The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / ACR 2013 State-of-the-Art Clinical Symposium: How to Identify Signs of Myositis and Metabolic Myopathies

ACR 2013 State-of-the-Art Clinical Symposium: How to Identify Signs of Myositis and Metabolic Myopathies

August 1, 2013 • By Kathy Holliman

  • Tweet
  • Email
Print-Friendly Version / Save PDF

You Might Also Like
  • Metabolic Myopathies
  • 2015 ACR/ARHP Annual Meeting: How to Identify, Manage Metabolic Myopathies & Their Mimics
  • ACR 2013 State-of-the-Art Clinical Symposium: The Challenge of Treating Low Back Pain
Explore This Issue
August 2013
Also By This Author
  • ACR Issues Guidelines, Recommendations for Lupus Nephritis, RA
High-magnification micrograph of dermatomyositis
High-magnification micrograph of dermatomyositis

Tips for diagnosis and treatment of myositis and metabolic myopathies were highlighted in two presentations at the ACR 2013 State-of-the-Art Clinical Symposium, held April 20–21 in Chicago, with speakers underlining the need to recognize the clinical presentations of diseases that can mimic other conditions.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Paul H. Plotz, MD, scientist emeritus at the Arthritis and Rheumatism Branch of the National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda, Md., reminded attendees that many diseases can appear to be myositis. Mistaken diagnoses can result in antiinflammatory therapy for patients who will not benefit and may even suffer from the treatment, he said.

The first step in diagnosis of myositis is determining the location of the illness, whether it is actually inside or outside the muscle, and whether it is inflammatory, structural, or metabolic. The inflammatory myopathies include polymyositis, dermatomyositis, and inclusion body myositis (IBM).

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Several clinical presentations should lead to a suspicion of the disease: Gottron’s or heliotrope rashes, a gradual onset of weeks to months, symmetry (except in the case of IBM), proximal limb and truncal involvement, Raynaud’s, arthritis, and idiopathic pulmonary fibrosis. Some myositic patients have musculoskeletal pain, but that is usually not the dominant feature of their illness, Dr. Plotz said. Most significantly, patients with myositis have elevated creatine kinase (CK), increasing weakness, and muscle edema that may be identified by magnetic resonance imaging (MRI). The MRI, however, will not identify the histology of the disease.

“Always biopsy a patient you suspect of having myositis. You are looking for lymphocytic information. Spend a moment and look at the biopsy yourself and convince yourself that there is truly inflammation and that there are some hints about whether it’s dermatomyositis or a polymyositis,” Dr. Plotz said, adding that dermatomyositis is a diagnosis made on examination of the skin for the characteristic rashes.

Several presentations should lead away from a diagnosis of myositis: a family history of a similar illness; weakness related to exercise, fasting, or eating; discrete episodes of reversible weakness; sensory, reflex, or other neurological signs; cranial nerve involvement; fasciculations; severe muscle cramping; myasthenia or myotonia; atrophy early in the disease or hypertrophy at any time; and CK that is normal or extremely high, he said.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Screening for Cancer

Patients with myositis, particularly those with dermatomyositis and polymyositis, develop cancer more frequently than the general population, with lung, ovarian, cervical, colorectal, gastric, breast, bladder, and pancreatic cancer topping the list of the most frequent.1 A middle-aged woman with dermatomyositis has a 2- to 4-fold risk of cancer within a year of her diagnosis of dermatomyositis and 1.5- to 2-fold risk if she has polymyositis. Patients most at risk of developing cancer are older than age 45. The cancer risk falls back to baseline risk within about five years of diagnosis of myositis, he said.

Pages: 1 2 3 4 | Single Page

Filed Under: Conditions, Meeting Reports, Systemic Inflammatory Syndromes Tagged With: AC&R, Diagnosis, Metabolic Myopathy, myositis, TreatmentIssue: August 2013

You Might Also Like:
  • Metabolic Myopathies
  • 2015 ACR/ARHP Annual Meeting: How to Identify, Manage Metabolic Myopathies & Their Mimics
  • ACR 2013 State-of-the-Art Clinical Symposium: The Challenge of Treating Low Back Pain
  • ACR 2013 State-of-the-Art Clinical Symposium: Diagnosis and Management of Vasculitis

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.