Cjane Padilla

POLYMYOSITIS AND DERMATOMYOSITIS Definition Polymyositis and dermatomyositis are chronic inflammatory diseases of the skeletal muscle and skin. Polymyositis - type of chronic inflammation of the muscles (inflammatory myopathy) Dermatomyositis - a connective-tissue disease that is characterized by inflammation of the muscles and the skin. While DM most frequently affects the skin and muscles, it is a systemic disorder that may also affect the joints, the esophagus, the lungs, and, less commonly, the heart Etiology: Unknown Risk Factors/Occurence Dermatomyositis occurs commonly in female patients Signs and Symptoms Polymyositis Pain, with marked weakness and/or loss of muscle mass in the muscles of the head, neck, torso and upper arms and legs. The hip extensors are often severely affected, leading to particular difficulty in ascending stairs and rising from a seated position.  Dermatomyositis Skin rash dysphagia (difficulty swallowing) feverish sensations vasculitis affecting the skin, muscles and internal organs muscle weakness Diagnosis Polymyositis Laboratory exam showing elevation of creatinine kinase history and physical examination electromyograph (EMG) alteration positive muscle biopsy Dermatomyositis - Differential diagnosis - differentiated from other common inflammatory myopathies. Perifascicular atrophy , a characteristic pattern or muscle fibers, makes this distinction trivial. Management Polymyositis A. Pharmacological 1. Drug class: Corticosteroid 2. Generic name: Prednisone 3. Use: Act as an immunosuppressant effective anti-inflammatory in polymyositis 4. Recommended dosage: 1 mg/kg/day, either as a single or divided dose. This high dose is usually continued for 4-8 weeks, until the creatinine kinase level returns to reference ranges. Taper prednisone by 5-10 mg on a monthly basis until the lowest dose that controls the disease is reached. 5. Side effects: high blood glucose levels fluid retention facial swelling weight gain confusion abdominal pain 6. Warnings/ Precautions: Corticosteroids may mask some signs of infection, and new infections may appear during their use. Infections with any pathogen including  viral, bacterial or fungal, protozoan or helminthic infections, in any location of the body, may be associated with the use of corticosteroids alone or in combination With other immunosupressive agents. Corticosteroids should be used cautiously in patients with ocular herper simplex because of possible cornmeal perforation. B. Non-Pharmacological: Specialized exercise therapy 1. Isometric training -  a type of strength training in which the joint angle and muscle length do not change during contraction 2. Aerobic Activity – also known as cardio 3. Weight bearing activity 4. Stretching and range of motion activity - Chest expansion and thoracic extension exercises Dermatomyositis I. Pharmacological A. Prednisolone 1. Drug Class: Corticosteroid 2. Generic name: Prednisolone 3. Use: Anti-inflammatory used in autoimmune diseases 4. Side effects: Fluid retention Acne Constipation Mood swings 5. Precautions: This medicine may cause you to get more infections than usual. If you start to have a fever, chills, sore throat, or any other sign of an infection, call your doctor right away. 6. Counselling points: Avoid prolonged use because of possible development of adrenal gland problems and ay cause changes in hormones or imbalances. 7. Contraindications: Pregnancy or women trying to get pregnant B. Methotrexate 1. Drug class: Antimetabolite/antifolate – a drug that prevents the use of a metabolite or folic acid 2. Generic Name: Methotrexate 3. Use: treat autoimmune diseases 4. Side effects: hair loss nausea headaches skin pigmentation 5. Adverse effects: ulcerative stomatitis low white blood cell count 6. Warnings/precautions: Abortifacient drug thus contraindicated in pregnant women or women trying to get pregnant. C. Intravenous immunoglobulin 1. Drug class: Blood Product 2. Generic Name: Immunoglobulin Antibodies 3. Use: treat auto immune and inflammatory diseases by suppressing inflammation 4. Side effects: Mild and transient Headache Flushing Malaise chest tightness fever chills 5. Warnings/Precautions: Patients’ vital signs should be monitored throughout the infusion. If side effects occur, it should be slowed or stopped depending on severity. Monitor renal function, including blood urea nitrogen and serum creatinine, and urine output in patients at risk of developing acute renal failure II. Non-Pharmacologic treatment: Specialized exercise therapy Evaluation of Therapeutic Outcomes One definite parameter to monitor is the creatinine kinase level. Continous monitoring is recommended. Evaluation of strength, symptoms are generally minimized or visible rash, inflammation disappearance may be helpful.