1
|
Ohad M, Shemer A, Lavie I, Ozeri D, Shoenfeld Y, Kivity S. Intravenous Immunoglobulin for Inflammatory Myositis: Experience in a Tertiary Medical Center. J Clin Rheumatol 2021; 27:e616-e621. [PMID: 32501943 DOI: 10.1097/rhu.0000000000001418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Inflammatory myopathies are treated with glucocorticoids and other immunosuppressive medications. Intravenous immunoglobulin (IVIG) is increasingly used for refractory or severe cases; however, the evidence for their effectiveness is limited. We assessed effectiveness and safety of IVIG when used with other immunomodulatory agents in the treatment of inflammatory myopathies. METHODS This study reviewed records of patients diagnosed with dermatomyositis or polymyositis and treated with IVIG, from 2009 through 2016 in 1 tertiary medical center. Mixed-effects general linear regression models were applied to determine effectiveness of treatment on muscle strength, creatinine phosphokinase levels, and steroid dosage. RESULTS Twenty-three patients with dermatomyositis/polymyositis treated with IVIG were followed up for a mean of 31 (SD, ±25) months. During this period, a significant improvement in muscle strength was demonstrated, with a mean increase of 0.92 Medical Research Council scale points (β = 0.14; confidence interval [CI], 0.136-0.149; p < 0.0001), a significant reduction of creatinine phosphokinase levels and steroid dosage with a mean decrease of 1140 IU/L (β = -0.274; CI, -0.354 to -0.195; p < 0.0001), and 36 mg/d (β = -0.008; CI, -0.011 to -0.006; p < 0.0001), respectively. Overall, remission was observed in 10 patients (43.5%), and partial remission in 6 patients (26%), whereas 1 patient (17%) remained refractory to treatment, and 6 patients (27%) were lost to follow-up. CONCLUSIONS The majority of patients with inflammatory myopathies experienced a clinical and laboratory improvement during IVIG treatment. In addition, a steroid-sparing effect was noticed in most patients. These results encourage the use of IVIG as an alternative treatment option for patients with limited responsiveness to conventional methods.
Collapse
Affiliation(s)
- Maayan Ohad
- From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | | | - Inbar Lavie
- From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | | | | | | |
Collapse
|
2
|
Yang SH, Chang C, Lian ZX. Polymyositis and dermatomyositis - challenges in diagnosis and management. J Transl Autoimmun 2019; 2:100018. [PMID: 32743506 PMCID: PMC7388349 DOI: 10.1016/j.jtauto.2019.100018] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
Polymyositis (PM) and dermatomyositis (DM) are different disease subtypes of idiopathic inflammatory myopathies (IIMs). The main clinical features of PM and DM include progressive symmetric, predominantly proximal muscle weakness. Laboratory findings include elevated creatine kinase (CK), autoantibodies in serum, and inflammatory infiltrates in muscle biopsy. Dermatomyositis can also involve a characteristic skin rash. Both polymyositis and dermatomyositis can present with extramuscular involvement. The causative factor is agnogenic activation of immune system, leading to immunologic attacks on muscle fibers and endomysial capillaries. The treatment of choice is immunosuppression. PM and DM can be distinguished from other IIMs and myopathies by thorough history, physical examinations and laboratory evaluation and adherence to specific and up-to-date diagnosis criteria and classification standards. Treatment is based on correct diagnosis of these conditions. Challenges of diagnosis and management influences the clinical research and practice of Polymyositis and dermatomyositis. Diagnostic criteria have been updated and novel therapies have been developed in PM/DM. Pathogenesis investigation and diagnosis precision improvement may help to guide future treatment strategies.
