Samantha Ruth Prabhu Is Suffering From Myositis. All About The Rare Autoimmune Condition

Myositis is the name for a group of rare conditions, characterised by weak, painful or aching muscles. A rare autoimmune condition that inflames and weakens muscle fibres, myositis usually gets worse.

Actor Samantha Ruth Prabhu has opened up about being diagnosed with a rare autoimmune condition called myositis. ( Image Source :Instagram/@Samantha )

Actor Samantha Ruth Prabhu has opened up about being diagnosed with a rare autoimmune condition called myositis. Prabhu, who gained immense popularity for her role in The Family Man: Season 2, recently shared a post on social media, speaking about her fight with the condition.

She wrote that she was diagnosed with myositis a few months back and the condition is taking a little longer to go into remission than what she had hoped. 

 

 

 

 

 

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Here is everything you need to know about myositis.

What is myositis?

Myositis is the name for a group of rare conditions, characterised by weak, painful or aching muscles. A rare autoimmune condition that inflames and weakens muscle fibres, myositis usually gets worse, slowly over time. Autoimmune diseases are those in which the immune system cannot differentiate between the body's host cells and foreign cells, causing the defence system to attack healthy cells by mistake.

Myositis is the condition in which the immune system attacks healthy muscle tissue, resulting in inflammation, swelling, pain and eventual weakness.

The word 'myositis' means muscle inflammation. White blood cells called lymphocytes, which are meant to project the body's immune system, may start attacking the body's healthy cells, resulting in myositis. 

The condition is also known as idiopathic inflammatory myopathy (IIM), according to the Myositis Association. 

When myositis causes inflammation and weakness in the muscles, it is called polymyositis. When myositis causes inflammation and weakness in both the skin and muscles, it is called dermatomyositis. Polymyositis is characterised by muscle weakness affecting both sides of the body, while dermatomyositis is characterised by muscle weakness and a distinctive skin rash. 

A person suffering from myositis may trip or fall a lot, and be very tired after walking or standing. They may find it difficult to climb stairs, rise from a seated position, or lift objects. 

What are the different types of myositis?

The different types of myositis are polymyositis, dermatomyositis, inclusion body myositis, autoimmune necrotising myopathy, and juvenile forms of myositis. Myopathy is a disorder of the skeletal muscles due to dysfunction of the muscle fibres. 

Polymyositis affects different muscles, particularly the shoulders, hips and thigh muscles, and is more common in women and tends to affect people aged 30 to 60 years. 

Dermatomyositis affects several muscles and causes a rash, and is more common in women and can also affect children. 

Inclusion body myositis causes weakness in the thigh muscles, forearm muscles and the muscles below the knee, and may also cause problems with swallowing. It is more common in men, and tends to affect people aged above 50 years. 

Autoimmune necrotising myopathy is a condition characterised by signs of necrosis, or cell death, in the muscles. This results in weakness and fatigue. Though the exact cause and cure for necrotising myopathy are not known, treatments are available that can successfully manage symptoms. 

Juvenile myositis is observed in children under 18 years of age and affects two to four children per million. Juvenile dermatomyositis is the most frequent form of juvenile myositis, and is characterised by muscle weakness and skin rash in children. Meanwhile, juvenile polymyositis is extremely rare in children. 

What are the symptoms of myositis?

Polymyositis, dermatomyositis and inclusion body myositis are the most common among the different types of myositis.

The symptoms of polymyositis include muscle weakness, finding it hard to sit up, or stand after a fall, feeling unhappy or depressed, aching or painful muscles, feeling very tired, swallowing problems, and finding it hard to hold the head up.

One may find it difficult to get up from a chair, climb stairs, lift objects, and comb their hair, according to the National Health Service (NHS), United Kingdom.

If one does not get treatment, muscle weakness steadily worsens. 

The symptoms of dermatomyositis are similar to those of polymyositis, but there is a distinctive rash that is usually seen on the eyelids, nose, cheeks and knuckles. A red, purple or dark rash often appears before the muscle symptoms start, and can sometimes be seen on the back, elbows, upper chest and knees. The rash appearing in patients with dermatomyositis can be itchy or painful, and one may also get hard lumps of tissue under their skin. 

