Distribution and severity of weakness among patients with polymyositis, dermatomyositis and juvenile dermatomyositis

Objective. To describe the distribution and severity of muscle weakness using manual muscle testing (MMT) in 172 patients with PM, DM and juvenile DM (JDM). The secondary objectives included characterizing individual muscle group weakness and determining associations of weakness with functional stat...

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Bibliographic Details
Published in:	Rheumatology (Oxford, England) Vol. 48; no. 2; pp. 134 - 139
Main Authors:	Harris-Love, M. O., Shrader, J. A., Koziol, D., Pahlajani, N., Jain, M., Smith, M., Cintas, H. L., McGarvey, C. L., James-Newton, L., Pokrovnichka, A., Moini, B., Cabalar, I., Lovell, D. J., Wesley, R., Plotz, P. H., Miller, F. W., Hicks, J. E., Rider, L. G.
Format:	Journal Article
Language:	English
Published:	Oxford Oxford University Press 01-02-2009 Oxford Publishing Limited (England)
Subjects:	Adult Analysis of Variance Biological and medical sciences Biomarkers - blood Child Child, Preschool Clinical Cross-Sectional Studies Dermatomyositis - blood Dermatomyositis - physiopathology Diseases of striated muscles. Neuromuscular diseases Diseases of the osteoarticular system Female Humans L-Lactate Dehydrogenase - blood Linear Models Male Manual muscle test Medical sciences Middle Aged Muscle Weakness Muscle, Skeletal - physiopathology Myositis Myositis - blood Myositis - physiopathology Neurology Polymyositis - blood Polymyositis - physiopathology Rehabilitation Retrospective Studies Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Severity of Illness Index Strength Myositis Manual muscle test Rehabilitation Strength Human Immunopathology Connective tissue disease Skin disease Dermatomyositis Manuals Rheumatology Autoimmune disease Striated muscle disease Polymyositis Systemic disease Adolescent
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Summary:	Objective. To describe the distribution and severity of muscle weakness using manual muscle testing (MMT) in 172 patients with PM, DM and juvenile DM (JDM). The secondary objectives included characterizing individual muscle group weakness and determining associations of weakness with functional status and myositis characteristics in this large cohort of patients with myositis. Methods. Strength was assessed for 13 muscle groups using the 10-point MMT and expressed as a total score, subscores based on functional and anatomical regions, and grades for individual muscle groups. Patient characteristics and secondary outcomes, such as clinical course, muscle enzymes, corticosteroid dosage and functional status were evaluated for association with strength using univariate and multivariate analyses. Results. A gradient of proximal weakness was seen, with PM weakest, DM intermediate and JDM strongest among the three myositis clinical groups (P ≤ 0.05). Hip flexors, hip extensors, hip abductors, neck flexors and shoulder abductors were the muscle groups with the greatest weakness among all three clinical groups. Muscle groups were affected symmetrically. Conclusions. Axial and proximal muscle impairment was reflected in the five weakest muscles shared by our cohort of myositis patients. However, differences in the pattern of weakness were observed among all three clinical groups. Our findings suggest a greater severity of proximal weakness in PM in comparison with DM.
Bibliography:	ark:/67375/HXZ-LPMVXJMB-6 istex:1E785DBEDCBF7F5C497B14372F5FF11DA6FEB060 ArticleID:ken441 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1462-0324 1462-0332
DOI:	10.1093/rheumatology/ken441