Collapse
Key Words
- APC, antigen presenting cell
- AZA, Azathioprine
- CAM, cancer associated myositis
- CK, creatine kinase
- DM, dermatomyositis
- Dermatomyositis
- Diagnosis criteria
- EMG, electromyography
- HLA, human leukocyte antigen
- IIM, idiopathic inflammatory myopathies
- ILD, interstitial lung disease
- IV, intravenous
- Idiopathic inflammatory myopathy
- JDM, juvenile dermatomyositis
- MAA, myositis associated antibody
- MAC, membrane attack complex
- MHC, major histocompatibility complex
- MMF, mycophenolate mofetil
- MRI, magnetic resonance imaging
- MSA, myositis specific antibody
- MTX, methotrexate
- MUAP, motor unit action potential
- NAM, necrotizing autoimmune myopathy
- PM, polymyositis
- Polymyositis
- TNF, tumor necrosis factor
- Treatment
- Treg, regulatory T cell
- UVR, ultraviolet radiation
- sIBM, sporadic inclusion body myositis
Collapse
Affiliation(s)
- Shu-Han Yang
- Chronic Disease Laboratory, Institutes for Life Sciences and School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, Davis, CA, USA.,Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Zhe-Xiong Lian
- Chronic Disease Laboratory, Institutes for Life Sciences and School of Medicine, South China University of Technology, Guangzhou, 510006, China
| |
Collapse
|
3
|
Hachulla E, Benveniste O, Hamidou M, Mouthon L, Schleinitz N, Lozeron P, Léger J, Vial C, Viala K. High dose subcutaneous immunoglobulin for idiopathic inflammatory myopathies and dysimmune peripheral chronic neuropathies treatment: observational study of quality of life and tolerance. Int J Neurosci 2016; 127:516-523. [DOI: 10.1080/00207454.2016.1204544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
4
|
Zengin O, Onder ME, Alkan S, Kimyon G, Hüseynova N, Demir ZH, Kısacık B, Onat AM. Three cases of anti-TNF induced myositis and literature review. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 57:590-595. [PMID: 29173693 DOI: 10.1016/j.rbre.2016.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/08/2015] [Indexed: 11/24/2022] Open
Abstract
Anti-tumor necrosis factor drugs are frequently preferred in the treatment of rheumatologic diseases and other inflammatory diseases. The development of myositis after using anti-tumor necrosis factor drugs is a rare clinical condition. Here we aimed to report cases who developed myositis after using anti-tumor necrosis factor drugs and review the current literature. We report two cases of rheumatoid arthritis and a case of ankylosing spondylitis developed idiopathic inflammatory myopathy following anti-tumor necrosis factor therapy. In conclusion, myositis could develop during anti-tumor necrosis factor therapy, so these patients should be evaluated carefully initially for myositis and should be closely monitored due to the potential for developing myositis in treatment process.
Collapse
Affiliation(s)
- Orhan Zengin
- Gaziantep University, School of Medicine, Department of Rheumatology, Gaziantep, Turkey.
| | - Mustafa Erkut Onder
- Gaziantep University, School of Medicine, Department of Rheumatology, Gaziantep, Turkey
| | - Samet Alkan
- Gaziantep University, School of Medicine, Department of Internal Medicine, Gaziantep, Turkey
| | - Gezmiş Kimyon
- Gaziantep University, School of Medicine, Department of Rheumatology, Gaziantep, Turkey
| | - Nergis Hüseynova
- Gaziantep University, School of Medicine, Department of Rheumatology, Gaziantep, Turkey
| | - Zeynep Hanım Demir
- NYU School of Medicine, Center for Cognitive Neurology, New York, United States
| | - Bünyamin Kısacık
- Gaziantep University, School of Medicine, Department of Rheumatology, Gaziantep, Turkey
| | - Ahmet Mesut Onat
- Gaziantep University, School of Medicine, Department of Rheumatology, Gaziantep, Turkey
| |
Collapse
|
5
|
Zengin O, Onder ME, Alkan S, Kimyon G, Hüseynova N, Demir ZH, Kısacık B, Onat AM. Three cases of anti-TNF induced myositis and literature review. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 57:S0482-5004(16)00043-7. [PMID: 27004932 DOI: 10.1016/j.rbr.2015.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/29/2015] [Accepted: 12/08/2015] [Indexed: 01/18/2023] Open
Abstract
Anti-tumor necrosis factor (anti-TNF) drugs are frequently preferred in the treatment of rheumatologic diseases and other inflammatory diseases. The development of myositis after using anti-TNF is a rare clinical condition. Here we aimed to report cases who developed myositis after using anti-TNF and review the current literature. We report two cases of rheumatoid arthritis (RA) and a case of ankylosing spondylitis (AS) developed idiopathic inflammatory myopathy following anti-TNF therapy. In conclusion, myositis could develop during anti-TNF therapy, so these patients should be evaluated carefully initially for myositis and should be closely monitored due to the potential for developing myositis in treatment process.
