From WSJ – Nov 17, 22
After a certain age, when muscle weakness and pain start to accompany exercise and simple daily tasks like getting up from a chair, we often dismiss it as part of the package of getting older.
But researchers are learning that some of these ailments that people dismiss as the result of aging may in fact be caused by medication, or an undiagnosed disease or infection. Some studies also have suggested that Covid-19 infection and its treatments can lead to muscle damage, including decreased muscle strength and endurance.
Often the causes of muscle weakness or pain are easy to identify and treat. For example, electrolytes, the minerals necessary to help nerves and muscles function, can be imbalanced. Other causes can be more serious. Unexplained pain in the limbs, difficulty climbing stairs, or more frequent trips and falls could be signs of myositis, a term for illnesses that include chronic inflammation of the muscles.
While the loss of muscle mass is normal in aging and can be managed with exercise and better nutrition, different forms of myositis are muscle-wasting diseases that can start in middle age and get progressively worse.
“People assume they are supposed to get weak as they get older, but having difficulty with walking and falls and getting up off the floor is not normal,” says Conrad C. Weihl, a neurologist at Washington University in St. Louis and chairman of a medical advisory board for the Myositis Association, a nonprofit that sponsors research and provides information and support for patients.
Though its causes aren’t clear, most types of myositis are classified as autoimmune diseases, in which the immune system begins to attack normal, healthy tissue. Muscles, joints, the heart, lungs, skin, and the digestive tract can be affected.
Some patients might have a predisposition to autoimmune disease, which can be triggered by an infection, virus, toxin, or even sunlight. Some forms appear with other connective-tissue diseases such as rheumatoid arthritis and lupus. Myositis is also sometimes linked to cancer.
While there are no cures for any of the forms of myositis, a number of medications can ease the symptoms, as can physical therapy and exercise. Researchers are investigating additional potential therapies.
Dr. Weihl says it’s important to create greater awareness of the different forms of myositis, which are also known as idiopathic inflammatory myopathies. Presented with symptoms, primary-care doctors may be hesitant to consider a serious muscle disease and be unaware of what to look for. Many patients are diagnosed only after being referred to specialists such as rheumatologists and neurologists.
To arrive at a diagnosis, Julie J. Paik, a rheumatologist, and director of clinical trials at Johns Hopkins Medicine’s Myositis Center in Baltimore say she starts with a medical history and physical exam to identify which muscles are experiencing weakness, as different muscle groups are affected by different conditions. Blood tests can identify levels of certain muscle enzymes and Dr. Paik may order an MRI of the muscles to pinpoint inflammation spots, as well as a muscle biopsy, which can show abnormalities including inflammation.
In cases of inclusion body myositis, one of the most common disabling inflammatory muscle diseases among patients older than 50, muscles in the wrists, fingers, and front of the thigh tend to be affected first. The muscles that lift the front of the foot also may be affected. Dermatomyositis, shown at the right, mostly affects the muscles of the hips and thighs, the upper arms, the top part of the back, the shoulder area, and the neck.
Source: Muscular Dystrophy Association
Myositis usually starts gradually, such as with weakness in climbing stairs and standing from a sitting position. One type, inclusion body myositis, can also cause weakness in the hands and feet. While other forms are relatively treatable, there is no effective treatment at present. In 2019, musician Peter Frampton announced he had been diagnosed with the disease, whose symptoms include a wasting of the quadriceps and forearm muscles. A fund named after him at Johns Hopkins offers support for patients and backs research seeking a cure.
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