PM & DM

Question 1

A pt presents with proximal muscle weakness, difficulty getting out of chairs, walking up steps, and combing her hair. She mentions that she often feels fatigued and has a decreased appetite. Her grip strength is unaffected. What do you suspect? What is the underlying pathophys of this condition?

Answer 1

Polymyositis (PM)
Idiopathic inflammatory myopathy
Autoimmune
Muscle weakness w/ muscle inflammation

Question 2

A pt presents complaining of muscle weakness and joint pain. Recently he has been having difficulty climbing stairs and getting up from sitting. What labs should you order?

Answer 2

Polymyositis
Serum muscle enzymes
CK, aldolase (muscle only)
AST, LDH (muscle & liver)
ALT (liver only)
Anti-Jo 1!!

Question 3

A pt presents with muscle weakness, joint pain, anorexia, and fatigue. His grip strength is unaffected. You suspect PM. What diagnostics could you order?

Answer 3

Polymyositis
Labs - serum muscle enzymes
EMG
Muscle biopsy - diagnostic

Question 4

A pt presents with muscle weakness, fatigue, difficulty swallowing, and difficulty walking up steps. Labs show elevated CK and aldolase and are Anti-Jo-1 +. What treatment do you recommend?

Answer 4

Polymyositis
Corticosteroids (1st line)
Immunosuppressants (2nd line)
Combination Tx - IVIg & biologics

Question 5

A pt presents with a skin rash, Gottron’s papules, a heliotrope rash, and mechanic’s hands. What do you suspect? What is the underlying pathophys?

Answer 5

Dermatomyositis
Idiopathic inflammatory myopathy
Autoimmune
Muscle weakness w/ muscle inflammation

Question 6

A pt presents with a shawl sign. What diagnostics should you order?

Answer 6

Dematomyositis
Labs - serum muscle enzymes (CK, aldolase)
Anti-Jo-1
EMG
Muscle Biopsy

Question 7

A pt presents with Gottron’s sign, a heliotrope rash, shawl sign, and periungual infarcts in the cuticle. Labs show elevated CK and aldolase, and Anti-Jo-1 +. What treatment do you recommend?

Answer 7

Dermatomyositis
Corticosteroids (1st line)
Immunosuppressants (2nd line)
Combination therapy (IVIg & biologics)

Question 8

How do you treat a pt with PM or DM?

Answer 8

Corticosteroids - 1st line
Immunosuppressants - 2nd line
Combination Tx (IVIg & biologics)

Question 9

What lab findings would you expect to see in PM/DM?

Answer 9

Elevated serum muscle enzymes
+ Anti-Jo-1
EMG shows myopathic changes d/t inflammation
Muscle biopsy

Question 10

What test is diagnostic of PM/DM?

Answer 10

Muscle biopsy