Muscle myositis: treatment, symptoms, causes

Leg pain can be a symptom of various diseases, but leg myositis manifests itself specifically. We will tell you exactly how in the article.

does not treat leg myositis. If you notice symptoms of the disease, immediately contact your doctor.

The lifestyle of modern city dwellers often leads to foot problems. For example, if a person has a sedentary job that he commutes to by car, his leg muscles are obviously underused. In such a situation, the leg muscles are susceptible to inflammation - leg myositis.

According to the localization of inflammation, leg myositis is divided into:

myositis of the thigh;
myositis of the leg;
myositis of the foot.

Causes of myositis

Myositis can be caused by various factors.
Often the exact etiology cannot be established - in such cases they speak of idiopathic myositis. All possible causes of myositis can be divided into two large groups: endogenous and exogenous. Endogenous factors include factors and pathologies that trigger the inflammatory process inside the body. In such cases, myositis is often secondary in nature and acts as a symptom or complication of other pathologies. The leading endogenous causes of skeletal muscle inflammation may be:

Autoimmune disorders. Inflammation of striated muscles is quite often the result of dysfunction of the immune system. Most often, myositis occurs against the background of such pathologies as systemic lupus erythematosus, rheumatoid arthritis, scleroderma, Sjogren's disease.
Bacterial and viral infections. The inflammatory reaction in muscles, as in other tissues and organs, can be caused by pathogenic bacteria and viruses. Depending on the type of infection, the pathological process can be purulent or non-purulent. The first often occurs against the background of acute respiratory viral infections and influenza, with typhus, tuberculosis, and syphilis. The second variant of myositis occurs with streptococcal and staphylococcal pathologies, for example, abscesses and phlegmon.
Parasitic diseases. Protozoa can parasitize skeletal muscles, forming cysts and calcifications in them. Similar myositis is observed with trichinosis, toxoplasmosis and echinococcosis.
Poisoning and intoxication. Inflammatory reactions in skeletal muscles can be one of the manifestations of the toxic effects of certain substances, for example, alcohol, hard drugs and some medications (alpha interferon, hydroxychloroquine, colchicine, statins).
Malignant neoplasms. With actively developing tumors in the body, especially in the later stages of cancer, paraneoplastic syndrome occurs. One of its manifestations may be myositis.

Exogenous causes of myositis include external influences that have a direct negative effect on skeletal muscles. These include:

Injuries. With traumatic injuries, muscle fibers often rupture, which is accompanied by an inflammatory reaction. With frequent or severe injuries, inflammation can worsen and lead to myositis. In some cases, the healing process is disrupted, due to which bone tissue is formed instead of muscle and connective tissue - myositis ossificans develops.
Muscle strain. Prolonged, excessive exercise can also cause inflammation of skeletal muscles. This is observed in professional athletes, musicians, builders and people whose work involves constant physical activity and prolonged exposure to an unnatural position.
Hypothermia. The inflammatory process can also provoke hypothermia, especially drafts. Myositis of the back and neck most often occurs in this way.

Important!

Myositis after intense exercise

Muscle pain after vigorous exercise is normal. It is associated with the accumulation of lactate in the muscles. Unpleasant sensations disappear after 1-2 days of rest. Myositis does not develop in this case. But if after active training signs of myositis appear, this means that the training is not going well, with excessively high loads or trauma.

After working out in the gym, your muscles may ache, but the pain should go away within a couple of days. Photo: ArturVerkhovetskiy / Depositphotos

Classification

In clinical practice, several classifications of muscle myositis are used, which are based on the etiology, characteristics of symptoms and the course of the disease.

Depending on the origin, all myositis is divided into the following forms¹:

Infectious purulent. Variants of myositis caused by pathogenic bacteria, in which the inflammatory process is accompanied by the formation of purulent-necrotic masses.
Infectious non-purulent. Inflammation of striated muscles of infectious origin (most often viral), in which purulent masses do not form. They occur more easily than purulent forms.
Parasitic. Muscle myositis, which is the result of toxic-allergic reactions and characteristic changes caused by infection with protozoa.
Myositis ossificans. A characteristic difference is the deposition of calcium salts in the connective tissue. The shoulders, hips and buttocks are most often affected.
Polymyositis. A variant of autoimmune myositis, in which a large number of muscles become inflamed at once. In children, such myositis can be combined with damage to the lungs, heart, blood vessels and skin, and in adults it is often associated with malignant tumors of internal organs.
Dermatomyositis or Wagner's disease. An independent autoimmune pathology, in which, in addition to inflammation of the striated muscles, the skin, smooth muscles and internal organs are also affected.

