Causes and symptoms of myositis
Myositis is inflammation of one or more skeletal muscles. The disease differs in etiology, symptoms, the nature of the course and localization. The inflammation, as it progresses, can spread to the heart, joints, intestines, skin, and lungs.
The disease is quite rare, so out of 1 million people, only one will suffer from myositis. But this statistics applies to those cases when myositis manifests itself as a systemic disease, that is, all skeletal muscles are involved in the inflammation process. The most common form of myositis is cervical myositis, which accounts for up to 60% of all cases of inflammation, followed by lumbar myositis. It is believed that every person will face such varieties of the disease at least once in their life.
Myositis can affect both adults and children, but dermatomyositis is more often diagnosed in childhood. Dermatomyositis in most cases affects the age group between 1 and 15 years, although it can be detected in adulthood. With regard to sex differences, women suffer more from dermatomyositis and polymyositis than men. Fibromyositis is more often diagnosed in people after the age of 50.
Currently, myositis is called "office disease", that is, the risk of developing it increases with sedentary work. Some myositis may be due to the profession, such as inflammation of certain muscle groups in pianists and violinists.
Myositis can manifest itself as an independent disease or be a consequence of other diseases, it can be mild and go away on its own after a few weeks, or it can have a severe course and bother a person throughout his life.
- Myositis causes
- Myositis symptoms
- Types of myositis
- Myositis classification
- What is the danger of myositis?
- How is myositis treated?
The causes of myositis can be due to the influence of exogenous and endogenous factors, including:
Infectious diseases. It is infections of a viral nature that are the most common causes of the development of myositis, less often muscle inflammation is provoked by bacterial agents. In this case, the infection from the base focus (for example, from the tonsils) spreads through the bloodstream to the muscle tissue. For influenza, SARS and other respiratory diseases, as well as for syphilis, tuberculosis, typhoid, non-purulent myositis is characteristic. Purulent myositis develops due to a generalized purulent infection, provoked most often by staphylococci and streptococci, ostiomyelitis, or fungal microorganisms. In this case, myositis is severe and requires surgical treatment. It is also possible that muscles can be damaged by microorganisms directly, when inflammation develops due to the action of toxins on them, as waste products of pathogenic agents.
- Autoimmune diseases. Most systemic diseases, especially collagen diseases, are accompanied by myositis. The body, starting to produce antibodies against its own tissues, provokes muscle inflammation. Such myositis has either subacute or chronic course and is accompanied by severe pain. Myositis is an almost constant companion of scleradema, lupus, rheumatoid arthritis.
- Parasitic invasions. Infection with parasites can provoke myositis. So, muscle inflammation is observed with toxoplasmosis, cysticercosis, trichinosis, and less often with echinococcosis. When the parasite is introduced into muscle tissue, an inflammatory process of a toxic-allergic nature starts.
The negative impact of toxic substances. Most often, people who abuse alcohol, take medications, and have suffered from insect bites suffer from myositis. The mechanism of development of inflammation is the direct effect of poison, alcohols, drug components on the muscles. Substances that increase the risk of developing myositis are: colchicine, statins, alpha interferon, corticosteroids, isoniazid, antimalarial drugs (Plaquenil, Delagil, Akriquin, etc.), cocaine, alcohol.
- Postponed injuries. In the place where the muscle fibers are ruptured, inflammatory edema always increases subsequently, weakness and pain join. As it heals, the swelling subsides and the normal muscle tissue is replaced by scar tissue, resulting in a shorter muscle. As a rule, myositis after minor injuries, hypothermia, muscle cramps, or simply intense physical exertion proceed quite easily. It is extremely rare that a condition such as rhabdomyosis, characterized by muscle necrosis, develops. Dermatomyositis and polymyositis can cause rhabdomyosis.
- Professional costs. Myositis often develops in pianists, violinists, PC operators, and drivers. The reason is prolonged stress on certain muscle groups or an uncomfortable body position. As a result, muscle nutrition suffers, normal blood circulation is disrupted, and dystrophic processes manifest.
The symptoms of myositis are diverse, but its main manifestation is the muscle symptom complex, expressed in muscle weakness. It can bother a person constantly and be quite pronounced, or it can appear only after a person has performed certain tests. The loss of muscle strength occurs gradually, and this process takes from several weeks to several months. Large muscles are involved in the inflammatory process - thighs, neck, shoulders, back. Muscle myositis is characterized by bilateral symmetrical inflammation. At the same time, a person is not able to lift weights, climb stairs, and sometimes even just raise his hand and dress on his own.
