Myositis: causes, symptoms, diagnosis, treatment in children and adults

Myositis is an inflammatory process in one or more skeletal muscles. The etiology of the disease is rare. Most often, various infections (ARVI, influenza, chronic tonsillitis) become the cause of myositis. In addition, myositis can occur with autoimmune diseases, due to parasitic infections, exposure to toxic substances, etc. The disease can occur both acutely and chronically. In some cases, the skin is involved in the process. Under certain conditions (local infection), a purulent process in the muscle may develop.

The severity of myositis can vary greatly. The most common myositis - cervical and lumbar - at least once in a lifetime develop in almost all people. Often they remain undiagnosed, since patients take manifestations of myositis for exacerbation of cervical or lumbar osteochondrosis. But there are also severe forms of myositis that require hospitalization and long-term treatment.

Causes of myositis

The first place in the incidence rate is occupied by muscle damage caused by the most common viral infectious diseases (ARVI, influenza). Less commonly, myositis occurs with bacterial and fungal infections. Perhaps the direct effect of microorganisms on the muscles, so the development of myositis due to the action of toxins.

Systemic autoimmune diseases are not the most common cause of myositis, but they cause the development of the most severe forms of the disease. As a rule, the most severe muscle damage occurs with polymyositis, dermatomyositis, and Münheimer’s disease (ossifying myositis). Other systemic diseases (rheumatoid arthritis, scleroderma, systemic lupus erythematosus) are characterized by mild myositis. Among the parasitic infections most often causing myositis are toxoplasmosis, echinococcosis, cysticercosis and trichinosis.

The cause of the development of myositis can be the effect of various toxic substances, both permanent and relatively short-term. So, toxic myositis often develops with alcoholism or cocaine addiction. Unstable muscle damage can occur when taking certain medications (alpha-interferon, hydroxychloroquine, colchicine, statins, etc.). Such lesions are not always inflammatory in nature, therefore, depending on the symptoms, they can be attributed to both myositis and myopathy.

Favorable leaking myositis of mild, less often - moderate severity can occur after hypothermia, injuries, muscle cramps or intense physical exertion (especially in patients with untrained muscles). Pain, swelling and weakness for several hours or several days in the latter case is caused by minor tears in muscle tissue. In extremely rare cases, usually with extreme physical exertion, the development of rhabdomyosis - necrosis of muscle tissue is possible. Rhabdomyosis can also occur with polymyositis and dermatomyositis.

In people of certain professions (violinists, pianists, PC operators, drivers, etc.), myositis can develop due to an uncomfortable body position and prolonged load of certain muscle groups. The cause of purulent myositis can be an open injury with a drift of infection, a focus of chronic infection in the body or local infection due to a violation of hygiene during intramuscular injections.

Classification

Given the nature of the process in surgery, neurology, traumatologists and orthopedics distinguish acute, subacute and chronic myositis, taking into account the prevalence of local (limited) and diffuse (generalized). In addition, there are several special forms of myositis:

  • Infectious non-purulent myositis. It occurs with viral infections (enteroviral diseases, flu), syphilis, brucellosis and tuberculosis. It is accompanied by severe muscle pain and noticeable general weakness.
  • Acute purulent myositis. It is usually a manifestation of septicopyemia or a complication of a chronic purulent process (for example, osteomyelitis), characterized by the presence of purulent and necrotic processes in the muscles. It is accompanied by local edema and severe local pain. Possible increase in body temperature, chills and leukocytosis.
  • Myositis with parasitic infections. It arises as a result of a toxic-allergic reaction. Accompanied by pain, swelling and muscle tension. Perhaps malaise, a slight increase in temperature, leukocytosis. Often it has a wave-like course, due to the life cycle of parasites.
  • Ossifying myositis. It usually occurs after injuries, but it can also be congenital. A distinctive feature is the deposition of calcium salts in connective tissue. Most often, the shoulders, hips and buttocks are affected. It is accompanied by muscle weakness, progressive muscle atrophy, muscle tightening and calcification. The pain is usually unsharp.
  • Polymyositis. Multiple muscle damage. Polymyositis usually develops with systemic autoimmune diseases, is one of the most severe forms of myositis. Accompanied by pain and increasing muscle weakness. In some cases, with such myositis, muscle atrophy and the disappearance of tendon reflexes are possible. In children, it can be combined with damage to the lungs, heart, blood vessels, and skin. In men over the age of 40, in half of the cases there is a simultaneous formation of tumors of the internal organs.
  • Dermatomyositis (Wagner-Unferricht-Hepp disease, Wagner disease). Dermatomyositis is a systemic disease, accompanied by damage to the skin, skeletal and smooth muscles, as well as internal organs.

Symptoms of myositis

Most often, a local process (damage to one or more, but not many, muscles) develops in the muscles of the neck, lower back, chest and lower legs. A characteristic symptom of myositis is aching pain, aggravated by movement and palpation of the muscles and accompanied by muscle weakness. In some cases, with myositis, slight redness (hyperemia) of the skin and slight swelling in the affected area are observed. Sometimes myositis is accompanied by common manifestations: low-grade fever or fever, headache and an increase in the number of white blood cells in the blood. On palpation of the affected muscle, painful seals can be determined.

Myositis can develop acutely or have a primarily chronic course. The acute form can also become chronic. This usually occurs in the absence of treatment or with inadequate treatment. Acute myositis occurs after muscle strain, trauma or hypothermia. Infectious and toxic myositis is characterized by a gradual onset with less pronounced clinical symptoms and a primarily chronic course.

Chronic myositis occurs in waves. Pain appears or intensifies with prolonged static stress, weather changes, hypothermia or overstrain. Muscle weakness is noted. Possible restriction of movements (usually insignificant) in adjacent joints.

Cervical and lumbar myositis

Cervical myositis is the most common of all myositis. It usually develops as a result of a cold, after muscle strain or a prolonged stay in an uncomfortable position. It is accompanied by dull pain, which is often localized on only one side of the neck. Sometimes the pain radiates to the back of the head, to the temple, ear, shoulder, or interscapular region. With movements, the patient with myositis spares the neck, movements in the cervical spine can be somewhat limited due to pain.

