eMedicine Specialties > Rheumatology > Systemic Rheumatic Disease

Polymyositis: Follow-up

Author: Ramesh Pappu, MD, Adjuct Associate Professor of Medicine, Drexel University College of Medicine
Coauthor(s): Mythili Seetharaman, MD, Clinical Assistant Professor, Thomas Jefferson University Hospital, Consulting Staff, Einstein Arthritis Center, Albert Einstein Medical Center, St Christopher's Hospital for Children
Contributor Information and Disclosures

Updated: Nov 6, 2009

Follow-up

Further Inpatient Care

  • Patients with polymyositis should be closely monitored in the hospital while they are taking high-dose corticosteroids.
  • Monitor serial CK levels to assess improvement.
  • Severe pulmonary or cardiac involvement may require management in an intensive care setting.
  • Ideally, purified protein derivative should be placed prior to initiation of corticosteroid treatment.
  • Regularly monitor CBC counts, liver function test findings, and renal function in patients treated with immunosuppressive agents.
  • Patients with polymyositis usually need aggressive inpatient physical therapy.

Further Outpatient Care

  • Patients with polymyositis should be seen every 2-3 weeks initially; if they are stable, see them at monthly intervals thereafter.
  • Frequently check laboratory tests, including CK (as outlined in Lab Studies), and document muscle strength evaluation results.
  • Check patients' weight during each visit.
  • Routine age-appropriate cancer screening is recommended.
  • Arrange outpatient physical therapy.

Deterrence/Prevention

  • Patients with polymyositis should avoid cold exposure if Raynaud phenomenon is a significant problem.
  • Patients with esophageal involvement can elevate the head of the bed and avoid eating before bedtime to minimize reflux and risk of aspiration.

Complications

  • Pulmonary disease
    • Interstitial lung disease
    • Aspiration pneumonia
  • Cardiac
    • Heart block
    • Arrhythmias
    • Congestive heart failure
    • Pericarditis
  • Gastrointestinal
    • Dysphagia
    • Malabsorption
  • Malignancy: Incidence of lung, bladder, and non-Hodgkin lymphoma may be increased in patients with polymyositis, especially in the first year after diagnosis.

Prognosis

  • In most patients, polymyositis responds well to treatment, although residual weakness is common. Osteoporosis, a common complication of long-term corticosteroid therapy, may cause significant morbidity.
  • Poor prognostic factors include the following:
    • Advanced age
    • Female sex
    • African American race
    • Interstitial lung disease
    • Presence of anti-Jo-1 (lung disease) and anti-SRP antibodies (severe muscle disease, cardiac involvement)
    • Associated malignancy
    • Delayed or inadequate treatment
    • Dysphagia, dysphonia
    • Cardiac and pulmonary involvement

Patient Education

  • Patients with polymyositis should be educated early about the disease and should be provided with realistic expectations about outcomes. Most patients show significant improvement with treatment.
    • Stress the need for close follow-up care, continued physical therapy, and long-term therapy.
    • Warn patients regarding adverse events related to medications.
    • Patients may visit the Myositis Association of America Web site for more information.
  • For excellent patient education resources, visit eMedicine's Muscle Disorders Center. Also, see eMedicine's patient education article Chronic Fatigue Syndrome.

Miscellaneous

Medicolegal Pitfalls

  • Delay in diagnosis
  • Misdiagnosis
  • Failure to diagnose malignancy
  • Failure to inform patient about potential drug toxicity
 


More on Polymyositis

Overview: Polymyositis
Differential Diagnoses & Workup: Polymyositis
Treatment & Medication: Polymyositis
Follow-up: Polymyositis
Multimedia: Polymyositis
References
[ CLOSE WINDOW ]

References

  1. Bohan A. History and classification of polymyositis and dermatomyositis. Clin Dermatol. Apr-Jun 1988;6(2):3-8. [Medline].

  2. Schnabel A, Hellmich B, Gross WL. Interstitial lung disease in polymyositis and dermatomyositis. Curr Rheumatol Rep. Apr 2005;7(2):99-105. [Medline].

  3. Cherin P, Pelletier S, Teixeira A, et al. Results and long-term followup of intravenous immunoglobulin infusions in chronic, refractory polymyositis: an open study with thirty-five adult patients. Arthritis Rheum. Feb 2002;46(2):467-74. [Medline].

  4. Kumar A, Teuber SS, Gershwin ME. Intravenous immunoglobulin: striving for appropriate use. Int Arch Allergy Immunol. 2006;140(3):185-98. [Medline].

  5. Hengstman G, Van den Housen F, Van Engelen B. Anti-TNF-blockade with infliximab (Remicade) in polymyositis and dermatomyositis. Arthritis and Rheumatology. 2000;43(9):S193.

  6. Levine TD. Rituximab in the treatment of dermatomyositis: an open-label pilot study. Arthritis Rheum. Feb 2005;52(2):601-7. [Medline].

