Inflammatory myopathy: a review of etiologic and pathogenetic factors

Human idiopathic inflammatory myopathy is an acquired disorder with an annual incidence of two to five cases per million. A genetic influence on host susceptibility may also play a role. With the marked heterogeneity of the disease one of the major challenges is to identify subsets that might share a more uniform pathogenesis and manifest a less diverse profile of clinical findings, histopathological abnormalities, and natural history. Dermatomyositis can be distinguished by clinical appearance and pathological changes, but the recognition of additional disease subsets remains very inexact. Current evidence suggests that dermatomyositis occurs as a result of a vasculopathy, but immune mechanisms involved in other categories of idiopathic inflammatory myopathy may also involve cell-mediated immunity and possibly multiple mechanisms. Even though viral-induced muscle inflammation occurs in humans, there is no convincing evidence for a viral cause of idiopathic inflammatory myopathy. Experimental allergic myositis may be produced by the injection of animals with skeletal muscle homogenates and complete Freund's adjuvant, but the myositogenic factor is unknown and the parallels between experimental allergic myositis and human idiopathic inflammatory myopathy are limited.