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Muscle inflammation, or myositis, is a condition that causes inflammation in muscles, leading to weakness, swelling, and pain. It can be caused by various factors, including injury, infection, autoimmune conditions, or drug side effects. While the exact causes of myositis are not fully understood, it is believed to be triggered by certain conditions that cause inflammation throughout the body, attacking muscle tissues and leading to muscle inflammation. This can result in difficulty performing everyday activities and a range of other symptoms. Myositis can be challenging to diagnose, and while there is no cure, treatments are available to manage the symptoms.
| Characteristics | Values |
|---|---|
| Medical conditions | Myositis, necrotizing autoimmune myopathy, dermatomyositis, polymyositis, anti-synthetase syndrome, inclusion body myositis, Raynaud's phenomenon |
| Symptoms | Muscle weakness, muscle pain, swelling, fatigue, skin rashes, lung inflammation, arthritis, difficulty swallowing, trouble walking, using arms, climbing stairs, etc. |
| Causes | Autoimmune conditions, infections, injury, intense exercise, certain medications, toxins, sunlight |
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What You'll Learn
Infection
Myositis is a disease that causes chronic inflammation of the muscles, leading to weakness, pain, and swelling. It is caused by the immune system attacking healthy muscle fibres, which can be triggered by infection, injury, autoimmune conditions, or drug side effects.
Infective myositis can be caused by a wide variety of pathogens, including bacteria, fungi, viruses, and parasites. Viral infections are the most common infectious cause of myositis, with the common cold, flu, and HIV being examples of viruses that can cause it. Viruses or bacteria can attack muscle tissue directly or release substances that damage muscle fibres. Bacterial infections that can cause myositis include Clostridial myositis, commonly known as gas gangrene, which is caused by C. perfringens and can occur in traumatic wounds with soil contamination, compound fractures, penetrating wounds, and more. Salmonella and Streptococci are other bacterial causes of myositis, which induce muscle damage by reducing oxidative and glycolytic enzyme activity and activating lysosomal enzymes.
In rare cases, some people with HIV develop long-term viral muscle infections. Post-infectious reactive myositis can occur even after the virus has been eliminated, as the immune system may continue to cause inflammation in some parts of the body for a few months.
Myositis is typically diagnosed through a comprehensive assessment involving a physical exam, blood tests, imaging exams (MRI and/or ultrasound), electromyography, nerve conduction studies, and biopsies of the muscle and/or skin. Treatment for myositis includes a combination of drug treatment and exercise, with steroids being the first choice of treatment.
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Injury
Muscle inflammation, or myalgia, can be caused by a variety of injuries. One common cause is muscle strain, which can occur when muscles are overused or used more than they are accustomed to. This can lead to small tears in the muscle fibres, causing pain and inflammation. Intense or vigorous exercise can also cause muscle inflammation, a mild form of myositis, which usually resolves with rest and recovery.
Traumatic injuries, such as sports injuries or accidents, can also lead to muscle inflammation. Blunt force trauma can bruise muscles, causing muscle contusions. Pulling or tearing muscles with too much force can result in muscle strains or even more severe tears. In some cases, rhabdomyolysis may occur, which is a condition where muscles break down rapidly after a major injury or extreme exercise.
In addition to physical injuries, certain medications and drugs can also cause temporary muscle damage and inflammation. This can be due to the toxicity of the drugs or the interaction between multiple medications. Statin drugs, for example, are known to cause muscle damage as a side effect. It is important to note that severe myositis caused by medications is rare.
Myositis, an inflammatory condition, can also be caused by injury. It is characterised by chronic inflammation that comes and goes over time, leading to muscle weakness and pain. The exact cause of myositis is unknown, but it is believed to be triggered by the immune system attacking healthy muscle fibres. Polymyositis, a type of myositis, affects multiple muscles simultaneously and can cause difficulty in performing everyday movements. Dermatomyositis, another form of myositis, affects both the skin and muscles and can develop quickly. While there is no cure for myositis, treatments are available to manage symptoms and prevent severe complications.
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Autoimmune conditions
Myositis, also known as inflammatory myopathy, is a rare autoimmune disease that causes chronic muscle inflammation. It is characterised by profound muscle weakness, pain, and inflammation, which comes and goes over time. The disease is caused when the immune system loses tolerance of the muscle, no longer recognising it as its own, and starts attacking it with immune cells and other inflammatory mediators. This results in injured or destroyed muscle fibres, affecting muscle function and leading to fatigue and weakness.
There are five different forms of myositis, each with its own symptoms and natural history:
- Polymyositis: Affects multiple muscles simultaneously, causing weakness and symptoms in muscles near the centre of the body.
- Dermatomyositis: Causes skin changes and progressive muscle weakness.
- Inclusion body myositis: Characterised by slow, progressive muscle weakness and muscle shrinking, commonly in the legs, hands, and feet.
- Necrotizing autoimmune myopathy: Involves muscle weakness in the upper and lower body.
- Overlap myositis: Occurs in patients with other rheumatic diseases, such as scleroderma or vasculitis.
