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Old 09-22-2012
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Arrow Gyrus Daily Questions; Internal Medicine #19

A 42-year-old female presents to the physician with 3 months of worsening dyspnea on exertion, malaise, and weakness. She reports that the symptoms have worsened gradually and are associated with low-grade fever, anorexia, and an 8-lb weight loss. She has trouble climbing stairs because of leg weakness and shortness of breath. Recently she has noticed that her arms tire while she is brushing her teeth or combing her hair. Her mother also commented that the patient seems to have difficulty rising from the couch. Her writing is normal, and she has no sensory symptoms. Physical examination is notable for a temperature of 37.8C (100F), bilateral lung crackles, and diminished strength in the deltoids, quadriceps, and psoas muscles. Laboratory studies are notable for an elevated creatine kinase. Chest radiography shows bilateral interstitial infiltrates, and lung volumes are reduced to 70% of the predicted values. Which of the following autoantibodies is most likely to be present in this patient?

A. Antiglomerular basement membrane antibody
B. Antihistone antibody
C. Anti-Jo-1 antibody
D. Antimicrosomal antibody
E. Antineutrophil cytoplasmic antibody (ANCA)
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Old 09-22-2012
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Anti-Jo1 antibodies are found in patients with polymyositis

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The answer is C. Anti-Jo-1 antibody

This patient presents with the classic symptoms, signs, and laboratory findings of polymyositis (PM) with antisynthetase antibodies.

The differential diagnosis for a patient with proximal muscle weakness includes inclusion-body myositis, viral infections, denervating conditions such as amyotrophic lateral sclerosis (ALS), metabolic myopathies such as acid maltase deficiency, endocrine myopathies such as hypothyroidism, paraneoplastic myopathy, and drug-induced myopathies such as Dpenicillamine, procainamide, statins, and glucocorticoids. PM is associated with an elevated creatine kinase, electromyography (EMG) showing irritability, and biopsy showing T cell infiltrates primarily in the muscle fascicles. Many patients with PM have autoantibodies targeted against the ribonucleoproteins involved in protein synthesis (antisynthetases).

The antibody directed against histidyl-transfer RNA synthetase or anti-Jo-1 identifies a group of patients with PM who have a high likelihood (80%) of having interstitial lung disease. Antiglomerular antibodies are found in patients with Goodpastures syndrome, antihistone antibodies in those with drug-induced lupus, and antimicrosomal antibodies in those with autoimmune hepatitis.
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Quote:
Originally Posted by cingulate.gyrus View Post
A 42-year-old female presents to the physician with 3 months of worsening dyspnea on exertion, malaise, and weakness. She reports that the symptoms have worsened gradually and are associated with low-grade fever, anorexia, and an 8-lb weight loss. She has trouble climbing stairs because of leg weakness and shortness of breath. Recently she has noticed that her arms tire while she is brushing her teeth or combing her hair. Her mother also commented that the patient seems to have difficulty rising from the couch. Her writing is normal, and she has no sensory symptoms. Physical examination is notable for a temperature of 37.8C (100F), bilateral lung crackles, and diminished strength in the deltoids, quadriceps, and psoas muscles. Laboratory studies are notable for an elevated creatine kinase. Chest radiography shows bilateral interstitial infiltrates, and lung volumes are reduced to 70% of the predicted values. Which of the following autoantibodies is most likely to be present in this patient?

A. Antiglomerular basement membrane antibody
B. Antihistone antibody
C. Anti-Jo-1 antibody
D. Antimicrosomal antibody
E. Antineutrophil cytoplasmic antibody (ANCA)
C. Anti-Jo-1 antibody

Polymyositis is associated with interstitial lung disease.
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