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To the Editor:
In the Amato et al. editorial on myositis,1 the authors are concerned with diagnostic criteria. We agree that it is important to have pathologic diagnostic criteria distinguishing sIBM from “polymyositis” and other muscle disorders having mononuclear-cell inflammation in muscle biopsies. In fact, such diagnostic criteria have been reported2–5⇓⇓⇓ and are being used. For example, in the presence of inflammation, the unique degenerative aspects of sIBM muscle fibers provide excellent criteria distinguishing sIBM from myositides. Those aspects include the following:
1) Intra-muscle-fiber amyloid inclusions,2 representing both amyloid-β (Aβ) and phosphorylated tau containing inclusions,3 which are a) congophilic and anisotropically greenish in polarized light with Congo red staining (but this might not be specific in overstained preparations)2,4⇓ and b) metachromatically red with crystal-violet staining.3,4⇓ However, the amyloid aspect of those inclusions is best and most specifically shown when …
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