Lumbar myositis is also quite widespread. Due to the same localization of pain, patients sometimes confuse it with lyubmago, however, the pain in this case is not so acute, mainly aching, does not decrease at rest, intensifies with movements and pressure on the muscles of the affected area.

Cervical myositis and myositis of the lumbar muscles usually have to be differentiated with exacerbation of osteochondrosis, and lumbar myositis also with a hernia of the corresponding spine. When making a diagnosis, attention is paid to the nature of the pain (aching), increased pain during muscle palpation and the presence or absence of neurological symptoms. To clarify the diagnosis, x-rays of the spine, MRI of the neck, magnetic resonance imaging of the spine or computed tomography can be performed.

It should be borne in mind that sometimes a constant, not too intense aching pain in the lumbar region indicates kidney disease. Therefore, if such pain occurs, you should definitely consult a doctor to evaluate the clinical symptoms, confirm or exclude the diagnosis of myositis and, if necessary, refer the patient to additional tests (blood and urine tests, ultrasound of the kidneys, etc.).

Dermatomyositis and polymyositis

Dermatomyositis belongs to the group of systemic diseases of the connective tissue. It is quite rare - according to foreign researchers, five people per 1 million people are ill. Usually affects children under 15 years of age or people of mature age (50 years and older). Women are twice as likely as men.

The classic manifestations of such myositis are typical symptoms of the skin and muscles. Weakness of the muscles of the pelvic and shoulder girdles, the muscles of the abdominals and flexors of the neck is observed. Patients have difficulty getting up from a low chair, climbing stairs, etc. With the progression of dermatomyositis, it becomes difficult for the patient to hold his head. In severe cases, damage to the swallowing and respiratory muscles is possible with the development of respiratory failure, difficulty swallowing and a change in the tone of the voice. Pain syndrome with dermatomyositis is not always expressed. A decrease in muscle mass is noted. Over time, muscle areas are replaced by connective tissue, tendon-muscle contractures develop.

On the skin side, there is a heliotropic rash (red or purple rashes on the eyelids, sometimes on the face, neck and trunk) and a Gottron symptom (pink or red scaly plaques and nodules along the extensor surface of the small and medium joints of the limbs). It is also possible damage to the lungs, heart, joints, gastrointestinal tract and disorders of the endocrine system. In about a quarter of patients, only muscles appear. In this case, the disease is called polymyositis.

The diagnosis is made on the basis of the clinical picture and the data of biochemical and immunological blood tests. A muscle biopsy can be performed to confirm the diagnosis. The basis of therapy is glucocorticoids. According to indications, cytostatic drugs (azathioprine, cyclophosphamide, methotrexate) are used, as well as drugs aimed at maintaining the functions of internal organs, eliminating metabolic disorders, improving microcirculation and preventing the development of complications.

Ossifying myositis

It is not one disease, but a group of connective tissue diseases. It is characterized by the formation of sites of ossification in the muscles. May occur due to trauma or be congenital, genetically determined. Traumatic ossifying myositis is characterized by a relatively favorable course. Only muscles and articular ligaments in the area of ​​injury are affected. It is treated surgically. The end result of the operation depends on the location and extent of the damage.

Progressive ossifying myositis is a hereditary disease. It starts spontaneously, gradually covers all muscle groups. The course of myositis is unpredictable. Specific prevention and treatment does not yet exist. Death with progressive myositis occurs due to ossification of the swallowing and pectoral muscles. It is extremely rare - 1 sick in 2 million people.

Myositis treatment

Doctors of various fields are involved in the treatment, the choice of a specialist is determined by the cause of the disease. So, parasitological etiology myositis is usually treated by parasitologists, infectious myositis - therapists or infectious disease specialists, traumatic myositis and myositis that developed after significant physical exertion - orthopedic traumatologists, etc. Myositis therapy includes pathogenetic and symptomatic measures. With bacterial damage, antibiotics are prescribed, with parasitic - anthelmintic drugs. With myositis, resulting from an autoimmune disease, long courses of immunosuppressants and glucocorticoids are indicated.

In acute myositis and exacerbation of chronic myositis, the patient is recommended bed rest and restriction of physical activity. With an increase in temperature, antipyretic drugs are prescribed. Analgesics are used to combat pain, and anti-inflammatory drugs are usually used to eliminate inflammation, usually from the NSAID group (ketoprofen, ibuprofen, diclofenac, etc.). With local myositis, warming ointments are effective. The local irritating effect of these drugs promotes muscle relaxation and reduces the intensity of the pain syndrome. Massage is also used (contraindicated in purulent myositis), physiotherapeutic procedures and physiotherapy exercises. With purulent myositis, autopsy and drainage of the purulent focus is performed, antibiotics are prescribed.

Varieties

Myositis is a serious type of disease that is characterized by a negative effect on the human muscles, causing unpleasant pain and sometimes leading to fatal consequences. The following types of inflammatory processes in the muscles are distinguished, depending on their location:

  1. Myositis of the neck,
  2. Myositis of the spinal muscles,
  3. Myositis of the chest
  4. Calf myositis.

Most often, people suffer from cervical myositis, and less often - gastrocnemius. The disease is characterized by the defeat of people of both advanced age, and younger contingent, and also kids. You can protect yourself from the disease, but, first of all, you need to know a maximum of information about it, which the article will tell about.

Myositis of the neck muscles - This is a frequent and widespread malaise among people who primarily affect the cervical muscular system. Cervical myositis is also the most dangerous ailment, since when it is localized, not only the muscles suffer, but the temporal part, the area of ​​the head and cervical vertebrae are also affected. Myositis of the cervical muscles is caused by the negative effect of cold on muscle tissue, which actually leads to their inflammation. But we will talk about the causes of the localization of the disease later.

Myositis of the back muscles also quite frequent human malaise, through which the back is affected. The inflammatory process begins its nucleation on the surface of muscle fibers and spreads to the skin and even bone tissue.

