MYOSITIS

Idiopathic Inflammatory Myopathies (IIM), sometimes known as myositis, are a rare group of acquired (not inherited), fatal, systemic inflammatory disorders.

Myositis simply refers to muscular inflammation. Swelling can occur when something is inflamed. It's a combination of rare disorders that can make muscles brittle, worn out, and painful.

• People of any age, including children, can develop myositis.
• The shoulders, hips, and thighs are the key muscles that are impacted.
• In addition to the muscles, the skin, lungs, and heart can all be impacted by myositis.
• Myositis can sometimes damage the muscles that control functions like breathing and swallowing.

CAUSES

INFECTION

•     The most frequent illnesses that result in myositis are viral infections.
•     Rarely, myositis can also be caused on by bacteria, fungus, or other species. 
•     Direct invasion of muscle tissue by viruses or bacteria is possible, as is the release of chemicals that harm muscle fibres. 
•     Viruses that can cause myositis include HIV, the common cold and flu viruses, and others.

INJURY

•     Muscle aches, swelling, and weakness may last for hours or days after engaging in strenuous exercise.

  AUTOIMMUNE DISEASE

    Myositis is more prone to occur in some patients with certain autoimmune illnesses, such as:

•       Lupus
•       Rheumatoid arthritis
•       Scleroderma

SYMPTOMS

Myositis symptoms vary from person to person.

They can include:

• Muscle weakness and fatigue that can make it difficult to perform daily activities like brushing your hair, climbing stairs, and getting in and out of cars

• Muscle pain

• Muscles that feel tender to the touch

• Muscles that occasionally swell

• General malaise

• Weight loss.

• Sweaty nights

TYPES OF MYOSITIS

DERMATOMYOSITIS (DM)

• People of any age or sex can get DERMATOMYOSITIS (DM), but women are more likely to develop it. 
• As a result of the usual presence of a skin rash brought on by an inflammation of the blood vessels beneath the skin, it is the easiest type of myositis to identify (vasculitis). 
• Patchy and reddish or purple in colour, the rash might appear on the eyes, cheeks, nose, back, upper chest, elbows, knees, or knuckles. 
• Some DM patients typically experience slow muscle wasting and occasionally pain, and they frequently notice the rash well before the muscle wasting.
• Amyopathic dermatomyositis, in which only the skin is impacted but not the muscles, and cancer-associated dermatomyositis, in which the two conditions are identified two or three years apart, are two subtypes of DM.

POLYMYOSITIS (PM)

• PM generally affects adults and is more prevalent in women than in men. 
• Patients eventually develop muscle weakness, which typically starts with the body parts that are closest to the core, such as the neck, hip, back, and shoulders, however some patients also suffer weakness in their hands and fingers. 
• Both sides of the body are equally impacted. Some people experience dysphagia, which is difficulties swallowing, or breathing problems, which may indicate interstitial lung disease, an inflammation of the lining of the lungs. 
• Many individuals experience muscle weakness in addition to discomfort. 
• Similar to DM, PM may be linked to a cancer or other autoimmune disorders.
  

Muscles typically affected by PM/DM

INCLUSION-BODY MYOSITIS (IBM)

• More men than women are affected with INCLUSION-BODY MYOSITIS (IBM), which is uncommon in adults under the age of 50.
• Compared to other myositis kinds, IBM progresses more slowly, and weakness develops gradually, sometimes over years. 
• Falling, having trouble rising from a chair, and having a weakened grasp are a few of the early symptoms of IBM. 
• The muscles that lift the feet, front of the thighs, upper arms, shoulders, neck, back, and, less frequently, the face are those that are most frequently afflicted. 
• Many IBM patients observe atrophy in the thighs and arms as their muscles deteriorate. 
• Dysphagia, sometimes known as trouble swallowing, is a typical issue among IBM patients.

The first muscles affected in inclusion-body myositis are usually those of the wrists and fingers, and the muscles at the front of the thigh. The muscles that lift the front of the foot also may be affected

JUVENILE MYOSITIS (JM)

• JUVENILE MYOSITIS (JM) affects children under the age of 18 more frequently in girls than in boys. 
• In contrast to the adult variants, JM is not connected to malignancy.
• Skin rashes, the noticeable reddish-purple rash over the eyelids or over joints, difficulty walking or lifting one's head, a hoarse voice (called dysphonia), or difficulties swallowing are all indications of JM (dysphagia). 
• The muscles closest to the center of the body—the neck, stomach, upper arms, and legs—are those that are most frequently affected.
• Children with JM experience muscle soreness in about half of their cases. 
• A child's joint may remain bent if they develop contractures or calcinosis, which are hardened lumps under the skin.