Collapse
Affiliation(s)
- Orhan Zengin
- Departamento de Reumatologia, Faculdade de Medicina, Gaziantep University, Gaziantep, Turquia.
| | - Mustafa Erkut Onder
- Departamento de Reumatologia, Faculdade de Medicina, Gaziantep University, Gaziantep, Turquia
| | - Samet Alkan
- Departamento de Medicina Interna, Faculdade de Medicina, Gaziantep University, Gaziantep, Turquia
| | - Gezmiş Kimyon
- Departamento de Reumatologia, Faculdade de Medicina, Gaziantep University, Gaziantep, Turquia
| | - Nergis Hüseynova
- Departamento de Reumatologia, Faculdade de Medicina, Gaziantep University, Gaziantep, Turquia
| | - Zeynep Hanım Demir
- Centro de Neurologia Cognitiva, NYU School of Medicine, Nova York, Estados Unidos
| | - Bünyamin Kısacık
- Departamento de Reumatologia, Faculdade de Medicina, Gaziantep University, Gaziantep, Turquia
| | - Ahmet Mesut Onat
- Departamento de Reumatologia, Faculdade de Medicina, Gaziantep University, Gaziantep, Turquia
| |
Collapse
|
6
|
Therapeutic Plasma Exchange in Patients with Neurologic Disorders: Review of 63 Cases. Indian J Hematol Blood Transfus 2016; 33:97-105. [PMID: 28194064 DOI: 10.1007/s12288-016-0661-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/16/2016] [Indexed: 12/16/2022] Open
Abstract
Therapeutic plasma exchange (TPE) is a procedure that reduces circulating autoantibodies of the patients. TPE is commonly used in neurological disorders where autoimmunity plays a major role. We report our experience with regard to the indications, adverse events and outcomes of plasma exchange in neurological disorders. Sixty-three patients were included to this retrospective study. Median age was 48 years (range 1-85), there was a predominance of males. Neurological indications included Guillain-Barrè syndrome (n = 22), myasthenia gravis (n = 21), chronic inflammatory demyelinating polyneuropathy (n = 7), polymyositis (n = 3), multifocal motor neuropathy (n = 2), acute disseminated encephalomyelitis (n = 2), neuromyelitis optica (n = 2), multiple sclerosis (n = 2), limbic encephalitis (n = 1) and transverse myelitis (n = 1). TPE was frontline therapy in 57 % of the patients (n = 36). Total number of TPE sessions was 517; median number of sessions per patient was 8 (range 1-66). TPE was done through a central venous access in 97 % and through a peripheral venous access in 3 % of the patients. Human albumin was used as replacement fluid in 49 %, hydroxyethyl starch (HES) in 49 % and fresh frozen plasma in 2 % of the cases. Adverse reactions were recorded in 60 % of the patients. Total ratio of complications in 517 TPE procedures was 10.8 % and these were mild and manageable such as allergic reactions and hypotension. Overall response rate was 81 %. Interestingly, complication and response rates were similar in both HES and human albumin groups. We conclude that TPE is an effective treatment in neurologic diseases in which autoimmunity plays an important role in the pathogenesis and HES can be used instead of albumin as replacement fluid in these disorders, since it is cost-effective, has similar efficacy and complication rates.
Collapse
|
7
|
Cheng YC, Tsai MY, Chen CJ, Hung YC. Combination therapy of traditional Chinese medicine and Western medicine to treat refractory polymyositis: a case report. J Altern Complement Med 2016; 21:304-6. [PMID: 25955239 DOI: 10.1089/acm.2014.0145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To illustrate the potential for clinical improvement and regimen decrement in treating a patient with a refractory case of polymyositis (PM) with a combination of Western medicine and traditional Chinese medicine (TCM). INTERVENTIONS AND OUTCOME MEASURES A 40-year-old man diagnosed with steroid-resistant PM in January 2011 demonstrated a poor response to immunosuppressants. Complementary TCM treatments were applied to treat his weakness at a clinic integrating TCM and rheumatology in February 2012. He was treated with herbal formula powders named "Bu-Zhong-Yi-Qi-Tang" and "Si-Jun-Zi-Tan." Within 1 month of treatment, the patient seemed to show significant improvement in the grade of disability. Daily doses of methotrexate and methylprednisolone were tapered to 25% and 95.8% after TCM treatments, respectively. Creatine phosphokinase also decreased from 6655 to 718 U/L until December 2013. CONCLUSIONS In our experience, weakness related to PM can be improved by invigorating the spleen-Qi with TCM treatments. This might indicate that TCM treatments can not only play a role in symptom control but also accelerate steroid tapping for refractory cases. Long-term follow-up and future experimental studies are warranted to examine the efficacy and explore the mechanism of TCM treatments for PM.