Myositis of the shoulder and pelvic muscles is most difficult for people. Such patients often suffer from gait disturbance, have difficulty lifting from the floor or from a chair, and may fall while moving.
Other symptoms of myositis can be:
- The appearance of a rash.
- Increased general fatigue.
- Thickening and hardening of the skin.
- Aching pain that increases with movement and palpation of muscles.
- Sometimes there is hyperemia of the skin and edema in the affected area.
- Fever, fever, headaches are possible.
- Joint pain occurs during periods of exacerbation of myositis, but the skin over the joints does not become swollen or hot, as in arthritis or arthrosis.
Myositis can have an acute onset, or it can have a chronic course. The acute phase can turn into a chronic one. This is often observed with insufficient treatment or in the absence of therapy at all. Acute myositis occurs after trauma, after severe muscle strain or after hypothermia.
A chronic disease is characterized by an undulating course with increased pain during changes in the weather, with muscle overstrain. Sometimes there is a slight restriction of mobility in adjacent joints.
Types of myositis
It is customary to distinguish between the following types of myositis, characterized by various manifestations:
- Neck myositis. Pain in neck myositis occurs several hours after exposure to a provoking factor. Painful sensations tend to intensify when a person tries to turn the neck, or tilt the head. Possible irradiation of pain to the head, shoulders, back and shoulder blades. The pain does not become weaker after a period of rest, does not leave a person when he is motionless. Redness of the skin over the areas of inflammation is possible. When exposed to cold, the patient's condition is aggravated.
Back myositis. The pain tends to intensify in the morning, after a person spends a long time without moving. At night, there is an increase in tissue edema, reflex muscle spasms. As a rule, back pains appear several days after exposure to the provoking factor and persist for a long time after its elimination. Any physical activity - bending, turning and other movements, accompanied by muscle stretching, leads to increased pain.
- Myositis of the legs and arms. This type of myositis is rare without the involvement of other skeletal muscles located in other parts of the body. Most often, the muscles of the lower and upper extremities become inflamed with polymyositis. It becomes difficult for the patient to move, raise his hands up.
Thoracic myositis. Thoracic myositis is quite widespread. Pain syndrome constantly pursues a person, since the patient is not able to restrict the movements of the chest resulting from breathing.
If the myositis of the thoracic region is difficult, then the muscles of the larynx and pharynx are involved in the pathological process. This contributes to difficulty swallowing, coughing and shortness of breath join. It becomes difficult for a person to take a deep breath. In extremely severe cases, it is possible to involve the respiratory muscles in the pathological process, followed by fibrosis of the lung tissue.
- Myositis of the eye muscles. Myositis can affect the muscles in one or two eyes. The pain increases when you try to look to the sides or up. The eyelids are swollen and cannot be opened completely. Development of unexpressed exophthalmos is likely. If the disease becomes chronic, there is a possibility of developing restrictive myopathy.
Polymyositis. Polymyositis is most often diagnosed in people with a predisposition to systemic diseases. Scientists suggest that viral infections, as well as oncological diseases, can become a pushing mechanism for the development of inflammation. By developing specific antibodies against them, the immune system directs them to fight their own tissues. A process called rhabdomyolysis is triggered, which is characterized by damage to muscle fibers. Rhabdomyolysis is accompanied by an inflammatory process that tends to spread to adjacent tissues. In this regard, polymyositis is so often accompanied by joint pain, dermatitis and arthritis.
Polymyositis with dermatitis symptoms is called dermatomyositis. This process begins acutely, it can affect both adults and children. In addition to the main symptoms of myositis, dermatomyositis is characterized by the appearance of rashes. The rash has a purple or lilac color, slightly rises above the skin. Rashes are located on the neck, trunk and face. Internal organs with polymyositis are rarely affected, but it is possible that the lungs, heart, gastrointestinal tract organs, and the endocrine system are involved in the pathological process.
With juvenile dermatomyositis, the child begins to complain of pain in the lower extremities that appears when walking. Particularly painful are areas of the leg in the area of the lower legs. Often, the development of an acute form of juvenile dermatomyositis is preceded by tonsillitis or a cold.
Dermatomyositis is twice as likely to be diagnosed in women as in men and is a systemic connective tissue disease.
Neuromyositis. Neuromyositis is a subtype of polymyositis, but the process involves both muscles and nerves, which are located in the area of inflammation. With the progression of the disease, inflammation spreads to the distal nerve fibers.
In this case, the patient experiences the following symptoms:
- Deterioration of sensitivity (paresthesia), or an increase in sensitivity (hyperesthesia).
- Severe pain.
