Latest Insights Into the Myositis Treatment

Introduction

The word myositis scientifically means muscle inflammation. It is an auto-immune condition that involves swelling of the involved muscles. The disease is not age-bound and can occur at any stage of life. Auto-immunity refers to the inability of the body's defense system to differentiate between native and foreign particles. The body's healthy cells appear to the immune system as a threat, causing the latter to attack them by releasing inflammatory chemicals. The main group of affected muscles involves the shoulder, hip, and thigh region. However, the effect can also pass on to other body regions. Examples include the skin, heart, or lungs. The duration of this disease varies from person to person, ranging from a few weeks to years. A significant loss of muscle mass is observed in cases of disease lasting multiple years.

What Are the Symptoms of Myositis?

The symptoms of myositis vary from person to person. General symptoms include:

• Muscle pain.

• Swelling of muscles.

• Muscles are tender to the touch.

• Loss of muscle mass; wasting of muscles.

• Fatigue.

• Weak and tired muscles cause routine tasks to be difficult to perform.

• Night sweats and fever may accompany them.

Specific symptoms may also be present depending on the type of myositis.

What Are the Causes of Myositis?

The exact cause of myositis is unknown. It can arise independently, but other medical issues sometimes induce it. Myositis is an auto-immune disorder. Auto-immune illnesses are caused by the immune system mistakenly attacking the body rather than protecting it. It needs to be clarified why the immune system does this. Some individuals with various auto-immune disorders are more likely to acquire myositis, including:

• Lupus.

• Rheumatoid arthritis.

• Scleroderma.

• Some people acquire myositis following a viral infection, including:

• The common cold.

• Influenza (flu).

• HIV.

What Are the Different Types of Myositis?

There are various types of myositis.

• Polymyositis: This refers to the involvement of more than one muscle.

• Dermatomyositis: A skin rash often accompanies this myositis.

• Inclusion Body Myositis (IBM): This subtype is characterized by muscle inflammation and tiny lumps of protein. These proteins may or may not be visible during the early onset of the disease, hence the difficulty of confirming its diagnosis. The muscles typically involved are in the hands, legs, and throat.

• Anti-Synthetase Syndrome: This type involves muscles, lungs, and skin. Owing to its seriousness, immediate treatment is often required. Some people affected may also experience Raynaud's phenomenon, wherein the fingers and toes turn extremely pale or blue when cold and red and swollen when warm.

• Immune-Mediated Necrotizing Myositis: This condition causes rapid muscle cell death or necrosis. People affected may find it extremely difficult to use their arms or legs.

• Post-Infectious Reactive Myositis: This condition occurs due to a viral infection experienced previously. Sometimes, even after recovery from viral infection, viral myositis may persist for some duration.

• Drug-Induced Myopathies: These are caused by certain drugs - usually statins (cholesterol-reducing drugs) - and resemble a lot like myositis. Once the drug administration is stopped, the myopathies can go away.

How to Diagnose Myositis?

• The patient history and chief complaint are the foremost factors that contribute to the diagnosis of myositis. The doctor can ask various questions, like the onset of the condition, alongside other existing diseases one may be having. To confirm the diagnosis, various blood tests are advised to check for the presence of auto-antibodies in the blood. One such example is the Anti-Nuclear Antibody Test (ANA Test). This test specifically looks for antibodies that attack the nucleus of healthy living cells.

• Electromyography (EMG) is another doctor-assisted test that can confirm the presence of myositis by assessing the electrical activity occurring at the nerve endings inside the muscle cell.

• A muscle biopsy for signs of inflammation is an alternate way to check for myositis.

• Magnetic resonance imaging (MRI) is also helpful in confirming the sites in the body that show muscle inflammation.

What Is the Treatment of Myositis?

The conventional treatment of myositis involves the administration of drugs and managing the disease with regular exercise and physical therapy.

• The first line of treatment involves using steroidal drugs. These can be administered parenterally (oral route) through tablets or intravenously via steroidal injections. These provide an immediate solution to muscle pain and remarkably reduce inflammation. Sometimes, a combination of drug therapy can also be opted for in cases where steroids alone fail to provide the desired outcome. Disease-modifying anti-rheumatic drugs are commonly the preferred choice of drugs. Caution must be taken not to exceed the steroidal dosage above the normal physiological limit as it may be associated with other debilitating conditions like osteoporosis. The doctor can prescribe additional drugs to manage the secondary conditions.

• Immunosuppressant therapy is generally started in conjunction with corticosteroid therapy. The drugs commonly used are Methotrexate, Azathioprine, or Cyclosporine. This therapy is, however, not advised due to its ability to increase the incidence of other infections in the body. This therapy is strictly not recommended in patients suffering from leukopenia (low white blood cell count) as it can increase the body’s susceptibility to other infections by multifold.

• Immunoglobulins (IVIG) administered intravenously showed improvements in the action of muscles when swallowing, and an overall increase in muscle strength, but the changes were only short-lived. No long-lasting effects were noted; most doctors do not utilize this therapy.

• Non-pharmacological treatment usually involves practicing regular physical activity and physiotherapy. Exercise is scientifically proven to increase muscular strength and gain muscle mass. A properly designed workout program that is made specific to one’s needs can prove to show extraordinary results if followed with consistency. Patients with myositis suffer from muscle damage and weight loss throughout their lives. Managing the disease with cautious drug administration followed by performing regular aerobic exercise or resistance training can improve patient's quality of life and allow them to live active, independent lives.

Conclusion

The term "myositis" refers to a collection of uncommon illnesses that can make muscles achy, weak, and uncomfortable. Simply said, myositis is the term for muscular inflammation. Something may swell if it is irritated. People of any age, including children, can develop myositis. A confirmed diagnosis caught on in the early stages can be very advantageous in improving the patient's status. Myositis is generally a manageable disease, except for the subtype Inclusion Body Myositis (IBM), which to date poses a challenge to doctors about its treatment.