Diseases with Dr Ditlotlo (Part 3)
It is important to perform age and sex appropriate malignancy (cancer) screening as Polymyositis may be associated with cancer
Chest X ray and High-Resolution CT scan to assess for lung fibrosis and its extent/severity if present
Lung function tests to assess respiratory muscle function and lung fibrosis
Echocardiogram and ECG to assess the effects of the inflammation on the heart muscle.
Discuss the treatments that can be used to stop the progression of polymyositis and possible side effects?
Polymyositis is not a curable disease. The approach to treatment is to control symptoms, improve muscle strength and achieve clinical remission. Early diagnosis is key, and TIME IS MUSCLE. This means that the longer it takes before appropriate treatment is started, the more muscle inflammation and damage occurs, and muscle is less likely to recover. Severity of the disease varies between patients. Poor prognostic features include severe weakness, difficulty swallowing, respiratory muscle weakness, Lung Fibrosis, heart muscle involvement, presence of cancer and presence of some antibodies associated with severe disease.
Treatment is aimed at controlling muscle inflammation. Steroids are the mainstay of therapy. These can be given as tablets or Intravenously (through a drip). They are initially started at a high dose and the dose is slowly tapered over time as the muscle inflammation and strength improve.
Immunosuppressants- These are medications that suppress or control the immune system and prevent it from producing antibodies that attack healthy tissues. They are used early to help reduce the steroid dose and they are for long term use. Some of these include Methotrexate, Azathioprine, MycophenolateMofetil, cyclophosphamide. The choice of the medication depends on the severity of the disease, organ involvement and other co-morbidities (underlying diseases).
Refractory disease (Poor response to treatment) can also be treated with Biologics therapy. These are drugs that target specific part of the immune system to treat the disease.
While all the above treatment options are essential for managing patients with Polymyositis, they also have some side effects that can be experienced by those taking them. This however does not mean that all patients on these medications will experience side effects
Steroids can cause- weight gain, thinning of the skin, reduction in bone density, acne, Peptic ulcer disease, risk for diabetes and high blood pressure, risk for infection, muscle weakness etc
Immunosuppressants mentioned above also have side effects such as risk for infection, some can affect the liver, cause bone marrow suppression, hair loss, diarrhoea, vomiting etc
Patients may also require use of medication to protect them form side effects of above medications such as Calcium and vitamin D, and gastric protection from effects of steroids
Since patients with Polymyositis have suppressed immune system, it is important that they receive vaccinations for conditions like flu virus, Pneumococcal infection, Hepatitis Bif not immune and Covid 19 to protect them from severe disease.
Referral to Allied health Professionals such as Physiotherapist, Occupational therapist, Dietician, psychologist is important for management of patients with Polymyositis.
Ongoing education of patients about their condition is important so that they understand the chronicity of the disease, the effects of treatment and potential side effects. It is also important for patients to understand that some of the medications can affect pregnancy and fertility and that pregnancy must be planned with the treating doctor.
What advice do you offer to young people interested in building a career in medicine?
Being a medical doctor requires passion and dedication to providing care with empathy. Taking part in continuous medical education is essential to keep abreast with latest medical developments and practice evidence-based medicine. Medicine offers a variety of specialties to suit different people, choose one that suits you.