Inclusion body myositis in association with rheumatoid arthritis – case report

Authors: M. Tošovský 1;  J. Zámečník 2
Authors‘ workplace: II. interní gastroenterologická klinika, FN LF UK Hradec Králové 1;  Ústav patologie a molekulární medicíny, 2. LF UK a FN Motol, Praha 2
Published in: Čes. Revmatol., 22, 2014, No. 2, p. 108-112.
Category: Case Report


Inclusion body myositis is a disease belonging to the group of idiopathic inflammatory myopathies. It is known for its resistance to treatment and poor prognosis. To date, treatment with corticosteroids, immunosuppressants or intravenous immunoglobulins has not proved to be of beneficial effect. We describe a case of a male patient, who was simultaneously diagnosed with inclusion body myositis and rheumatoid arthritis. In this case, treatment with corticosteroids had a favorable laboratory and clinical effect. Association of these two diseases is rare. To date, only four cases of such patients have been described in the literature. An association with other inflammatory rheumatic diseases, especially Sjögren's syndrome, as well as systemic lupus erythematosus and systemic sclerosis, is described more frequently. In these cases, a favorable response to treatment with corticosteroids was reported as well.

Key words:
Inclusion body myositis, rheumatoid arthritis, corticosteroids


1. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010; 69: 1580–1588.

2. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315–24.

3. Kula RW, Sawchak JA, Sher JH. Inclusion body myositis. Curr Opin Rheumatol 1989; 1: 460.

4. Mhiri C, Gherardi R. Inclusion body myositis in French patients. A clinicopathological evaluation. Neuropathol Appl Neurobiol 1990; 16: 333.

5. Ringel SP, Kenny CE, Neville HE, et al. Spectrum of inclusion body myositis. Arch Neurol 1987; 44: 1154.

6. Lotz BP, Engel AG, Nishino H et al. Inclusion body myositis. Observation in 40 patients. Brain 1989; 112(Pt3): 727.

7. Sayers ME, Chou SM, Calabrese LH. Inclusion body myositi: analysis of 32 cases. J Rheumatol 1992; 19: 1385.

8. Beyenburg S, Zierz S, Jerusalem F. Inclusion body myositis: clinical and histopathological features of 36 patients. Clin Investig 1993; 71: 351.

9. Felice KJ, North WA. Inclusion body myositis in Connecticut: observation in 35 patients during an 8-year period. Medicine 2001; 80: 320.

10. Wintzen AR, Bots GT, de Bakker HM, et al. Dysphagia in inclusion body myositis. J Neurol Neurosurg Psychiatry 1988; 51: 1542.

11. Riminton DS, Chambers ST, Parkin PJ, et al. Inclusion body myositis presenting solely as dysphagia. Neurology 1993; 43: 1241.

12. Dion E, Cherin P, Payan C, et al. Magnetic resonance imaging criteria for distinguishing between inclusion body myositis and polymyositis. J Rheumatol 2002; 29: 1897.

13. Mikol J, Engel AG. Inclusion body myositis. In: Engel AG, Franzini-Armstrong C (Eds). Myology, 2nd Ed. New York: McGraw-Hill; 1994. p. 1385

14. Engel WK, Askanas V. Inclusion-body myositis: clinical, diagnostic, and pathologic aspects. Neurology 2006; 66: S20.

15. Engel AG, Arahata K. Monoclonal antibody analysis of mononuclear cells in myopathies. II: Phenotypes of autoinvasive cells in polymyositsi and inclusion body myositis. Ann Neurol 1984; 16: 209.

16. Leff RL, Miller FW, Hicks J, et al. The treatment of inclusion body myositis: a retrospective review and a randomized, prospective trial of immunosupressive therapy. Medicene (Baltimore) 1993; 72: 225.

17. Yood RA, Smith TW. Inclusion body myositis and systemic lupus erythemathosus. J Rheumatol 1985; 12: 568.

18. Cohen MR, Sulaiman AR, Garancis JC, Wortman RL. Clinical heterogeneity and treatment responce in inclusion body myositis. Arthritis Rheum 1989; 32: 734.

19. Derk CT, Vivino FB, Kenyon L, Mandel S. Inclusion body myositis in connective tissue disorders: case report and review of the literature. Clin Rheumatol 2003; 22: 324–3258.

20. Massawi G, Hickling P, Hilton D, Patterson C. Inclusion body myositis evolving in systemic lupus erytematosus? A case report. Rheumatology 2003; 42: 1012–1014.

21. Quartuccio L, De Marci G, Scott CA, et al. Treatment of inclusion body myositis with cyclosporin-A or tacrolimus: successful long-term management in patients with earlier active disease and concomitant autoimmune features. Clin Exp Rheumatol 2007; 25: 246–251.

22. Badrising UA, Maat. Schieman ML, Ferrari MD, et al. Comparison of weakness progresion in inclusion body myositis during treatment with methotrexate or placebo. Ann Neurol 2002; 51: 369.

23. Dalakas MC, Koffman B, Fujii M, et al. A controlled study of intravenous immunoglobulin combined with prednisone in treatment of IBM. Neurology 2001; 56: 323.

24. Dalakas MC, Sonies B, Dambrosia, J et al. Treatment of inclusion-body myositis with IVIg: a double-blind, placebo controlled study. Neurology 1997; 48: 721.

25. Walter MC, Lochmüller H, Toepfer M, et al. High-dose immunoglobulin therapy in sporadic inclusion body myositis: a double-blind, pacebo-controlled study. J Neurol 2000; 247: 22.

26. Dalakas MC, Rakocevis G, Schidt J, et al. Brain 2009; 132: 1536–44.

27. Soden M, Boundy K, Burrow D, et al. Inclusion body myositis in association with rheumatoid arthritis. J Rheumatol 1994; 21: 344–346.

28. Kalla R, Soumakiyan M, Tuck S. A case of inclusion body myositis responsive to prednisolone therapy. Clin Rheumatol 2009; 28 (Suppl 1): 21–22.

29. Vordebäumen S, Neuen-Jacob E, Richter J, et al. Inclusion body myositis in a patient with long standing rheumatoin arthritis treated with anti-TNFα and rituximab. Clin Rheumatol 2010; 29: 555–558.

30. Kanellopulos P, Baltoyiannis C, Tzioufas AG. Primary Sjögren´s syndrome associated with inclusion body myositis. Rheumatology 2002; 41: 440–444.

Dermatology & STDs Paediatric rheumatology Rheumatology
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