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==Overview==
==Overview==
Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for muscle weakness, hyporeflexia, skin lesions, and respiratory symptoms. The presence of Gottron's papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis.
Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for [[muscle weakness]], [[hyporeflexia]], [[skin]] lesions, [[Respiratory system|respiratory]] symptoms. The presence of Gottron's papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis. [[Muscle atrophy]] in severe, long standing disease might occur.


==Physical Examination==
==Physical Examination==
*Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for muscle weakness, hyporeflexia, skin lesions, respiratory symptoms.<ref name="KhanChristopher-Stine2011">{{cite journal|last1=Khan|first1=Sabiha|last2=Christopher-Stine|first2=Lisa|title=Polymyositis, Dermatomyositis, and Autoimmune Necrotizing Myopathy: Clinical Features|journal=Rheumatic Disease Clinics of North America|volume=37|issue=2|year=2011|pages=143–158|issn=0889857X|doi=10.1016/j.rdc.2011.01.001}}</ref><ref name="DoblougGaren2015">{{cite journal|last1=Dobloug|first1=Cecilie|last2=Garen|first2=Torhild|last3=Bitter|first3=Helle|last4=Stjärne|first4=Johan|last5=Stenseth|first5=Guri|last6=Grøvle|first6=Lars|last7=Sem|first7=Marthe|last8=Gran|first8=Jan Tore|last9=Molberg|first9=Øyvind|title=Prevalence and clinical characteristics of adult polymyositis and dermatomyositis; data from a large and unselected Norwegian cohort|journal=Annals of the Rheumatic Diseases|volume=74|issue=8|year=2015|pages=1551–1556|issn=0003-4967|doi=10.1136/annrheumdis-2013-205127}}</ref><ref name="ChinoyFertig2007">{{cite journal|last1=Chinoy|first1=H.|last2=Fertig|first2=N.|last3=Oddis|first3=C. V|last4=Ollier|first4=W. E R|last5=Cooper|first5=R. G|title=The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis|journal=Annals of the Rheumatic Diseases|volume=66|issue=10|year=2007|pages=1345–1349|issn=0003-4967|doi=10.1136/ard.2006.068502}}</ref><ref name="DalakasHohlfeld2003">{{cite journal|last1=Dalakas|first1=Marinos C|last2=Hohlfeld|first2=Reinhard|title=Polymyositis and dermatomyositis|journal=The Lancet|volume=362|issue=9388|year=2003|pages=971–982|issn=01406736|doi=10.1016/S0140-6736(03)14368-1}}</ref><ref name="DouglasTazelaar2001">{{cite journal|last1=Douglas|first1=William W.|last2=Tazelaar|first2=Henry D.|last3=Hartman|first3=Thomas E.|last4=Hartman|first4=Robert P.|last5=Decker|first5=Paul A.|last6=Schroeder|first6=Darrell R.|last7=Ryu|first7=Jay H.|title=Polymyositis–Dermatomyositis-associated Interstitial Lung Disease|journal=American Journal of Respiratory and Critical Care Medicine|volume=164|issue=7|year=2001|pages=1182–1185|issn=1073-449X|doi=10.1164/ajrccm.164.7.2103110}}</ref>
*Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for [[muscle weakness]], [[hyporeflexia]], [[skin]] lesions, [[Respiratory system|respiratory]] symptoms.<ref name="KhanChristopher-Stine2011">{{cite journal|last1=Khan|first1=Sabiha|last2=Christopher-Stine|first2=Lisa|title=Polymyositis, Dermatomyositis, and Autoimmune Necrotizing Myopathy: Clinical Features|journal=Rheumatic Disease Clinics of North America|volume=37|issue=2|year=2011|pages=143–158|issn=0889857X|doi=10.1016/j.rdc.2011.01.001}}</ref><ref name="DoblougGaren2015">{{cite journal|last1=Dobloug|first1=Cecilie|last2=Garen|first2=Torhild|last3=Bitter|first3=Helle|last4=Stjärne|first4=Johan|last5=Stenseth|first5=Guri|last6=Grøvle|first6=Lars|last7=Sem|first7=Marthe|last8=Gran|first8=Jan Tore|last9=Molberg|first9=Øyvind|title=Prevalence and clinical characteristics of adult polymyositis and dermatomyositis; data from a large and unselected Norwegian cohort|journal=Annals of the Rheumatic Diseases|volume=74|issue=8|year=2015|pages=1551–1556|issn=0003-4967|doi=10.1136/annrheumdis-2013-205127}}</ref><ref name="ChinoyFertig2007">{{cite journal|last1=Chinoy|first1=H.|last2=Fertig|first2=N.|last3=Oddis|first3=C. V|last4=Ollier|first4=W. E R|last5=Cooper|first5=R. G|title=The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis|journal=Annals of the Rheumatic Diseases|volume=66|issue=10|year=2007|pages=1345–1349|issn=0003-4967|doi=10.1136/ard.2006.068502}}</ref><ref name="DalakasHohlfeld2003">{{cite journal|last1=Dalakas|first1=Marinos C|last2=Hohlfeld|first2=Reinhard|title=Polymyositis and dermatomyositis|journal=The Lancet|volume=362|issue=9388|year=2003|pages=971–982|issn=01406736|doi=10.1016/S0140-6736(03)14368-1}}</ref><ref name="DouglasTazelaar2001">{{cite journal|last1=Douglas|first1=William W.|last2=Tazelaar|first2=Henry D.|last3=Hartman|first3=Thomas E.|last4=Hartman|first4=Robert P.|last5=Decker|first5=Paul A.|last6=Schroeder|first6=Darrell R.|last7=Ryu|first7=Jay H.|title=Polymyositis–Dermatomyositis-associated Interstitial Lung Disease|journal=American Journal of Respiratory and Critical Care Medicine|volume=164|issue=7|year=2001|pages=1182–1185|issn=1073-449X|doi=10.1164/ajrccm.164.7.2103110}}</ref>
*The presence of Gottron's papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis.
*The presence of Gottron's papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis.


