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Myositis
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What is Myositis?
Myositis is the medical term for muscle inflammation. In myositis, inflammation damages the fibers of a muscle. This causes muscles to be weak by interfering with the ability of the muscles to contract. Although myositis can cause muscle aches and muscle tenderness, weakness is usually the dominant symptom.
In some cases, myositis is a short-term problem that goes away after a few days or weeks. In other cases, it is part of a chronic (long-term) condition. Chronic forms of myositis can lead to muscle atrophy (wasting and shrinking) and severe disability.
There are many different types of myositis, including:
- Idiopathic inflammatory myopathies. In this rare group of muscle diseases, the cause of the muscle inflammation is unknown (idiopathic). There are three major types: dermatomyositis, polymyositis and inclusion body myositis.
In the United States, idiopathic inflammatory myopathies affect about 1 out of every 100,000 people. Polymyositis and dermatomyositis are most common in women, whereas inclusion body myositis affects men more often. Symptoms can start at any age, but the average age of first symptoms is a bit younger in dermatomyositis and polymyositis (age 50) than in inclusion body myositis (age 60).
So far, most of the evidence suggests that polymyositis and dermatomyositis are autoimmune disorders, illnesses in which the immune system mistakenly attacks the body's own tissues. The muscles of people with inclusion body myositis contain an abnormal protein called amyloid, but the reason it forms is unknown. This amyloid protein is similar to the protein deposited in the brains of people with Alzheimer's disease, and some experts believe that the two diseases may develop the same way. In inclusion body myositis, the muscle also contains tiny structures that resemble viral particles (called inclusion bodies), although no viral infection has been consistently identified in association with this disease.
In dermatomyositis, cancer is found in approximately 10% to 20% of cases. Sometimes, the muscle problem develops first. In other cases, the cancer is detected before the myositis.
Myositis quite similar to polymyositis or dermatomyositis may accompany other autoimmune disease such as systemic lupus erythematosus (SLE) or progressive systemic sclerosis (also called scleroderma ).
- Infectious myositis. Myositis sometimes occurs as part of a systemic (whole body) infection, especially a viral infection. It is especially common in people who have the flu (influenza). Myositis also can be caused by trichinosis, an infection in which tiny parasites invade the muscles. People can develop this infection by eating meat that has not been cooked enough. One type of infectious myositis is called pyomyositis, a bacterial infection that causes one or more pockets of pus (abscesses) inside a muscle. It usually is caused by Staphylococcus ("staph") bacteria. Pyomyositis is a relatively common infection in developing countries in tropical climates, especially where sanitation and health care are poor. However, it sometimes occurs in the United States, primarily in people who inject illegal drugs and in people infected with HIV.
- Benign acute myositis. In benign acute myositis, a young child suddenly develops severe leg pain and cannot walk normally. These symptoms are dramatic and frightening, but they usually disappear within a few days. Benign acute myositis usually occurs in children who are recovering from the flu or some other respiratory infection caused by a virus. Doctors are not sure whether the child's muscle symptoms are caused by the virus itself or by the body's immune reaction to the virus.
- Myositis ossificans. In myositis ossificans, a lump of bony material forms inside a muscle. This usually happens after a muscle injury, especially a deep bruise.
- Drug-induced myositis. In drug-induced myositis, muscle inflammation occurs as a side effect of a medication or a combination of medicines. Although this is rare, the most common medications that can cause myositis are the cholesterol-lowering drugs called statins, including atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor) and zidovudine (Retrovir), also called AZT, a drug used to treat HIV/AIDS.
Is there any treatment?
Treatment
Treatment varies, depending on the
type of myositis.
- Idiopathic inflammatory
myopathies. For polymyositis and
dermatomyositis, doctors usually
begin treatment with a
corticosteroid drug, such as
prednisone (sold as a generic) or
methylprednisolone (Solumedrol,
others). If this fails, methotrexate
(Rheumatrex) or azathioprine (Imuran)
may be added. Intravenous
immunoglobulin (an injection of
antibodies collected from blood
donors) may be effective in cases
that fail these other treatments.
Other immunosuppressant medications
may be recommended to treat
resistant dermatomyositis and
polymyositis, including
cyclosporine, rituximab,
mycophenolate mofetil or
cyclophosphamide. Unfortunately,
there is no reliably effective
treatment for inclusion body
myositis, although corticosteroid
treatment and immunosuppressive
therapies (as with polymyositis and
dermatomyositis) are often tried for
at least several months. If
treatment is effective, ongoing
therapy may improve strength or
prevent worsening weakness.
When myositis accompanies another
autoimmune disease (such as SLE),
treatment of the underlying disease
may be helpful; otherwise, treatment
of the myositis is similar to that
of polymyositis and dermatomyositis.
- Infectious myositis. If
you have the flu, you should rest in
bed and drink plenty of fluids. You
also can take nonprescription
medicines for fever and muscle
aches. If you have trichinosis, your
doctor may treat you with
mebendazole (Vermox) or albendazole
(Albenza), antibiotic drugs that
kill the trichinosis parasites. In
addition, you should rest in bed and
take nonprescription drugs for pain.
Your doctor may also prescribe
prednisone to reduce inflammation
associated with the infection. For
pyomyositis, your doctor may
recommend drainage of the abscess by
making an incision or by inserting a
needle. In addition, he or she will
prescribe antibiotics to fight the
infection.
- Benign acute myositis.
Your child's doctor will prescribe
medication for pain. No other
treatment is necessary, because the
illness usually gets much better
within a few days.
- Myositis ossificans. Your
doctor may wait to see whether the
bony lump disappears on its own. If
it doesn't, he or she may recommend
surgery to remove the lump.
- Drug-induced myositis.
Your doctor will discontinue any
medication thought to be causing
myositis. Medications called
corticosteroids may help you to
recover faster.
In many cases control of inflammation by IVIg and
steroids helps the case.
877-577-4844 for
IVIg in USA or send email to
info@cidpus.org
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After drug
treatment takes effect, a
program of regular stretching
exercises prescribed by your
doctor can help maintain range
of motion in weakened arms and
legs. Physical therapy may also
help prevent permanent muscle
shortening. You may also want to
add whirlpool baths, heat and
gentle massage.
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Getting enough rest is an
important component of managing
myositis. Take frequent breaks
during the day and limit your
activity.
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Nutrition. What you
eat can affect your overall
health. At the Myositis Center,
a trained nutritionist is on
hand to help design a diet
that’s right for you and your
lifestyle. Learn more about our
Nutritionist. (link to
Nutrition)
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It is imperative that myositis
patients find outlets for the
daily stress that most of us
have in our lives. To that end,
your doctor may suggest exercise
as a form of relaxation, like
yoga, or biofeedback exercises.
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- Infectious myositis. Flu
symptoms usually last three to seven
days. In trichinosis, symptoms peak in
about three weeks, and then gradually
subside. For pyomyositis, your doctor
will drain the abscess and you will be
given antibiotics. Once the infection is
gone, healing can start. Recovery can
take weeks or even months in people with
chronic illnesses.
- Benign acute myositis.
Patients usually recover within three to
seven days.
- Myositis ossificans. In some
cases, the bony lump disappears on its
own. However, this can take a few
months. If the lump does not go away, it
may remain indefinitely or your doctor
can remove it surgically.
- Drug-induced myositis.
Symptoms usually disappear once you stop
taking the drug. However, this can take
weeks or months.
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- Thoroughly cook pork and other
meats.
- Never inject illegal drugs under
your skin or into your muscles. With
prescription drugs that are injected,
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