A Study on Cardiopulmonary Manifestations in Inflammatory Myositis.

Senthil Kumar, B (2012) A Study on Cardiopulmonary Manifestations in Inflammatory Myositis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : The Inflammatory Myopathies encompass a group of heterogenous muscle disorders which share the clinical features of slowly progressive weakness of skeletal muscle, decreased muscle endurance and muscle fatigue. Another common feature is presence of inflammatory infiltrates, mainly composed of T cells and macrophages, in muscles tissue. Autoantibodies are also frequent in patients with inflammatory myopathies. The presence of infiltrating lymphyocytes in the target organ, the muscles, and autoimmune disease but a target autoantigen has not been determined. Although muscle symptoms predominate in myositis patients, other clinical manifestations are common. Besides skin rash, which by definition is present in dermatomyositis patients, interstinal lung disease is a frequently observed extramuscular manifestations, as are arthritis, Raynaud’s phenomenon and gastrointestinal involvement. Moreover, myositis is often observed in patients with other connective tissue diseases, particularly in those with systemic sclerosis, mixed connective tissue disease (MCTD) and Sjogren’s syndrome and occasionally in patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). These observations suggests that the idiopathic inflammatory myopathies are systemic inflammatory connective tissue disorders and that there could be etiological factors or pathogenic mechanisms that are shared with other connective tissue diseases. AIMS AND OBJECTIVES : To determine the various cardiopulmonary manifestations in inflammatory myositis. MATERIALS AND METHODS : The study was conducted in the Department of Rheumatology, Madras Medical College, Chennai-3 from February 2011 to January 2012, after ethical committee clearance. Total number of patients included in the study is 50 who fulfills inclusion criteria. All these patients were subjected to clinical examination, CBC, RFT, LFT, CRP, RF, Muscle enzymes (CPK, LDH, SGOT, SGPT) ECG, ECHO, PFT, HRCTLung, CXR, Broncho Alveolar Lavage (BAL), auto antibody profile (ANA, ENA Profile), muscle biopsy, ultra sound abdomen and EMG studies. Inclusion Criteria : 1. Patients fulfilling Bohan & Peter criteria for idiopathic inflammatory myositis. 2. Patients with overlap syndromes presenting with inflammatory myositis. Exclusion Criteria : 1. Features of congenital myopathy, 2. Features of metabolic myopathy, 3. Features of Drug induced myopathy, 4. Features of Endocrine myopathy, 5. Features of muscular dystrophy, 6. H/o. Pulmonary TB in the past, 7. H/o. Diabetes Mellitus, 8. H/o. Exposure to irradiation to body. RESULTS : HRCT lung was done in 42 cases. HRCT lung involvement in the form of interstitial infiltrates, Non Specific Interstitial Pneumonitis (NSIP), Usual Interstitial Pneumonitis (UIP), nodular, reticular patterns, ground glass opacities and traction bronchiectasis were seen in 21(50%) out of 42 patients. In our study, various patterns of lung involvement in inflammatory myositis are 1. NSIP (Non specific interstitial Pneumonitis) characterized by reticular and or ground glass opacities with or without consolidation are seen in 15 (71%) out of 21 patients. 2. Honey combing, bronchiectatic changes with fibrosis seen in 4 (19%) patients out of 21. 3. UIP (Usual Interstitial Pneumonia) 2 (9.5%) patients out of 21. 4. Cryptogenic organizing pneumonia, diffuse alveolar damage were not seen in our study. 5. Pleural effusion with consolidation was seen in 1 case of SLE myositis overlap. CONCLUSION : In out study, inflammatory myositis is more common in females than in males. In our study, myositis is more common in overlap syndromes compared to Idiopathic Inflammatory Myositis. In our study, among the overlap syndromes SLE with myositis overlap is more common. In our study, ILD was seen in 50% of the adult patients with NSIP being the most common. In our study, a symptomatic ECG abnormalities was common (48%). In our study, 58% of the patients showed inflammatory cells in the BAL study, out of which 52% of the patient had ILD changes by HRCT Lung. In patients with myositis, routine use of HRCT Lung and ECG evaluation is more useful.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cardiopulmonary Manifestations ; Inflammatory Myositis.
Subjects: MEDICAL > Rheumatology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:45
Last Modified: 16 Aug 2017 05:36
URI: http://repository-tnmgrmu.ac.in/id/eprint/1812

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