ExampleCasesforDiseaseDamageAssessment.docVIP

CASE EXAMPLES FOR THE MYOSITIS DISEASE DAMAGE ASSESSMENT EXERCISE IN LONDON USE OF THE MYOSITIS DAMAGE INDEX (MDI) The purpose of this exercise is to provide some guidelines in scoring these instruments. The scores provided in 3 cases are suggestions for your consideration, but we realize there may be some differences of opinion. These cases particularly focus on scoring of the muscle systems and global activity/damage VAS scores, although the discussion presents the scoring of other involved organ systems as well. Prepared by Fred Miller, Lisa Rider, Clarissa Pilkington, and David Isenberg - May 2002 Disease Damage Assessments Case 4 - PM at follow-up A 52 y.o. Asian woman had an insidious onset of weakness, which was likely undiagnosed for many years after onset. She underwent a full evaluation, which resulted in a diagnosis of definite polymyositis. She refused treatment with corticosteroids or other therapies but took herbal remedies for an additional 3 years. Two years ago, when her muscles were very painful, she was confined to a wheelchair and unable to swallow solids. Her family convinced her to seek medical treatment and she was found to have very active polymyositis. She received intravenous pulse solumedrol and was begun on high dose oral prednisone in divided doses and methotrexate therapy. While on high dose oral prednisone, she developed brittle insulin-dependent diabetes that never resolved, aseptic necrosis of the left hip requiring joint replacement, and myocarditis with subsequent congestive heart failure, which also limits her function. She never regained much strength and at first was confined to a wheelchair, but has been bed-bound for a year, requiring assistance for most activities of daily living (HAQ = 2.8). Her myalgias resolved, but her swallowing continued to be a worsening problem, eventually requiring a nasogastric feeding tube to prevent aspiration. She develops severe shortness of breath with any activity, and someti