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

Harris‐Love, Michael O.; Shrader, Joseph A.; Koziol, Deloris E.; Pahlajani, N; Jain, Minal; Smith, M. I.; Cintas, Holly M.; McGarvey, Charles L.; James-Newton, Laura; Pokrovnichka, Angelina; Moini, B.; Cabalar, Imelda Victoria; Lovell, Dan; Wesley, Robert; Plötz, Paul H.; Miller, Frederick W.; Hicks, Jeanne E.; Rider, Lisa G.

doi:10.1093/rheumatology/ken441

Cited by 102 publications

(63 citation statements)

References 30 publications

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“…Indeed, in other connective tissue diseases, such as systemic lupus erythematosus or juvenile dermatomyositis, the frequency of several clinical manifestations differed from those observed in adults [18,19]. …”

Section: Discussionmentioning

confidence: 99%

Clinical features of childhood granulomatosis with polyangiitis (wegener’s granulomatosis)

et al. 2014

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BackgroundGranulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis (WG), belongs to the group of ANCA-associated necrotizing vasculitides. This study describes the clinical picture of the disease in a large cohort of GPA paediatric patients.Children with age at diagnosis ≤ 18 years, fulfilling the EULAR/PRINTO/PRES GPA/WG classification criteria were extracted from the PRINTO vasculitis database. The clinical signs/symptoms and laboratory features were analysed before or at the time of diagnosis and at least 3 months thereafter and compared with other paediatric and adult case series (>50 patients) derived from the literature.FindingsThe 56 children with GPA/WG were predominantly females (68%) and Caucasians (82%) with a median age at disease onset of 11.7 years, and a median delay in diagnosis of 4.2 months. The most frequent organ systems involved before/at the time of diagnosis were ears, nose, throat (91%), constitutional (malaise, fever, weight loss) (89%), respiratory (79%), mucosa and skin (64%), musculoskeletal (59%), and eye (35%), 67% were ANCA-PR3 positive, while haematuria/proteinuria was present in > 50% of the children. In adult series, the frequency of female involvement ranged from 29% to 50% with lower frequencies of constitutional (fever, weight loss), ears, nose, throat (oral/nasal ulceration, otitis/aural discharge), respiratory (tracheal/endobronchial stenosis/obstruction), laboratory involvement and higher frequency of conductive hearing loss than in this paediatric series.ConclusionsPaediatric patients compared to adults with GPA/WG have similar pattern of clinical manifestations but different frequencies of organ involvement.

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Section: Discussionmentioning

confidence: 99%

Clinical features of childhood granulomatosis with polyangiitis (wegener’s granulomatosis)

et al. 2014

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“…A single composite score (sumROM) was defined as the total of these four motions. A composite score for manual muscle test (sumMMT) was defined as the sum of six individual shoulder strength tests (scored individually 1 – 10, composite sumMMT scored 6 – 60) [41–43]. The six shoulder MMTs included shoulder flexors (FLEX), internal rotators (IR), external rotators (ER), abductors (ABD), and individual muscle tests for pectoralis major (PEC) and serratus anterior (SA).…”

Section: Methodsmentioning

confidence: 99%

Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer

Springer¹,

Levy

McGarvey³

et al. 2010

Breast Cancer Res Treat

107

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Purpose-To determine the extent and time course of upper limb impairment and dysfunction in women being treated for breast cancer, and followed prospectively, using a novel physical therapy surveillance model post-treatment.Patients and Methods-Subjects included adult women with newly diagnosed, untreated, unilateral, Stage I to III BC and normal physiological and biomechanical shoulder function. Subjects were excluded if they had a previous history of BC, or prior injury or surgery of the affected upper limb. Measurements included body weight, shoulder ranges of motion (ROM), manual muscle tests, pain levels, upper limb volume, and an upper limb disability questionnaire (ULDQ). Measurements were taken at baseline (pre surgery), and one, three-six, and 12 months post surgery. All subjects received pre-operative education and exercise instruction and specific physical therapy (PT) protocol after surgery including ROM and strengthening exercises.Results-All measures of function were significantly reduced one month post surgery, but most recovered to baseline levels by one year post surgery. Some subjects developed signs of lymphedema 3-12 months post surgery, but this did not compromise function. Shoulder abduction, flexion, and external rotation, but not internal rotation ROM, were associated with the ULDQ.Conclusion-Most women in this cohort undergoing surgery for BC who receive PT intervention may expect a return to baseline ROM and strength by three months. Those who do not reach baseline, often continue to improve and reach their pre-operative levels by one year post surgery. Lymphedema develops independently of shoulder function three to 12 months post surgery, necessitating continued monitoring. A prospective physical therapy model of surveillance allows for detection of early and later onset of impairment following surgery for BC in this specific cohort of patients.

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“…A recent study verified that weakness is symmetric, that proximal extremity weakness is greater than distal, and that neck flexors are significantly weaker than extensors in PM, DM and JDM (5). In that study, the target muscles most affected were the neck flexors; hip abductors, extensors and flexors; and the deltoid (5). …”

Section: Introductionmentioning

confidence: 92%

Validation of manual muscle testing and a subset of eight muscles for adult and juvenile idiopathic inflammatory myopathies

Rider¹,

Koziol²,

Giannini³

et al. 2010

Arthritis Care & Research

220

124

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Objective. To validate manual muscle testing (MMT) for strength assessment in juvenile and adult dermatomyositis (DM) and polymyositis (PM).Methods. Patients with PM/DM (73 children and 45 adults) were assessed at baseline and reevaluated 6 -9 months later. We compared Total MMT (a group of 24 proximal, distal, and axial muscles) and Proximal MMT (7 proximal muscle groups) tested bilaterally on a 0 -10 scale with 144 subsets of 6 and 96 subsets of 8 muscle groups tested unilaterally. Expert consensus was used to rank the best abbreviated MMT subsets for face validity and ease of assessment.

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

Cited by 102 publications

References 30 publications

Clinical features of childhood granulomatosis with polyangiitis (wegener’s granulomatosis)

Clinical features of childhood granulomatosis with polyangiitis (wegener’s granulomatosis)

Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer

Validation of manual muscle testing and a subset of eight muscles for adult and juvenile idiopathic inflammatory myopathies

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