g. cardiomyopathy and early ventilatory insufficiency in LGMD 2I). For the myositides, we can distinguish between those conditions for which we know the cause, and subclassify by aetiology, and those for Alpelisib order which we do not. But within both categories the main aim is to be able to identify homogeneous groups of patients. Some may be homogeneous because they have the same aetiology, others homogeneous because they have similar clinic-pathological characteristics, but however so defined they should have similar characteristics in terms of natural history/prognosis

and Modulators response to treatment. It is unarguably the latter features that are of greatest value to the clinician and patient, and must be at the heart of any system of classification. The current difficulty is trying to identify a “gold standard” test/definition for each separate disease category. Most attempts at classification have been based on a combination of clinical and laboratory features, the latter including muscle biopsy, electromyography, muscle enzymes and antibodies. For some

conditions either the aetiology is known (e.g. infection, drug, toxin) or the inflammatory myopathy is seen in association with a specific disease (e.g. sarcoidosis). For others there is very strong evidence of an immune basis (e.g. DM and PM). Sporadic IBM (sIBM) TAM Receptor inhibitor remains an enigma with features suggesting both disturbed immunity and degeneration and, rarely, genetic factors. Weakness is a feature of most inflammatory myopathies, and is typically proximal and axial in distribution, but not showing the highly selective pattern of muscle involvement that is so characteristic of many of the dystrophies. The exception, again, is sIBM in which the early selective

involvement of the forearm flexors and quadriceps is virtually pathognomonic. Onset may be subacute (e.g. DM, infection), measured in weeks, chronic (e.g. PM), old measured in months, or insidious and difficult to date the onset (e.g. sIBM). With very rare exceptions, all are progressive without specific intervention. The most specific associated clinical feature is rash in DM, with cutaneous calcinosis sometimes being seen in childhood cases. Interstitial lung disease, cardiac involvement and bowel infarction are potentially serious complications. Connective tissue symptomatology includes Raynaud’s phenomenon, sclerodermatous change, “mechanics’ hands”, and arthropathy. DM may be a paraneoplastic disorder. A final clinical feature that may aid classification is the response to treatment. By and large the inflammatory myopathies respond to steroids and other immunosuppressant drugs. Acute DM usually responds well. In the more chronic myositides, treatment may prevent further progression but recovery may be limited by existing irreversible muscle damage.