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766          Part SIX  Systemic Immune Diseases






















          A                                                B
                   FIG 56.3  Biopsy in Dermatomyositis. (A) Low-power (original magnification ×100) view of a
                   muscle biopsy from a patient with dermatomyositis. Note the marked variation in fiber size and
                   the large number of atrophic myocytes, particularly at the periphery of the fascicles. (B) High-power
                   (original magnification ×200) view of inflammation around the vessels in the muscle biopsy of a
                   patient with dermatomyositis. There are nearby atrophic cells and cells whose nuclei have moved
                   away from the periphery of the cell (centralized nuclei).


                                                                5.  Rose MR. 188th ENMC International Workshop: Inclusion Body
        PITFALLS                                                  Myositis, 2–4 December 2011, Naarden, The Netherlands. Neuromuscul
                                                                  Disord 2013;23:1044–55.
        It is increasingly apparent that the boundary between IIM and   6.  Kao AH, Lacomis D, Lucas M, et al. Anti-signal recognition particle
        some genetically determined myopathies cannot be cleanly drawn.   autoantibody in patients with and patients without idiopathic
        Recently dystrophies with an extraordinary variety of clinical   inflammatory myopathy. Arthritis Rheum 2004;50:209–15.
        manifestations (with regard to age and distribution of weakness)   7.  Christopher-Stine L, Casciola-Rosen LA, Hong G, et al. A novel
                            39
        have also been described.  Not only can inflammation be seen   autoantibody recognizing 200-kd and 100-kd proteins is associated with
        on biopsy in some patients, but a partial clinical response to   an immune-mediated necrotizing myopathy. Arthritis Rheum
        corticosteroids also can occur. Furthermore, it is increasingly   2010;62:2757–66.
        recognized that mitochondrial abnormalities can be limited to   8.  Mammen AL, Chung T, Christopher-Stine L, et al. Autoantibodies against
        groups of skeletal muscles, leading to confusion with IIM. Toxic   3-hydroxy-3-methylglutaryl-coenzyme A reductase in patients with
        myopathies, of course, will continue to occur with the release   statin-associated autoimmune myopathy. Arthritis Rheum
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        of new drugs and thus will continue to be a possible source of   9.  Lahouti AH, Amato AA, Christopher-Stine L. Inclusion body myositis:
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           Thus not only must the history, physical examination, and   10.  Lloyd TE, Christopher-Stine L, Pinal-Fernandez I, et al. Cytosolic
        biopsy be performed and interpreted with compulsiveness and   5’-nucleotidase 1A as a target of circulating autoantibodies in
        care, but molecular diagnostic techniques also must be employed   autoimmune diseases. Arthritis Care Res (Hoboken) 2016;68:
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                                                               13.  Dalakas MC. Pathophysiology of inflammatory and autoimmune
        Please check your eBook at https://expertconsult.inkling.com/   myopathies. Presse Med 2011;40:e237–47.
        for self-assessment questions. See inside cover for registration   14.  Mor A, Wortmann RL, Mitnick HJ, et al. Drugs causing muscle disease.
        details.                                                  Rheum Dis Clin North Am 2011;37:219–31, vi.
                                                               15.  Walji S, Rubenstein J, Shannon P, et al. Disseminated pyomyositis
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