- Feeling of muscle tension.
- Decreased muscle strength, decreased muscle tone.
- Joint pain.
Painful sensations with neuromyositis tend to increase as the disease progresses. Over time, the pain ceases to subside, even when the person is at rest.
Polyfibromyositis. Polyfibromyositis is another subtype of polymyositis, which manifests itself in the fact that muscle tissue is replaced by connective tissue. This is due to the fact that muscles that are in an inflamed state for a long period of time begin to collapse. In their place, scar tissue is formed in the form of nodules that can be felt. If scars form in the tendon area, then contractures and deterioration of muscle mobility are possible.
Signs of polyfibromyositis can be:
- Compaction of muscles in the area of inflammation.
- The appearance of nodules.
- Abnormal muscle contractions.
- Reduced range of motion.
- More than 20% of patients complain of difficulty swallowing food.
- Muscle soreness, especially on deep palpation.
Polyfibromyositis is characterized by the fact that nodules can appear and disappear on their own, without any treatment. If the process of formation of contractures has started, then muscle deformation occurs, accompanied by severe pain. Most often, this type of disease affects people in old age.
Ossifying myositis. Ossifying myositis is one of the rarest types of polymyositis, which occurs as a result of an injury: dislocation, bruising, stretching or tearing of a muscle, or after a bone fracture. So, ossifying myositis of the hip is often observed in riders, and myoisitis of the chest in fencers. In addition, this type of disease can be congenital.
Ossifying myositis is a consequence of untreated polyfibromyositis. The scar tissue that appears due to it is transformed into a mass with heterogeneous contents, which is saturated with minerals and other substances (salts of phosphate acid, calcium, potassium). When there are too many minerals, the ossification process starts. If muscles with ossified areas are located in close proximity to skeletal bones, then the latter deforms.
The following symptoms may indicate ossifying myositis:
- Deformation of the arms and legs.
- The presence of muscle areas with uncharacteristic seals.
- Impaired mobility.
- The appearance of severe pain that tends to increase during movement.
During palpation, hard, hard areas of muscle are found that are similar in density to bones. As the disease progresses, a complete loss of limb motor activity is possible.
If ossifying myositis resulting from trauma has a favorable course, then the hereditary type of the disease begins spontaneously and is characterized by an unpredictable prognosis. The death of the patient often occurs from ossification of the pectoral and swallowing muscles.
Lumbar myositis. Lumbar myositis is widespread. Patients often confuse this disease with lumbago, but myositis pains are less severe. It is aching in nature and does not stop even when a person is at rest. Increased pain occurs when pressure is applied to the lumbar zone, as well as during movements: bending, turning the body, etc.
Lumbar myositis must be differentiated not only from osteochondrosis, from kidney disease, but also from a hernia of the lumbar spine. To do this, the doctor should pay special attention to the symptoms of the disease, conduct an X-ray examination, MRI or CT.
This type of myositis is most often diagnosed in the elderly and in office workers.
The classification of myositis can vary. So, depending on the nature of the course of the disease, chronic, acute and subacute myositis are distinguished, and depending on the prevalence: limited and generalized.
In addition, scientists note such special forms of myositis as:
- Infectious non-purulent with severe pain and general malaise. This form develops with viral infections.
- Acute purulent with the formation of purulent foci in the muscles, with their swelling and severe pain. This form of myositis is often a complication of already existing purulent processes, or acts as a symptom of septicopyemia.
- The parasitic form of the disease is the result of a toxic-allergic reaction of the body.
- Ossifying myositis, can be congenital or acquired as a result of an injury.
- Polymyositis is expressed in multiple lesions of muscle tissue.
- Dermatomyositis, called Wagner's disease, is a systemic disease.
What is the danger of myositis?
The danger of myositis lies not only in the fact that the disease disrupts the patient's quality of life, limiting his freedom of movement, but also threatens the development of more serious consequences.
Complications of myositis are:
- The spread of the disease to adjacent muscles with the involvement of vital organs in the pathological process.
- Muscle tissue atrophy. If the disease progresses and is not treated, then a complete loss of working capacity is possible with the appearance of the need for systematic care.
- Ossification of muscle fibers, which can eventually even lead to the death of the patient.
- Breathing and swallowing disorders, if the muscles of the larynx, esophagus, pharynx are involved in the inflammation process.
- Complications of cervical myositis can be extensive lesions of the upper respiratory tract, followed by shortness of breath and stress on the cardiovascular system.
- Purulent myositis often leads to abscesses, phlegmon, which is a threat to human life.
How is myositis treated?
