Bones, joints, muscles and tendons
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Myositis ossificans is calcification, or ossification, in part of a muscle. It is an uncommon condition that may follow an injury that has caused extensive intramuscular haemorrhage, sometimes associated with a fracture of the adjacent bone. Bone pain and joint pain are often ‘diffuse’ and poorly localized. A ‘greenstick’ fracture is a type of incomplete fracture that is common in childhood, in which the bone buckles like a bent green twig, but the periosteum and bone ends remain in continuity. Tendons can be ruptured by direct violence, especially if they have been weakened by rubbing over a bone, which causes attritional wear. Bone can become infected by organisms that reach it through the bloodstream or directly through a wound. The tumour has a red fleshy appearance and consists of multinucleate giant cells in a background of stromal cells that extend into the surrounding bone.
Muscle Disorders
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Skeletal muscle tissue is unique in several regards. It comprises individual, large, multinucleated, tube-shaped syncytial structures called myofibers. These develop through fusion of mononucleated precursors. Myofibers are grouped into fascicles that, in turn, are arranged into individual muscles. The basic contractile units of myofibers are sarcomeres, composed of actin and myosin filaments, which give muscles their striated appearance. An acquired inflammatory myopathy characterized by progressive muscle weakness and the presence of inflammatory infiltrates and degenerating or regenerating fibers in the muscle. Dermatomyositis is an inflammatory myopathy with characteristic cutaneous manifestations. Childhood dermatomyositis is more common than childhood and adolescent polymyositis. Sporadic inclusion body myositis is a slowly progressive, often asymmetric myopathy. Degenerative and inflammatory factors may play a role in its pathogenesis. Metabolic and endocrine myopathies are a large, heterogeneous group of inherited and acquired disorders of muscle due to a disturbance of metabolism.
Autologous Hematopoietic Stem Cell Transplantation for Idiopathic Inflammatory Myositis
Richard K. Burt, Alberto M. Marmont in Stem Cell Therapy for Autoimmune Disease, 2019
The term idiopathic inflammatory myopathies (IIM) refers to a group of disorders of unknown cause in which immune-mediated inflammation results in muscle injury and complaints of weakness. IIM consist of six distinct subtypes including: type I- primary idiopathic polymyositis (PM), type II- primary idiopathic dermatomyositis (DM), type III- dermatomyositis or polymyositis associated with malignancy, type IV-juvenile dermatomyositis or polymyositis (JDM), type V- myositis associated with another connective tissue disease, and type VI- inclusion body myositis (IBM). 1 IIM is believed to be triggered by environmental factors in genetically susceptible individuals. Response to immunosuppressive therapies, frequent coexisting autoimmune diseases, existence of autoantibodies in patients’ serum, and experimental animal models all suggest an autoimmune pathogenesis. Patients develop proximal muscle weakness with or without tenderness of involved muscle. Laboratory tests reveal elevated serum muscle enzymes, myopathic changes by electromyography (EMG) and biopsy evidence of mononuclear cell infiltration with lymphocytes and plasma cells. Treatment includes corticosteroids, immunosuppressive drugs such as azathioprine, methotrexate, cyclophosphamide, cyclosporin and IVIG. While the overall prognosis for patients with IIM has improved in the last 20 years, there remain subsets of patients who continue to have active disease despite conventional therapy, for whom effects from long-term corticosteroids or immunosuppressive therapies are of concern, and for whom hematopoietic stem cell transplantation (HSCT) may be considered.
Spontaneous resolution of focal eosinophilic myositis of the adductor pollicis complicated by lung lesions
Published in Modern Rheumatology Case Reports, 2020
Sayuri Yamashita, Hidenaga Kawasumi, Makiko Kimura, Mutsuto Tateishi
Eosinophilic myositis is characterised by peripheral blood eosinophilia and eosinophilic infiltration in muscles, and is comprised three subtypes: focal eosinophilic myositis (FEM), eosinophilic polymyositis, and eosinophilic perimyositis. Muscle involvement of FEM is usually limited to the lower legs, and pulmonary complications have not been reported. We report a rare case of FEM in the left adductor pollicis complicated by lung lesions. A 37-year-old woman developed swelling of the first web space in the left hand. Magnetic resonance imaging (MRI) of the left hand demonstrated increased signal on fat-suppressed T2-weighted imaging in the left adductor pollicis. A muscle biopsy specimen demonstrated perimysial and endomysial infiltration of mononuclear cells and eosinophils, and necrosis and regeneration of muscle fibres. Chest computed tomography (CT) revealed upper-lobe–dominant ground-glass opacities (GGO). Both focal myositis and pulmonary lesions improved without treatment. This case suggests that FEM could involve adductor pollicis and have pulmonary lesions. In this case, myositis and GGO resolved spontaneously. Some FEM cases treated with glucocorticoids were reported in the past. Further studies are required to determine whether patients with FEM require therapeutic intervention.
A case of granulomatous myositis in a patient with rheumatoid arthritis receiving anti-TNF-α treatment
Published in Modern Rheumatology Case Reports, 2020
Akito Kawamura, Yumi Tsuchida, Hirofumi Shoda, Kanae Kubo, Naohiro Uchio, Jun Shimizu, Keishi Fujio
A 66-year old woman with a 14-year history of rheumatoid arthritis (RA) and uveitis was admitted to our department for evaluation of a mass in the left neck. Fourteen months prior to this admission the patient was started on golimumab. Serum creatine kinase (CK) level was elevated and myositis-specific and -associated antibodies were negative. Manual muscle test showed weakness in the neck flexor, sternocleidomastoid and deltoid muscles. Magnetic resonance imaging (MRI) of the neck, erector muscle of spine, breech, thigh and lower thigh demonstrated high-intensity lesions in the muscles in short-tau inversion recovery images. Electromyography in the right deltoid detected fibrillation potentials. Muscle biopsy from the left neck mass showed granulomatous myositis. Muscle weakness improved and CK levels normalized after discontinuation of golimumab. We report a case of granulomatous myositis under anti-TNF-α treatment for RA.
Statins and myositis: the role of anti-HMGCR antibodies
Published in Expert Review of Clinical Immunology, 2015
Albert Selva-O’Callaghan, Marcelo Alvarado-Cardenas, Ana Marin, Iago Pinal-Fernandez
Muscle toxicity is a recognized adverse effect of statin use. Recently, a new myositis syndrome was described in association with antibodies directed against the pharmacologic target of statins, anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR antibody). The patient’s genetic background, characteristic histologic patterns (immune-mediated necrotizing myopathy), and presence of anti-HMGCR antibodies define the syndrome. In most patients, statin discontinuation is insufficient to reverse the myositis symptoms, and immunosuppressive therapy is needed. The mechanisms by which these antibodies may lead to disease are not fully elucidated. Several important questions remain unsolved and warrant further research.
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