Inflammatory Myopathies : Types, causes, symptoms, treatment

Inflammatory myopathies are the chronic muscles inflammation which becomes by a group of diseases or muscle weakness It is also called myositis and derived from two words:

Inflammatory myopathies (HMs) are a group of chronic systemic autoimmune diseases that mainly affect the skeletal muscle The common subtypes include adult dermatomyositis (DM), polymyositis (PM), and inclusion body myositis (IBM).

In 1975, Bohan and Peter proposed the diagnostic criteria for DM and PM using clinical, laboratory, and pathological features which remain to be the gold standard for use in clinical studies Malignancies associated with these myopathies have been extensively reported in the medical literature since 1916 and then confirmed by subsequent meta-analysis.

Most of the earlier epidemiological studies that describe the clinical characteristics of as well as their association with cancer come from the Western population. However, in recent years, several case series have been reported in the Asian population.

Types of Inflammatory Myopathies

  •     Dermatomyositis
  •     Polymyositis
  •     Inclusion body myositis

 Dermatomvotisis

It is rare disease than other myopathies

DM skin rash appear on body due to muscles weakness

  • It includes the degeneration of connective tissues and also concerned with underlying cancer Juvenile dermatomyositis, the most common inflammatory myopathy of childhood, is a rare systemic autoimmune vasculopathy that is characterised by weakness in proximal muscles and pathognomonic skin rashes.

Symptoms of Inflammatory Myopathies

Skin color changes

  •     The first sign that appears on the affected person is the purple or red rash on the skin
  •     In some cases face, eyelid, elbow, chest are effected
  •     Sometimes these rashes are painful due to muscle weakness

Weakness feci in muscles

  •     Person feel weakness in the muscles upper arms and neck
  •     Sometimes this weakness affected the whole body

Other symptoms include

  •     Fever
  •     Fatigue
  •     Weight loss
  •     Calcium deposition under skin
  •     Itching in muscles
  •     Lungs problem

Causes

Possible complications of dermatomyositis include:

Difficulty swallowing. If the muscles in your esophagus are affected, you can have problems swallowing (dysphagia), which can cause weight loss and malnutrition

Aspiration pneumonia. Difficulty swallowing can also cause you to breathe food or liquids, including saliva, into your lungs (aspiration)

Breathing problems. If the condition affects your chest muscles, you might have breathing problems, such as shortness of breath.

Calcium deposits. These can occur in your muscles, skin and connective tissues (calcinosis) as the disease progresses. These deposits are more common in children with dermatomyositis and develop earlier in the course of the disease.

Associated conditions

Dermatotnyositis may cause other conditions or put you at higher risk of developing them, including:

Raynaud’s phenomenon. This condition causes your fingers, toes, cheeks, nose and ears to turn pale when exposed to cold temperatures

 

Other connective tissue diseases. Other conditions, such as lupus, rheumatoid arthritis, scleroderma and Sjogren’s syndrome, can occur with dermatomyositis (overlap syndromes)

Cardiovascular disease. Dennatomyositis can cause heart muscle inflammation (myocarditis) In a small number of people who have dermatomyositis, congestive heart failure and heart arrhythmias develop

Lung disease. Interstitial lung disease can occur with dermatomyositis. Interstitial lung disease refers to a group of disorders that cause scarring (fibrosis) of lung tissue, making the lungs stiff and inelastic. Signs and symptoms include a dry cough and shortness of breath

Cancer. Dennatomyositis in adults has been linked to an increased likelihood of developing cancer, particularly of the cervix, lungs, pancreas, breasts, ovaries and gastrointestinal tract Risk of cancer increases with age, although it appears to level off three years or so after a diagnosis of dermatomyositis Dennatomyositis can also develop after you receive a diagnosis of cancer.

Possible complications of dermatomyositis include:

Difficulty swallowing. If the muscles in your esophagus are affected, you can have problems swallowing (dysphagia), which can cause weight loss and malnutrition

Aspiration pneumonia. Difficulty swallowing can also cause you to breathe food or liquids, including saliva, into your lungs (aspiration).

