Description

Polymyositis (pol-e-my-o-SY-tis) is a rare inflammatory disease that causes muscle weakness affecting both sides of your body. Having this condition can make it difficult to climb stairs, rise from a sitting position, lifting objects, or reaching overhead.

Polymyositis most commonly affects adults in their 30's, 40 or 50 years. Women are affected more often than men. Signs and symptoms usually develop gradually, over weeks or months.

While there is no cure for polymyositis, treatments, ranging from medications to physical therapy can improve your muscle strength and function.

Symptoms

The muscle weakness associated with polymyositis affects muscles closest to the trunk, such as those in the hips, thighs, shoulders, upper arms and neck. The weakness affects both the left and right sides of his body, and tends to get worse with time.

When to see a doctor

Seek medical attention if you experience unexplained muscle weakness.

Causes

The exact cause of polymyositis is unknown, but the disease shares many features with autoimmune disorders, in which your immune system mistakenly attacks its own tissues of the body.

Risk factors

The risk of polymyositis is higher if you have lupus, rheumatoid arthritis, scleroderma, or sjögren's syndrome.

Complications

The possible complications of polymyositis include:

  • Difficulty swallowing. If the muscles in the esophagus are affected, you may have trouble swallowing (dysphagia), which in turn can cause weight loss and malnutrition.
  • Aspiration pneumonia. Difficulty swallowing may also cause your breathing food or liquid, including saliva, in the lungs (aspiration), which can lead to pneumonia.
  • Breathing problems. If the muscles of the chest are affected by the illness, you may experience respiratory problems, such as shortness of breath or, in severe cases, respiratory failure.

Associated conditions

Although these are not the complications, polymyositis is often associated with other conditions that can cause further complications of their own, or in combination with polymyositis symptoms. Associated conditions include:

  • Raynaud's phenomenon. This is a condition in which your fingers, toes, cheeks, nose, and ears are initially pale when exposed to cold temperatures.
  • Other connective tissue diseases. Other conditions, such as lupus, rheumatoid arthritis, scleroderma, and Sjogren's syndrome, can occur in combination with polymyositis.
  • Cardiovascular disease. Polymyositis can cause the muscular walls of the heart become inflamed (myocarditis). In a small number of people who have polymyositis, congestive heart failure, and cardiac arrhythmias may develop.
  • The lung disease. A condition called interstitial lung disease can occur with polymyositis. Interstitial lung disease refers to a group of disorders that cause scarring (fibrosis) of the tissues of the lungs, causing the lungs stiff and inelastic. Signs and symptoms include dry cough, and difficulty breathing.
  • Cancer. People who have polymyositis have an elevated risk of cancer.

Diagnosis

If your doctor suspects that you have polymyositis, he or she may suggest some of the following tests:

  • Blood tests. A blood test will let your doctor know if you have elevated levels of muscle enzymes, which may indicate muscle damage. A blood test can also detect specific autoantibodies associated with different symptoms of polymyositis, which may assist in determining the best medication and treatment.
  • Electromyography. This test consists in the insertion of a thin needle electrode through the skin, into the muscle. The electrical activity is measured as you relax or tighten the muscles, and changes in the pattern of electrical activity, may confirm a muscle disease. The doctor can determine the distribution of the disease by testing different muscles.
  • Magnetic resonance imaging (MRI). A scanner creates cross-sectional images of the muscles of the data generated by a powerful magnetic field and radio waves. Unlike a muscle biopsy, an mri can assess inflammation through a large area of muscle.
  • The muscle biopsy. During this test, a small piece of muscle tissue is surgically removed for laboratory analysis. The analysis may reveal abnormalities, such as inflammation, damage, certain proteins or enzyme deficiencies.

Treatment

Although there is no cure for polymyositis, the treatment can improve your muscle strength and function. The earlier treatment is started in the course of polymyositis, the more effective it is leading to fewer complications.

However, as with many conditions, not only is it the best method; your doctor will tailor your treatment strategy based on the symptoms and on how well you respond to therapy.

