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Between 400,000 and 3.1 million adults have Sjögren’s syndrome. This condition can affect people of any age, but symptoms usually appear between the ages of 45 and 55. It affects 10 times as many women as men. About half of patients also have rheumatoid arthritis or other connective tissue diseases, such as lupus.

In the early 1900s, Swedish physician Henrik Sjögren (SHOW­gren) first described a group of women whose chronic arthritis was accompanied by dry eyes and dry mouth. Today,rheumatologists (/I­Am­A/Patient­Caregiver/Health­Care­Team/What­is­a­Rheumatologist)know more about the syndrome that is namedfor Sjögren and—most significantly for patients—can offer advice about how to live with it.

Fast Facts

Sjögren’s syndrome is an autoimmune condition that can occur at any age, but is most common in older

women. Many patients develop Sjögren’s syndrome as a complication of another autoimmune disease, such as rheumatoid arthritis or lupus

Symptoms vary in type and intensity, but many people with Sjögren’s are able to live normal lives.

Most of the treatment for Sjögren’s syndrome is aimed at relieving symptoms of dry eyes and mouth and preventing and treating long­term complications such as infection and dental disease. Treatments often do not completely eliminate the symptoms of dryness.

Most patients with Sjögren’s syndrome remain healthy, but some rare complications have been described, including an increased risk for cancer of the lymph glands (lymphoma). Thus, regular medical care and follow up is important for all patients.

What is Sjögren’s syndrome?

Sjögren’s syndrome is an inflammatory disease that can affect many different parts of the body, but most often affects the tear and saliva glands. Patients with this condition may notice irritation, a gritty feeling, or painful burning in the eyes. Dry mouth (or difficulty eating dry foods) and swelling of the glands around the face and neck are also common. Some patients experience dryness in the nasal passages, throat, vagina and skin. Swallowing difficulty and symptoms of acid reflux are also common.

“Primary” Sjögren’s syndrome occurs in people with no other rheumatic disease. “Secondary” Sjögren’s occurs in people who have another rheumatologic disease, most oftensystemic lupus erythematosus (/I­Am­A/Patient­Caregiver/Diseases­Conditions/Lupus)andrheumatoid arthritis (/I­Am­A/Patient­Caregiver/Diseases­Conditions/Rheumatoid­Arthritis). It can occasionally be confused witha newly described syndrome call IGG4 disease.

Most of the complications of Sjögren’s syndrome occur because of decreased tears and saliva. Patients with dry eyes are at increased risk for infections around the eye and may have damage to the cornea. Dry mouth may cause an increase in dental decay, gingivitis (gum inflammation), and oral yeast infections (thrush) that may cause pain and burning. Some patients have episodes of painful swelling in the saliva glands around the face.

Complications in other parts of the body can occur. Pain and stiffness in the joints with mild swelling may occur in some patients, even in those without rheumatoid arthritis or lupus. Rashes on the arms and legs related to inflammation in small blood vessels (vasculitis) and inflammation in the lungs, liver, and kidney may occur rarely and be difficult to diagnose. Numbness, tingling, and weakness also have been described in some patients. The parotid gland is at the edge of the jaw and can become swollen and inflamed in some people with Sjögren’s Syndrome.

What causes Sjögren’s syndrome?

The cause of Sjögren’s syndrome is not known, but it is an autoimmune disorder. People with this disease have abnormal proteins in their blood. This suggests that the immune system, which normally functions to protect the body against cancers and infections, is reacting against its own tissue. The decrease in tears and saliva seen in Sjögren’s syndrome occurs when the glands that produce these fluids are damaged by inflammation. Research suggests that genetic factors and possibly viral infections may predispose people to developing this condition.

How is Sjögren’s syndrome diagnosed?

Diagnosis depends on a combination of symptoms, physical examination, blood tests, and sometimes special studies. Dry eyes and mouth may be early signs of the condition but require further investigation, because these symptoms can be caused by many other conditions or medications. Special tests may assess any decrease in tear or saliva production. An eye examination is helpful in detecting any eye changes seen in Sjögren’s. Blood tests can determine the presence of antibodies (immune system proteins that help destroy foreign invaders) typical of the disease. Typical antibodies includeanti­nuclear antibodies (ANA) (/I­Am­A/Patient­Caregiver/Diseases­Conditions/Antinuclear­Antibodies­ANA), anti­SSA and SSB antibodies orrheumatoid factor, but these are not always present. Biopsies of saliva glands around the face or under the surface of the inner lip also may be used to make a diagnosis.

