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Adult-onset inflammatory myopathy: North Canterbury experience 1989-2001.
- Source :
-
Internal medicine journal [Intern Med J] 2005 Mar; Vol. 35 (3), pp. 170-3. - Publication Year :
- 2005
-
Abstract
- Aim: To perform a clinical audit of all patients diagnosed with inflammatory myopathy in the North Canterbury region.<br />Methods: A retrospective case note audit of patients with a discharge diagnosis of inflammatory myopathy from June 1989 to June 2001 was performed. The audit was based at Christchurch Hospital, New Zealand, which services a population of 430,000.<br />Results: Of 77 case notes reviewed, 44 patients were identified who were considered to fulfil clinical criteria for inflammatory myopathy. There was a female preponderance (80% female, 20% male). Diagnostic categories in descending order of frequency included: dermatomyositis (41%), polymyositis (39%), inclusion body myositis (IBM) (14%) and overlap syndromes (6%). Malignancy-associated myositis occurred in 20% overall (dermatomyositis 11%, polymyositis 9%). Delays in diagnosis and late age at presentation (average 72 years) were seen in the IBM group. Proximal limb weakness was common, but not universal at presentation (80%). A muscle biopsy was performed in all patients and electromyography in 82%. All were treated with high dose prednisone (0.5-1 mg/kg) of whom 29% were maintained on prednisone alone. Immunosuppressives/immunomodulators used included: azathioprine (58%), methotrexate (31%), intravenous immunoglobulin (13%), chlorambucil (13%), and cyclophosphamide (9%). Thirteen patients (42%) required more than one agent, with three trialling five agents. There were 59 relapses in 20 patients (45%), with mean time to first relapse of 7.8 months. At audit completion, 33% had deceased with malignancy and respiratory failure the main causes.<br />Conclusion: Inflammatory myopathy is a challenging condition in both diagnosis and management. Our audit has shown delays in the diagnosis of IBM, a relatively high incidence of malignancy and a notable risk of relapse and mortality.
- Subjects :
- Aged
Biopsy
Diagnostic Errors
Drug Therapy, Combination
Electromyography
Female
Glucocorticoids therapeutic use
Humans
Immunosuppressive Agents therapeutic use
Incidence
Male
Medical Audit
Middle Aged
Muscle, Skeletal pathology
Myositis drug therapy
Myositis epidemiology
New Zealand epidemiology
Patient Discharge
Prednisone therapeutic use
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Myositis diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1444-0903
- Volume :
- 35
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Internal medicine journal
- Publication Type :
- Academic Journal
- Accession number :
- 15737137
- Full Text :
- https://doi.org/10.1111/j.1445-5994.2004.00764.x