Drugs

The most commonly used medications for the treatment of polymyositis include:

  • Corticosteroids. Medications such as prednisone can be very effective in the control of polymyositis symptoms. But the long-term use of these drugs can have serious and wide range of side effects, your doctor may gradually taper the dose of medication to lower levels.
  • Corticosteroid-sparing agents. When used in combination with a corticosteroid, these drugs can decrease the dose and potential side effects of corticosteroids. The two most common medications used for polymyositis are azathioprine (Azasan, Imuran) and methotrexate (Trexall). Other medications prescribed for polymyositis include mycophenolate mofetil (CellCept), cyclosporine and tacrolimus.
  • Rituximab (Rituxan). Most commonly used to treat rheumatoid arthritis, rituximab is an option if the initial therapies do not adequately control your polymyositis symptoms.

Therapy

Depending on the severity of your symptoms, your doctor may suggest:

  • The physical therapy. A physical therapist can show you exercises to maintain and improve your strength and flexibility, and advise an appropriate level of activity.
  • Speech therapy. If your swallowing muscles are weakened by polymyositis, speech therapy can help you learn how to compensate for these changes.
  • Dietary assessment. Later in the course of polymyositis, chewing and swallowing may be more difficult. A registered dietitian can teach you how to prepare easy-to-eat, nutritious foods.

Surgical and other procedures

Intravenous immunoglobulin (IVIg) is a purified blood product that contains healthy antibodies from thousands of blood donors. These healthy antibodies can block the harmful antibodies that attack muscle in polymyositis. Given as an infusion through a vein, IVIg treatments may need to be repeated periodically for the purposes of continue.

Coping and support

Living with a chronic autoimmune disease can make you question at times if you are up to the challenge. To help you deal with the problems, try to supplement their health care with the following suggestions:

  • To know of their disease. Read everything you can about the polymyositis and other muscle and autoimmune disorders. Talk with others who have a similar condition. Don't be afraid to ask your doctor any questions you may have about your disease, the diagnosis or plan of treatment.
  • Be a part of your medical team. Considered to you, your doctor and any other medical experts involved as a united front in the fight against the disease. Follow the treatment plan agreed upon, it is of vital importance. Keep your doctor informed of any new signs or symptoms that you may experience.
  • Know and enforce your boundaries. Learning to say no effectively and ask for help when you need it.
  • Rest when you are tired. Do not wait until the exhaustion. This will only cost you more as your body tries to recover. Learning to pace yourself can help you to maintain a constant level of power, accomplish just as much, and feel better emotionally.
  • Acknowledge your emotions. The denial, the anger and frustration are normal feelings when you're dealing with a disease. Things don't seem normal or fair, and it seems likely that outside of your control. The feelings of fear and isolation are common, so stay close to your family and friends. Try to keep your daily routine as best you can and do not forget those things that you like. Many people find support groups to be a useful resource.

Preparing for your appointment

Probably the first to bring your symptoms to the attention of your family doctor. He or she may refer you to a doctor who specializes in the treatment of arthritis and other diseases of the joints, muscles and bones (rheumatologist) or a doctor who specializes in disorders of the nervous system (neurologist).

What you can do

When you go to see your doctor, make sure you have a record of your symptoms. Although it can be difficult to identify when symptoms began, trying to estimate when did you first notice the weakness, and the muscles have been affected. You can write a list that includes:

  • Detailed descriptions of their symptoms, including the muscles are affected
  • The information about the medical problems that you have had
  • Information about the health problems of your parents or siblings
  • All of the medications and supplements you take
  • Questions you want to ask the doctor

Prepare a list of questions ahead of time to help make the most of your limited time with your doctor. For polymyositis, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • There are other possible causes of the symptoms?
  • Are my symptoms can change over time?
  • What kinds of tests might I need? Are the special preparations required?
  • Are the available treatments for my condition? What treatments are recommended?
  • I have other medical conditions. How can I best manage them together?
  • Do you have any brochures or other printed material that I can take with me? What sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, do not hesitate to ask questions during your appointment if you think of something new.

What to expect from your doctor

Your doctor will probably ask you several questions, such as:

  • When did you first notice the muscle weakness?
  • Did your condition develop gradually or come on suddenly?
  • You're easy-to-fatigue during waking hours?
  • What other symptoms that you are experiencing?
  • Does your condition limit your activities?
  • Has someone in your family has been diagnosed with a disease or condition that affects the muscles?
  • Are you currently taking medications or dietary supplements?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Polymyositis