• Facial Rash
  • Dermatomyositis- Usually involves nasolabial fold
  • SLE - Usually spares the nasolabial fold
  
  

  Posted 08/03/16 09:33:35 AM by Adam Faye

• When evaluating a patient with weakness, also check core strength and neck strength. Extremities may be 5/5 but may find that patient is unable to lift head off the bed.
  
  

  Posted 08/03/16 09:35:02 AM by Adam Faye

• Dermatomyositis: Skin Findings
  • Gottron's Papules (found over bony prominences - usually MCPs, PIPs, DIPs)
  • Heliotrope Rash (violaceous rash without edema in a symmetrical distribution on the face
  • Pokilodermia (atrophy, dyspigmentation, and telangiectasia) can occur on extensor surfaces, V-neck area, upper back (shawl sign), or upper-lateral thighs (holster sign)
  
  Tissue Diagnosis:
  • Biopsy where there is weakness and MRI/EMG evidence of inflammation
  • if you biopsied the skin in dermatomyositis- would show "Interfaced Dermatitis" which is non-specific (can also see this in SLE as well). 
  
  Association between Malignancy and Dermatomyositis:
  • New diagnosis of dermatomyositis - eval for malignancy with CT Chest/A-P. 
  • High association with ovarian Ca
  • Usually increased association with malignancy in first 5 years- as time goes on the association weakens. 
  
  

  Posted 08/03/16 09:40:04 AM by Adam Faye

• 1. Usually Dermatomyositis and Polymyositis are without myalgias
  2. Check medication list- statins can cause autoimmune necrotizing myopathy
  3.  If patient has distal weakness + proximal weakness - think about Inclusion Body Myositis
  4. If ANA generally > 1:40 or 1:80 start to think of underlying autoimmune process 
  
  

  Posted 08/03/16 09:50:00 AM by Adam Faye

• For further reading...

  Dermatomyositis
  
  

  Posted 08/03/16 09:33:51 AM by Adam Faye

Created by Christopher Kelly

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