Chest myositis manifests itself in rare cases, but is characterized by spreading to the shoulders, arms, neck.

Calf - The most rare disease, but it entails great problems. Due to damage to the calf muscle, a person is characterized by a manifestation of weakness in the legs up to the impossibility of movement.

Depending on the stage of development of the disease, the following two types of disease are distinguished:

  1. Acute, which is characterized by a sudden lesion of certain muscle groups and is characterized by a painful manifestation of symptoms.
  2. Chronic, manifested due to a prolonged lack of therapeutic measures. Symptoms in a chronic form are less pronounced, but manifest themselves independently (without cause) during a person’s life.

Ossifying type of myositis

Ossifying myositis, which is characterized by the formation of petrification of muscle areas, is also a separate species. As a result of the ossification of muscle areas, their growth occurs, which entails serious ailments. Ossifying myositis is divided into three subspecies:

  1. Traumatic,
  2. Progressive,
  3. Trophoneurotic.

Traumatic ossifying myositis characterized by the speed of localization and the presence of a solid component in the muscle that resembles sarcoma. Traumatic subspecies occurs mainly in childhood and often in boys.

Progressive Ossifying Myositis characterized by the formation during fetal development. Muscle ossification with a progressive subspecies is determined by the duration of the growth of the disease.

Trophoneurotic ossifying myositis it has similar signs with a traumatic appearance and differs only in the reasons for its formation: it arises as a result of disorders of the central and peripheral nervous systems.

Causes of disease

What is myositis, and what types of it are now known, it is still necessary to find out what are the signs of the onset of the disease. Consider the main causes of the ailment in humans.

So, in medicine, the following main reasons are distinguished for which the formation of inflammatory processes in human muscle tissues is characteristic:

  1. Hypothermia of the immediate muscles or the effect of drafts,
  2. Muscle fiber injuries,
  3. Viral diseases
  4. Damage to muscle tissue by parasitic creatures,
  5. Infection in muscle fibers,
  6. Toxic or autoimmune lesion,
  7. Under the influence of frequent stay in one position of the human body,
  8. Constancy and duration of statistical types of muscle loads.

Consider what are the causes of the provocation of the disease inherent in one or another type of this disease.

Cervical myositis often arises due to the influence of cold on the surface of the body. A minor reason for the formation of this species is a cold, muscle strain and an uncomfortable posture.

Spinal myositis arises due to the influence of the following factors:

  • ingestion of infectious or bacterial microorganisms,
  • with osteochondrosis or scoliosis,
  • due to the frequent predominance of heavy physical exertion, overstrain,
  • with edema or hypothermia.
  • Often, myositis of the back muscles occurs during pregnancy, when the fetus grows every day, and the load on the back increases.

Chest myositis arises as a result of the influence of the following factors:

  • injuries
  • pathological abnormalities of connective tissues,
  • rheumatism, scoliosis and arthritis,
  • in case of infection.

The formation of inflammatory processes of the chest through its hypothermia or constant tension is not excluded.

The disease also has the following classification, which is characteristic of the causes of localization of myositis.

  1. The predominance of purulent processes that were triggered by anaerobic microorganisms, staphylococci or streptococci, is called acute purulent myositis.
  2. Viral infections, as well as acute and chronic diseases of an infectious genus, are mainly called infectious myositis.
  3. The causes of the autoimmune disease are referred to as autoimmune myositis.
  4. With diffuse inflammation of the muscle tissue of the whole body, a disease occurs polymyositis.
  5. With the influence of toxic-allergic components on the muscular system parasitic myositis.
  6. With injuries, bruises or sprains, formation is characteristic traumatic myositis.
  7. With a physical or infectious effect on the intercostal muscles intercostal myositis.
  8. The cause of the disease can also be caused by the deposition of calcium salts in the connective tissues, which indicates the disease ossifying myositis.

In addition, such factors as a genetic predisposition, frequent stressful situations and sudden mood swings, as well as ultraviolet radiation, are not excluded. Radioactive radiation in addition to affecting the skin can also cause inflammation of muscle tissue.

Having information about the causes of the ailment, you can try by all means to avoid its localization. In the case of inflammation of the muscle system, the development of an ailment begins, characterized by certain symptoms.

Symptoms of cervical myositis

Myositis of the cervical muscles manifests itself in the form of a predominance of symptoms of dull pain, which often occurs only on one side of the neck. With such pain, it is difficult for a person to turn and raise his head. With the development of the disease, pain spreads, which already radiates to the ear, shoulder, temple and interscapular region. There is also pain in the vertebrae of the cervical spine.

Cervical myositis is also at an early stage of localization caused by an increase in the temperature of the human body, the appearance of chills and even fever. The neck area swells, turns red and becomes hard. During the touch “hellish pain” is felt.

Myositis of the neck can be both chronic and acute. Acute myositis of the neck occurs unexpectedly, for example, due to injury. Chronic develops gradually, and the basis for its development can serve as an acute form.

Symptoms of spinal myositis

If a person has developed myositis of the back, then the symptoms will differ from the previous species. First of all, myositis of the back or lower back has a longer course of the symptoms of the disease. It all starts with a light pulling of the muscles and the predominance of aching character. The muscles are in a sealed state, but when you try to stretch them, dull pain is felt.

With the development of the disease, muscles can often atrophy. Pain can be localized not only in the lumbar region, but also spread throughout the back surface. In such cases, the patient’s spine is affected, resulting in acute pain. With palpation, stiffness and swelling of the spinal muscles can be observed. Often the place of the pain syndrome is accompanied by a color change, the predominant role of which is purple.

Spinal myositis is a consequence of problems with the spine. During the localization of the disease, fatigue, weakness appears, the temperature rises to 37–38 degrees and mild signs of chills.

