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Polymyositis Differential Diagnosis

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1. Polymyositis without Beneficial Response to Steroid Therapy: Should Miyoshi Myopathy be a Differential Diagnosis? (PubMed)

Polymyositis without Beneficial Response to Steroid Therapy: Should Miyoshi Myopathy be a Differential Diagnosis? BACKGROUND Miyoshi myopathy (MM) is an autosomal-recessive muscle disorder caused by mutations in the DYSF gene. Clinical features and histopathological changes in dysferlinopathies may mimic inflammatory myopathies and a high degree of clinical suspicion is required to guide the genetic investigation. CASE REPORT We report the case of a 16-year-old male who presented with severe (...) bilateral calf pain and elevated CK levels (15 000 IU/l) who was on prolonged steroid therapy prompted by the clinical suspicion of inflammatory myopathy. Three years into his illness, he was referred for neuromuscular evaluation presenting with untreatable muscle pain and progressive weakness. The diagnosis of "refractory polymyositis" was revisited. Targeted exome sequencing revealed homozygous pathogenic mutations in the DYSF gene, confirming a diagnosis of Miyoshi myopathy. CONCLUSIONS Our case

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2017 The American journal of case reports

2. [18F]Florbetapir positron emission tomography: identification of muscle amyloid in inclusion body myositis and differentiation from polymyositis. (PubMed)

[18F]Florbetapir positron emission tomography: identification of muscle amyloid in inclusion body myositis and differentiation from polymyositis. With the tools available currently, confirming the diagnosis of inclusion body myositis (IBM) can be difficult. Many patients are initially misdiagnosed with polymyositis (PM). In this observational study at a UK adult neuromuscular centre, we investigated whether amyloid positron emission tomography could differentiate between IBM and PM.Ten patients (...) compared with PM for all assessed regions (total-[18F]florbetapir standardised uptake value ratio 1.45 (1.28 to 2.05) vs 1.01 (0.80 to 1.22), p=0.005). For total-[18F]florbetapir standardised uptake value ratios≥1.28, sensitivity and specificity for IBM was 80% and 100%, respectively.[18F]florbetapir amyloid positron emission tomography differentiates IBM from PM. Successful development could facilitate accurate diagnosis, inclusion in clinical trials and help avoid unnecessary exposure to potentially

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2019 Annals of the Rheumatic Diseases

3. Polymyositis Differential Diagnosis

Polymyositis Differential Diagnosis Polymyositis Differential Diagnosis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Polymyositis (...) Differential Diagnosis Polymyositis Differential Diagnosis Aka: Polymyositis Differential Diagnosis , Dermatomyositis Differential Diagnosis , Myopathy Causes , Muscle Weakness Causes From Related Chapters II. Differential Diagnosis: Cutaneous (Dermatomyositis) (once occurs) Polymorphous light eruption Trichinosis III. Differential Diagnosis: Neuromuscular Disorders tic Spinal Muscular Atrophy Eaton Lambert Syndrome Myotonia See Guillain-Barre (other autoimmune polyneuropathies) Porphyria IV. Differential

2018 FP Notebook

4. Circulating plasma microRNA profiling in patients with polymyositis/dermatomyositis before and after treatment: miRNA may be associated with polymyositis/dermatomyositis (PubMed)

individuals. The level of plasma hsa-miR-4442 was positively correlated with Skeletal Disease Activity in MITAX (Myositis Intention to Treat Activity Index).This is the first report describing plasma miRNA expression profiles in PM/DM patients. The present data suggest that plasma levels of miRNAs may be associated with polymyositis/dermatomyositis and hsa-miR-4442 could be used as a biomarker for PM/DM diagnosis and/or disease activity. (...) Circulating plasma microRNA profiling in patients with polymyositis/dermatomyositis before and after treatment: miRNA may be associated with polymyositis/dermatomyositis MicroRNAs (miRNAs) are involved in the regulation of key biological processes and have been implicated in various diseases, including autoimmune disorders. The pathogenesis of polymyositis (PM) and dermatomyositis (DM) is considered to be mediated by autoimmune reactions. To determine miRNA role in the development

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2018 Inflammation and regeneration

5. Atorvastatin-induced necrotizing autoimmune myositis: An emerging dominant entity in patients with autoimmune myositis presenting with a pure polymyositis phenotype. (PubMed)

for atorAIM. Statin-induced AIM should be included in the differential diagnosis of asymptomatic hyperCKemia. Three patterns of MAC deposition, while nonpathognomonic, were pathological clues to atorAIM. AtorAIM was uniformly corticosteroid resistant but responsive to IVIG as induction and maintenance therapy. (...) Atorvastatin-induced necrotizing autoimmune myositis: An emerging dominant entity in patients with autoimmune myositis presenting with a pure polymyositis phenotype. The general aim of this study was to evaluate the disease spectrum in patients presenting with a pure polymyositis (pPM) phenotype. Specific objectives were to characterize clinical features, autoantibodies (aAbs), and membrane attack complex (MAC) in muscle biopsies of patients with treatment-responsive, statin-exposed necrotizing

