Inflammatory myositis, dermatomyositis, polymyositis

Question 1

inflammatory myositis or myopathy includes

Answer 1

dermatomyositis and polymyositis

Question 2

characteristic rashes seen with inflammatory myositis

Answer 2

see Gottron’s papules - on metacarpalphalangeal joints

heliotrope rash - seen in 50% of pts

V sign - violaceous rash on chest in V pattern

See “shawl” sign

Question 3

what should be done for pts who have inflammatory myositis?

Answer 3

need to get age appropriate cancer screenings; 5x more likely to get cancer

in high risk pts get: CT c/a/p
urinalysis for hematuria
serum CA 125 and CA 19-9
serum PSA and EGD.

Question 4

for active dermatomyositis treatment is with

Answer 4

high dose steroids 1mg/kg/day to maximum dose of 80 mg/day for several months to achieve disease control prior to tapering to lowest dose tolerated by pt.

Question 5

other associations with dermatomyositis:

Answer 5

interstitial lung dx, esophageal dysmotility
myocarditis
systemic conditions like fever, weight loss
Raynaud’s phenomenon

Question 6

diagnosis of dermatomyositis and positive lab findings:

Answer 6

elevation in CK, LDH and adolase, and AST (muscle enzymes)
autoantibody ANA and Anti Jo -1
EMG may show nonspeicifc signs of muscle irritation

Question 7

see mechanics hands

Answer 7

painful roughened skin cracking on lateral sides of fingers and erythroderma

Question 8

treatment of dermatomyositis

Answer 8

steroids