  •     Breathing problems. If the condition affects your chest muscles, you might have breathing problems, such as shortness of breath
  •     Calcium deposits. These can occur in your muscles, skin and connective tissues (calcinosis) as the disease progresses. These deposits are more common in children with dermatomyositis and develop earlier in the course of the disease

Cardiovascular disease, Dermatomyositis can cause heart muscle inflammation (myocarditis). In a small number of people who have dermatomyositis. congestive heart failure and heart arrhythmias develop

Lung disease. Interstitial lung disease can occur with dermatomyositis. Interstitial lung disease refers to a group of disorders that cause scarring (fibrosis) of lung tissue, making the lungs stiff and inelastic. Signs and symptoms include a dry cough and shortness of breath

Cancer, Dermatomyositis in adults has been linked to an increased likelihood of developing cancer, particularly of the cervix, lungs, pancreas, breasts, ovaries and gastrointestinal tract Risk of cancer increases with age. although it appears to level off three years or so after a diagnosis of dermatomyositis Dermatomyositis can also develop after you receive a diagnosis of cancer

Calcium deposits. These can occur in your muscles, skin and connective tissues (calcinosis) as the disease progresses These deposits are more common in children with dermatomyositis and develop earlier in the course of the disease.

Polymyositis

Polymyositis is also one of the inflammatory myopathies caused by a group of muscle diseases It consists of inflammation of muscles and its concerned tissues such as blood vessels. Myopathy damage the muscle cells.

Background diagnosis

If your doctor suspects you have polymyositis, he or she might suggest some of the following tests: 

Muscle biopsy. During this test, a small piece of muscle tissue is surgically removed for laboratory analysis. Analysis may reveal abnormalities, such as inflammation, damage, certain proteins or enzyme deficiencies

Treatment of Inflammatory Myopathies

Although there’s no cure for polymyositis, treatment can improve your muscle strength and function The earlier treatment is started in the course of polymyositis, the more effective it is — leading to fewer complications

However, as with many conditions, no single approach is best; your doctor will tailor your treatment strategy based on your symptoms and how well they respond to therapy

  Medications

The most commonly used medications to treat polymyositis include

Corticosteroids. Drugs such as prednisone can be very effective in controlling polymyositis symptoms But prolonged use of these drugs can have serious and wide-ranging side effects, which is why your doctor may gradually taper the dose of medication down to lower levels

Corticosteroid-sparing agents. When used in combination with a corticosteroid, these drugs can decrease the dose and potential side effects of the corticosteroid The two most common medications used for polymyositis are azathioprine (Azasan. Imuran) and methotrexate (Trexall). Other medications prescribed for polymyositis include mycophenolate mofetil (CellCept), cyclosporine and tacrolimus.

Therapy

Depending on the severity of your symptoms, your doctor might suggest:

Physical therapy. A physical therapist can show you exercises to maintain and improve your strength and flexibility and advise an appropriate level of activity

Speech therapy. If your swallowing muscles are weakened by polymyositis, speech therapy can help you learn how to compensate for those changes

Dietetic assessment. Later in the course of polymyositis, chewing and swallowing can become more difficult. A registered dietitian can teach you how to prepare easy-to-eat. nutritious foods

Surgical and other procedures

Intravenous immunoglobulin (IVIg) is a purified blood product that contains healthy antibodies from thousands of blood donors. These healthy antibodies can block the damaging antibodies that attack muscle in polymyositis. Given as an infusion through a vein, IVIg treatments may need to be repeated regularly for the effects to continue

Raynaud’s phenomenon. This condition causes your fingers, toes, cheeks, nose and ears to turn pale when exposed to cold temperatures.

Other connective tissue diseases. Other conditions, such as lupus, rheumatoid arthritis, scleroderma and Sjogren’s syndrome, can occur with dermatomyositis (overlap syndromes).

If I nod tests. A blood test will let your doctor know if you have elevated levels of muscle enzymes, which can indicate muscle damage. A blood test can also detect specific autoantibodies associated with different symptoms of polymyositis, which can help in determining the best medication and treatment.

Electromyography, This test involves inserting a thin needle electrode through the skin into the muscle Electrical activity is measured as you relax or tighten the muscle, and changes in the pattern of electrical activity can confirm a muscle disease The doctor can determine the distribution of the disease by testing different muscles.

Magnetic resonance imaging (MRI). A scanner creates cross-sectional images of your muscles from data generated by a powerful magnetic field and radio waves. Unlike a muscle biopsy, an MRI can assess inflammation over a large area of muscle

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