Download PDF
Semin Neurol 2012; 32(05): 491-499
DOI: 10.1055/s-0033-1334467
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Inflammatory and Toxic Myopathy

James W. Teener
1   Department of Neurology, University of Michigan Health System, Ann Arbor, Michigan
› Author Affiliations
Further Information

Publication History

Publication Date:
15 May 2013 (online)

    Permissions and Reprints

Abstract

Although muscle diseases are relatively rare, several treatable myopathies must be recognized by the clinician to maximize the possibility of restoring strength in affected patients. The inflammatory myopathies, including polymyositis, dermatomyositis, inflammatory necrotizing myopathy, and myositis in association with mixed connective tissue disease, typically respond well to immunosuppressive treatment. Inclusion body myositis, a myopathy that has features of both inflammation and primary degeneration, may not be treatable at this time, but treatments are actively being sought. Muscle dysfunction caused by toxins must also be recognized because removal of the offending toxin usually results in restoration of normal muscle function. Important muscle toxins include cholesterol-lowering medications, colchicine, zidovudine, corticosteroids, emetine, and ethanol.

Keywords

myositis - polymyositis - dermatomyositis - inclusion body myositis - necrotizing myopathy - toxic myopathy - cholesterol-lowering agent myopathy
 

  • Reference

  • 1 Amato AA, Barohn RJ. Evaluation and treatment of inflammatory myopathies. J Neurol Neurosurg Psychiatry 2009; 80 (10) 1060-1068
    CrossrefPubMedSearch in Google Scholar
  • 2 Hochberg MC, Feldman D, Stevens MB. Adult onset polymyositis/dermatomyositis: an analysis of clinical and laboratory features and survival in 76 patients with a review of the literature. Semin Arthritis Rheum 1986; 15 (3) 168-178
    CrossrefPubMedSearch in Google Scholar
  • 3 Bohan A, Peter JB, Bowman RL, Pearson CM. Computer-assisted analysis of 153 patients with polymyositis and dermatomyositis. Medicine (Baltimore) 1977; 56 (4) 255-286
    CrossrefPubMedSearch in Google Scholar
  • 4 Nozaki K, Pestronk A. High aldolase with normal creatine kinase in serum predicts a myopathy with perimysial pathology. J Neurol Neurosurg Psychiatry 2009; 80 (8) 904-908
    CrossrefPubMedSearch in Google Scholar
  • 5 Hengstman GJ, van Engelen BG, van Venrooij WJ. Myositis specific autoantibodies: changing insights in pathophysiology and clinical associations. Curr Opin Rheumatol 2004; 16 (6) 692-699
    PubMedSearch in Google Scholar
  • 6 Hengstman GJ, ter Laak HJ, Vree Egberts WT , et al. Anti-signal recognition particle autoantibodies: marker of a necrotising myopathy. Ann Rheum Dis 2006; 65 (12) 1635-1638
    CrossrefPubMedSearch in Google Scholar
  • 7 Rutkove SB, De Girolami U, Preston DC , et al. Myotonia in colchicine myoneuropathy. Muscle Nerve 1996; 19 (7) 870-875
    CrossrefPubMedSearch in Google Scholar
  • 8 Rich MM, Teener JW, Raps EC, Schotland DL, Bird SJ. Muscle is electrically inexcitable in acute quadriplegic myopathy. Neurology 1996; 46 (3) 731-736
    CrossrefPubMedSearch in Google Scholar
  • 9 Rich MM, Pinter MJ, Kraner SD, Barchi RL. Loss of electrical excitability in an animal model of acute quadriplegic myopathy. Ann Neurol 1998; 43 (2) 171-179