The symptoms of necrotising myopathy include weakness in the muscles closest to the centre of the body, such as the forearms, thighs, hips, shoulders, neck and back, difficulty lifting arms over the head, a general feeling of fatigue, difficulty climbing stairs and standing up from a chair, and difficulty getting up from a fall. 

The symptoms of inclusion body myositis include frequent falls, trouble climbing stairs or standing from a seated position, weakened hand grip and difficulty bending the fingers, weakness and noticeable shrinking of the quadriceps, which are the main muscle of the thighs, pain or discomfort as muscles weaken, difficulty walking, a foot that seems to drop when walking, difficulty writing and manipulating keys, weakness in the forearm muscles, and difficulty swallowing, according to the Myositis Association. 

Juvenile myositis is characterised by symptoms such as reddish-purple rash over the eyelids or joints, irritability, trouble climbing stairs or onto a bus, standing from a seated position or getting dressed, trouble lifting the head, gradual muscle weakness, mostly in the neck, stomach, upper arms and legs, trouble swallowing, also known as dysphagia, general tiredness, tummy aches, difficulty reaching up to objects such as a shampoo, difficulty combing hair, swelling or redness in the skin around the fingernails, hardened lumps or sheets of calcium under the skin, known as calcinosis, and a hoarse-sounding voice. 

Overall, people suffering from myositis have trouble washing, brushing or blow drying their hair, reaching things high on shelves, hanging up an overcoat, difficulty getting up from a low chair, and climbing steps. In severe cases, myositis causes the muscles of the throat or diaphragm to weaken, leading to trouble swallowing or shortness of breath. 

Those suffering from myositis may find it hard to distinguish fatigue from weakness. They may drop things, or have difficulty carrying heavy items like bags of groceries. 

Diseases and conditions occurring in myositis patients

Inflammatory arthritis, interstitial lung disease, rash, Mechanic's hands, Raynaud's phenomenon, and nail bed or cuticle inflammation are the diseases and conditions that often occur in myositis patients, according to the Hospital for Special Surgery, the top orthopaedic hospital in the United States. 

Inflammatory arthritis refers to the pain or swelling of joints, which generally gets worse with inactivity and early in the morning, and is associated with prolonged stiffness.

The characteristic rashes in dermatomyositis are dark red or purple hues, are commonly itchy, and often affect the scalp, around the eyes, the chest and the hands. 

Raynaud's phenomenon is an abrupt, episodic decrease in blood flow to one or more fingers at a time, is associated with a change in skin colour to blue or white, and typically occurs after exposure to cold. 

Interstitial lung disease is an inflammatory lung disease that leads to cough or shortness or breath. 

'Mechanic's hands' is a condition characterised by thickening of skin on the sides of the fingers, and is often associated with uncomfortable cracking or splitting of the skin.  

Nail bed or cuticle inflammation refers to the redness or pain occurring along the nail beds.

What causes myositis?

The role of white blood cells is to protect the body from foreign bodies or antigens such as bacteria, viruses and fungi. In myositis, the immune system mistakenly attacks healthy muscle tissue, resulting in muscle-related weakness and other conditions. 

However, the exact reason why these conditions develop in some people is not known. According to some studies, in myositis, lymphocytes infiltrate healthy muscle fibres as well as foreign invaders. Muscle fibres are destroyed after a period of inflammation, affecting the functionality of muscle tissue, and eventually leading to fatigue and muscle weakness. 

How can myositis be diagnosed?

Myositis can be diagnosed through blood tests, biopsies, magnetic resonance imaging (MRI) scans and electromyography (diagnostic procedure to assess the health of muscles and nerve cells that control them). 

Blood tests for muscle proteins

Blood tests looking for evidence of muscle damage are the most common. The body's general maintenance program fixes damaged cells and grows new ones. However, when cells are damaged, they leak out some proteins, which can be found in the bloodstream. Due to the general maintenance program, there is a low level of these proteins in the blood all the time. 

But in case of an infection or some other injury to a particular type of cell, there could be a spike in those proteins from that cell. Blood tests are done to detect these proteins. 

The muscle proteins for which blood tests are conducted include creatine kinase or creatine phosphokinase, lactate dehydrogenase, aldolase and myoglobin. 

Even vigorous exercise can cause the blood levels of these proteins to increase. The levels of these proteins go up when myositis is out of control. However, treatment improves their levels. 

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are non-specific indicators of inflammation often elevated in myositis patients. 