Symptoms of ossifying myositis

Symptoms of this type are of a special nature due to the fact that foci of inflammation of tissue sites are formed in the deep sections. Ossifying myositis affects the following parts of the body:

With the localization of the disease, a soft, slight swelling arises, reminiscent of feeling the dough. After some time (depending on the nature of the course), ossification of the compaction occurs, which is clearly expressed by signs of pain. This pain makes it clear to the specialist the prevalence of the disease and the reason for the treatment.

If treatment is not started, then the symptoms are aggravated and appear in the form of an increase in swelling and acquiring a rough form. Body temperature rises and chills occur closer to 2-3 weeks after the first symptoms. If the disease turns into a complication, then surgical intervention is necessary, otherwise the inflammation will spread to neighboring organs and ultimately lead to fatal consequences.

Diagnostics

Diagnosis includes, in addition to an anamnesis, the following types of examinations:

  • A blood test for enzymes through which muscle inflammation is determined,
  • A blood test for antibodies, on the basis of which the presence of immune diseases will be determined,
  • MRI, through which the determination of muscle fiber damage,
  • Muscle response is determined by electromyography.
  • A muscle biopsy will also be needed to show the presence of cancer cells.

The main success in getting rid of the disease is considered the time at which the patient with the disease will turn. If an early diagnosis is made, then treatment will be more effective.

Myositis is subject to treatment, but depending on the stage of deepening of the disease, various methods are used. First of all, bed rest and muscle warming will be required, which will help reduce pain symptoms.

Myositis is treated using non-steroidal anti-inflammatory drugs:

Muscle warming can be carried out with ointments:

These ointments, in addition to warming, also reduce muscle tension. Children can be treated at home with Doctor Mom ointment.

If the temperature rises, then antipyretic drugs are used. Mandatory treatment of myositis should be carried out using therapeutic methods. These include:

  • massage,
  • physiotherapy,
  • gymnastics,
  • physiotherapy.

Treatment of myositis of the neck is aimed at relieving pain and removing the cause of the disease. In addition to rubbing the neck with warming ointments, novocaine blockade is prescribed for intolerable pain. When using novocaine, a rapid and effective reduction in pain is observed.

In the case of the most severe type of myositis - purulent, only surgical intervention will be required. The operation includes the formation of an incision on the skin in the area of ​​the focus of inflammation and the removal of pus by installing a special drainage.

It is possible to treat the initial stages of the disease at home, but more complex in the hospital and under supervision. The appointment of antibiotic agents is not excluded in order to be able to overcome the cause of the disease (viruses, infections).

At home, a new type of treatment is carried out - postisometric relaxation. Its essence lies in the tension and relaxation of muscles in a certain period of time. It acts quite effectively.

You can treat the disease at home with improvised means:

  • woolen things
  • quilted jackets,
  • warming inside with herbal teas (chamomile).

Causes and symptoms of myositis


Myositis is an inflammation of one or more skeletal muscles. The disease varies in etiology, symptomatology, nature of the course and localization. Inflammation, as it progresses, can spread to the heart, joints, intestines, skin, and lungs.

The disease is quite rare, so out of 1 million people, only one will suffer from myositis. But this statistic applies to cases where myositis is manifested as a systemic disease, that is, all skeletal muscles are involved in the inflammation process. The most common form of myositis is cervical myositis, it accounts for up to 60% of all cases of inflammation, in second place in frequency of occurrence is lumbar myositis. It is believed that with such varieties of the disease at least once in a lifetime, every person will encounter.

Myositis can affect both adults and children, but in childhood dermatomyositis is more often diagnosed. Dermatomyositis in most cases affects the age group in the range from 1 to 15 years, although it can be detected in adulthood. As for gender differences, women are more affected by dermatomyositis and polymyositis than men. After the age of 50, people are more often diagnosed with fibromyositis.

Currently, myositis is called "office disease", that is, the risk of its development increases with sedentary work. Some myositis may be the result of a profession, for example, inflammation of certain muscle groups in pianists and violinists.

Myositis can manifest itself as an independent disease or be a consequence of other diseases, can occur in a mild form and pass independently after a few weeks, and can have a severe course and disturb a person throughout life.

Types of myositis

It is customary to distinguish the following types of myositis, characterized by various manifestations:

Myositis of the neck. Pain with neck myositis occurs several hours after exposure to a provoking factor. Painful sensations tend to intensify during a person’s attempt to turn his neck or tilt his head. Possible irradiation of pain in the head, on the shoulders, on the back and shoulder blades. The pains do not become weaker after a period of rest, do not leave a person when he is motionless. Perhaps redness of the skin over areas of inflammation. When exposed to cold, the patient's condition is aggravated.

Myositis of the back. Pain tends to intensify in the morning, after a person spends a long time without movement. At night, there is an increase in swelling of tissues, reflex muscle spasms. As a rule, back pains appear several days after exposure to a provoking factor and persist for a long time after its elimination. Any motor activity - inclinations, turns and other movements, accompanied by muscle strain, leads to increased pain.

Myositis of the legs and arms. This type of myositis is rare without the involvement of other skeletal muscles located in other parts of the body. Most often, the muscles of the lower and upper extremities become inflamed with polymyositis. It becomes difficult for the patient to move around, raise his hands up.

Thoracic myositis. Thoracic myositis is quite widespread. The pain syndrome constantly haunts the person, since the patient is not able to limit the movements of the chest cell resulting from breathing.

If myositis of the thoracic section is difficult, then the muscles of the larynx and pharynx are involved in the pathological process. This contributes to difficulties with swallowing, cough and shortness of breath join. It becomes difficult for a person to take a deep breath. In extremely severe cases, respiratory muscles may be involved in the pathological process, followed by pulmonary fibrosis.

Myositis of the eye muscles. Myositis can affect the muscles of one or two eyes. The pain intensifies when trying to look sideways or up. The eyelids swell; they cannot be fully opened. Probably the development of unexpressed exophthalmos. If the disease acquires a chronic course, there is a possibility of developing restrictive myopathy.