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2017 Medicine

6. Polymyositis with elevated serum IgG4 levels and abundant IgG4+ plasma cell infiltration: A case report and literature review. (PubMed)

differential diagnosis. Herein, we report the first case of PM with elevated serum IgG4 levels and IgG4 plasma cells in the muscles, mimicking IgG4-RD.A 73-year-old woman visited our hospital because of proximal muscle weakness of both thighs. Her blood test showed high levels of serum creatinine kinase, aldolase, and IgG4. Magnetic resonance imaging of the thighs showed muscle edema. Needle electromyography showed findings typical of myositis. Histological analysis of her left quadriceps revealed (...) Polymyositis with elevated serum IgG4 levels and abundant IgG4+ plasma cell infiltration: A case report and literature review. Polymyositis (PM) is a type of autoimmune, inflammatory myopathy. IgG4-related disease (IgG4-RD) is a recently recognized disease entity characterized by elevated serum IgG4 levels and IgG4 plasma-cell infiltration of various organs. However, several reports have described cases of other diseases that present with those features, suggesting the importance of careful

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2017 Medicine

7. Polymyositis Differential Diagnosis

Polymyositis Differential Diagnosis Polymyositis Differential Diagnosis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Polymyositis (...) Differential Diagnosis Polymyositis Differential Diagnosis Aka: Polymyositis Differential Diagnosis , Dermatomyositis Differential Diagnosis , Myopathy Causes , Muscle Weakness Causes From Related Chapters II. Differential Diagnosis: Cutaneous (Dermatomyositis) (once occurs) Polymorphous light eruption Trichinosis III. Differential Diagnosis: Neuromuscular Disorders tic Spinal Muscular Atrophy Eaton Lambert Syndrome Myotonia See Guillain-Barre (other autoimmune polyneuropathies) Porphyria IV. Differential

2015 FP Notebook

8. Comprehensive assessment of myositis-specific autoantibodies in polymyositis/dermatomyositis-associated interstitial lung disease. (PubMed)

Comprehensive assessment of myositis-specific autoantibodies in polymyositis/dermatomyositis-associated interstitial lung disease. Myositis-specific autoantibodies (MSAs) are associated with clinical phenotypes in polymyositis/dermatomyositis (PM/DM). No study has investigated the clinical features based on comprehensive MSA assessment in PM/DM-associated interstitial lung disease (ILD). We aimed to determine the practical significance of MSAs in PM/DM-ILD.Sixty consecutive PM/DM-ILD patients (...) were retrospectively analysed. Serum MSAs were comprehensively measured using immunoprecipitation assay. Clinical features and prognosis were compared among MSA subgroups.Twenty-six (43.3%) PM/DM-ILD patients were anti-aminoacyl tRNA-synthetase antibody-positive (anti-ARS-positive), 15 (25.0%) were anti-melanoma differentiation-associated gene 5 antibody-positive (anti-MDA5-positive), 3 (5%) were anti-signal recognition particle antibody-positive, 1 (1.7%) was anti-transcriptional intermediary

2016 Respiratory medicine

9. Primary Idiopathic Polymyositis

, thigh, or calf aching (10%) Tenderness to palpation (20%) VI. Symptoms: Other (25%) Weakness of extensor neck muscles Respiratory (5%) Cardiac involvement (30%) (EKG) change or arrhythmia secondary to VII. Signs Proximal Distal muscle sparing in 75% Muscles tender to palpation with signs of atrophy slow and waddling VIII. Differential Diagnosis See IX. Evaluation See X. Management See XI. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing (...) Primary Idiopathic Polymyositis Primary Idiopathic Polymyositis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Primary Idiopathic

2018 FP Notebook

10. Polymyositis

- Nondestructive or Pathologic inflammatory signs Systemic inflammation signs over 37 C at axilla increased >20 mm/hour IV. Differential Diagnosis See V. Evaluation See VI. Management See VII. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Polymyositis." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Ontology: Polymyositis (C0085655) Definition (...) Chapters II. Types Type 1: (33%) Type 2: (25%) Type 3: Neoplasia related Type 4: Childhood disease with Type 5: Collagen Vascular disease related Type 6: Miscellaneous (Inclusion body, ic) III. Diagnostic Criteria Diagnosis Four or more findings seen in Polymyositis (below) Cutaneous findings suggestive of Polymyositis Diagnosis (4 or more criteria below) Proximal (trunk, thighs, s) Increased serum or Aldolase Muscle pain on grasping or spontaneously EMG myogenic changes (see ) Positive anti