Collapse
Affiliation(s)
- Yu-Chen Cheng
- 1 Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung, Taiwan
| | | | | | | |
Collapse
|
8
|
Omotoso BA, Ogden MI, Balogun RA. Therapeutic plasma exchange in antisynthetase syndrome with severe interstitial lung disease. J Clin Apher 2015; 30:375-9. [DOI: 10.1002/jca.21387] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/09/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Bolanle A. Omotoso
- Division of Nephrology; University of Virginia; Charlottesville Virginia
- Department of Medicine; Obafemi Awolowo University Teaching Hospitals' Complex; Ile - Ife Osun State Nigeria
| | - Melissa I. Ogden
- School of Medicine; University of Virginia; Charlottesville Virginia
| | - Rasheed A. Balogun
- Division of Nephrology; University of Virginia; Charlottesville Virginia
| |
Collapse
|
9
|
Ameye H, Ruttens D, Benveniste O, Verleden G, Wuyts W. Is Lung Transplantation a Valuable Therapeutic Option for Patients With Pulmonary Polymyositis? Experiences From the Leuven Transplant Cohort. Transplant Proc 2014; 46:3147-53. [DOI: 10.1016/j.transproceed.2014.09.163] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Kurita T, Yasuda S, Amengual O, Atsumi T. The efficacy of calcineurin inhibitors for the treatment of interstitial lung disease associated with polymyositis/dermatomyositis. Lupus 2014; 24:3-9. [DOI: 10.1177/0961203314554849] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Interstitial lung disease (ILD) in patients with polymyositis (PM) and dermatomyositis (DM) is often resistant to treatment and life threatening, being recognized as one of the severest complication in these autoimmune disorders. Patients with clinically amyopathic dermatomyositis (CADM) or those with anti-CADM140/MDA5 antibody are especially prone to develop rapidly progressive interstitial pneumonia. We retrospectively analyzed 46 patients with PM/DM admitted to our hospital and identified DM, rapidly progressive disease, honeycomb lung, CADM and extensive ILD as risk factors for recurrence or death. In the presence of two or more risk factors, the sensitivity and specificity for the prediction of death or relapse were 81.3% and 76.7%, respectively. Calcineurin inhibitors have been widely used as induction and maintenance therapy for PM/DM-associated ILD. Recently we reported the benefit of tacrolimus on the disease-free survival and event-free survival of the patients with PM/DM-associated ILD. Among those patients treated with tacrolimus, poor prognostic factors for death, recurrence or severe adverse event were identified as acute progression of the disease, honeycomb lung, forced vital capacity (FVC) less than 80% and having DM. The potential effectiveness of an intensive therapy protocol with triple therapy that comprises high-dose corticosteroids, calcineurin inhibitors and cyclophosphamide has been reported.
Collapse
Affiliation(s)
- T Kurita
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - S Yasuda
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - O Amengual
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Atsumi
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
11
|
Therapeutic plasma exchange in treatment of neuroimmunologic disorders: Review of 92 cases. Transfus Apher Sci 2013; 49:174-80. [DOI: 10.1016/j.transci.2013.02.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 12/19/2012] [Accepted: 02/13/2013] [Indexed: 11/18/2022]
|
12
|
Abstract
A 59-year-old man presented with a history of dysphagia and generalized myalgia and muscle weakness and a rash on the face, neck, and upper arms. Serum muscle enzymes, myoglobin, C-reactive protein, and erythrocyte sedimentation rate were elevated and antinuclear antibodies positive. Electromyographic conduction studies showed pathological changes on arm and leg muscles and magnetic resonance imaging of the oral and neck muscles. A diagnosis of dermatomyositis with severe esophageal involvement was established. Treatment with prednisolone was started and methotrexate added. Enteral feeding with a percutaneous endoscopic gastrostomy was started and a therapy with intravenous immunoglobulin (IVIG) initiated, which caused a rapid improvement of the patient's ability to swallow. This case demonstrates a patient with polymyositis/dermatomyositis who showed steroid-resistant life-threatening esophageal impairment. IVIG resulted in a dramatic improvement of symptoms.
