Myositis

What is Myositis?

Myositis means inflammation of the muscles. The term is used for a group of autoimmune diseases, called idiopathic inflammatory myopathies, in which muscle weakness is the classic feature and the skin, joints, lungs, heart and digestive tract can also be involved.^[1] Infections and some medicines can also cause muscle inflammation, and those cases are handled differently by a physician.^[2]

Common symptoms

The typical symptom is symmetric weakness of the muscles near the trunk, which makes climbing stairs, lifting and rising from a chair hard.^[3] Many people also have fatigue and muscle pain.^[1]

• A red or purple skin rash, especially on the eyelids, knuckles, elbows or knees, in dermatomyositis
• Joint pain or stiffness
• Trouble swallowing, which is a particular concern in inclusion body myositis^[4]
• Shortness of breath when the lungs are involved^[5]

Causes and risk factors

Myositis is thought to be autoimmune, meaning the immune system attacks muscle, but the target proteins have not been fully identified.^[3] Genetic risk factors have been described, and infections, some medicines, cancer and geography are also named as risk factors.^[2]

The main subtypes are dermatomyositis, polymyositis, immune-mediated necrotizing myopathy, inclusion body myositis, and overlap myositis including antisynthetase syndrome. Their outlook and treatment differ.^{[1, 6]} The condition is rare, with an estimated 2 to 25 cases per 100,000 people.^[2]

How it is diagnosed and treated conventionally

Diagnosis combines the history and examination with blood tests for muscle enzymes and myositis-related autoantibodies, electromyography, muscle MRI and often a muscle biopsy.^{[3, 6]} Specific autoantibodies help identify the subtype and the risk of complications such as lung disease or cancer.^[5]

Treatment is largely based on expert opinion and small studies, and guidelines vary between regions.^{[6, 7]} It typically uses steroids and other immune-suppressing medicines, and intravenous immunoglobulin is effective in refractory dermatomyositis. People usually need care from a multidisciplinary team.^[5] In inclusion body myositis, exercise remains the main available therapy.^[4]

Why Myositis calls for a whole-person approach

Myositis is a systemic disease, and about two thirds of adults have a chronic course.^[5] The first priority is specialist-directed immune treatment.

The factors below are ones where supportive care may be considered. They do not treat the autoimmune process.

Muscle pain and weakness

Weakness and muscle pain limit movement and daily activity.^{[1, 3]} Pain control and staying as active as a specialist advises are part of day-to-day care.

Fatigue and sleep

Fatigue is a common feature of myositis.^[1] Poor sleep, pain and medicine side effects can all add to it, and these can be addressed in supportive care.

Skin, lungs and swallowing

When the skin, lungs or swallowing muscles are involved, these need direct medical care. Lung disease and swallowing trouble in particular call for specialist evaluation.^{[4, 5]}

Stress and the burden of chronic illness

A rare, chronic disease with an uncertain course creates stress for many people. We support this with routines and relaxation approaches, but the evidence for this in myositis is not established.

Acupuncture as supportive care in Myositis

What the research shows

No clinical trials of acupuncture for myositis were found in PubMed, so we cannot say that acupuncture affects muscle weakness, muscle enzymes or the immune process, and it should not be used to try to do so.

For pain in other conditions the research is stronger. An individual-patient meta-analysis of 39 trials with adequate allocation concealment and 20,827 patients found that acupuncture reduced chronic musculoskeletal pain, osteoarthritis pain, headache and shoulder pain more than no acupuncture and more than sham needling, with effects that mostly persisted for a year. The difference from sham was small.^[8] This research did not include inflammatory muscle disease, so we do not know whether it applies to myositis.

For sleep, a systematic review of 24 trials in people with insomnia included a meta-analysis of 15 trials that found better sleep quality with acupuncture than with medication, with a clear difference only from about three weeks and results that varied widely between studies.^[9]

How acupuncture may work

The reviewers of the pain trials concluded that the effect is not explained by placebo alone, but that factors beyond needle placement also contribute.^[8] The mechanisms in inflammatory muscle disease have not been studied.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. A short course of visits is followed by reassessment of pain, fatigue and sleep.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] Tell the practitioner first if you take immune-suppressing medicine or steroids, since infection risk and fragile skin matter, and if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker. Please also tell us about any skin rash or ulcers, and about recent muscle blood tests.