DIAGNOSIS 

PHYSICAL EXAMINATION

Naturally, weakness is the predominant sign of a muscular disorder. We have found that not all of the body's muscles are similarly afflicted in myositis patients. For instance, with inclusion-body myositis, particular muscle groups, such as the ones that we use to bend our fingers to make a fist, appear to be disproportionately weak (IBM). Therefore, noticing weakness in the finger flexor muscles is a significant indication that a patient may have IBM.

Physical examination reveals that the deltoids, biceps, triceps, hip flexors, quadriceps, and hamstrings are the most commonly affected muscles.

Fever, dyspnea (caused by interstitial lung disease, aspiration, weak diaphragm, or cardiomyopathy), arthralgia, arthritis, and Raynaud's phenomenon are other symptoms that could be present.

Patients who suffer from overlap myositis may also exhibit signs of other connective tissue disorders, such as systemic lupus erythematosus, scleroderma, Sjögren's syndrome, or mixed connective tissue disease.

BLOOD TEST

Inflammation levels, muscle damage, and the presence of autoantibodies—tiny proteins that can target the body's own healthy tissues and cells—can all be detected during blood tests.

ELECTROMYOGRAPHY

There are two sections to this study. The first is the nerve conduction study (NCS), which involves recording nerve and muscle activity while various sites along a nerve are subjected to intermittent electrical shocks. The EMG investigation, which involves inserting a tiny needle electrode into several muscles, comes after the NCS.

An inflammatory condition can be detected by specific electrical abnormalities in nerves and muscles.

MAGNETIC RESONANCE IMAGING (MRI) 

In recent years, medical professionals have discovered that muscle appearance on magnetic resonance imaging (MRI) scans of a leg can reveal information regarding muscle disorders. Patients who may have myositis are increasingly having MRI scans done by neuromuscular physicians. This investigation can also offer proof of the muscles' selective involvement.

MUSCLE BIOPSY 

The results of a physical examination, blood tests, an electromyogram (EMG), and MRI scans can indicate that a muscle disease is the most likely diagnosis, but other nervous system diseases may manifest similarly problems. The neuromuscular physician typically performs muscle biopsy since decisions concerning treatment depend on obtaining an accurate diagnosis.

TREATMENT

MEDICAL TREATMENT

To stop the muscle from being damaged, treatment is required.

Myositis is often managed using a variety of techniques.

CORTICOSTEROID

Typically, reducing inflammation is the primary course of treatment.

IMMUNOSUPRESSIVE THERAPY

A medication used to "switch off" (suppress) the immune system is administered if corticosteroids do not reduce symptoms.

Methotrexate and azathioprine (Imuran) are the most often prescribed medications.

Intravenous Immunoglobulin (IVIG) THERAPY

To improve immunological function. This is applied both at the beginning of the illness and during flare-ups.

PLAN OF CARE

• Physiotherapy can start once the inflammation has subsided. 
• A physiotherapist will design an exercise regimen to encourage full joint motion, reduce muscle stiffness and waste, and rebuild muscular strength.
• You will need to quit working out and reduce your activities when a flare-up occurs. In order to stop additional muscle deterioration, you must rest.
• Your diet is essential to your recovery. Take calcium (500 mg daily) and vitamin D supplements (400 iu a day).
• Maintaining good posture
• Exercising frequently
• Pacing your activities
• Reducing stress
• Setting aside time each day to perform relaxation techniques, and
• Using ice and heat packs 

It's important to keep in mind that not all suffering is "bad." While some soreness is to be expected while exercising, if you are doing the right activity at the right level and with the right form, there won't be any bodily harm done.

