# data[].attributes.headline
Team members names and student identification number:

# data[].attributes.subject
Team members names and student identification number:

# data[].attributes.body
Raja Suresh Kumar (SID: 4998857)

Ryan Douglas McGaha (SID: 4998864)

Kiara Maria Leon Nazario (SID: 5001712)

Alanis Enid Melendez Guzman  (SID: 5001736)

Priscilla Michelle Ruiz Toledo (SID:5001798)

Eliam Jair Rios Green (SID: 5003356)

# data[].attributes.body
Polymyositis is is an inflammatory disease that affects the muscles, causing symmetrical proximal muscle weakness.

# data[].attributes.body
Proximal skeletal muscle weakness:

➻Shoulders, upper arms, hips, thighs and neck are more commonly involved

➻Tenderness or muscle pain may be present

Patients may have Trouble:

➻Extending knees

➻Climbing stairs

➻Getting up from a chair

➻Carrying groceries

➻Lifting objects

➻Picking up their children

➻Compared to dermatomyositis, polymyositis doesn't show signs and symptoms of skin involvement

Complications:

➻Difficulty swallowing (dysphagia)

➻Breathing problems ( lung inflammation, respiratory insufficiency)

➻Myocarditis

# data[].attributes.body
Normal function of CD8-T Cell Complex

Cell protein MHC 1 (major histocompatibility complex) on the surface of cell membrane that presents samples to the CD8-T cell complex.

Self antigen

Recognized; no response will be elicited

A foreign antigen

activates immune response

Perforins

punches holes

granzymes

induce apoptosis

# data[].attributes.attachment_link.title
Polymyositis and Dermatomyositis in 3 Minutes

# data[].attributes.body
Autoimmune response to self-antigens

inappropriate reaction of CD8-T cell complex to normal muscle protein

B-cells also secrete antibodies against auto antigens

Normal muscle protein targets

T-RNA synthetase (Jo-1)

Mi-2 (nuclear protein)

components of signal recognition particle (SRP)

Apoptosis of muscle cells

muscle enzymes spill into the blood

Creatine Kinase

Aldolase

# data[].attributes.body
1. Anan, R., Akiyama, M., Kaneko, Y., Kikuchi, J., Suzuki, K., Matsubara, S., & Takeuchi, T. (2017). Polymyositis with elevated serum IgG4 levels and abundant IgG4+ plasma cell infiltration: A case report and literature review. Medicine, 96(48), e8710. https://doi.org/10.1097/MD.0000000000008710

2. Diagnosis - Polymyositis (PM) - Diseases | Muscular Dystrophy Association. (2024, May 15). Muscular Dystrophy Association. https://www.mda.org/disease/polymyositis/diagnosis#:~:text=People%20with%20polymyositis%20(PM)%20may,exclusion%20of%20other%20IIM%20subgroups.

3. Findlay, A. R., Goyal, N. A., & Mozaffar, T. (2015). An overview of polymyositis and dermatomyositis. Muscle & nerve, 51(5), 638-656.

4. JoVE (Journal of Visualized Experiments). (2022, July 6). Modified Bergstrom Technique for Human Skeletal Muscle Biopsy | Protocol Preview. YouTube. https://www.youtube.com/watch?v=Azv2s6JVdqM

5. Milisenda, J., Selva-O’Callaghan, A., & Grau, J. (2014, February 1). The diagnosis and classification of polymyositis. Journal of Autoimmunity. https://doi.org/10.1016/j.jaut.2014.01.025

6. Muscular Dystrophy Association. (n.d.). Muscular Dystrophy Association. https://www.mda.org

7. Sarwar, A., Dydyk, A. M., & Jatwani, S. (2020). Polymyositis. PubMed; StatPearls

8. Seetharaman, M. (n.d.). Polymyositis Workup: Approach Considerations, Imaging Studies,  Electromyography. https://emedicine.medscape.com/article/335925-workup?form=fpf

9. (2024). Amboss.comhttps://next.amboss.com/us/search?q=polymyositis&v=overview

10. YouTube. (2021, March 12). Polymyositis. YouTube. https://www.youtube.com/watch?v=yw87XQWXTPo

# data[].attributes.body
The first clinical tool or method to diagnose PM is a physical examination, in which it is determined if there is any proximal skeletal muscle weakness and the absence of dermatological abnormalities (which is characteristic of Dermatomyositis).

# data[].attributes.body
Blood tests can also be performed to determine if there are high levels of muscle enzymes such as creatine kinase.

# data[].attributes.body
A magnetic resonance image to determine the grade of muscle inflammation in a large area.

# data[].attributes.body
It is not associated with any myositis antibody, so the absence or presence of certain myositis antibodies are useful to rule out other myopathic diseases. An example of one, that can be increase, is Antinuclear antibodies (ANA).

