Polymyositis

What is Polymyositis?

• Polymyositis is an abnormal inflammatory disease that causes muscle weakness affecting both sides of your body.
• Polymyositis most normally affects adults in their 30s, 40s, or 50s. Women are affected more than men.
• Myositis means inflammation of the muscle. This condition can affect the muscles all over the body.
• Normally, polymyositis affects the muscles that are closest to the trunk of the body.
• Sometimes, people with polymyositis have trouble when rising from the sitting position, climbing stairs, lifting objects, or reaching overhead.
• In some cases, muscles that are not close to the trunk of the body become most affected as the disease progresses.
• The muscles finally start to break down & become weak.
• Polymyositis develops gradationally over time, & it rarely affects persons younger than the age of 18. It is more usual in women.
• still, it is called dermatomyositis, If the condition is accompanied by an inflammatory process that strikes the skin as well.
• Polymyositis can be present in combination with another sickness.
• Both polymyositis & dermatomyositis can occasionally be associated with cancers, including lymphoma, breast, lung, ovarian, & colon cancer.
• Having this condition can make it delicate to climb stairs, rise from a seated position, lift objects or reach overhead.
• Signs & symptoms generally develop gradually, over weeks or months.
• While there is no prevention for polymyositis, treatment — ranging from drugs to physical therapy — can improve your muscle strength & function.
• Polymyositis is a disease that causes the muscles to become irritated & inflamed.
• This can make even simple movements difficult.
• It inflames your muscles & their affiliated tissues, like the blood vessels that supply them.
• It can cause muscle weakness and pain on both sides of your body.
• There is no cure for this chronic condition, yet there are treatments that can help with symptoms

What are the causes of Polymyositis?

• The cause of polymyositis is not known, though there are indications that heredity plays a role in the disease.
• It is more common in people with other autoimmune diseases like lupus & rheumatoid arthritis. It is also more usual among people with HIV.
• Current research suggests that the condition may happen when immune system cells infiltrate & attack muscle tissue (an autoimmune process).
• Research into the workings of the immune system & what causes it to malfunction may result in further knowledge about the causes of polymyositis.
• The exact cause of polymyositis is unknown, but polymyositis disease shares many characteristics with autoimmune disorders, in which your immune system mistakenly attacks your own body tissues.
• The exact cause of polymyositis is not known. Most of the people who have polymyositis get diagnosed between the ages of 31 & 65.
• It is very rare in children, & it affects women more often than men.
• It rarely happens in people younger than 17 (seventeen).
• Experts think that polymyositis may be related to or triggered by contagion or an autoimmune response.
• An autoimmune response when the body attacks its own tissues.
• In certain cases, a drug may lead to an allergic response that causes muscle irritation & damage.
• But in maximum cases, healthcare providers are not suitable to find the exact cause of the condition.
• Yet doctors do know that it’s an autoimmune condition, which means the body can attack its own tissues.

What are the Symptoms of Polymyositis?

• Polymyositis symptoms are caused by inflammation in the muscles.
• The muscle weakness associated with polymyositis includes the muscles closest to the trunk, like those in your hips, thighs, shoulders, upper arms & neck.
• This condition affects muscles all over the body, & can affect the capability to run, walk, or lift objects.
• The weakness affects both the right and left sides of your body, & tends to gradually worsen.
• It can too affect the muscles that permit you to eat & breathe.
• The muscles closest to the base of the body tend to be affected the most sometimes.
• Muscle weakness affects both the right and left sides of the body equally. This condition sometimes worsens slowly, & you might not notice symptoms for months.
• This condition tends to target the muscle groups closest to the trunk of the body — the hips, thighs, shoulders, upper arms, upper back, And neck.
• Still, you may see you have trouble lifting your arms over your head, walking up flights of stairs, If you have to rise from a chair, or carrying things. In certain cases, it may exist hard to swallow food, yet this is unusual.
• You may or may not have pain in the zone where the muscles are weak.
• Over time, the muscles may atrophy, meaning they waste down or becomes less bulky.

