Polymyositis - Effective Treatments

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How is polymyositis treated?

Initially, polymyositis is treated with high doses of corticosteroids. Corticosteroids are cortisone medications (such as prednisone and prednisolone). These are medications related to cortisone and can be given by mouth or intravenously. They are given because they can have a powerful effect to decrease the inflammation in the muscles. They usually are required for years, and their continued use will be based on what the doctor finds related to symptoms, examination, and muscle enzyme blood test.

Corticosteroids have many predictable and unpredictable side effects. In high doses, they commonly cause an increase in appetite and weight, puffiness of the face, and easy bruising. They can also cause sweats, facial-hair growth, upset stomach, sensitive emotions, leg swelling, acne, cataracts, osteoporosis, high blood pressure, worsening of diabetes, and increased risk of infection. A rare complication of cortisone medications is severe bone damage (avascular necrosis) which can destroy large joints, such as the hips and shoulders. Further, abruptly stopping corticosteroids can cause flares of the disease and result in other side effects, including nausea, vomiting, and decreased blood pressure.

Corticosteroids do not always adequately improve polymyositis. In these patients, immunosuppressive medications are considered. These medications can be effective by suppressing the immune response that attracts the white blood cells of inflammation to the muscles. Many types are now commonly used and others are still experimental. Methotrexate (Rheumatrex, Trexall) can be taken by mouth or by injection into the body. Azathioprine (Imuran) is an oral drug. Both can cause liver and bone-marrow side effects and require regular blood monitoring. Cyclophosphamide (Cytoxan), chlorambucil (Leukeran), and cyclosporine (Sandimmune) have been used for serious complications of severe disease, such as scarring of the lungs (pulmonary fibrosis). These also can have severe side effects which must be considered with each patient individually. Treatment with intravenous infusion of immunoglobulins (IVIG) has been shown to be effective in severe cases of polymyositis that are resistant to other treatments. Recent research reports indicate that intravenous rituximab (Rituxan) may be helpful in treating resistant disease.

Patients with calcium deposits (calcinosis) from dermatomyositis can sometimes benefit by taking diltiazem (Cardizem) to shrink the size of the calcium deposits. This effect, however, occurs slowly (frequently over years) and is not always effective. The complication of calcium deposits in muscles and soft tissues occurs more frequently in children than adults.

Physical therapy with gradual muscle strengthening is an important part of the treatment of polymyositis. When to begin and the continued degree of exercise and range of motion of extremities is customized for each patient.

Patients can ultimately do well, especially with early medical treatment of disease and disease flares. The disease frequently becomes inactive, and rehabilitation of atrophied muscle becomes a long-term project. Monitoring for signs of cancer, heart, and lung disease are essential. Accordingly, EKG, lung function testing, and X-ray tests are used.

As mentioned above, the related muscle disease called inclusion body myositis is often more resistant to treatment than polymyositis. As scientists better define the specific causes of the different forms of polymyositis, treatment will be more accurately aimed at cure of this disease. Researchers are finding more specific antibodies in patients that may be used to diagnose and define active disease.

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See what others are saying

Comment from: Dan, 55-64 Male (Patient) Published: January 31

I was diagnosed with polymyositis 22 years ago when I had a lot of muscle pain and they used 60 mg of prednisone to get it under control and I am taking 5 mg now. I still have pretty good muscle strength but they have no endurance and I am often in a lot of pain. Moderate water exercises and heat have done the most to maintain my strength. Methotrexate (hair loss, itchy, feel hot, red skin) and Imuran (anemia and elevated liver tests and a cyst) did more harm than good in my case and they can't seem to replace prednisone for me. The pain has gotten worse in the past 2 years and Naprosyn and tramadol don't always work anymore so we will be trying Cymbalta next. I can only work a couple hours a day now. I have many related minor problems with my esophagus, breathing, hand cramps, gastrointestinal bleeding, stomach polyps, lumps under skin, being tired and fast heart rate.

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Comment from: Fir, 25-34 Male (Patient) Published: February 03

I was diagnosed with polymyositis when I was 19. Having been an active person, it really affected me. More so, I am a male and this disease occurs less frequently in males at my age. I started with a high dose of prednisolone and it took me over a year to get off the medication. Today I am in remission for the past 4 years or so and trying my best to exercise every week. I do have residual weakness here and there pretty much around the hip region but I am grateful I am able to walk and run and gym. Oh, I do have some degree of tremors which started after taking the high dose of prednisolone. The degree reduced overtime but I have never recovered fully even after stopping the medication. I wonder if this happens to anyone else. Lastly to all those with polymyositis, I feel you, let us all have a positive mindset and stay strong. Take care everyone.

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