# data[].attributes.body
Is a test where an electrode is introduced in the muscle tissue to measure the electrical activity of the patient as they contract and relax the muscle. there is an increase in the presence of spontaneous electrical discharges and fibrillation potentials.

# data[].attributes.body
This exam consists of removing a piece of muscle tissue to determine if there is inflammation, damage, presence or absence of certain proteins and enzymes (examples: CD4+, CD8+ and MHC class I antigens). Histopathology is currently considered the best study to diagnose PM.

# data[].attributes.body
ENDOMYSIAL INFLAMMATION

CD8+ T CELLS INFILTRATION

# data[].attributes.body
A 71-year-old woman with progressive muscle weakness in both thighs. This weakness likely affected her ability to perform daily activities such as climbing stairs, standing from a seated position, or rising from bed.

Physical examination revealed weakness in neck flexor tendons (muscles that bend the head forward), biceps, triceps, quadriceps (muscles that extend the knee), and iliopsoas muscles (muscles that flex the hip joint and help with hip flexion during walking).

The weakness pattern suggests a proximal myopathy, meaning the weakness is more severe in muscles closer to the body's center (trunk) compared to those further away (distal muscles in hands and feet). This is a characteristic feature of polymyositis.

# data[].attributes.body
1. Elevated serum creatinine kinase (384 IU/L, normal range: 50–170 U/L):

Creatine kinase is an enzyme found in muscle cells. When muscle damage occurs, creatine kinase leaks into the bloodstream, causing elevated levels. The degree of elevation can provide clues about the severity of muscle damage. In this case, a significant increase suggests substantial muscle involvement.

2. Elevated aldolase (6.2 IU/L, normal range: 2.7–5.9 IU/L):

Similar to creatine kinase, aldolase is another enzyme found in muscle cells. Its elevation further supports muscle damage.

3. Elevated lactate dehydrogenase (314 U/L, normal range: 120–220 U/L):

Lactate dehydrogenase is an enzyme present in various tissues, including muscle. While not specific to muscle damage, its elevation alongside creatine kinase and aldolase strengthens the suspicion of myopathy

# data[].attributes.body
Electromyography (EMG) showed spontaneous fibrillations and positive sharp waves in bilateral femoral quadriceps.

EMG is a test that assesses the electrical activity of muscles and nerves. Spontaneous fibrillations are abnormal electrical discharges indicating muscle fiber damage.

Positive sharp waves suggest ongoing muscle fiber injury or denervation (loss of nerve supply).

These findings in the femoral quadriceps muscles (located in the thighs) confirm the presence of myopathy in this specific muscle group.

# data[].attributes.body
Histological examination of left quadriceps: mononuclear inflammatory cells that surrounded and invaded muscle fibers (were positive for CD8 and MHC class I antigen was extensively expressed on the surface of almost all muscle fibers).

Scattered necrotic and regenerating muscle fibers as well as variations in muscle fiber size were characteristic of inflammatory myopathy (Image A and B).

# data[].attributes.body
Infiltration of inflammatory cells at perivascular sites and perifascicular atrophy were not observed.

CD138, IgG, and IgG4 immunostaining revealed that over 40% of infiltrated IgG positive plasma cells were IgG4+ cells (Image E, F, G)

Important findings for IgG4-RD of storiform fibrosis and obliterative phlebitis were not found (ImageH).

# data[].attributes.attachment_link.provider_name
National Institute of Neurological Disorders and Stroke

# data[].attributes.attachment_link.readable_text
The, a component of the National Institutes of Health (), is a leading federal funder of research on muscle diseases like polymyositis.

Polymyositis is one of a group of rare diseases called the inflammatory myopathies that involve chronic (long-standing) muscle inflammation and weakness, and in some cases, pain. Myopathy is a general term used to describe a number of conditions affecting the muscles. All myopathies can cause muscle weakness. Both children and adults can be affected.

Polymyositis affects skeletal muscles (the type involved in body movement) on both sides of the body. It is rarely seen in people younger than age 20. Generally, the onset occurs between age 30 and 60. Untreated progressive muscle weakness may lead to difficulty doing the following actions:

Some people with polymyositis also may develop:

In some cases of polymyositis, the distal muscles, which are the muscles away from the center of the body, such as those in the forearms and around the ankles and wrists, may be affected as the disease progresses. The disorder also may be associated with collagen-vascular or autoimmune diseases such as lupus, in which the body's immune response system that normally defends against infection and disease attacks its own muscle fibers, blood vessels, connective tissue, organs, or joints.

Learn About Clinical Trials

Clinical trials are studies that allow us to learn more about disorders and improve care. They can help connect patients with new and upcoming treatment options.

