Polymyositis, invasion of non-necrotic muscle fibres, and the art of repetitionBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7480.1464 (Published 16 December 2004) Cite this as: BMJ 2004;329:1464
All rapid responses
Once again, I read that a structured literature search shows that the
research evidence of histological feature of cellular inflammatory
infiltrates with invasion of non-necrotic muscle fibres – until now
considered as prerequisite for the diagnosis of polymyositis – is
insufficiently strong to be used as a diagnostic criterion (1). So a
lot of dispute has arisen on diagnostic criteria for polymyositis, and, then,
disagreement has occurred among physicians around the world, over the
diagnostic criteria used. In my opinion, in day-to-day practice, once
again, a general practitioner has to consider, and strongly respect, Henle-Kock’s three famous parameters, as regards doctor’s “clinical” diagnostic
tool: hopefully, the Biophysical Semeiotics (B.S.) (See HONCode website
www.semeioticabiofisica.it). Consequently, the patient, affected by one of
idiopathic inflammatory myopathies, notoriously a group of heterogeneous
disorders characterised by acquired progressive muscle weakness and
inflammatory infiltrates in skeletal muscle tissue, necessarily presents
– at first – a “rheumatic b.s. constitution”, conditio sine qua non of
rheumatism, as well as all aspecific inflammatory signs (increased
Reticulo-Endothelial System-Hyperfunction-Syndrome (RESHS), Acute Phase
Proteins b.s. syndrome, b.s. acute Antibody Synthesis Syndrome, raised
inflammatory tissue cytochines, typical rheumatic diagram of finger-pulp
tissue microvascular unit (m.t.u.), microvascular alterations in diseased
tissues, a.s.o. (2,3, 4) (See above-cited website).
Finally, a specific
sign of polymyositis, which allows the proper diagnosis to be made, consists
of a skeletal muscle-gastric aspecific rheumatic reflex (See later on). In
addition, in case of dermatomyositis, a humorally mediated angiopathy
resulting in myositis and a typical dermatitis, cutaneous lasting
pinching brings about b.s. typical aspecific-gastric reflex, followed by
tonic Gastric Contraction, indicating a rheumatic disorder (2, 3, 4).
Interestingly, Biophysical Semeiotics allowed me to recognize more than 20
years ago a new, “variant” form of rheumatic classic polimyalgia, I termed
Acute Benign Rheumatic Polimyalgia (5). With the ascertained presence of a
rheumatic disorder, even corroborated by proper laboratory investigations
(including levels of muscle associated enzymes, serology,
electromyography, and muscle biopsy), prescribed therapy causes the
slow disappearing of above-mentioned signs, even partially, monitored
clinically by means of the original physical semeiotics.
1)Hengstman GHD., van Engelen BGM. Polymyositis, invasion of non-
necrotic muscle fibres, and the art of repetition BMJ 2004;329:1464-1467
(18 December), doi:10.1136/bmj.329.7480.1464
2) Stagnaro S., Auscultatory Percussion of Rheumatic Diseases. X European
Congress of Rheumatology. Moscow. 26 June-July, Proceedings, pg 175, 1983
3) Stagnaro S., Auscultatory Percussion Therapeutic Monitoring and
Cerebral Dominance in Rheumatology. 2nd World Congress of Inflammation,
Antirheumatics, analgesics, immunomodulators. Abstracts, A. Book 1, pg.
116, March 19-22, Montecarlo,1986
4) Stagnaro Sergio, Stagnaro-Neri Marina. Introduzione alla Semeiotica
Biofisica. Il Terreno oncologico”. Travel Factory SRL., Roma, 2004.
5) Stagnaro S., Polimialgia Reumatica Acuta Benigna Variante. Clin. Ter.
118, 193, 1986 (Medline)
Competing interests: No competing interests
"Through repetition, conclusions — even though they have become
invalid over time — become embedded in the medical literature, the
pathophysiological concepts of disease, and the minds of clinicians and
The very first newspaper report of mine on Munchausen's by Proxy
involved a child who died from polymyositis, but the mother was accused of
killing her through MSBP (1) (The Independent 21/8/92 pp 1-3) This was
before the natural cause had been fully investigated. This is a common
feature of such cases.
It is interesting to note that Allison and Roberts (2) have analysed
(deconstructed) MSBP research and literature and have stated it to be
'recursive' much as the BMJ item responded to describes.
This aspect of the manner by which so much of MSBP has become
established is missing from current assessments.
May we see a New Year's resolution to address this?
2 Disordered Mothers Or Disordered Diagnosis - Munchausen By Proxy
Syndrome. The Analytic Press, Inc., Hillsdale, NJ 07642.
Note: Drs Allison and Roberts are philosophers teaching at NYSU Stony
Brook. I have met and interviewed them.
It is not impossible that I might report on this for payment.
Competing interests: No competing interests