Polymyositis Masquerading as Motor Neuron Disease

Abstract

Bulbar-onset polymyositis may mimic MND, particularly in the absence of inflammatory markers or elevated muscle enzyme levels. Caution should be exercised in the clinical diagnosis of bulbar dysfunction, and further investigations such as electromyography and muscle biopsy are indicated to confirm the diagnosis.

Is Polymyositis a Rare or Over-Diagnosed Entity? A Descriptive Follow-Up Study of Patients Initially Admitted in a Tertiary Center with the Diagnosis of Polymyositis

“…Until the present study, 72.3% of our patients had a change in the diagnosis after a detailed reinvestigation. Series and cases reports [9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] corroborate our findings, showing the diagnostic difficulty and the need to redefine diagnoses in patients initially diagnosed with PM.…”

Is Polymyositis a Rare or Over-Diagnosed Entity? A Descriptive Follow-Up Study of Patients Initially Admitted in a Tertiary Center with the Diagnosis of Polymyositis

“…Until the present study, 72.3% of our patients had a change in the diagnosis after a detailed reinvestigation. Series and cases reports [9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] corroborate our findings, showing the diagnostic difficulty and the need to redefine diagnoses in patients initially diagnosed with PM.…”

The Impact of Dysphagia in Myositis: A Systematic Review and Meta-Analysis

“…IIM can result in impairment of the oral [ 29 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ], pharyngeal [ 7 , 23 , 24 , 27 , 29 , 31 , 32 , 33 , 44 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ,…”

“…Reduced pharyngeal contractility can result in insufficient pharyngeal bolus clearance [ 139 ]. Consequently, myositis patients often show pharyngeal residue after swallowing [ 7 , 27 , 29 , 31 , 33 , 44 , 58 , 59 , 60 , 61 , 65 , 66 , 67 , 69 , 71 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 83 , 84 , 86 , 87 , 91 , 93 , 96 , 100 , 101 , 103 , 104 , 106 , 111 , 112 , 115 ]. These can impact on swallowing safety and ultimately cause aspiration, which is a frequently reported finding [ 33 , 78 , 81 , 86 ].…”

“…There are several articles reporting positive therapeutic effects of immunomodulatory medication on symptoms and/or on findings of objective swallowing evaluations. These include intravenous methylprednisolone pulse therapy [ 19 , 33 , 70 , 81 , 87 , 134 , 154 , 155 , 156 , 157 , 158 , 159 ], methotrexate [ 30 , 76 , 89 , 124 , 136 , 154 , 159 , 160 , 161 ], long-term prednisone/prednisolone [ 29 , 30 , 33 , 59 , 64 , 70 , 74 , 76 , 81 , 83 , 84 , 87 , 89 , 101 , 103 , 111 , 118 , 122 , 124 , 134 , 136 , 143 , 154 , 158 , 159 , 161 , 162 , 163 , 164 , 165 ,…”

“…Consequently, myositis patients often show pharyngeal residue after swallowing [7,27,29,31,33,44,[58][59][60][61][65][66][67]69,71,[73][74][75][76][77][78][79][80]83,84,86,87,91,93,96,100,101,103,104,106,111,112,115]. These can impact on swallowing safety and ultimately cause aspiration, which is a frequently reported finding [33,78,81,86].…”

Is Polymyositis a Rare or Over-Diagnosed Entity? A Descriptive Follow-Up Study of Patients Initially Admitted in a Tertiary Center with the Diagnosis of Polymyositis

“…Until the present study, 72.3% of our patients had a change in the diagnosis after a detailed reinvestigation. Series and cases reports [9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] corroborate our findings, showing the diagnostic difficulty and the need to redefine diagnoses in patients initially diagnosed with PM.…”

The Impact of Dysphagia in Myositis: A Systematic Review and Meta-Analysis

“…IIM can result in impairment of the oral [ 29 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ], pharyngeal [ 7 , 23 , 24 , 27 , 29 , 31 , 32 , 33 , 44 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ,…”

