Polymyositis is an idiopathic inflammatory myopathy that causes symmetrical, proximal muscle weakness; elevated skeletal muscle enzyme levels; and characteristic electromyography (EMG) and muscle biopsy findings

1. CASEPRESENTATON
ON
POLYMYOSITIS
Presented by
MAKBUL HUSSAIN CHOWDHURY
Pharm. D 5th year
H.T. No. 15Z11T0006
Anurag Pharmacy College, Kodad

2. POLYMYOSITIS
 Polymyositis is an idiopathic inflammatory myopathy that
causes symmetrical, proximal muscle weakness; elevated
skeletal muscle enzyme levels; and characteristic
electromyography (EMG) and muscle biopsy findings

3. TYPES
Bohan and Peter classify the idiopathic inflammatory myopathies
as follows :
I. Primary idiopathic polymyositis
II. Primary idiopathic dermatomyositis
III. Polymyositis or dermatomyositis associated with malignancy
IV. Childhood polymyositis or dermatomyositis
V. Polymyositis or dermatomyositis associated with another
connective-tissue disease
VI. Inclusion body myositis
VII. Miscellaneous (eg, eosinophilic myositis, myositis ossificans,
focal myositis, giant cell myositis)

4. Sign and Symptoms
 Muscle pain and stiffness.
 Muscle weakness, particularly in the belly (abdomen),
shoulders, upper arms, and hips.
 Joint pain and stiffness.
 Trouble catching your breath.
 Problems with swallowing.
 Irregular heart rhythms, if the heart muscle becomes inflamed
Etiology
 Causes/Inheritance. In most cases, the cause of an
inflammatory myopathy like polymyositis (PM) is unclear

5. Pathophysiology:

6. CASE STUDY
PATIENT NAME : Xxx
AGE: 30 yrs
GENDER :Female
DEPARTMENT : General medicine (FMW- I)
DOA : 23/01/19
CHIEF COMPLAINTS:
 The patient XXX is a 30 years old female with following
complaints
 Muscle pains From lower limbs, then upper limbs then whole
body There is also history of associated B/L knee joint pain but
no inflammation associated with it since 2 months.
 Gen. Body weakness since 1 month.
 Difficulty in swallowing since 10 days.

7. History of present Illness
 There is no history of any associated fever, respiratory tract or
GIT infection in past few weeks, palpitation, heat or cold
intolerance, any change in urine color, cough, sputum.
 There is also no history of use of any drugs for a long period,
also no history of any homeo or herbal medicine.
 There is no h/o mouth ulcers alopacia, sun burns, change in
color of finger tips in cold.

8. Past History
 There is no significant past medical or surgical history.
Family History
 There is no family history of such illness and diabetes.
Drug History
 No known allergy
 Not using any kind of medicine for longer period of time.
Personal history
 Married for last 8 years
 Never conceived
 Not properly evaluated for infertility
 Non smoker and non drinker

9. Menstrual History
 She c/o oligo-menorrhea for last one year.
 No h/o dysmenorrhea
 No h/o dysprunea.
Vital Sign
 B.P 110/70 mmHg
 Pulse 82/min
 R.R 20/min
 Temp. 98`F

10. General Physical Examination
 No erythematous rash at face
 Shawl sign -ve
 Heliotrope rash –ve
 No signs of cushing’s disease
 No skin changes
 No signs of hyper/hypothyroidism

11. Musculoskeletal & Nervous system
 Well oriented in time place and person
 GCS 15/15
 Mild tenderness in muscles of lower thigh
 Plantars B/L down going
 Power 1/5 at proximal muscles, 3/5 at distal muscles of lower
limbs
 2/5 in proximal muscles of upper limb and 4/5 in lower limbs

12. Other Systemic Examination
Respiratory system:
 Normal in shape, bilateral chest movements equal, and
bilaterla air entery equal. On auscultation normal vesicular
breathing with few bibasal inspiratory crackles not changing
character with cough.
CVS:
 Apex beat in 5th intercostal space just lateral to mid clavicular
line non taping, non-heaving with S1+S2+
Abdomen:
 Scaphoid, with umbilicus normal in shape and position, flanks
not filled and no visible veins or stria
 soft, non tender, no visceromegaly
 No shifting dullness
 Bowel sounds 3/min

13. Differential diagnosis
 Polymyositis
 Mixed connective tissue disease
 Polymyalgia Rheumatica
 Fibromyalgia
 Subclinical Hyperthyroidism/hypothyroidism
 Steroid induced myopathy
 Gillian Berre syndrome
 Hyper/hypo/normo kalemic periodic paralysis

14. CBC
Content Name Value Normal Value
Hb 10.7 mg/dl 12.0 - 15.5 mg/dl
WBC 10800 per microliter of
blood
4000-11000 per
microliter of blood
PLT count 191000per microliter of
blood
150,000-450,000 per
microliter of blood
N 88% 40–80%
E 1% 1–6%
ESR 100 mm/ hr 0-29 mm/hr

15. Serum electrolytes
RFTS
Content Name Value Normal Value
Na 139 mmol/L 135-145 mmol/L
K 4.4 mmol/L 3.5-5 mmol/L
Cl 102mmol/L 95-105 mmol/L
Content Name Value Normal Value
Urea 60 mg/dL 7 to 20 mg/dL
Creatinine 1.2 0.6 to 1.2mg/dL

16. LFTs
Urine C/E
Content Name Value Normal Value
ALT 370 IU 7 - 56 IU
AST 490 IU 10 - 40IU
S. bilirubin 0.7mg/dL 0.1 to 1.2 mg/dL
Alk. PO4 204 IU/L 44 to 147 IU/L
Content Name Value Normal Value
Albumin nil 3.5 to 5.5 g/dL
Pus cells rare 0-4
RBC 9-10 4 cells
Crystals uric acid + 250 to 750 milligrams
per 24 hours
Blood ++ 4 RBC/HPF
pH 7.0 about 6.0

17. Final diagnosis
POLYMYOSITIS

18. Treatment given
Non Pharmacological
High protein diet
Physiotherapy

19. Drug Chart
Name Brand Name Dose Frequency ROA Time of
Administration
Tab prednisolon
(blood disorders)
Prednisolone 55mg OD Oral 23-26/01
Cap. Omeprazole
(proton pump
inhibitors)
Zegerid 40mg OD Oral 24-26/01
Tab. Paracetamol
(knee joint pain )
DOLO 650mg TDS Oral 23-24/01
Bisphosphonates(bon
e pain)
Fosamax™ 70 mg OD Oral 23-26/01
Ca supplements CALBO-D 200mg OD Oral 25-26/01

20. Patient Counseling
Regarding Disease
 There is no known way to prevent polymyositis, because the
exact cause is not known. In some cases where medicines
may be to blame, stopping these medicines can prevent
future episodes of the condition. Don't stop taking any
medicine without your doctor's approval.
 If your symptoms get worse or you notice new symptoms,
call your healthcare provider. If you have trouble breathing
or can't swallow normally, you may need emergency medical
help.

21. Patient Counseling
Regarding Medication
Corticosteroids.
 Drugs such as prednisone can be very effective in controlling
polymyositis symptoms. But prolonged use of these drugs
can have serious and wide-ranging side effects, which is why
your doctor may gradually taper the dose of medication
down to lower levels.
Omeprazole
 Do not crush, break, or chew the tablets. Swallow this
medication whole with a glass of water.