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| Dermatomyositis |
Last updated: Nov 19, 2009 |
Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations
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Dermatomyositis is one of a group of acquired muscle diseases called inflammatory myopathies. Symptoms in children and adults are similar, the only distinction being that childhood onset is more likely to be very acute, and adult onset more gradual. Females are more often affected than males.
An acute infection may precede or incite the initial symptoms. Dermatomyositis is characterized by a rash accompanying, or more often, preceding muscle weakness. The rash is described as patchy, bluish-purple discolorations on the face, neck, shoulders, upper chest, elbows, knees, knuckles, and back. Some patients may also develop hardened bumps of calcium deposits under the skin.
The most common symptom is muscle weakness, usually affecting those muscles that are closest to the trunk of the body (proximal). Eventually, patients have difficulty rising from a sitting position, climbing stairs, lifting objects, or reaching overhead. In some cases, distal muscles (those not close to the trunk of the body) may be affected later in the course of the disease. Trouble with swallowing (dysphagia) may occur. Occasionally, the muscles ache and are tender to touch. Patients may also feel fatigue and discomfort and have weight loss or a low-grade fever.
Conventional treatment for dermatomyositis generally consists of a steroid drug called prednisone. For patients in whom prednisone is not effective, other immunosuppressants such as azathioprine and methotrexate may be prescribed. Recently, a drug called intravenous immunoglobulin was shown to be effective and safe in the treatment of the disease. Physical therapy is usually recommended to preserve muscle function and avoid muscle atrophy.
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Signs, symptoms & indicators of Dermatomyositis: | |  | | | | Symptoms - Gas-Int - General | Difficulty swallowing
Counter-indicators:
No difficulty swallowing | Symptoms - General |
Constant fatigue | Symptoms - Head - Mouth/Oral |
Voice change | Symptoms - Metabolic |
Mild/moderate unexplained fevers or unexplained fevers that hit hard or unexplained high fevers
Occasional/frequent unexplained fevers | Symptoms - Muscular |
Individual weak muscles | The muscle weakness may appear suddenly and progress over weeks to months. Patients may have difficulty raising the arms above the shoulders, climbing steps, or arising from a sitting position, and be unable to raise the head from the pillow. Patients may become wheelchair bound or bedridden because of weakness of pelvic and shoulder girdle muscle groups. The flexors of the neck may be severely affected. The muscles of the hands, feet, and face escape involvement. |
Tender muscles | Symptoms - Skeletal |
Joint pain/swelling/stiffness | Symptoms - Skin - Conditions |
Rashes |
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Conditions that suggest Dermatomyositis:
Risk factors for Dermatomyositis:
Dermatomyositis suggests the following may be present:
Recommendations for Dermatomyositis: | |  | | | | Drug | Antibiotics | Dr. Thomas McPherson Brown pioneered the use of low dose antibiotics in the treatment of rheumatologic diseases. He also saw improvement in cases of mixed connective tissue disease, ankylosing spondylitis, dermatomyositis and polymyositis. Minocin (minocycline) is currently the antibiotic of choice. |
| Vitamins |
Vitamin Paba | There have been several cases where paba, taken as "Potaba", caused significant and lasting improvement in those with dermatomyositis. Suppression and reversal of autoimmunity seemed to occur. Doses taken ranged up to 20 grams per day. [N Y State J Med 63: pp.140-4, 1963] |
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KEY |  | Weak or unproven link |  |  | Strong or generally accepted link |  |  | Weakly counter-indicative |  |  | May do some good |  |  | Likely to help |
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