<prompt> Weakness of extraocular muscle may be seen in all of the following conditions except :PolymyositisMyasthenia-gravisEaten-lambe-myasthenic syndromeThyrotoxicosis  <response>: A i.e. Polymyositis Ocular muscles are spared even in advanced, untreated cases of inflammatory myopathies polymyositis, dermatomyositis inclusion body myositis Q. If these muscles are affected, the diagnosis of inflammatory myopathy should be questioned. H-2540 Inflammatory Myopathies Characteristic Dermatomyositis Polymyositis Inclusion body myositis Age Adulthood and childhood 18 years 50 years Male: Female 3:1 Sex Female Male Familial association Absent Absent Present in some cases Associated conditions Drugs - D-penicillamine - D-penicillamine Absent - Contaminated tryptophan - Zidovudine Connective tissue disease Present e.g. scleroderma mixed connective tissue disease overlap Present e.g. SLE, RA, sjogren, systemic sclerosis mixed Present e.g. SLE, RA, sjogren, systemic sclerosis syndrome connective tissue disease mixed connective tissue disease Systemic autoimmune disease Infrequent Frequent e.g. chrons ds, vasculitis, sarcoidosis, 10 biliary cirrhosis etc. Infrequent Malignancy Present, in upto 15 cases Absent Absent Viruses Unproven Present e.g. HIV HTLV-1 Present e.g.HIV HTLV-1 Parasites bacteria Absent Present Absent Clinical features Rash - Accompany or more often precede muscle weaknessQ - Consists of a blue purple discolouration on the upper eyelids with edema heliotrope rash Q, a flat red rash on the face upper trunk, erythema of knuckles with raised violaceous scaly eruption Gottron rashQ. The erythematous rash on neck anterior chest V sign or back shoulder Shawl sign can also occur. It is a diagnosis of exclusion. It is subacute myopathy affecting adults rarely children who do not have - rash Q, involvement of extraocular facial muscles Q, family ho neuromuscular disease, ho exposure to myotoxic drugs or toxins, endocrinopathy, neurogenic disease, muscular dystrophy, biochemical muscle disorder deficiency of enzyme or IBM as excluded by muscle biopsy analysis. - May worsen after sun exposure may be pruritic The cuticles may be irregular thickened distoed and the fingers lateral palmar areas may become rough cracked with irregular diy horizontal lines, resembling mechanics hands. Muscle weakness - Progressive often - Progressive often - Progress very slowly over symmetrical muscle weakness, which progress subacutely, over a period of weeks or month symmetrical muscle weakness, which progress sub acutely, over a period of weeks or years simulating a late life muscular dystrophy or - Increasing difficulty with month slowly progressive motor everyday tasks requiring the - Increasing difficulty with neuron disease use of proximal muscles Q such everyday tasks requiring the - Fine motor movements as getting up from a chair, climbing steps or combing hair etc. use of proximal muscles Q such as getting up from a chair, climbing steps or combing hair distal muscles are involved early _ Mild fascial weakness is - Fine motor movements that depend on the strength of distal etc. - Fine motor movements that common muscles, such as buttoning a depend on the strength of - Falling is common shi, sewing, knitting or distal muscles, such as because of early writing are affected only late in course buttoning a shi, sewing, knitting or writing are affected involvement of quadriceps muscle with buckling of - Fascial muscle are unaffected only late in course knees. - Myalagia muscle tenderness may occur in some patients of - Fascial muscle are unaffected DM with connective tissue disease 