Polymyositis and dermatomyositis physical examination

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

Physical Examination

• Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for:[finding 1], [finding 2], and [finding 3].
• The presence of gottron's papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis.

Appearance of the Patient

• Patients with polymyositis and dermatomyositis usually appear normal. They might be weak in severe cases.

Vital Signs

• Low-grade fever

Skin

• Skin eruptions like:
  • Gottron's papules is pathognomonic of dermatomyositis.
  • Heliotrope eruption is pathognomonic of dermatomyositis.
  • Gottron's sign
  • Facial erythema
  • Photodistributed poikiloderma
  • Nailfold changes
  • Scalp involvement
  • Calcinosis cutis
  • Mechanic's hands
  • Cutaneous ulceration
• Skin manifestations of dermatomyositis can be divided into 5 categories:

Lesion	Location	Picture	Percentage	Pathognomonic	highly characteristic	characteristic	more common in JDM	rare in DM
Gottron papules	Dorsal aspect of interphalangeal or metacarpophalangeal joints		80%	+
Heliotrope rash	Eyelids and periorbital tissue				+
Gottron sign	dorsal aspect of the interphalangeal or metacarpophalangeal joints, olecranon process, patella, and medial malleoli					+
Macular violaceous erythema	Symmetric distribution in classic areas					+
shawl sign	Nape of the neck, shoulders, and upper back					+
“V sign”	V-shaped region of the neck and upper chest					+
Linear extensor erythema	Extensor aspects of the legs, thighs, arms, fingers, hands, and feet					+
Mechanic’s hands	Palms and fingers					+
Nail abnormalities	nail fold telangiectasias, cuticular overgrowth, and prominent periungual erythema	30-60%
Pruritus
Cutaneous calcinosis	Sites of compression, such as elbows and buttocks						30-70%	10%

HEENT

• Periorbital swelling

Neck

• Neck examination of patients with polymyositis and dermatomyositis is usually normal.

Lungs

• Asymmetric chest expansion
• Lungs are hypo/hyperresonant
• Fine crackles upon auscultation of the lung bilaterally
• Wheezing may be present

Heart

• Cardiovascular examination of patients with polymyositis and dermatomyositis is usually normal.

Abdomen

• Abdominal examination of patients with polymyositis and dermatomyositis is usually normal.

Back

• Back examination of patients with polymyositis and dermatomyositis is usually normal.

Genitourinary

• Genitourinary examination of patients with polymyositis and dermatomyositis is usually normal.

Neuromuscular

• Patient is usually oriented to persons, place, and time
• Symmetric proximal muscle weakness mostly in:
  • Deltoids
  • Hips
  • Neck flexors
• Mild distal muscle weakness

• Hyporeflexia / areflexia
• Muscle rigidity

Extremities

• Muscle atrophy in severe, long standing disease
• Fasciculations in the upper/lower extremity