Inflammatory myopathy: Difference between revisions
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==Differentiating Inflammatory Myopathy from other Diseases== | ==Differentiating Inflammatory Myopathy from other Diseases== | ||
{| | {| | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Organ system | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Age of onset | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Age of onset | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Muscle weakness | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Muscle weakness | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Myoglobinuria | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Myoglobinuria | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other features | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other features | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |History | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical | |||
Examination | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory Findings | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory Findings | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Creatine Kinase | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Creatine Kinase | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Electromyogram | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Electromyogram | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" + |[[Dermatomyositis]]<ref name=" | ! rowspan="7" align="center" style="background:#DCDCDC;" + |Inflammatory/ Rheumatologic | ||
! align="center" style="background:#DCDCDC;" + |[[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> | |||
| align="center" style="background:#F5F5F5;" + |40s−50s | | align="center" style="background:#F5F5F5;" + |40s−50s | ||
Can affect children | Can affect children | ||
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*[[Myopathic]] | *[[Myopathic]] | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" + |[[Polymyositis]] | ! align="center" style="background:#DCDCDC;" + |[[Polymyositis]]<ref name="pmid16586492">{{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> | ||
| align="center" style="background:#F5F5F5;" + |> 18 years | | align="center" style="background:#F5F5F5;" + |> 18 years | ||
| align="center" style="background:#F5F5F5;" + |Proximal | | align="center" style="background:#F5F5F5;" + |Proximal | ||
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*Patchy necrosis | *Patchy necrosis | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" + |Inclusion body myositis | ! align="center" style="background:#DCDCDC;" + |Inclusion body [[myositis]]<ref name="pmid16586493">{{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> | ||
| align="center" style="background:#F5F5F5;" + |50s | | align="center" style="background:#F5F5F5;" + |50s | ||
| align="center" style="background:#F5F5F5;" + |Proximal | | align="center" style="background:#F5F5F5;" + |Proximal | ||
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*[[Neurogenic]] | *[[Neurogenic]] | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" + | | ! | ||
| align="center" style="background:#F5F5F5;" + | | ! | ||
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! align="center" style="background:#DCDCDC;" + |[[Fibromyalgia]]<ref name="pmid27803417">{{cite journal |vauthors=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 |title=Fibromyalgia in a Patient with Cushing's Disease Accompanied by Central Hypothyroidism |journal=Intern. Med. |volume=55 |issue=21 |pages=3185–3190 |date=2016 |pmid=27803417 |pmc=5140872 |doi=10.2169/internalmedicine.55.5926 |url=}}</ref> | |||
| align="center" style="background:#F5F5F5;" + |40−50s | |||
| align="center" style="background:#F5F5F5;" + |Generalized | |||
| 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" style="background:#F5F5F5;" + |− | | align="center" style="background:#F5F5F5;" + |− | ||
| align="center" style="background:#F5F5F5;" + |− | | align="center" style="background:#F5F5F5;" + |− | ||
| align="left" style="background:#F5F5F5;" + | | |||
*[[Anxiety]] or depression features | |||
*[[Fatigue]] | |||
*Sleep disturbance | |||
*[[Numbness]] | |||
*[[Muscle spasms]] | |||
| align="left" style="background:#F5F5F5;" + | | |||
*History of [[depression]] | |||
| align="left" style="background:#F5F5F5;" + | | |||