Polymyositis. Polymyositis is most often diagnosed in people who are predisposed to systemic diseases. Scientists suggest that viral infections, as well as oncological diseases, can become a jerky mechanism for the development of inflammation. By developing specific antibodies against them, the immune system directs them to fight against their own tissues. A process called rhabdomyolysis begins, characterized by damage to muscle fibers. Rhabdomyolysis is accompanied by an inflammatory process, which tends to spread to adjacent tissues. In this regard, polymyositis is so often accompanied by joint pain, dermatitis and arthritis.

Polymyositis with symptoms of dermatitis is called dermatomyositis. This process begins acutely, it can affect both adults and children. In addition to the main symptoms of myositis, dermatomyositis is characterized by the appearance of rashes. The rash has a purple or lilac color, slightly rises above the skin. There are rashes on the neck, trunk and face.Internal organs with polymyositis are rarely affected, but involvement in the pathological process of the lungs, heart, digestive tract, and endocrine system is not ruled out.

With juvenile dermatomyositis, the child begins to complain of pain in the lower extremities that appears when walking. Particularly painful areas of the leg in the region of the legs. Often the development of an acute form of juvenile dermatomyositis is preceded by a sore throat or catarrhal disease.

Dermatomyositis is two times more often diagnosed in women than in men and refers to systemic diseases of the connective tissue.

Neuromyositis. Neuromyositis is a subspecies of polymyositis, but at the same time both muscles and nerves are involved in the process, which are located in the area of ​​inflammation. With the progression of the disease, inflammation spreads to the distal nerve fibers.

In this case, the patient experiences the following symptoms:

Deterioration of sensitivity (paresthesia), or increase in sensitivity (hyperesthesia).

A feeling of muscle tension.

Decreased muscle strength, decreased muscle tone.

Joint pain.

Painful sensations with neuromyositis tend to intensify, as the disease progresses. Over time, the pain ceases to recede, even when a person is at rest.

Polyfibromyositis. Polyphibromyositis is another subspecies of polymyositis, which manifests itself in the fact that muscle tissue is replaced by connective tissue. This is due to the fact that muscles that are in an inflamed state for a long period of time begin to break down. In their place, scar tissue is formed in the form of nodules that can be felt. If scars form in the tendon area, then the appearance of contractures and the deterioration of muscle mobility are not ruled out.

Symptoms of polyfibromyositis can be:

Compaction of muscles in the area of ​​inflammation.

Abnormal muscle contractions.

Reduced range of motion.

More than 20% of patients complain of difficulty in swallowing food.

Sore muscles, especially with deep palpation.

Polyphibromyositis is characterized by the fact that nodules can appear and disappear on their own, without any treatment. If the process of formation of contractures has started, then muscle deformation occurs, accompanied by severe pain. Most often, this type of disease affects people in old age.

Myositis ossifying. Ossifying myositis is one of the rarest varieties of polymyositis that occurs as a result of a trauma: dislocation, contusion, stretching or rupture of a muscle, or after a bone fracture. So, ossifying hip myositis is often observed in riders, and chest myoitis in fencers. In addition, this kind of disease can be congenital.

Ossifying myositis is a consequence of untreated polyphibromyositis. The scar tissue sites that appeared due to it are transformed into a mass with heterogeneous contents, which is impregnated with minerals and other substances (salts of phosphate acid, calcium, potassium). When there are too many minerals, the process of ossification begins. If the muscles with ossified areas are located in close proximity to the skeletal bones, then the deformation of the latter occurs.

The following symptoms may indicate ossifying myositis:

Deformation of the arms and legs.

The presence of muscle areas with uncharacteristic seals.

The appearance of severe pain, prone to buildup during movement.

During palpation, hard, hard muscle areas are found that are similar in density to the bones. As the disease progresses, a complete loss of limb motor activity is possible.

If ossifying myositis resulting from trauma is characterized by a favorable course, then the hereditary variety of the disease begins spontaneously and is characterized by unpredictability of the prognosis. The death of the patient often occurs from ossification of the pectoral and swallowing muscles.

Lumbar myositis. Lumbar myositis is widespread. Patients often confuse this disease with lumbago, but pain in myositis is less acute. It is aching in nature and does not stop even when a person is at rest. The intensification of pain occurs when pressure is applied to the lumbar region, as well as during movements: bending, turning the body, etc.

Lumbar myositis must be differentiated not only from osteochondrosis, from kidney disease, but also from a lumbar hernia. To do this, the doctor should pay special attention to the symptoms of the disease, conduct an x-ray, MRI or CT.

This type of myositis is most often diagnosed in the elderly and in office workers.

What is the danger of myositis?

The danger of myositis is not only that the disease violates the quality of life of the patient, restricting the freedom of his movements, but also threatens the development of more serious consequences.

Complications of myositis are:

The spread of the disease to adjacent muscles with the involvement of vital organs in the pathological process.

Atrophy of muscle tissue. If the disease progresses and is not treated, then a complete loss of working capacity with the emergence of a need for systematic care is possible.

Ossification of muscle fibers, which can ultimately lead to the death of the patient.

Respiratory and swallowing disorders, if the muscles of the larynx, esophagus, and pharynx are involved in the process of inflammation.

Complications of cervical myositis can be extensive lesions of the ENT organs, followed by shortness of breath and a load on the cardiovascular system.

Purulent myositis often leads to abscesses, phlegmon, which is a threat to human life.

How to treat myositis?

Treatment will primarily depend on the severity of the symptoms of the disease. It can be reduced to taking antibacterial drugs, antiviral agents, immunosuppressants, etc.

The treatment regimen for myositis should be selected individually, taking into account all the clinical manifestations of the disease.

To eliminate the inflammatory phenomena that provoked myositis, it is possible to use immunosuppressive drugs, for example, Methotrexate, Prednisolone, Azathioprine.

If myositis is of a viral nature, then treatment should be aimed at maintaining the body's immune forces and fighting infection, since etiological therapy does not exist. If a bacterial infection has become the cause of muscle inflammation, then antibiotics are advisable.

When myositis occurs while taking medications, then their cancellation is necessary. Muscle fibers usually return to normal after 14-21 days.