Line 16: Line 16:
===Vital Signs===
===Vital Signs===


*Low-grade fever
*Low-grade [[fever]]


===Skin===
===Skin===
*Skin manifestations of dermatomyositis can be divided into 5 categories:<ref name="KhanChristopher-Stine2011">{{cite journal|last1=Khan|first1=Sabiha|last2=Christopher-Stine|first2=Lisa|title=Polymyositis, Dermatomyositis, and Autoimmune Necrotizing Myopathy: Clinical Features|journal=Rheumatic Disease Clinics of North America|volume=37|issue=2|year=2011|pages=143–158|issn=0889857X|doi=10.1016/j.rdc.2011.01.001}}</ref>
*[[Skin]] manifestations of dermatomyositis are as follow:<ref name="KhanChristopher-Stine2011">{{cite journal|last1=Khan|first1=Sabiha|last2=Christopher-Stine|first2=Lisa|title=Polymyositis, Dermatomyositis, and Autoimmune Necrotizing Myopathy: Clinical Features|journal=Rheumatic Disease Clinics of North America|volume=37|issue=2|year=2011|pages=143–158|issn=0889857X|doi=10.1016/j.rdc.2011.01.001}}</ref>
{| class="wikitable"
{| class="wikitable"
!Lesion
!Lesion
!Location
!Location
!Picture
!Percentage
!Percentage
!Pathognomonic
!Pathognomonic
Line 29: Line 28:
|Gottron papules
|Gottron papules
|Dorsal aspect of interphalangeal or metacarpophalangeal joints  
|Dorsal aspect of interphalangeal or metacarpophalangeal joints  
|
|80%
|80%
|Pathognomonic
|Pathognomonic
Line 35: Line 33:
|Heliotrope rash
|Heliotrope rash
|Eyelids and periorbital tissue  
|Eyelids and periorbital tissue  
|
|
|
|Pathognomonic
|Pathognomonic
Line 41: Line 38:
|Gottron sign  
|Gottron sign  
|dorsal aspect of the interphalangeal or metacarpophalangeal joints, olecranon process, patella, and medial malleoli  
|dorsal aspect of the interphalangeal or metacarpophalangeal joints, olecranon process, patella, and medial malleoli  
|
|
|
|Characteristic
|Characteristic
Line 47: Line 43:
|Macular violaceous erythema  
|Macular violaceous erythema  
|Symmetric distribution in classic areas  
|Symmetric distribution in classic areas  
|
|
|
|Characteristic
|Characteristic
Line 53: Line 48:
|Shawl sign
|Shawl sign
|Nape of the neck, shoulders, and upper back  
|Nape of the neck, shoulders, and upper back  
|
|
|
|Characteristic
|Characteristic
Line 59: Line 53:
|“V sign”
|“V sign”
|V-shaped region of the neck and upper chest  
|V-shaped region of the neck and upper chest  
|
|
|
|Characteristic
|Characteristic
Line 65: Line 58:
|Linear extensor erythema  
|Linear extensor erythema  
|Extensor aspects of the legs, thighs, arms, fingers, hands, and feet
|Extensor aspects of the legs, thighs, arms, fingers, hands, and feet
|
|
|
|Characteristic
|Characteristic
Line 71: Line 63:
|Mechanic’s hands  
|Mechanic’s hands  
|Palms and fingers  
|Palms and fingers  
|
|
|
|Characteristic
|Characteristic
Line 80: Line 71:
* Prominent periungual erythema  
* Prominent periungual erythema  
|Nail of hands and feet
|Nail of hands and feet
|
|30-60%
|30-60%
|Characteristic
|Characteristic
Line 86: Line 76:
|Cutaneous calcinosis  
|Cutaneous calcinosis  
|Sites of compression, such as elbows and buttocks
|Sites of compression, such as elbows and buttocks
|
|30-70% in JDM
|30-70% in JDM


