31. Physiotherapy based case review of four patients presenting with Juvenile dermatomyositis

Abstract

Background: Juvenile dermatomyositis (JDM) is a rare systemic autoimmune condition affecting three per million children per year. The predominant clinical features are of proximal muscle weakness, severe skin rashes and fatigue. It often leads to reduced exercise tolerance and pain. Recent evidence shows the use of exercise in JDM benefits patients, without worsening the inflammation. Aim(s): To evaluate JDM management of the paediatric physiotherapy team at Southampton University Hospital NHS Foundation Trust by reviewing the physiotherapy management of JDM patients that presented to our service. Method(s): All patients with JDM that were referred to the Southampton Paediatric Physiotherapy team between September 2014 and September 2016 were included. Clinical data were collected of presentation and follow up. Each patient completed a Childhood myositis assessment scale (CMAS), manual muscle testing (MMT8) and Childhood health assessment questionnaire (CHAQ) on their initial physiotherapy assessment and these were repeated regularly throughout their rehabilitation. They commenced an individualised physiotherapy programme to include pacing, core strength, range of movement, stretches and progressive strengthening, as recommended in current literature. Results/Progress: Four patients presented aged 7-16 years old. All patients presented with pain, reduced endurance, characteristic rash, proximal symmetrical muscle weakness and raised serum muscle enzymes. All patients responded positively to a combination of medical and physiotherapy treatment as measured by CMAS, MMT8 and CHAQ. One patient required specific occupational therapy to help with hand function. All patients returned to full time education within six months of onset of treatment. After a range of eight months to 12 months of follow up, each patient had a CMAS within normal ranges and they felt that their physiotherapy management was very important to their rehabilitation. None of the cases had any long term difficulties or contractures. Close multidisciplinary team working ensured rapid responses were made to changes in their disease process. Conclusion(s): This clinical review shows physiotherapy is beneficial in the treatment of JDM confirming the literature. It is clear from these cases that physiotherapy is well appreciated by patients with JDM. Using the outcome measures of CMAS and MMT8 were shown to be effective for evaluating progress and helping to direct ongoing physiotherapy management.