12 August

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

whole life is connected with the movement, which is provided by a variety of muscle groups.In violation of their functions, the quality of life is significantly reduced - it can not serve themselves fully and follow the usual daily routine.Fortunately, these diseases are rare.The most common of these are myositis.According to statistics professor NAMukhina, they observed no more than 1 case per 100 thousand population.

Myositis - an inflammation of specific muscle groups, developing under the influence of a damaging factor.In the initial stages, it appears only weakness or heaviness in the limbs, "disguised" as an ordinary fatigue or flu.However, after a few days or weeks the patient is not able to get out of bed because of the immobility of the muscles.Timely detection of myositis and adequate treatment can eliminate the pathological process and return to the previous quality of life.

Classification and causes of myositis

There are several forms of the disease, which differ on the mechanism of

occurrence, symptoms, and treatment strategies.In the tenth revision of the International Classification of Diseases, they were systematically taking into account the above criteria.However, the main feature of which suggests a form of myositis patients already at the poll, is the cause of development.

Acute infectious myositis

Currently, quite rare.Acute infectious myositis may occur for two reasons:

  1. viruses - after suffering flu, SARS or other diseases, where the virus was the causative agent.It should be noted that often forms after myositis enterovirus infection (affecting bowel) because its migration through the blood into muscle tissue;
  2. bacteria - any ingress of microorganisms in the muscles leads to the development of infective myositis.They can enter the following ways:
    • from the environment because of the deep soft tissue injuries (deep cuts, open fracture, wrongly delivered by intramuscular injection, etc.);
    • from an infectious focus in other organs (in contact with bacteria in the blood, or sepsis development);
    • from the surrounding tissue (fat in phlegmon, osteomyelitis).

Acute infectious myositis, usually has a favorable course - healing occurs within 2 weeks (exception - the development of myositis with sepsis).

Interstitial myositis

This is a special form of myositis, which develops due to the destruction of connective tissue between the muscles (interstitial).Most often, it occurs in tuberculosis, when Mycobacteria (Koch's bacillus) pass from the lungs by the blood flow in other tissues.They are deposited in the interstices and form granuloma - a dense three-dimensional formation of pathogens and immune cells.The inflammatory response to the connective tissue moves to surrounding muscles and developed myositis.

Traumatic myositis ossificans

This myositis can develop after any injury limbs (fractures, dislocations, penetrating trauma, and so on), because of which there was bleeding in the muscle tissue.If the blood is not broken up for 7-10 days, in its place is gradually formed portion "ossification" who constantly injure muscles and cause its inflammation.

«typical» traumatic myositis

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

  • outer thighs - players;
  • shoulder - gymnasts;
  • buttocks and inner thighs - riders;
  • front surface of the femur and tibia - hockey.

Myositis in parasitic infections

Some parasitic worms may spread through the human body and multiply in muscle tissue, leading to its inflammation.It is known for a few parasitic pathogens that form of myositis: Trichinella (disease - trichinosis), pork tapeworm (cysticercosis), Echinococcus and bovine tapeworm (disease - beef tapeworm infection).

Polymyositis and dermatopolymyositis

These forms are very similar to each other, the only significant difference - at dermatopolymyositis along with muscles strongly affected skin.The exact cause of these diseases is not clear, however, proved the role of heredity.Under certain features of immune cells can be "wrong" and produce antibodies to the normal tissues of the body (this is called an autoimmune process).

Juvenile dermatomyositis

The course of this form is very similar to the classic dermatomyositis.The difference is in the age of patients (juvenile form affects children from 5 to 15 years) and the end - the disease is more severe and more common "ossification" (ossification) in the muscles.Typical localization is considered myositis neck.

