Polymyositis

What is Polymyositis?

Polymyositis is one of the idiopathic inflammatory myopathies, a group of autoimmune diseases in which the immune system causes long-lasting inflammation in skeletal muscle, leading to weakness.^[1] It is uncommon, and modern antibody testing has led doctors to reclassify many people once labeled with polymyositis as having other types of myositis.^{[1, 2]}

Common symptoms

The main symptom is weakness of muscles closest to the trunk, such as the hips, thighs, shoulders and upper arms, which makes climbing stairs, lifting or rising from a chair difficult.^[3] Muscle aches and fatigue can occur, though weakness is more prominent than pain.

Other organs can be involved. Interstitial lung disease can cause breathlessness, and swallowing muscles can be affected.^{[1, 2]} A purplish rash around the eyes or on the knuckles points to dermatomyositis, a related condition, rather than polymyositis.^[3]

Causes and risk factors

The cause is not known. It likely involves an interaction between genetic and environmental factors.^[1] Myositis can occur alone, or alongside another connective tissue disease, cancer or specific autoantibodies.^[1]

How it is diagnosed and treated conventionally

Diagnosis is made by a physician using the pattern of weakness, blood tests including muscle enzymes and myositis-related antibodies, and often muscle MRI, electromyography and muscle biopsy.^{[1, 2]} Some experts now regard polymyositis as a diagnosis of exclusion, so specialist assessment matters.^[1] People with myositis may also be screened for hidden cancer.^[1]

Treatment relies mainly on corticosteroids and other immune-suppressing drugs, chosen largely by experience because few large trials exist.^{[3, 4]} Exercise is now a recognized part of care, and more active exercise programs have shown benefit even in people with active disease.^[4]

Why Polymyositis calls for a whole-person approach

Polymyositis is a systemic autoimmune disease, and its effects reach beyond the muscle. Weakness, fatigue and the side effects of long-term steroids and immune-suppressing drugs all shape daily life.

Supportive care can look at those parts of living with the disease. It cannot control the immune attack on the muscle, and it does not replace immunosuppressive treatment or monitoring.

Immune activity and inflammation

Polymyositis involves immune-driven inflammation in muscle, and different subtypes appear to have different underlying mechanisms.^[2] This is why treatment is directed by specialists who can sort out the subtype and any organ involvement.

Movement, strength and deconditioning

Staying active matters. A meta-analysis of 19 studies with 298 people with dermatomyositis or polymyositis found that exercise was probably safe and moderately improved strength and aerobic capacity, though the certainty of the evidence was reduced.^[5] A Cochrane review reported more uncertain results, with only very low-certainty evidence in these two diseases.^[6] Exercise should be planned with your medical team.

Fatigue and sleep

Fatigue is common in myositis and can be made worse by poor sleep, pain, low mood and medicines such as steroids. Treating these contributors is a reasonable goal of supportive care, although direct research in polymyositis is lacking.

Medication side effects and infection risk

Steroids and other immune-suppressing drugs can have significant side effects, which your physician monitors. Some herbs can interact with these drugs, so supportive care has to be chosen carefully.^[7]

Acupuncture as supportive care in Polymyositis

What the research shows

We found no clinical trials of acupuncture in polymyositis, so we cannot say it helps the disease, muscle strength or inflammation. Acupuncture does not restore muscle strength.

For pain, an individual patient data meta-analysis of 39 trials with 20,827 patients found acupuncture was better than sham and no-acupuncture controls for chronic musculoskeletal pain, osteoarthritis, headache and shoulder pain, with effects persisting at one year.^[8] Those results come from other conditions and may not apply to the muscle aches of myositis.

For fatigue, a 2019 meta-analysis of 16 trials in chronic fatigue syndrome found acupuncture more effective than sham acupuncture, but most studies were of low quality and the authors reached no firm conclusion.^[9] For sleep, a review of 24 trials in insomnia included a meta-analysis of 15 trials that suggested acupuncture improved sleep scores more than medication after about three weeks, with large variation between studies.^[10] Neither was in people with myositis.

How acupuncture may work

We know of no research on how acupuncture might act in polymyositis, and we cannot say it influences the immune attack on muscle.

What treatment involves

Treatment uses fine, sterile, single-use needles at selected points, typically left in place for about 20 to 40 minutes. A course involves several visits with reassessment. Needling is gentler when muscles are weak or skin is fragile, and we adjust to your comfort.