Reception of corticosteroids. Hormonal drugs have as their goal the reduction of inflammation. Most often, doctors use prednisone for this. Means such as: Methylprednisolone, Hydrocortisone, Triamcinolone, Betamethasone, Dexamethasone can also be used. Taking large doses of these drugs can reduce the activity of immunity, which will lead to a decrease in inflammation. However, in this case, the risk of infection with other diseases increases. The dose of corticosteroids is calculated in each case individually, it is forbidden to use these drugs on their own.

If a patient with myositis is recommended to take hormonal drugs, he needs to be observed by an ophthalmologist at least once a year. The fact is that these drugs increase the risk of cataracts. A serious complication from taking corticosteroids is bone necrosis, so if there is pain in the skeleton, you should immediately inform your doctor.

Azathioprine and methotrexate. These are two immunosuppressive drugs that are aimed at inhibiting the function responsible for the production of red blood cells and white blood cells. Their intake requires monthly blood control. Side effects are also hair loss, liver dysfunction, vomiting, nausea, and secondary infections.

Plaquenil. The drug helps to relieve inflammation and has an immunosuppressive effect. Most often, it is prescribed for elderly people who suffer from dermatomyositis.

Gamma immunoglobulin. This drug has been used for 15 years to treat a wide variety of diseases. With myositis, it can reduce the level of the enzyme (creatine phosphokinase), which appears in the blood in large volumes due to muscle destruction. This drug is advisable to use for myositis provoked by viruses. This drug can cause many side effects (digestive disorders, aseptic meningitis, fever, headaches), so it is used when other drugs have been found to be ineffective.

Cyclophosphamide. A potent immunosuppressant drug, which is used only in severe cases of the disease. The risk of developing all side effects when taking cyclophosphamide increases.

We should also mention physiotherapeutic methods for the treatment of patients with myositis. They are a prerequisite for the recovery of the patient, and without them the therapeutic course would not be complete. Physiotherapy can increase muscle tone, prevent their atrophy and improve the patient’s well-being.

Physical activity should be present daily. It is worth visiting the pool, since swimming has a positive effect on all muscle groups.

The following expert recommendations should be followed:

Before starting any physical work, muscles need to be warmed up. This will normalize blood flow and accelerate the work of the heart.

You can not strain, all exercises should be performed at the pace that is optimal for a person.

After exercise, rest should follow.

The pace should increase smoothly.

It should be concentrated on the inflamed muscle, in the case when the sore area is too overstressed, it is necessary to stop classes and relax.

At a time when the state of health is severely impaired, the training program should be somewhat simplified.

It is better if the classes will be held in pairs.

There is no specific training scheme for myositis; they are recommended to each patient individually. This takes into account the severity of the disease, the affected area, the age of the patient.

Specialists pay special attention to water aerobics. Regular exercises can quickly restore activity, increase muscle tone.

As for drugs, research is constantly ongoing in this area and new drugs will appear in the near future that will help get rid of myositis more effectively.

As a rule, people with various types of polymyositis most often either completely or partially restore the lost muscle activity and tone. Therapy of fibromyositis does not allow you to completely get rid of the disease, but its progression is significantly slowed when all the doctor's recommendations are followed. Such patients for a long time manage to do without wheelchairs and other mobility aids. Against the background of concomitant diseases, such as oncology and pneumonia, the prognosis is much worse.

Infectious myositis will be more successfully cured, the sooner therapy is started. Therefore, with the first symptoms of muscle inflammation, you should immediately contact a doctor.

About the doctor: From 2010 to 2016 Practitioner of the therapeutic hospital of the central health unit No. 21, the city of elektrostal. Since 2016, he has been working in the diagnostic center No. 3.

Foods Nutritionists Never Eat

10 natural remedies for arthritis, the effectiveness of which is scientifically proven

Acute Infectious Myositis

Currently, it is quite rare. Acute infectious myositis can develop for two reasons:

  1. viruses - after the transferred flu, SARS or other disease caused by the virus. It should be noted that most often myositis forms after enterovirus infection (affecting the intestines), due to its migration through the blood into muscle tissue,
  2. bacteria - any penetration of these microorganisms into the muscles leads to the development of infectious myositis. They can penetrate in the following ways:
    • from the environment due to deep damage to soft tissues (deep cut, open fracture, improperly delivered intramuscular injection, and so on),
    • from an infectious focus in other organs (when bacteria enter the bloodstream or the development of sepsis),
    • from surrounding tissues (with phlegmon of fatty tissue, osteomyelitis).

Acute infectious myositis, as a rule, has a favorable course - recovery occurs within 2 weeks (with the exception of the development of myositis against sepsis).

Interstitial myositis

This is a special form of myositis, which develops due to damage to the connective tissue between the muscles (interstitium). Most often, this is observed with tuberculosis, when mycobacteria (Koch sticks) pass from the lungs, through the blood stream, to other tissues. They settle in the interstitium and form granulomas - dense volume formations of pathogens and immune cells. An inflammatory reaction from the connective tissue passes to the surrounding muscles and myositis develops.

Traumatic ossifying myositis

This myositis can develop after any limb injury (fracture, dislocation, penetrating wound, and so on) due to which a hemorrhage in the muscle tissue has occurred. If the blood does not break up within 7-10 days, a ossification site is gradually formed in its place, which constantly injures the muscle and causes its inflammation.

"Typical" traumatic myositis

Professional sports are often the cause of myositis. Typical localizations are:

  • outer thigh - soccer players,
  • shoulder - gymnasts,
  • buttocks and inner thighs - riders,
  • the front surface of the thigh and lower leg are hockey players.

Myositis for parasitic infections

Some types of parasitic worms can spread throughout the human body and multiply in muscle tissue, leading to its inflammation. Several parasitic pathogens of this form of myositis are reliably known: trichinella (disease - trichinosis), pork tapeworm (cysticercosis), echinococcus and bovine tapeworm (disease - teniarinhosis).

