Polymyositis - adult
Polymyositis and dermatomyositis are rare inflammatory diseases. (The condition is called dermatomyositis when it involves the skin.) These diseases lead to muscle weakness, swelling, tenderness, and tissue damage. They are part of a larger group of diseases called myopathies.
Polymyositis affects the skeletal muscles. It is also known as idiopathic inflammatory myopathy. The exact cause is unknown, but it may be related to an autoimmune reaction or infection.
Polymyositis can affect people at any age. It is most common in adults between ages 50 and 60, and in older children. It affects women twice as often as men. It is more common in African Americans than white people.
Polymyositis is a systemic disease. This means it affects the whole body. Muscle weakness and tenderness can be signs of polymyositis. A rash is a sign of a related condition, dermatomyositis.
Common symptoms include:
You may also have:
Exams and Tests
Tests may include:
People with this condition also must be watched carefully for signs of cancer.
The main treatment is the use of corticosteroid medicines. The dose of medicine is slowly tapered off as muscle strength improves. This takes about 4 to 6 weeks. You will stay on a low dose of a corticosteroid medicine after that.
Medicines to suppress the immune system may be used to replace the corticosteroids. These drugs may include azathioprine, methotrexate or mycophenolate.
For disease that remains active in spite of corticosteroids, intravenous gamma globulin has been tried with mixed results. Biologic drugs also may be used. Rituximab appears to be the most promising. It is important to rule out other conditions in people who do not respond to treatment. A repeat muscle biopsy may be needed to make this diagnosis.
If the condition is associated with a tumor, it may improve if the tumor is removed.
Response to treatment varies, based on the complications. As many as 1 in 5 people may die within 5 years of developing the condition.
Many people, especially children, recover from the illness and do not need ongoing treatment. For most adults, however, immunosuppressant drugs are needed to control the disease.
The outlook for people with lung disease with the anti-MDA-5 antibody is poor despite current treatment.
In adults, death may result from:
The major causes of death are cancer and lung disease.
Complications may include:
When to Contact a Medical Professional
Call your health care provider if you have symptoms of this disorder. Seek emergency treatment if you have shortness of breath and difficulty swallowing.
Aggarwal R, Rider LG, Ruperto N, et al. 2016 American College of Rheumatology/European League Against Rheumatism Criteria for Minimal, Moderate, and Major Clinical Response in Adult Dermatomyositis and Polymyositis: An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatol. 2017;69(5):898-910. PMID: 28382787 www.ncbi.nlm.nih.gov/pubmed/28382787.
Dalakas MC. Inflammatory muscle diseases. N Engl J Med. 2015;373(4):393-394. PMID: 26200989 www.ncbi.nlm.nih.gov/pubmed/26200989.
Greenberg SA. Inflammatory myopathies. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 269.
Nagaraju K, Gladue HS, Lundberg IE. Inflammatory diseases of muscle and other myopathies. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 85.
Yoshida N, Okamoto M, Kaieda S, et al. Association of anti-aminoacyl-transfer RNA synthetase antibody and anti-melanoma differentiation-associated gene 5 antibody with the therapeutic response of polymyositis/dermatomyositis-associated interstitial lung disease. Respir Investig. 2017;55(1):24-32. PMID: 28012490 www.ncbi.nlm.nih.gov/pubmed/28012490.
Review Date: 1/10/2019
Reviewed By: Gordon A. Starkebaum, MD, MACR, ABIM Board Certified in Rheumatology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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