Treatment will primarily depend on the severity of the symptoms of the disease. It can be reduced to taking antibacterial drugs, antiviral drugs, immunosuppressants, etc.
The treatment regimen for myositis should be selected on an individual basis, taking into account all clinical manifestations of the disease.
To eliminate the inflammatory phenomena that provoked myositis, it is possible to use immunosuppressive drugs, for example, Methotrexate, Prednisolone, Azathioprine.
If myositis is of a viral nature, then treatment should be aimed at maintaining the body's immune forces and fighting infection, since there is no etiological therapy. If the cause of muscle inflammation is a bacterial infection, then antibiotics are advisable.
When myositis occurs while taking medications, then they must be canceled. Muscle fibers usually return to normal after 14-21 days.
Taking corticosteroids. Hormonal drugs are designed to reduce inflammation. Most often, doctors use prednisone for this. Can also be used such drugs as: Methylprednisolone, Hydrocortisone, Triamcinolone, Betamethasone, Dexamethasone. Taking large doses of these drugs can reduce the activity of the immune system, which will lead to a decrease in inflammation. However, in this case, the risk of infection with other diseases increases. The dose of corticosteroids is calculated in each case individually; it is forbidden to use these drugs independently.
If a patient with myositis is recommended to take hormonal drugs, he needs to be observed by an ophthalmologist at least once a year. The fact is that these drugs increase the risk of cataract formation. A serious complication from taking corticosteroids is bone necrosis, therefore, if pain in the skeleton appears, you must immediately inform your doctor about it.
- Azathioprine and Methotrexate. These are two immunosuppressive drugs that are aimed at inhibiting the function responsible for the production of red blood cells and leukocytes. Taking them requires monthly blood monitoring. Side effects also include hair loss, liver dysfunction, vomiting, nausea, and secondary infections.
- Plaquenil. The drug helps relieve inflammation and has an immunosuppressive effect. Most often, it is prescribed for admission to older people who suffer from dermatomyositis.
- Gamma immunoglobulin. This drug has been used for the treatment of various diseases for 15 years. With myositis, it helps to reduce the level of an enzyme (creatine phosphokinase), which appears in the blood in large volumes due to muscle breakdown. This drug is advisable to use in case of myositis provoked by viruses. This drug can cause many side effects (digestive disorders, aseptic meningitis, fever, headaches), so it is used when other drugs are ineffective.
- Cyclophosphamide. A potent immunosuppressive drug that is used only in severe disease. The risk of developing all side effects when taking Cyclophosphamide increases.
We should also mention physiotherapy techniques for the treatment of patients with myositis. They are a prerequisite for the patient's recovery, and without them, the therapeutic course will not be complete. Physiotherapy allows you to increase muscle tone, prevent muscle atrophy and improve the patient's well-being.
Physical activity should be present daily. It is worth visiting the pool as swimming has a positive effect on all muscle groups.
You should adhere to the following recommendations of specialists:
- Before starting any physical work, the muscles need to be warmed up. This will help normalize blood flow and speed up the heart.
- Do not overexert yourself, all exercises should be performed at the pace that is optimal for a person.
- After physical activity, rest should follow.
- The pace should build up smoothly.
- It is necessary to concentrate on the inflamed muscle, in the case when the sore area is too overstrained, it is necessary to stop exercising and rest.
- At a time when the state of health is severely impaired, the exercise program should be somewhat simplified.
- It is better if the classes are held in pairs.
There is no specific training scheme for myositis; they are recommended to each patient individually. This takes into account the severity of the disease, the affected area, the patient's age.
Specialists pay special attention to water aerobics. Regular exercises allow you to quickly restore activity, increase muscle tone.
As for drugs, research is ongoing in this area, and in the near future new drugs will appear that make it possible to get rid of myositis more effectively.
As a rule, people with various types of polymyositis most often either completely or partially restore the lost muscle activity and tone. Fibromyositis therapy does not allow to fully get rid of the disease, but its progression is significantly slowed down if all the doctor's recommendations are followed. Such patients manage to do without wheelchairs and other mobility devices for a long time. Against the background of concomitant diseases, such as oncology and pneumonia, the prognosis is much worse.
Infectious myositis the more successfully it will be cured, the sooner therapy is started. Therefore, at the first symptoms of muscle inflammation, you should immediately consult a doctor.
Author of the article: Alekseeva Maria Yurievna | Therapist
Education: From 2010 to 2016 Practitioner of the therapeutic hospital of the central medical-sanitary unit No. 21, city of elektrostal. Since 2016 she has been working in the diagnostic center No. 3.