*[[Tenderness]] in the soft tissue anatomical location | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Normal | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Normal | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Normal | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Normal | |||
|- | |||
! align="center" style="background:#DCDCDC;" + |[[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> | |||
| align="center" style="background:#F5F5F5;" + |50s | |||
| align="center" style="background:#F5F5F5;" + |Diffuse | |||
| align="center" style="background:#F5F5F5;" + |<nowiki>+</nowiki> | |||
| 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" style="background:#F5F5F5;" + |− | | align="center" style="background:#F5F5F5;" + |− | ||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | | align="center" style="background:#F5F5F5;" + |− | ||
| align=" | | align="left" style="background:#F5F5F5;" + | | ||
* | *[[Weight loss]] | ||
| align=" | | align="left" style="background:#F5F5F5;" + | | ||
*History of joints stiffness, worse in the morning | |||
| align=" | | align="left" style="background:#F5F5F5;" + | | ||
*Restricted shoulder motion | |||
| align=" | | align="left" style="background:#F5F5F5;" + | | ||
| | *'''↑↑''' [[Erythrocyte sedimentation rate|ESR]] | ||
*'''↑↑''' [[C-reactive protein|CRP]] | |||
| align="left" style="background:#F5F5F5;" + | | |||
| align=" | *Normal | ||
| align="left" style="background:#F5F5F5;" + | | |||
| align=" | *Normal | ||
| align="left" style="background:#F5F5F5;" + | | |||
| align=" | *Normal | ||
|- | |- | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Organ system | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Age of onset | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Age of onset | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Muscle weakness | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Muscle weakness | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Myoglobinuria | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Myoglobinuria | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other features | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other features | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |History | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical | |||
Examination | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory Findings | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory Findings | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Creatine Kinase | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Creatine Kinase | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Electromyogram | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Electromyogram | ||
|} | |} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} |
Revision as of 18:42, 2 May 2018
Inflammatory Myopathy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Classification
- The 2017 European League Against Rheumatism and American College of Rheumatology (EULAR/ACR) classified idiopathic inflammatory myopathy into 6 subtypes:[1][2][3][4][5]
- Polymyositis
- Dermatomyositis
- Inclusion body myositis
- Immune-mediated necrotizing myopathies (IMNM)
- Amyopathic dermatomyositis
- Juvenile dermatomyositis
The 2017 EULAR/ACR classification criteria for adult and juvenile idiopathic inflammatory myopathy | Score | |
---|---|---|
Variable | No muscle biopsy | With muscle biopsy |
Age of onset ≥ 18 and < 40 years | 1.3 | 1.5 |
Age of onset ≥ 40 years | 2.1 | 2.2 |
Objective symmetric weakness, usually progressive, of the proximal upper extremities | 0.7 | 0.7 |
Objective symmetric weakness, usually progressive, of the proximal lower extremities | 0.8 | 0.5 |
Neck flexors are relatively weaker than neck extensors | 1.9 | 1.6 |
In the legs, proximal muscles are relatively weaker than distal muscles | 0.9 | 1.2 |
Heliotrope rash | 3.1 | 3.2 |
Gottron’s papules | 2.1 | 2.7 |
Gottron’s sign | 3.3 | 3.7 |
Dysphagia or esophageal dysmotility | 0.7 | 0.6 |
Anti-Jo1 autoantibody present | 3.9 | 3.8 |
Elevated serum levels of CK or LDH* or ASAT/AST/SGOT* or ALAT/ALT/SGPT* | 1.3 | 1.4 |
Endomysial infiltration of mononuclear cells surrounding, but not invading, myofibers on muscle biopsy | 1.7 | |
Perifascicular atrophy | 1.9 | |
Rimmed vacuoles | 3.1 |
Probability of IIM including muscle biopsy=1/[1+exponential (5.33–score)]
Probability of IIM without muscle biopsy=1/[1+exponential (6.49–score)]
To use the calculator to assess the probability of IIM, click here.
