Diagnosis

As with other muscle diseases, a doctor diagnoses dermatomyositis (DM) by considering an individual’s history, family medical history and the results of a careful physical examination. This may be followed by some lab tests, perhaps of the electrical activity inside the muscles, and usually a muscle biopsy.

After a careful history and physical exam to document the pattern of weakness in the patient’s muscles, a doctor who suspects myositis likely will order a blood test to check the level of creatine kinase (CK), an enzyme that leaks out of muscle fibers when the fibers are being damaged. In DM, the CK level is usually very high.

In some cases, the doctor may ask for a blood test for specific antibodies, proteins produced by the immune system in myositis and other autoimmune diseases. Some of these antibodies appear to be specific to autoimmune muscle disease.

The next step is sometimes an electromyogram, a test in which tiny needles are inserted into the muscles to test their electrical activity both at rest and when the person tries to contract the muscle.

Inflammatory myopathies show a distinctive pattern of electrical activity that can help differentiate them from other types of muscle disease.

A nerve conduction velocity test is sometimes performed. This test measures how fast a nerve impulse travels and how strong it is.

Sometimes these tests are used to rule out disorders that may mimic the symptoms of inflammatory myopathies.

A person with a suspected inflammatory myopathy is often asked to undergo a muscle biopsy, a procedure in which a small piece of muscle is removed for examination. This biopsy can enable the physician to pinpoint the diagnosis to a type of myositis.

In DM, the pattern of cellular invasion suggests that it’s the blood vessels in the muscles, and not the muscles themselves, that are the target of the attack. Muscle cells appear smaller than normal around the edges of bundles of muscle fibers, and capillaries are scarce in these regions.

Normal and polymyositis muscle cells
In DM, inflammatory cells are concentrated around blood vessels at the borders of the muscle fiber bundles (fascicles), and fibers in this region often shrink. Inflammatory cells can sometimes be seen forming a cuff around blood vessels.

 

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