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Types

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There are several types of myositis, which include the following:

Polymyositis affects the large muscles of the shoulders, hips, and thighs and sometimes the neck, throat, and upper esophagus. It can cause severe weakness, making it difficult for a person to perform normal daily functions such as getting dressed or climbing stairs. Difficulty with swallowing is common if polymyositis affects the throat and upper esophagus. Onset of symptoms is normally gradual.

Dermatomyositis includes the symptoms of polymyositis, with additional symptoms of patchy or scaly rashes on the skin or scalp, nodules (calcium deposits) under the skin, and areas of discoloration, which appear on the chest, back, eyelids, cheeks, nose, neck, knuckles, knees, and/or ankles. It may be aggravated by sun exposure. Onset of symptoms is normally quick and severe.

Inclusion body myositis normally affects people older than 50 and is characterized by gradually progressing, widespread muscle weakness and atrophy. It typically includes weakness in the wrists and fingers, atrophy in the muscles of the thighs and forearms, and difficulty swallowing. The muscle involvement is typically not symmetrical.

Toxic myopathy is a form of myositis caused by a reaction to certain medications, such as cholesterol-lowering drugs (statins). It can also be caused by an overaccumulation of certain medications such as antimalarials or colchicine, used to prevent gout attacks. Typical symptoms include muscle pain and weakness near the trunk of the body and difficulty swallowing. Toxic myopathy will normally go away if the medication that causes it is discontinued.

Myositis ossificans is a condition of abnormal bone growth within muscle tissue, causing pain and swelling. This rare condition occurs after trauma, surgery, or neurologic injury. When it is caused by an injury, symptoms are normally localized to the affected area. When it is an inherited condition, it is widespread and disabling and can be fatal.

Symptoms

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Symptoms of all types of myositis typically include muscle or joint pain and weakness. You may also feel tired or experience muscle wasting (muscle atrophy). Muscle tenderness does occur but is generally not as severe as other muscle-related conditions, like virus-related myalgias or fibromyalgia. General symptoms may also include fever or difficulty swallowing. Shortness of breath can occur when chest muscles or diaphragm is involved or when the lungs are affected.

Additional symptoms may help determine the specific type of myositis involved. For example, symptoms of polymyositis and dermatomyositis may include heart and lung-related complications. In dermatomyositis, symptoms may include patchy, purplish rashes on the neck, scalp, shoulders, and face and swelling of the eye or discoloration of the eyelids. If symptoms of myositis improve with cessation of certain medications, this may indicate toxic myopathy.

Lung inflammation, also called interstitial lung disease (ILD), can be associated with various forms of myositis. Chest X-rays and other studies may be useful in evaluation of ILD.

Causes and Risk Factors

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We do not know exactly what causes myositis but it may be a combination of factors. Myositis is a disorder of the body’s immune system, which means that antibodies and immune cells inappropriately attack healthy muscle tissue. Researchers believe that autoimmune disorders may have genetic and/or environmental causes, such as viruses.

The risk factors for myositis vary, depending on the form of the disease. For example, women are significantly more likely than men to develop polymyositis or dermatomyositis, whereas men develop inclusion body myositis more frequently than women.

Diagnosis

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Based on your symptoms, we will want to review your medical history and perform a physical examination. Specifically, we will focus on areas of muscle pain or tenderness and swelling in joints. Testing muscle strength, and looking for rashes or bumps on the skin can also help us diagnose myositis. We may recommend the following types of diagnostic tests:

Blood tests. These usually include a creatine kinase (CK) and aldolase test, which measures blood levels of certain enzymes found in muscle tissue. High levels of these enzymes in the bloodstream may indicate muscle damage. Additional blood tests may include a test for antibodies and tests to measure inflammation levels in the body, such as an erythrocyte sedimentation rate (ESR) test.

Muscle biopsy. A tissue sample may be taken from an affected muscle and examined under a microscope to determine if muscle fibers are inflamed or damaged. This is helpful to confirm the diagnosis of myositis and to identify the specific type of myositis present. This test is currently considered the gold standard test for myositis.

Electromyogram (EMG) and nerve conduction study. This is a special test during which a very thin needle is inserted into a muscle and stimulates it with an electrode. The needle is connected to a machine that registers muscle response and indicates if there is damage to nerves or muscle fibers.

