Idiopathic inflammatory myopathies
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- difficulty with motor tasks
- muscle weakness
- muscle atrophy
- heliotrope rash with eyelid edema
- Gottron papules
Outros fatores diagnósticos
- frequent falls
- fatigue and generalized malaise
- weight loss
- signs of heart failure and/or myocardial infarction, arrhythmias, shortness of breath, abnormal breath sounds, palpitations, syncope
- mild fever
- dysphagia
- myalgia
- arthralgia and/or swollen joint
- facial rash
- erythematous rash
- nail fold changes
- facial muscle weakness
- skin calcinosis
- malignancy
- systemic signs of autoimmune disease
- Raynaud phenomenon
Fatores de risco
- age >40 years
- genetic predisposition
- female sex and/or black ethnicity (polymyositis and dermatomyositis)
- male sex and/or white ethnicity (inclusion body myositis)
- use of statins
- tobacco smoking
- exposure to high intensity of global UV radiation
- infections
- vaccination
- use of certain drugs
- other environmental factors
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- creatine kinase
- electromyograph
- muscle biopsy
- myositis-specific and associated autoantibodies
- magnetic resonance imaging
- aldolase
- lactate dehydrogenase
- alanine aminotransferase
- aspartate aminotransferase
- myoglobin
Investigações a serem consideradas
- erythrocyte sedimentation rate
- C-reactive protein
- antinuclear antibodies
- serum creatinine
- high resolution computed tomography of the lungs
- pulmonary function test
- diffusion capacity
- serum ferritin
- troponins
- electrocardiography
- echocardiography
- cardiac magnetic resonance imaging
- fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography
- muscle ultrasound scan
Algoritmo de tratamento
severe idiopathic inflammatory myopathies: initial presentation
nonsevere idiopathic inflammatory myopathies: initial presentation
remission achieved: any severity
Colaboradores
Autores
Hector Chinoy, PhD, FRCP, BMBS, MSc, BMedSci
Professor of Rheumatology and Neuromuscular Disease
National Institute for Health Research Manchester Biomedical Research Centre
Manchester University NHS Foundation Trust
The University of Manchester
Manchester
UK
Declarações
HC has received grant support from Eli Lilly and UCB; consulting fees from Novartis, Eli Lilly, Orphazyme, AstraZeneca, Pfizer, Kezar Life Science; speaker for UCB and Biogen. He is also an author of several references cited in this topic.
James Lilleker, PhD, MBChB
Consultant Neurologist and Honorary Senior Lecturer
Muscle Disease Unit
Salford Royal Hospital Manchester
Centre for Clinical Neurosciences
Salford
Centre for Musculoskeletal Research
Division of Musculoskeletal and Dermatological Sciences
University of Manchester
Manchester
UK
Declarações
JL has been reimbursed by Roche for consultancy, received sponsored travel and accommodation conference support from Roche, and is on the speakers’ bureau for Sanofi, and is an author of several references cited in this topic.
Choon Guan Chua, MBBS, MRCP (UK), DAvMed (UK), FRCP
Consultant Rheumatologist
Department of Rheumatology, Allergy, and Immunology
Tan Tock Seng Hospital
Singapore
Declarações
CGC declares that he has no competing interests.
Agradecimentos
Dr Hector Chinoy and Dr James Lilleker would like to gratefully acknowledge Dr Nizar Souayah, the previous contributor to this topic.
Declarações
NS declares that he has no competing interests.
Revisores
Hani Kushlaf, MD
Associate Professor of Neurology & Pathology
Director of Neuromuscular Research
University of Cincinnati
College of Medicine
Cincinnati
OH
Declarações
HK has served as a consultant on advisory boards for Alexion AstraZeneca Rare Disease, Argenx, Catalyst, Sanofi, Takeda, Immunovant, and UCB. HS has served for the speaker bureau of Sanofi.
Créditos aos pareceristas
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Declarações
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Referências
Principais artigos
Lundberg IE, Fujimoto M, Vencovsky J, et al. Idiopathic inflammatory myopathies. Nat Rev Dis Primers. 2021 Dec 2;7(1):86. Resumo
Schmidt J. Current classification and management of inflammatory myopathies. J Neuromuscul Dis. 2018;5(2):109-29.Texto completo Resumo
Oldroyd A, Lilleker J, Chinoy H. Idiopathic inflammatory myopathies: a guide to subtypes, diagnostic approach and treatment. Clin Med (Lond). 2017 Jul;17(4):322-8.Texto completo Resumo
Oldroyd AGS, Lilleker JB, Amin T, et al. British Society for Rheumatology guideline on management of paediatric, adolescent and adult patients with idiopathic inflammatory myopathy. Rheumatology (Oxford). 2022 May 5;61(5):1760-8.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Hereditary inclusion body myositis
- Oculopharyngeal muscular dystrophy
- Late-onset distal myopathy
Mais Diagnósticos diferenciaisGuidelines
- Guideline for vaccinations in patients with rheumatic and musculoskeletal diseases
- Guideline for idiopathic inflammatory myopathy-associated cancer screening
Mais Guidelines
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