Impact and Management of Dysphagia in Inflammatory Myopathies
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INFLAMMATORY MUSCLE DISEASE (L DIEDERICHSEN AND H CHINOY, SECTION EDITORS)
Impact and Management of Dysphagia in Inflammatory Myopathies Rachel Zeng 1 & Jens Schmidt 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Dysphagia is a common symptom in inflammatory myopathies. This review provides an overview on the epidemiology, clinical impact, and management of dysphagia in myositis. Relevant diagnostic tools and treatment strategies are discussed. Recent Findings Dysphagia can occur in any inflammatory myopathy, particularly in inclusion body myositis (IBM). It can lead to malnutrition or aspiration with subsequent pneumonia or even death. Dysphagia can be explored and monitored by patientreported outcome scales for swallowing. New diagnostic tools such as real-time MRI and oro-pharyngo-esophageal scintigraphy have been studied for assessing dysphagia. Botulinum toxin injection can alleviate dysphagia in IBM. High-dose glucocorticosteroids are considered a first-line treatment for dysphagia in all other myositis subforms. Summary Evaluation of dysphagia in myositis requires thorough clinical workup and appropriate instrumental procedures. Treatment options are available for dysphagia, but controlled trials and consensus on best patient care are required for this important symptom. Keywords Dysphagia . Swallowing . Idiopathic inflammatory myopathies . Myositis . Polymyositis . Dermatomyositis . Necrotizing myopathy . Inclusion body myositis . Anti-synthetase syndrome . Overlap syndrome
Introduction Inflammatory myopathies—in short: myositis—are acquired diseases, commonly characterized by acute or subacute muscle weakness, elevated creatine kinase level in serum, specific antibodies, and inflammatory infiltrates in muscle biopsy. The subtypes of myositis include polymyositis (PM), dermatomyositis (DM), inclusion body myositis (IBM), necrotizing myopathy (NM), anti-synthetase syndrome (ASS), and overlap syndromes (OM); this current classification along with the diagnostic pathway have recently been reviewed [1]. Apart from weakness of skeletal muscle, myositis can affect other This article is part of the Topical Collection on Inflammatory Muscle Disease * Jens Schmidt [email protected] Rachel Zeng [email protected] 1
Department of Neurology, Muscle Immunobiology Group, Neuromuscular Center, University Medical Center Göttingen, Robert-Koch-Sr. 40, 37075 Göttingen, Germany
organs, e.g., skin, lung, heart, and joints. Inflammatory manifestation in the gastrointestinal tract particularly impairs function of the pharynx and esophagus, which results in dysphagia. Symptoms of dysphagia range from mild to severe, promoting malnutrition, dehydration, and aspiration with subsequent pneumonia or even death. Besides the increased health risk, dysphagia may also place a social and psychological burden with severely impaired quality of life, e.g., when certain food needs to be avoided or meals in company with others are avoided [2]. Although dysphagia is a signi
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