Serious problems are rare. 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.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). People taking steroids or immune-suppressing drugs should say so, because they may bruise more easily or be more prone to infection. Please also share your latest creatine kinase result and any recent changes in your strength.

Ayurvedic medicine as supportive care in Polymyositis

The Ayurvedic view

Ayurveda has no classical diagnosis called polymyositis. Traditional practitioners describe progressive muscle weakness with wasting in terms of Vata imbalance and weakened tissues (dhatu), and inflammation in terms of Pitta. These are traditional frameworks, not biomedical diagnoses.

Therapies that may be used

Within a supportive role, care might include:

• Diet and daily routine advice, such as regular warm meals, enough protein if your physician agrees, and steady sleep hours
• Gentle warm oil massage to the limbs, for comfort
• Relaxation and breathing practices for stress and sleep, which can be combined with the exercise plan from your physical therapist

Panchakarma procedures are not appropriate for people with active autoimmune disease on immune-suppressing treatment, and are also unsuitable during acute illness, pregnancy or frailty. They are not a sensible option for polymyositis.

What the research shows

We found no clinical trials or systematic reviews of Ayurvedic medicine in polymyositis or other inflammatory myopathies. The evidence is therefore none for this condition.

Product quality is a documented concern: about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[12] Ayurvedic herbs are also plant preparations that can interact with the drugs used to treat inflammatory disease, so the cautions in the herbal section below apply to them.^[13]

Herbal medicine as supportive care in Polymyositis

Herbs and formulas that have been studied

We found no clinical studies of any herb or formula in polymyositis. Research on Chinese herbal medicine in other autoimmune rheumatic diseases does not tell us whether it helps in polymyositis.

What the research shows

There is no clinical evidence that herbal medicine treats polymyositis or reduces its symptoms. We do not suggest herbs as a replacement for corticosteroids or other immune-suppressing drugs.

Safety and herb-drug interactions

Safety is the main concern with herbs in this setting. A scoping review of 65 articles found 44 documented interactions between Chinese herbs and drugs used in autoimmune rheumatic disease, including steroids, methotrexate and mycophenolate. The best documented involved St. John's wort with cyclosporine and tacrolimus and Schisandra with tacrolimus, but most of the evidence came from animal studies and was of low quality.^[7] Another review of herb-drug interactions in inflammatory diseases highlights methotrexate and other basal medicines.^[13]

Herbs can also affect bleeding, and many alter how warfarin works.^{[14, 15]} Please tell us about all of your medicines, including steroids, methotrexate, azathioprine, mycophenolate, and anticoagulants, and about pregnancy, breastfeeding, and liver or kidney disease. Any herb should be checked with your rheumatologist first.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine would describe muscle weakness as a "flaccidity" pattern with deficiency of spleen qi or damp-heat, and Ayurveda would speak of Vata imbalance and weak muscle tissue. Researchers describe an autoimmune attack on muscle with immune-mediated inflammation that varies by subtype.^[2]

No study has shown that a traditional pattern corresponds to a measurable process in polymyositis. Traditional systems also stress gentle, regular movement, and current medical thinking likewise treats structured exercise as part of care, though this is a loose parallel and not evidence for any traditional therapy.^{[4, 5]}

How this care fits with your medical care

Polymyositis needs a physician's care, usually from a 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. We do not diagnose or monitor polymyositis, and we do not change prescribed drugs.

Keep taking your steroids and immune-suppressing drugs exactly as prescribed, and keep your lab tests and follow-up. Please bring your diagnosis, recent muscle enzyme and antibody results, a full list of medicines and supplements, and any exercise guidance from your physical therapist.

When to seek urgent medical care

Myositis can affect swallowing, breathing and the heart, so some symptoms need prompt attention.^{[1, 2]}

• New or worsening shortness of breath, or a dry cough that does not clear
• Difficulty swallowing, choking on food or liquids, or repeated chest infections
• Rapidly worsening weakness, or trouble holding your head up or lifting your arms
• Dark brown or cola-colored urine with severe muscle pain
• Fever, chills or signs of infection while taking immune-suppressing drugs
• Chest pain, fainting or an irregular heartbeat

If you have severe breathing difficulty, choking, chest pain or fainting, call 911 or go to the nearest emergency department.