Clinical features

• peak incidence 40-60 years

• muscle weakness and wasting proximal limb muscles

• main complaint is weakness

• muscle pain and tenderness in about 50%

• arthralgia or arthritis in about 50% (resembles distribution of rheumatoid arthritis)

• dysphagia in about 50% due to oesophageal involvement

• Raynaud's phenomenon

• consider associated malignancy: lung and ovary

The rash

The distinctive rash shows features of photosensitivity. There is violet discolouration of the eyelids, forehead and cheeks, and possible erythema resembling sunburn and periorbital oedema. There is a characteristic rash on the hands especially the fingers and nail folds. The knees and elbows are commonly involved.

The main features are summarised in Figure 28.4 .

hell otnopt- c-alijurid -~ phdcossnsinvity rash proximal mustJe weakness and casting

_ iflsh on dorsum Of hands;

Fig. 28.4 Clinical features of polymyositis/dermatomyositis

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