The following are certain symptoms of polymyositis. These symptoms may come & go:

1. Muscle weakness: This is the most usual symptom. The muscles involved commonly are those closest to the trunk of the body, and the onset of weakness is commonly gradual, occurring over 2 (two) to 6 (six) months, or rarely the symptoms come on rapidly.
2. Difficulty in getting up from climbing stairs, chairs, or lifting objects: Certain people also have trouble getting up after lying down.
3. Difficulty in swallowing.
4. Muscle ache: In certain cases, muscles ache & are tender to the touch.
5. Fatigue.
6. Raynaud’s phenomenon: this condition in which the fingers or toes become very cold & discolored due to problems with blood flow.
7. Shortness of breath due to lung and heart involvement.
8. Patchy red or violet rash around the eyes: Certain people also get patchy, red skin over the knuckles, knees, and elbows, or a red rash on the neck & upper chest.
9. Fever,
10. Weight loss And poor nutrition may come to a problem if muscle weakness leads to trouble eating and swallowing.
11. Muscle weakness:  Especially in the abdomen, shoulders, upper arms, & hips.
12. Muscle pain and stiffness,
13. Joint pain & stiffness,
14. Trouble catching your breath,
15. Irregular heart rhythms, if the heart muscles come inflamed.
16. Polymyositis can make it actually hard to do everyday things.
17. You may look trouble walking up a flight of stairs, lifting up your arms, or getting out of your chair.
18. As inflammation gets worse around the body pain & weakness may affect the ankles, lower arm area & wrists.

What are the risk factors for Polymyositis?

• Your risk of polymyositis is higher if you have scleroderma, lupus, rheumatoid arthritis, and Sjogren’s syndrome.
• Risk factors for polymyositis involve:
  • Autoimmune conditions such as:
  • Lupus
  • Rheumatoid arthritis
  • Scleroderma
  • Sjogren’s syndrome
  • Viral infections like HIV & AIDS
  • Diseases that affect your ability to breathe.

How is Polymyositis Diagnosed?

• There’re no simple tests to diagnose polymyositis.
• It occasionally takes time before doctors know for sure you have it.
• The process begins with a health history and a physical test.
• The test will involve seeing how strong your muscles are.
• The diagnosis of the disease generally starts with a physician’s test and blood testing.
• People who have polymyositis occasionally have unusually high levels of muscle enzymes.
• The enzymes are released into the blood by the muscle that is being damaged by inflammation.
• Routine blood & urine tests can check for inside organ abnormalities.
• Chest X-rays, PAP smears, mammograms, and other screening tests might be considered to look for signs of the cancers that may arise with polymyositis.
• Additional testing can rule out another condition suggesting polymyositis.
• Your doctor will consider your medical record, & your family’s, to rule out another condition.

You may also get tests like as:

• Blood tests: These can assist the doctor spot signs of muscle injury. The process begins with a health history & a physical test. The test will involve seeing how strong your muscles are.
• EMG (electromyography): Checks to see if the figures of electrical impulses in your muscles are normal. This may exist to discover abnormal electrical activity in affected muscles. Electromyography (EMG) and NCV(nerve conduction velocity) studies are electrical trials of muscle & nerves that can show abnormal findings typical of polymyositis. These trials also can rule out another nerve-muscle disease. Imaging of the muscles can show parts of muscle inflammation and can be used to discover muscle biopsy sites.
• MRI (magnetic resonance imaging): This uses a magnet to scan & produce images of large parts of muscles. This trial uses large magnets & a computer to see for inflammation in the body.
• Muscle biopsy: Your doctor will take a sample of your muscle for testing to see if the muscle tissue is inflamed. You may need to get magnetic resonance imaging (MRI) to assist your doctor find a good spot to biopsy. Little pieces of tissue are taken to be checked with a microscope. Muscle biopsy is a surgical process in which muscle tissue is detached & examined. A muscle biopsy is used to confirm the presence of muscle inflammation to differentiate the polymyositis

What are the Complications of Polymyositis?

