Definition:
Polymyositis is an inflammatory muscle
disease causing weakness and pain. Dermatomyositis is
identical to polymyositis with the addition of a skin
rash.
Description:
Polymyositis is an inflammatory disorder
in which muscle tissue becomes inflamed and deteriorates,
causing weakness and pain. It is one of several types
of inflammatory muscle disease, or myopathy. Others
included dermatomyositis and inclusion body myositis.
All three types are progressive conditions, usually
beginning in adulthood. A fourth type, juvenile dermatiomyositis,
occurs in children. Although polymyositis and dermatomysitis
can occur at any age, 60% of cases appear between the
ages of 30 and 60. Females are affected twice as often
as males.
Causes:
The cause is unknown. Polymyositis is
an autoimmune disease, caused by the immune system’s
attack on the body’s own tissue. The reason for
this attack is unknown, although some believe that a
combination of immune system susceptibility and an environmental
trigger may explain at least some cases. Here’s
some known environmental agents associated with polymyositis
they include infectious agents such toxoploasma borrella
(Lyme disease bacterium), and coxsackievirus, most cases,
howver, have no obvious triggers. There may also be
a genetic component in the development of polymyositis.
Symptoms:
The early symptoms of polymyositis are
slowly progressing muscle weakness, usually symmetrical
between the two sides of the body. Polymyositis affects
primarily the muscles of the trunk and those closest
to the trunk, while the hands, feet, and face usually
are not involved. Weakness may cause difficulty walking,
standing, and lifting objects. Muscles of breathing
may also be affected. Weakness of the muscles used for
swallowing can cause difficulty with swallowing. Joint
pain and swelling also may be present. Later in the
course of the disease, muscle wasting or shortening
may develop in the arms or legs. If you have polymyositis
you have a 30% chance of having heart abnormalities,
including electrocardiogram changes and arrhythmias.
Diagnosis:
Polymyositis is often difficult to diagnose,
because it’s so rare. Because the symptoms come
on it can be mistaken for other diseases that cause
muscle weakness.
Accurate diagnosis involves: Blood tests to determine
the level of your muscle enzyme creatine kinase (CPK’s),
muscle biopsy, in which a small sample of affected muscles
is surgically removed for microscopic analysis. A biopsy
revealing muscle cells surrounded by immune system cells
is a strong indicator of myositis.
Treatment:
Polymyositis responds to high doses of
immunosuppressant drugs in most cases. The most common
medication used is the corticosteroid prednisone. Prednisone
therapy usually leads to improvement within two or three
months, at which point the dose can be tapered to a
lower level to avoid the significant side effects associated
with high doses of prednisone. Unresponsive patients
are often given a replacement or supplementary immunosuppressant,
such as azathioprine, cyclosporine, or methotrexate.
Intravenous immunoglobulin treatments may help some
people who are unresponsive to other immunosuppressants.
Pain can usually be controlled with an
over-the-counter analgesic, such as aspirin, ibuprofen,
or naproxen. A speech-language therapist can help suggest
exercises and tips to improve difficulty in swallowing.
Avoidance of weight gain helps prevent overtaxing weakened
muscles.
Therapies & Treatments:
As with all autoimmune conditions, food
allergies/intolerances and environemental triggers may
be contributing factors. For the food allergies and
intolerances, an elimination/challenge diet can be used
under the supervision of a trained practitioner, naturopath,
or nutritionist, to identify trigger foods. These foods
can then be eliminated from the person's diet. For environmental
triggers, it is helpful to identify the source so that
it can be avoided or eliminated. A thorough detoxification
program can help alleviate symptoms and change the course
of the disease. Dietary changes from processed foods
to whole foods that do not include allergen trigger
foods can have significant results. Nutrient supplements,
especially the antioxidants zinc, selenium, and vitamins
A, C, and E, can be beneficial. Consistutional homeopathic
treatment can work at a deep level to rebalance the
whole person. Acupuncture and Chinese herbs can be effective
in symptom alleviation and deep healing. Visualization,
guided imagery, and hypnosis for pain management are
also useful.
Prognosis:
The progression of Polymyositis varies
considerably from person to person. Immunosuppressants
can improve strength, although not all patients respond,
and relapses may occur. Polymyositis can lead to increasing
weakness and disability, although the lifespan usually
is not significantly affected. About half of the patients
recover and can discontinue treatment within five years
of the onset of their symptoms. About 20% still have
active disease requiring ongoing treatment after five
years, and about 30% have inactive disease but some
remaining muscle weakness.
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