Myositis

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Myositis Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Myositis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Xray

CT scan

MRI

Ultrasound

Other Imaging Studies

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Synonyms and Keywords:

Overview

Myositis is a general term for inflammation of the muscles. Many such conditions are considered likely to be caused by autoimmune conditions, rather than directly due to infection (although autoimmune conditions can be activated or exacerbated by infections.)

Elevation of creatine kinase (CK) in blood is indicative of myositis. The MM and not the MB or BB fraction of the CK will be elevated.

Differential diagnosis of myositis

Myositis must be differentiated from the following conditions causing muscle weakness, hypotonia, or flaccid paralysis:

Diseases History and Physical Diagnostic tests Other Findings
Motor Deficit Sensory deficit Cranial nerve Involvement Autonomic dysfunction Proximal/Distal/Generalized Ascending/Descending/Systemic Unilateral (UL)

or Bilateral (BL)

or

No Lateralization (NL)

Onset Lab or Imaging Findings Specific test
Adult Botulism + - + + Generalized Descending BL Sudden Toxin test Blood, Wound, or Stool culture Diplopia, Hyporeflexia, Hypotonia, possible respiratory paralysis
Infant Botulism + - + + Generalized Descending BL Sudden Toxin test Blood, Wound, or Stool culture Flaccid paralysis (Floppy baby syndrome), possible respiratory paralysis
Guillian-Barre syndrome[1] + - - - Generalized Ascending BL Insidious CSF: ↑Protein

↓Cells

Clinical & Lumbar Puncture Progressive ascending paralysis following infection, possible respiratory paralysis
Eaton Lambert syndrome[2] + - + + Generalized Systemic BL Intermittent EMG, repetitive nerve stimulation test (RNS) Voltage gated calcium channel (VGCC) antibody Diplopia, ptosis, improves with movement (as the day progresses)
Myasthenia gravis[3] + - + + Generalized Systemic BL Intermittent EMG, Edrophonium test Ach receptor antibody Diplopia, ptosis, worsening with movement (as the day progresses)
Electrolyte disturbance[4] + + - - Generalized Systemic BL Insidious Electrolyte panel ↓Ca++, ↓Mg++, ↓K+ Possible arrhythmia
Organophosphate toxicity[5] + + - + Generalized Ascending BL Sudden Clinical diagnosis: physical exam & history Clinical suspicion confirmed with RBC AchE activity History of exposure to insecticide or living in farming environment. with : Diarrhea, Urination, Miosis, Bradycardia, Lacrimation, Emesis, Salivation, Sweating
Tick paralysis (Dermacentor tick)[6] + - - - Generalized Ascending BL Insidious Clinical diagnosis: physical exam & history - History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area)
Tetrodotoxin poisoning[7] + - + + Generalized Systemic BL Sudden Clinical diagnosis: physical exam & dietary history - History of consumption of puffer fish species.
Stroke[8] +/- +/- +/- +/- Generalized Systemic UL Sudden MRI +ve for ischemia or hemorrhage MRI Sudden unilateral motor and sensory deficit in a patient with a history of atherosclerotic risk factors (diabetes, hypertension, smoking) or atrial fibrillation.
Poliomyelitis[9] + + + +/- Proximal > Distal Systemic BL or UL Sudden PCR of CSF Asymmetric paralysis following a flu-like syndrome.
Transverse myelitis[10] + + + + Proximal > Distal Systemic BL or UL Sudden MRI & Lumbar puncture MRI History of chronic viral or autoimmune disease (e.g. HIV)
Neurosyphilis[11][12] + + - +/- Generalized Systemic BL Insidious MRI & Lumbar puncture CSF VDRL-specifc

CSF FTA-Ab -sensitive[13]

History of unprotected sex or multiple sexual partners.

History of genital ulcer (chancre), diffuse maculopapular rash.

