eMedicine Specialties > Emergency Medicine > Allergy & Immunology

Polymyositis: Follow-up

Author: Henry Rosenkranz, MD, Assistant Professor, Department of Emergency Medicine, Tufts University, New England Medical Center
Contributor Information and Disclosures

Updated: Aug 25, 2009

Follow-up

Further Outpatient Care

  • Physical therapy should begin early in the course of polymyositis to maintain mobility and strength.
  • Findings from continuing clinical assessment and muscle enzyme abnormalities guide the duration of treatment.

Complications

  • Pneumonia
  • Infection
  • Myocardial infarction
  • Carcinoma (especially in the breast and lung)
  • Severe dysphagia
  • Interstitial lung disease
  • Aspiration pneumonitis
  • Steroid myopathy or other complications of steroid therapy

Prognosis

  • Overall, the 5-year mortality rate for polymyositis (PM) and dermatomyositis (DM) is 20%.
  • Significant morbidity is associated with these diseases, and medications used in treating them may also cause significant side effects.
  • Death is closely related to presence of malignancy or respiratory/pulmonary involvement.2
  • Residual weakness occurs in approximately 30% of patients.
  • Persistent active disease is present in approximately 20% of patients.
  • Survival is less likely in women and African American patients.
  • Most patients improve with therapy.
  • Full recovery is expected in 50% of patients.

Patient Education

  • The Myositis Association of America Web site is an excellent resource for patients with inflammatory myopathies, their families, and the medical community.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider an underlying malignancy when diagnosing DM or PM
 


More on Polymyositis

Overview: Polymyositis
Differential Diagnoses & Workup: Polymyositis
Treatment & Medication: Polymyositis
Follow-up: Polymyositis
Multimedia: Polymyositis
References
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References

  1. Hengstman GJ, van den Hoogen FH, van Engelen BG. Treatment of the inflammatory myopathies: update and practical recommendations. Expert Opin Pharmacother. May 2009;10(7):1183-90. [Medline].

  2. Bronner IM, van der Meulen MF, de Visser M, Kalmijn S, van Venrooij WJ, Voskuyl AE. Long-term outcome in polymyositis and dermatomyositis. Ann Rheum Dis. Nov 2006;65(11):1456-61. [Medline].

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

  4. Chahin N, Engel AG. Correlation of muscle biopsy, clinical course, and outcome in PM and sporadic IBM. Neurology. Sep 26 2007;[Medline].

  5. Christopher-Stine L, Plotz PH. Myositis: an update on pathogenesis. Curr Opin Rheumatol. Nov 2004;16(6):700-6. [Medline].

  6. Dalakas MC, Hohlfeld R. Polymyositis and dermatomyositis. Lancet. Sep 20 2003;362(9388):971-82. [Medline].

  7. Dalakas MC, Sivakumar K. The immunopathologic and inflammatory differences between dermatomyositis, polymyositis and sporadic inclusion body myositis. Curr Opin Neurol. Jun 1996;9(3):235-9. [Medline].

  8. Hengstman GJ, van Engelen BG. Polymyositis, invasion of non-necrotic muscle fibres, and the art of repetition. BMJ. Dec 18 2004;329(7480):1464-7. [Medline]. [Full Text].

  9. Koopman WJ. Polymyositis/dermatomyositis classification criteria. In: Arthritis and Allied Conditions. 1997:17-8.

  10. Mastaglia FL, Ojeda VJ. Inflammatory myopathies: Part 1. Ann Neurol. Mar 1985;17(3):215-27. [Medline].

  11. Nirmalananthan N, Holton JL, Hanna MG. Is it really myositis? A consideration of the differential diagnosis. Curr Opin Rheumatol. Nov 2004;16(6):684-91. [Medline].

  12. Olsen NJ, Park JH. Inflammatory myopathies: issues in diagnosis and management. Arthritis Care Res. Jun 1997;10(3):200-7. [Medline].

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Further Reading

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Keywords

polymyositis, PM, dermatomyositis, DM, inclusion body myositis, idiopathic inflammatory myopathy, inflammatory muscle disease, immune-mediated muscle inflammation, proximal muscle weakness, dysphagia, aspiration, arthralgias, muscle atrophy, heliotrope rash, purple-red edematous periorbital eruption, scaly purple-erythematous papular eruption over knuckles, Gottron sign, conduction defects, arrhythmias, myocarditis, interstitial lung disease, aspiration pneumonia, skeletal muscle disease

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Contributor Information and Disclosures

Author

Henry Rosenkranz, MD, Assistant Professor, Department of Emergency Medicine, Tufts University, New England Medical Center
Henry Rosenkranz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Gino A Farina, MD, Program Director, Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine
Gino A Farina, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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