Myositis or muscle inflammation can be hereditary or caused by various pathogens. Infections, immune disorders, parasites, viruses, bacteria, or toxins can trigger such muscle inflammation. This complicates both the diagnosis and treatment of myositis.
What is myositis?
Muscle inflammation or myositis refers to all inflammatory diseases of muscles of the human skeleton. A distinction is made between various forms of myositis. The most important are known as polymyositis, inclusion body myositis, or dermatomyositis. However, myositis can also be triggered by various bacterial or viral pathogens or infections, as well as by injuries to muscles. Myositis sometimes occurs for hereditary reasons, such as Münchmeyer syndrome. It can also occur as a result of exposure to toxins. In our latitudes, myositis is a relatively rare disease. Inclusion body myositis is most common in adults over the age of 50. However, dermatomyositis is more common overall in the population. Interestingly, both forms of myositis occur preferentially in childhood and adolescence and then again after midlife. Such muscle inflammations can be accompanied by muscle weakness in certain areas of the body, skin symptoms or swallowing disorders. The course of myositis can be quite treatable. However, myositis can also progress and require permanent hospital treatments.
Causes
Myositis caused by certain parasites as well as bacterial or viral pathogens is rather rare in our latitudes. Much more often, muscle inflammation occurs when an inflammatory systemic disease is present. Inflammatory rheumatic diseases or connective tissue diseases can also cause muscle inflammation. In polymyositis and also in dermatomyositis, auto-immune disease is thought to be the cause of muscle inflammation. Inclusion body myositis, on the other hand, is thought to be due to degenerative and inflammatory processes. Typically, elevated levels of certain inflammatory parameters and enzymes are often found in patients with myositis. However, these enzymes are not the cause of myositis. They are produced in the muscle fibers and are released in increased amounts as a result of muscle inflammation. Therefore, these enzymes can serve as diagnostic tools to detect myositis.
Symptoms, complaints, and signs
The clinical spectrum of myositis is quite comprehensive, ranging from mild joint pain to neurologic symptoms, depending on the form and severity. Patients with polymyositis mainly complain of nonspecific symptoms such as fatigue and exhaustion in the early stages of the disease. Fever may also occur. A characteristic symptom of polymyositis is a muscle ache-like feeling in the muscles of the arms and legs. This pain occurs regardless of whether patients have done much or little exercise. Many patients also complain of marked muscle weakness. This always occurs progressively and symmetrically, i.e., on both sides of the body. People with myositis can only lift their arms with difficulty or suffer from restricted movement of the legs and head. In both poly- and dermatomyositis, the function of internal organs may be impaired in addition to the muscles. If the striated muscles of the larynx and/or lungs are affected by the disease, difficulty swallowing and shortness of breath occur. In dermatomyositis, various skin symptoms appear in addition to the muscular impairments. These may vary in intensity and in individual cases may even be completely absent.
Course of the disease
Diagnosis must precede treatment of myositis. Electrical voltage measurement, muscle biopsy, or electroneurography can be used to track down myositis, as can measurement of enzyme levels in the muscle fibers. Complicating the diagnosis of myositis is the fact that muscle inflammation – depending on its form – can develop over months or years. It is now known that patients with dermatomyositis are more likely to develop malignant or malignant tumors. Necrosis or infiltrated inflammatory cells can provide important clues about the course of the disease. Each form of myositis has its own diagnostic criteria.Nevertheless, it is difficult to detect. The course of the disease is gradual and is often only noticed at an advanced stage. In addition, diseases such as muscular dystrophy can complicate the diagnosis.
Complications
Muscle inflammation can cause several complications. Initially, myositis leads to symptoms such as limb pain, fatigue, fever, and loss of appetite, which can worsen the general condition and result in dehydration or nutritional deficiencies. Prolonged illness is also often associated with bedriddenness. The associated immobility can trigger depressive moods and cause eczema and inflammation in elderly patients. Sometimes the muscle inflammation can spread to surrounding areas of the body and cause serious complications. For example, if it spreads to the ankle, it can encapsulate and eventually stiffen. If muscle inflammation is not treated, it becomes progressively worse. This can result in muscle damage and even paralysis. If the affected muscle can then no longer be moved as before, this can promote psychological complaints. The treatment of muscle inflammation also carries risks. The prescribed antibiotics and cortisone preparations can trigger side effects such as diarrhea and skin irritation. Intolerance can lead to joint pain, serious intestinal disorders and depression. Paralysis and muscle injury can cause induration, which can lead to tissue damage if not treated properly.
When should you see a doctor?