Magnetic resonance imaging (MRI). MRI is an important diagnostic tool in the evaluation of myositis. An MRI can demonstrate areas of inflammation or swelling (edema) and damage in the muscle. The MRI can sometimes be used to locate a suitable biopsy site but does not replace EMG or a muscle biopsy.

Lung function test and imaging of the chest. Because myositis can cause breathing difficulties, chest X-rays and/or a CT scan of the lungs may be useful in evaluation of ILD. A test of lung function may be done as well. This involves having a person breathe into a tube connected to a machine that measures lung function.

Treatment

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Myositis is normally treated with medication. Physical therapy, lifestyle adaptations, and, in rare cases, surgery may also be part of treatment.

Medications

Myositis may be treated with the following types of medications:

Corticosteroids are the most common type of medication prescribed for myositis. Corticosteroids reduce pain and inflammation by suppressing the body’s immune system response. Commonly prescribed corticosteroid drugs include prednisone (Deltisone, Meticorten) and methyl-prednisolone (Medrol). Corticosteroid therapy is normally very effective in relieving symptoms within a few weeks to 6 months for the majority of people with myositis. Many people experience a complete remission of their condition after a course of corticosteroids. If taken over a long period, however, corticosteroid medication may cause serious side effects such as weight gain, bone loss, high blood pressure, high cholesterol, cataracts, and diabetes. Therefore, we recommend the lowest possible effective dosage for the shortest period of time.

Disease-modifying anti-rheumatic drugs (DMARDs) may be added to the treatment regiment if corticosteroids are not sufficiently effective. Commonly prescribed DMARDs for myositis include azathioprine (Imuran), mycophenolate mofetil (Cellcept), and methotrexate (Rheumatrex). These medications may take several weeks to become effective. In cases of severe or poorly responsive “refractory” cases, other medicines, including cyclosporine, may be used. DMARDs require careful monitoring because they may cause serious side effects, including liver and blood count-related complications, if taken over an extended period of time.

Rituximab. This is a biologic agent given intravenously to treat severe refractory myositis that does not respond to usual treatment. It is given as an infusion once a week for 4 weeks and takes several weeks to produce any benefit. Infection is a possible side effect, related to this medication's ability to suppress a certain part of the immune system.

Intravenous immunoglobulin. If drug therapies are not effective enough, infusions of gamma globulin (also known as immunoglobulin) can reduce inflammation. The infusion process takes several hours and must be done at the clinic on 2 to 5 consecutive days. Depending on how you respond, this treatment may need to be repeated monthly. This form of treatment normally takes effect within a few weeks to a few months.

Nonsteroidal anti-inflammatory drugs (NSAIDs) include prescription drugs such as nabumetone (Relafen) as well as over-the-counter products such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Naprosyn, Aleve). NSAIDs are effective for pain relief and should be used cautiously when used together with corticosteroids. Taken over a long period of time, NSAIDs pose a risk of irritation or bleeding in the gastrointestinal tract.

Surgery

In rare cases of a condition known as myositis ossificans, surgery is performed to remove abnormal bone growth. This is done only if the irregular bone formation is interfering significantly with joint functioning or limiting a person’s mobility.

Lifestyle Management

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If you have myositis, there are some lifestyle changes that can help you preserve your strength.

Take breaks often during the day and do not “push yourself.” When you are tired, try to take a break.

Consider adopting a stress-reduction practice such as meditation or yoga. Warm baths and massages are also good for relaxation and can help relieve discomfort.

Physical therapy

Physical therapy includes range of motion, stretching, and strength-building exercises prescribed or supervised by a physical therapist. Physical therapy can help to relieve pain and stiffness and preserve physical strength and muscle mass.

Once you are on medication for myositis, it is also important to regularly perform the stretching and range of motion exercises. This will help you to preserve the health of your muscles.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If you need to see a rheumatologist, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. We may do diagnostic testing as well. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you call the Appointment and Advice line

• Our call centers are open every day of the year around the clock. If you need advice, we will transfer you to one of our skilled advice nurses (RNs). They can help you determine when you need to be seen and in what location.
• The advice nurse can often start your treatment by telephone depending on the situation and has access to your electronic medical record.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization.  
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the Radiology department. When the results are ready I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

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If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results. 
• View your preventive services to see whether you are due for a routine screening or updated immunization. 
• Manage your family’s health by setting up access to act on their behalf. Learn how to coordinate care for the ones you love. 

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures. 
• Find interactive health tools, videos, and podcasts to help you manage your condition. 
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center. 
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy. 
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.