What is polymyositis?

A person with polymyositis has inflammation of the muscles, resulting in muscle weakness. The cause
of polymyositis is unknown. Polymyositis may result from an abnormal immune system, which
normally fights infection. The immune system mistakenly attacks normal muscle tissue, causing
inflammation and breakdown of the muscle cells. The cause of the abnormal immune system in
polymyositis is unknown.

What are the symptoms of polymyositis?

The most common symptom of polymyositis is muscle weakness. Initial symptoms of polymyositis
include arm weakness, leg weakness, and fatigue. Additional symptoms of polymyositis may include
difficulty swallowing, diminished voice, hand tremor, muscle pain, muscle swelling, and joint pains.

How does the doctor treat polymyositis?

Treatment for polymyositis may include oral corticosteroids, medications that suppress the immune
system, regular exercise, and physical therapy.

Polymyositis Incidence
Facts about polymyositis:

 About 1 out of 200,000 people in the US develop polymyositis each year.

 It is most common in people between the ages of 50 and 70.
 Women develop this condition almost twice as often as men.

The most common symptom of polymyositis is muscle weakness.

Initial symptoms of polymyositis include:

 Arm weakness (bilateral):

o Occurs in both shoulders or both upper arms
 Leg weakness (bilateral):
o Occurs in both hips or both thighs

Additional symptoms of polymyositis may include:

 Fatigue
 Malaise
 Difficulty speaking
 Difficulty swallowing
 Difficulty walking
 Hoarse voice
 Hand tremor
 Muscle aches:
 o Arm pain (bilateral)
o Leg pain (bilateral)
 Muscle swelling
 Muscle tenderness
 Joint pains

 Difficulty breathing during exertion

The evaluation of polymyositis begins with a history and physical examination.

Physical findings in someone with polymyositis may include:

 Generalized muscle weakness:

o Arm weakness (bilateral)
o Leg weakness (bilateral)
 Muscle tenderness

A muscle biopsy is required to make the diagnosis of polymyositis.

Tests that may be used to evaluate polymyositis include:

 Muscle enzyme levels:

 o Aldolase

o Creatine phosphokinase

o Lactate dehydrogenase level (LDH)

 Electromyogram:
 Nerve conduction studies
Treatment for polymyositis may include oral corticosteroids, medications that suppress the
immune system, regular exercise, and physical therapy.

Specific treatment for polymyositis may include:

 Oral corticosteroid medications:

o Prednisone
o Medrol
 Medications that suppress the immune system:
o Azathioprine (Imuran)
o Methotrexate (Rheumatrex)
o Chlorambucil (Leukeran)
o Cyclophosphamide (Cytoxan)
o Cyclosporin (Sandimmune)
 Exercise plan developed by your doctor
 Physical therapy for polymyositis

Home care for polymyositis includes:

 Follow an exercise plan developed with your doctor.

 Stretching exercises for polymyositis
 Take your medications as directed:
o Don't skip doses of your medication. This makes them less effective.
o Avoid running out of your medication. Refill your prescriptions early.
o Don't stop taking your medication just because you feel better.
o If you feel worse, talk to your doctor before you stop your medication.
o Be aware of the common side effects that may be caused by your medication.

 Acetaminophen for pain

  Nonsteroidal anti-inflammatory medications for pain:

o Ibuprofen (Motrin, Advil, Nuprin, NeoProfen)

o Ketoprofen (Actron, Orudis, Oruvail)
o Naproxen (Anaprox, Naprosyn, Aleve)

Medications commonly used to control pain and inflammation in adults with polymyositis
include:

 Acetaminophen
 o Controls pain, but has no anti-inflammatory properties
 Nonsteroidal anti-inflammatory drugs:
o Aspirin
o Ibuprofen

o Naproxen
o Ketoprofen
 Narcotic pain medications:
 o Require a doctor's prescription
o Generally reserved for moderate to severe pain or severe pain

Acetaminophen

 Acetaminophen decreases fever and pain, but does not help inflammation.
 Adult dosing is 2 regular strength (325 mg) every 4 hours or 2 extra-strength (500
mg) every 6 hours.
 Maximum dose is 4,000 mg per day.
  Avoid this drug if you have alcoholism, liver disease or an allergy to the drug. See the
package instructions.
 Common brand names include Tylenol, Panadol, and many others.

Aspirin

 Aspirin decreases pain, fever and inflammation.

 It is a nonsteroidal anti-inflammatory medication (NSAID).
 Adult dosing is two regular strength (325 mg) every 4 hours with food.
 There are numerous products that contain aspirin.
 Follow the package instructions and NSAID precautions (below).