Dermatomyositis neoplasms

Myositis may occur in malignant tumors.This is due to the formation of paraneoplastic syndrome - a rare phenomenon, because of which the cells of the immune system attacks not only tumors, but also normal cells (including muscle)

Professional myositis

The International Classification of last revision illnesses this kind does not stand alonebecause it is traumatic myositis.However, pathologist doctors marginalize it from others.For those employees of state organizations whose profession is associated with daily physical activity (and ill myositis), provides benefits of a social nature and organization of work (increasing the number of breaks, reducing the number of shifts, switching to a job with a lower load).


symptoms of myositis

course and myositis symptoms differ greatly in different forms of the disease, allowing them to diagnose already at the stage of inspection and survey.It is important to pay attention not only to the loss of muscle, but also on the condition of surrounding tissues (skin, fat over the muscles, bones) as well as changes in them can also be symptoms of myositis.

Symptoms of acute infectious myositis

This is the most favorable form of the disease.As a rule, it is preceded by flu-like symptoms or other SARS:

  • fever;
  • reduction / loss 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) appear initial manifestations of myositis muscles in the arms and legs : weakness or heaviness;pain, equal on both sides.As a rule, they are more pronounced in the shoulders and hips than in the more remote parts of the extremities (feet / wrists).

disease progresses very quickly.In just a few days (in severe cases one) join the symptoms of myositis muscles of the back, chest and neck.The patient becomes absolutely motionless.The hallmark of the disease - the reflexes (knee, elbow, and so on) while fully retained.Pain is also expressed - any muscle palpation causes suffering to the patient.

How to check the knee-jerk reaction at home? If you have a house or apartment is not a rubber hammer, then for this purpose you can use the edge of the palm.Before checking reflex - check that the patient's arm or leg was completely relaxed.Reflex with a knee it's best to call from the "foot to foot" - it is necessary to strike an average force of 2-4 cm below the patella (on the tendon of the quadriceps muscle, which can be felt by hand).

How quickly develop muscle damage - as it passes quickly.After the loss of the ability to move, after 6-10 hours (rarely up to 24 hours) without treatment begins to disappear myositis muscles of the neck.On average, all symptoms regressed in 2-3 days.In severe cases, the patient is more than a week is not able to get out of bed - with such a course of muscle damage may take up to 2-3 weeks.

Symptoms of interstitial myositis

Most often, this form develops in the tuberculosis or syphilis.The disease is chronic, often occurs without acute symptoms and progresses slowly.It is characterized by atypical localization.For example, these patients often appear myositis thoracic or cervical spine, without destruction of muscles.

For interstitial myositis characterized by the following symptoms:

  • nagging pain, moderate or low intensity, that have a specific location and do not migrate;
  • when probing, you can determine not only the muscle soreness, but limited areas of the seal;
  • patient seldom feels the pronounced weakness of the affected muscles.Typically, muscle function and stored motion limited slightly.

addition myositis symptoms in patients showing signs of the underlying disease, which is necessary to pay attention in the diagnosis.In tuberculosis - a violation of normal breathing (cough, shortness of breath) and overall weight loss.Syphilis in the first period is manifested by local symptoms in the genital area (chancre in the form of seals or ulcers).

Symptoms of traumatic myositis ossificans

For a long time after the injury (a few months - a year) myositis ossificans can occur hidden.Often, patients seek medical assistance, revealing a dense portion in his leg or arm, which resembles bone density.Pain syndrome can be expressed in different ways - it depends on the location and size of the formation.If it is more superficial, it hurts more lean muscle tissue and causes pain.When the location is closer to the bone the patient may not experience discomfort.

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

symptoms of polymyositis

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


Later joined by pain in the weakened muscles.As a rule, they are pulling character, medium intensity, spreading over the entire surface of the affected muscles.When probing and exertion pain intensifies.

If the patient receives appropriate treatment, the disease progresses very slowly.They can join the signs of cervical myositis, defeat thoracic or scapular muscles.Violations of the functions of hands and feet occurs only in 5-10% of cases.

There may be additional symptoms:

  • slight peeling, cracking, redness of the skin over the affected muscles;
  • pain in the joints, which are transient in nature (appear with different localization and quickly disappear when the treatment);
  • shortness of breath (dyspnea during prolonged physical work or walking), because of the weakness of the diaphragm muscle.

