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Screening muscles, fascia, and joints for chronic GVHD

Evaluation

Patient-reported symptoms and signs

  • Muscle cramps
  • Muscle pain
  • Muscle weakness
  • Joint stiffness
  • Restricted range of motion
  • Tightened muscles, tendons and fascia
  • Contractures

Clinical examination

  • Palpation for areas of thickening, tightening, shortening of muscles or fascia; muscle tenderness
  • Evaluate range of motion
  • Muscle strength testing
  • Inspection for signs of edema or peau d’orange skin changes
  • Visual inspection for grooving, ridging

Diagnostic testing

  • Creatinine kinase
  • Aldolase
  • Electromyography

Clinical manifestation

Clinical manifestation
Description

Fasciitis

Stiffness, restricted range of motion

Joint stiffness or contractures (secondary to fasciitis or sclerosis)

Groove sign, dimpling

Myositis or polymyositis*

Muscle tenderness and elevated muscle enzymes. Evaluate with electromyography and measurement of creatinine phosphokinase and aldolase. Muscle/sural nerve biopsies should be considered in the absence of other manifestations of GVHD to rule out other causes of myositis

Edema**
Present in extremities, with or without erythema and peau d’orange skin
Muscle cramps**
May be present with increased muscle enzymes
Arthralgia or arthritis**
Uncommon, occasionally associated with the presence of autoantibodies

* Distinctive but insufficient alone to establish an unequivocal diagnosis of chronic GVHD without further testing or additional organ involvement.

** Rare, controversial, or non-specific features of chronic GVHD.

*** Common in both acute and chronic GVHD.

Photo Atlas

This photo atlas contains pictorial representations of various clinical manifestations of chronic GVHD.

  • Male upper torso suffering from blemished and puffy skin

    Edema

    Edema in the extremities can be bilateral or unilateral (shown). May be present with erythema and peau d’orange skin. Edema may be associated as prodromal symptom to subcutaneous sclerosis and fasciitis.