422(12)70204-1 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |<18 years
-| style="background:#F5F5F5;" align="center" + |Proximal<br>&<br>distal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* [[Myotonia]]
-* [[Cataracts]]
-* [[Diabetes mellitus]]
-* Frontal balding
-* Cardiac arrhythmias
-* [[Cholecystitis]]
-* [[Pregnancy]]
-* Eyelid [[ptosis]]
-| style="background:#F5F5F5;" align="left" + |
-* Positive family history
-| style="background:#F5F5F5;" align="left" + |
-* Muscles often contract and are unable to relax
-| style="background:#F5F5F5;" align="left" + |
-* Mutations in the [[DMPK]] gene
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* [[Myopathic]]
-|-
-| style="background:#DCDCDC;" align="center" + |[[Glycogen storage disease]]<ref name="pmid11957192">{{cite journal |vauthors=Kannourakis G |title=Glycogen storage disease |journal=Semin. Hematol. |volume=39 |issue=2 |pages=103–6 |date=April 2002 |pmid=11957192 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Variable
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* [[Autosomal recessive|AR]]
-* [[Fatigue|Faituge]]
-* [[Hypoglycemia]]
-| style="background:#F5F5F5;" align="left" + |
-* [[Exercise intolerance]]
-| style="background:#F5F5F5;" align="left" + |
-* [[Hypotonia]]
-* [[Hepatomegaly]]
-| style="background:#F5F5F5;" align="left" + |
-* [[Lactic acidosis]]
-* Elevated liver enzymes
-* [[Ketosis]]
-| style="background:#F5F5F5;" align="left" + |
-* '''↑↑'''
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-|-
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Age of onset
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle weakness
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myalgia
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Contractures'''
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gait abnormality
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Neuropathy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Atrophy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stiffness
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myoglobinuria
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |History
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical
-Examination
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Laboratory Findings
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Creatine Kinase
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle Biopsy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
-|-
-! rowspan="5" style="background:#DCDCDC;" align="center" + |Infectious
-! style="background:#DCDCDC;" align="center" + |[[Lyme disease]]<ref name="pmid2795056">{{cite journal |vauthors=Schoenen J, Sianard-Gainko J, Carpentier M, Reznik M |title=Myositis during Borrelia burgdorferi infection (Lyme disease) |journal=J. Neurol. Neurosurg. Psychiatry |volume=52 |issue=8 |pages=1002–5 |date=August 1989 |pmid=2795056 |pmc=1031843 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Variable
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +/−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* Erythema Migrans
-* Flu−like symptoms
-* [[Lyme arthritis]]
-* [[Neurological]] manifestations
-| style="background:#F5F5F5;" align="left" + |
-* H/o tick bite
-* Hiking trip
-| style="background:#F5F5F5;" align="left" + |
-* Target−like [[lesions]]
-* HSM
-| style="background:#F5F5F5;" align="left" + |
-* Clinical diagnosis
-* +Serology
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-|-
-! style="background:#DCDCDC;" align="center" + |[[Influenza]]<ref name="pmid6687269">{{cite journal |vauthors=Bove KE, Hilton PK, Partin J, Farrell MK |title=Morphology of acute myopathy associated with influenza B infection |journal=Pediatr Pathol |volume=1 |issue=1 |pages=51–66 |date=1983 |pmid=6687269 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Variable
-| style="background:#F5F5F5;" align="center" + | Proximal and Distal
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="left" + |
-* [[Fever]]
-* [[Malaise]]
-* [[Rhinorrhea]]
-* [[Muscle pain]] worse with movement
-| style="background:#F5F5F5;" align="left" + |
-*Cold weather
-*H/o Ill contacts
-| style="background:#F5F5F5;" align="left" + |
-* Muscle weakness, tenderness, and swelling.
-| style="background:#F5F5F5;" align="left" + |
-* '''↑↑''' Liver enzymes
-* Positive PCR
-| style="background:#F5F5F5;" align="left" + |
-* '''↑↑'''
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-|-
-! style="background:#DCDCDC;" align="center" + |[[Polio]]<ref name="pmid15933355">{{cite journal |vauthors=Howard RS |title=Poliomyelitis and the postpolio syndrome |journal=BMJ |volume=330 |issue=7503 |pages=1314–8 |date=June 2005 |pmid=15933355 |pmc=558211 |doi=10.1136/bmj.330.7503.1314 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |<5 yrs
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* Asymmetrical [[paralysis]]
-* [[Muscle atrophy]]
-* [[Tremors]]
-* [[Skeletal]] deformities
-| style="background:#F5F5F5;" align="left" + |
-* History of skipped immunization.
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-* [[Meningeal signs]]
-* Asymmetrical flaccid paralysis
-* Pharyngeal paralysis
-| style="background:#F5F5F5;" align="left" + |
-* Isolation from [[pharyngeal]]<nowiki/>secretions, CSF
