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Rheumatology Advance Access published online on December 11, 2008
Rheumatology, doi:10.1093/rheumatology/ken441
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© Published by Oxford University Press on behalf of the British Society for Rheumatology 2008.

Distribution and severity of weakness among patients with polymyositis, dermatomyositis and juvenile dermatomyositis

M. O. Harris-Love1,2,3, J. A. Shrader3, D. Koziol4, N. Pahlajani5, M. Jain3, M. Smith3, H. L. Cintas3, C. L. McGarvey3, L. James-Newton2, A. Pokrovnichka5, B. Moini5, I. Cabalar5, D. J. Lovell6, R. Wesley4, P. H. Plotz5, F. W. Miller2, J. E. Hicks3 and L. G. Rider2

1George Washington University, School of Medicine and Health Sciences, Washington DC, 2Environmental Autoimmunity Group, Office of Clinical Research, National Institute of Environmental Health Sciences, 3Rehabilitation Medicine Department (RMD), 4Biostatistics and Clinical Epidemiology Service, Clinical Center, 5National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD and 6Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

Correspondence to: L. G. Rider, Environmental Autoimmunity Group, NIEHS, NIH; CRC 4-2352, MSC 1301, 10 Center Drive, Bethesda, MD 20892-1301, USA. E-mail: riderl{at}mail.nih.gov


  Abstract

Objective. To describe the distribution and severity of muscle weakness using manual muscle testing (MMT) in 172 patients with PM, DM and juvenile DM (JDM). The secondary objectives included characterizing individual muscle group weakness and determining associations of weakness with functional status and myositis characteristics in this large cohort of patients with myositis.

Methods. Strength was assessed for 13 muscle groups using the 10-point MMT and expressed as a total score, subscores based on functional and anatomical regions, and grades for individual muscle groups. Patient characteristics and secondary outcomes, such as clinical course, muscle enzymes, corticosteroid dosage and functional status were evaluated for association with strength using univariate and multivariate analyses.

Results. A gradient of proximal weakness was seen, with PM weakest, DM intermediate and JDM strongest among the three myositis clinical groups (P ≤ 0.05). Hip flexors, hip extensors, hip abductors, neck flexors and shoulder abductors were the muscle groups with the greatest weakness among all three clinical groups. Muscle groups were affected symmetrically.

Conclusions. Axial and proximal muscle impairment was reflected in the five weakest muscles shared by our cohort of myositis patients. However, differences in the pattern of weakness were observed among all three clinical groups. Our findings suggest a greater severity of proximal weakness in PM in comparison with DM.

KEY WORDS: Myositis, Manual muscle test, Strength, Rehabilitation

Submitted 30 April 2008; revised version accepted 22 October 2008.
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