Intense exercise or other physical activity may cause pain or a decrease in usual performance. Normally, a visit to the doctor is not necessary. If the discomfort reduces within a few hours or after a restful night’s sleep, no doctor is needed. The organism uses the time of a necessary regeneration with sufficient rest and protection. Subsequently, freedom from symptoms is expected after a short time. If pain or other discomfort occurs during normal everyday movements, a doctor should be consulted. If the complaints persist over several days and weeks or increase in intensity, a visit to the doctor is advisable. If there are signs such as a reduction in general mobility, fatigue, an increased body temperature or a reduced physical resilience, a doctor should be consulted. If there is an inner irritability, a gentle posture of the body or a crooked posture, a visit to the doctor is recommended. Changes in the appearance of the skin, sensitivity to pressure or increased sensitivity to temperature influences should be examined and treated. Of particular concern are impairments in respiratory activity. If complaints occur during the natural act of swallowing or if breathing is difficult, medical clarification of the symptoms should take place immediately. In these cases, the muscle discomfort leads to impairment of the organ activity of the lungs and requires medical attention.
Treatment and therapy
Depending on the form and severity of the muscle inflammation, one must treat differently. The standard treatment for dermatomyositis- or polymyositis-type muscle inflammation has been the administration of high doses of cortisone. Depending on the type of myositis, the symptoms improve and the cortisone can be dosed down after a few weeks. Sometimes, however, the course of myositis cannot be positively influenced even with cortisone. In such cases, immunosuppressants or immunoglobulins are used. They suppress the immune system‘s overreactions. Patients with inclusion body myositis are treated with physiotherapy or occupational therapy. However, the course of this myositis often necessitates treatment in a clinic that specializes in neuromuscular disease patterns. In cases of paralysis or muscle injury, induration may occur, necessitating more specific treatment of myositis.
Outlook and prognosis
The prognosis for myositis depends on the cause, the type of treatment, and the duration of the inflammation. No uniform statements can be made in this regard. For example, if autoimmune-related conditions are responsible for the muscle inflammation, weeks of therapy are usually necessary to produce an improvement.Moreover, such causative conditions are always chronic, which is why, on the one hand, lifelong therapy is necessary and, on the other, recurrence of myositis is possible. In such cases, the prognosis is all the better if those affected can keep their muscles healthy for a long time thanks to good exercise and well-adjusted medication. If local infections or other inflammations are the trigger, the success of the therapy determines the prognosis. It can sometimes take several weeks before there is any improvement at all. The problem with muscle inflammation, however, is not the pain, but the symptoms of failure that occur later. For example, muscles can become undersupplied or atrophy during inflammation. Avoiding exercise due to pain also leads to muscle atrophy. It is true that affected individuals are often weakened after surviving myositis and require exercise therapy to rebuild muscles. However, muscle damage resulting from acute myositis is considered to be readily reversible.
Prevention
Prevention of the development of myositis is virtually impossible. One can protect oneself to some extent from viral, bacterial, or parasitic pathogens, but could still develop myositis due to other circumstances. There is nothing you can do to prevent autoimmune disease or toxin-induced myositis.
Follow-up
The disease myositis requires lifelong treatment because, according to current scientific knowledge, it cannot be cured. The goal of follow-up care is to inhibit the inflammation and minimize the weakening of the muscles, and the mobility of the affected skeletal muscles is preserved. This requires follow-up, the extent of which depends on the severity of the symptoms. The doctor and the patient make regular appointments. At these, necessary prescriptions for medications such as cortisone and immunosuppressants, as well as for physiotherapy and occupational therapy, are issued. Immediately after diagnosis, a rehabilitation program is often ordered. Under professional guidance, the patient learns about the consequences of myositis on his or her life and how to address them. However, for successful measures, the inflammation must have healed as far as possible. In any case, a follow-up examination includes a discussion of the complaint situation. Especially the professional and private everyday life can be provided with great difficulties. Possible offers of help are discussed if necessary. In addition, a blood test is performed to determine inflammation parameters. This enables the physician to document the progress of the disease and, if necessary, adjust the therapy. The success of treatment depends to a decisive extent on the patient’s willingness to cooperate. Prolonged sparing not infrequently leads to loss of muscle function.
What you can do yourself
Muscle inflammation usually requires comprehensive medical treatment. Accompanying this, the patient can take some measures to relieve the discomfort. First, the affected muscle should be spared. If the pain is severe, warm compresses and accompanying measures such as soothing teas or gentle massages are recommended. A bandage can also contribute to a rapid recovery. Physiotherapy and occupational therapy are important components of the therapy. The patient can support these measures at home with moderate movement and individual exercises. The type of workout is best determined in collaboration with a sports medicine specialist. If the muscle inflammation is accompanied by paralysis, muscle injuries or hardening, further measures must be initiated. Usually, a drug therapy is started, supported by massages and alternative methods from Chinese medicine. In consultation with the doctor, acupuncture can also be used. Muscle inflammation usually heals within a few days to weeks. If the symptoms persist over a longer period of time, treatment in a clinic may be necessary. The patient should inform the doctor about any complaints and suggest a change in the medication in case of side effects or interactions of the prescribed medication.
