Objective To describe the distribution and severity of muscle weakness using manual muscle testing (MMT) in 172 patients with polymyositis (PM), dermatomyositis (DM) and juvenile dermatomyositis (JDM). The secondary objectives included characterizing individual muscle group weakness and determining associations of weakness with functional status and myositis characteristics in this large cohort of patients with myositis. Methods Strength was assessed for 13 muscle groups using the 10-point MMT and expressed as a total score, subscores based on functional and anatomical regions, and grades for individual muscle groups. Patient characteristics and secondary outcomes such as clinical course, muscle enzymes, corticosteroid dosage, and functional status were evaluated for association with strength using univariate and multivariate analyses. Results A gradient of proximal weakness was seen, with PM weakest, DM intermediate and JDM strongest among the three myositis clinical groups (p ≤ 0.05). Hip flexors, hip extensors, hip abductors, neck flexors, and shoulder abductors were the muscle groups with the greatest weakness among all three clinical groups. Muscle groups were affected symmetrically. Conclusions Axial and proximal muscle impairment was reflected in the five weakest muscles shared by our cohort of myositis patients. However, differences in the pattern of weakness were observed among all three clinical groups. Our findings suggest a greater severity of proximal weakness in PM in comparison to DM.

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PURPOSE Men with Gleason score (GS) 8-10 prostate cancer (PCa) are assumed to have a very high risk of micrometastatic disease at presentation. However, local failure is also a major problem. We sought to establish the importance of more aggressive local radiotherapy to ≥80 Gy. METHODS There were 226 men treated consecutively with RT ± ADT from 1988 to 2002 for GS 8-10 PCa. Conventional, 3D conformal, or intensity-modulated (IM) RT was used. Radiation dose was divided into three groups: 1: <75 Gy (n=50); 2: 75-79.9 Gy (n=60); or 3: ≥80 Gy (n=116). The endpoints examined included biochemical failure (BF; nadir+2 definition), distant metastasis (DM), cause specific mortality (CSM) and overall mortality (OM). RESULTS Median follow-up was 66, 71, and 58 months for groups 1, 2 and 3. On Fine and Gray’s competing risk regression analysis, significant predictors of reduced BF were RT dose ≥80 Gy (p=0.011) and ADT duration ≥24 months (p=0.033). In a similar model of DM, only RT dose ≥ 80 Gy was significant (p=0.007). On Cox regression analysis, significant predictors of reduced OM were RT dose ≥ 80 Gy (p=0.035) and T-category (T3/4 vs. T1, p=0.041). Dose was not a significant determinant of CSM. Results for RT dose were similar in a model with RT dose and ADT duration as continuous variables. CONCLUSION The results indicate that RT dose escalation to ≥80 Gy is associated with lower risks of BF, DM, and OM in men with GS 8-10 PCa, independently of ADT.