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  • Writer's pictureRobin R Varghese, PT.

Polymyositis

Polymyositis

Polymyositis is one of a group of rare diseases called the inflammatory myopathies that involve chronic (long-standing) muscle inflammation and weakness, and in some cases, pain. Myopathy is a general term used to describe a number of conditions affecting the muscles.

  • Myositis means inflammation of muscle.

  • Usually it affects muscles that are closest to the trunk.

  • Polymyositis affects skeletal muscles (the type involved in body movement) on both sides of the body.

  • The onset occurs between age 30 and 60.

  • If the condition is accompanied by an inflammatory process that strikes the skin as well, it is called dermatomyositis.

Causes

  • The exact cause of polymyositis is unknown, but the disease shares many characteristics with autoimmune disorders, in which your immune system mistakenly attacks your own body tissues. there are indications that heredity plays a role in the disease.


Risk factors

The risk of polymyositis is higher if one has Lupus, Rheumatoid Arthritis, Scleroderma, or Sjogren's syndrome.


Symptoms


There will be muscle weakness associated with polymyositis and involves the muscles closest to the trunk, such as those in hips, thighs, shoulders, upper arms and neck. The weakness affects both the left and right sides of body, and tends to gradually worsen. In some cases of polymyositis, the distal muscles may also get affected.


Muscle weakness affects both sides of the body. Having this condition can make it difficult to climb stairs, rise from a seated position, lift objects or reach overhead.


Untreated progressive muscle weakness may lead to difficulty doing the following actions:

  • Swallowing

  • Speaking

  • Rising from a sitting position

  • Climbing stairs

  • Lifting objects

  • Reaching overhead

  • Muscle ache: In some cases, muscles ache and are tender to the touch.

  • Fatigue

  • Shortness of breath due to heart and lung involvement.

Some people with polymyositis also may develop:

  • Arthritis

  • Shortness of breath

  • Heart arrhythmias (irregular heartbeats)

  • Congestive heart failure (when the heart is no longer able to pump out enough oxygen-rich blood)


Complications

  • Dysphagia or difficulty in swallowing

  • Aspiration Pneumonia

  • Breathing problems.


How is polymyositis treated?

  • Polymyositis is treated with high doses of corticosteroids as a first course of treatment. Corticosteroids are given because they can effectively decrease the inflammation in the muscles. Corticosteroids do not always adequately improve polymyositis. In these patients immunosuppressive medications are considered.

  • In severe cases of polymyositis, the intravenous infusion of immunoglobulins (IVIG) has been an effective treatment.

  • Given the difference in presentation of symptoms and individual reactions to medications the course of medical management is unique to each patient

Physical Therapy Management

  • Physical therapy plays an important role in the treatment of polymyositis.

  • Among the wide range of clinical manifestations, ones most relevant to physical therapy are muscle weakness, fatigue, and shortness of breath.

  • A key goal of physical therapy is to maintain function and reduce fall risk in PM patients

  • The traditional school of thought was that exercise was safe and effective to improve muscle strength and function in patients with chronic, stable polymyositis, but that it may not be appropriate for patients with active, recent onset inflammatory myopathies.

  • But an exercise program is both safe and beneficial for patients during the recent onset period of the disease.

  • During acute exacerbations it is recommended that patients utilize pharmacological management to control their inflammation prior to starting their exercise program, and limit their physical activity to normal functional mobility.

  • It is important that patients remain active to maintain function, and it is encouraged that they exercise 5-6 times per week.

  • Strengthening exercises should not occur on back-to-back days, but patients must practice “active rest days,” where they focus on ROM, positioning, and relaxation rather than strengthening.

Resistance Training

• Preservation of muscle function • Avoidance of disuse atrophy • Light resistance (be cautious with eccentric activity) • Strengthening of distal musculature, which has the greater potential for strength gains, can contribute greatly to an overall improvement in performance with ADL’s • Open chain exercises utilize less energy than closed chain, but closed chain exercises yield the greatest outcomes with functional mobility. • Energy conservation is key (avoid high resistance open chain or aggressive closed chain exercises

Aerobic Training • Cycle ergometer • Walking


PROM/AAROM/AROM/Stretching • This will help in prevention of contractures.


Aquatic Therapy • Provides ability to mirror functional movements with decreased energy expenditure • Patient can control resistance of water with modified movement • Buoyancy assists with posture and lower extremity muscle weakness • Hydrostatic volume of water increases blood volume in the chest cavity. Patients may experience a significant increase in stroke volume and cardiac output. • Water turbulence increase blood flow to the surface of the skin • Therapeutic benefits with a decreased fall risk.


Patient education • A loss of muscle mass results in weakness and fatigue, which may result in the adoption of a sedentary lifestyle. It is very important that patients remain active to avoid disuse atrophy and further muscle weakness.


While there is no cure for polymyositis, treatment — ranging from medications to physical therapy — can improve your muscle strength and function.


At Valley Healing Hands, we provide the best physical therapy treatment for Polymyositis. Our therapists are highly qualified to plan the right regime for you and help you overcome your difficulties. We believe in the multidisciplinary team work and our aim is to help you manage your pain, improve daily chores and to keep your muscles strong. Our patients are completely satisfied with us . You may learn about what they have to say about us here and get connected to us here. Our patients love us. You too will.


Sources


https://www.mayoclinic.org/diseases-conditions/polymyositis/symptoms-causes/syc-20353208

https://www.physio-pedia.com/Polymyositis

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