The cause of myositis is not fully understood, and there is currently no cure. However, certain factors have been identified as potential triggers for the immune system, including environmental factors, infectious organisms, certain drugs, and cancer. Treatment options include medications such as corticosteroids, immunosuppressants, and immunoglobulin, as well as physical therapy and exercise to manage symptoms and reduce inflammation.
Another group of autoimmune diseases that can cause muscle inflammation are the idiopathic inflammatory myopathies. These diseases cause inflammation and weakness in the muscles and can also affect the skin and other organs. They typically occur in adults aged 40 to 60 or children aged 5 to 15, with women being more susceptible than men. While the cause is unknown, it is believed to be triggered by an autoimmune reaction to muscle tissue in individuals with certain genetic predispositions. Viral infections, certain medications, and cancer are also associated with these diseases.
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Drug side effects
Drug-induced myopathies are a common cause of muscle pain and inflammation. The range of drugs that can cause muscle side effects is vast and constantly expanding. These side effects can vary significantly between drugs and between patients taking the same drug.
Statins
Statins are among the most prescribed medications for managing cholesterol. However, they are also one of the most prevalent and well-documented drugs that cause muscle toxicity. Muscle pain and weakness are common side effects of statins. Researchers believe that genetics, calcium leakage, and other factors may contribute to drug-induced myopathy. Statins can also lower levels of the antioxidant coenzyme Q10 in the body, which may play a role in muscle pain. Taking more than one medication that causes muscle weakness increases the chances of experiencing this side effect. Simvastatin, for example, should not be taken with gemfibrozil (Lopid) as it raises the chances of experiencing rhabdomyolysis (muscle breakdown), which can be life-threatening. Other statins that can cause muscle weakness include atorvastatin (Lipitor, Atorvaliq) and levofloxacin.
Corticosteroids
Oral corticosteroids, commonly known as steroids, are a broad group of medications used to relieve swelling, pain, and inflammation. However, they can also cause several side effects, especially with long-term use. One such side effect is steroid-induced myopathy, which typically affects pelvic muscles and presents as muscle weakness without pain. Older people and women are more likely to experience steroid-induced myopathy, but it can occur in anyone taking steroids long-term or at high doses.
Other Drugs
Other drugs that can cause muscle pain and weakness include fluoroquinolone antibiotics such as levofloxacin, fibrates such as gemfibrozil (Lopid), aromatase inhibitors such as anastrozole (Arimidex), and oral steroids such as prednisone. Cancer treatments, including chemotherapy and immune checkpoint inhibitors like nivolumab (Opdivo) and pembrolizumab (Keytruda), are also linked to drug-induced myopathy. HIV medications, such as zidovudine, can also cause muscle weakness, although modern HIV drugs have fewer side effects than in the past. Additionally, bisphosphonates can cause muscle and joint pain, which usually goes away if the medication is stopped. Teriparatide (Forteo), a medication used to treat osteoporosis, can also cause joint pain in up to 10% of people taking it.
It is important to note that this list is not exhaustive, and new classes of drugs with unintended muscle toxicity are constantly being discovered. If you experience any muscle pain, weakness, or other unusual symptoms while taking medication, it is crucial to consult your healthcare provider.
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Exercise
During exercise, the body experiences mechanical strain, especially during eccentric exercises, which can lead to "popped sarcomeres" and a reduction in force production. This, in turn, causes membrane disruption and excitation-contraction coupling dysfunction, resulting in prolonged loss of muscle strength. The microtrauma of myofibers and subsequent inflammation are believed to cause delayed-onset muscle soreness (DOMS).
The inflammatory response during exercise serves a purpose in the repair process. Inflammation increases blood flow to the affected area, providing oxygen and fuel to the muscles while clearing out waste. The immune system then signals the body to begin repairing the damage. While excessive amounts of prolonged, high-intensity exercise may impair immune function, moderate exercise can enhance it. Additionally, exercise-induced inflammation mobilises T cells (Tregs), which improve the muscles' ability to use energy as fuel and enhance overall exercise endurance.
Managing inflammation is crucial for optimising recovery and achieving peak performance. While inflammation is a natural response to exercise-induced muscle damage, excessive or chronic inflammation can lead to negative health consequences. Therefore, allowing adequate time for the body to heal and recover is essential to prevent chronic inflammation and maintain overall health.
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Frequently asked questions
Myositis is a group of conditions that cause inflammation in muscles, but it can also refer to the muscle inflammation itself.
Experts are unsure of the exact cause of myositis, but several factors can trigger inflammation, including inflammatory conditions, infections, injury, autoimmune conditions, and drug side effects.
Symptoms of myositis include muscle inflammation, weakness, fatigue, and muscle pain. It can also affect the whole body, causing symptoms such as arthritis, lung inflammation, skin inflammation, and rashes.
There is no cure for myositis, but symptoms can be treated. Treatment options include medications such as corticosteroids, physical therapy, exercise, heat therapy, assistive devices, and rest.
