Polymyositis is an inflammatory disease that attacks muscles. IIn polymyositis, T-cells that ordinarily would release chemicals and B-cells that would ordinarily release antigens to destroy a germ instead release the same immune agents on healthy muscles and sometimes skin. Polymyositis has some of the same symptoms as a condition called dermatomyositis, but the two conditions damage healthy tissues with different antigens. The misguided immune attack caused by polymyositis is probably triggered by a viral infection, specifically with Coxsackie virus (a virus that is spread through fecal matter than causes flu-like symptoms and sometimes inflammation of the heart), echovirus (another virus that primarily attacks the gastrointestinal tract), HIV, flu, and sometimes even the adenovirus that causes mild upper respiratory infections. The immune system overreacts to the virus with polymyositis. There is also a real possibility of developing polymyositis as a side effect of taking statin drugs, ACE Inhibitors for high blood pressure, the old-style seizure medication Dilantin (phenytoin), or D-penicillamine for heavy metal poisoning.
More often than not, doctors are able to treat polymyositis successfully. About 70 percent of people who get the disease go into remission. Even in this more fortunate group, steroid drugs used to control inflammation interfere with bone turnover, and many women and some men who get steroids for polymyositis will develop osteoporosis. However, about 30 percent of people who get polymyositis have serious complications. How long they survive depends on how well they are treated before they develop complications. Let's look at the major problems posed by the disease:
- Blood clots. People who have polymyositis are prone to having blood clots, at a rate about seven times higher than the general population. The most common location of these clots is veins, and the most common presentation of the problem is as deep vein thrombosis. Fortunately, recognizing the risk of blood clots enables taking precautions to prevent it. At the very least, doctors should monitor clotting factors every month. If you are at higher than normal risk for clots, you can be put on a blood thinner to stop clots before they form. You will certainly get advice on how to prevent clots from forming when you have to sit or lie still for long periods of time, and you may be advised to wear support stockings. All of these measures are inconvenient, but clots can be fatal.
- Aspiration pneumonia. Polymyositis can cause dysphagia, an inability to swallow food easily. When food "goes down the wrong pipe," it can cause pneumonia, and when polymyositis inflames the intracostal muscles that are essential for breathing, it become extra hard to get enough oxygen.Eat slowly. Take small bites. If you enjoy spicy food that might cause a spasm in your throat, you don't necessarily have to give it up, but you do have to take extra-small bites. It's much better to take the simple precautions that prevent aspirating food than it is to deal with pneumonia.
- Cancer. Bladder cancer and non-Hodgkin's lymphoma occur at higher rates in people who have polymyositis, especially during the first year of the disease. Both of these forms of cancer are treatable, but it's always better to be looking for them so they can be treated at the earliest possible stage.
- Wasting. Especially in people who develop polymyositis after the age of 60, muscle wasting can be a major problem. The body (1) starts using protein at a very high rate at the same time (2) eating becomes more difficult. Muscles get even weaker, and falls, breathing problems, and swallowing problems become immediate issues. It is very hard to deal with wasting, but if you have an ingenious cook who can prepare easy to eat meals that actually taste good, you'll have a longer and happier life.
Polymyositis has about an 80 percent survival rate. If the disease is going to "get you," it will most likely be due to cancer or a pulmonary complication. Take precautions to get cancer detected as soon as possible and to avoid breathing problems. Many people won't want to hear this, but people who have polymyositis need to take special care to avoid getting infected with the flu. They need pneumonia vaccine. They need cancer checkups every three months, even if they have not been diagnosed.
The older you are, the more you need these preventive measures. Surviving polymyositis isn't just a matter of chance. It's a matter of good care.
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