2018 FP Notebook

11. Diagnosis of Idiopathic Pulmonary Fibrosis

be in the differential diagnosis of acute respiratory worsening, chest CT angiography should be obtained to detect pulmonary embolus, either alone or in addition to a noncontrast HRCT protocol, limited to supine acquisitions. A second major goal is to detect new ground-glass changes that raise the probability of acute exacerbation. HRCT Features of the UIP Pattern HRCT features frequently seen in UIP include honeycombing, traction bronchiectasis, and traction bronchiolectasis, which may be seen with the concurrent (...) Diagnosis of Idiopathic Pulmonary Fibrosis AMERICANTHORACICSOCIETY DOCUMENTS DiagnosisofIdiopathic PulmonaryFibrosis An Of?cial ATS/ERS/JRS/ALAT Clinical Practice Guideline Ganesh Raghu, Martine Remy-Jardin, Jeffrey L. Myers, Luca Richeldi, Christopher J. Ryerson, David J. Lederer, Juergen Behr, Vincent Cottin, Sonye K. Danoff, Ferran Morell, Kevin R. Flaherty, Athol Wells, Fernando J. Martinez, Arata Azuma, Thomas J. Bice, Demosthenes Bouros, Kevin K. Brown, Harold R. Collard, Abhijit Duggal

2018 American Thoracic Society

12. Tocilizumab in the Treatment of Refractory Polymyositis and Dermatomyositis

Tocilizumab in the Treatment of Refractory Polymyositis and Dermatomyositis Tocilizumab in the Treatment of Refractory Polymyositis and Dermatomyositis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more (...) . Tocilizumab in the Treatment of Refractory Polymyositis and Dermatomyositis (TIM) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT02043548 Recruitment Status : Recruiting First Posted : January 23, 2014 Last Update Posted

2014 Clinical Trials

13. The concurrent association of inflammatory polymyositis and Crohn's ileo-colitis in a Sri Lankan man: a case report of a rare association and literature review. (PubMed)

manifestation of Crohn's disease and can be used in the differential diagnosis of corticosteroid or hypokalemia-induced myopathy in Crohn's disease. (...) The concurrent association of inflammatory polymyositis and Crohn's ileo-colitis in a Sri Lankan man: a case report of a rare association and literature review. Crohn's disease is a relapsing, systemic inflammatory disease affecting the gastrointestinal tract with associated extraintestinal manifestations and immune disorders. Among the few cases reported, the association of Crohn's disease with polymyositis varies in its complexity and severity. We report here the first known case

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2014 BMC Gastroenterology

14. Clinical and laboratory features distinguishing juvenile polymyositis and muscular dystrophy. (PubMed)

Clinical and laboratory features distinguishing juvenile polymyositis and muscular dystrophy. To differentiate juvenile polymyositis (PM) and muscular dystrophy, both of which may present with chronic muscle weakness and inflammation.We studied 39 patients with probable or definite juvenile PM and 9 patients with muscular dystrophies who were initially misdiagnosed as having juvenile PM. Differences in demographic, clinical, and laboratory results; outcomes; and treatment responses were (...) evaluated by Fisher's exact and rank sum tests. Random forests classification analysis and logistic regression were performed to examine significant differences in multivariable models.Clinical features and serum muscle enzyme levels were similar between juvenile PM and dystrophy patients, except 89% of dystrophy patients had muscle atrophy compared with 46% of juvenile PM patients. Dystrophy patients had a longer delay to diagnosis (median 12 versus 4 months) and were less frequently hospitalized than

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2013 Arthritis care & research

15. Diagnosis and Management of Immune-Mediated Myopathies. (PubMed)

by a necrotizing pathologic process with no or minimal inflammation in muscle. The recent discovery of antibodies associated with specific subtypes of autoimmune myopathies has played a major role in characterizing these diseases. Although diagnostic criteria and classification of IMMs currently are under revision, on the basis of the clinical and muscle histopathologic findings, IMMs can be differentiated as NAM, inclusion body myositis (IBM), dermatomyositis, polymyositis, and nonspecific myositis. Because (...) Diagnosis and Management of Immune-Mediated Myopathies. Immune-mediated myopathies (IMMs) are a heterogeneous group of acquired muscle disorders characterized by muscle weakness, elevated creatine kinase levels, and myopathic electromyographic findings. Most IMMs feature the presence of inflammatory infiltrates in muscle. However, the inflammatory exudate may be absent. Indeed, necrotizing autoimmune myopathy (NAM), also called immune-mediated necrotizing myopathy, is characterized

