People with polymyositis often do not experience symptoms at the onset of immune-mediated muscle cell damage. Weakness occurs when at least 50% of muscle cells become damaged, so the patient experiences progressive muscle weakness spanning three to six months. In polymyositis, the muscle weakness is always symmetrical and the areas of involvement may fluctuate from time to time. Unlike in dermatomyositis, skin rash is rare in polymyositis.
A patient with polymyositis may be unable to perform motor functions due to muscle weakness. Things like getting up from a chair, climbing stairs or lifting become difficult. The patient may also complain difficulty on swallowing and lifting the head as the flexor muscles of the neck becomes affected. Some cases of polymyositis have manifestations of muscle weakness in the orbital muscles. Rare cases also have weaknesses in facial and bulbar muscles.
Aside from muscle weakness, a person with polymyositis may or may not experience myalgia. Polymyositis patients may also experience other symptoms such as morning stiffness, fatigue and anorexia, fever and weight loss. In addition, people with polymyositis may also have arthralgia and arthritis .
Polymyositis can also manifest symptoms like nasal regurgitation, reflux esophagitis, bloating and constipation and odynophagia.
Rarely, kidney problem is present in polymyositis. In some cases, polymyositis can affect the muscles of the heart. The patient may suffer from arrhythmias, conduction defects and myocarditis and pericarditis. People with polymyositis may suffer from serious heart problems like pulmonary hypertension and congestive heart failure. Dyspnea is also seen in rare cases of polymyositis, which is caused by weakening of muscles involved in breathing.
The patient may be unable to execute fine motor movements in later stages of the disease. Symptoms of dysphagia and dysphonia are often signs of poor prognosis.
There is no single test that can prove diagnosis of polymyositis. Polymyositis is regarded as a diagnosis of exclusion because it affects several organ systems and has different symptoms. A person with polymyositis may also have other myopathy and connective tissue disorders.
Diagnosis of polymyositis is further complicated because its symptoms tend to resemble other myopathies or conditions such as lupus, Cushing syndrome or multiple sclerosis, causing it to become frequently misdiagnosed.
Different and several laboratory tests are used to determine if the patient has polymyositis. Complete blood counts can reveal leukocytosis or thrombocytosis. 50% of polymyositis patients have leukocytosis, positive Rh factor and elevated erythrocyte sedimentation rate (ESR). Myoglobinuria is often present.
Electromyography findings are often used as one of the confirmatory tests for polymyositis. It is used to determine extent of muscle damage in patients with polymyositis. Findings are almost always abnormal, with evidence of membrane irritability, fibrillation potentials, myopathic changes of motor unit action potential, increased polyphasic potentials and bizarre high-frequency repetitive discharges, and evidence of denervation-reinnervation.
Muscle biopsy findings often supports diagnosis of polymyositis, and it helps determine it from other muscle diseases. Electromyography is often first used to determine best sites for muscle biopsies for diagnosis because polymyositis tends to involve patches of muscles. Muscle biopsy findings consistent with polymyositis include presence of inflammation, necrosis and regeneration of muscle fibers, plus focal endomysial infiltration by mononuclear cells; CD8 T lymphocytes and macrophages. Capillary obliteration, endothelial cell damage and increased presence of connective tissue may also be present. In late stage polymyositis, muscle biopsy findings consist of degeneration of muscle cells, fibrosis and presence of regeneration. These findings, along with elevated creatine kinase, confirm the diagnosis of polymyositis.
Patients with polymyositis tend to have elevated serum creatine kinase (CK), usually 5-50 times the reference range. CSK levels greater than 100 times the normal levels are indicative of other conditions. Polymyositis patients may also have elevated lactic dehydrogenase, aspartate aminotransferase and alanine aminotransferase.
Polymyositis patients may exhibit specific antibody findings. Myositis-specific antibodies are often present in patients with polymyositis. Antinuclear antibody assay is also present in one-third of polymyositis cases. Other antibodies that may be present in polymyositis patients include antisynthetase antibodies such as anti-Jo-1 antibodies and Signal-recognition particle (SRP) antibodies.
