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Re: PART 1 - Myositis

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You know I have had cervical cancer at age 26 and had a

tumor removed out of my mouth when I was a teen. Around

the time I had the cervical cancer is when I got

arachnioditis and had mysterious unexplained rashes and

muscle weakness. I still get those mysterious rashes that

noone can tell me what they are, when the get on my wrist

it leaves a scaly patch and my wrist is so weak it is all I

can do to move it some times. Any way this was just a

thought. Hugs Dee R

--- anzavic@... wrote:

>

> Hope I haven't sent this out before....brain fade ya

> know...

>

> ------

>

> As understanding of disorders such as polymyositis has

> developed,

> classification schemes have been modified. Myositis and

> related

> disorders are now generally referred to under the rubric

> of inflammatory

> muscle diseases. As a group, they are still relatively

> rare and poorly

> understood disorders. Although there are characteristic

> differences,

> they share certain overlapping clinical features and are

> considered here

> together.

>

> As with many inflammatory disorders of obscure cause,

> inflammatory

> muscle diseases are considered as genetically-mediated

> autoimmune

> disorders with an otherwise unknown trigger. Human

> leukocyte antigen

> (HLA)-DR3, as in many systemic rheumatic disorders, has

> been

> demonstrated to be a risk factor for inflammatory muscle

> disease.

>

> Examination of muscle and sera from patients with

> inflammatory muscle

> diseases has provided evidence of both cellular and

> humoral responses

> that have been proposed as playing a role in the

> pathogenesis of these

> disorders. Muscles from patients with polymyositis are

> infiltrated by

> CD8+ T cells, most of which are cytotoxic. Analysis of T

> cell receptors

> indicate oligoclonality, suggesting at least some

> specificity of the

> response. Interestingly, in dermatomyositis, B cells are

> also often

> seen, where they are not a prominent component of the

> infiltrating cells

> in polymyositis.

>

> Evidence to suggest a humoral role is also indirect.

> Specific

> autoantibodies are found in sera of patients with

> inflammatory muscle

> disease. Moreover, these antibodies have been shown to

> penetrate cell

> membranes and to interact with and inhibit specific

> enzymatic functions.

> How and if this relates to the development of myositis is

> yet to be

> elucidated.

>

> The disorders considered as inflammatory muscle diseases

> are relatively

> rare. Surveys in England in the 1960s suggested a

> prevalence of 1 in

> 37,000 and an annual incidence of about 3 per million

> population.

> Comparable incidence figures were found in Tennessee over

> a similar time

> period for whites, but in black females the incidence was

> 18 cases per

> million population per year. Most studies do suggest that

> the disease is

> more common in women. Onset is bimodal, with peaks in

> childhood and

> middle age.

>

> The most common presentation is the insidious onset of

> proximal muscle

> weakness. Patients frequently complain of increasing

> inability to:

> Rise from a squat or from a chair

> Climb stairs

> Get their hand over their heads to reach objects

> Comb their hair.

> Later in the course, distal muscles or pharyngeal muscles

> may become

> weak.

>

> In most individuals, specific muscle group testing will

> establish that

> there is weakness in predominantly the proximal muscles.

> The examiner

> should not be misled by " give-way " weakness, which is

> more often due to

> either pain or feigned weakness. In general, muscles are

> not tender.

> Patients with dermatomyositis will have characteristic

> rashes, which may

> temporarily occur in any relationship with the muscle

> involvement.

> Gottron's papules, a pathognomonic feature of the

> disease, are

> erythematous plaques over the extensor surface of the

> elbows, fingers,

> and knees, and over the malleoli. The heliotrope rash

> which is a

> violaceous discoloration around the eyes, is also a

> signature finding in

> dermatomyositis.

>

> More nonspecific rashes are also seen, including a

> photosensitive

> erythroderma, particularly over the neck, face and upper

> torso.

> Subcutaneous calcification can be extensive and varies

> from an

> asymptomatic radiographic finding to a pruritic lesion

> that ulcerates

> through the skin.

>

> Other organ systems are only occasionally directly

> involved. Arthralgias

> and arthritis are not uncommon. When arthritis is

> present, it generally

> is non-erosive. Pulmonary interstitial fibrosis is a

> worrisome finding

> which may be unresponsive to therapy, and presents with a

> dry cough and

> dyspnea on exertion.

> Of course, individuals with extensive weakness may have

> problems

> clearing their secretions and aspiration or atelectasis

> due to

> diminished respiratory excursion. An occasional patient

> may have heart

> failure or arrythmias due to myocarditis.

>

> Classification of inflammatory muscle diseases have

> historically been

> based on associated clinical findings (ie, idiopathic

> polymyositis,

> idiopathic dermatomyositis, juvenile myositis, myositis

> associated with

> malignancy, and overlap syndromes). As understanding of

> these disorders

> has improved, certain histologic and serologic

> associations have been

> made (see Pathogenesis and Laboratory Tests and

> Radiographs sections,

> this chapter). The difference between primary

> polymyositis and

> dermatomyositis is based on the absence or presence of

> the

> characteristic rash described above. Juvenile myositis

> appears to be

> much like the adult disease, but children are more likely

> to have

> dermatomyositis.

>

> Patients are said to have a myositis overlap syndrome if

> myositis is

> part of another inflammatory rheumatic disease. Patients

> with rheumatoid

> arthritis, systemic lupus erythematosus, and scleroderma

> may have

> myositis as a component of their illnesses. In most

> patients, the muscle

> disease is overshadowed by the other features of their

> disorders.

>

> One clinical impression is that patients with myositis

> are more likely

> to develop malignancies. For the most part, these

> observations were

> based on anecdotal reports. More recent controlled trials

> have yielded

> conflicting results, but there is a suggestion that

> gastric and ovarian

> cancers are seen more often in patients with myositis. An

> often

> recommended approach is to perform a careful examination

> and the routine

> screening tests (eg, mammograms, PAP smears, rectal exam)

> appropriate

> for an individual of that particular age. Abnormalities

> uncovered with

> these procedures should be vigorously pursued. Outcome of

> patients with

> malignancy and myositis is dependent on the outcome of

> the malignancy.

> There have been reports of the myositis improving with

> remission of the

> cancer, even when there has been surgical extirpation.

>

>

=====

Love always Dee

Hugs and Love

Dee R

O'Fallon, MO

__________________________________________________

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I am aiming to find out really soon. Thanks Dee R

--- anzavic@... wrote:

>

>

> Dee..... Maybe you've had DM for a long time but in a

> mild form. Since

> you were also having other problems at that time it could

> have been

> easily overlooked.

>

> Vicki

>

>

=====

Love always Dee

Hugs and Love

Dee R

O'Fallon, MO

__________________________________________________

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