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Clinical characteristics of polymyositis
Myopathic weakness
Evolves over weeks to months, spares facial and eye
muscles, and presents as difficulty in climbing steps, rising
from a chair, lifting objects, combing hair.
Disease onset
Above the age of 18 years
Features the patient DOES NOT have
Rash (characteristic of dermatomyositis)
Family history of neuromuscular diseases
Exposure to myotoxic drugs, especially penicillamine,
and (rarely) statins28, 29
Endocrine disease (hypothyroidism, hyperthyroidism,
hypoparathyroidism, hypercortisolism)
Neurogenic disease (excluded by electromyography and
neurological examination)
Dystrophies and metabolic myopathies (excluded by history
and muscle biopsy)
Inclusion-body myositis (excluded by clinical examination and
muscle biopsy)
Possible associations
Other autoimmune or viral infections, such as:
lupus, rheumatoid arthritis, Sjogren's syndrome, Crohn's
disease, vasculitis, sarcoidosis, primary biliary cirrhosis,
adult celiac disease, chronic graft-versus-host disease,
discoid lupus, ankylosing spondylitis, Behcet's syndrome,
myasthenia gravis, acne fulminans, dermatitis
herpetiformis, psoriasis, Hashimoto's disease,
granulomatous diseases, agammaglobulinaemia,
Hypereosinophilic syndrome, Lyme disease, Kawasaki
disease, autoimmune thrombocytopenia,
hypergammaglobulinaemic purpura, hereditary
complement deficiency, HIV and HTLV-1 infection.
Reconsider polymyositis
If the diagnosis was based on Bohan and Peter's criteria, in
patients with:
Disease onset before the age of 18
Slow-onset myopathy that evolved over months to years (in
such cases think of inclusion-body myositis or dystrophy)
Fatigue and myalgia, muscle weakness without, even if a
transient rise in creatine kinase activity is seen (such
patients may have fibromyalgia or fasciitis, and their
muscle biopsy sample is normal or shows very few
endomysial inflammatory cells in the septae)
No typical histological features of polymyositis

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