Dermatomyositis

Stephanie Johnson- Critical Friend Alison Ober-Facilitator Ashley Elser- Facilitator Andrea Lloyd - Editor Katrina Frey- Editor Lena Frennborn- Critical Friend

=__** Dermatomyositis **__=

__ Signs & Symptoms __
===One of the most common symptoms is a skin rash. The rash is most common on the knuckles, elbows, eyelids, knees, chest, and back. The rash is a red and sometimes purplish-blue color that appears patchy on the skin. This is often the first sign of dermatomyositis. Another common sign of this disease is muscle weakness. The weakness is usually located toward the trunk of the body such as the hips, thighs, shoulders, upper arms, and neck. People usually feel weak on both sides instead of one specific spot. If not seen by a doctor or treated, the muscle weakness gradually gets worse. Other symptoms may include dysphagia which is a medical term for difficulty swallowing. Weight loss is another sign and symptom of the disease. Other less commons signs and symptoms include weight loss, fever, Calcinosis, or formation of calcium deposits (usually in children), lung problems, and gastrointestinal ulcers.=== === Symptoms of dermatomyositis usually begin gradually, with muscle weakness, joint pain, fever, weight loss, and fatigue. Children may experience a more rapid onset. Muscle weakness usually affects the upper arms, neck, and legs, on both sides of the body. Some people experience joint and muscle pain, and some have difficulty swallowing. As the disease progresses, the muscles begin to waste away (atrophy) and permanently shorten (contracture). A grayish-red rash appears at the same time as the muscle weakness. The rash commonly appears on the face and includes a purplish swelling, called a heliotrope, around the eyes. There may be a shawl-like rash over the neck, shoulders, and upper chest and back. Another rash often appears around the joints, especially around the fingers. This rash may be smooth or have scaly patches, and is called Gottron’s sign. When the rash fades, it leaves behind pigmented patches of skin. Some people with dermatomyositis develop a rash without muscle weakness. This is called dermatomyositis sine myositis. Others may also have Raynaud’s phenomenon, in which the small arteries in the fingers and toes constrict, causing the skin to look pale or bluish, usually after exposure to cold. People with dermatomyositis are more likely to develop malignant cancers.(Penn State Milton S. Hershey Medical Center, 2004) ===



__ Background Information __
===A person without dermatomyositis has a relatively good auto immune system. A person's auto immune system who has the disease often attacks normal body components. Your immune system is to protect you from bacteria and viruses but someone with this disease has an immune system that makes autoimmune antibodies that attack your own tissues. Small blood vessels in the muscular tissue are affected and causes degeneration of muscle fibers. Those autoimmune antibodies can often be detected in the blood.===

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Typically a person with dermatomyositis is a female. It usually occurs between the ages of 5 and 15 in children. In adults it could occur between the ages of 40's to early 60's.
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__ Complications & Prognosis __
===There are muscle weakness symptoms and skin symptoms complications. Due to muscle weakness; Dysphagia, or diffuculty swallowing, is due to the muscles in the esophagus being affected, this could then cause weight loss and malnutrition. The dysphagia may also lead to aspiration, in which the food or liquids will go into lungs, which can lead to pneumonia. If chest muscles are affected, then this may create breathing trouble, such as shortness of breath, and chest pain. Skin symptom complications include; calcium deposits, these occur later in the disease, except with children they develop ealrier and more common. These calcium deposits can develop in the muscles, skin and connective tissues. One with Dermatomyositis is at a higher risk of infection, especially within the respiratory and digestive tracts. Dermatomyositis can also lead to or put you at higher risk for developing other diseases, which are; Raynaud's Phenomenon, other connective tissue diseases, cardiovascular disease, lung disease, and cancer. (Mayoclinic)===

__ Diagnosis __
=== Dermatomyositis is diagnosed through a thorough physical exam and the characteristic symptoms. Your doctor will order diagnostic tests to check levels of certain enzymes in your bloodstream. He or she will also take a small sample of tissue from the affected muscle, called a muscle biopsy, to check for abnormalities. A test called electromyography will reveal any abnormal electrical activity in the muscles. Magnetic resonance imaging (MRI) is also helpful in revealing muscle inflammation. Your doctor will order blood tests and other cancer screening tests to check for malignancies..(Penn State Milton S. Hershey Medical Center, 2004) ===



__ Causes __
===The cause of dermatomyositis is unknown because doctors are unable to identify an infection. One possible cause is viral infection of the muscles or a problem with the immune system. In fact, some doctors believe the it is genetics that play a role in the disease. (MayoClinic)===

__ Treatments __
===** The first line of treatment for dermatomyositis is restricted activity and a daily injection of a corticosteroid, such as prednisone, to reduce inflammation and relieve pain. This dose is gradually decreased as the condition improves. Adults usually need to stay on a maintenance dose for life. However, children may be able to stop steroid treatment after approximately one year. Some patients cannot tolerate or do not respond to corticosteroids. These patients may be treated with immunosuppressive drugs, such as azathioprine or methotrexate. Other patients may respond well to intravenous immune globulin. Dermatomyositis often improves with treatment of malignant tumors. (Penn State Milton S. Hershey Medical Center, 2004) **===

__ ﻿Current Research __
===Right now research is looking at patterns of gene expression among the inflammatory myopathies and the role viral infections may have as a precursor to the disorder. The safety and effectiveness of treatments are also studied.===