  7. Alexanderson H. Exercise: an important component of treatment in the idiopathic inflammatory myopathies. Curr Rheumatol Rep. Apr 2005;7(2):115-24. [Medline].

  8. Adams EM, Plotz PH. The treatment of myositis. How to approach resistant disease. Rheum Dis Clin North Am. Feb 1995;21(1):179-202. [Medline].

  9. Aleksza M, Szegedi A, Antal-Szalmás P, Irinyi B, Gergely L, Ponyi A, et al. Altered cytokine expression of peripheral blood lymphocytes in polymyositis and dermatomyositis. Ann Rheum Dis. Oct 2005;64(10):1485-9. [Medline].

  10. Amato AA, Barohn RJ. Idiopathic inflammatory myopathies. Neurol Clin. Aug 1997;15(3):615-48. [Medline].

  11. Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. Feb 13 1975;292(7):344-7. [Medline].

  12. Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med. Feb 20 1975;292(8):403-7. [Medline].

  13. Briani C, Doria A, Sarzi-Puttini P, et al. Update on idiopathic inflammatory myopathies. Autoimmunity. May 2006;39(3):161-70. [Medline].

  14. [Best Evidence] Choy EH, Hoogendijk JE, Lecky B, et al. Immunosuppressant and immunomodulatory treatment for dermatomyositis and polymyositis. Cochrane Database Syst Rev. Jul 20 2005;CD003643. [Medline].

  15. Dalakas MC. Polymyositis, dermatomyositis and inclusion-body myositis. N Engl J Med. Nov 21 1991;325(21):1487-98. [Medline].

  16. Hicks JE. Rehabilitating patients with idiopathic inflammatory myopathy. Musculoskel Med. 1995;12:4-54.

  17. Hill CL, Zhang Y, Sigurgeirsson B, et al. Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet. Jan 13 2001;357(9250):96-100. [Medline].

  18. Marie I, Hachulla E, Cherin P, et al. Opportunistic infections in polymyositis and dermatomyositis. Arthritis Rheum. Apr 15 2005;53(2):155-65. [Medline].

  19. O'Rourke KS. Myopathies in the elderly. Rheum Dis Clin North Am. Aug 2000;26(3):647-72, viii. [Medline].

  20. Oddis CV. Idiopathic inflammatory myopathies: a treatment update. Curr Rheumatol Rep. Dec 2003;5(6):431-6. [Medline].

  21. Plotz PH, Miller F, Hoffman E, et al. Workshop on inflammatory myopathy Bethesda, 5-6 April 2000. Neuromuscul Disord. Jan 2001;11(1):93-5. [Medline].

  22. Plotz PH, Rider LG, Targoff IN, et al. NIH conference. Myositis: immunologic contributions to understanding cause, pathogenesis, and therapy. Ann Intern Med. May 1 1995;122(9):715-24. [Medline].

  23. Reimers CD, Finkenstaedt M. Muscle imaging in inflammatory myopathies. Curr Opin Rheumatol. Nov 1997;9(6):475-85. [Medline].

  24. Salomonsson S, Lundberg IE. Cytokines in idiopathic inflammatory myopathies. Autoimmunity. May 2006;39(3):177-90. [Medline].

  25. Spiera R, Kagen L. Extramuscular manifestations in idiopathic inflammatory myopathies. Curr Opin Rheumatol. Nov 1998;10(6):556-61. [Medline].

  26. Targoff IN. Update on myositis-specific and myositis-associated autoantibodies. Curr Opin Rheumatol. Nov 2000;12(6):475-81. [Medline].

  27. Henes JC, Heinzelmann F, Wacker A, Seelig HP, Klein R, Bornemann A, et al. Antisignal recognition particle-positive polymyositis successfully treated with myeloablative autologous stem cell transplantation. Ann Rheum Dis. Mar 2009;68(3):447-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

polymyositis, PM, primary idiopathic polymyositis, idiopathic inflammatory myopathy, dermatomyositis, DM, inclusion body myositis, IBM, virus-mediated muscle injury, microvascular insult, collagen vascular disease

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ramesh Pappu, MD, Adjuct Associate Professor of Medicine, Drexel University College of Medicine
Ramesh Pappu, MD is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Rheumatology, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Mythili Seetharaman, MD, Clinical Assistant Professor, Thomas Jefferson University Hospital, Consulting Staff, Einstein Arthritis Center, Albert Einstein Medical Center, St Christopher's Hospital for Children
Mythili Seetharaman, MD is a member of the following medical societies: American College of Rheumatology and American Medical Association
Disclosure: Novartis Honoraria Speaking and teaching

Medical Editor

Kristine M Lohr, MD, MS, Program Director, Professor, Department of Internal Medicine, Division of Rheumatology and Women's Health, University of Kentucky School of Medicine
Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians, American College of Rheumatology, and American Medical Women's Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; UCB  Speaking and teaching; Omnicare Consulting fee Consulting; Centocor Consulting fee Consulting; Roche Grant/research funds Other

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.