Dermatomyositis – Signs & Symptoms | Johns Hopkins

Dermatomyositis – Signs & Symptoms | Johns Hopkins


(gentle music) – The symptoms depend on each patient. Each patient can present with different type of symptoms, but
most commonly we look for skin, lung, or muscle. The patient might develop some erythema over the knuckles and usually most people don’t pay any attention to it, especially if they’re fair-skinned, this can be common. But the significant part would be that this would be a new occurrence. The patient wouldn’t have those before. Another thing that can happen very early in the disease, and it’s not unique for dermatomyositis, but any kind of rheumatic diseases is Reynaud’s. Reynaud’s is the phenomenon
where the fingers when they are exposed to the cold, they turn white, totally white and then might change
colors like red or purple. When it appears after the age of 25 or 30, then it means that something is going on and the patient needs to be evaluated for rheumatologic diseases. Another early symptom of the disease is that the patient might
develop an inflammatus rash on sun-exposed areas like the face, the upper chest or upper back, but this can happen even if the patient is not exposed to the sun or if they patient is exposed to the sun then the rash doesn’t go away with time. Another thing that we
often miss is the scalp. The scalp can be an important part of dermatomyositis. It can be affected and
cause like scaly rash and a lot of itching and that can be misdiagnosed
as other conditions, but even though the patient
is using topical shampoos, it doesn’t go away, so that would be indication that the patient should be evaluated for dermatomyositis. Then the symptoms from the muscle, as we said before, it could be progressive muscle weakness. The patient first notices that they cannot hold their arms above the head for a long, they have
difficulty getting up from a chair, especially
from the toilet seat because it’s lower than usual and they notice they
have to use their arms to climb up and stand up. One of the early symptoms
could be difficulty climbing up stairs because it needs extra effort and extra strength. That could be also a sign
of early lung disease because in dermatomyositis,
the lungs can be affected and they have progressive
shortness of breath, especially on exertion, like when they see that before they could run like a mile, now they can only run like half a mile because they get short of breath. So that needs to be evaluated
as soon as possible. We’ll go into the severe symptoms of myositis, the symptoms that can send the patient to the hospital. So these are two, either
the shortness of breath or dysphasia. Shortness of breath,
it comes most commonly from lung disease, which
means the condition of where the lungs are inflamed and the patient cannot
take a deep, full breath and oxygen cannot reach the tissues. If it happens suddenly, it can be severe and the patient needs to be hospitalized. Another severe symptom is dysphasia, which means that the patient
has difficulty swallowing, so these are the severe symptoms that need to be evaluated
as soon as possible. So the trajectory of the disease can be different depending on the patient. In some patients, they
have one-time symptoms, we treat them, and then they
never have any symptoms again, or some patients, which are the majority of the ones we see, they will
have flares of the disease, which means it’s well-controlled and then for some reason,
they can get again a flare of the disease. Usually there is some trigger behind it, like infection, underlying malignancy, or even stress can cause a flare-up, but sometimes we’re not able to find out why these people have again a recurrence of their symptoms.

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