Ibuprofen

 Ibuprofen decreases pain, fever and inflammation.

 It is a nonsteroidal anti-inflammatory medication (NSAID).
 Adult dosing is 200-400 mg every 4-6 hours.
 Do not exceed 1,200 mg per day without a doctor's recommendation.
 Brand names include Advil, Motrin and Nuprin.
 Follow the package instructions and NSAID precautions (below).

Naproxen

 Naproxen decreases pain, fever and inflammation.

 It is a nonsteroidal anti-inflammatory medication (NSAID).
 Adult dosing is 200 or 220 mg twice a day with food.
 Do not exceed 500 mg per day.
 Its brand name is Aleve.
 Follow the package instructions and NSAID precautions (below).

Ketoprofen

 Ketoprofen decreases pain, fever and inflammation.

 It is a nonsteroidal anti-inflammatory medication (NSAID).
 Adult dosing is 12.5 mg every 4-6 hours with food.
 Do not exceed 75 mg per day.
 Its brand name is Orudis KT.
 Follow the package instructions and NSAID precautions (below).

NSAID Precautions

 Avoid using alcohol when taking any of these medications.

  Do not mix prescription and non-prescription NSAIDS unless directed to do so by
your doctor.
 NSAIDS can interact with other blood thinners, such as Coumadin, and cause
bleeding complications.
 Ask your doctor before using an NSAID if you are pregnant or breastfeeding.
 Ask your doctor before using an NSAID if you have a history of:
o Allergy to aspirin
o Asthma
o Peptic ulcer disease
o Stomach ulcers
o Esophageal ulcers
o Bleeding problems
o Liver disease
o Kidney disease

The successful treatment of polymyositis requires your participation. Here are answers to
some important questions.

Do you have control over your health and wellness?

Many people believe they have no control over their health and wellness. Many ignore
personal health decisions or simply leave them to their doctors, relatives, or friends. In
reality, you have the greatest potential to determine your relative health.

How is this possible? Do people really have control of their own health? The biggest killers
are heart disease and cancer. Although many of these diseases seem to strike at random, our
lifestyle choices greatly influence personal risk.

How can you participate in your health care?

To participate you must:

 Learn to take responsibility for your own health.

 Learn to partner with your doctor.
 Learn how to make active decisions about your health.

How can you learn what you need to know?

 Educate yourself.
 Be skeptical: Learn to separate fact from fiction.
 Billions of dollars are spent each year marketing dietary supplements, vitamins, and
new medical treatments. Much of this is unnecessary and wasteful.
 Be careful about where you get your health information.
o Some of the best sources for health information on the web are professional
societies and non-profit organizations.
o Ask your doctor what he or she recommends.
 Examine the credentials of the authors.
 o If you are reading about symptoms and disease, your best source is a licensed
physician.
o Pay attention to when the content was last updated.
o Make sure the person is not just trying to sell you something.

Important questions you need to answer:

 What things in your control can increase your risk for disease?
 What can you do to decrease this risk?
 What are vaccines and how can they help you?
 How do your lifestyle choices increase your risk for disease?
 How can you reduce stress?
 What minor health problems can you treat at home?
 When is a medical problem "serious"?
 When should you call the doctor?

How can you find the right doctor?

Key points:

 Everyone should have a primary care physician or family doctor. A primary physician
is usually a family practitioner, internist, or pediatrician.
 Establish a relationship in advance with your doctor.
 Make sure you are comfortable with your primary care physician.
 The internet contains many resources where you can do research to locate the doctor
that is best for you.
 You may wish to schedule a brief visit with the doctor to see if he or she is right for
you.
o Be open-minded, and allow your doctor to know you well. This will improve
communication.

Important information you need to make your decision:

 Physician credentials:
o Internship and residency training is usually best from respected institutions,
universities, and major hospitals.
o Look for board certification in the specialty.
o Ask about membership in medical societies.
 Community and professional reputation are also important.
o Are other patients happy with the doctor?
o Has the doctor been disciplined by hospitals or agencies?
o How long has the doctor been in practice?
o In general, more than a few malpractice suits over a 5-10 year period should
trigger caution.
 Does the doctor communicate well? Are your questions answered during busy times?
 Does the doctor welcome you to help make decisions about your care?
  Is the doctor available when you need care?
 What is the doctor's after-hours coverage?
 Is he or she a member of a large group?
o Do the doctors' cross-cover one another?
 Where do they admit patients?

What is shared decision making?