How is Sjögren’s syndrome treated?

Treatment is designed to lessen the most bothersome symptoms. Dry eyes usually respond to artificial tears applied regularly during the day or to gels applied at night. Other measures, such as plugging or blocking tear ducts, can be used in more severe cases. Eye drops that reduce inflammation in the glands around the eyes, such as cyclosporine (Restasis), may be used to increase tear production. Drinking water, chewing gum, or using saliva substitutes may relieve dry mouth. Some patients benefit from using prescription medications that stimulate saliva flow, such as pilocarpine (Salagen) or cevimuline (Evoxac). If patients develop yeast infections, anti­fungal therapies may be used. Humidifiers and nasal saline irrigation may improve nasal dryness. Medications that reduce gastric acid (such as proton­pump inhibitors and H2 blockers) may lessen symptoms of acid reflux. Treatments may help relieve some of the dryness, but usually some dryness persists.

All patients should receive regular dental care to prevent cavities and tooth loss that may occur as a complication of Sjögren’s. Patients with dry eyes should see an ophthalmologist (eye doctor) regularly for signs of damage to the cornea. Patients with excessive redness and pain in the eyes should be evaluated for infections.

Hydroxychloroquine (/I­Am­A/Patient­Caregiver/Treatments/Hydroxychloroquine­Plaquenil)(Plaquenil), an antimalarial drug used in lupus and rheumatoid arthritis, may be helpful in some patients with Sjögren’s syndrome by reducing joint pain and rash experienced by some patients. Patients with rare but serious

systemic symptoms, such as fever, rashes, abdominal pain, or lung or kidney problems, may require treatment with corticosteroids such as prednisone (Deltasone and others) and/or immunosuppressive agents like methotrexate (/I­Am­A/Patient­Caregiver/Treatments/Methotrexate­Rheumatrex­Trexall)(Rheumatrex), azathioprine (/I­Am­A/Patient­Caregiver/Treatments/Azathioprine­Imuran)(Imuran),mycophenolate (/I­Am­A/Patient­Caregiver/Treatments/Mycophenolate­Mofetil­Mycophenolate­Sodium)(Cellcept) orcyclophosphamide (/I­Am­A/Patient­Caregiver/Treatments/Cyclophosphamide­Cytoxan)(Cytoxan). In addition, researchers are evaluating rituximab (Rituxan) and other biological therapies to treat cases of Sjögren’s that affect the entire body.

Broader health impact of Sjögren’s syndrome

A vast majority of patients with Sjögren’s syndrome remain very healthy, without any serious complications. Patients should know that they face an increased risk for infections in and around the eyes and an increased risk for dental problems due to the long­term decrease in tears and saliva.

Rarely, patients may have complications related to inflammation in other body systems, including:

Joint and muscle pain with fatigue

Lung problems that may mimic pneumonia

Abnormal liver and kidney function tests

Skin rashes related to inflammation of small blood vessels

Neurologic problems causing weakness and numbness

In a small number of people, Sjögren’s syndrome may be associated with lymphoma, a cancer of the lymph glands.

Living with Sjögren’s syndrome

Sjögren’s syndrome cannot be cured, but in many cases proper treatment helps to alleviate symptoms. Rheumatologists (/I­Am­A/Patient­Caregiver/Health­Care­Team/What­is­a­Rheumatologist)are specialists in musculoskeletal disorders and, therefore, are more likely to make a proper diagnosis. They also can advise patients about the best treatment options available.

People with Sjögren’s syndrome usually are able to live normal lives with very few adjustments. When a diagnosis is made, many patients must focus a great deal of attention dealing with dry eyes and dry mouth, but these symptoms tend to subside with time. Any pain or redness in the eyes should be evaluated promptly, as this may signal an infection. To reduce risk for cavities and other dental problems, patients must pay close attention to proper oral hygiene and regular dental care.

Patients should see their physician regularly for general health screening. They also should pay close attention to any abnormal swelling in the glands around the face or neck, under the arms, or in the groin areas, as this may be a sign of lymphoma.