Muscular dystrophy[14] + - - - Proximal > Distal Systemic BL Insidious Genetic testing Muscle biopsy Progressive proximal lower limb weakness with calf pseudohypertrophy in early childhood. Gower sign positive.
Multiple sclerosis exacerbation[15] + + + + Generalized Systemic NL Sudden CSF IgG levels

(monoclonal)

Clinical assessment and MRI [16] Blurry vision, urinary incontinence, fatigue
Amyotrophic lateral sclerosis[17] + - - - Generalized Systemic BL Insidious Normal LP (to rule out DDx) MRI & LP Patient initially presents with upper motor neuron deficit (spasticity) followed by lower motor neuron deficit (flaccidity).
Inflammatory myopathy[18] + - - - Proximal > Distal Systemic UL or BL Insidious Elevated CK & Aldolase Muscle biopsy Progressive proximal muscle weakness in 3rd to 5th decade of life. With or without skin manifestations.


The following drugs or conditions may additionally need to be differentiated from myositis:

Atorvastatin

Cellulitis

Deep vein thrombosis

Dermatomyositis

Dolutegravir

Hematoma

Idiopathic inflammatory myopathies

Inclusion body myositis

Influenza myositis

Juvenile dermatomyositis

Lovastatin

Lyme myositis

Myositis ossificans

Neuromuscular complications accompanying AIDS

Osteoarthritis

Osteomyelitis

Paraneoplastic neuropathy

Peripheral vascular disease

Polymyositis

Pravastatin (less likely than other statins)

Pyomyositis

Rheumatoid arthritis

Simvastatin

Statin therapy

Systemic lupus erythematosus

Toxoplasma myositis

Trichinosis

Trypanosomiasis

Tuberculous pyomyositis

Viral myositis (including following an episode of influenza)

Wasting syndrome

Causes

Drug Side Effect

Diagnostic Findings

MRI

(Images courtesy of RadsWiki)

See also

External links

Cost Effectiveness of Myositis

| group5 = Clinical Trials Involving Myositis | list5 = Ongoing Trials on Myositis at Clinical Trials.govTrial results on MyositisClinical Trials on Myositis at Google


| group6 = Guidelines / Policies / Government Resources (FDA/CDC) Regarding Myositis | list6 = US National Guidelines Clearinghouse on MyositisNICE Guidance on MyositisNHS PRODIGY GuidanceFDA on MyositisCDC on Myositis


| group7 = Textbook Information on Myositis | list7 = Books and Textbook Information on Myositis


| group8 = Pharmacology Resources on Myositis | list8 = AND (Dose)}} Dosing of MyositisAND (drug interactions)}} Drug interactions with MyositisAND (side effects)}} Side effects of MyositisAND (Allergy)}} Allergic reactions to MyositisAND (overdose)}} Overdose information on MyositisAND (carcinogenicity)}} Carcinogenicity information on MyositisAND (pregnancy)}} Myositis in pregnancyAND (pharmacokinetics)}} Pharmacokinetics of Myositis


| group9 = Genetics, Pharmacogenomics, and Proteinomics of Myositis | list9 = AND (pharmacogenomics)}} Genetics of MyositisAND (pharmacogenomics)}} Pharmacogenomics of MyositisAND (proteomics)}} Proteomics of Myositis


| group10 = Newstories on Myositis | list10 = Myositis in the newsBe alerted to news on MyositisNews trends on Myositis


| group11 = Commentary on Myositis | list11 = Blogs on Myositis

| group12 = Patient Resources on Myositis | list12 = Patient resources on MyositisDiscussion groups on MyositisPatient Handouts on MyositisDirections to Hospitals Treating MyositisRisk calculators and risk factors for Myositis


| group13 = Healthcare Provider Resources on Myositis | list13 = Symptoms of MyositisCauses & Risk Factors for MyositisDiagnostic studies for MyositisTreatment of Myositis

| group14 = Continuing Medical Education (CME) Programs on Myositis | list14 = CME Programs on Myositis

| group15 = International Resources on Myositis | list15 = Myositis en EspanolMyositis en Francais

| group16 = Business Resources on Myositis | list16 = Myositis in the MarketplacePatents on Myositis

| group17 = Informatics Resources on Myositis | list17 = List of terms related to Myositis