You and your doctor must work together to jointly decide the best course of action to manage
your health. This process is called "shared decision making". Your doctor becomes a guide
and teacher and helps steer you toward the best treatment. Most doctors welcome this
partnership. You must learn about your illnesses for shared decision-making to work.

For any recommended test, medication, or surgery, remember to ask:

 How will this help me?

 How much will it cost?
 Is it covered by your insurance?
 What are the potential side effects and risks?
 What are my alternatives?

For tests, remember to ask:

 Is it done in the office or at another facility?

 Is it painful?
 How will the results of this test influence my care?

For surgery or other procedures, remember to ask:

 How long will it take to heal?

 How many cases has the doctor done?
 What would your doctor do if he or she were the patient?
 Where is it done?
 Who will perform it?
 What are the doctor's qualifications?

What should you expect?

Shared decision making becomes impossible if you do not know what to expect from your
doctor.

The American Hospital Association has published a "Patient's Bill of Rights" that is a good
guide. It states that you have the right:

 To be spoken to in words that you understand

 To be told what's wrong with you
 To know the benefits of any treatment and any alternatives
  To know what a treatment or test will cost
 To share in treatment decisions
 To read your medical record
 To refuse any medical procedure

What should you do before an office visit?

 Bring all important medical information with you to the visit.

 Make sure you can answer questions about the following:
o Allergies and side effects to medicines
o Current medicines you are taking. This includes herbs and vitamins. Make a
list if necessary.
o Insurance information
o Marital and sexual history
o Past injuries and hospital stays
o Past medical problems
o Past surgeries and operations
o Pre-visit questionnaires
o Use of tobacco, alcohol and drugs
o Work history

What should you expect from the visit?

 You should plan to wait if you go without an appointment. Emergencies or sick

patients in the hospital may interrupt your doctor.
 Bring along a book or toys for the kids. You may also have to wait during busy times.
 Tell your doctor about your problem in a clear manner. Start from the beginning and
go through each symptom as it appeared.
 Before the visit, think about what makes your problem better or worse. Your doctor
will probably ask you questions about this.
 Most doctors ask many questions about unrelated symptoms. These questions help
assure that there are no other problems that need attention.
 Be sure to answer all questions truthfully. This includes sensitive questions about
smoking, drug use, sexual activity, and work. Your history is the most important part
of deciding what is wrong with you.
 If you have any difficulty communicating your concerns, bring a family member or
friend to assist in this task.
 Talk to your doctor and do not leave the office without asking necessary questions.
Your doctor can make you more comfortable if he or she understands your concerns.

What should you know about your medications?

Every year many people become ill because of problems with medications.

Remember to ask:
  What side effects to expect.
 What drug interactions are possible.
o Find out if a new medicine reacts with those that you are taking now.
o Many over-the-counter drugs and dietary supplements can also cause serious
side effects and drug interactions.
o Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
 Make sure you can drive or operate machines safely while taking a medicine.
 Ask your doctor how much a prescription costs.
o Is there a less expensive option or a generic version?

What is a treatment plan?

A treatment plan is what you and your doctor decide to do for an illness. A treatment plan
cannot be effective without your participation.

Three simple questions can help you get the most from your treatment plan:

 What is my main problem?

 What do I need to do?
 Why is it important for me to do these things?

Other important points:

 Be sure you understand your treatment plan.

 Stick with the treatment plan and allow time for improvement.
 Don't stop medicines when you feel better; check with your doctor first.
 Call your doctor if your condition is becoming worse.
 Your doctor should tell you what to expect and when to follow-up or call the office.

Notify your doctor if you have polymyositis and any of the following:

 Worsening muscle pain

 Worsening muscle weakness:
o Worsening arm weakness (bilateral)
o Worsening leg weakness (bilateral)
 Worsening joint pains
  Difficulty swallowing
 Difficulty speaking
 Tremor
 Palpitations
 Difficulty breathing

Possible complications of polymyositis include:

 Joint contractures:
o Severe joint stiffness
 Myocarditis
 Pleuritis
 Pulmonary disease:
o Pulmonary fibrosis
  Respiratory failure

Polymyositis may result from an abnormal immune system, which normally fights infection. The
immune system mistakenly attacks normal muscle tissue, causing inflammation and breakdown of
the muscle cells. The cause of the abnormal immune system in polymyositis is unknown.

To better understand polymyositis, it helps to understand the anatomy of the muscles.

Muscles make up about 40% of total body weight. The human body contains over 300
muscles that provide movement for the entire body.
Examples of major muscles include the:

 Whole body view

 Abdominal muscles
 Face

 Back
 Chest
 Shoulder

 Arm

 Neck
 Thigh

 Leg