Updated May 2015. Written by Christopher Wise, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee. This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

© 2015 American College of Rheumatology

© 2015 American College of Rheumatology. All rights reserved.

Gout is a painful and potentially disabling form of arthritis that has been around since ancient times. It is sometimes referred to as the “disease of kings,” because people long have incorrectly linked it to the kind of overindulgence in food and wine only the rich and powerful could afford. In fact, gout can affect anyone, and its risk factors vary.

The first symptoms usually are intense episodes of painful swelling in single joints, most often in the feet, especially the big toe. The swollen site may be red and warm. Fifty percent of first episodes occur in the big toe, but any joint can be involved. Fortunately, it is possible to treat gout and reduce its very painful attacks by avoiding food and medication triggers and by taking medicines that can help. However, diagnosing gout canbe hard, andtreatment plans (/I­Am­A/Patient­Caregiver/Diseases­Conditions/Living­Well­with­Rheumatic­Disease/Importance­of­Following­your­Treatment­Plan)often must be tailored for each person.

Fast Facts

Intensely painful, swelling joints (most often in the big toe or other part of the foot) and/or bouts of arthritis that come and go may indicate gout.

Finding the characteristic crystals in the fluid of joints allows health care providers to correctly diagnose gout.

Gout treatments exist, but therapy should be tailored for each person. Treatment choices depend on kidney function, other health problems, personal preferences and other factors.

Patients may need medications to lower their elevated blood uric acid levels that predispose to gout. The goal is a uric acid level less than 6 milligrams per deciliter (mg/dL).

There are two types of medicine for gout. For control of acute attacks of joint pain, there areNSAIDs (/I­Am­A/Patient­Caregiver/Treatments/NSAIDs), colchicine and corticosteroids. After gout flares haveresolved, there are medications that can lower the level of uric acid over time in order to prevent or lessen attacks.

Lifestyle changes such as controlling weight, limiting alcohol intake and limiting meals with meats and fish rich in purines also can help control gout.

What causes gout?

Gout occurs when excess uric acid (a normal waste product) collects in the body, and needle‐like urate crystals deposit in the joints. This may happen because either uric acid production increases or, more often, the kidneys cannot remove uric acid from the body well enough. Certain foods and drugs may raise uric acid

levels and lead to gout attacks. These include:

Shellfish and red meats

Alcohol in excess

Sugary drinks and foods that are high in fructose

Some medications, such as:

low­dose aspirin (but because it can help protect against heart attacks and strokes, we do not recommend that people with gout stop taking low­dose aspirin)

certain diuretics (“water pills”) such as hydrochlorothiazide (Esidrix, Hydro‐D) and Lasix immunosuppressants used in organ transplants such as cyclosporine (Neoral, Sandimmune) and tacrolimus (Prograf)

Over time, increased uric acid levels in the blood may lead to deposits of urate crystals in and around the joints. These crystals can attract white blood cells, leading to severe, painful gout attacks and chronic arthritis. Uric acid also can deposit in the urinary tract, causing kidney stones.

Who gets gout?

Gout affects more than three million Americans. This condition and its complications occur more often in men, women after menopause, and people with kidney disease. Gout is strongly linked to obesity, hypertension (high blood pressure), hyperlipidemia (high cholesterol and triglycerides) and diabetes. Because of genetic factors, gout tends to run in some families. Gout rarely affects children.

How is gout diagnosed?

Some other kinds of arthritis can mimic gout, so proper diagnosis (detection) is key. Health care providers suspect gout when a patient has joint swelling and intense pain in one or two joints at first, followed by pain‐ free times between attacks. Early gout attacks often start at night.

Diagnosis depends on finding the distinguishing crystals. The physician may use a needle to extract fluid from an affected joint and will study that fluid under a microscope to find whether urate crystals are present. Crystals also can be found in deposits (called tophi) that can appear under the skin. These tophi occur in advanced gout.

Uric acid levels in the blood are important to measure but can sometimes be misleading, especially if measured at the time of an acute attack. Levels may be normal for a short time or even low during attacks. Even people who do not have gout can have increased uric acid levels.

X­rays may show joint damage in gout of long duration. Ultrasound and dual energy computed tomography (commonly called dual energy CT) can show early features of gouty joint involvement. These imaging techniques also can help suggest the diagnosis.

