Polymyositis and Dermatomyositis (eBook)

Front Cover 1
Polymyositis and Dermatomyositis 4
Copyright Page 5
Table of Contents 8
Contributing Authors 6
Preface 10
Chapter 1. A Classification of Polymyositis and Dermatomyositis 
14 
FORMS OF PM/DM 15
SUMMARY 24
REFERENCES 25
PART I: Clinical Features 30
Chapter 2. Clinical Presentation and Diagnosis of Polymyositis and Dermatomyositis 32
SUSPICIOUS SIGNS AND SYMPTOMS 33
DIAGNOSIS 34
DIFFERENTIAL DIAGNOSIS 35
CLINICAL FEATURES 38
DIAGNOSTIC AND CLINICAL TESTS 43
CONCLUSIONS 46
REFERENCES 47
Chapter 3. Association of Inflammatory Myopathies with Other Connective Tissue Disorders and Malignancies 50
CONNECTIVE TISSUE DISORDERS 54
MALIGNANCY 72
CONCLUSION 75
REFERENCES 76
Chapter 4. Inflammatory Myopathies of Childhood 84
PATHOPHYSIOLOGY 85
DERMATOMYOSITIS 86
POLYMYOSITIS 90
COLLAGEN VASCULAR DISEASE 92
TRANSIENT MYOSITIS OF CHILDHOOD 92
CONCLUSIONS 92
REFERENCES 93
PART II: Etiology and Mechanisms 96
Chapter 5. Immunopathology of Polymyositis and Dermatomyositis 
98 
IMMUNOPATHOLOGY 99
IMMUNOGENETICS 104
REFERENCES 107
Chapter 6. Viral Etiology of Polymyositis /Dermatomyositis 110
DIRECT EVIDENCE FOR VIRAL INFECTIONS IN PM/DM 111
SEROLOGIC SCREENING FOR VIRUS INFECTION 113
EXPERIMENTAL MODELS OF VIRUS-INDUCED MYOSITIS: IN VITRO SYSTEMS 114
EXPERIMENTAL MODELS OF VIRUS-INDUCED PM 119
RETROVIRUSES AND POLYMYOSITIS 120
VIRUSES, AUTOIMMUNITY, AND PM/DM 121
CONCLUSION 128
REFERENCES 129
Chapter 7. Inclusion Body Myositis 134
HISTORICAL PERSPECTIVES 134
PATHOLOGY 135
CLINICAL CHARACTERISTICS 138
CURRENT CONTROVERSIES 139
CONCLUSION 141
REFERENCES 141
Chapter 8. Animal Models of Polymyositis and Derma tomyositis 146
NONIMMUNE MODELS FOR POLYMYOSITIS 148
NATURAL AND EXPERIMENTAL IMMUNOLOGIC MODELS OF PM/DM 155
DISCUSSION 162
CONCLUSION 164
REFERENCES 164
PART Ill: Diagnosis and Treatment 168
Chapter 9. Histopathology of the Inflammatory Myopathies 170
CHARACTERISTIC PATHOLOGIC FINDINGS IN PM/DM 171
PATHOLOGIC FINDINGS IN OTHER INFLAMMATORY MYOPATHIES 196
INFECTIOUS MYOSITIS 198
PRACTICAL RECOMMENDATIONS REGARDING MUSCLE BIOPSIES 202
REFERENCES 203
Chapter 10. Resin Histology and Electron Microscopy in Inflammatory Myopathies 210
DERMATOMYOSITIS 210
POLYMYOSITIS 219
INCLUSION BODY MYOSITIS 220
SUMMARY 227
REFERENCES 230
Chapter 11. Electromyography in Polymyositis and Dermatomyositis (PM/DM) 232
THE MOTOR UNIT 233
THE NORMAL MOTOR UNIT ON ROUTINE NEEDLE EMG 233
THE ABNORMAL MOTOR UNIT 235
ABNORMAL INSERTION ACTIVITY AND ABNORMAL POTENTIALS AT REST 242
DIFFERENTIAL DIAGNOSIS OF PM/DM BY EMG 243
REFERENCES 245
Chapter 12. Treatment of Polymyositis and Dermatomyositis with Corticosteroids: A First Therapeutic Approach 250
PRINCIPLES OF STEROID THERAPY IN PATIENTS WITH PM OR DM 251
WHICH PATIENTS TO TREAT 252
HOW TO START THERAPY WITH CORTICOSTEROIDS IN AN ADULT WITH PM OR DM 
252 
OBLIGATORY "COLLATERAL" STEROID PROGRAM 256
PARAMETERS TO FOLLOW DURING STEROID THERAPY AND DISTINCTION BETWEEN STEROID-INDUCED "MYOPATHY" VERSUS EXACERBATION OF THE DISEASE 
257 
LACK OF RESPONSE TO STEROID THERAPY 258
STEROID SIDE EFFECTS: MY EXPERIENCE 260
POSSIBLE ACTION OF CORTICOSTEROIDS IN PM/DM 263
TREATMENT OF CALCINOSIS AND OTHER MEDICAL COMPLICATIONS 263
SUMMARY 265
REFERENCES 265
Chapter 13. Nonsteroidal Immunosuppressive Therapy in Polymyositis and Dermatomyositis 270
PRACTICAL CRITERIA FOR STEROID FAILURE 271
IMMUNOSUPPRESSIVE THERAPY: AT WHAT RISK? 271
METHOTREXATE 272
AZATHIOPRINE 276
CYCLOPHOSPHAMIDE 279
CHLORAMBUCIL 282
PLASMAPHERESIS 283
CYCLOSPORINE 285
CONCLUSION 288
REFERENCES 289
Chapter 14. Total Body Irradiation in the Treatment of Intractable Polymyositis and Dermatomyositis 
296 
LYMPHOID IRRADIATION FOR HODGKIN'S DISEASE OR IMMUNOSUPPRESSION 
297 
THERAPEUTIC IRRADIATION IN PATIENTS WITH NEUROMUSCULAR DISEASES 
297 
TOTAL BODY IRRADIATION IN POLYMYOSITIS AND DERMATOMYOSITIS 298
REFERENCES 304
Chapter 15. Comprehensive Rehabilitative Management of Patients with Polymyositis and Derma tomyositis 308
REHABILITATIVE PROCESS AND GOALS 309
REHABILITATION ASSESSMENTS 309
GENERAL REHABILITATION INTERVENTIONS 311
OVERVIEW OF REHABILITATIVE MANAGEMENT OF PM/DM 323
APPLICATION OF SPECIFIC REHABILITATIVE INTERVENTIONS 324
PROBLEMS AND INTERVENTIONS RELATED TO SPECIFIC SYSTEMS 326
CONCLUSION 329
REFERENCES 329
Chapter 16. Fibromyalgia Syndrome and Chronic Epstein-Barr Virus/ Chronic Fatigue Syndrome 334
FIBROMYALGIA SYNDROME 335
CHRONIC EBV/CHRONIC FATIGUE SYNDROME 336
REFERENCES 338
PART IV: Overview 340
Chapter 17. Polymyositis and Dermatomyositis: An Overview 
342 
CLINICAL FEATURES 342
ETIOLOGY AND MECHANISMS 344
DIAGNOSIS 346
TREATMENT 348
REFERENCES 350
Index 352