RCP Medicine Podcast Episode 98: Unmasking Myositis: A Multisystem Challenge for Every Clinician
Dec 18, 2025
Dr. Tam Malley, a consultant rheumatologist at the Royal Free Hospital, delves deep into the complexities of inflammatory myositis. He presents a compelling clinical case, highlighting initial symptoms and the diagnostic challenges faced in practice. Key discussion points include identifying subtle signs such as Gottron papules and interpreting muscle enzyme levels. Malley underscores the importance of early intervention and multidisciplinary care, sharing insights on managing patient cases, including cancer screening related to myositis.
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Myositis Is A Multisystem Family Of Diseases
- Idiopathic inflammatory myopathies are uncommon multisystem autoimmune diseases with muscle and extra-muscular involvement.
- Distinct subtypes (dermatomyositis, antisynthetase syndrome, IMNM, IBM, overlap) have different clinical, biopsy and serological profiles.
Assess Weakness By Function, Not Labels
- Ask patients about specific activities (e.g., rising from a chair, getting out of the bath) rather than asking 'do you feel weak?'.
- Use functional questions to distinguish true reduced muscle force from fatigue or pain.
Localize The Lesion With Bedside Exam
- The anatomical distribution of signs (tone, reflexes, fasciculations) helps localize weakness to brain, nerve, NMJ, or muscle.
- Early bedside neuro exam reduces missed alternative diagnoses like myasthenia gravis or motor neuron disease.