Letter to the Editor
Polymyositis in a Patient With Ulcerative Colitis
Polimiositis en un paciente con colitis ulcerosa
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(B) Muscle expression of the class I antigens of the human leukocyte antigen (HLA) system. (C) There is an endomysial lymphocyte cell infiltrate located in the (hematoxylin–eosin stain ×40). (D) Variability of the size of the muscle fibers and periendomysial (hematoxylin–eosin stain ×10).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ulcerative colitis (UC) is an inflammatory disease that affects the colorectal mucosa in a diffuse form, continuously and superficially.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Polymyositis (PM) belongs to the spectrum of idiopathic inflammatory myopathies, and is differentiated from dermatomyositis (DM) because of the absence of the characteristic skin rash.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Muscle involvement in the form of PM has rarely been described in UC. We report the case of a patient who was initially diagnosed as having UC, and developed PM over the course of his disease. We also review cases published to date. Our patient was a 46-year-old man, an ex-smoker, who presented with persistent bloody diarrhea with no other associated symptoms, and was diagnosed with UC. At the age of 58 years, he presented with an episode of pain and swollen hands, and was too weak to climb stairs. Laboratory tests detected increases in creatine kinase (CK) (1578<span class="elsevierStyleHsp" style=""></span>U/L) and lactate dehydrogenase (LDH) (506<span class="elsevierStyleHsp" style=""></span>U/L), although all other inflammatory parameters were normal. The rest of the biochemical study, including complete blood count, showed normal values. The immunological study demonstrated the presence of antinuclear antibodies, at a titer of 1/160, and negative tests for anti-extractable nuclear antigens (ENA), anti-DNA antibodies, antineutrophil cytoplasmic antibodies (ANCA), anti-centromere antibodies, anti-Scl-70 and antibodies specific for myositis (Jo-1, PL7, PL12, OJ, EJ, SRP, Pm-Scl, Mi2 and Ku). A muscle biopsy of quadriceps was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and evidenced variability in the size of the muscle fibers, with some necrotic fibers, regenerative basophilic fibers and frequent mononuclear inflammatory cell infiltrates, mostly lymphocytic and located in the endomysium. The expression of the major histocompatibility complex class I antigens was positive in the muscle fibers, all of which was compatible with the diagnosis of PM. Treatment was begun with a tapering dose of prednisone starting at 20<span class="elsevierStyleHsp" style=""></span>mg/day, to be followed by methotrexate (maximum dose 25<span class="elsevierStyleHsp" style=""></span>mg/week), and normalization of the CK and LDH levels was achieved after 16 months of treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Muscle involvement in inflammatory bowel disease is uncommon; in fact, only 7 cases associating PM and UC have been published to date<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3–9</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Only in the patient we describe was the diagnosis reached because of the increase in muscle enzymes. The response to glucocorticoid treatment was so good, in general, except in an individual who was refractory to several immunosuppressive agents and whose disease entered remission with mycophenolate mofetil.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> It has been suggested that the basis for the development of PM in UC results from the common immune-mediated mechanism, in which bowel inflammation and the damage to the mucosa would lead to a release of antigens, stimulating the production of antibodies that would damage the muscle. In conclusion, the development of PM in UC should be taken into account, especially when these patients describe symptoms such as myalgia, muscle weakness or present an increase in muscle enzymes. Although there are few cases reported in the literature, it may be underdiagnosed given that the symptoms may be few and not very specific, and can be attributed to other causes.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare they have no conflict of interest directly or indirectly related to the contents of this manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: González García A, Sifuentes-Giraldo WA, Diz Fariña S, Pian H. Polimiositis en un paciente con colitis ulcerosa. Reumatol Clin. 2016;12:360–362.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2102 "Ancho" => 2833 "Tamanyo" => 1020836 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image of the muscle biopsy: (A) There are muscle fibers with regenerative peripheral basophilic areas (hematoxylin–eosin stain ×63). (B) Muscle expression of the class I antigens of the human leukocyte antigen (HLA) system. (C) There is an endomysial lymphocyte cell infiltrate located in the (hematoxylin–eosin stain ×40). (D) Variability of the size of the muscle fibers and periendomysial (hematoxylin–eosin stain ×10).</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">AAB, autoantibodies; ANA, antinuclear antibodies; CK, creatine kinase; IV, intravascular; M, man; PM, polymyositis; Ref, reference; RF, rheumatoid factor; UC, ulcerative colitis; W, woman.