Diagnosing muscle disease in a cohort of classic dermatomyositis patients seen at a rheumatologic dermatology outpatient clinic - 16/06/21

Doi : 10.1016/j.jaad.2021.05.026

Sarah Ahmed, MD ^a,^b, Josef Symon Salgado Concha, MD ^a,^b, Srita Chakka, MD ^a,^b, Rebecca Louise Krain, MD ^a,^b, Danielle Zamalin, BS ^a,^b, Galen Foulke, MD ^c, Victoria P. Werth, MD ^a,^b,^⁎
^a Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
^b Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
^c Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania

^∗Correspondence to: Victoria P. Werth, MD, Department of Dermatology, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA 19104.Department of DermatologyPerelman Center for Advanced MedicineSuite 1-330A, 3400 Civic Center BoulevardPhiladelphiaPA19104

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Abstract

Background

Existing criteria to improve the probability of capturing dermatomyositis (DM) include muscle biopsy but little is known about whether less invasive diagnostic procedures may be just as useful.

Objective

We aimed to determine whether skin biopsy, electromyography, or magnetic resonance imaging of the involved muscle could be done in lieu of muscle biopsy.

Methods

Two hundred and seventy-five patients were reviewed to investigate the presence of cutaneous and muscle disease, their timing in relation to diagnosis, and results of skin biopsies, muscle biopsies, magnetic resonance imaging, and electromyography.

Results

Of the cases with findings consistent with DM on muscle biopsy, 65% were in agreement with diagnostic features on electromyography or magnetic resonance imaging. Results of skin and muscle biopsies supported DM in 67% of patients who underwent both procedures.

Limitations

A limited number of patients had muscle biopsies.

Conclusion

In the presence of DM-specific skin findings, less invasive procedures may be sufficient to diagnose DM and guide its management.

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Key words : autoimmune disease, cost efficacy, dermatomyositis, diagnosis, myositis, practice, rheumatologic dermatology

Abbreviations used : CPT, DM, EMG, IIM, IRB, MRI

Plan

	Funding sources: Supported by National Institutes of Health (R21 AR066286) and Veterans Affairs Merit Review (I01BX000706) to Dr Werth.
	IRB approval status: Not applicable.
	Reprints not available from the authors.