“…Reduced pharyngeal contractility can result in insufficient pharyngeal bolus clearance [ 139 ]. Consequently, myositis patients often show pharyngeal residue after swallowing [ 7 , 27 , 29 , 31 , 33 , 44 , 58 , 59 , 60 , 61 , 65 , 66 , 67 , 69 , 71 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 83 , 84 , 86 , 87 , 91 , 93 , 96 , 100 , 101 , 103 , 104 , 106 , 111 , 112 , 115 ]. These can impact on swallowing safety and ultimately cause aspiration, which is a frequently reported finding [ 33 , 78 , 81 , 86 ].…”

“…There are several articles reporting positive therapeutic effects of immunomodulatory medication on symptoms and/or on findings of objective swallowing evaluations. These include intravenous methylprednisolone pulse therapy [ 19 , 33 , 70 , 81 , 87 , 134 , 154 , 155 , 156 , 157 , 158 , 159 ], methotrexate [ 30 , 76 , 89 , 124 , 136 , 154 , 159 , 160 , 161 ], long-term prednisone/prednisolone [ 29 , 30 , 33 , 59 , 64 , 70 , 74 , 76 , 81 , 83 , 84 , 87 , 89 , 101 , 103 , 111 , 118 , 122 , 124 , 134 , 136 , 143 , 154 , 158 , 159 , 161 , 162 , 163 , 164 , 165 ,…”

“…Consequently, myositis patients often show pharyngeal residue after swallowing [7,27,29,31,33,44,[58][59][60][61][65][66][67]69,71,[73][74][75][76][77][78][79][80]83,84,86,87,91,93,96,100,101,103,104,106,111,112,115]. These can impact on swallowing safety and ultimately cause aspiration, which is a frequently reported finding [33,78,81,86].…”

Is Polymyositis a Rare or Over-Diagnosed Entity? A Descriptive Follow-Up Study of Patients Initially Admitted in a Tertiary Center with the Diagnosis of Polymyositis

“…Until the present study, 72.3% of our patients had a change in the diagnosis after a detailed reinvestigation. Series and cases reports [9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] corroborate our findings, showing the diagnostic difficulty and the need to redefine diagnoses in patients initially diagnosed with PM.…”

The Impact of Dysphagia in Myositis: A Systematic Review and Meta-Analysis

“…IIM can result in impairment of the oral [ 29 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ], pharyngeal [ 7 , 23 , 24 , 27 , 29 , 31 , 32 , 33 , 44 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ,…”

“…Reduced pharyngeal contractility can result in insufficient pharyngeal bolus clearance [ 139 ]. Consequently, myositis patients often show pharyngeal residue after swallowing [ 7 , 27 , 29 , 31 , 33 , 44 , 58 , 59 , 60 , 61 , 65 , 66 , 67 , 69 , 71 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 83 , 84 , 86 , 87 , 91 , 93 , 96 , 100 , 101 , 103 , 104 , 106 , 111 , 112 , 115 ]. These can impact on swallowing safety and ultimately cause aspiration, which is a frequently reported finding [ 33 , 78 , 81 , 86 ].…”

“…There are several articles reporting positive therapeutic effects of immunomodulatory medication on symptoms and/or on findings of objective swallowing evaluations. These include intravenous methylprednisolone pulse therapy [ 19 , 33 , 70 , 81 , 87 , 134 , 154 , 155 , 156 , 157 , 158 , 159 ], methotrexate [ 30 , 76 , 89 , 124 , 136 , 154 , 159 , 160 , 161 ], long-term prednisone/prednisolone [ 29 , 30 , 33 , 59 , 64 , 70 , 74 , 76 , 81 , 83 , 84 , 87 , 89 , 101 , 103 , 111 , 118 , 122 , 124 , 134 , 136 , 143 , 154 , 158 , 159 , 161 , 162 , 163 , 164 , 165 ,…”

“…Consequently, myositis patients often show pharyngeal residue after swallowing [7,27,29,31,33,44,[58][59][60][61][65][66][67]69,71,[73][74][75][76][77][78][79][80]83,84,86,87,91,93,96,100,101,103,104,106,111,112,115]. These can impact on swallowing safety and ultimately cause aspiration, which is a frequently reported finding [33,78,81,86].…”