Classification algorithm for subgroups of IIM
Abbreviation: ACR, American College of Rheumatology; EULAR, European League Against Rheumatism; IIM, idiopathic inflammatory myopathies;
A patient meets the EULAR/ACR classification criteria for IIM (probability of IIM ≥55%) | |||||||||||||||||||||||||||||||||||||||||||||
Age of onset 0-17 years old | |||||||||||||||||||||||||||||||||||||||||||||
No | Yes | ||||||||||||||||||||||||||||||||||||||||||||
Skin manifestations include Heliotrope rash, Gottron's papules, or Gottron's sign | Skin manifestations include Heliotrope rash, Gottron's papules, or Gottron's sign | ||||||||||||||||||||||||||||||||||||||||||||
No | Yes | No | Yes | ||||||||||||||||||||||||||||||||||||||||||
Clinical features include finger flexor weakness, or no treatment response, or Muscle biopsy includes rimmed vacuoles | Muscle weakness manifested as objective progressive symmetric muscle weakness of proximal upper or lower extremities, neck flexors relatively weaker than extensors, or in the legs proximal muscles relatively weaker than distal | Juvenile myositis other than juvenile dermatomyositis | Juvenile dermatomyositis | ||||||||||||||||||||||||||||||||||||||||||
No | Yes | No | Yes | ||||||||||||||||||||||||||||||||||||||||||
Polymyositis, or immune-mediated necrotizing myopathy | Inclusion body myositis | Amyopathic dermatomyositis | Dermatomyositis | ||||||||||||||||||||||||||||||||||||||||||
Differentiating Inflammatory Myopathy from other Diseases
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 |
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Inflammatory/ Rheumatologic | Dermatomyositis[6] | 40s−50s
Can affect children |
Proximal | + | + | − | − | − | − | + | − |
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Polymyositis[7] | > 18 years | Proximal | + | + | − | − | − | − | + | − |
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Inclusion body myositis[8] | 50s | Proximal
& distal |
− | − | − | − | − | − | − | − |
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Fibromyalgia[9] | 40−50s | Generalized | − | − | − | − | + | − | − | − |
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Polymyalgia Rheumatica[10] | 50s | Diffuse | + | + | − | − | − | − | + | − |
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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
- ↑ Leclair V, Lundberg IE (March 2018). "New Myositis Classification Criteria-What We Have Learned Since Bohan and Peter". Curr Rheumatol Rep. 20 (4): 18. doi:10.1007/s11926-018-0726-4. PMC 5857275. PMID 29550929.
- ↑ Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, Visser M, Alfredsson L, Amato AA, Barohn RJ, Liang MH, Singh JA, Aggarwal R, Arnardottir S, Chinoy H, Cooper RG, Dankó K, Dimachkie MM, Feldman BM, Torre IG, Gordon P, Hayashi T, Katz JD, Kohsaka H, Lachenbruch PA, Lang BA, Li Y, Oddis CV, Olesinska M, Reed AM, Rutkowska-Sak L, Sanner H, Selva-O'Callaghan A, Song YW, Vencovsky J, Ytterberg SR, Miller FW, Rider LG (December 2017). "2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups". Ann. Rheum. Dis. 76 (12): 1955–1964. doi:10.1136/annrheumdis-2017-211468. PMID 29079590.
- ↑ Hilton-Jones, David (2011). "Observations on the classification of the inflammatory myopathies". La Presse Médicale. 40 (4): e199–e208. doi:10.1016/j.lpm.2010.10.035. ISSN 0755-4982.
- ↑ Benveniste, Olivier; Léger, Jean-Marc (2011). "Inflammatory or necrotizing myopathies, myositides and other acquired myopathies, new insight in 2011". La Presse Médicale. 40 (4): e197–e198. doi:10.1016/j.lpm.2011.02.002. ISSN 0755-4982.
- ↑ Lundberg, Ingrid E.; Tjärnlund, Anna; Bottai, Matteo; Werth, Victoria P.; Pilkington, Clarissa; de Visser, Marianne; Alfredsson, Lars; Amato, Anthony A.; Barohn, Richard J.; Liang, Matthew H.; Singh, Jasvinder A.; Aggarwal, Rohit; Arnardottir, Snjolaug; Chinoy, Hector; Cooper, Robert G.; Dankó, Katalin; Dimachkie, Mazen M.; Feldman, Brian M.; Garcia-De La Torre, Ignacio; Gordon, Patrick; Hayashi, Taichi; Katz, James D.; Kohsaka, Hitoshi; Lachenbruch, Peter A.; Lang, Bianca A.; Li, Yuhui; Oddis, Chester V.; Olesinska, Marzena; Reed, Ann M.; Rutkowska-Sak, Lidia; Sanner, Helga; Selva-O'Callaghan, Albert; Song, Yeong-Wook; Vencovsky, Jiri; Ytterberg, Steven R.; Miller, Frederick W.; Rider, Lisa G. (2017). "2017 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Adult and Juvenile Idiopathic Inflammatory Myopathies and Their Major Subgroups". Arthritis & Rheumatology. 69 (12): 2271–2282. doi:10.1002/art.40320. ISSN 2326-5191.
- ↑ 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.
- ↑ 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.