-* Positive serology
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* Neurological pattern
-|-
-! style="background:#DCDCDC;" align="center" + |[[Syphilis]]<ref name="pmid17235095">{{cite journal |vauthors=French P |title=Syphilis |journal=BMJ |volume=334 |issue=7585 |pages=143–7 |date=January 2007 |pmid=17235095 |pmc=1779891 |doi=10.1136/bmj.39085.518148.BE |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Variable
-| style="background:#F5F5F5;" align="center" + |Negative
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* [[Chancre]]
-* [[Lymphadenopathy]]
-* Condylomata lata
-* [[Neurosyphilis|Neuro syphilis]]
-* Cardiovascular syphilis
-| style="background:#F5F5F5;" align="left" + |
-* History of risk factors (MSM, unprotected sex, multiple sex partners)
-| style="background:#F5F5F5;" align="left" + |
-* Non−tender [[chancre]] in primary syphilis.
-* Followed by [[rash]]
-* Generalized [[lymphadenopathy]] in secondary syphilis
-| style="background:#F5F5F5;" align="left" + |
-* Darkfield examinations
-* VDRL
-* RPR
-* [[FTA-ABS|FTA−ABS]]
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-|-
-! style="background:#DCDCDC;" align="center" + |[[Pyomyositis]]<ref name="pmid15380499">{{cite journal |vauthors=Crum NF |title=Bacterial pyomyositis in the United States |journal=Am. J. Med. |volume=117 |issue=6 |pages=420–8 |date=September 2004 |pmid=15380499 |doi=10.1016/j.amjmed.2004.03.031 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Variable
-| style="background:#F5F5F5;" align="center" + |Proximal<br>&<br>Distal
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* [[Fever]]
-* [[Malaise]]
-* [[Psoas abscess]]
-| style="background:#F5F5F5;" align="left" + |
-* [[Immunocompromised]]
-| style="background:#F5F5F5;" align="left" + |
-** Muscles are painful, swollen, tender, and indurated.
-** Depending on the site of involvement, it may mimic appendicitis (psoas muscle), septic arthritis of the hip (iliacus muscle), or epidural abscess (piriformis muscle).
-| style="background:#F5F5F5;" align="left" + |
-* Leukocytosis
-* Elevated ESR
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* N/A
 |-
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
@@ Line 1,003: / Line 300: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle Biopsy
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
-|-
-! rowspan="4" style="background:#DCDCDC;" align="center" + |Neurologic
-! style="background:#DCDCDC;" align="center" + |[[Amyotrophic lateral sclerosis|ALS]]<ref name="pmid26629397">{{cite journal |vauthors=Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF, Pagani W, Lodin D, Orozco G, Chinea A |title=A comprehensive review of amyotrophic lateral sclerosis |journal=Surg Neurol Int |volume=6 |issue= |pages=171 |date=2015 |pmid=26629397 |pmc=4653353 |doi=10.4103/2152-7806.169561 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |>35
-| style="background:#F5F5F5;" align="center" + |Proximal<br>&<br>Distal
-* Distal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* [[Dysphagia]]
-* [[Spasticity]]
-* [[Hyperreflexia]]
-* [[Babinski's sign|Babinski's]] +
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* Both [[Upper motor neurons|upper]] and [[lower motor neuron]] signs
-| style="background:#F5F5F5;" align="left" + |
-* Clinical diagnosis
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Nonspecific findings of chronic denervation with reinnervation
-| style="background:#F5F5F5;" align="left" + |
-* Neuropathic
-|-
-! style="background:#DCDCDC;" align="center" + |[[Stroke]]<ref name="pmid20412000">{{cite journal |vauthors=Baldwin K, Orr S, Briand M, Piazza C, Veydt A, McCoy S |title=Acute ischemic stroke update |journal=Pharmacotherapy |volume=30 |issue=5 |pages=493–514 |date=May 2010 |pmid=20412000 |doi=10.1592/phco.30.5.493 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |>65
-| style="background:#F5F5F5;" align="center" + |Proximal<br>&<br>distal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* [[Dysphagia]]
-* Unilateral/Bilateral weakness
-| style="background:#F5F5F5;" align="left" + |
-* H/o [[Hypertension|HTN]], [[dyslipidaemia]] [[Diabetes mellitus|DM]]
-| style="background:#F5F5F5;" align="left" + |
-* Weakness of the involved arm
-| style="background:#F5F5F5;" align="left" + |
-*Head CT
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Neuropathic
-|-
-! style="background:#DCDCDC;" align="center" + |[[GBS]]<ref name="pmid23628447">{{cite journal |vauthors=van Doorn PA |title=Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS) |journal=Presse Med |volume=42 |issue=6 Pt 2 |pages=e193–201 |date=June 2013 |pmid=23628447 |doi=10.1016/j.lpm.2013.02.328 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |18  −350
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* [[Ascending paralysis]]
-| style="background:#F5F5F5;" align="left" + |
-* Precedes a [[Gastrointestinal diseases|gastrointestinal disease]]
-| style="background:#F5F5F5;" align="left" + |
-* Weakness of lower extremities followed by upper extremities
-| style="background:#F5F5F5;" align="left" + |
-* Cytologic albumin ratio
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* Neuropathic
-|-
