ABSTRACT
INTRODUCTION: In patients with idiopathic inflammatory myopathies (IIM), magnetic resonance imaging (MRI) has been proposed as a useful tool for diagnosis and follow-up. It may identify muscle inflammation (edema) and fatty infiltration for evaluation of disease activity and damage. Little information is available on the role of MRI in assessment of large cohorts of adult patients with IIM. METHODS: Fifty-one patients underwent MRI of the thigh muscles, laboratory tests, and clinical evaluation, including Physician Global Assessment (PGA) of myositis activity and the Manual Muscle Test 8 (MMT8). RESULTS: Muscle edema correlated significantly with creatine kinase values (P = 0.017) and PGA (P < 0.001). A significant correlation between edema and MMT8 values (P = 0.025) was observed when patients with muscle fatty infiltration were excluded. With respect to clinical diagnosis, the sensitivity of MRI was 92.3%, and specificity was 83.3%. CONCLUSIONS: MRI appears to provide additional information that complements clinical and biochemical examinations. Muscle Nerve 54: 666-672, 2016.
Subject(s)
Disease Progression , Magnetic Resonance Imaging/methods , Myositis/diagnostic imaging , Thigh/diagnostic imaging , Adult , Aged , Aged, 80 and over , Edema/blood , Edema/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/metabolism , Myositis/bloodABSTRACT
OBJECTIVE: Clinically amyopathic dermatomyositis (CADM) is characterized by the presence of specific cutaneous manifestations of dermatomyositis (DM) without clinical signs of muscular involvement. The aim of this study was to examine the prevalence, clinical characteristics, and outcome of patients with CADM followed at our Rheumatology Unit. METHODS: Clinical charts of patients diagnosed as DM were retrospectively examined. Epidemiological, clinical, laboratory, instrumental, and histological features of the patients at the time of diagnosis were collected. CADM was diagnosed in the presence of DM-like rash without muscular involvement. RESULTS: A total of 103 DM patients were identified, of these, 8 were diagnosed with CADM. Six of patients with CADM had subclinical muscle involvement, and were therefore classifiable as hypomyopathic DM. CONCLUSIONS: In our case series, CADM represents 7.7% of the total DM. However, if investigated with instrumental methods, most patients with CADM result to have subclinical muscular involvement.
Subject(s)
Dermatomyositis/pathology , Adult , Biopsy , Cohort Studies , Dermatomyositis/epidemiology , Dermatomyositis/therapy , Electromyography , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Retrospective Studies , Steroids/therapeutic use , Treatment Outcome , Young AdultABSTRACT
This study is aimed at retrospectively studying cancer-associated inflammatory myopathies (CAM) in a cohort of patients with inflammatory myopathies. CAM were diagnosed if the tumor was diagnosed 2 years before or after disease onset. One hundred and sixty-two patients were included, 27 (17 %) had CAM. A significant association was observed between CAM and dermatomyositis (DM), older age and dysphagia at disease onset. CAM have lower creatine kinase (CK) levels at onset and a low prevalence of autoantibodies. In conclusion, the association of male sex, older age, DM, dysphagia at onset, lower CK, and autoantibodies negativity carries a high suspicion of CAM.
Subject(s)
Myositis/epidemiology , Neoplasms/epidemiology , Age Factors , Autoantibodies/blood , Biomarkers/blood , Creatine Kinase/blood , Deglutition Disorders/epidemiology , Dermatomyositis/epidemiology , Female , Humans , Italy/epidemiology , Kaplan-Meier Estimate , Male , Middle Aged , Myositis/blood , Myositis/diagnosis , Myositis/mortality , Myositis/therapy , Neoplasms/diagnosis , Neoplasms/mortality , Neoplasms/therapy , Predictive Value of Tests , Prevalence , Prognosis , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
Skeletal involvement is described in 25% of patients with non-Hodgkin's lymphoma, typically as secondary, rarely as primary lymphoma of bone. Joint infiltration is very rare and monoarthritis can be a secondary synovial reaction to adjacent bone disease or direct synovial involvement. We describe an unusual case of monoarthritis of the elbow in a middle-aged man without signs and/or symptoms associated with malignancy and with no previous rheumatic disease. Synovial biopsy revealed a diffuse infiltrate of large atypical lymphocytic B cells diagnosed by morphological and immunohistochemical findings as a malignant lymphoma. Staging procedures including total body CT scan, bone marrow biopsy, technetium-99m methylene diphosphonate bone scintigraphy were normal. We discuss the case and the review of literature and suggest that in the evaluation of patients with an unclassified arthritis, synovial or bone biopsy should be strongly considered.
