Differentiating dermatomyositis from other diseases: Difference between revisions

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(Created page with "__NOTOC__ {{Dermatomyositis}} {{CMG}} ==Overview== Dermatomyositis must be differentiated from other common, lymphocyte predominant inflammatory myopathies. [[Hypothyroidism]...")
 
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*[[Hypothyroidism]]
*[[Hypothyroidism]]
*[[Sarcoidosis]]
*[[Sarcoidosis]]
{| class="wikitable"
!Disease
!Differentiating signs and symptoms
!Diagnostic findings
|-
|[[Fibromyalgia]]
|
* Symptoms have been present at a similar level for at least 3 months.
* Chronic [[musculoskeletal pain]] with multiple tender points
* [[Stiffness]], [[numbness]], and [[fatigue]]
* [[Headaches]]
* [[Sleep disorder]]
|
*All lab tests are normal
|-
|[[Rheumatoid arthritis]]
|
* Multiple [[joint swelling]]
* Morning [[stiffness]]
* [[Rheumatoid nodules]]
|
* [[Rheumatoid factor|RF]] or [[Anti-citrullinated protein antibody|anti-cyclic citrullinated protein (CCP) antibody]] is positive.
* Markers of systemic inflammation ([[ESR]], [[CRP]]) are typically elevated.
|-
|[[SLE]]
|
* [[Maculopapular rash]]
* Multi-system involvement
|
*Positive anti-Smith [[antibodies]]
|-
|[[Chronic fatigue syndrome]]
|Fatigue plus 4 of the following symptoms:
*Short-term [[memory loss]]
*[[Sore throat]]
*Tender [[lymph nodes]] in the neck or armpit
*[[Muscle pain]]
*[[Joint pain]] without [[swelling]] or [[Redness of the skin|redness]]
*[[Headaches]]
*[[Insomnia]]
*[[Malaise]]
|
*Diagnosis of exclusions
*Symptoms must present for more than 6 months
|-
|[[Spondyloarthritis]]
|
* [[Axial skeleton|Axial skeletal]] pain and [[stiffness]]
* Restricted spinal motion
|
* Elevated [[ESR]] or [[CRP]]
* Negative [[RF]]
* [[Bamboo spine]] on [[x-ray]]
|-
|[[Polymyalgia rheumatica]]
|
* Older at onset
* Generalized [[stiffness]]
|
* An elevated [[erythrocyte sedimentation rate]] ([[ESR]]) OR [[C-reactive protein]] (CRP)
* Response to [[corticosteroids]]
|-
|[[Osteoarthritis]]
|
* Localized [[joint pain]]
* Restricted to affect joints
* Older at onset
|
* [[X-ray]] of the involved joints demonstrate degenerative changes
|-
|[[Hypothyroidism]]
|
*Systemic symptoms such as [[weight gain]], [[constipation]], [[dry skin]]
*[[Myalgia|Muscular aching]] and prominent [[fatigue]] that improves on replacement of [[thyroid hormone]].
|
*[[TSH]] is elevated and free [[T4]] is low.
|-
|Myopathaies ([[polymyositis]] and [[dermatomyositis]])
|
*Pelvic and shoulder girdle [[muscle weakness]]
*[[Rash]]
|
*[[Muscle biopsy]] confirms the diagnosis
*Elevated [[CPK|CPK enzyme]]
|-
|[[Neuropathy]]
|
*[[Numbness]] and [[tingling]]
*[[Paresthesia]]
|
*Abnormal [[EMG]]
|}


==References==
==References==

Revision as of 18:44, 14 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Dermatomyositis must be differentiated from other common, lymphocyte predominant inflammatory myopathies. Hypothyroidism and sarcoidosis have some symptoms in common with dermatomyositis, and therefore need to be ruled out.

Differentiating Dermatomyositis from other Diseases

Dermatomyositis must be differentiated from other common, lymphocyte predominant inflammatory myopathies. If present, the characteristic perifascicular atrophy makes this distinction trivial.

There is some overlap in the microscopic appearances of different inflammatory myopathies, but some helpful differences are often present.[2] The rimmed vacuoles of inclusion body myositis (IBM) are absent in dermatomyositis. Polymyositis is characterised by diffuse or patchy inflammation of the muscle fascicles, a random pattern of muscle atrophy, and T-cell predominance with T-cells seen invading otherwise viable appearing muscle fibers.[3]

Diseases that can present with similar symptoms as those of dermatomyositis are-

Disease Differentiating signs and symptoms Diagnostic findings
Fibromyalgia
  • All lab tests are normal
Rheumatoid arthritis
  • Markers of systemic inflammation (ESR, CRP) are typically elevated.
SLE
Chronic fatigue syndrome Fatigue plus 4 of the following symptoms:
  • Diagnosis of exclusions
  • Symptoms must present for more than 6 months
Spondyloarthritis
Polymyalgia rheumatica
Osteoarthritis
  • Localized joint pain
  • Restricted to affect joints
  • Older at onset
  • X-ray of the involved joints demonstrate degenerative changes
Hypothyroidism
  • TSH is elevated and free T4 is low.
Myopathaies (polymyositis and dermatomyositis)
Neuropathy

References

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