Imaging studies like magnetic resonance imaging (MRI), chest radiography and high-resolution computerized tomography (CT) is used to determine extent of muscle involvement in patients with polymyositis. MRI is especially useful in scanning muscle inflammation, edema and scarring, and is also used to guide muscle biopsy procedures and monitor disease progression. Chest x-rays and CT scans are used to assess presence of lung disease and possible malignancies.
Patients with diagnosed or suspected polymyositis must be assessed for malignancy. Mammography, pelvic ultrasonography and upper- and lower-endoscopy procedures are used to screen for any associated malignancies.
There is no exact cure for polymyositis. Cases of polymyositis tend to have different presentations, so the mainstay of treatment is to address the symptoms.
Another reason why treatment is empirical is because only few randomized clinical trials have been conducted to determine best treatment courses for polymyositis.
Since polymyositis is caused by a faulty immune system, drugs that can suppress the activity of the immune system are used for treatment. Corticosteroids like prednisone are used to suppress inflammation to help damaged muscle cells recuperate. High dose is usually maintained for 4 to 8 weeks until creatinine kinase levels go down. Then the dose of prednisone is tapered gradually to minimum therapeutic levels. If effective, the patient may need to take corticosteroids for years. Corticosteroids may not work for everyone, and may cause undesirable adverse effects like changes in personality, swellings of the extremities, acne, cataracts, osteoporosis, diabetes and hypertension.
Immunosuppressants are used to reduce the activity of the nervous system, and they are indicated for cases of polymyositis unresponsive to corticosteroids and for late-stage cases with difficulty in swallowing or speaking. Some examples of immunosuppressants used for polymyositis include azathioprine, cyclophosphamide, methotrexate, chlorambucil, and cyclosporine. Because immunosuppressants can lower down the ability of the immune system to respond against disease-causing pathogens, the patient needs to be protected against infection. Many immunosuppressive drugs also have strong side effects.
Intravenous immunoglobulin and tumor necrosis factor (TNF) has demonstrated efficacy in treatment of refractory cases of polymyositis. Agents like rituximab (anti-CD20 monoclonal antibody) and interferon Alfa-2A are also considered for management of treatment-resistant polymyositis.
Both corticosteroids and immunosuppressants can exert undesirable adverse effects and complications. Therefore, doctors additionally recommend supplementary vitamins and minerals and order frequent lab tests to assess for problems caused by medications.
Plasmapheresis may be used in polymyositis to remove inflammation-causing antibodies in the blood.
Aside from medicines, physical therapy is used for treatment of polymyositis to counter muscle weakness. The goals of physical therapy are to gradually strengthen the muscles and prevent disability. A supervised exercise program may be instituted to improve muscle strength and improve range of motion.
Development of contractures due to muscle weakness may be countered with application of splints. There is a clear need to rehabilitate atrophied muscles after flares ended. Active range-of-motion exercises and isometric contractions can help bring back control on atrophied muscles, and when enough strength has returned, light resistance exercises are then instituted for continued improvement.
Polymyositis can have different prognosis on patients . Some patients only experience brief episodes of muscle weakness followed by a remission that may not require further treatment. Others experience repeated alternating episodes of flares and remissions. But most patients with polymyositis respond to therapy.
Some patients with poor prognosis experience progressive muscle weakness, especially in crucial areas like the heart, chest and throat, causing heart failure, respiratory ammonia, or malnutrition and cachexia.
Polymyositis is caused by an abnormal immune system. In polymyositis, a type of white blood cell called cytotoxic T-cells attack skeletal muscles to cause symptoms. Experts are still unsure how and why T-cells turn and attack healthy and indigenous skeletal muscle cells. According to available evidence, this adverse immune response may be caused by or is associated with viral infections, possible malignancies, autoimmune or connective tissue disorders .
Some studies suggests that polymyositis occurs when the T-cells induce a cytotoxic response to some unidentified antigens found in muscle cells. There is also an evidence of autoimmune response to these antigens in muscle cells. It is postulated that these antigens may be a result of an unknown viral infection to the muscle cells, provoking the immune system to attack it. The presence of antibodies specific to these unknown antigens has also been found in some patients. There may be also a genetic link that makes some people predisposed to polymyositis.