Still, it can conduct to severe complications, If polymyositis is not treated.

• As the muscles become gradually weaker, you may fall occasionally and be limited in your daily activities.
• If the muscles in the digestive tract & chest wall are affected, you may have problems with malnutrition, breathing (respiratory failure), & weight loss. Polymyositis that is treated but can’t be managed easily can cause severe disability.
• This includes an incapacity to swallow or breathe without assistance.

Complications that might come on with polymyositis involve:

• Trouble swallowing: This could be if the muscles in your esophagus are affected. It can conduct to weight loss & malnutrition. If the muscles in your esophagus are affected, you may have problems swallowing, which in turn may cause weight loss & malnutrition.
• Aspiration pneumonia: When you can not swallow well, you are more probable to breathe food or liquid (including saliva) into your lungs. This can cause pneumonia. Difficulty swallowing may also do you to breathe food or liquids, involving saliva, into your lungs (aspiration), which can lead to pneumonia.
• Breathing problems: If your chest muscles are affected, you could have shortness of breath or respiratory failure.
• still, you may experience breathing problems, like shortness of breath, or, If your chest muscles are affected by the disease.

How is Polymyositis Treated?

• Polymyositis is treated with high medications of corticosteroids as the first course of treatment.
• Corticosteroids are given because they can effectively drop inflammation in the muscles.
• Corticosteroids do not always adequately better polymyositis.
• In these patients, immunosuppressive medications are considered.
• Polymyositis is a chronic condition.
• That means that one time you have it, it sticks around.
• Yet there are ways to help handle it.
• Treatment will relate to your symptoms, your age, & your general health.
• It will also relate to how tough the condition is.
• There is no cure for polymyositis, yet the symptoms can be handled.
• You may need more than 1 kind of treatment.
• And your treatment may want to be changed over time.
• In tough cases, some treatments don’t work as well.

Treatments involve:

1. Anti-inflammatory medicines: These are steroid medicines or corticosteroids. They don’t trouble inflammation in the body. Symptoms normally get better within 4 to 6 weeks.
   • Your healthcare provider may lower the dose of steroids latterly that to ease side effects. Certain people may want to take steroids ongoing to manage the condition and reduce symptoms.
   • Methotrexate,
   • Azathioprine,
   • Cyclophosphamide,
   • Chlorambucil,
   • Cyclosporine,
   • Tacrolimus,
   • Mycophenolate,
   • Rituximab.
2. Immunosuppressive medicines: These are drugs that block or steady down your body’s immune system.
3. Physical therapy: This involves special exercises that support stretching and strengthen the muscles. These can assist keep muscles from shrinking. This will make you stronger and assist you to move better. Physical therapy similarly is the main in the treatment of polymyositis.
4. Heat therapy and rest: These can support and ease muscle symptoms.
5. Braces or other special devices: These can help to support muscles and help with movement.
   • Speak with your healthcare providers about the risks, benefits, & possible side effects of all medicines.
   • In critical cases of polymyositis, the intravenous infusion of immunoglobulins (IVIG) has existed as an effective treatment.
6. Steroids: These assist with muscle inflammation, ease pain, and truly increase muscle strength. Yet steroids can have multiple side effects, so when your doctor prescribes them, they will keep an eye on you. Most people begin with prednisone, but if you have a severe case, the doctor may add methylprednisone, too.
7. Medicines that suppress the immune system: You may take these with steroids, or on their own, if steroids do not help. The doctor will presumably begin you off with azathioprine or methotrexate.

• Ask your doctor about any problems you have, and for another way to produce your life easier. With primary medical treatment of the disease and disease flares, cases with polymyositis can do well. The disease often becomes inactive, enabling the case to concentrate on muscle rehabilitation.

