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- The symptoms depend on each patient.
Each patient can present with different
type of symptoms, but most commonly we look
for skin, lung, or muscle.
The patient might develop some erythema
over the knuckles and usually most people
don't pay any attention to it,
especially if they're fair-skinned,
this can be common.
But the significant part would be
that this would be a new occurrence.
The patient wouldn't have those before.
Another thing that can happen very early
in the disease, and it's not unique
for dermatomyositis, but any kind
of rheumatic diseases is Reynaud's.
Reynaud's is the phenomenon where the fingers
when they are exposed to the cold,
they turn white, totally white
and then might change colors like red or purple.
When it appears after the age of 25 or 30,
then it means that something is going on
and the patient needs to be evaluated
for rheumatologic diseases.
Another early symptom of the disease is
that the patient might develop an inflammatus rash
on sun-exposed areas like the face,
the upper chest or upper back,
but this can happen even if the patient
is not exposed to the sun
or if they patient is exposed to the sun
then the rash doesn't go away with time.
Another thing that we often miss is the scalp.
The scalp can be an important part
of dermatomyositis.
It can be affected and cause like scaly rash
and a lot of itching
and that can be misdiagnosed as other conditions,
but even though the patient is using topical shampoos,
it doesn't go away,
so that would be indication
that the patient should be evaluated
for dermatomyositis.
Then the symptoms from the muscle,
as we said before, it could be progressive
muscle weakness.
The patient first notices that they cannot
hold their arms above the head
for a long, they have difficulty getting up
from a chair, especially from the toilet seat
because it's lower than usual
and they notice they have to use their arms
to climb up and stand up.
One of the early symptoms could be difficulty climbing
up stairs because it needs extra effort
and extra strength.
That could be also a sign of early lung disease
because in dermatomyositis, the lungs can be affected
and they have progressive shortness of breath,
especially on exertion, like when they see
that before they could run like a mile,
now they can only run like half a mile
because they get short of breath.
So that needs to be evaluated as soon as possible.
We'll go into the severe symptoms
of myositis, the symptoms
that can send the patient to the hospital.
So these are two, either the shortness of breath
or dysphasia.
Shortness of breath, it comes most commonly
from lung disease, which means the condition
of where the lungs are inflamed
and the patient cannot take a deep, full breath
and oxygen cannot reach the tissues.
If it happens suddenly, it can be severe
and the patient needs to be hospitalized.
Another severe symptom is dysphasia,
which means that the patient has difficulty swallowing,
so these are the severe symptoms
that need to be evaluated as soon as possible.
So the trajectory of the disease
can be different depending on the patient.
In some patients, they have one-time symptoms,
we treat them, and then they never have any symptoms again,
or some patients, which are the majority
of the ones we see, they will have flares of the disease,
which means it's well-controlled
and then for some reason, they can get again
a flare of the disease.
Usually there is some trigger behind it,
like infection, underlying malignancy,
or even stress can cause a flare-up,
but sometimes we're not able
to find out why these people have again
a recurrence of their symptoms.