    CrossrefPubMedSearch in Google Scholar
  • 10 Arahata K, Engel AG. Monoclonal antibody analysis of mononuclear cells in myopathies. I: Quantitation of subsets according to diagnosis and sites of accumulation and demonstration and counts of muscle fibers invaded by T cells. Ann Neurol 1984; 16 (2) 193-208
    CrossrefPubMedSearch in Google Scholar
  • 11 Engel AG, Arahata K. Monoclonal antibody analysis of mononuclear cells in myopathies. II: Phenotypes of autoinvasive cells in polymyositis and inclusion body myositis. Ann Neurol 1984; 16 (2) 209-215
    CrossrefPubMedSearch in Google Scholar
  • 12 Amato AA, Barohn RJ. Inclusion body myositis: old and new concepts. J Neurol Neurosurg Psychiatry 2009; 80 (11) 1186-1193
    CrossrefPubMedSearch in Google Scholar
  • 13 Bronner IM, Hoogendijk JE, Wintzen AR , et al. Necrotising myopathy, an unusual presentation of a steroid-responsive myopathy. J Neurol 2003; 250 (4) 480-485
    CrossrefPubMedSearch in Google Scholar
  • 14 Emslie-Smith AM, Engel AG. Necrotizing myopathy with pipestem capillaries, microvascular deposition of the complement membrane attack complex (MAC), and minimal cellular infiltration. Neurology 1991; 41 (6) 936-939
    CrossrefPubMedSearch in Google Scholar
  • 15 Callen JP. Relationship of cancer to inflammatory muscle diseases. Dermatomyositis, polymyositis, and inclusion body myositis. Rheum Dis Clin North Am 1994; 20 (4) 943-953
    PubMedSearch in Google Scholar
  • 16 Joffe MM, Love LA, Leff RL , et al. Drug therapy of the idiopathic inflammatory myopathies: predictors of response to prednisone, azathioprine, and methotrexate and a comparison of their efficacy. Am J Med 1993; 94 (4) 379-387
    CrossrefPubMedSearch in Google Scholar
  • 17 Kissel JT, Levy RJ, Mendell JR, Griggs RC. Azathioprine toxicity in neuromuscular disease. Neurology 1986; 36 (1) 35-39
    CrossrefPubMedSearch in Google Scholar
  • 18 Majithia V, Harisdangkul V. Mycophenolate mofetil (CellCept): an alternative therapy for autoimmune inflammatory myopathy. Rheumatology (Oxford) 2005; 44 (3) 386-389
    CrossrefPubMedSearch in Google Scholar
  • 19 Goei The HS, Jacobs P, Houben H. Cyclosporine in the treatment of intractable polymyositis. Arthritis Rheum 1985; 28 (12) 1436-1437
    CrossrefPubMedSearch in Google Scholar
  • 20 Oddis CV, Sciurba FC, Elmagd KA, Starzl TE. Tacrolimus in refractory polymyositis with interstitial lung disease. Lancet 1999; 353 (9166) 1762-1763
    CrossrefPubMedSearch in Google Scholar
  • 21 Cronin ME, Miller FW, Hicks JE, Dalakas M, Plotz PH. The failure of intravenous cyclophosphamide therapy in refractory idiopathic inflammatory myopathy. J Rheumatol 1989; 16 (9) 1225-1228
    PubMedSearch in Google Scholar
  • 22 Fries JF, Sharp GC, McDevitt HO, Holman HR. Cyclophosphamide therapy in systemic lupus erythematosus and polymyositis. Arthritis Rheum 1973; 16 (2) 154-162
    CrossrefPubMedSearch in Google Scholar
  • 23 Sinoway PA, Callen JP. Chlorambucil. An effective corticosteroid-sparing agent for patients with recalcitrant dermatomyositis. Arthritis Rheum 1993; 36 (3) 319-324
    CrossrefPubMedSearch in Google Scholar
  • 24 Dalakas MC, Illa I, Dambrosia JM , et al. A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis. N Engl J Med 1993; 329 (27) 1993-2000