Some medical conditions, such as hepatitis B, Coxsackievirus B1, influenza and adenovirus, may increase risk of having polymyositis. Drugs such as hydroxychloroquine and colchicine may also increase risk of metabolic myopathy, though they rarely induce immune-mediated myopathy .
Polymyositis is an incredibly rare medical condition. There are only few studies that examined the prevalence of polymyositis. Estimates show that there are only 50 cases of polymyositis for every million people in the United States . In a Quebec-based study, hospital and billing records show that there are only estimated 21.5 polymyositis cases for every 100,000 people .
Both polymyositis and dermatomyositis are more commonly seen in females and in adults. Cases of polymyositis are very rare in patients below 18 years of age.
Polymyositis happens when the white blood cells invokes an abnormal immune response that targets skeletal muscle cells, causing progressive inflammation that causes to cellular damage. Normally, white blood cells attack foreign and disease-causing pathogens to protect us from disease. Due to some unknown reason, white blood cells attack the healthy skeletal muscle cells .
The resulting damage causes inflammation in the muscle cells that results to atrophy and loss of ability to contract. The patient then experiences symptoms of profound muscle weakness once enough numbers of muscle cells have been affected. Leucocytes affects more and more healthy muscle cells, so more muscle groups becomes weak over time.
Polymyositis always affects the muscles nearest to the trunk first, and then gradually progresses outward until remission occurs.
There are no guidelines for prevention of polymyositis.
Polymyositis is a medical condition wherein the skeletal muscles experiences persistent inflammation that leads to muscular weakness. Polymyositis is somewhat similar to a condition called dermatomyositis, which affects both the skin and muscles. Both conditions are termed as idiopathic inflammatory myopathies .
In polymyositis, the leucocytes attacks skeletal muscle cells in the same way it attacks foreign pathogens, causing inflammation that causes the affected muscles to lose muscle tone and thus unable to contract.
Polymyositis tends to produce symmetrical weakness on muscles proximal to the trunk. People with polymyositis experience progressive muscle weakness (or flares), and only few cases experience periods of minimal symptoms (or remission).
Aside from the skeletal muscles, a person with polymyositis may experience other symptoms and have problems to other organs as well. In addition, polymyositis is linked to certain cancers in the ovaries, lung, pancreas, stomach and colon and lymph nodes.
Polymyositis exclusively affects adults, and has a tendency for females rather than males. Polymyositis is a chronic illness, and the bouts of severe muscle weakness can be debilitating at times.
Polymyositis is a medical condition wherein, for unknown reasons, the white blood cells that are supposed to defend the body from disease-causing pathogens attacks normal and healthy muscle cells in the body. Aside from muscle involvement, patients with polymyositis may have other problems in the organs.
Polymyositis belongs to a class of medical conditions called myopathies, and it shares many symptoms with other conditions such as dermatomyositis. And like most myopathies, polymyositis can last for a long period of time. Polymyositis is very rare, and tends to be confined to adults and more common in females.
The exact mechanism on how white blood cells attach normal muscle cells and cause polymyositis is not well understood.
Unknown viral infections, undetected malignancies, disorders in the immune system or connective tissues may make white blood cells turn against muscle cells that cause polymyositis. Regardless of the cause, the white blood cells attack the muscle cells and cause inflammation that results to muscle wasting
A lot of patients with polymyositis also have other conditions including lupus, multiple sclerosis, Cushing syndrome and chronic viral infections like hepatitis B. Polymyositis is also linked to cancers in the ovaries, lungs, colon and lymph nodes and other organs. Therefore, if you have polymyositis you must be regularly screened for presence of cancer.
The main symptom of polymyositis is progressive muscle weakness that spreads outward from the trunk, on both sides of the body. The patient may also experience other symptoms like muscle and joint pains, and kidney problems. The resulting muscle weakness may also make you unable to swallow, speak, move your head or even speak.
Because the symptoms of polymyositis are somewhat same with other conditions, and because it concurrently occurs with other medical conditions, diagnosing is somewhat a challenge. Several different lab tests and imaging studies are required in diagnosis of polymyositis.
The prognosis of polymyositis can vary among patients. Some may only experience brief muscle weakness followed by recovery with no need for more treatment, while others may experience prolonged and progressive muscle weakness plus complications.