Polymyositis and dermatopolymiositis

These forms are very similar to each other, the only significant difference is that with dermatopolymiosis, along with the muscles, the skin is severely affected. The exact cause of the development of these diseases has not been elucidated, but the role of heredity has been proved. With certain characteristics of the immune system, lymphocytes can “make mistakes” and produce antibodies to normal body tissues (this is called an autoimmune process).

Juvenile dermatomyositis

The course of this form is very similar to classic dermatomyositis. The difference lies in the age of the patients (the juvenile form affects children from 5 to 15 years) and the outcome - the disease is more severe and more often there is ossification (ossification) in the muscles. Myositis of the neck is considered a typical localization.

Professional myositis

In the International classification of diseases of the latest revision, this species is not allocated separately, since it is traumatic myositis. However, occupational therapists separate it from others. For those employees of state organizations whose profession is associated with daily physical activity (and those suffering from myositis), social benefits are also provided for in the organization of work (increasing the number of breaks, reducing the number of shifts, switching to work with less workload).

Symptoms of acute infectious myositis

This is the most favorable form of the disease. As a rule, it is preceded by symptoms of influenza or other acute respiratory viral infections:

  • fever,
  • decreased / lack of appetite,
  • weakness,
  • local symptoms (runny nose, sore throat or nose, cough of any nature, and so on).

After their disappearance (within 1-2 days), the initial manifestations of myositis of the muscles of the arms and legs appear: weakness or heaviness, pain, the same on both sides. As a rule, they are more pronounced in the shoulders and hips than in the more distant parts of the limbs (feet / wrists).

The disease progresses extremely rapidly. For several days (in severe cases for one), the symptoms of myositis of the muscles of the back, chest and neck join. The patient becomes completely motionless. A hallmark of the disease - reflexes (knee, ulnar, and so on) are fully preserved. Pain syndrome is also pronounced - any palpation of the muscles causes suffering to the patient.

How to check knee reflex at home?If you do not have a rubber mallet in your house or apartment, then you can use the palm edge for this purpose. Before checking the reflex - make sure that the patient’s hand or foot is completely relaxed. The reflex from the knee is most conveniently called from the “foot to foot” position - for this it is necessary to strike an average force 2-4 cm below the patella (on the quadriceps tendon, which can be felt with the hand).

How quickly muscle damage develops - it also passes quickly. After losing the ability to move, after 6-10 hours (rarely up to 24 hours) without treatment, myositis of the neck muscles begins to disappear. On average, all symptoms regress in 2–3 days. In severe cases, the patient is not able to get out of bed for more than a week - with this course, muscle damage can last up to 2-3 weeks.

Symptoms of interstitial myositis

Most often, this form develops against a background of tuberculosis or syphilis. The disease is chronic in nature, often proceeds without acute symptoms and slowly progresses. It is characterized by atypical localization. For example, in such patients myositis of the thoracic or cervical region more often appears, without damage to the muscles of the limbs.

The following symptoms are characteristic of interstitial myositis:

  • drawing pains of medium or low intensity, which have a specific location and do not migrate,
  • when palpating, it is possible to determine not only muscle soreness, but also limited areas of compaction,
  • the patient rarely feels severe weakness in the affected muscles. As a rule, muscle functions are preserved and movements are limited slightly.

In addition to the symptoms of myositis in patients, there are signs of the underlying disease, which must be paid attention to during diagnosis. With tuberculosis, this is a violation of normal breathing (cough with sputum, shortness of breath) and general weight loss. Syphilis in the first period is manifested by local symptoms in the genital area (hard chancres in the form of seals or ulcers).

Symptoms of traumatic ossifying myositis

For a long time after receiving an injury (several months - a year), ossifying myositis can proceed secretly. Often, patients seek medical help after finding a dense area on their leg or arm, which in density resembles bone. Pain can be expressed in different ways - it depends on the location and size of the formation. If it lies more superficially, it harms muscle tissue more and causes pain. When located closer to the bone, the patient may not experience discomfort.

Muscle weakness is rare in traumatic myositis. Common symptoms (fever, weight loss, decreased / lack of appetite) are also absent.

Symptoms of polymyositis

Polymyositis can develop in different ways. In a younger group of the population (up to 20-25 years), it often begins acutely. The patient feels sudden weakness and pain in the muscles of the upper or lower extremities, there may be general symptoms: a slight fever (up to 38 ° C), headache, lack / loss of appetite. Older people are characterized by the erased onset of polymyositis, which is manifested by muscle pain in the arms or legs.

Subsequently, the pains in the weakened muscles join. As a rule, they are of a pulling nature, of medium intensity, extending to the entire surface of the affected muscle. With palpation and physical exertion, the pain syndrome intensifies.

If the patient receives adequate treatment, the disease progresses very slowly. Signs of cervical myositis, damage to the pectoral or scapular muscles can join. Impaired function of the hands and feet develops only in 5-10% of cases.

The appearance of additional symptoms is possible:

  • slight peeling, cracking, redness of the skin over the affected muscles,
  • joint pains that are transient in nature (appear with different localization and quickly disappear with treatment),
  • difficulty breathing (shortness of breath with prolonged physical work or walking), due to weakness of the diaphragmatic muscle.

More often than not, polymyositis does not lead to life-threatening conditions.

Symptoms of dermatomyositis

The first symptom of dermatomyositis is most often a skin rash over certain muscles (usually on the shoulders, shoulder blades, hips and buttocks). The rash can also spread to the joints, neck and face (upper eyelids, nose wings). It has a characteristic appearance:

  • red or bright pink
  • rises above the surface of the skin (less often in the form of flat, smooth spots of a round shape),
  • the rash is constantly peeling.

After that, weakness and muscle pain gradually appear. In general, the subsequent course of dermatomyositis is similar to polymyositis. A hallmark may be the appearance of Raynaud's syndrome - the constant pallor of the hands and a feeling of "cold" in them.