    CrossrefPubMedSearch in Google Scholar
  • 25 Hennekens CH. Statin-induced myopathy: hypothesis about randomized evidence and clinical impressions. Am J Med 2009; 122 (1) 4-5
    CrossrefPubMedSearch in Google Scholar
  • 26 McAdams M, Staffa J, Dal Pan G. Estimating the extent of reporting to FDA: a case study of statin-associated rhabdomyolysis. Pharmacoepidemiol Drug Saf 2008; 17 (3) 229-239
    CrossrefPubMedSearch in Google Scholar
  • 27 Vladutiu GD. Genetic predisposition to statin myopathy. Curr Opin Rheumatol 2008; 20 (6) 648-655
    CrossrefPubMedSearch in Google Scholar
  • 28 Grable-Esposito P, Katzberg HD, Greenberg SA, Srinivasan J, Katz J, Amato AA. Immune-mediated necrotizing myopathy associated with statins. Muscle Nerve 2010; 41 (2) 185-190
    PubMedSearch in Google Scholar
  • 29 Walsh RJ, Amato AA. Toxic myopathies. Neurol Clin 2005; 23 (2) 397-428
    CrossrefPubMedSearch in Google Scholar
  • 30 Kuncl RW, Duncan G, Watson D, Alderson K, Rogawski MA, Peper M. Colchicine myopathy and neuropathy. N Engl J Med 1987; 316 (25) 1562-1568
    CrossrefPubMedSearch in Google Scholar
  • 31 Kuncl RW, Cornblath DR, Avila O, Duncan G. Electrodiagnosis of human colchicine myoneuropathy. Muscle Nerve 1989; 12 (5) 360-364
    CrossrefPubMedSearch in Google Scholar
  • 32 Kiyomoto BH, Tengan CH, Godinho RO. Effects of short-term zidovudine exposure on mitochondrial DNA content and succinate dehydrogenase activity of rat skeletal muscle cells. J Neurol Sci 2008; 268 (1-2) 33-39
    CrossrefPubMedSearch in Google Scholar
  • 33 Mhiri C, Baudrimont M, Bonne G , et al. Zidovudine myopathy: a distinctive disorder associated with mitochondrial dysfunction. Ann Neurol 1991; 29 (6) 606-614
    CrossrefPubMedSearch in Google Scholar
  • 34 Pascuzzi RM. Drugs and toxins associated with myopathies. Curr Opin Rheumatol 1998; 10 (6) 511-520
    CrossrefPubMedSearch in Google Scholar
  • 35 Kissel JT, Mendell JR. The endocrine myopathies. In: Rowland LP, DiMauro S, , eds. Handbook of Clinical Neurology. Amsterdam: Elsevier; 1992: 527-551
    Search in Google Scholar
  • 36 Faludi G, Gotlieb J, Meyers J. Factors influencing the development of steroid-induced myopathies. Ann N Y Acad Sci 1966; 138 (1) 62-72
    PubMedSearch in Google Scholar
  • 37 Hirano M, Ott BR, Raps EC , et al. Acute quadriplegic myopathy: a complication of treatment with steroids, nondepolarizing blocking agents, or both. Neurology 1992; 42 (11) 2082-2087
    CrossrefPubMedSearch in Google Scholar
  • 38 MacFarlane IA, Rosenthal FD. Severe myopathy after status asthmaticus. Lancet 1977; 2 (8038) 615
    PubMedSearch in Google Scholar
  • 39 Lacomis D, Petrella JT, Giuliani MJ. Causes of neuromuscular weakness in the intensive care unit: a study of ninety-two patients. Muscle Nerve 1998; 21 (5) 610-617
    CrossrefPubMedSearch in Google Scholar
  • 40 Palmer EP, Guay AT. Reversible myopathy secondary to abuse of ipecac in patients with major eating disorders. N Engl J Med 1985; 313 (23) 1457-1459
    CrossrefPubMedSearch in Google Scholar
  • 41 Amato AA, Kagan-Hallet K, Jackson CE , et al. The wide spectrum of myofibrillar myopathy suggests a multifactorial etiology and pathogenesis. Neurology 1998; 51 (6) 1646-1655
    CrossrefPubMedSearch in Google Scholar