Treatment and Prevention of Myositis
There is no known means of preventing myositis and treatment results are highly variable. In some cases, the symptoms are highly responsive to corticosteroid therapy, the first treatment method typically used. At other times, symptoms do not respond to any treatments. In many cases, general physicians refer patients to specialists, particularly rheumatologists (physicians who specialize in inflammatory diseases), for treatment. If left untreated and the disease becomes severe and progressive (worsening), it can be fatal.
Treatment of myositis is highly individualized. Physicians typically attempt to predict treatment outcomes according to a variety of points. These include:
* Age (in children). Children usually respond better to treatment than adults. Younger children tend to respond better than teenagers.
* Duration of disease before diagnosis and treatment. Responsiveness is best with early therapy, particularly within three to six months of the onset of symptoms.
* Severity of muscle weakness. Typically, the more severe the muscle weakness, the more resistant the myositis is to treatment.
* Dysphagia (difficulty swallowing). When dysphagia is present, the myositis is usually more resistant to treatment.
* Involvement of cardiac or respiratory muscles. When myositis affects the heart or the muscles involved in breathing, treatment is typically less effective.
* Form of myositis present. Different forms of myositis respond differently to treatment. Myositis associated with cancer is typically responsive only to the effective treatment of the cancer. Myositis associated with medications or infections typically goes away when the drug is removed or the infection is treated. Inclusion body myositis (IBM) is particularly unresponsive to treatment.
Pregnancy may worsen the signs and symptoms of myositis, and active myositis may increase the risk of premature birth or stillbirth. This risk is greatly reduced when the disease is in remission. Physicians usually recommend that the patient ensure that the disease is controlled before attempting to conceive. Many pharmacological agents are best avoided during pregnancy. However, if absolutely necessary, corticosteroids may be used throughout the pregnancy with close supervision by a specialist.
Restricting strenuous activities when inflammation is most intense often helps with pain and healing. When symptoms are less severe, physical therapy and rehabilitation may prove helpful. Physical therapists can teach a patient how to be aware of positioning to reduce the risk of pressure sores in bed or wheelchairs and can recommend exercises, including low-impact activities (e.g., walking, swimming) and active or passive range of motion exercises to prevent or improve joint contractures (when the joint remains in a bent position). Occupational therapy may be prescribed if myositis hinders the patient’s performance of daily activities.
Certain nutritional concerns exist for myositis patients. Protein in the diet is important for muscle growth and healing. Calcium is important for strong bones. During corticosteroid therapy, the diet needs to be low in salt and sugar.
Several medications may be used to treat myositis. Typically, the first medications attempted are corticosteroids. These may help to relieve muscle and joint pain and swelling, improve muscle strength, and control fever and rash. Corticosteroids are generally given in pill forms and in high doses. Muscle enzyme levels in the blood are monitored during treatment to determine if the corticosteroid treatment is working and to catch any signs of relapse. In general, if corticosteroids are started earlier in the course of the disease, they work faster and more effectively. Usually 90 percent of patients attain some response with corticosteroids, and 50 to 70 percent of these attain complete remission.
After about four to 12 weeks on the initial high dose of corticosteroids, the muscle enzyme levels have usually returned to normal and muscle strength has returned. At this time, the dose is gradually reduced. Most adults continue taking a low dose for many years or even indefinitely to Osteoporosis involves the bones becoming thin, brittle and more prone to fracture, causing pain.prevent a relapse. Most children, however, are able to stop corticosteroid therapy entirely without fear of further relapses after about two years. Prolonged use of corticosteroids has been associated with complications including diabetes and osteoporosis, and may affect children’s bone development. Usually corticosteroids are tapered slowly after prolonged use; stopping corticosteroids abruptly can make a person very sick.
In some cases, intravenous corticosteroids are used as an alternative to pill form. When using this method, the corticosteroids are typically administered for three consecutive days weekly or monthly as needed.
Not all forms of myositis respond well to corticosteroids. In cases of inclusion body myositis (IBM), corticosteroids may have no effect or only stabilization or slight improvement of muscle strength.
Sometimes, corticosteroids may not be effective or may even worsen myositis conditions. In these cases, other drugs may be prescribed, including:
* Immunosuppressive drugs. May be employed as initial treatment in patients with indicators of poor prognosis (e.g., those with a delayed diagnosis or with difficulty swallowing) and those at significant risk of corticosteroid side effects. Immunosuppressive drugs may also be used with corticosteroid therapy.
* Intravenous immune globulin (IVIG). Contains large quantities of many antibodies and may be given when other drugs are not effective. IVIG has shown some cases of great improvement or even full remission. It may provide even greater benefit when patients also have difficulty swallowing. IVIG is usually given for two to five consecutive days a month for as long as nine months. However, the costs of this treatment are very high and relapse is common once treatment has stopped.
* Antimalarial drugs, including DMARDs (disease-modifying antirheumatic drugs). May be used to treat rash in dermatomyositis. Typically, the medications for myositis treat pain, inflammation and muscle weakness, not rash. There are some cases where adverse reactions to antimalarial drugs may be confused with the rash and weakness of dermatomyositis itself.
When these drugs prove ineffective, a number of other medications and therapies may be used, such as alkylating agents (cancer drugs), blood plasma exchange or radiation therapy. These drugs and therapies have shown mixed results in studies and may not be effective.
In addition to medical treatment, some physicians may recommend certain complimentary or alternative pain therapies, including acupuncture or thermotherapy (heat therapy). However, these treatments remain controversial and unproven.
In cases of dermatomyositis, the use of sunscreen helps with the prevention and management of photosensitive rashes.
When dysphagia (difficulty swallowing) is involved with myositis, it increases the risk of inhaling food or liquids into the lungs (aspiration), which can cause pneumonia. In some cases, feeding tubes may be necessary. Speech therapists may offer advice about aspiration risk and precautions (e.g., elevation of the head of the bed, semisolid diets).
Dermatomyositis may be accompanied by calcinosis (deposits of calcium and phosphate in the fat layer beneath the skin), particularly in children who do not receive prompt treatment. This can be medically treated in its early stages, but once calcinosis becomes established, it is highly resistant to treatment. In some cases, deposits may need to be surgically removed, particularly if they interfere with joint function, persistently drain, or are painful or infected.
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