Physiotherapy Treatment

• Focus on the development of an exercise schedule to increase physical activity, decrease impairments and disability, and increase the general quality of life.
• Polymyositis and other idiopathic inflammatory myopathies immediately with wide-ranging systemic clinical instantiations.
• Among those many relevant to physical therapy are muscle weakness, tiredness, and shortness of breath.
• The musculature proximal to the trunk is the most affected, with pronounced weakness being in the neck, back, shoulders, forearms, thighs, and hips.
• Distal weakness may do but is less common still the trunk often remains strong.
• Respiratory musculature is also generally involved, thus best evidence supports a combination of resistance and aerobic training.
• The exercise was safe and effective to improve muscle strength and function in patients with chronic, stable polymyositis, but it may not be appropriate for patients with active, recent-onset inflammatory myopathies.
• Further current research has since shown that an exercise program is both safe and beneficial for cases during the recent onset period of the disease.
• During acute exacerbations, it is recommended that cases use pharmacological management to control their inflammation previous to starting their exercise program and limit their physical activity to normal functional mobility.
• A key goal of physical therapy is to maintain function and reduce fall risk cases.
• It is important that cases remain active to maintain function, and it is encouraged that they exercise 4-6 times per week.
• Strengthening exercises should not do on back-to-back days, Still, it is recommended that cases practice “active rest days”.
• They concentrate on ROM, positioning, and relaxation rather than strengthening.
• Every patient is different and should consult with their physical therapist to have a specific plan of care outlined that meets their specific requirements and goals.

Functional Impairments Secondary to Marked Weakness

• Difficulty with all functional mobility in include walking, climbing stairs, etc
• Difficulty lifting, and carrying objects
• Difficulty with ADLs
• Impaired Balance
• Severe Fatigue

Resistance Training

• Preservation of muscle function
• Avoidance of disuse atrophy
• Light resistance (be conservative with eccentric activity)
• Strengthening of distal musculature, which has the greater capability for strength gains, can contribute greatly to an overall improvement in performance with ADLs
• Open-chain exercises use less energy than closed-chain, but closed-chain exercises yield the greatest outcomes with functional mobility.
• Energy conservation is key (escape high resistance open chain or aggressive closed chain exercises (Ex: plyometrics))

Aerobic Training

• Cycle ergometer
• Walking

To prevent muscle contraction range of motion such as:

• Passive Range Of Motion(PROM) Exercise,
• Active Assisted Range Of Motion(AAROM) Exercise,
• Active Range Of Motion(AROM) Exercise,
• Gentle Stretching exercise

Aquatic Therapy

• Provides the capability to mirror functional movements with decreased energy expenditure
• The case can control the resistance of water with modified movement
• Buoyancy help with posture and lower extremity muscle weakness
• Cases may experience a meaningful increase in stroke volume and cardiac output. The hydrostatic volume of water increases blood volume in the chest cavity.
• Water turbulence increases blood flow to the surface of the skin
• remedial benefits with a decreased fall risk

Patient Education

• A loss of muscle mass results in weakness and fatigue, which may result in the relinquishment of a sedentary lifestyle. It is most important that cases remain active to avoid disuse atrophy and further muscle weakness.

Associated Conditions

• Although these are not complications, polymyositis is occasionally associated with other conditions that may cause further complications of their own, or in combination with polymyositis symptoms.

Associated conditions involve:

1. Raynaud’s phenomenon: This is a condition in which your fingers, toes, cheeks, nose & ears originally turn light when exposed to cold temperatures.
2. Other connective tissue diseases: Other conditions, such as lupus, rheumatoid arthritis, scleroderma, & Sjogren’s syndrome, can happen in combination with polymyositis.
3. Cardiovascular disease: Polymyositis may cause the muscular walls of your heart to serve inflamed (myocarditis). In a short number of people who have polymyositis, congestive heart failure & heart arrhythmias may develop.
4. Lung disease: A condition called interstitial lung condition may be polymyositis. Interstitial lung disease (ILD) refers to a group of complications that cause scarring (fibrosis) of lung tissue, making lungs stiff & inelastic. Signs & symptoms involve a dry cough & briefness of breath.
5. Cancer: People who have polymyositis have elevated trouble with cancer.

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