Line 95: Line 84:
|Trunk, back, and proximal extremities
|Trunk, back, and proximal extremities
|
|
|
|Rare
|
|-
|-
|Poikiloderma  
|Poikiloderma  
|Sun exposed areas
|Sun exposed areas
|
|
|
|Rare
|
|-
|-
|Pityriasis rubra pilaris–like lesions    
|Pityriasis rubra pilaris–like lesions    
|dorsal aspect of the hands and feet, frequently over the bony prominences  
|dorsal aspect of the hands and feet, frequently over the bony prominences  
|
|
|
|Rare
|Rare
|-
|-
|Nonscarring alopecia
|Nonscarring alopecia
|Head
|
|
|
|Rare
|
|
|-
|-
|Erythroderma
|Erythroderma
|
|
|
|
|
|Rare
|
|-
|-
|Vesiculobullous lesions
|Vesiculobullous lesions
|
|
|
|
|
Line 135: Line 118:
|
|
|
|
|
|Rare
|
|-
|-
|Leukocytoclastic vasculitis  
|Leukocytoclastic vasculitis  
|Underlying malignancy
|Underlying malignancy
|
|
|
|Rare
|
|-
|-
|Raynaud phenomenon  
|Raynaud phenomenon  
|
|
|
|25%
|25%
|
|-
|
|
|
|
|
|
|}
|}


===HEENT===
===HEENT===
* Periorbital swelling
* [[Periorbital edema]]
===Neck===
===Neck===
* Neck examination of patients with polymyositis and dermatomyositis is usually normal.
* Neck examination of patients with polymyositis and dermatomyositis is usually normal.


===Lungs===
===Lungs===
* Asymmetric chest expansion
* Asymmetric [[Respiratory examination|chest expansion]]
*Lungs are hypo/hyperresonant
*Lungs are hyporesonant
*Fine [[crackles]] upon auscultation of the lung bilaterally
*Fine [[crackles]] upon auscultation of the lung bilaterally
*[[Wheezing]] may be present
*[[Wheezing]] may be present
Line 178: Line 152:
* Genitourinary examination of patients with polymyositis and dermatomyositis is usually normal.
* Genitourinary examination of patients with polymyositis and dermatomyositis is usually normal.
===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
*Patient is usually oriented to persons, place, and time.
* Symmetric proximal [[muscle weakness]] mostly in:
* Symmetric proximal [[muscle weakness]] mostly in:
**Deltoids
**[[Deltoid|Deltoids]]
**Hips
**[[Hip (anatomy)|Hips]]
**Neck flexors
**[[Neck]] flexors
* Mild distal muscle weakness
* Mild distal [[muscle weakness]]


* Hyporeflexia / areflexia
* [[Hyporeflexia]] / [[Hyporeflexia|areflexia]]
* Muscle rigidity
* [[Hypertonia|Muscle rigidity]]


===Extremities===
===Extremities===
*Muscle atrophy in severe, long standing disease  
*[[Muscle atrophy]] in severe, long standing disease  
*Fasciculations in the upper/lower extremity
*[[Fasciculation|Fasciculations]] in the upper/lower extremity


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 19:24, 18 April 2018

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

Overview

Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for muscle weakness, hyporeflexia, skin lesions, respiratory symptoms. The presence of Gottron's papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis. Muscle atrophy in severe, long standing disease might occur.

Physical Examination

  • Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for muscle weakness, hyporeflexia, skin lesions, respiratory symptoms.[1][2][3][4][5]
  • The presence of Gottron's papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis.