Collapse
|
13
|
The future of immunoglobulin therapy: An overview of the 2nd international workshop on natural antibodies in health and disease. Autoimmun Rev 2013; 12:639-42. [DOI: 10.1016/j.autrev.2013.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 01/25/2013] [Indexed: 12/12/2022]
|
14
|
|
15
|
Sánchez-Fernández SÁ, Carrasco Fernández JA, Rojas Vargas LM. Eficacia de rituximab en dermatomiositis y polimiositis refractarias al tratamiento convencional. ACTA ACUST UNITED AC 2013; 9:117-9. [DOI: 10.1016/j.reuma.2012.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/21/2012] [Accepted: 02/23/2012] [Indexed: 10/26/2022]
|
16
|
The Use of Methotrexate in Dermatology / Upotreba metotreksata u dermatologiji. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2011. [DOI: 10.2478/v10249-011-0045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Methotrexate is a cytotoxic antimetabolite agent and a folic acid antagonist. Except for its use in oncology and rheumatology, it is widely used in dermatology. The most important indications include severe forms of psoriasis, but also a wide range of autoimmune diseases and dermatoses with different etiology and pathophysiology such as: bullous pemphigoid, dermatomyositis, pityriasis rubra pilaris, sarcoidosis, T-cell lymphomas, Behcet’s disease, adult atopic eczema, scleroderma, Reiter’s syndrome and many others. For dermatological indications methotrexate is usually taken in low oral doses, 5-25 mg once a week. In certain diseases it can be applied to the lesion itself, or in the form of local preparations. Considering the fact that numerous drugs affect various metabolic phases of methotrexate and may increase its toxicity, it is of utmost importance to consider other prescribed drugs, especially certain antibiotics, nonsteroidal antiinflammatory drugs, antiepileptic drugs, retinoids, proton pump inhibitors and so on. If the selection of patients is correct, if drugs are taken regularly and laboratory monitoring is included, methotrexate is a truly efficient and safe drug that can be taken for months or years if necessary.
Collapse
|
17
|
Chawla J. Stepwise approach to myopathy in systemic disease. Front Neurol 2011; 2:49. [PMID: 21886637 PMCID: PMC3153853 DOI: 10.3389/fneur.2011.00049] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 07/14/2011] [Indexed: 12/18/2022] Open
Abstract
Muscle diseases can constitute a large variety of both acquired and hereditary disorders. Myopathies in systemic disease results from several different disease processes including endocrine, inflammatory, paraneoplastic, infectious, drug- and toxin-induced, critical illness myopathy, metabolic, and myopathies with other systemic disorders. Patients with systemic myopathies often present acutely or sub acutely. On the other hand, familial myopathies or dystrophies generally present in a chronic fashion with exceptions of metabolic myopathies where symptoms on occasion can be precipitated acutely. Most of the inflammatory myopathies can have a chance association with malignant lesions; the incidence appears to be specifically increased only in patients with dermatomyositis. In dealing with myopathies associated with systemic illnesses, the focus will be on the acquired causes. Management is beyond the scope of this chapter. Prognosis is based upon the underlying cause and, most of the time, carries a good prognosis. In order to approach a patient with suspected myopathy from systemic disease, a stepwise approach is utilized.
Collapse
Affiliation(s)
- Jasvinder Chawla
- Chief of Neurology, Hines VA Hospital and Neurology Residency Program Director, Loyola University Medical Center Hines, IL, USA
| |
Collapse
|
18
|
Inflammatory or necrotizing myopathies, myositides and other acquired myopathies, new insight in 2011. Presse Med 2011; 40:e197-8. [DOI: 10.1016/j.lpm.2011.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|