How can I or my loved one help improve care for people with polymyositis?

Consider participating in a clinical trial so clinicians and scientists can learn more about polymyositis and related disorders. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.

All types of volunteers are needed- those who are healthy or may have an illness or disease- of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.

For information about participating in clinical research visit NIH Clinical Research Trials and You . Learn about clinical trials currently looking for people with polymyositis at Clinicaltrials.gov .

# data[].attributes.attachment_link.description
Polymyositis is one of a group of rare diseases called the inflammatory myopathies that involve chronic (long-standing) muscle inflammation and weakness, and in some cases, pain. Polymyositis affects skeletal muscles (the type involved in body movement) on both sides of the body.

# data[].attributes.attachment_link.readable_text
Polymyositis (PM)

What is polymyositis (PM)?

Polymyositis (PM) is one of the idiopathic inflammatory myopathies (IIMs), a group of muscle diseases that involves inflammation of the muscles or associated tissues. A myopathy is a muscle disease, and inflammation is response to cell damage. Another word for inflammatory myopathy is myositis. The myo root means muscle, and the itis root means inflammation; so a myositis is an inflammatory muscle disease.

In PM, inflammatory cells of the immune system directly attack muscle fibers, leading to weakness in the skeletal muscles (muscles that connect to bone and allow movement). PM presents with some overlapping symptoms to other IIMs and is sometimes misdiagnosed as one of the other conditions.

What are the symptoms of PM?

The muscles of the shoulders, upper arms, hips, thighs and neck display the most weakness in PM. There also can be pain or tenderness in the affected areas, as well as swallowing problems and inflammation of the heart and lung muscle tissues. For more, see Signs and Symptoms.

What causes PM?

In most cases, the cause of an IIM is unclear. For some reason, the body's immune system turns against its own muscles and damages muscle tissue in an autoimmune process. In PM, the inflammatory cells of the immune system directly attack muscle fibers.

PM is not a genetic disorder, although there may be genetic factors that make it more or less likely that an inflammatory myopathy will develop. For more, see Causes/Inheritance.

What is the progression of PM?

The symptoms of PM usually begin in adulthood, after age 20, and the disease progresses gradually. Over a period of weeks to months, people with PM will begin to experience slowly worsening weakness in the skeletal muscles.

Although IIMs like PM can lead to great discomfort for at least a period of time, effective treatments are available, and for the most part these conditions aren't life-threatening. Many people recover partially or completely from PM.

What is the status of research on PM?

Research studies to increase the understanding of PM and clinical trials of medications to treat IIMs are underway. For a list of polymyositis clinical trials, see MDA's Clinical Trials Finder Tool.

References

1. Findlay AR, Goyal NA, Mozaffar T. An overview of polymyositis and dermatomyositis. Muscle Nerve. 2015;51(5):638-656. doi:10.1002/MUS.24566

2. Baig S, Paik JJ. Inflammatory muscle disease - An update. Best Pract Res Clin Rheumatol. 2020;34(1):101484. doi:10.1016/j.berh.2019.101484

Last update: Feb 2023
Reviewed by Julie Paik, MD, MHS; Johns Hopkins University

# data[].attributes.attachment_link.title
Polymyositis (PM) - Diseases | Muscular Dystrophy Association

# data[].attributes.attachment_link.description
What is polymyositis (PM)? Polymyositis (PM) is one of the idiopathic inflammatory myopathies (IIMs), a group of muscle diseases that involves inflammation of the muscles or associated tissues. A myopathy is a muscle disease, and inflammation is response to cell damage. Another word for inflammatory myopathy is myositis.

# data[].attributes.body
Blood counts, serum levels of electrolyte, creatinine, IgE, and blood glucose, within normal range.

Antinuclear antibody was positive with a titer of 1:1240 (homogeneous and speckled patterns).

Anti Aminoacyl-tRNA synthetase, anti-RNP, anti-dsDNA antibody, and anti-Sm antibodies were all negative.

# data[].attributes.body
Magnetic resonance imaging of bilateral femoral quadriceps revealed:

Normal intensity on T1-weighted image (A)

High intensity onT2-weighted image (B)

Fat-suppressed T2-weighted image

# data[].attributes.body
First line: Glucocorticoids (Prednisone and Methylprednisolone) and a steroid-sparing immunosuppressive agent (Methotrexate and Azathioprine).

Starting dose: 1 mg/kg of prednisone a day, steroids should be tapered off gradually

Second-line: immune-modulators (methotrexate, azathioprine, cyclosporine) in those patients who either do not respond to steroids or develop severe adverse effects due to steroids usage. Cyclosporine is the most efficient in patients with pulmonary disease.

*Intravenous immunoglobulins (infliximab and etanercept) should be considered in patients having dysphagia due to esophageal involvement.