2017 Mayo Clinic Proceedings

16. Diagnosis and management of thrombocytopenic purpura and other thrombotic microangiopathies

the diagnosis and monitor the course of the disease and possible need for additional treatments. Table 1. Differential diagnosis of thrombocytopenia and microangiopathic haemolytic anaemia Autoimmune haemolysis/Evans syndrome Disseminated intravascular coagulation Pregnancy‐associated e.g. HELLP (haemolysis, elevated liver enzymes and low platelets), eclampsia, haemolytic uraemic syndrome Drugs eg quinine, simvastatin, interferon, Calcineurin inhibitors Malignant hypertension Infections, typically viral (...) to differentiate between D + HUS, atypical HUS and TTP because the prognosis and management are different (Table ). The reader is referred to (Ariceta et al , ) and (Taylor et al , ) for further guidance in children and adults, respectively. Table 5. Differential Diagnosis of haemolytic uraemic syndrome Infection (diarrhoea‐positive) Shiga & verocytoxin (Shiga‐like toxin)‐producing bacteria Disorders of complement regulation (diarrhoea‐negative) Genetic disorders of complement regulation e.g. Factor H, I, MCP

2012 British Committee for Standards in Haematology

17. Primary Idiopathic Polymyositis

, thigh, or calf aching (10%) Tenderness to palpation (20%) VI. Symptoms: Other (25%) Weakness of extensor neck muscles Respiratory (5%) Cardiac involvement (30%) (EKG) change or arrhythmia secondary to VII. Signs Proximal Distal muscle sparing in 75% Muscles tender to palpation with signs of atrophy slow and waddling VIII. Differential Diagnosis See IX. Evaluation See X. Management See XI. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing (...) Primary Idiopathic Polymyositis Primary Idiopathic Polymyositis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Primary Idiopathic

2015 FP Notebook

18. Polymyositis

- Nondestructive or Pathologic inflammatory signs Systemic inflammation signs over 37 C at axilla increased >20 mm/hour IV. Differential Diagnosis See V. Evaluation See VI. Management See VII. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Polymyositis." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Ontology: Polymyositis (C0085655) Definition (...) Chapters II. Types Type 1: (33%) Type 2: (25%) Type 3: Neoplasia related Type 4: Childhood disease with Type 5: Collagen Vascular disease related Type 6: Miscellaneous (Inclusion body, ic) III. Diagnostic Criteria Diagnosis Four or more findings seen in Polymyositis (below) Cutaneous findings suggestive of Polymyositis Diagnosis (4 or more criteria below) Proximal (trunk, thighs, s) Increased serum or Aldolase Muscle pain on grasping or spontaneously EMG myogenic changes (see ) Positive anti

2015 FP Notebook

19. HIV-1 Associated Neuromuscular Complications (Diagnosis) (Diagnosis)

infection. Early diagnosis and treatment are important. Improvement of zidovudine (AZT) myopathy begins several months after dose reduction or discontinuation. Recovery may be incomplete, however. Previous Next: Clinical Presentation The following may be evident in early HIV infection: Nemaline rod myopathy - Slowly progressive weakness and wasting, negative family history, possibly autoimmune Immune-mediated polymyositis and dermatomyositis - Similar presentation as in non-HIV patients; usually (...) , demonstrating necrosis and inflammation. HIV-related myopathy must be differentiated from toxin-related (zidovudine) myopathies. Previous Next: Differential Diagnosis The differential diagnosis of HIV-associated myopathies includes the following: Reiter's Syndrome Psoriatic Arthritis Other problems to be considered include hereditary adult-onset myopathies, viral myositis, deep venous thrombosis, rhabdomyolysis caused by severe illness, and non-Hodgkin lymphoma. Previous Next: Diagnostic Testing The workup

2014 eMedicine.com

20. Polymyositis and Dermatomyositis

[which are less specific than CK]) Characteristic electromyographic or MRI muscle abnormalities Muscle biopsy changes (the definitive test) Muscle biopsy findings can be variable, but chronic inflammation and muscle degeneration and regeneration are typical. A definite diagnosis made by muscle biopsy is recommended before treatment of polymyositis to exclude other muscle disorders, such as those due to missing or defective enzymes and postviral rhabdomyolysis. Muscle biopsy is not usually necessary (...) for dermatomyositis. To establish the diagnosis, look for characteristic rash, muscle weakness, elevated CK level, and muscle changes on electromyography or MRI. Unless patients have the characteristic skin findings, do a muscle biopsy to confirm the diagnosis. Consider screening patients ≥ 40 yr with dermatomyositis and patients ≥ 60 yr with polymyositis for cancer. Treat patients with corticosteroids and other immunosuppressants. Last full review/revision February 2018 by Alana M. Nevares, MD NOTE

2013 Merck Manual (19th Edition)

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