Myositis

About

Myositis

What is myositis?

Myositis is a group of conditions involving chronic inflammation of the muscles. The inflammation may, or may not cause pain and weakness of the muscles. About 75,000 Americans have been diagnosed with myosotis. Myositis can be caused by numerous different things, but traditional myositis involves symptoms other than just muscle weakness and pain. Myositis usually has a gradual onset and may be unrecognizable in the beginning stages of the disease.

What are the different types of myositis?

There are two different types of myositis. They include:

  • Polymyositis- a form of myositis that causes muscle weakness usually bilateral. It is known to affect the hips, thighs, shoulders, upper arms, and neck
  • Dermatomyositis- a form of myositis that has the traditional symmetric muscle weakness but also involves skin manifestations in the form of a rash. The rash may present before, during, or after the episodes of muscle weakness. The locations the rash may appear includes:
  1. Face
  2. Eyelids
  3. Elbows
  4. Knees
  5. Toes
  6. Chest
  7. Back
  • Necrotizing myopathy- a new form of myositis involving muscle death.
  • Sporadic inclusion body myositis- this is the most common form of myositis.
  • Juvenile forms of myositis- a category for myositis symptoms affecting anyone under the age of 18.

Causes

What is the cause of myositis?

Inflammatory myositis is considered an autoimmune disorder. It occurs as the body accidentally destroys the healthy muscle tissues instead of the foreign invaders that it should be focused on. The condition can develop from anything that may cause swelling to the muscles. This may be excessive exercise, infections, medications, illicit drugs, inherited diseases, electrolyte imbalances, and thyroid disease. Currently, there is no explanation on how myositis occurs, but researchers feel that genetics may play a role along with an environmental trigger.

What other autoimmune diseases may cause myositis?

Some autoimmune disorders have been known to cause milder symptoms of myositis. They include:

  • Rheumatoid arthritis
  • Lupus
  • Mixed connective tissue disease
  • Scleroderma

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Symptoms

What are the symptoms of myositis?

The onset of myositis is usually gradual and may present as the person affected just having difficulty with simple tasks like getting out of the chair, getting up off of the floor or climbing the stairs. The most common symptoms of myositis include: 

  • Muscle weakness
  • Muscle pain
  • Joint pain
  • Swelling
  • Fatigue
  • Inability to move limbs
  • History of falling
  • Shortness of breath
  • Fever
  • Trouble swallowing
  • Raynaud’s phenomenon
  • Weight loss
  • Thickening of the skin, especially in the hands
  • Rash
  • Calcinosis

What complications are associated with myositis?

  • Dysphagia- trouble swallowing due to muscle weakness in the throat. About 33% of people that suffer from myositis also develop dysphagia.
  • Myocarditis- chronic inflammation of the heart muscles may occur, which may cause scarring and damage to this vital organ.
  • Breathing complications- tissue damage may occur in the lungs due to the chronic inflammation of these muscles resulting in scarring and difficulty with breathing. 1 in 3 people who develop myositis also develop lung complications.
  • Cancer associated myositis- research has found people with myositis have a higher chance of developing cancer. Myositis, however, does not directly cause cancer.
  • Rhabdomyolysis- a serious condition that involves rapid death of muscle. Additionally, kidney failure may occur as well as the potential of death in very rare cases.

Diagnosis

How is myositis diagnosed?

Diagnosis of myositis may be tricky as there are several different causes or conditions that have a similar presentation. Because the condition is not common, healthcare providers may overlook some of the initial symptoms, which may cause a delay in the diagnosis and treatment of the condition. Usually, a medical history and physical exam will be performed along with ordering some blood tests, performing tissue biopsies, and review of diagnostic testing when required.

Treatment

What are treatment options for myositis?

Early and aggressive treatment of myositis is key to preventing long term complications from this rare but serious medical condition. Focus is usually centered around the management of the symptoms associated with myositis as there is no cure for this condition. Because symptoms vary from person to person, so does the treatment. Some treatment examples include:

  • Corticosteroids- a form of treatment that is usually provided in an oral or injectable form and is used in high doses to reduce inflammation as quickly as possible. This is usually the first line of treatment for myositis.
  • Disease-modifying antirheumatic drugs (DMARDs)- treatments that reduce the immune system’s inflammatory response. This is usually the next phase of treatment if corticosteroid treatment fails. Most common examples include:
  1. methotrexate 
  2. azathioprine 
  3. mycophenolate mofetil
  4. cyclosporine
  5. tacrolimus
  6. cyclophosphamide
  7. hydroxychloroquine
  • Immunoglobulin- an intravenous procedure involving purified plasma from donated blood that has healthy antibodies infused into the body to prevent further damage of the muscle tissues.
  • Physical therapy-  an effective treatment that helps reduce muscle weakness, atrophy, and improve mobility due to increasing the flexibility to the affected areas.
  • Exercise- recommended as this helps reduce inflammation, fatigue, and build muscle mass.

Myositis sometimes may be a tricky condition to manage. Learning more about medications or self-care treatments have been very effective with treating this condition. If you would like to learn more on how you or a loved one can better manage myositis, reaching out to one of our healthcare providers at TeleMed2U may be the first step to successful management.

If you have been recently diagnosed with myositis, or think you may have myositis, consider visiting the Myositis Foundation website for more information and support: https://www.myositis.org/patient-support/living-with-myositis/

References

Arthritis Foundation. (n.d.). Myositis. https://www.arthritis.org/diseases/myositis 
The Myositis Association. (n.d.). Myositis. https://www.myositis.org/about-myositis/types-of-myositis/

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Roy Kedem started his premedical studies at Harvard, and research in genetics and gene sequencing at Harvard, Beth Israel. He attended medical school in the UK at the Cambridge Overseas Medical Program in 1998.  Dr Kedem then completed his residency in Internal Medicine at Columbia College of Physicians and Surgeons in Stamford, Connecticut and his fellowship in Hospital Medicine at the Cleveland Clinic in Cleveland, Ohio.

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