There is no known cause to the autoimmune response that results in myositis. However, investigators are studying whether the disease is triggered by such environmental agents as the organism that causes toxoplasmosis , Toxoplasma gondii , the Lyme disease organism, Borrelia burgdorferi , the coxsackievirus, or by food allergies. Some cases of IBM are thought to be inherited.
The first symptoms of most types of myositis are weakness and pain in the muscles of the hips and shoulders. The affected person may have trouble getting up from a chair, lifting the arms above the head, or climbing stairs, and may be too tired to walk or stand. DM and PM mostly affects muscles that are close to and within the trunk of the body, while IBM involves a wider range of muscles. Myositis may make it difficult for the person to speak or swallow.
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When the disease affects the lungs or chest muscles, the person may have difficulty breathing. If the person has DM, they may develop characteristic rashes. Other symptoms may include fever and joint pain and swelling. Weak muscles may develop at the same time as the rash, or may develop days, weeks, or months after the appearance of the rash.
Other symptoms of JM include falling, a weaker voice dysophonia , or dysphagia. Calcinosis usually develops later during the course of the disease. Myositis can a difficult disease to diagnose, because it is rare, because the symptoms develop slowly, and because it can be mistaken for other diseases causing muscle weakness such as limb-girdle muscular dystrophy.
Many cases of myositis go undiagnosed for years.
http://josip-debeljuh.from.hr/the-corrections-by-jonathan-franzen-character-analysis.php The health care provider must rule out other conditions such as hypothyroidism , toxin exposure, drug reactions, and genetic disorders that can also affect muscles. The physical examination will include a complete medical history focusing on symptoms and when they occurred, and blood tests for autoantibodies and muscle enzymes for example, creatine kinase CK , which when present in the blood indicates muscle damage.
Specialized tests may also be performed, including:.
There is no cure for myositis. However, prompt and aggressive treatment may reduce muscle inflammation and prevent muscle weakness from progressing. Because of the many different kinds of symptoms and a wide range of reactions to different drugs, each person's treatment for myositis should be individualized. Drugs that are used for treatment include corticosteroids , such as prednisone, to reduce inflammation and improve the body's reaction to infections.
Corticosteroids are usually taken in the form of pills, but may also be injected. The amount of creatine kinase CK levels in the blood are monitored to determine how well the medicine is working.
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Corticosteroids may produce a number of side effects, such as weight gain, difficulties in fighting infections, psychiatric changes, sleeping troubles, water retention, bone thinning, facial swelling, diabetes, and cataracts. Corticosteroid therapy usually leads to improvement in myositis symptoms within two to three months, after which the dose can be lowered to avoid the side effects. If the dose of corticosteriods is going to be reduced, it is essential to lower the dose over a period of time.
Immunosuppressant drugs are used to slow down the immune system's attack on healthy tissue and improve skin rashes. Persons may be prescribed these drugs to control myositis if they are unable to tolerate corticosteroids or if the corticosteroids are not accomplishing the desired degree of treatment.
Immunosuppressant drugs may also be used in conjunction with corticosteroids so that lower doses of corticosteroids can be used. Immunosuppressant drugs include azathioprine, methotrexate, cyclosporine, tacrolimus, etanercept, and mycophenolate mofetil. Intravenous immunoglobulin IVIg appears to aid in improving muscle strength in many persons with myositis, particularly those with DM. It may be less effective in PM, and its role in treating IBM requires more study, although it has been shown to help some patients with IBM if they are diagnosed early.
Immunoglobulins are normal proteins in the blood that attack anything foreign in the body, such as viruses and bacteria. IVIg is made from donated blood plasma from people with normal immune systems. Side effects from the the use of IVIg include headache and flu-like symptoms.
Topical cream or ointment forms of some of the medicines, such as prednisone and tacrolimus, can be used to heal and soothe the rash associated with DM. Calcinosis can be treated with prednisone, plaquenil also called hydroxychloroquine , intravenous immunoglobin IVIG , cyclosporine, and methotrexate.
After drug treatment results in improvement, the affected person begins a program of regular stretching exercises to maintain range of motion in the weakened arms and legs. Physical therapy may be used to prevent permanent muscle shortening. Whirlpool baths, heat, and gentle massages may also provide relief. Adequate rest is necessary, and affected persons should take frequent breaks throughout the day and limit their activity.
Patients with throat problems should be evaluated by a speech therapist who can evaluate the swallowing-related problems and make recommendations regarding diet changes and safe swallowing techniques. Before a woman with myositis becomes pregnant, she should discuss the medicines that she is taking with her health care provider and evaluate the possible risks that she and the baby face if she does become pregnant.
Many of the drugs used in the treatment of myositis may be harmful to the fetus or to a breastfed baby. It is recommended that a doctor experienced in the treatment of myositis, assisted by a rheumatologist, dermatologist, or neurologist, be consulted. Oftentimes a patient may have to be treated at a major medical center, where the disease has been seen and treated before. Various supplements may be used in conjunction with traditional treatment to offset side effects of conventional drug treatment.
The use of these suppplements should be approved by the primary health care provider. Immunosuppressant drugs such as methotroxate and cyclophosphamide increase the risk of infection, so a healthy well-balanced diet is required. Methotroxate impairs the body's ability to absorb folic acid , so foods high in folic acid, such as leafy green vegetables, fruits, and folate-fortified breads and cereals are recommended. The use of folate supplements may also be recommended by the health care provider. Vitamins C and E can be used to help with the pain and infections associated with calcinosis.
Corticosteroids may have multiple side effects when taken for long periods of time at high doses. Calcium and Vitamin D are recommended to lower the risk of osteoporosis , a common side effect of prednisone use. Hypertension and fluid retention may be controlled by a diet low in salt. Steroid-induced diabetes hyperglycemia can be aided by a diet low in sugar and other simple carbohydrates. Proteinuria, in which the body breaks down protein faster than normal, may mean that more protein should be included in the diet.
Weight gain associated with the use of corticosteroids can be managed by the use of the DASH Dietary Approach to Stop Hypertension diet, which is high in fruits, vegetables, dietary fiber, and low-fat dairy products. Information concerning this diet, developed by the National Institutes of Health, can be found at [www.
Weight gain can overtax weakened muscles and should be avoided if possible. The progression of PM and DM varies from person to person, but the lifespan of an affected person is not usually significantly affected. DM responds more favorably to therapy than PM. Overall, many patients do improve and have a functional recovery.
About half of the patients recover and can discontinue treatment within 5 years of beginning treatment. In children the chances of a cure are better than in adults, although some children do suffer a relapse. However, IBM is disabling, and most patients will require the use of an assistive device such as a cane, walker, or wheel chair. The older the patient is when contracting IBM, the more rapidly the disease progresses. Kilpatrick, James R. Coping with a Myositis Disease. Icon Health Publications.