Most often, polymyositis does not lead to life-threatening.

symptoms of dermatomyositis

first symptom of dermatomyositis are most often rash over certain muscles (usually on the shoulders, shoulder blades, hips and buttocks).The rash may also be extended to the area of ​​the joints, neck and face (upper eyelids, nostrils).It has a characteristic form:

  • red or bright pink color;
  • rises above the surface of the skin (sometimes in the form of flat spots smooth round shape);
  • rash constantly shelled.

Then, gradually there is a weakness and muscle pain.In general, for a subsequent similar polymyositis dermatomyositis.The hallmark could be the appearance of Raynaud's syndrome - a permanent pallor of the hands and the feeling of "cold" in them.

symptoms of myositis in parasitic diseases

This form of myositis are usually asymptomatic (particularly when cysticercosis and teniarinhoza).During the period of activity of Trichinella larvae, the patient may experience discomfort in the affected muscles.Weakness and impaired limb function is not observed almost never.

symptoms of myositis in neoplastic

Against tumor malignancy myositis symptoms are expressed in the form of dermatomyositis (much more frequently) or polymyositis.Additionally, the patient is often observed cachexia / weight loss;small temperature (about 37 C), which persists for weeks or months;loss of appetite and fatigue.

diagnosis of myositis

To confirm the presence of myositis and determine its form, survey and examination of the patient is not enough.To do this, carry out additional tests using instrumental and laboratory diagnostic techniques.

mandatory investigations to confirm the diagnosis "myositis" are: laboratory and instrumental methods.

Laboratory

  • Complete blood count - in acute purulent (infectious) myositis marked increase in the number of white blood cells, neutrophils and ESR.Parasitic myositis provokes an increase in the number of eosinophils;

normal indicators:
leukocytes - 4,0-9,0 * 109 / 1L;
neutrophils - 2,0-5,5 * 109 / 1l (47-72% of the total number of white blood cells;
Eosinophils - 0.02-0.3 * 109 / 1l (0.5-5% of the total number of white blood cells).

  • Biochemical analysis of blood - pay attention to the level of CK fraction MB (the enzyme creatine phosphokinase), an increase which shows the defeat of muscle tissue; C-reactive protein, which is a sign of autoimmune inflammation;

normal indicators:
CK-MB - 0-24 U / l, CRP - 0,78-5,31 ng / ml

  • serological blood test (determination of antibodies in the blood) - the appearance of "miozitspetsificheskih antibody" is a reliable sign of an autoimmune inflammation

Tool

  • EMG.(electromyographic study) - this method is of little diagnostic value, as only able to determine the presence of muscle weakness (or its replacement by connective tissue) to determine the cause, you must use other methods;.
  • fluorography - to diagnose tuberculosis (interstitial) myositis;
  • X-ray of the affected area - and uninformative method of diagnosis, which is essential to avoid degenerative disc disease and osteoarthritis.When myositis, joint changes are found in the images.The projection of the muscles may be determined some dense calcifications that may help in the diagnosis of myositis ossificans.In rare cases, X-ray limb (arm or leg) can detect cysts of the parasite, which is the recommended absolute sign of parasitic myositis.

To determine the form of myositis, you need to assess the state of complex patient data and diagnostic measures.

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

Treatment of acute infection (purulent) myositis

The main thing with this form of myositis - a timely manner to eliminate the cause of the disease.If muscle has not happened formation of purulent focus (cellulitis or abscess), you can restrict use of antibiotics:

  • penicillins (amoxicillin, carbenicillin Ampicillin) - if the patient 3 months before the disease has not taken any antibiotics;
  • Protected options penicillins (Amoxiclav) - if the patient took penicillin in the next 3 months;
  • macrolides (azithromycin, erythromycin) - the best option to eliminate the immunity of bacteria to penicillins (including protected).For the treatment of myositis in a child under 5 years is preferable to use Josamycin - an antibiotic that has minimal side effects.

Appointment of one of these drugs can cope with a bacterial infection, which is the cause myositis.