Laboratory

  • General blood test - in acute purulent (infectious) myositis, an increase in the number of leukocytes, neutrophils and ESR is noted. Parasitic myositis provokes an increase in the number of eosinophils,

Normal indicators:
white blood cells - 4.0-9.0 * 10 9 / 1l,
neutrophils - 2.0-5.5 * 10 9 / 1l (47-72% of the total number of leukocytes,
Eosinophils - 0.02-0.3 * 10 9 / 1l (0.5-5% of the total number of leukocytes).

  • Biochemical blood test - pay attention to the level of KFK fraction MB (creatine phosphokinase enzyme), an increase in which indicates damage to muscle tissue, C-reactive protein, which is a sign of autoimmune inflammation,

Normal indicators:
KFK-MV - 0-24 U / L, CRP - 0.78-5.31 ng / ml

  • Serological blood test (determination of antibodies in the blood) - the appearance of "myositispecific antibodies" is a reliable sign of autoimmune inflammation.

Instrumental

  • EMG (electromyographic study) - this method has a small diagnostic value, since it can only determine the presence of muscle weakness (or its replacement with connective tissue). Other methods must be used to determine the cause.
  • Fluorography - for the diagnosis of tuberculous (interstitial) myositis,
  • X-ray of the affected area is also an uninformative diagnostic method, which is necessary to exclude osteochondrosis and osteoarthrosis. With myositis, changes in the joints in the pictures are not detected. In the projection of the muscle, some dense calcifications can be detected, which can help in the diagnosis of ossifying myositis. In rare cases, on radiography of a limb (arms or legs), parasitic cysts can be found, which is the absolute sign of parasitic myositis.

To determine the form of myositis, it is necessary to evaluate the patient's condition and the data of diagnostic measures in a complex.

The treatment of myositis is determined by the form of the disease. For successful therapy, it is necessary to stop / delay the inflammatory process in the muscles, eliminate its cause and provide adequate pain relief to the patient in order to improve the quality of his life.

Treatment of acute infectious (purulent) myositis

The main thing with this form of myositis is to timely eliminate the cause of the disease. If the formation of a purulent focus (phlegmon or abscess) has not yet occurred in the muscle, then you can limit yourself to the appointment of antibiotics:

  • Penicillins (Amoxicillin, Carbenicillin, Ampicillin) - if the patient did not take any antibacterial drugs 3 months before the disease,
  • Protected penicillins (Amoxiclav) - if the patient has taken penicillins in the next 3 months,
  • Macrolides (Azithromycin, Erythromycin) - the best option to exclude the immunity of bacteria to penicillins (including protected ones). For the treatment of myositis in a child under 5 years old, it is preferable to use Josamycin, an antibiotic that has a minimal amount of side effects.

The appointment of one of these drugs can cope with a bacterial infection, which is the cause of myositis. To improve the general condition of the patient with severe intoxication (fever over 38 ° C, severe weakness, lack of appetite, and so on) recommend:

  • intravenous drip infusion (dropper) with saline (sodium chloride) in a volume of 1.5-2 liters,
  • heavy alkaline drink (mineral waters of Essentuki, Naftusya, Arzni),
  • NSAIDs in combination (paracetamol, solutions of "Antigrippin", "Coldrex", "Teraflu").

When forming an abscess / phlegmon, surgical intervention is necessary to eliminate the purulent focus.

Treatment of dermatomyositis and polymyositis

The main reason for the development of these forms of myositis is the “error” of the body's immunity (autoimmune process). Therefore, patients need to reduce the function of the immune system. For this, glucocorticosteroid hormones are prescribed in the form of “Prednisolone” or “Methylprednisolone” preparations. The dose is selected individually and constantly adjusted, depending on the effect of therapy, therefore, constant monitoring by a doctor is necessary.

Cytostatics or glucocorticosteroids? Currently, there are various schemes for starting treatment. In the first case, all therapy is carried out with hormones (prednisone), starting with large doses and gradually decreasing to supportive doses (for continuous use). In the second - the first drug uses cytostatic (a drug that inhibits the growth of immune cells), which has more side effects, but better efficacy. The doctor can use one of these schemes, since there is no unambiguous decision on the treatment of these forms of myositis.

On average, the effect of treatment occurs 4-6 weeks after the start of Prednisolone. If muscle strength returns to the patient, and the pain disappears, they leave the minimum dose for a lifetime intake. If symptoms persist, they increase doses or switch to cytostatics (Methotrexate, Azathioprine, Cyclosporin).

Treatment of traumatic ossifying myositis

It is proved that conservative treatment has no effect on the course of this form of myositis. Therefore, it is necessary to take a wait-and-see tactic - wait until the bone formation is finally formed and determine whether it prevents the patient from leading his usual lifestyle. If the patient needs to get rid of him, surgical removal of the ossificate is performed. Indications for surgery:

  • damage to the nearest joint
  • compression of a large nerve / vessel,
  • regular muscle trauma.

The prognosis after treatment is favorable; there is no relapse of the disease.

Treatment of occupational myositis

For the treatment of occupational myositis, an integrated approach is used, which is based on a combination of physiotherapeutic procedures with pharmacological drugs. Currently, patients are advised to conduct the following activities:

  • warming the affected muscles and improving their blood circulation (paraffin baths, galvanic currents, UHF) - has a good effect on myositis of the back,
  • spa treatment - preferably at mineral springs or with the possibility of taking radon baths.

  • Vitamin B intake6 (pyridoxine) and B12 (folic acid)
  • NSAIDs (Diclofenac, Ketorolac, Ibuprofen and so on) to eliminate pain.

Myositis is a disease that affects one of the most important tissues in the body - muscle. A large number of species makes it difficult to diagnose, but laboratory and instrumental methods of examination can determine the specific type of myositis in the early stages of the disease. Treatment should be selected individually for each patient, depending on the form, severity of symptoms and the course of the disease. It is aimed not only at reducing symptoms, but also at eliminating the cause. If doctors manage to complete both stages of therapy in full, the patient will be able to forget about myositis forever. Unfortunately, some of the forms of the disease cannot be completely cured, but even with them, one can maintain a decent quality of life for the patient.

Watch the video: Myositis Inflammatory Myopathy Treatment (January 2020).