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Flashcards in Inflammatory Myopathy/Myositis Deck (17):

Inflammatory myopathy/Myositis: Definition

Autoimmune disease causing inflammation and degeneration of muscle (unknown cause)


5 types of Myopathy

1. Adult polymyositis (PM)
2. Peddermatomyositis
3. Adult dermatomyositis (DM)- muscle + skin issues
4. Overlap syndrome- PM or DM + 1 other autoimmune dis.
5. Inclusion body myositis- early distal muscle weakness


Who makes the diagnosis

Neurologist and rheumatologist


Items involved in making the diagnosis

1. CPK- elevated (in the 1000s) --> degradation of muscle
2. Troponin levels (breakdown of heart muscle)
3. Muscle biopsy- seeing inflammatory cells (WBC) and muscle degradation
4. EMG- nerve conduction velocity is fine, but no muscle response (cannot recruit)
5. type specific antibodies (ANA in PM)


Medical management

2. high dose steroids
3. clinical drug trials: remicade
4. respiratory care
5. speech and swallowing


PT impairments

1. strength
2. muscle pain (fatigued and broken down)
3. fatigue (unable to recruit all muscle fibers)
4. ROM limitations (hip + knee flexor tightness if non-ambulatory)
5. endurance


Muscle fiber regeneration

the muscles do regenerate, but it ends up having a lot of scar tissue; loss of some muscles you cannot get back


Particular Activity limitation

1. bed mobility
2. transfers
3. ambulation
*all have to do with proximal weakness


Clinical Features

1. symmetrical, proximal muscle weakness (myopathic, may include respiratory muscles)
2. Distal muscle weakness occurs late in dx (except in IBM)
* if hand weakness within a couple weeks of dx, thinking IBM
3. Distinctive rashes (DM)
4. Cardiac involvement (CHF)- look at troponin levels


Labs to check before seeing the Myositis pt

1. Troponin- make sure there is no cardiac ischemia
2. CPK- want these to be declining; if levels are elevating do not see them
3. WBC- clueing you in to if there is a new infection
4. PFTs- what is their respiratory status?


Recovery rate (PM)

only 30% achieve full recovery (most have lingering functional deficits)


5yr survival rate (PM and DM)

90% (other 10% die from respiratory issues)


Long term complications of Corticosteroids

1. osteoporosis
2. avascular necrosis of the hip
3. Steroid myopathy


Problems with the literature

Groups all neuromuscular dx together
comes from MD population
small number of pts included


Strengthening: evidence from the literature

small numbers of sets and reps (3 sets of 10 at 5 R)
Rotate the muscles you're working- avoid CPK elevations


Aerobic Conditioning: evidence from the literature

exercise at 60% HRmax
no on had increased CPK levels
5 min bouts up to 30min 3x/wk
don't do specific aerobics with pt in crisis (everything will be aerobic for them)


Clinical suggestions for this population

1. Positioning devices/PROM exercises (maintain resting muscle length)
2. monitor blood markers for injury/inflammation
3. Target proximal musculature and respiration
4. Keep pts on program forever (lifestyle change)