{"id":17605,"date":"2023-11-30T13:43:27","date_gmt":"2023-11-30T13:43:27","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=17605"},"modified":"2026-07-30T11:47:38","modified_gmt":"2026-07-30T10:47:38","slug":"myositis","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/myositis\/","title":{"rendered":"Myositis"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Definition<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Inflammatory myositis is the name for a group of autoimmune disorders characterized by immune-mediated damage to skeletal muscle.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Major subtypes are:<\/strong><strong><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Inclusion body myositis<\/strong><\/li>\n\n\n\n<li><strong>Immune mediated necrotising myositis<\/strong><\/li>\n\n\n\n<li>Dermatomyositis<\/li>\n\n\n\n<li>Antisynthetase syndrome<\/li>\n\n\n\n<li>Overlap myositis with other connective tissue diseases such as lupus, systemic sclerosis.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>History<\/strong>&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Proximal muscle weakness\u00a0causing difficulty rising from a chair, getting out of the car, climbing stairs, lifting objects and combing hair associated with fatigue, myalgia<\/li>\n\n\n\n<li>Onset over weeks to months and steady progression\u00a0<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Associated Systemic features:<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pharyngeal muscle(dysphagia) or laryngeal muscle(dysphonia) or respiratory muscle weakness may also be present<\/li>\n\n\n\n<li>Chronic dry cough with breathlessness (CXR &#8211;\u00a0features of interstitial lung disease)\u00a0<\/li>\n\n\n\n<li>Symptoms of connective tissue disease such as Raynaud\u2019s, sicca symptoms, photosensitive rash, serositis, inflammatory arthritis\u00a0<\/li>\n\n\n\n<li>Weight loss<\/li>\n\n\n\n<li>Distinctive skin rash:\n<ul class=\"wp-block-list\">\n<li>Gottron papules on the dorsal aspect of the hands and fingers<\/li>\n\n\n\n<li>Periorbital oedema and erythema of the face (heliotrope rash)<\/li>\n\n\n\n<li>Rash on the anterior upper chest (V-sign) or the posterior neck (shawl sign)<\/li>\n\n\n\n<li>Periungual erythema and telangiectasia<\/li>\n\n\n\n<li>Thickened and cracked skin of acral surface of the fingers (mechanic\u2019s hand)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Investigation<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Creatine kinase- raised \u00a0(CK can be normally up to 5 times upper limit normal)<\/strong><strong>\u00a0<\/strong><\/li>\n\n\n\n<li>Inflammatory markers\u00a0\u2013 raised<\/li>\n\n\n\n<li>Abnormal liver function test (high ALT can be seen with raised CK)\u00a0<\/li>\n\n\n\n<li>Autoimmune antibodies\u00a0\u2013 ENA, ANA, CCP<\/li>\n\n\n\n<li>Malignancy screen if suspected (e.g. CT chest, abdomen, Pelvis)\u00a0\u2013 association of malignancy with myositis<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>M.A &amp; H.B\/S.R &#8211; 29-7-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">When to refer\u00a0:\u00a0<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Patients who meet all the criteria listed below should be referred <strong><u>urgently<\/u><\/strong> to rheumatology:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>elevated inflammatory markers and\/or typical rash (as above)<\/li>\n\n\n\n<li>acute or sub-acute onset of symmetrical proximal muscle weakness<\/li>\n\n\n\n<li>elevated creatine kinase (CK &gt; 5 Upper Limit Normal)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Elevated CK without above clinical features &#8211; Consider an alternative diagnosis (See reference <strong><sup>1<\/sup><\/strong>)<\/li>\n\n\n\n<li>Patients with diffuse myalgia with normal creatine kinase (up to 5 x ULN) and normal inflammatory markers<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer to Rheumatology:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Urgent referral via SCI referral system\u00a0<\/li>\n\n\n\n<li>SCI Gateway &gt; Rheumatology &gt; WGH<\/li>\n\n\n\n<li>Discuss with on-call via page for consideration of hospital admission if patient has pharyngeal\/laryngeal\/ respiratory muscle weakness \u00a0<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong>:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">1. Kim E J, Wierzbicki A S. Investigating raised creatine kinase BMJ 2021; 373:n1486 doi:10.1136\/bmj.n1486 available at \u00a0<a href=\"https:\/\/doi.org\/10.1136\/bmj.n1486\">https:\/\/doi.org\/10.1136\/bmj.n1486<\/a><br>2. <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMra2415426\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMra2415426<\/a> <\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.arthritis-uk.org\/information-and-support\/understanding-arthritis\/conditions\/myositis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Myositis: Symptoms, causes and treatment | Arthritis UK<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Definition Inflammatory myositis is the name for a group of autoimmune disorders characterized by immune-mediated damage to skeletal muscle. Major subtypes are: History&nbsp; Associated Systemic features: Investigation M.A &amp; H.B\/S.R &ndash; 29-7-26<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4395,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1048],"class_list":["post-17605","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-inflammatory-myositis"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/rheumatology\/https-apps-nhslothian-scot-refhelp-inflammatory-myositis\/\" rel=\"tag\">Inflammatory Myositis<\/a>","rttpg_excerpt":"Definition Inflammatory myositis is the name for a group of autoimmune disorders characterized by immune-mediated damage to skeletal muscle. Major subtypes are: History&nbsp; Associated Systemic features: Investigation M.A &amp; H.B\/S.R &ndash; 29-7-26","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/17605","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=17605"}],"version-history":[{"count":8,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/17605\/revisions"}],"predecessor-version":[{"id":29269,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/17605\/revisions\/29269"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4395"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=17605"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=17605"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}