Treatment of Dermatomyositis (Polymyositis)

Polymyositis and dermatomyositis — are related autoimmune diseases in which inflammation affects the muscles and gradually causes muscle weakness. In dermatomyositis, in addition to the muscles, the skin is involved in the process, therefore characteristic rashes may appear. In polymyositis, the main manifestations are usually weakness and decreased muscle endurance.

According to MedlinePlus, dermatomyositis and polymyositis are separate forms of myositis — inflammation of the muscles, which may occur due to autoimmune processes. Such diseases require careful diagnosis, since their symptoms may resemble neurological, endocrine, infectious and other rheumatological pathologies.

At the medical center «Oxford Medical», patients can undergo the necessary examination, receive a consultation with a rheumatologist and an individual treatment plan. Timely consultation helps assess the activity of inflammation, reduce the risk of complications and select therapy according to the form of the disease and the patient’s condition.

The exact cause of the development of dermatomyositis and polymyositis has not been finally established. It is believed that these diseases occur due to disruption of the immune system, when it mistakenly attacks the body’s own tissues. As a result, inflammation of the muscles is formed, and in dermatomyositis — also of the skin.

Factors that may be associated with the development of the disease include:

• hereditary predisposition to autoimmune diseases;

• disorders of immune regulation;

• previous viral or bacterial infections;

• exposure to ultraviolet radiation;

• taking certain medications;

• concomitant oncological processes.

In most cases, it is impossible to name one factor that exactly caused the disease.

For dermatomyositis, violet-red rashes on the eyelids, spots or papules on the finger joints, redness in the area of the neck, shoulders, upper part of the chest or back may be characteristic. Sometimes skin manifestations appear earlier than noticeable muscle weakness, therefore the patient may first consult a dermatologist.

In polymyositis, weakness itself comes to the foreground. A person may notice that it is harder for them to lift objects, walk for a long time, get up or keep their arms raised. Unlike ordinary fatigue, such weakness does not pass completely after rest and may gradually progress.

Doctors of «Oxford Medical» recommend consulting a doctor if muscle weakness persists for several weeks, gradually increases or is combined with rashes on the skin. Such symptoms require diagnosis, since early initiation of therapy helps reduce the risk of damage to internal organs.

If difficulty breathing, cough, chest pain, interruptions in heart function or difficulties during swallowing appear, it is necessary to consult a doctor in the near future. Such manifestations may indicate systemic damage and require additional examination.

Diagnosis of dermatomyositis and polymyositis begins with a consultation with a rheumatologist. The doctor conducts an examination and assesses the presence of complaints that may indicate the systemic course of the disease.

To clarify the diagnosis, the following may be prescribed:

• general and biochemical blood tests;

• determination of the level of creatine phosphokinase and other muscle enzymes;

• immunological tests, in particular studies for specific autoantibodies;

• electromyography to assess muscle function;

• biopsy of a muscle or skin, if it is necessary to confirm the nature of inflammation;

• additional examinations of internal organs in the presence of corresponding symptoms.

According to the criteria EULAR/ACR, during the assessment of idiopathic inflammatory myopathies, the age of disease onset, the nature of muscle weakness, skin manifestations, laboratory indicators and results of additional studies are taken into account. It is the combination of these data that helps distinguish dermatomyositis, polymyositis and other forms of myositis.

If there is suspicion of lung damage, the doctor may prescribe CT of the chest organs. Such an examination helps assess the condition of lung tissue and detect interstitial changes that sometimes accompany inflammatory myopathies.

In the presence of complaints of chest pain, swelling or shortness of breath, cardiological examinations may be needed. In particular, ECHO allows assessing heart function, the condition of valves and the contractile function of the myocardium.

Treatment methods are selected individually. The tactics depend on the form of the disease, the severity of muscle weakness, the activity of inflammation, the presence of skin manifestations, as well as damage to internal organs.

Treatment may include:

• anti-inflammatory hormonal medications — for rapid reduction of active inflammation in the muscles;

• immunosuppressive therapy — for suppression of excessive activity of the immune system and prevention of exacerbations;

• biological or targeted medications — in severe course of the disease or insufficient effectiveness of standard therapy;

• therapeutic physical exercises and physical rehabilitation — for gradual restoration of muscle strength after reduction of active inflammation;

• local treatment of the skin in dermatomyositis — anti-inflammatory agents, special care and protection from the sun.

The doctor selects therapy not according to a universal scheme, but according to the clinical situation. In each patient, the treatment protocol may differ: someone first of all needs to quickly reduce the activity of inflammation, and someone — long-term maintenance therapy and gradual restoration of muscle strength.

Doctors of «Oxford Medical» recommend not stopping treatment independently after the first signs of improvement. In inflammatory myopathies, reduction of weakness or rashes does not always mean complete fading of inflammation, therefore control tests and regular observation are important.

Without timely diagnosis and treatment, dermatomyositis and polymyositis can lead to persistent muscle weakness, impaired motor activity and damage to internal organs. The risk of complications depends on the activity of the disease, the rate of progression, the patient’s age and the presence of concomitant diseases.

Possible complications:

• pronounced decrease in muscle strength;

• difficulties during walking, climbing stairs and self-care;

• swallowing disorder;

• aspiration pneumonia when food or liquid enters the respiratory tract;

• damage to the lungs;

• disruption of heart function;

• calcifications in soft tissues, more often in juvenile dermatomyositis;

• increased risk of some oncological diseases.

It is especially important not to ignore swallowing disorder, shortness of breath, chest pain, sharp increase in weakness or the appearance of new systemic symptoms. Such manifestations require repeated assessment of the condition and correction of treatment.

Timely therapy helps reduce the activity of inflammation, slow the progression of the disease and reduce the risk of complications. In many patients, provided that treatment is correctly selected, it is possible to control symptoms.

There is no specific prevention, since the exact mechanisms of the development of these diseases have not been fully clarified. At the same time, patients with an already established diagnosis can reduce the risk of exacerbations and complications if they are regularly monitored by a doctor and follow the prescribed treatment.

To control the disease, it is recommended:

• not to interrupt therapy without consulting a doctor;

• to undergo control tests within the determined timeframes;

• to avoid excessive physical overload during active inflammation;

• to gradually restore physical activity after stabilization of the condition;

• to use sunscreen cream in dermatomyositis;

• to treat infectious diseases in a timely manner.

It is important for patients with dermatomyositis to protect the skin from the sun, since ultraviolet radiation can intensify skin manifestations. It is recommended to use sunscreen products, wear closed clothing during periods of active sun and avoid prolonged stay under direct rays.

Doctors of «Oxford Medical» recommend not waiting for a pronounced deterioration in well-being. If weakness returns, new rashes appear, shortness of breath, chest pain or difficulties during swallowing occur, it is necessary to consult a doctor earlier than the planned control examination.

The cost of treatment depends on the activity of the disease, the necessary scope of diagnostics, the number of consultations and the individual therapy scheme. In some cases, a consultation with a rheumatologist, laboratory tests and observation are sufficient, in others additional examinations and treatment procedures may be needed.

You can preliminarily familiarize yourself with the prices for doctors’ consultations here. During the appointment, the doctor will assess the symptoms, examination results, determine further tactics and orient you regarding the cost of the necessary medical services. To make an appointment for a consultation at a convenient time for you, contact the contact center or use the online appointment form on the website.

The information is of an introductory nature and does not replace a doctor’s consultation.

Sources:

• MedlinePlus
• European Alliance of Associations for Rheumatology
• US National Library of Medicine