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How to differentiate steroid induced myopathy from inflammatory myopathy?

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Reference - EULAR text book

Key characteristics of steroid myopathy include;

  • Worsening of proximal muscle weakness—predominantly in the lower extremities
  • Creatine kinase levels improved or normal
  • Improvement with reduction of glucocorticoid dose
  • No signs of active myositis on electromyography or MRI
  • Selective atrophy of type II muscle fibres
  • Increased urinary creatinine excretion
  • Obvious extra muscular signs of glucocorticoid use: Cushing features
  • Worsening of neck flexor weakness is an indicator of active myositis

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