| disease | Polymyositis |
It is an autoimmune disease primarily characterized by muscle weakness and myalgia. It mainly affects the limb-girdle muscles, neck muscles, and pharyngeal muscle groups. When the skin is also involved, it is referred to as dermatomyositis.
bubble_chart Diagnosis
1. Medical History and Symptoms:
It is more common in women aged 20-40. Some patients may have a history of infection prior to the onset of the disease. The main symptoms are symmetrical proximal limb muscle weakness, pain, and tenderness. It can affect the pharyngeal muscles, respiratory muscles, and neck muscles. In the advanced stage, muscle atrophy may occur. Some cases may be accompanied by skin or visceral damage, or malignant tumors.
2. Physical Examination Findings:
Affected muscles show tenderness, weakness, and reduced tendon reflexes.
3. Auxiliary Examinations:
1. Serum CPK, LDH, and GOT are all elevated. Serum myoglobin levels are significantly increased. Serum protein electrophoresis shows increased α and γ globulins. Common bletilla tuber serum IgG, IgA, and IgM are elevated. More than half of the patients have an accelerated erythrocyte sedimentation rate.
2. The 24-hour urinary creatinine excretion can be significantly increased, >1000mg/24 hours, and is related to the severity of the condition.
3. Electromyography: Prolonged insertion potential, possible myotonic-like discharge activity. During light contraction, the average amplitude of motor unit potentials decreases, the duration shortens, and there may be a large number of fibrillation waves. The number of polyphasic waves increases, and during strong contraction, low-amplitude interference patterns or pathological interference patterns appear.
4. Muscle Biopsy: Shows degeneration, necrosis, inflammatory cell infiltration, muscle fiber swelling, hyaline, granular, or vacuolar changes, interstitial edema, and perivascular lymphocyte and plasma cell infiltration.5. Electrocardiogram: The abnormality rate can reach about 40%, with tachycardia, myocarditis-like manifestations, or arrhythmias.
4. Differential Diagnosis:
It needs to be differentiated from muscular dystrophy, thyroid dysfunction, systemic lupus erythematosus, etc.
bubble_chart Treatment Measures
1. Application of corticosteroids. Prednisone 40-60mg/d administered at draught. Gradually reduce the dose after the condition stabilizes. For critically ill patients, hydrocortisone 200-300mg/d, or dexamethasone 10-20mg/d added to 10% glucose for intravenous drip. Switch to oral administration after the condition stabilizes, adjust the dose to the level where the efficacy is best and side effects are minimal as the maintenance dose, sometimes lasting 2-3 years. During the course of treatment, ACTH should be used intermittently.
2. For those who are ineffective with high-dose short-course hormone therapy, consider discontinuation and switch to immunosuppressants, azathioprine 100-200mg daily. Pay attention to side effects. Nandrolone phenylpropionate 25mg intramuscular injection twice a week is effective in relieving pain and alleviating symptoms.
3. For those with difficulty swallowing, nasal feeding should be provided to ensure adequate nutrition. For those with respiratory obstruction or respiratory muscle paralysis, timely tracheotomy and assisted ventilation are necessary. Stronger Neo-Minophagen C has hormone-like effects without its side effects and can be selected. 40mg V.D once daily.
