How to distinguish weakness from fatigue and pain
In inflammatory myopathies, it is the strength of the muscles located closer to the body that suffers, not endurance. A person notices specific difficulties: he cannot climb stairs without support, he gets up from a chair using his hands, he cannot keep his hands raised to dry his hair. At the same time, the hands and feet usually retain strength. There is often no pain or it is moderate, which distinguishes the condition from polymyalgia rheumatica, where pain and stiffness come first. Weakness increases gradually, over weeks and months, and does not go away with rest.
- Weakness of the muscles of the shoulder and pelvic girdle
- Difficulty climbing stairs and standing up
- Inability to hold arms up for long
- Hand and foot strength is usually preserved
- Pain is moderate or absent
- Gradual increase in symptoms
Skin manifestations of dermatomyositis
The rash often appears before muscle weakness and serves as an important clue. Characteristic features include purple discoloration and swelling of the upper eyelids, red or purple indurated rashes over the knuckles, redness in the neck and upper chest, as well as on the shoulders and back. The skin on the sides of the fingers may crack and peel. The rash worsens after exposure to the sun. Children often develop subcutaneous calcium deposits, which can be felt as dense nodules.
- Purple swelling of the eyelids
- Rash over the knuckles
- Redness of the neck, chest, shoulders
- Peeling and cracks on fingers
- Worse after sun
- Calcium deposits in children
What else can be affected?
The disease is not limited to the muscles of the limbs. Weakness of the muscles of the pharynx causes choking, difficulty swallowing and food getting into the nose; this is dangerous due to the risk of food entering the respiratory tract. The lungs are often affected with the development of inflammation of the lung tissue, which is manifested by shortness of breath and dry cough. Possible joint inflammation, cold white finger syndrome, and heart changes. In adults, especially those over forty years of age, dermatomyositis sometimes accompanies a malignant tumor, so the examination necessarily includes an oncological search.
- Swallowing difficulties and choking
- Lung damage with shortness of breath and cough
- Joint inflammation
- Raynaud's syndrome
- Heart rhythm disturbances
- Association with cancer in adults
Diagnostics
The examination begins with tests that reflect muscle damage: creatine kinase, aldolase, as well as liver enzymes, which increase with muscle damage without liver disease. Next, antinuclear and specific myositis antibodies are determined, which help clarify the variant of the disease and prognosis. Electroneuromyography shows the nature of muscle damage and helps to distinguish it from nerve diseases. MRI reveals muscle swelling and suggests the location for a biopsy, which remains the most accurate method. Additionally, the lungs and swallowing are assessed and an oncological examination is carried out according to age and gender.
- Creatine kinase and aldolase
- Liver enzymes
- Antinuclear and myositis-specific antibodies
- Electroneuromyography
- Muscle MRI
- Muscle biopsy
- Computed tomography of the lungs and swallowing assessment
- Oncology search in adults
Treatment and rehabilitation
The basis of therapy is glucocorticoids, which are prescribed in sufficient doses and then very gradually reduced. To reduce their dose and maintain the effect, drugs that suppress the excessive immune response are additionally used; in severe cases, intravenous immunoglobulin and other methods are used. All regimens are selected by a rheumatologist. Rehabilitation is no less important: in the acute period, gentle exercises are performed, then the load is gradually increased to restore strength and prevent contractures. Skin needs protection from the sun. If swallowing is impaired, the consistency of food and the position when eating are selected.
- Glucocorticoids with gradual dose reduction
- Immunosuppressive drugs as prescribed by a doctor
- Intravenous immunoglobulin for severe cases
- Therapeutic exercise with a gradual increase in load
- Skin protection from the sun
- Correction of nutrition for swallowing disorders
- Prevention of osteoporosis during long-term therapy