Depending on the prevalence of the pathological process, the following are distinguished:

Local myositis. More often they are of traumatic and infectious origin. Accompanied by inflammation of one or more adjacent muscles.
Diffuse or generalized. Inflammation of skeletal muscles in different parts of the body differs. In most cases, they are associated with autoimmune pathologies.

Based on the activity and nature of inflammation, myositis is divided into the following options:

Spicy. They are characterized by a debut with pronounced symptoms.
Subacute. They often appear gradually, but progress relatively quickly.
Chronic. They can be the result of acute myositis or develop independently, accompanied by moderate persistent symptoms.

Figure 1. Exercises for the neck: maximum turns of the head to the right and left (5 times), slow tilts of the head to the shoulders to the right and left (5 times in each direction). Dynamic resistance of the neck and palms to head tilts in different directions. Image: cteconsulting/Depositphotos

Symptoms of myositis

Depending on the etiology and localization, myositis can occur with certain clinical features and associated phenomena. But in most cases, muscle inflammation is characterized by the following symptoms:

Pain in the affected muscle. The pain can be sharp or dull, often worsening with movement and pressure. Over time, the pain increases, and painful lumps may appear in the muscles.
Muscle weakness. With myositis, a decrease in muscle tone and loss of contractility are often observed. This affects their functions, for example, walking, posture or even breathing are impaired. In severe cases, atrophy develops - loss of muscle tissue volume.
Edema and hyperemia. Often, tissue swelling and visible redness of the skin occur at the site of the lesion, which becomes slightly warmer to the touch than neighboring areas.
Intoxication syndrome. Myositis is often accompanied by a systemic intoxication syndrome, which includes headache, increased body temperature to 38-39°C, general weakness and malaise, loss of appetite, etc.

Types of myositis

In clinical practice, the following types of myositis are most often encountered:

Cervical myositis. The most common option. The main manifestation is a dull pain in the neck muscles, most often one-sided. Sometimes it can radiate to the ear, back of the head, temple or interscapular area. Head movement is often limited due to pain.
Lumbar myositis. The key symptom is a dull pain in the lower back that can radiate down the leg. It intensifies when bending the body, pressing on the muscles of the lower back.
The most common cases are cervical and lumbar myositis. Photo: starast/Depositphotos
Dermatomyositis. Manifested by weakness of the muscles of the shoulder and pelvic girdle, as well as the abs and neck. Because of this, patients have difficulty when trying to get up from a sitting or lying position, or climbing stairs. In severe forms of the disease, breathing and swallowing are impaired. In this case, the pain is less pronounced. Dermatomyositis also affects the skin, which is manifested by a heliotrope rash (red rashes on the eyelids, less often on the face, neck and torso) and Gottron's sign (pink or reddish scaly plaques and nodules on the extensor surfaces of the elbows and knees). Additionally, disturbances in the functioning of the lungs and heart may occur.

Myositis in pregnant women

In some cases, the triggering factor for the development of myositis or the aggravation of its course is pregnancy. The most common triggers are:

Effect of the hormone relaxin on skeletal muscles.
A shift in the center of gravity and additional stress on the abdominal muscles and lower extremities.
Exacerbation of previously existing pathologies in connection with pregnancy.

Clinical manifestations of myositis during pregnancy are no different from the symptoms of the disease in other categories of patients. However, during treatment, you need to choose the right medications, avoiding drugs with a teratogenic effect. Therefore, treatment tactics must be coordinated with the attending physician.

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Complications of myositis

Potential complications of muscle inflammation depend on the etiology of the disease. The most likely ones include:

Spread of the purulent process to adjacent tissues with the formation of osteomyelitis, abscesses and phlegmons, purulent arthritis.
Limitation of physical capabilities, contractures and muscle atrophy.
Impaired swallowing and breathing, which leads to respiratory failure and the risk of developing aspiration pneumonia.
Rhabdomyolysis is the melting of muscle tissue with breakdown products entering the systemic circulation. In this case, renal failure and sepsis can develop, which often lead to death.

Why is it necessary to treat myositis of the leg?

Modern medical practice has reliable means that can successfully treat leg myositis. Early contact with a doctor is of great importance. An advanced disease takes longer and is more difficult to treat.

What will happen if you don’t go to the doctor?

Unfortunately, home remedies will not lead to a complete cure. The pain will subside, but in the presence of unfavorable factors it will return - the disease will take a chronic form. And frequent relapses can cause gradual muscle atrophy - this is a very serious problem.