Ayurvedic medicine as supportive care in Myositis

The Ayurvedic view

Ayurveda has no classical name for the autoimmune myositis. Practitioners may describe muscle weakness and wasting through the idea of depleted muscle tissue (mamsa dhatu) and aggravated Vata, with joint and skin symptoms described in other terms. This is a traditional framework and not a medical diagnosis.

Therapies that may be used

Supportive Ayurvedic care is chosen for the individual and may include:

• Regular meals, rest and sleep routines, with attention to adequate protein-containing, easily digested food, agreed with your physician
• Gentle warm oil massage, avoiding any area of rash, broken skin or severe tenderness
• Breathing and relaxation practices for stress

Panchakarma is not appropriate during pregnancy, an active flare or acute illness, in frailty, or in people with significant weakness or swallowing trouble, and we would not offer it in these situations. Strong immune-suppressing treatment is another reason for caution.

What the research shows

No clinical studies of Ayurvedic treatment for myositis were found in PubMed. Ayurvedic care for myositis rests on tradition and not on trial evidence.

Turmeric (curcumin) is commonly used in Ayurveda and has been studied in autoimmune disease in general. A meta-analysis of 31 trials across 10 autoimmune diseases did not include myositis and called for larger trials, so it does not show a benefit for this disease.^[11] Product quality is also a concern, since about one fifth of Ayurvedic medicines sold online contained detectable lead, mercury or arsenic.^[12]

Herbal medicine as supportive care in Myositis

Herbs and formulas that have been studied

We found no clinical trial of any herb or Chinese formula in myositis. Traditional Chinese medicine may describe myositis as a "flaccidity" pattern with weakness of the muscles, but we found no trial that tested herbal treatment of this pattern in myositis.

What the research shows

Because there is no research in people with myositis, we cannot report any effect of herbs on this disease. Curcumin has been studied in other autoimmune diseases but not in myositis.^[11]

Safety and herb-drug interactions

Herbs are active substances and can interact with prescribed medicines. This matters for people taking immunosuppressants such as ciclosporin or tacrolimus: a literature review reported that St John's wort lowered blood levels of both, and in some cases lower ciclosporin levels led to organ rejection.^[13] Herbs described as immune-stimulating are generally avoided in autoimmune disease unless the treating physician agrees.

Herbal and dietary supplements are a recognized cause of liver injury, which is relevant because several myositis medicines also affect the liver.^[14] The same review also describes bleeding with blood thinners such as warfarin and aspirin when taken with herbs like danshen or ginkgo, so a practitioner must review each herb against your complete medicine list.^[13] Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or take statins, since statins can themselves cause muscle disease.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine may describe muscle weakness as deficiency of qi and blood or of the spleen, which is said to govern the muscles. Ayurveda may describe it as depleted muscle tissue with aggravated Vata. These are traditional ways of grouping symptoms.

The biology of myositis is described in terms of autoantibodies, immune cells in muscle and, in dermatomyositis, interferon signaling.^{[1, 5]} No study has shown that a traditional pattern matches this process or that traditional treatment alters it.

How this care fits with your medical care

Care here is supportive and works alongside your rheumatologist or neurologist. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Do not stop or change steroids, immune-suppressing medicines, immunoglobulin or any other prescribed treatment without your prescriber.

We do not diagnose or manage myositis itself. Please bring your diagnosis and subtype, antibody and muscle enzyme results, your medicine and supplement list, and your specialist's name. If you have been told to avoid or follow a specific exercise plan, tell us so supportive care fits with it.

When to seek urgent medical care

Some features of myositis can become serious quickly and need prompt medical assessment.^{[4, 5]}

• New or worsening trouble swallowing, choking or coughing with eating
• New shortness of breath, dry cough or trouble breathing
• Rapidly worsening weakness, or difficulty lifting the head or climbing stairs
• Dark or cola-colored urine with severe muscle pain
• Fever or signs of infection while on immune-suppressing medicine
• Chest pain, a racing or irregular heartbeat, or fainting

If any of these occur, contact your specialist right away. In an emergency, call 911 or go to the nearest emergency department.