Myositis is a disease that occurs for a number of reasons and leads to an inflammatory process in the muscle tissues. Depending on what caused the disease, it is classified into different types. One group of pathological conditions is conditionally harmless and can be treated, while the other, causing serious disorders in the body, can lead to death. In the article we will consider the main issues related to this pathology. Here the reader will find out in what cases myositis occurs, what forecasts for treatment for myositis ossificans exist today, how to protect yourself from this disease.
What is this?
Myositis refers to a whole range of diseases, which are based on the inflammatory process that occurs in the muscles. A key symptom indicating the possible occurrence of a disease in the body is muscle pain, which increases with movement or probing.
Pathology occurs against the background of an infection or hypothermia, and can also develop as a result of autoimmune diseases,injuries, bruises, etc.
The causes of the disease are conditionally classified into two groups:
- endogenous - that occur inside the body;
- exogenous - causes from outside.
Endogenous include:
- autoimmune diseases such as lupus erythematosus, rheumatoid arthritis, etc.;
- infections of various nature - enterovirus, typhoid, influenza;
- diseases caused by the activity of parasites in the human body (echinococcosis, trichinosis);
- intoxication of the body.
Exogenous causes are injuries, hypothermia, periodic muscle tension caused by any activity. Myositis is considered an occupational disease of musicians and athletes.
Types
According to the origin of the disease, the nature of its course and other signs, myositis is classified into infectious, purulent and parasitic categories. There are also toxic and traumatic varieties. Polymyositis (ossifying myositis) is a pathology with the most severe course and ambiguous consequences. This disorder is a disease of the connective tissue and, in turn, is classified into:
- traumatic myositis ossificans;
- progressive myositis ossificans;
- neuromyositis.
Traumatic myositis ossificans (symptoms of the disease will be discussed later) is an inflammatory disease that occurs against the background of a severe injury or repeated repeated microtraumas. Pathology is localized in the articular ligaments and subsequently leads tothe occurrence of ossification in the problem area. Successfully treated with surgery.
Progressive myositis ossificans (we will describe the symptoms of the disease below) is a genetic disease caused by a mutation of a certain gene, leading to severe disorders in the body and, as a result, to the death of a person. It is considered very rare (no more than 200 cases known to world medical practice).
Neurotrophic myositis occurs against the background of injuries of large nerve trunks or spinal cord. Most often, the pathology develops in the knee or hip joint.
Neuromyositis
As noted earlier, it affects intramuscular nerve fibers. It happens in the following way. The inflammatory process leads to the destruction of muscle cells, resulting in the release of various kinds of substances that have a toxic effect on nerve fibers. The sheath of the nerve is gradually destroyed, which leads to damage to the axial nerve cylinder.
Signs of neuromyositis are:
- decrease or increase in sensitivity in the area of localization of pathology;
- pain;
- muscle weakness;
- joint pain.
The destruction of the sheath of nerve fibers causes a change in the sensitivity of the skin. This may present with numbness or tingling that is accompanied by progressive pain. At first, the pain syndrome is moderate, but it intensifies even with minor loads. Pain causes breathing, turning or tilting of the body, movement of the limbs. Later, she makes itself felt even at rest. Often withpathology, a symptom of tension occurs when palpation of the muscles in a tense state becomes very sensitive.
Progressive form of the disease
The second type of polymyositis caused by genetic disorders is progressive myositis ossificans. Symptoms of pathology are almost impossible to eliminate, because it is considered incurable. With progressive myositis ossificans, ossification of the muscles, tendons and ligaments occurs. The disease occurs almost spontaneously and over time covers a large group of muscles. A lethal outcome is inevitable, since the ossification of the pectoral and swallowing muscles makes it impossible for a person to eat and breathe. Progressive ossifying myositis has another name - fibrodysplasia ossificans progressive (FOP).
The pathology is based on the occurrence of an inflammatory process in the tendons, ligaments and muscles, which ultimately leads to their ossification. The muscles of the back (broad, trapezius) undergo the greatest initial changes in ossifying myositis. What are the consequences of this disease? Serious disturbances in the functioning of the musculoskeletal system, stiffness of movements, the inability to eat and breathe normally - all this significantly reduces the patient's quality of life. As a rule, the process begins in children at the age of ten and progresses over the years, however, most patients die before reaching the age of ten.
Only in 2006 thanks to research conducted by a group of scientists fromPennsylvania State University, a gene has been identified whose mutation leads to severe pathology. Today, experts are developing blockers of mutations in the gene.
Symptoms of FOP
As mentioned above, FOP occurs in childhood. The possible formation of the disease in a baby can be indicated by several signs that occur for the most part precisely with myositis ossificans. What are the most obvious symptoms of the disease?
With a 95% probability, it is possible to diagnose a pathology in a child if one or more phalanges of the big toe are bent inward. In some cases, the finger is missing a joint. Most often, progressing myositis affects boys. A symptom of the disease in early infancy is painful palpation of the muscles, while they are quite dense, tense.
Another sign of pathology is swelling of the soft tissues of the head, which could occur with minor bruises or scratches, insect bites. However, in the presence of FOP, the swelling does not respond to drug therapy and does not go away within a month. Lumps up to ten centimeters in size can also occur under the skin in the back, forearm or neck.
First, FOP affects the muscles of the neck, back, head, and later descends into the abdominal and femoral muscles. However, the disease never affects the muscle tissue of the heart, the diaphragm, the tongue, the muscles around the eyes.
The disease is often confused with oncology and they try to remove the hardening that has arisen, which does not lead to recovery,but provokes the rapid growth of "unnecessary" bones.