REHABILITATION 

HOW TO BEGIN THE REPARATION

• Begin under the guidance of a physiotherapist, and perform the prescribed exercises for 20 to 30 minutes each day, seven days a week.
• Always warm up with stretches and range-of-motion exercises.
• Move forward slowly.
• Begin strength training gradually and with light weights (a 1- or 2-pound weight can make a big difference).
• Heat up aching joints
• Use ice packs after working out 
• Increase aerobic activity.
• Take it easy if your joints start to hurt, swell, or turn red. Work with your physiotherapist to identify the source and fix the problem.
• Pick an exercise regimen you enjoy and develop a routine for it.
• Consider a suitable recreational activity (after doing range-of-motion, strengthening, and aerobic exercise). When recreational exercise is preceded by range-of-motion, strengthening, and aerobic training that gets your body in the greatest condition possible, injuries to diseased joints are less likely to occur.

EXERCISES

·       Range-of-motion exercises can be done daily and should be done at least every other day.

The easiest level is passive range of motion. Someone else moves parts of your body for you. For example, someone may move your arm around for you; you don't work the muscles at all. Passive range of motion exercises keep motion around the joint when a person is not able to do such exercises for themselves.

The next level is active assistive range of motion. In this case, you move your arm as much as you can, and someone finishes the movement for you.

The final level is active range of motion exercises. You move that part of your body by yourself.

·       Strengthening exercises should be done every other day unless you have severe pain or swelling.

·       Endurance exercises should be done for 20 to 30 minutes three times a week. According to the American College of Rheumatology, 20 to 30 minute exercise routines can be performed in increments of 10 minutes over the course of a day.

·       Balance, coordination, and agility training, which includes posture awareness and task-specific training

·       Aerobic endurance conditioning, which can be done through swimming, class-based exercises, dance, Tai Chi (also good for balance training) and by using equipment like stationery bikes, elliptical machines, and arm bikes

·       Non-aerobic, might include the use of free weights, hand strengthening exercises (squeezing putty or a gripper), functional exercises (sit-to-stand training, reaching for weights on multi-level shelving) weight machines, and thera-bands

·       Relaxation/respiratory training helps to patients use diaphragmatic breathing in various positions to help strengthen this muscle and to learn to use movement more efficiently during exercise, transfers from bed to chair, chair to toilet, and activities of daily living.

·       Gait training to learn how to use assistive devices and to demonstrate proper movement and use mirrors for visual feedback. A physical therapist should be able to help minimize abnormalities in gait to a point where a patient is able to walk as independently as possible.

Assistive Devices

·       Examples of gait assistive devices include: canes, rolling walkers, crutches, and platform rolling walkers.

·       Some of the most common durable medical equipment for use in the home include the tub transfer bench, grab bars for the bath, shower, and raised toilet seats.

·       To help with foot drop, suggests an ankle/foot orthotic made of carbon fiber.

 

HOW CAN I MODIFY AN EXERCISE PROGRAM IF I HAVE DIFFICULTY?

There are many ways to modify your exercise program.

1. Change the length of time you exercise.

2. Change your posture. You can either use gravity and body weight as resistance by standing up or you can avoid gravity by sitting or lying down or exercising in a pool. For example, raising your arm to shoulder height is different while standing on the ground than while standing in a pool.

3. Increase or decrease the number of repetitions (the number of time you repeat an exercise) or the number of sets (a group of repetitions).

4. Use resistance, like elastic bands or weights, and change the amount of resistance.

5. Increase or decrease the amount of time you rest between sets or repetitions.

6. Increase or decrease the number of times per week that you exercise.

7. Add or delete exercises in your program

8. How do I know if I am doing these exercises correctly?

9. Listen to your body. It will probably tell you if you are doing too much or if you are doing an exercise incorrectly. Move at your own pace. If something hurts, stop. Use pain as a warning sign to make you reevaluate what movement it was that you were doing that caused pain, and why the pain happened. Too many repetitions? Too much weight?

10.Forget the old "No pain, no gain" motto of exercise. While muscle fatigue and soreness are expected in any exercise program, whether for healthy or inflamed muscles, something may be wrong if there is pain. Stop and think about it.

Rest is very important. It allows your muscles to recover. You are doing micro-damage to your muscles every time they contract, and you need to let this heal. You also need to vary the pace and the types of exercises you do. Start exercising gradually and plan your week around your exercise. That way, your "bigger workouts" will be followed by well-deserved periods of rest.