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  1. Talukder RK, Sutradhar SR, Rahman KM, Uddin MJ, Akhter H (2011). "Guillian-Barre syndrome.". Mymensingh Med J. 20 (4): 748–56. PMID 22081202. 
  2. Merino-Ramírez MÁ, Bolton CF (2016). "Review of the Diagnostic Challenges of Lambert-Eaton Syndrome Revealed Through Three Case Reports.". Can J Neurol Sci. 43 (5): 635–47. PMID 27412406. doi:10.1017/cjn.2016.268. 
  3. Gilhus NE (2016). "Myasthenia Gravis.". N Engl J Med. 375 (26): 2570–2581. PMID 28029925. doi:10.1056/NEJMra1602678. 
  4. Ozono K (2016). "[Diagnostic criteria for vitamin D-deficient rickets and hypocalcemia-].". Clin Calcium. 26 (2): 215–22. PMID 26813501. doi:CliCa1602215222 Check |doi= value (help). 
  5. Kamanyire R, Karalliedde L (2004). "Organophosphate toxicity and occupational exposure.". Occup Med (Lond). 54 (2): 69–75. PMID 15020723. 
  6. Pecina CA (2012). "Tick paralysis.". Semin Neurol. 32 (5): 531–2. PMID 23677663. doi:10.1055/s-0033-1334474. 
  7. Bane V, Lehane M, Dikshit M, O'Riordan A, Furey A (2014). "Tetrodotoxin: chemistry, toxicity, source, distribution and detection.". Toxins (Basel). 6 (2): 693–755. PMC 3942760Freely accessible. PMID 24566728. doi:10.3390/toxins6020693. 
  8. Kuntzer T, Hirt L, Bogousslavsky J (1996). "[Neuromuscular involvement and cerebrovascular accidents].". Rev Med Suisse Romande. 116 (8): 605–9. PMID 8848683. 
  9. Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J (2010). "Aging and sequelae of poliomyelitis.". Ann Phys Rehabil Med. 53 (1): 24–33. PMID 19944665. doi:10.1016/j.rehab.2009.10.002. 
  10. West TW (2013). "Transverse myelitis--a review of the presentation, diagnosis, and initial management.". Discov Med. 16 (88): 167–77. PMID 24099672. 
  11. Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients.". J Neurol Sci. 317 (1-2): 35–9. PMID 22482824. doi:10.1016/j.jns.2012.03.003. 
  12. Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. PMID 24365430. doi:10.1016/B978-0-7020-4088-7.00098-5. 
  13. Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. PMC 3746559Freely accessible. PMID 22421697. doi:10.1097/OLQ.0b013e31824ee574. 
  14. Falzarano MS, Scotton C, Passarelli C, Ferlini A (2015). "Duchenne Muscular Dystrophy: From Diagnosis to Therapy.". Molecules. 20 (10): 18168–84. PMID 26457695. doi:10.3390/molecules201018168. 
  15. Filippi M, Preziosa P, Rocca MA (2016). "Multiple sclerosis.". Handb Clin Neurol. 135: 399–423. PMID 27432676. doi:10.1016/B978-0-444-53485-9.00020-9. 
  16. Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group.". Arch Neurol. 51 (1): 61–6. PMID 8274111. 
  17. Riva N, Agosta F, Lunetta C, Filippi M, Quattrini A (2016). "Recent advances in amyotrophic lateral sclerosis.". J Neurol. 263 (6): 1241–54. PMC 4893385Freely accessible. PMID 27025851. doi:10.1007/s00415-016-8091-6. 
  18. Michelle EH, Mammen AL (2015). "Myositis Mimics.". Curr Rheumatol Rep. 17 (10): 63. PMID 26290112. doi:10.1007/s11926-015-0541-0. 

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