RCP Medicine Podcast Episode 98: Unmasking Myositis: A Multisystem Challenge for Every Clinician
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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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Don't Trust CRP Alone; Screen Lungs And Swallow
- Do not rely on CRP/ESR to exclude myositis; they may be normal or only mildly raised.
- Perform a baseline chest X-ray and assess bedside FVC and swallow if diaphragmatic or bulbar involvement is suspected.
Send Myositis Antibodies Early
- Send myositis-specific and associated autoantibodies early (e.g., anti-Jo1, anti-MDA5, anti-TIF1γ, anti-NXP2, anti-HMGCR).
- Use antibody profiles to risk-stratify for ILD, malignancy, and statin-associated necrotizing myopathy.
Stop Statins If Proximal Weakness Appears
- If a patient on statins develops proximal weakness, stop the statin immediately and reassess.
- Consider HMGCR antibody testing when weakness persists or features suggest immune-mediated necrotizing myopathy.