Diagnosis of myositis

When diagnosing myositis, data from anamnesis are used (questioning the patient to determine the potential causes of the development of the pathology, its course and existing complaints), physical examination, additional laboratory and instrumental examination methods. Of the latter, the most frequently prescribed are:

General and biochemical blood tests. They allow you to identify signs of an inflammatory reaction in the body, as well as increased levels of certain enzymes, for example, creatine phosphokinase (CPK). In autoimmune pathologies, specific antibodies are also detected.
Electromyography (EMG). It is used to assess the functional capabilities of the muscle and its innervation, as well as for differential diagnosis with other diseases.
Magnetic resonance imaging (MRI). Allows you to obtain a layer-by-layer image of the affected tissue. It is often used to differentiate myositis from other pathologies, including osteochondrosis.
Muscle biopsy. Allows you to identify changes in the striated muscles specific to a particular pathology. An invasive, but the most accurate diagnostic method makes it possible to establish a final diagnosis.

What are the dangers of myositis?

What is the etiology and pathogenesis of this condition?

The most common causes of myositis include the following:

traumatic effects and excessive physical activity;
infectious agents;
infection with worms (this mainly concerns Trichinella);
unfavorable climatic and production factors causing hypothermia and various stages of vibration disease;
genetic predisposition.

The most common pathogenetic mechanism of myositis is hematogenous, when infectious agents and their metabolic products that enter the body from the area affected by the inflammatory process spread through the bloodstream throughout all organs and tissues, including into the muscles.

The second most common mechanism is autoimmune. Its essence is that when bacterial (most often streptococcal) flora enters the human body, it begins to secrete antibodies, which, while acting on bacterial antigens, also damage its own connective tissue. It should be noted that in addition to muscle fibers, muscles also have connective tissue bridges called stroma. When an autoimmune process occurs, these structures are the first to be damaged, and only then the muscle tissue.

How does this disease usually manifest?

The main symptoms of myositis, like any other inflammatory process in the human body, are pain, hyperemia, tissue swelling, increased local temperature, as well as functional disorders of varying severity.

This inflammation can be acute or chronic. The second is usually a consequence of the untreated first.

The most common symptom is pain. Usually it is not sharp, but rather a pulling or aching sensation, intensifying during the work of these muscle fibers or when palpating them. However, in advanced cases it becomes very intense and becomes permanent even at rest. As the pain intensifies, the local temperature often increases, and sometimes even fever is observed (this is a sign of purulent inflammation of the muscle). Also, with purulent myositis, it is usually possible to determine the symptom of fluctuation.

There is also a restriction of movement in some joints to which the affected muscles are attached using tendons. As already said. The skin and nerve fibers may be affected, resulting in motor and sensory disturbances, tingling and burning sensations. Late stages are characterized by muscle atrophy and complete immobilization.

How to diagnose and treat myositis?

To correctly diagnose this pathological condition, you must contact a qualified doctor at a medical institution, who will carefully question and examine you, palpate the muscles, and prescribe additional laboratory (clinical and biochemical blood and urine tests) and instrumental (electromyography) research methods.

Treatment of the back muscles and other areas of the body is based on the etiological factor. In all cases, non-steroidal anti-inflammatory drugs are used, which act symptomatically. If an infectious cause is confirmed, antibacterial drugs are prescribed; if Trichinella or other representatives of worms were found, then anthelmintics are used. In case of muscle abscess or phlegmon, surgical intervention is required, which consists of opening and draining them. Immunomodulatory and detoxifying drugs are also widely used.

When treating myositis, it is difficult to do without physiotherapy, which consists of the use of electro- and phonophoresis, UHF, and dynamic currents. It should be noted that these procedures are used only during the period of remission; they are contraindicated for toxic and purulent myositis.

Another excellent method in the treatment of this pathology is massage, which helps strengthen the affected muscle fibers and improves blood circulation in them.
Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Treatment of myositis

Treatment of myositis, depending on the causes of its occurrence, can be carried out by various specialists. For example, for infectious etiology, therapy is prescribed by an infectious disease specialist or therapist, for traumatic etiology, therapy is prescribed by an orthopedic traumatologist, etc.

The remedies used for myositis can be divided into medications and physiotherapy. Less often there is a need for surgical interventions.

Drug therapy

For bacterial myositis, the basis of treatment is antibiotics, for parasitic myositis - anthelmintics. The exact drug and its group are determined by the doctor. In autoimmune pathologies, glucocorticosteroid and immunosuppressive therapy may be required. To combat muscle pain and elevated body temperature, non-steroidal anti-inflammatory drugs (NSAIDs) are used: diclofenac, ibuprofen.

Physiotherapy

Physical exercise and exercise therapy (PT) are an important part of the treatment of all types of myositis. They help reduce swelling, restore muscle strength and improve overall well-being3. The therapy program is drawn up by a physiotherapist. Massage, magnetic therapy, moxotherapy (warming), warm dry wraps, and ultrasound are also used.

