The Rheumatologist
COVID-19 NewsACR Convergence
  • 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
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis 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
    • Interprofessional Perspective
  • 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
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • 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 / From Strength to Strength: Idiopathic Inflammatory Myopathy Diagnosis & Management

From Strength to Strength: Idiopathic Inflammatory Myopathy Diagnosis & Management

December 2, 2021 • By Jason Liebowitz, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF

Muscle Weakness

Dr. Aggarwal provided important clinical pearls with respect to the historical aspects of IIM. Although fatigue and myalgias can certainly be seen in patients with IIM, muscle weakness is a key element consistent across nearly all forms of these diseases. The onset of muscle weakness in dermatomyositis, polymyositis and juvenile dermatomyositis can be quite acute and the progression of weakness typically occurs over weeks to months—although with IBM a very slow progression over the course of years is the norm.

You Might Also Like
  • New Approaches to Inflammatory Myopathy
  • Statins Linked to Idiopathic Inflammatory Myositis
  • Management of Inflammatory Myositis: Options for Refractory Disease & New Therapies Discussed
Also By This Author
  • Lessons from Master Clinicians: An Interview with Dr. Gail Kerr

In contrast to metabolic myopathies, which often cause intermittent weakness, IIM demonstrates progressive, chronic weakness that tends to increase over time. When assessing for these diseases, it is important to evaluate for extra-muscular manifestations of myositis, such as dysphagia; signs and symptoms of cardiomyopathy; lung disease, which can manifest as interstitial lung disease or respiratory muscle weakness; arthritis; Raynaud’s phenomenon; rash; calcinosis; and/or such systemic symptoms as fevers and weight loss.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

In any patient being evaluated for IIM, the clinician must also consider the possibility of metabolic myopathy, genetic myopathy, muscular dystrophy, thyroid disease and toxic myopathies that can be associated with alcohol or drug use, as well as with certain medications, such as statins and glucocorticoids.

Dr. Aggarwal stated the laboratory findings in IIM must be interpreted carefully and within the right clinical framework. Not only will creatine kinase and aldolase be elevated in many forms of IIM, so too will aspartate and alanine transaminases and lactate dehydrogenase. About 20% of patients with dermatomyositis, unlike polymyositis, will demonstrate normal muscle enzyme levels.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Autoantibodies

Specific autoantibodies correlate well with certain phenotypes within the category of IIM. For example, antibodies against signal recognition particle and HMG-CoA-reductase are commonly found in patients with immune-mediated necrotizing myopathy, whereas antibodies against melanoma differentiation-associated protein-5 (anti-MDA5) occur in patients with very specific skin findings (i.e., skin ulcerations, tender palmar papules), a propensity for severe and often rapidly progressive interstitial lung disease and frequent occurrence of clinically myopathy disease.

Additional studies that can aid in diagnosis include electromyogram and nerve conduction studies, magnetic resonance imaging of the muscles using specific myositis protocols and muscle biopsy.

IIM Treatments

Dr. Aggarwal concluded his lecture discussing treatments for IIM. First-line agents remain methotrexate and azathioprine, with second-line agents consisting of mycophenolate mofetil, tacrolimus and cyclosporine; a combination of first- and second-line agents can also be used in patients with disease that is refractory to methotrexate or azathioprine alone. Third-line agents include rituximab and cyclophosphamide, and such medications may be particularly appropriate for patients with interstitial lung disease. Experimental treatments at this time include ACTH gel, abatacept, and tofacitinib.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 3 4 | Single Page

Filed Under: ACR Convergence, Conditions, Meeting Reports, Systemic Inflammatory Syndromes Tagged With: ACR Convergence 2021, myositis

You Might Also Like:
  • New Approaches to Inflammatory Myopathy
  • Statins Linked to Idiopathic Inflammatory Myositis
  • Management of Inflammatory Myositis: Options for Refractory Disease & New Therapies Discussed
  • Myositis Management: Clinical Trials Provide New Insights into Treatment Options

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 »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts 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 / Cookie Preferences

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

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

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