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Authors [Ref] \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age (years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Associated defects \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AAB \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time between the diagnosis of UC and the development of PM \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Muscle groups affected \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Extramuscular manifestations \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hernández et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HLA-B27 (−) Sacroiliitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Simultaneous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Regions proximal to extremities and neck flexors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral prednisone 1.5<span class="elsevierStyleHsp" style=""></span>mg/kg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement of muscle manifestations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Evrard et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not associated chronic liver disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 years earlier \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lower extremities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral sulfasalazine 1.5<span class="elsevierStyleHsp" style=""></span>g/day<br>Betamethasone enemas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement of bowel and muscle manifestations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Kaneoka et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not associated liver cirrhosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ANA 1/160<br>RF (+) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 years earlier \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Torso and regions proximal to extremities and neck flexors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral prednisolone 40<span class="elsevierStyleHsp" style=""></span>mg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UC quiescent, PM with moderate activity. Death due to liver failure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Chugh et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Esophagitis and erosive gastritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 years earlier \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Torso and regions proximal to extremities and neck flexors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Polyarthralgia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral prednisolone 40<span class="elsevierStyleHsp" style=""></span>mg/day<br>Oral 5-aminosalicylic acid 400<span class="elsevierStyleHsp" style=""></span>mg/8<span class="elsevierStyleHsp" style=""></span>h<br>Prednisolone enemas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UC in remission, improvement of muscle manifestations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Voigt et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ANA 1:2.560<br>Anti-DNA (+) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 years earlier \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Regions proximal to extremities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IV prednisolone 200<span class="elsevierStyleHsp" style=""></span>mg/day for 7 days, followed by oral prednisone 60<span class="elsevierStyleHsp" style=""></span>mg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UC quiescent, PM in remission \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245407.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the Patients With Polymyositis Associated With Ulcerous Colitis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ulcerative colitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 13 | 25 |
| 2024 October | 85 | 32 | 117 |
| 2024 September | 108 | 26 | 134 |
| 2024 August | 79 | 44 | 123 |
| 2024 July | 96 | 32 | 128 |
| 2024 June | 80 | 32 | 112 |
| 2024 May | 88 | 30 | 118 |
| 2024 April | 85 | 18 | 103 |
| 2024 March | 94 | 56 | 150 |
| 2024 February | 67 | 28 | 95 |
| 2024 January | 47 | 27 | 74 |
| 2023 December | 50 | 36 | 86 |
| 2023 November | 92 | 25 | 117 |
| 2023 October | 73 | 39 | 112 |
| 2023 September | 85 | 36 | 121 |
| 2023 August | 77 | 13 | 90 |
| 2023 July | 70 | 25 | 95 |
| 2023 June | 56 | 25 | 81 |
| 2023 May | 57 | 27 | 84 |
| 2023 April | 53 | 10 | 63 |
| 2023 March | 89 | 32 | 121 |
| 2023 February | 86 | 34 | 120 |
| 2023 January | 63 | 28 | 91 |
| 2022 December | 88 | 40 | 128 |
| 2022 November | 64 | 22 | 86 |
| 2022 October | 117 | 27 | 144 |
| 2022 September | 78 | 36 | 114 |
| 2022 August | 51 | 66 | 117 |
| 2022 July | 78 | 86 | 164 |
| 2022 June | 37 | 32 | 69 |
| 2022 May | 67 | 30 | 97 |
| 2022 April | 53 | 45 | 98 |
| 2022 March | 48 | 42 | 90 |
| 2022 February | 107 | 37 | 144 |
| 2022 January | 43 | 27 | 70 |
| 2021 December | 45 | 39 | 84 |
| 2021 November | 50 | 41 | 91 |
| 2021 October | 83 | 57 | 140 |
| 2021 September | 65 | 41 | 106 |
| 2021 August | 33 | 48 | 81 |
| 2021 July | 48 | 29 | 77 |
| 2021 June | 63 | 32 | 95 |
| 2021 May | 62 | 41 | 103 |
| 2021 April | 98 | 87 | 185 |
| 2021 March | 86 | 37 | 123 |
| 2021 February | 54 | 33 | 87 |
| 2021 January | 47 | 30 | 77 |
| 2020 December | 55 | 35 | 90 |
| 2020 November | 52 | 25 | 77 |
| 2020 October | 34 | 22 | 56 |
| 2020 September | 53 | 31 | 84 |
| 2020 August | 37 | 27 | 64 |
| 2020 July | 41 | 9 | 50 |
| 2020 June | 30 | 26 | 56 |
| 2020 May | 48 | 18 | 66 |
| 2020 April | 22 | 19 | 41 |
| 2020 March | 23 | 5 | 28 |
| 2020 February | 2 | 0 | 2 |
| 2019 September | 2 | 0 | 2 |
| 2019 February | 2 | 0 | 2 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 36 | 6 | 42 |
| 2018 March | 82 | 8 | 90 |
| 2018 February | 31 | 4 | 35 |
| 2018 January | 77 | 5 | 82 |
| 2017 December | 29 | 7 | 36 |
| 2017 November | 33 | 6 | 39 |
| 2017 October | 34 | 5 | 39 |
| 2017 September | 39 | 11 | 50 |
| 2017 August | 25 | 19 | 44 |
| 2017 July | 42 | 14 | 56 |
| 2017 June | 45 | 22 | 67 |
| 2017 May | 35 | 17 | 52 |
| 2017 April | 42 | 12 | 54 |
| 2017 March | 39 | 19 | 58 |
| 2017 February | 17 | 6 | 23 |
| 2017 January | 42 | 25 | 67 |
| 2016 December | 66 | 30 | 96 |
| 2016 November | 48 | 32 | 80 |
| 2016 October | 5 | 4 | 9 |
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