| |
Polymyositis
Polymyositis is an uncommon disease that affects your muscles
leaving you with muscle weakness in the muscles closest to your
trunk. Polymyositis is one of the myopathies, or illnesses and
diseases that affect the muscular system. Some doctors suspect that
as with other myopathis, polymyositis, is a result of an autoimmune
response in the body.
Polymyositis is a connective tissue disease because of the way it
attacks the body. It is most common in people 40-50 years old. It
has a higher incidence in black people than whites and more women
are affected than men. Interestingly periods of spontaneous
remission do happen. Polymyositis is also connected with other
connective tissue disease such as lupus erythematosus.
There are diseases that can mimic polymyositis such as some of the
muscular dystrophies, drug toxins, metabolic and hormonal disorders
and infectious diseases. The signs and symptoms of Polymyositis may
appear gradually or rapidly and they may fluctuate over time.
Patients experience a progressive symmetrical weakness in the
muscles closest to the trunk, trouble swallowing, mild joint and
muscle tenderness and fatigue.
The loss of strength will be recognized when patients experience
difficulty getting up from a chair, climbing stairs or lifting
objects above the shoulders, Fatigue can be pervasive and cause
patients lost work time and lost family time. By listening to their
bodies and resting when they are tired they may decrease the amount
of time they suffer debilitating fatigue.
Polymyositis has a skin component called dermatomyositis that can be
present alone or in combination with the systemic disease. The
dermatomyositis will present with a purplish discoloration around
the eyes or reddish discoloration around the knees and elbows and
knuckles. There can also be a reddish rash over the face, neck and
upper chest.
When a patient first sees the doctor for polymyositis he will
perform a systematic physical exam that accounts for muscle strength
and potential involvement of other organ systems. Blood tests may
reveal abnormally high levels of muscle enzymes. An EMG is used to
exclude other nerve muscle diseases. Imaging with an MRI can show
areas of inflammation to help determine a good biopsy site. A muscle
biopsy will confirm the type of inflammation typical of
polymyositis. The biopsy is usually taken from the quadriceps,
biceps or deltoid muscle.
Complications associated with polymyositis include weight loss and
pneumonia if the difficulty swallowing becomes so severe that the
patient can’t eat or the liquid goes to the lungs instead of the
stomach. Patients can develop myocarditis, or inflammation of the
heart muscle; congestive heart failure or heart arrhythmias may
follow. Interstitial lung disease is also possible with
polymyositis. This causes scarring of the lungs leading to a lower
elasticity and difficulty breathing. The signs are a dry cough and
shortness of breath. Cancer seems to be more common in people with
polymyositis but this seems to be even more pronounced in people
with dermatomyositis.
Initial treatment is large doses of corticosteroids to help decrease
the inflammation in the muscles. Based on the initial response they
may be needed for years. In patients that do not respond well to the
corticosteroids immunosuppressive medications are considered. Both
the corticosteroids and the immunosuppressive therapy have severe
side effects from long term use.
Physical therapy is often a part of the treatment plan. Polymyositis
often becomes inactive and rehabilitating weakened muscles is a long
term concern.
There are several treatments that are currently in trials to
determine the long term efficacy of the treatment. These are
plamapharesis, IVIG and radiation. These are all treatments used for
other illness so long term side effects are known but whether they
are effective against Polymyositis is under question.
By having a better knowledge of your disease and the treatment you
will have better outcomes and increased success with rehabilitation.
|
|
