Polymyositis: a case history approach to the differential diagnosis and treatment

Mayo Clin Proc. 1990 Nov;65(11):1480-97. doi: 10.1016/s0025-6196(12)62170-3.

Abstract

A wide range of conditions can mimic polymyositis. Thus, diagnosing this condition can be a challenge. Although no single criterion is diagnostic of polymyositis, the following criteria have been proposed and widely used: (1) symmetric proximal muscle weakness; (2) characteristic violaceous rash on the hands, elbows, and knees; (3) increased muscle enzymes in the serum; (4) characteristic electromyographic findings (insertional activity, fibrillation potentials, motor unit potentials of increased frequency and decreased duration, and normal conduction velocity in nerves); and (5) muscle biopsy specimen with characteristic inflammatory and myopathic changes. Although polymyositis primarily involves muscle, up to 20% of patients may have extramuscular problems. The main treatment for polymyositis is high-dose corticosteroids. In corticosteroid-resistant patients, methotrexate is often effective. In this report, case histories are presented to highlight the usefulness and the limitations of the common diagnostic criteria for polymyositis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Diagnosis, Differential
  • Electromyography
  • Female
  • Humans
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • Muscles / enzymology
  • Muscles / pathology
  • Myositis / complications
  • Myositis / diagnosis*
  • Myositis / enzymology
  • Myositis / pathology
  • Myositis / therapy*

Substances

  • Adrenal Cortex Hormones
  • Methotrexate