Secondary Causes of Myositis
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Neurologic Manifestations of Systemic Disease (David Lapides, Section Editor)
Secondary Causes of Myositis Sarah H. Berth, MD, PhD Thomas E. Lloyd, MD, PhD* Address * Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Neurologic Manifestations of Systemic Disease Keywords Inflammatory myopathy I SARS-CoV-2 I HIV myositis I Immune checkpoint inhibitors I Anti-HMGCR I Malignancy-associated myositis I Overlap myositis I Immunosuppression
Abstract Purpose of review The purpose of this paper is to comprehensively evaluate secondary causes of inflammatory myopathies (myositis) and to review treatment options. Recent findings This review highlights recent advancements in our understanding of known causes of myositis, including newer drugs that may cause myositis such as checkpoint inhibitors and viruses such as influenza, HIV, and SARS-CoV2. We also discuss treatment for malignancy-associated myositis and overlap myositis, thought to be a separate entity from other rheumatologic diseases. Summary Infections, drugs, rheumatologic diseases, and malignancies are important causes of myositis and are important to diagnose as they may have specific therapies beyond immunomodulatory therapy.
Introduction The term “myositis” is often used interchangeably with “idiopathic inflammatory myopathy” (IIM), referring to primary autoimmune diseases of muscle including dermatomyositis, inclusion body myositis (IBM), antisynthetase syndrome, and necrotizing autoimmune myopathy [1–6]. However, there are also known causes of inflammatory myopathies which must be considered in the evaluation of patients with acute or subacute myopathy, including infections, drugs, mixed connective tissue disease, and malignancies. Furthermore, while polymyositis is classically included in IIMs, most cases are now thought to either be early IBM or secondary to
another disease such as those covered here. As several excellent recent reviews have covered treatment of IIM [6,7••,8], this review will focus on known, or secondary, causes of myositis. Infectious myositis can occur with bacterial, viral, fungal, or parasitic infections. Bacterial myositis, which is typically focal, can occur via hematogenous spread (pyomyositis) or via spread from contiguous infection or trauma [9]. While a range of bacteria can cause pyomyositis, the most common is Staphylococcus aureus, which causes up to 90% of cases in tropical regions and up to 70% in the USA [10, 11]. The most common cause of bacterial myositis not due to
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hematogenous spread is Streptococcus, whereas myositis in the setting of trauma is typically due to polymicrobial infection [9]. Viral myositis is most commonly caused by influenza and enterovirus but can be caused by many different classes of viruses [12], and clinical presentations range from myalgias to focal myositis to rhabdo
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