Diagnosis and classification of idiopathic inflammatory myopathies

Abstract

The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of diseases, collectively termed myositis, sharing symptoms of muscle weakness, fatigue and inflammation. Other organs are frequently involved, supporting the notion that these are systemic inflammatory diseases. The IIMs can be subgrouped into dermatomyositis, polymyositis and inclusion body myositis. The myositis-specific autoantibodies (MSAs) identify other and often more distinct clinical phenotypes, such as the antisynthetase syndrome with antisynthetase autoantibodies and frequent interstitial lung disease and anti-SRP and anti-HMGCR autoantibodies that identify necrotizing myopathy. The MSAs are important both to support myositis diagnosis and to identify subgroups with different patterns of extramuscular organ involvement such as interstitial lung disease. Another cornerstone in the diagnostic procedure is muscle biopsy to identify inflammation and to exclude noninflammatory myopathies. Treatment effect and prognosis vary by subgroup. To develop new and better therapies, validated classification criteria that identify distinct subgroups of myositis are critical. The lack of such criteria was the main rationale for the development of new classification criteria for IIMs, which are summarized in this review; the historical background regarding previous diagnostic and classification criteria is also reviewed. As the IIMs are rare diseases with a prevalence of 10 in 100 000 individuals, an international collaboration was essential, as was the interdisciplinary effort including experts in adult and paediatric rheumatology, neurology, dermatology and epidemiology. The new criteria have been developed based on data from more than 1500 patients from 47 centres worldwide and are based on clinically easily available variables.

Keywords: criteria; dermatomyositis; idiopathic inflammatory myopathy; inclusion body myositis; polymyositis.

Figure 1

Pathognomonic rashes of DM: Gottron’s papules, red or violet papules occurring over the knuckles, the interphalangeal joints and other extensor surfaces (A); Gottron’s sign, red or violet macules occurring over the knuckles and sometimes the interphalangeal joints in patients with dermatomyositis (B); and heliotrope rash, red or violate eruption over the upper eyelids and sometimes extending around the eye (C).Reproduced from (31) with permission.

Figure 1

Pathognomonic rashes of DM: Gottron’s papules, red or violet papules occurring over the knuckles, the interphalangeal joints and other extensor surfaces (A); Gottron’s sign, red or violet macules occurring over the knuckles and sometimes the interphalangeal joints in patients with dermatomyositis (B); and heliotrope rash, red or violate eruption over the upper eyelids and sometimes extending around the eye (C).Reproduced from (31) with permission.

Figure 1

Pathognomonic rashes of DM: Gottron’s papules, red or violet papules occurring over the knuckles, the interphalangeal joints and other extensor surfaces (A); Gottron’s sign, red or violet macules occurring over the knuckles and sometimes the interphalangeal joints in patients with dermatomyositis (B); and heliotrope rash, red or violate eruption over the upper eyelids and sometimes extending around the eye (C).Reproduced from (31) with permission.