How is gout treated?

Treatment of acute attacks

One treatment for active gout flares is colchicine. This medicine can be effective if given early in the attack. However, colchicine can cause nausea, vomiting, diarrhea and other side effects. Side effects may be less frequent with low doses. Patients with kidney or liver disease, or who take drugs that interact (interfere) with colchicine, must take lower doses or use other medicines. Colchicine also has an important role in preventing gout attacks (see below).

Nonsteroidal anti‐inflammatory drugs (/I­Am­A/Patient­Caregiver/Treatments/NSAIDs)– commonly called NSAIDs – are aspirin‐like medications that can decrease inflammation and pain in joints and other tissues. NSAIDs, such as indomethacin (Indocin) and naproxen (Naprosyn), have become the treatment choice for most acute attacks of gout. There is no proof that any one NSAID is better than others. High doses of short‐ acting NSAIDs give the fastest relief of symptoms. These medicines may cause stomach upset, ulcers or diarrhea, but they are well tolerated by most people when used for the short term. Some people cannot take NSAIDs because of health conditions such as ulcer disease or impaired kidney function or the use of blood thinners. The fact sheet on NSAIDs lists the types of patients who cannot take NSAIDs.

In patients with chronic undertreated gout crystals can be found in uric acid deposits (called tophi) that can damage joints & can appear under the skin. Corticosteroids such as prednisone and triamcinolone are useful options for patients who cannot take NSAIDs. Given orally (by mouth) or by injection (shot) into the muscle, these medicines can be very effective in treating gout attacks. If only one or two joints are involved, your doctor can inject a corticosteroid directly into your joint.

Health care providers may prescribeanakinra (Kineret) (/I­Am­A/Patient­Caregiver/Treatments/Anakinra­Kineret), an “interleukin 1 beta antagonist,” for very severe attacks of gout. Though thisrheumatoid arthritis(/I­Am­A/Patient­Caregiver/Diseases­Conditions/Rheumatoid­Arthritis)drug is not approved by the Food andDrug Administration (FDA), for gout treatment, it can quickly relieve gout symptoms for some patients. Some home remedies may help ease gout pain. Rest the affected joint and apply ice packs or cold compresses (cloths soaked in ice water and wrung out) to that spot.

Treatment to remove excess uric acid

Patients who have repeated gout flares, abnormally high levels of blood uric acid, or tophi or kidney stones should strongly consider medicines to lower blood uric acid levels. These medications do not help the painful flares of acute gout, so most patients should start taking them after acute attacks subside. The drug most often used to return blood levels of uric acid to normal is allopurinol (Lopurin, Zyloprim). It blocks production of uric acid. Another option, febuxostat (Uloric), also acts by blocking uric acid production.

Probenecid (Benemid) helps the kidneys remove uric acid. Only patients with good kidney function who do not overproduce uric acid should take probenecid.

Pegloticase (Krystexxa) is given by injection and breaks down uric acid. This drug is for patients who do not respond to other treatments or cannot tolerate them. New drugs to lower uric acid levels and to treat gout inflammation are under development.

Gout flares often can occur when you first start to use medications that lower blood uric acid levels. Patients can help prevent flares when starting these medications by also using low‐dose colchicine or NSAIDs. Often, doctors advise patients to keep taking colchicine in a low, preventive dose together with the uric acid­lowering medicine for at least six months.

If you are taking a uric acid­lowering drug, your doctor should slowly raise the dose and keep checking your blood uric acid levels. Once your uric acid levels drop below 6 mg/dL (normal), crystals tend to dissolve and new deposits of crystals can be prevented. You probably will have to stay on this medicine long term to prevent gout attacks.

What works well for one person may not work as well for another. Therefore, decisions about when to start treatment and what drugs to use should be tailored for each patient. Treatment choices depend on kidney function, other health problems, personal preferences and other factors.

What you eat can increase uric acid levels. Limit the amount of high­fructose drinks, such as non­diet soda. Also, do not drink alcohol, especially beer. Restrict eating foods that are rich in purines, compounds that break down into uric acid. These compounds are high in meat and certain types of seafood. New research has found purines in vegetables appear to be safe. Low‐fat dairy products may help lower uric acid levels.

In almost all cases, it is possible to successfully treat gout and bring a gradual end to attacks. Treatment also can decrease the number and size of tophi (deposits of uric acid crystals).

