Alexa-Rae P.

Zagado
BNS-III
NCM 104 – Clinicals
Sir Ronald Ramo, RN MAN
April 9-10, 2020

Polymyolitis / Polymyositis

Polymyolitis/Polymyositis is one of the inflammatory myopathies, a group of

muscle diseases that involves inflammation of the muscles or associated tissues,
such as the blood vessels that supply the muscles. A myopathy is a muscle disease,
and inflammation is response to cell damage.

Causes:

The exact cause of polymyositis is unknown, but the disease shares many
characteristics with autoimmune disorders, in which your immune system
mistakenly attacks your own body tissues.

Risk Factors:

Your risk of polymyositis is higher if you have lupus, rheumatoid arthritis,

scleroderma, or Sjogren's syndrome.

Complications:

Possible complications of polymyositis include:

 Difficulty swallowing. If the muscles in your esophagus are affected, you

may have problems swallowing (dysphagia), which in turn may cause weight
loss and malnutrition.

 Aspiration pneumonia. Difficulty swallowing may also cause you to breathe

food or liquids, including saliva, into your lungs (aspiration), which can lead to
pneumonia.
  Breathing problems. If your chest muscles are affected by the disease, you
may experience breathing problems, such as shortness of breath or, in severe
cases, respiratory failure.

Associated Conditions:

Although these are not complications, polymyositis is often associated with other
conditions that may cause further complications of their own, or in combination
with polymyositis symptoms. Associated conditions include:

 Raynaud's phenomenon. This is a condition in which your fingers, toes,

cheeks, nose and ears initially turn pale when exposed to cold temperatures.

 Other connective tissue diseases. Other conditions, such as lupus,

rheumatoid arthritis, scleroderma and Sjogren's syndrome, can occur in
combination with polymyositis.

 Cardiovascular disease. Polymyositis may cause the muscular walls of your

heart to become inflamed (myocarditis). In a small number of people who have
polymyositis, congestive heart failure and heart arrhythmias may develop.

 Lung disease. A condition called interstitial lung disease may occur with
polymyositis. Interstitial lung disease refers to a group of disorders that cause
scarring (fibrosis) of lung tissue, making lungs stiff and inelastic. Signs and
symptoms include a dry cough and shortness of breath.

 Cancer. People who have polymyositis have an elevated risk of cancer.

Medical Management:

Polymyositis is treated with high doses of corticosteroids as a first course of

treatment. Corticosteroids are given because they can effectively decrease the
inflammation in the muscles. Corticosteroids do not always adequately improve
polymyositis. In these patients immunosuppressive medications are considered.
These medicines include:

 Methotrexate (brand names Rheumatrex® and Trexall®)

 Azathioprine (brand name Imuran® and Azasan®)
  Cyclophosphamide (brand name Cytoxan®)
 Chlorambucil (brand name Leukeran®)
 Cyclosporine (brand name Sandimmune®, Gengraf®, and Neoral®)
 Tacrolimus (brand name Astagraf XL®, Hecoria®, Prograf®)
 Mycophenolate (brand name CellCept®, Myfortic®)
 Rituximab (brand name Rituxan®)

In severe cases of polymyositis, the intravenous infusion of immunoglobulins (IVIG)

has been an effective treatment. Physical therapy also is important in the treatment
of polymyositis.

With early medical treatment of the disease and disease flares, patients with
polymyositis can do well. The disease frequently becomes inactive, enabling the
patient to focus on muscle rehabilitation.

Diagnosis:

If your doctor suspects you have polymyositis, he or she might suggest some of the
following tests:

 Blood tests. A blood test will let your doctor know if you have elevated
levels of muscle enzymes, which can indicate muscle damage. A blood test can
also detect specific autoantibodies associated with different symptoms of
polymyositis, which can help in determining the best medication and
treatment.

 Electromyography. This test involves inserting a thin needle electrode

through the skin into the muscle. Electrical activity is measured as you relax or
tighten the muscle, and changes in the pattern of electrical activity can confirm
a muscle disease. The doctor can determine the distribution of the disease by
testing different muscles.

 Magnetic resonance imaging (MRI). A scanner creates cross-sectional

images of your muscles from data generated by a powerful magnetic field and
radio waves. Unlike a muscle biopsy, an MRI can assess inflammation over a
large area of muscle.

 Muscle biopsy. During this test, a small piece of muscle tissue is surgically

removed for laboratory analysis. Analysis may reveal abnormalities, such as
inflammation, damage, certain proteins or enzyme deficiencies.
Treatment:

Although there's no cure for polymyositis, treatment can improve your muscle
strength and function. The earlier treatment is started in the course of polymyositis,
the more effective it is — leading to fewer complications.

However, as with many conditions, no single approach is best; your doctor will
tailor your treatment strategy based on your symptoms and how well they respond
to therapy.

Nursing Management:

 Educate patient about polymyositis and other muscle and autoimmune

disorders. Talk to other people who have a similar condition. Encourage
patient not to be afraid to ask the nurse and doctor about any questions that
they may have concerning their illness, diagnosis or treatment plan.

 Encourage patient to be involved as a united front in the fight against your

disease. Following the treatment plan you agreed to is vital. Encourage the
patient to keep the doctor updated on any new signs or symptoms that they
may experience.

 Encourage patient to learn to say no effectively and to ask for help when they
need it.

 Encourage and educate patient in learning to pace themselves which can help
them maintain a consistent level of energy, and accomplish just as much and
feel better emotionally.

 Acknowledge the patient’s emotions. Denial, anger and frustration are

normal feelings when dealing with an illness. Things do not seem normal or
fair and likely seem out of their control. Feelings of fear and isolation are
common, so family and friends should remain close. Patient should try to
maintain daily routine as best as they can and do not neglect doing those
things they enjoy. Many patients find support groups to be a helpful resource.