Case history

A 36 year old married, non-smoker was referred for further management of a 10 week history of Raynaud’s phenomenon affecting the hands and feet beginning in mid-summer. There was an associated history of myalgia, fatigueability and exertional praecordial chest pain radiating into the neck and relieved by rest. Her symptoms had increased such that she was no longer able to work. She had no significant past medical history and was taking no regular medication. There was no family history of note.

On examination, there was proximal muscle tenderness in the limb girdles with reduced power. She was comfortable at rest, normotensive and full cardiorespiratory examination was normal. All peripheral pulses were present and symmetrical and there was no sclerodactly or nail fold capillary changes. There was no associated rash.

Initial investigations including full blood count, erythrocyte sedimentation rate, renal and hepatic function, chest radiography, and electrocardiography were all normal. Urine analysis was negative. ANF, antiphospholipid antibodies and antibodies to extractable nuclear antigens, including anti-Jo1 were not detected. Creatine kinase was increased at 313 U/l (normal range 10–171). Needle muscle biopsy showed an inflammatory infiltrate with no muscle necrosis. Electronmicrography showed spontaneous …