Non-Pharmacological: Physical therapy and resistance training of affected muscles, and high-protein diet  to prevent tissue atrophy

# data[].attributes.headline
AN OVERVIEW OF POLYMYOSITIS AND DERMATOMYOSITIS

# data[].attributes.subject
AN OVERVIEW OF POLYMYOSITIS AND DERMATOMYOSITIS

# data[].attributes.headline
The Diagnosis and Classification of Polymyositis

# data[].attributes.subject
The Diagnosis and Classification of Polymyositis

# data[].attributes.attachment_link.description
Listen to this episode from The Medbullets Step 1 Podcast on Spotify. In this episode, we review the high-yield topic of Polymyositis / Dermatomyositis from the MSK section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message

# data[].attributes.body
TMA is so excited about our brand new offering, The Myositis Family Podcast. The Myositis diagnosis and journey is different for each person and includes more than the individual. This podcast is designed to share patient stories, provide support, information, and inspiration for our Myositis family and caregivers.

# data[].attributes.attachment_link.readable_text
TMA provides a collection of informative podcasts by myositis experts, covering topics related to the forms of myositis, treatments, complications, research, and more.
TMA is so excited about our brand new offering, The Myositis Family Podcast. The Myositis diagnosis and journey is different for each person and includes more than the individual. This podcast is designed to share patient stories, provide support, information, and inspiration for our Myositis family and caregivers.

Season 2

Episode 1 Join us and listen in as Eric shares her journey with dermatomyositis, from its gradual start into a place of full blown. We know that every myositis journey is different, and Eric's is a perfect example.

Episode 2 Join us and listen in as Chuck shares her journey with dermatomyositis, from its harrowing start into a place of acceptance and recovery. We know that every myositis journey is different, and Chuck's is a perfect example.

Season 1

Episode 1 Join us and listen in as Elisa shares her journey with dermatomyositis, from its harrowing start into a place of acceptance and recovery. We know that every myositis journey is different, and Elisa's is a perfect example as a Women of Color.

Episode 2 Join us and listen in as Vuma shares her journey with dermatomyositis and polymyositis, undergoing a battery of tests before being diagnosed. We know that every myositis journey is different, and Vuma's is a perfect example.

Episode 3 Join us and listen in as Danielle shares her journey with dermatomyositis, from its harrowing start into a place of acceptance and recovery. We know that every myositis journey is different, and Danielle's is a perfect example.

Episode 4 Join us and listen in as Bruce shares his journey with Inclusion Body Myositis (IBM), from 'it came from nowhere' and how he is managing this progressive disease. We know that every myositis journey is different, and Bruce's is a perfect example.

Episode 5 Join us and listen in as Barbara shares her journey with myositis, from one diagnosis to the next. Even with her medical background, Barbara faced similar struggles with getting diagnosed and treatment. We know that every myositis journey is different, and Barbara's is a perfect example.

Episode 6 Join us and listen in as Robert shares his journey with dermatomyositis, from one treatment to another. We know that every myositis journey is different, and Robert's is a perfect example.

Episode 7 Join us and listen in as Jason shares how his diagnosis has affected his family and his tips for family and caregivers. We know that every myositis journey is different, and Jason's is a perfect example.

Episode 8 Join us and listen in as Fiona shares her journey with dermatomyositis, the years of ups and downs until she took control of her recovery. We know that every myositis journey is different, and Fiona's is a perfect example. You'll enjoy her tips for wellness and regaining her physical strength.

Episode 9 Join us and listen in as Colleen shares her journey with polymyositis and then NAM. You will enjoy hearing how her horses made adjustments to accommodate her condition. We know that every myositis journey is different, and Colleen's is a perfect example.

Episode 10 Join us and listen in as Molly shares her journey with dermatomyositis, along with her family support. We know that every myositis journey is different, and Molly's is a perfect example.

Episode 11 Join us and listen in as Malati shares not only her journey with IBM but also some tips for thriving with this disease. We know that every myositis journey is different, and Malati's is a perfect.

Episode 12 Join us and listen in as Krista shares her journey with dermatomyositis, from its harrowing start into a place of acceptance and recovery. We know that every myositis journey is different, and Krista's is a perfect example.

TMA medical advisor Dr. Andrew Mammen gives an overview of myositis and discusses the specifics of polymyositis.

# data[].attributes.attachment_link.description
Find a collection of informative podcasts by myositis experts, covering topics related to the forms of myositis, treatments, complications and research.

# data[].attributes.wish_content.attachment_props.question
The main difference between polymyositis and dermatomyositis

# data[].attributes.wish_content.attachment_props.poll_choices[].choice_text
POLY - no skin involvement  DERMA- skin involvement 