RT Book, Section
A1 Adler, Brittany
A1 Truong, Alex
A1 Mammen, Andrew L.
A1 Christopher-Stine, Lisa
A2 Stone, John H.
SR Print(0)
ID 1180197069
T1 Autoimmune Myopathies, Immune-Mediated Necrotizing Myopathies, & Their Mimickers
T2 Current Diagnosis & Treatment: Rheumatology, 4e
YR 2021
FD 2021
PB McGraw Hill
PP New York, NY
SN 9781259644641
LK accessmedicine.mhmedical.com/content.aspx?aid=1180197069
RD 2024/04/20
AB Symmetric  proximal  muscle  weakness  progressing  over  weeks  to  months.Elevated  muscle  enzymes,  including  creatine  kinase  (CK),  aldolase,  aspartate  aminotransferase  (AST),  and  alanine  aminotransferase  (ALT).An  “irritable  myopathy”  shown  by  electromyography  (EMG).Magnetic  resonance  imaging  (MRI)  of  affected  muscles  reveals  evidence  of  edema,  fasciitis,  or  both.Heliotrope  rash  or  Gottron  sign/papules  are  pathognomonic  of  dermatomyositis.Muscle  biopsy  in  dermatomyositis  and  polymyositis  frequently  reveals  endomysial,  perimysial,  and  perivascular  lymphocytic  infiltrates.  Perifascicular  atrophy  is  pathognomonic  of  dermatomyositis.Muscle  biopsy  with  necrotizing  and  regenerating  muscle  fibers  is  characteristic  of  the  immune-mediated  necrotizing  myopathies,  including  statin-associated  autoimmune  myopathy.A  careful  family  history,  medication  list  review,  physical  examination,  laboratory  evaluation,  and  muscle  biopsy  are  all  critical  parts  of  the  evaluation.Exclusion  of  alternative  diagnoses,  such  as  an  inherited  muscle  disease  or  toxic  myopathy,  is  essential.