Dermatomyositis – Diagnosis and Treatment
Diagnosis
Doctors use a mix of tests and physical checks to find out if someone has dermatomyositis, a type of inflammatory muscle disease. They look for muscle weakness and special skin rashes.
The steps for spotting this condition include blood work, scans, and sometimes removing a tiny bit of skin or muscle to study under a microscope.
Common Testing Methods
Blood Tests: Doctors use blood samples to spot raised muscle enzymes like creatine kinase, which show muscle damage. They also check for autoantibodies linked to autoimmune disorders, such as dermatomyositis.
Physical Examination: The doctor checks muscle strength in areas such as the shoulders and hips. They also look for skin changes, for example, Gottronโs papules or a rash on the face or knuckles.
Electromyography (EMG): A thin needle goes into a muscle so the doctor can check electrical activity. This helps find out which muscles are weak or inflamed.
Magnetic Resonance Imaging (MRI): MRI takes pictures of muscles to spot areas of inflammation. This is helpful because it does not require surgery.
Chest X-Ray: The doctor uses this imaging test to look for lung changes, since dermatomyositis can affect the lungs.
Biopsy: The doctor may take a small piece of muscle or skin to look for inflammation or other changes. If a skin sample already confirms dermatomyositis, a muscle biopsy may not be needed.
Treatment
Medicines for Control
Many people with dermatomyositis use medications to help manage symptoms. Corticosteroids are often the first choice because they quickly reduce swelling and calm the immune system.
Doctors typically start with a higher dose and then lower it slowly as the person improves to reduce the risk of side effects. Sometimes, doctors add or switch to other immunosuppressants (antimetabolites) to lessen corticosteroid side effects.
For people who donโt get better or have severe symptoms, doctors might use a monoclonal antibody (B-cell depleting agent).
For skin rashes that do not improve, antimalarial drugs can be helpful. Using sunscreen and wearing protective clothing is important to prevent rash flare-ups caused by sun exposure.
Exercise and Help with Speech or Eating
Physical therapy helps people stay strong and flexible. A physical therapist shows safe exercises to improve movement and muscle strength.
Starting these exercises early can delay muscle weakness. If swallowing muscles are affected, a speech therapist helps with safer eating and drinking.
Some people may also need advice from a dietitian to make meals easier to eat, especially if chewing or swallowing becomes hard.
A basic therapy checklist:
- Physical therapy for building strength.
- Speech therapy to aid swallowing.
- Diet advice for easier eating if muscles are weak.
Other Treatments and Operations
Some people may need treatments other than medicines. Intravenous immunoglobulin (IVIg) gives healthy antibodies through a vein to help block harmful immune actions in muscles and skin.
IVIg often needs to be repeated and is usually for those who do not improve with standard medicines. In rare cases, doctors may remove hard, painful calcium deposits under the skin to prevent sores or infections.
Looking After Yourself
People with dermatomyositis should use sunscreen or wear hats and long sleeves when outdoors. Light exercise and gentle stretching help keep muscles flexible and improve movement.
Staying safe in the sun and staying active are both important.
Ways to Manage and Find Support
Living with dermatomyositis can be challenging, but people can take steps to feel more in control and supported each day. Staying informed about the condition helps individuals make better choices about their care.
Talking with doctors, reading reliable sources, and connecting with others who have similar experiences can increase understanding and build confidence. Taking an active role as part of the healthcare team is important.
Patients should share updates with their medical providers and follow the treatment plan. This teamwork can improve symptom management.
Physical activity helps maintain or build muscle strength. Some ideas include:
- Following a personalized exercise plan created with a healthcare professional.
- Taking regular short walks.
- Using light weights or bands, if approved.
- Stretching to stay flexible.
Rest is also important. Taking breaks before feeling extremely tired helps keep energy levels steadier throughout the day.
Dealing with the emotional side matters as much as managing physical symptoms. People may feel upset, frustrated, or worried.
Keeping a daily routine and continuing with hobbies can help. Staying connected with friends and family brings comfort and lessens feelings of loneliness.
Support groups or counseling services offer a place to talk and get encouragement from others facing similar challenges. These groups can give practical ideas for daily life.
Many people benefit from sharing their stories and learning from each other.
Getting Ready for Your Visit
Steps You Can Take Before Your Appointment
Patients can prepare for their visit by making a list of their symptoms, when each symptom started, and any changes over time. It helps to write down all current health issues, including those of close family members.
Listing every medicine, vitamin, and supplement, along with how much and how often they are taken, is important. Bringing a family member or friend may make it easier to remember what the healthcare provider says.
Patients should create a list of topics and questions to discuss, such as:
- What might be the cause of the symptoms?
- What tests will be needed?
- Are there treatment options available?
- How should other health problems be managed at the same time?
They should add other questions during the visit as needed. Staying organized can help the visit go more smoothly and ensure all concerns are addressed.
What Your Healthcare Provider May Ask
The healthcare provider will likely ask when the symptoms began. They may also ask if the symptoms appeared slowly or suddenly.
They may want to know if the patient gets tired easily during the day. The provider might ask if certain activities are difficult.
They may also ask if anyone in the family has muscle problems. Questions could cover what helps or makes the symptoms worse.
