1. Internist, Rheumatologist
Iraj Salehi-Abari
The “Bohan and Peter Criteria” is not a good instrument for the diagnosis of Polymyositis/Dermatomyositis
Iraj Salehi-Abari, MD.
Internist, Rheumatologist
Tehran, Iran

2. In the name of God the merciful and compassionate

3. At first; the presentation of some cases with Polymyositis (PM) or Dermatomyositis (DM)

4. Case 1: A 48 year old man with: y Symmetric proximal muscle weakness
Iraj Salehi-Abari
Case 1:
A 48 year old man with:
Symmetric proximal muscle weakness
Elevated AST, ALT and CPK in serum
Positive Anti-Jo-1
Abnormal EMG with myogenic pattern
No another positive finding y

5. Case 2: A 41 year old woman with: y Heliotrope rash
Iraj Salehi-Abari
Case 2:
A 41 year old woman with:
Heliotrope rash
Symmetric proximal muscle weakness
Inflammation signaling in muscle MRI
No another positive finding y

6. Case 3: A 51 year old man with: y Symmetric proximal muscle weakness
Iraj Salehi-Abari
Case 3:
A 51 year old man with:
Symmetric proximal muscle weakness
Positive Anti-SRP
Lymphocyte infiltration in muscle pathology
No another positive finding y

7. Case 4: A 45 year old man with: y Shawl sign along with V sign
Iraj Salehi-Abari
Case 4:
A 45 year old man with:
Shawl sign along with V sign
Elevated AST, ALT and Aldolase in serum
Positive Anti-Mi-2
No another positive finding y

8. Case 5: A 17 year old man with: y Symmetric proximal muscle weakness
Iraj Salehi-Abari
Case 5:
A 17 year old man with:
Symmetric proximal muscle weakness
Polyarthritis, fever, ILD and Raynaud’s P.
Positive Anti-Jo-1
Nail fold telangiectasia & Mechanic’s hands, No another positive finding y

9. Case 6: A 39 year old woman with: y Symmetric proximal muscle weakness
Iraj Salehi-Abari
Case 6:
A 39 year old woman with:
Symmetric proximal muscle weakness
Positive Anti-SRP
Inflammation signaling in muscle MRI
Abnormal EMG with myogenic pattern
No another positive finding y

10. Case 7: A 32 year old woman with: y Gottron’s sign
Iraj Salehi-Abari
Case 7:
A 32 year old woman with:
Gottron’s sign
Elevated AST, ALT and CPK in serum
Abnormal EMG with myogenic pattern
No another positive finding y

11. Case 8: A 55 year old man with: y Symmetric proximal muscle weakness
Iraj Salehi-Abari
Case 8:
A 55 year old man with:
Symmetric proximal muscle weakness
Elevated AST, Aldolase & CPK in serum
Inflammation signaling in muscle MRI
Abnormal EMG with myogenic pattern
No another positive finding y

12. Case 9: A 36 year old woman with: y Gottron’s papules & Holster sign
Iraj Salehi-Abari
Case 9:
A 36 year old woman with:
Gottron’s papules & Holster sign
Symmetric proximal muscle weakness
Lymphocyte infiltration along with vasculitis in muscle pathology
No another positive finding y

13. Case 10: A 44 year old woman with: y Gottron’s papules Heliotrope rash
Iraj Salehi-Abari
Case 10:
A 44 year old woman with:
Gottron’s papules
Heliotrope rash
Shawl sign & V sign
Symmetric proximal muscle weakness
No another positive finding y

14. Gold standard for the diagnosis of PM/DM:
Iraj Salehi-Abari
Gold standard for the diagnosis of PM/DM:
Is the Clinical/Paraclinical judgement of an expert Rheumatologist, the same as other systemic Rheumatic disease y

15. Gold standard for the diagnosis of PM/DM:
Iraj Salehi-Abari
Gold standard for the diagnosis of PM/DM:
All of above cases upon the Clinical/ Paraclinical judgement of an expert Rheumatologist are Polymyositis (PM) or Dermatomyositis (DM) y

16. Bohan and Peter Classification Criteria of PM/DM:
Iraj Salehi-Abari
Bohan and Peter Classification Criteria of PM/DM:
Symmetric proximal muscle weakness
Elevated muscle enzymes in serum
Abnormal EMG with myogenic pattern
Inflammation in muscle pathology
Gottron’s papules &/or Heliotrope rash y

17. Bohan and Peter Classification Criteria of PM/DM:
Iraj Salehi-Abari
Bohan and Peter Classification Criteria of PM/DM:
For definite diagnosis of Polymyositis, we need all first four criteria whereas the combination of characteristic skin rash in the last criteria with at least 3 out of 4 first criteria means definite Dermatomyositis y

18. Bohan and Peter Classification Criteria of PM/DM:
Iraj Salehi-Abari
Bohan and Peter Classification Criteria of PM/DM:
Anyone of above cases can not be classified as Polymyositis (PM) or Dermatomyositis (DM) according to the Bohan and Peter criteria y

19. 2015 Persian Gulf Criteria (PGC) for Early Diagnosis of Polymyositis:
Iraj Salehi-Abari
2015 Persian Gulf Criteria (PGC) for Early Diagnosis of Polymyositis:
Clinical Criteria:
Symmetric proximal muscle weakness point
First-degree family history of muscle weakness -1 point
Laboratory Criteria:
Elevated muscle enzymes in serum point
Myositis Specific Autoantibodies (MSA) points
EMG: myogenic (1point) &/or neurogenic pattern (-1point)
Muscle inflammation: point
Inflammation signaling in muscle MRI or
Lymphocyte infiltration &/or Vasculitis in muscle pathology y

20. 2015 Persian Gulf Criteria (PGC) for Early Diagnosis of Polymyositis:
Iraj Salehi-Abari
2015 Persian Gulf Criteria (PGC) for Early Diagnosis of Polymyositis:
MSA: Anti-Jo-1, Anti-SRP, Anti-Mi-2
For definite diagnosis of Polymyositis we need at least 4 points including 1 point from clinical criteria y

21. 2015 Persian Gulf Criteria for Early Diagnosis of Dermatomyositis:
Iraj Salehi-Abari
2015 Persian Gulf Criteria for Early Diagnosis of Dermatomyositis:
Cutaneous Criteria:
Gottron’s papules or sign points
Heliotrope rash points
Holster sign point
Shawl sign point
V sign point
Mechanic’s hands point
Periungual telangiectasia point
Muscular Criteria:
The same as Polymyositis y

22. 2015 Persian Gulf Criteria for Early Diagnosis of Dermatomyositis:
Iraj Salehi-Abari
2015 Persian Gulf Criteria for Early Diagnosis of Dermatomyositis:
For definite diagnosis of Dermatomyositis we need at least 4 points including at least 2 points from cutaneous criteria and at least one point from muscular criteria y

23. 2015 Persian Gulf Criteria for Early Diagnosis of PM/DM:
Iraj Salehi-Abari
2015 Persian Gulf Criteria for Early Diagnosis of PM/DM:
All of above cases are definite Polymyositis or Dermatomyositis according to the 2015 Persian Gulf Criteria for Early Diagnosis of PM/DM y