Myositis.
Last updated Friday, February 11, 2005
Management and treatmentTreatment There are many forms of treatment for myositis, but most include medications, exercise, physical therapy, and rest.
The treatment will vary from person to person and will change over
time in a single person. The specific therapy recommended by your
doctor will depend upon the severity and type of problems, the presence
of other medical conditions, and adverse reactions to previous therapy. Exercise and therapy A physical therapy or exercise program
is an important part of treating myositis and can help improve muscle
strength. However, you should not begin vigorous exercise until the
drug treatment takes effect. In the early stages of treating myositis,
your muscle fibers are fragile and could be damaged further by such
exercises. Physical examination and laboratory tests will help your
doctor determine the appropriate time to start an exercise program.
But even when strenuous exercise is not recommended, it is important
to prevent loss of flexibility of your arms, legs, and other parts of
your body by doing range of motion stretching of the joints and
muscles. Other physical therapy activities may range from simple
exercises at home to formal sessions with a specially trained health
professional. They can also include whirlpool baths, heat and gentle
massage, or similar therapies. As you get better, your physical therapy
program will be adjusted accordingly with more vigorous exercises. Exercising in pools can be very helpful in restoring your muscle function to normal.
Getting adequate rest is another important aspect of managing
myositis. During times of increased muscle weakness, you need to take
frequent rests during the day and to limit your activity to a tolerable
level. If you are employed, you need to discuss your situation with coworkers, supervisors,
and your doctors to develop a work plan to accommodate your disease.
When your myositis is active, you should minimize strong physical
activity, and your workday should include rest breaks. More activity
can be undertaken and fewer rest breaks will be needed as your
condition improves, but you need to avoid overdoing activity at the
first sign of improvement. Your doctor and physical therapist can help
decide the proper balance of rest and activity at each stage of
myositis. Medications Corticosteroids
The most effective drugs in treating myositis are corticosteroids.
These drugs are related to hormones produced naturally in the body.
Corticosteroids are powerful and can have serious side effects. Some of
these side effects include:
- weight gain
- rounding of the face
- easy bruising
- thinning of the bones
- depression
- high blood pressure
- cataracts
- diabetes
- increased risk of infection
- rarely, bleeding from the stomach
- avascular necrosis, an arthritis like condition that most commonly affects the hips or shoulders, and can be treated with total hip replacement or total shoulder replacement
If you take corticosteroids, you should be monitored
carefully by your doctor and should report any new medical problems to
the doctor.
Anyone taking corticosteroids should be aware of several
precautions. During such therapy, the body slows or stops its own
natural production of steroids. For this reason, any time the dose is
to be lowered, your doctor will gradually reduce the level of steroids
you are taking over a period of weeks or months. During this time, your
body will gradually increase its own corticosteroid production. Do not
ever decide on your own to stop or drastically reduce the amount of
prednisone or other corticosteroid you are taking, even if you feel
well. Serious health problems could result if you do! You may want to
wear a medic alert bracelet that says you are taking corticosteroids.
If you have taken corticosteroids for a long time, be sure to
discuss your medications with all doctors and dentists treating you.
Any situation that places extra stress on your body, such as surgery or
major dental work, may require higher levels of corticosteroids than
you will be able to produce. This may require that the corticosteroid
dosage be increased temporarily during such stressful periods.
The corticosteroid most commonly used for myositis is
prednisone. If your myositis is severe, your doctor may prescribe
fairly high doses of corticosteroids. This may be done by giving
prednisone as pills to be taken by mouth or in liquid form given
through a plastic tube that enters a vein (intravenously). It may take
several weeks or months for you to notice improvement, even though you
may be getting better without realizing it. Throughout the treatment of
myositis your doctor will repeat blood tests for muscle enzymes to
watch for signs of progress. Often the CK muscle enzyme will begin
returning to normal before you notice any improvement.
After your strength improves, your doctor probably will begin
slowly reducing the dose of prednisone to a lower level that may remain
the same for a long period of time. If your myositis is under good
control, your doctor may eventually be able to take you off prednisone
completely, at least for a time.
Immunosuppressants
You may not respond to prednisone therapy alone. Your doctor
may then prescribe both prednisone and a drug that suppresses the
immune system. Such drugs are called immunosuppressants, and the most
common ones used in myositis are methotrexate and azathioprine.
Immunosuppressants slow down the immune system, reducing its ability to
attack infections and attack healthy tissue in persons with autoimmune
disease.
Immunosuppressant drugs are powerful agents and can result in
side effects. If you are taking these medications, see your doctor
regularly so that he or she can check for any side effects and decrease
the dosage of medicine if necessary. Your doctor may request ongoing
consultation with a arthritis specialist when your treatment includes
the use of immunosuppressant drugs.
If any of these side effects occur, contact your doctor
- upset stomach
- loss of appetite
- mouth sores
- hair loss
- skin rash
- fever
- chills
- blood in urine
- diarrhea
- missed menstrual periods
Caution: Methotrexate may cause birth defects. Women on methotrexate must go off their medication during pregnancy
and for several months prior to a planned pregnancy! Methotrexate
should not be taken by people who have serious kidney or liver disease
or who drink alcohol.
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