Continuum Audio Inclusion Body Myositis With Dr. Elie Naddaf
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Oct 29, 2025 Dr. Elie Naddaf, a renowned neuromuscular neurologist at Mayo Clinic, dives deep into inclusion body myositis (IBM). He discusses its classic and atypical presentations, highlighting key symptoms like finger flexor and quadriceps weakness, as well as dysphagia and severe facial weakness. Naddaf outlines diagnostic tools, emphasizing the gold standard muscle biopsy and the role of EMG and antibody testing. He also explores why IBM is uniquely resistant to immunosuppression and its underlying mechanisms, providing valuable insights for clinicians.
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Typical IBM Presentation
- Inclusion body myositis (IBM) has a characteristic pattern: slowly progressive, painless weakness over years, often in older males.
- The deep finger flexors and quadriceps are most commonly affected and may be asymmetric or isolated to one limb.
Use Functional Tests For Quadriceps Weakness
- Test quadriceps strength functionally (kneeling/squatting) when manual testing is normal because the muscle is large and early weakness may be missed.
- Use focused functional maneuvers to reveal subtle weakness rather than relying solely on resisted movements.
Atypical IBM Phenotypes
- IBM can present atypically in about 14% of patients with dysphagia, proximal, axial, or facial weakness and even isolated foot drop.
- Recognize that atypical phenotypes (e.g., isolated dysphagia or severe facial weakness, especially in females) may precede limb findings.