Appearance of the Patient

  • Patients with polymyositis and dermatomyositis usually appear normal. They might be weak in severe cases.

Vital Signs

Skin

  • Skin manifestations of dermatomyositis are as follow:[1]
Lesion Location Percentage Pathognomonic
Gottron papules Dorsal aspect of interphalangeal or metacarpophalangeal joints   80% Pathognomonic
Heliotrope rash Eyelids and periorbital tissue   Pathognomonic
Gottron sign   dorsal aspect of the interphalangeal or metacarpophalangeal joints, olecranon process, patella, and medial malleoli   Characteristic
Macular violaceous erythema   Symmetric distribution in classic areas   Characteristic
Shawl sign Nape of the neck, shoulders, and upper back   Characteristic
“V sign” V-shaped region of the neck and upper chest   Characteristic
Linear extensor erythema   Extensor aspects of the legs, thighs, arms, fingers, hands, and feet Characteristic
Mechanic’s hands   Palms and fingers   Characteristic
Nail abnormalities such as
  • Nail fold telangiectasias
  • Cuticular overgrowth
  • Prominent periungual erythema  
 Nail of hands and feet 30-60% Characteristic
Cutaneous calcinosis   Sites of compression, such as elbows and buttocks 30-70% in JDM

10% in DM

Flagellate erythema   Trunk, back, and proximal extremities Rare
Poikiloderma   Sun exposed areas Rare
Pityriasis rubra pilaris–like lesions   dorsal aspect of the hands and feet, frequently over the bony prominences   Rare
Nonscarring alopecia Head Rare
Erythroderma Rare
Vesiculobullous lesions Rare
Cutaneous vasculitis such as
  • Palpable purpura
  • Urticaria-like lesions
  • Livedo reticularis
  • Digital ulcerations  
 Rare
Leukocytoclastic vasculitis   Underlying malignancy Rare
Raynaud phenomenon   25%

HEENT

Neck

  • Neck examination of patients with polymyositis and dermatomyositis is usually normal.

Lungs

Heart

  • Cardiovascular examination of patients with polymyositis and dermatomyositis is usually normal.

Abdomen

  • Abdominal examination of patients with polymyositis and dermatomyositis is usually normal.

Back

  • Back examination of patients with polymyositis and dermatomyositis is usually normal.

Genitourinary

  • Genitourinary examination of patients with polymyositis and dermatomyositis is usually normal.

Neuromuscular

Extremities

References

  1. ↑ 1.0 1.1 Khan, Sabiha; Christopher-Stine, Lisa (2011). "Polymyositis, Dermatomyositis, and Autoimmune Necrotizing Myopathy: Clinical Features". Rheumatic Disease Clinics of North America. 37 (2): 143–158. doi:10.1016/j.rdc.2011.01.001. ISSN 0889-857X.
  2. ↑ Dobloug, Cecilie; Garen, Torhild; Bitter, Helle; Stjärne, Johan; Stenseth, Guri; Grøvle, Lars; Sem, Marthe; Gran, Jan Tore; Molberg, Øyvind (2015). "Prevalence and clinical characteristics of adult polymyositis and dermatomyositis; data from a large and unselected Norwegian cohort". Annals of the Rheumatic Diseases. 74 (8): 1551–1556. doi:10.1136/annrheumdis-2013-205127. ISSN 0003-4967.
  3. ↑ Chinoy, H.; Fertig, N.; Oddis, C. V; Ollier, W. E R; Cooper, R. G (2007). "The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis". Annals of the Rheumatic Diseases. 66 (10): 1345–1349. doi:10.1136/ard.2006.068502. ISSN 0003-4967.
  4. ↑ Dalakas, Marinos C; Hohlfeld, Reinhard (2003). "Polymyositis and dermatomyositis". The Lancet. 362 (9388): 971–982. doi:10.1016/S0140-6736(03)14368-1. ISSN 0140-6736.
  5. ↑ Douglas, William W.; Tazelaar, Henry D.; Hartman, Thomas E.; Hartman, Robert P.; Decker, Paul A.; Schroeder, Darrell R.; Ryu, Jay H. (2001). "Polymyositis–Dermatomyositis-associated Interstitial Lung Disease". American Journal of Respiratory and Critical Care Medicine. 164 (7): 1182–1185. doi:10.1164/ajrccm.164.7.2103110. ISSN 1073-449X.
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