Treatment
Unfortunately, today progressive myositis ossificans is practically impossible to eliminate, and the therapy used is ineffective. There are no proven methods for the prevention of FOP. With the discovery of the mutating gene, it became possible only to study the processes of the onset of the disease. Treatment methods are developed in the laboratory and are not used in medical practice. In addition, possible experimental therapies should be seriously evaluated in terms of dosage and duration of treatment.
Specialists who deal specifically with myositis ossificans work in the USA, at the McKay Laboratory at the Pennsylvania Federal University. Frederick Kaplan, MD, PhD, supervises the scientific work.
In the initial stages of the disease, therapy includes anti-inflammatory drugs, ascorbic acid, vitamins A and B, biostimulants. In severe cases of pathology, steroid hormones are used, although their effectiveness has not been proven either.
Physiotherapy leads to some improvements - ultrasound, electrophoresis. These procedures give a resolving and analgesic effect. It is necessary to adhere to the minimum intake of products containing calcium, to avoid any intramuscular injections. Surgery and removal of bone formations is pointless.
Traumatic myositis ossificans
Localized traumatic myositis ossificans is a diseasewhich leads to the formation of bone formations as a result of acute injuries - dislocations, fractures, sprains, or due to repeated minor trauma, for example, in athletes or musicians.
The pathology is based on hemorrhage into the muscle tissue. Most often, ossificates are formed in the gluteal, femoral and shoulder muscles. Some time after the injury, the first symptoms of the pathology appear. A seal is formed in the muscle, which grows rapidly and is painful on palpation. After a few weeks, the induration transforms into an indeterminate ossification that limits the mobility of the nearby joint. Then the pain gradually disappears. The disease affects young people, mostly men with developed muscles.
Only after an x-ray is taken, the diagnosis of traumatic ossifying myositis is reliably made. The photo of the x-ray is shown above. The result of the radiograph indicates that a kind of light “cloud” is observed in the affected area, which does not have clear boundaries. The ossificates arising from pathology at first do not have a definite shape, but later acquire a structure and clear contours.
Traumatic myositis ossificans: treatment
How to eliminate the disease? Traumatic myositis ossificans has a favorable prognosis for treatment. Immediately after the injury, a plaster cast is indicated for up to two weeks. After detecting the first signs of the disease and establishing a diagnosis, it is necessary toapply light heat, radon baths, radiotherapy, electrophoresis, light therapeutic exercises. At the same time, massage, paraffin, electric field cannot be used for medicinal purposes.
After the radiograph has revealed the presence of a cloud shadow, it is still possible to prevent the development of the disease and reverse the process. Under the influence of hormones, the formation is resorbed. Steroid injections are given topically. Often in the treatment they use "Hydrocortisone" in conjunction with a solution of "Novocain".
After several months after the injury, when the ossification is already formed, it makes no sense to apply conservative treatment. Six months later, they resort to surgical intervention - the ossiophyte is removed along with the capsule.
There are some conditions, the fulfillment of which will lead to a positive outcome of therapy and the absence of relapses - the operation must be atraumatic, it is necessary to use an electric knife, carefully suture the wound cavity, and carry out the prescribed preventive measures in the postoperative period.
Diagnosis of myositis ossificans
Identification of the disease begins with the study of the clinical picture. A conversation with the patient allows you to find out the presence in the life of the last ailments that could become a trigger for the development of myositis. Often, pathology occurs due to cystitis, osteomyelitis, erysipelas of the skin. Viruses, bacteria and fungal infections also provoke the development of myositis. The disease is also formed after injuries, muscle cramps, hypothermia. Prolonged loads on some muscle groups also lead topathology.
As noted earlier, with myositis ossificans, pain occurs. Patients often complain of aching pain and muscle weakness. Palpation of the affected areas of the body helps to determine the presence / absence of heaviness and nodules in the muscles.
The disease can develop under the influence of toxic substances, such as alcoholism and drug use. Certain medications also cause muscle damage.
Examination process
In addition to the history and physical examination, an x-ray is performed to confirm the diagnosis, which reveals the ossification. Sometimes a CT scan and radioisotope study of affected muscles may be done.
The presence of myositis in the body is indicated by characteristic changes in the general blood test. Another method of laboratory research is to conduct rheumatic tests - tests that help determine the nature of the disease and exclude autoimmune diseases, as well as identify the intensity of the inflammatory process.
Indicators of rheumatic tests indicate various states of the body. For example, C-reactive protein is a marker of the acute phase of the inflammatory process. Antistreptolysin-O is a substance that is produced in the body during a streptococcal infection. Its presence indicates rheumatism or rheumatoid arthritis. Rheumofactor is an antibody that is produced in the body during autoimmunepathologies.
Morphological study in the diagnosis of myositis is a biopsy - the taking of biomaterial for analysis and its careful study. The main task is to determine structural changes in muscles and connective tissue.
Prevention
Prevention of myositis ossificans includes several principles, the main of which is maintaining the right lifestyle - activity without excessive physical exertion, balanced nutrition and timely treatment of any diseases.
Complete nutrition helps to avoid inflammatory processes in the muscles - fatty polyunsaturated acids contained in fish are useful; foods high in salicylates (vegetables); easily digestible proteins (almonds, chicken meat); foods high in calcium; cereals.
The drinking regimen is very important, in which about two liters of water should be consumed per day. Fruit drinks and compotes should not be neglected; green tea is also useful. To eliminate puffiness, it is recommended to take a rosehip decoction. For the prevention of myositis, it is useful to spend time in the fresh air. Many patients are often concerned about this question: is it possible to do exercises with ossifying myositis? It is possible, however, the load should be light and dosed. In addition to gymnastics, hardening, swimming, cycling are recommended for this disease.
Prevention of myositis also includes constant movement, it is important to prevent physical inactivity and hypothermia. Of course, the best prevention of pathology is the absence of any injuries.