Broader health impacts of gout

Gout often is associated with high blood pressure, heart and kidney disease, or the use of medications that increase uric acid levels. Therefore, health care providers should test for these related health problems. Researchers are studying whether lowering blood uric acid levels can help heart disease and kidney disease.

Living with gout

Gout affects quality of life by both the intermittent attacks and the potential for chronic (lasting) arthritis. Compliance with your treatment plan is critical. Lifestyle changes may make it easier to manage this lifelong disease. Suggestions include gradual weight loss, avoidance of alcohol and reduced consumption of fructose‐ containing drinks and foods high in purines.

The rheumatologist’s role in the treatment of gout

Treatment of gout can be difficult because of coexisting illnesses and other medications. As experts in the treatment of arthritis,rheumatologists (/I­Am­A/Patient­Caregiver/Health­Care­Team/What­is­a­Rheumatologist)examine patients to learn whether gout is the cause of their arthritis and toeducate them about the role and proper use of medications and other treatments for gout. They also act as a resource to primary care doctors.

Written by H. Ralph Schumacher, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee. This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

© April 2015 American College of Rheumatology

© 2015 American College of Rheumatology. All rights reserved.

The prospect of a muscle disease worries some people because they are afraid of not being able to walk. Yet in many cases, treatment exists for myopathy (muscle disease). Proper diagnosis and treatment raise the chance of living life fully despite this illness.

Fast Facts

Myopathy almost always causes loss of muscle strength.

Some patients also have rashes or breathing problems, or both.

While there is no cure for myopathies, treatment is most often effective. Following your doctor’s treatment plan is key to having a good outcome.

What are myopathies?

Myopathy is the medical term for muscle disease. Some muscle diseases occur when the body’s immune system attacks muscles. The result is misdirected inflammation, hence the name inflammatory myopathies. This damages muscle tissue and makes muscles weak.

People with inflammatory myopathies may have these features:

Weakness in the large muscles around the neck, shoulders and hips

Trouble climbing stairs, getting up from a seat, or reaching for objects overhead

Little, if any, pain in the muscles

Choking while eating or aspiration (intake) of food into the lungs

Shortness of breath and cough

The inflammatory myopathies include polymyositis and dermatomyositis. Muscle inflammation and weakness occur in both conditions while patients with dermatomyositis also have a rash. This rash most often appears as purple or red spots on the upper eyelids or as scaly, red bumps over the knuckles, elbows or knees. Children with the disease also may have white calcium deposits in the skin called calcinosis.

Sometimes patients can have the rash with no sign of muscle disease. Doctors call this form of the disease amyopathic dermatomyositis. People with dermatomyositis (/I­Am­A/Patient­Caregiver/Diseases­Conditions/Dermatomyositis­Juvenile) may also have lung inflammation that causes cough andshortness ofbreath. Children with the disease may have an inflammation of the blood vessels (vasculitis (/I­Am­A/Patient­Caregiver/Diseases­Conditions/Vasculitis)) that can result in skin lesions.

Some doctors group a health problem called inclusion body myositis with the inflammatory myopathies. Yet, it differs from them. Men get it more often than women, and the patients tend to be older. Most of these patients do not respond to standard treatment. Therefore, this fact sheet will not discuss this disease.

What causes myopathies and who gets them?

There are many causes of muscle disease. They include infection, muscle injury due to medicine, inherited diseases that affect muscle function, disorders of electrolyte levels, and thyroid disease. We do not know what causes inflammatory myopathies. A top theory is that something goes wrong in the immune system that leads to inflammation. This damages muscle cells or the blood vessels that are in the muscle.

Inflammatory myopathies are rare. Polymyositis and dermatomyositis occur in about one person per 100,000.

All ages can get these diseases. The peak time to get them, though, is ages 5 to 10 in children, and 40 to 50 in adults. Women get inflammatory myopathies about twice as often as men. These diseases affect all ethnic groups. No one can predict who will get an inflammatory myopathy.

How are myopathies diagnosed?

A doctor suspects myopathy when patients complain of trouble doing tasks that require muscle strength, or when they get certain rashes or breathing problems. Most people with myopathy have little or no pain in their muscles. This differs from other health problems. Examples are other forms of muscle disease, joint pain due to arthritis and nerve problems that cause numbness or tingling in the hands and feet. Many patients with other illnesses think they feel weak. In fact, they are tired, short of breath or depressed, rather than having true muscle weakness.

