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« on: January 17, 2006, 09:10:00 pm »

Polymyositis 
 


Polymyositis (pol-e-mi-o-SI-tis) is an uncommon disease that causes inflammation in your muscles. Doctors also refer to polymyositis as a type of connective tissue disease. Its most noticeable characteristic is muscle weakness, especially in the muscles closest to your trunk, such as your shoulder and hip muscles. As a result, you may find it difficult to get out of chairs, climb stairs, brush your hair or work with your arms over your head. Polymyositis is rarely fatal, but it can be disabling in its more severe forms.

Although polymyositis can occur at any age, it mostly affects adults in their 40s and 50s. It is more common in blacks than in whites, and women have it more often than men do. Polymyositis usually develops gradually over weeks or months.

Periods of remission, during which signs and symptoms improve spontaneously, rarely occur in polymyositis. However, treatment can improve your muscle strength and function.


Signs and symptoms

Signs and symptoms of polymyositis usually appear gradually, so it may be difficult to pinpoint when they first started. They may also fluctuate from week to week or month to month. The most common signs and symptoms include:

Progressive muscle weakness, particularly in the muscles closest to the trunk, such as those in your hips, thighs, shoulders, upper arms and neck. This weakness is symmetrical, affecting both the left and right sides of your body.
Difficulty swallowing (dysphagia).
Mild joint or muscle tenderness.
Fatigue.



Causes


Polymyositis belongs to a group of conditions called inflammatory myopathies. Myopathies are diseases or abnormal conditions of the striated muscles that cover your skeleton. The cause of most inflammatory myopathies is unknown. Infections caused by bacteria, parasites or viruses can cause inflammatory myopathies, but in most cases, doctors aren't able to identify a preceding infection in polymyositis.

A disease similar to polymyositis is dermatomyositis. Dermatomyositis leads to many of the same symptoms as polymyositis, but it causes skin inflammation or a rash as well. Other inflammatory muscle diseases include inclusion body myositis, which progresses more slowly than other forms; myositis associated with other connective tissue diseases, such as lupus or scleroderma; and myositis associated with cancer (malignancy).

Doctors suspect that myopathies are autoimmune disorders, in which your body's immune system mistakes normal components of your body for foreign substances and attacks them. If you have polymyositis, an unknown cause seems to trigger your immune system to begin producing autoimmune antibodies (also called autoantibodies) that may damage healthy body tissues. Many people with polymyositis show a detectable level of autoantibodies in their blood. It's still unclear, however, whether these autoantibodies are indeed involved in causing polymyositis.

Polymyositis has also been associated with several viral diseases, including HIV. Some researchers speculate that, in some form, polymyositis may be caused by a viral infection of the muscle. This theory isn't well supported, however.


Your immune system

Your immune system is responsible for helping to eliminate invaders (antigens) such as infectious organisms. The key cells in your immune system are lymphocytes known as B cells and T cells, which ...


When to seek medical advice


If you experience weakness in your shoulder and hip muscles for a continued period, see your doctor. The earlier polymyositis is detected, the better your response may be to treatment. With treatment, you can manage and sometimes even reverse your signs and symptoms. If your doctor thinks you may have polymyositis, he or she may refer you to a specialist, such as a rheumatologist or a neurologist.

If you have difficulty swallowing or shortness of breath, call your doctor right away, as this may indicate the need for immediate help.


Screening and diagnosis

Diagnosis of polymyositis isn't always easy and can be a lengthy process. Even though the attempt to diagnose your condition may be frustrating, remember that an accurate diagnosis is necessary to receive appropriate treatment.

In addition to a thorough physical exam, including assessment of your muscle strength, your doctor will likely use some or all of the following information and tests to assist in the diagnosis:

Family medical history. A careful history of muscle disease in your family and your own age at onset of the disease will help your doctor distinguish between polymyositis and muscular dystrophy.

Muscular dystrophy is an inherited condition; its signs and symptoms usually begin in early childhood.
Electromyography. A thin needle electrode is inserted through your skin into the muscle to be tested. Electrical activity is measured as you relax or tighten the muscle. Changes in the pattern of electrical activity can confirm a muscle disease. The distribution of the disease can be determined by testing different muscles.
 
Blood analysis. A blood test can let your doctor know if you have elevated levels of muscle enzymes, such as creatine kinase (CK) and aldolase. Increased CK and aldolase levels can indicate muscle damage. A blood test can also determine whether autoantibodies are present in your blood.
Muscle biopsy. A small piece of muscle tissue is removed surgically for laboratory analysis. A muscle biopsy may reveal abnormalities in your muscles, such as inflammation, damage or infection. The sample also can be examined for the presence of abnormal proteins and checked for enzyme deficiencies.
 
Magnetic resonance imaging (MRI). A scanner creates cross-sectional images of your muscles from data generated by a powerful magnetic field and radio waves. These images can be viewed from any direction or plane. During the test you lie inside the cylindrical-shaped scanner for 15 minutes to an hour. MRI scans may help detect inflammation in your muscles.


Complications

If the muscles in your esophagus are affected, you may have problems swallowing (dysphagia), which in turn may cause weight loss and malnutrition. Dysphagia may also lead to entrance of food or liquids, including saliva, into your lungs (aspiration), which can result in pneumonia. If your chest muscles are involved, you may experience breathing problems, such as shortness of breath. Deposits of calcium in your muscles, skin and connective tissues (calcinosis) can occur late in the disease, particularly if you've had the disease for a long time.

Polymyositis is often associated with other conditions, including:
Other connective tissue diseases. Diseases such as lupus, rheumatoid arthritis, scleroderma and Sjogren's syndrome can occur in combination with polymyositis.
Cardiovascular disease. The muscle of your heart may become inflamed (myocarditis). In a small number of people who have polymyositis, congestive heart failure and heart arrhythmias may develop.
Lung disease. A condition called interstitial lung disease may occur with polymyositis. Interstitial lung disease refers to a group of disorders that cause inflammation and scarring (fibrosis) of lung tissue, making lungs stiff and inelastic. Signs and symptoms include a dry cough and shortness of breath. In the late stage of lung disease, high blood pressure in the pulmonary arteries (pulmonary hypertension) can occur and can lead to right-sided heart failure.
Cancer. Cancer may be more common in people with polymyositis, but the evidence for this association is more pronounced in dermatomyositis.
Pregnancy may worsen signs and symptoms in women whose disease is active. Active polymyositis can also increase the risk of premature birth or stillbirth. If the disease is in remission, the risk isn't as great.

People with polymyositis or dermatomyositis may also be at an increased risk of infections, particularly respiratory and digestive infections. As a result, your doctor may monitor your signs and symptoms for any indication of infection so that you can receive prompt diagnosis and treatment.

*Note, on October 2, 1985, my oldest sister Sheryl passed away from complications of Polymyositis.My Doctors have ruled out my symptoms are NOT that of Polymyositis, but with the low positive ANA's and symptoms I have, that I have a MCTD.I have bunches of ailments, from Raynauds to degenerative arthritis to peripheral artery diease.
Wishing You Well,
~Kathy
 



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