Polymyositis and dermatomyositis physical examination
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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
- Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for:[finding 1], [finding 2], and [finding 3].[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
- Low-grade fever
Skin
- Skin manifestations of dermatomyositis can be divided into 5 categories:[1]
| Lesion | Location | Picture | Percentage | Pathognomonic |
|---|---|---|---|---|
| Gottron papules | Dorsal aspect of interphalangeal or metacarpophalangeal joints | 80% | Pathognomonic | |
| Heliotrope rash | Eyelids and periorbital tissue | |||
| 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
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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 | |||
| Poikiloderma | Sun exposed areas | |||
| Pityriasis rubra pilaris–like lesions | dorsal aspect of the hands and feet, frequently over the bony prominences | Rare | ||
| Nonscarring alopecia | ||||
| Erythroderma | ||||
| Vesiculobullous lesions | Rare | |||
Cutaneous vasculitis such as
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| Leukocytoclastic vasculitis | Underlying malignancy | |||
| Raynaud phenomenon | 25% | |||
HEENT
- Periorbital swelling
Neck
- Neck examination of patients with polymyositis and dermatomyositis is usually normal.
Lungs
- Asymmetric chest expansion
- Lungs are hypo/hyperresonant
- Fine crackles upon auscultation of the lung bilaterally
- Wheezing may be present
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
- Patient is usually oriented to persons, place, and time
- Symmetric proximal muscle weakness mostly in:
- Deltoids
- Hips
- Neck flexors
- Mild distal muscle weakness
- Hyporeflexia / areflexia
- Muscle rigidity
Extremities
- Muscle atrophy in severe, long standing disease
- Fasciculations in the upper/lower extremity
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.