-! style="background:#DCDCDC;" align="center" + |[[Multiple sclerosis|Multiple Sclerosis]]<ref name="pmid22605909">{{cite journal |vauthors=Goldenberg MM |title=Multiple sclerosis review |journal=P T |volume=37 |issue=3 |pages=175–84 |date=March 2012 |pmid=22605909 |pmc=3351877 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |30's
-| style="background:#F5F5F5;" align="center" + |Proximal<br>&<br>distal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* Ocular findings
-* [[Urinary incontinence]]
-* Problems with [[Speech and language pathology|speech]] or [[swallowing]]
-| style="background:#F5F5F5;" align="left" + |
-* Attacks or exacerbation
-| style="background:#F5F5F5;" align="left" + |
-** Localized weakness
-** Focal sensory disturbances
-** Hyper reactive reflexes
-** Increased tone or stiffness
-| style="background:#F5F5F5;" align="left" + |
-* Head CT ologo−clonal bands
-| style="background:#F5F5F5;" align="left" + |
-* Normal
-| style="background:#F5F5F5;" align="left" + |
-* N/A
-| style="background:#F5F5F5;" align="left" + |
-* Neuropathic
-|-
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Age of onset
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle weakness
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myalgia
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Contractures'''
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gait abnormality
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Neuropathy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Atrophy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stiffness
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myoglobinuria
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |History
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical
-Examination
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Laboratory Findings
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Creatine Kinase
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle Biopsy
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
-|-
-! rowspan="3" style="background:#DCDCDC;" align="center" + |Neuromuscular
-! style="background:#DCDCDC;" align="center" + |[[Botulinum]]<ref name="pmid15257512">{{cite journal |vauthors=Cherington M |title=Botulism: update and review |journal=Semin Neurol |volume=24 |issue=2 |pages=155–63 |date=June 2004 |pmid=15257512 |doi=10.1055/s-2004-830901 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Variable
-| style="background:#F5F5F5;" align="center" + |Distal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="left" + |
-* [[Double vision]]
-* [[Blurred vision]]
-* Drooping eyelids
-* [[Slurred speech]]
-* [[Difficulty swallowing]]
-| style="background:#F5F5F5;" align="left" + |
-* H/O food exposure
-| rowspan="3" style="background:#F5F5F5;" align="left" + |
-* [[Hyporeflexia]]
-* Decreased strength
-| style="background:#F5F5F5;" align="left" + |
-* +Toxin
-| rowspan="3" style="background:#F5F5F5;" align="left" + |
-* Normal
-| rowspan="3" style="background:#F5F5F5;" align="left" + |
-* N/A
-| rowspan="3" style="background:#F5F5F5;" align="left" + |
-* Myopathic
-|-
-! style="background:#DCDCDC;" align="center" + |[[Lambert-Eaton syndrome|Lambert−Eaton syndrome]]<ref name="pmid22094130">{{cite journal |vauthors=Titulaer MJ, Lang B, Verschuuren JJ |title=Lambert-Eaton myasthenic syndrome: from clinical characteristics to therapeutic strategies |journal=Lancet Neurol |volume=10 |issue=12 |pages=1098–107 |date=December 2011 |pmid=22094130 |doi=10.1016/S1474-4422(11)70245-9 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Variable
-| style="background:#F5F5F5;" align="center" + |Distal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* Weakness of the bulbar muscles
-* Ocular
-* Limb weakness
-| style="background:#F5F5F5;" align="left" + |
-* Weaknessa is often relieved temporarily after exertion or physical exercise.
-| style="background:#F5F5F5;" align="left" + |
-* Antibodies against voltage−gated calcium channels
-|-
-! style="background:#DCDCDC;" align="center" + |[[Myasthenia gravis]]<ref name="pmid23193443">{{cite journal |vauthors=Jayam Trouth A, Dabi A, Solieman N, Kurukumbi M, Kalyanam J |title=Myasthenia gravis: a review |journal=Autoimmune Dis |volume=2012 |issue= |pages=874680 |date=2012 |pmid=23193443 |pmc=3501798 |doi=10.1155/2012/874680 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Variable
-| style="background:#F5F5F5;" align="center" + |Proximal
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="left" + |
-* [[Ocular]]
-* [[Bulbar]]
-* Limb weakness
-* Isolated neck, limbs and respiratory weakness
-| style="background:#F5F5F5;" align="left" + |
-* Weakness often worsens with activity
-| style="background:#F5F5F5;" align="left" + |
-* Antibodies that block or destroy nicotinic [[acetylcholine receptors]]
 |}
 ==References==
 {{reflist|2}}
-{{WH}}
-{{WS}}
+[[Category:Medicine]]
-[[Category:Disease]]
 [[Category:Rheumatology]]
+[[Category:Up-To-Date]]

Differentiating Polymyalgia rheumatica from other diseases: Difference between revisions

Latest revision as of 21:23, 29 July 2020

Overview

Differentiating Polymyalgia Rheumatica from other Diseases

Differentiating polymyalgia rheumatica on the basis of fatigue and chronic pain

Differentiating polymyalgia rheumatica from other causes of inflammatory myopathy

References

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