Dry heat for myositis

One of the methods for treating myositis is dry heat.
This procedure improves blood supply to the affected muscle and normalizes its tone. However, it is contraindicated in active infectious diseases, especially purulent processes, which may worsen. Dry heat helps relieve cervical myositis. Photo: imagepointfr / Depositphotos

Surgery

Surgery is performed for purulent forms of myositis. The essence of the operation is to open the purulent focus, remove purulent-necrotic masses and establish drainage. After this, active antibiotic therapy is carried out.

Myositis

Myositis is an inflammatory process in one or more skeletal muscles. The etiology of the disease is rare and diverse. The most common myositis - cervical and lumbar - develops in almost all people at least once in their lives. They often remain undiagnosed, since patients mistake the manifestations of myositis for an exacerbation of cervical or lumbar osteochondrosis. But there are also severe forms of myositis that require hospitalization and long-term treatment. Taking into account the nature of the process, acute, subacute and chronic myositis are distinguished, taking into account the prevalence - local (limited) and diffuse (generalized).

Causes of myositis development.

The first place in terms of incidence is occupied by myositis caused by the most common viral infectious diseases (ARVI, influenza). Less commonly, myositis occurs with bacterial and fungal infections. It is possible both the direct impact of microorganisms on the muscles and the development of myositis due to the action of toxins.

Systemic autoimmune diseases are not the most common cause of myositis, but they are the ones that cause the development of the most severe forms of the disease. Typically, the most severe muscle damage occurs with polymyositis, dermatomyositis and Munheimer's disease (myositis ossificans). Other systemic diseases (rheumatoid arthritis, scleroderma, systemic lupus erythematosus) are characterized by moderate myositis.

Among the parasitic infections that most often cause myositis are toxoplasmosis, echinococcosis, cysticercosis and trichinosis.

The cause of the development of myositis can be the action of various toxic substances. Thus, toxic myositis often develops with alcoholism or cocaine addiction. Unstable muscle damage can also occur when taking certain medications (alpha-interferon, Plaquenil, colchicine, statins, etc.). Favorable myositis of mild, less often moderate severity can occur after hypothermia, injury, muscle cramps or intense physical activity (especially in patients with untrained muscles). Pain, swelling and weakness for several hours or several days in the latter case are caused by small tears in the muscle tissue. In extremely rare cases, usually with extreme physical exertion, the development of rhabdomyosis - necrosis of muscle tissue - is possible.

In people of certain professions (violinists, pianists, PC operators, drivers, etc.), myositis can develop due to uncomfortable body position and prolonged stress on certain muscle groups.

Symptoms of myositis.

A characteristic symptom of myositis is aching pain, aggravated by movement and palpation of the muscles and accompanied by muscle weakness. In some cases, with myositis, slight redness (hyperemia) of the skin and slight swelling in the affected area are observed. Sometimes myositis is accompanied by general symptoms: low-grade fever or fever, headache and an increase in the number of leukocytes in the blood. When palpating the affected muscle, painful lumps may be detected.

Treatment of myositis

Myositis is treated by doctors of various specialties; the choice of specialist is determined by the cause of the disease. Thus, myositis of parasitic etiology is usually treated by parasitologists, infectious myositis by therapists or infectious disease specialists, traumatic myositis and myositis that developed after significant physical activity by traumatologists, etc.

For bacterial infections, antibiotics are prescribed; for parasitic infections, anthelmintics are prescribed. For myositis resulting from an autoimmune disease, long courses of immunosuppressants and glucocorticoids are indicated.

In case of acute myositis and exacerbation of chronic myositis, the patient is recommended bed rest and limitation of physical activity. When the temperature rises, antipyretics are prescribed. Analgesics are used to combat pain, and anti-inflammatory drugs, usually from the NSAID group (ketonal, nurofen, diclofenac, etc.), are used to eliminate inflammation.

For local myositis, warming ointments (finalgon, nicoflex, apizartron, etc.) are effective. The local irritant effect of these drugs helps relax muscles and reduce the intensity of pain. Massage (contraindicated in case of purulent myositis), physiotherapeutic procedures and physical therapy are also used.

Prevention of myositis

Prevention of myositis is based on eliminating or minimizing trigger and risk factors. The following tips and tricks can help prevent the development of muscle inflammation:

Maintain adequate physical activity.
Sports should be regulated. Before intense exercise, a warm-up must be carried out. It is recommended to use protective sports equipment (belts, knee pads, etc.).
Stop using tobacco products, drugs, and alcoholic beverages.
Avoid hypothermia and drafts.
Eat a balanced, nutritious diet.
Observe hygiene rules.
Treat existing diseases in a timely manner.