A doctor will do a muscle strength exam to find if true muscle weakness is present. The following test may then be needed:

A blood test to measure the level of various muscle enzymes

An electromyogram — often referred to as an EMG— to gauge electrical activity in muscle

A biopsy of a weak muscle (a small piece of muscle tissue is removed for testing)

Magnetic resonance imaging — more often called MRI — to try to show abnormal muscle

Some patients may have a blood test for myositis­specific antibodies (immune proteins). This test helps detect myopathy. It also gives some information about prognosis (how serious the disease is). In adults, dermatomyositis and, to a much lesser extent, polymyositis at times may be linked to cancer. Therefore, all adults with these diseases should have tests to rule out cancer.

How are myopathies treated?

You need a correct diagnosis of myopathy to have the best possible outcome. Rheumatologists are doctors who are experts in diagnosing and treating diseases of the muscles, joints and bones. Therefore, they are more likely to make a proper diagnosis of myopathy. They can also advise patients about the best treatment options available. Doctors most often treat these diseases with medications. Some of the most common treatments are as follows:

Corticosteroids: Often, the first treatment is an oral (by mouth) corticosteroid, such as prednisone, at a highdose. This reduces inflammation. Blood muscle enzymes tend to return to normal about 4−6 weeks after treatment starts. Most patients regain muscle strength in 2−3 months.

Combination treatment: Your doctor likely will add another drug to your treatment plan:methotrexate (/I­Am­A/Patient­Caregiver/Treatments/Methotrexate­Rheumatrex­Trexall) or azathioprine (/I­Am­A/Patient­Caregiver/Treatments/Azathioprine­Imuran). This gives better long­range control of the disease and helpsavoid long­term side effects of corticosteroids. These side effects include weight gain and redistribution of body fat, thinning of the skin, osteoporosis (/I­Am­A/Patient­Caregiver/Diseases­Conditions/Osteoporosis)and cataracts. Even muscle weakness can be a side effect. Because patients taking prednisone are at risk for osteoporosis, they should receive proper treatment to prevent it.

Immune treatments: Patients whose disease is severe or who do not respond to standard treatment haveother options. They include intravenous immunoglobulin — sometimes referred to as IVIg — or medicinesthat suppress the immune system. These immunosuppressive drugs include cyclosporine (/I­Am­A/Patient­Caregiver/Treatments/Cyclosporine­Neoral­Sandimmune­Gengraf) (Neoral,Sandimmune), tacrolimus(Prograf), mycophenolate mofetil (/I­Am­A/Patient­Caregiver/Treatments/Mycophenolate­Mofetil­Mycophenolate­Sodium) (CellCept) and rituximab (Rituxan) (/I­Am­A/Patient­Caregiver/Treatments/Rituximab­Rituxan­MabThera).

Physical therapy: Physical therapy can help patients with muscle disease go on leading active lives. Physicaltherapy and exercise are important in the treatment of muscle disease. Very weak patients who do not walk should receive range of motion exercises. These exercises prevent joint contractures (deformity of the joint). Patients with medium weakness should start an exercise program to strengthen their muscles. The goal is to slowly increase in intensity as the patient regains strength. Mildly weak patients should take part in their normal activities.

Living with myopathy

Myopathies are chronic (long­term) diseases. To help control your illness, it is important to practice good health measures. Eat a healthy, well­balanced diet, exercise and try to keep a healthy weight.

If you have a dermatomyositis rash, protect yourself from the sun. This is because the rash gets worse after sun exposure, for reasons that are not clear. Therefore, limit time outdoors, and put on sunscreen when you go outside.

If you have trouble swallowing, eat soft or semisolid foods, or puree your solid foods. To prevent choking if you are bedbound, you should be seated up in bed to eat.

People with myopathy may look healthy and normal. It is important for employers, teachers and family members to understand the limits that muscle weakness causes in people with myopathy.

Updated May 2015. This information was written by Marc Miller, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee. This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice,

diagnosis and treatment of a medical or health condition.

© 2015 American College of Rheumatology

© 2015 American College of Rheumatology. All rights reserved.