Blood tests can also detect increased levels of enzymes in the blood. 

Blood marker tests

Certain blood markers, or antibodies, appear only in myositis patients. Some of these blood markers have clear clinical associations, such as an increased risk of lung disease or arthritis. 

These blood markers are useful in patients whose symptoms are in the early stages, not neatly defined, or when the main initial symptom is something other than muscle weakness, like lung disease. Blood marker tests can shed light on the underlying condition, leading to a faster diagnosis. 

Additional tests

Electromyography and nerve conduction studies, skin biopsy, muscle biopsy and MRI are some additional tests to diagnose myositis. 

Electromyography and nerve conduction studies are specialised tests performed by neurologists to examine the function of nerves, muscles and the ability of nerves to communicate with muscles using small electrical signals.

While performing electromyography, a small needle-shaped electrode is put through the skin and into the muscle, after a local anaesthetic, to record the electrical signals from the nerve endings in the muscles. 

When patients have myositis, a pattern of changes develops. By identifying these patterns, one can confirm the diagnosis in a patient who has weakness. 

A muscle biopsy could reveal cellular or molecular evidence of muscle damage by the immune system, and rule out other causes of muscle injury. A skin biopsy can show cellular or molecular evidence of muscle damage in patients with dermatomyositis. 

In order to observe the muscle in a less invasive fashion, an MRI can be done. The muscle swells up when injured, and holds on to water. An MRI can be used to detect this pattern of muscle swelling, which is a sign of myositis. 

How can myositis be treated?

Myositis can be treated through exercise and physiotherapy, steroids, immunoglobulin therapy, biologic therapies, and disease-modifying anti-rheumatic drugs.

Exercise and physiotherapy 

The symptoms of all types of myositis can be controlled through exercise, which helps reduce swelling, makes one feel more energetic, and builds up or restores muscle strength.

If one has inclusion body myositis, exercise and physiotherapy can prove to be helpful because these are the only treatments for this type of myositis. Inclusion body myositis cannot be treated with medicines. 

However, one with severe symptoms of myositis must be careful while exercising. Severe symptoms include severe muscle pain and weakness. 

If one develops myositis in their childhood, it is very important to maintain gentle movement of the muscles and joints to make sure that joints do not become stiff and end up in a fixed position.

Physical therapy can help maintain and improve muscle function in myositis patients. 

Steroids

Polymyositis and dermatomyositis can be treated with steroids, which help to quickly reduce swelling and ease muscle pain. Steroids can be administered as a tablet or injection, or directly into a vein through a drip. A patient will usually be given a high dose to start with, which is reduced over time.

However, high doses of steroids taken over a long time can cause side effects such as weight gain, diabetes, osteoporosis, high blood pressure, and cataracts. 

Immunoglobulin therapy

Immunoglobulin therapy to stop the immune system from attacking the muscles is required in very rare cases. The therapy involves having an injection or healthy antibodies or immunoglobulins from donated blood, and is given in hospitals, usually directly into a vein or through a drip. 

Biologic therapies

Biologic therapies, such as rituximab, can help manage the symptoms of myositis, and help reduce swelling. These therapies tend to be used only for severe myositis. 

Disease-modifying anti-rheumatic drugs

Some patients also undergo immunosuppressive therapies. One's doctor may prescribe a disease-modifying anti-rheumatic drug if the swelling in their muscles flares up. Some examples include azathioprine, methotrexate, cyclophosphamide, and mycophenolate. These suppress the immune system and may help reduce swelling. 

Though these medicines take time to work they may help reduce the dose of steroids in the long term, and can help ease the side effects of steroids. 

Additional medications

Additional medications are required for 'steroid sparing' because myositis treatment is mostly long-term. This will allow for less use of steroids. 

Some of the additional agents used include mycophenolate mofetil and tacrolimus. 

The Food and Drug Administration (FDA) has not approved immunosuppressive medications like methotrexate or azathioprine. However, they have been frequently incorporated into treatment of myositis for many years. 

How medications to treat myositis work

The medicines used to treat myositis mostly work by blocking the white blood cells in a certain way because they are responsible for the underlying damage to muscle tissue. Steroids like prednisone are the most common treatment, work very quickly, and can be very effective. However, they have a number of side effects that accumulate the longer patients are on treatment, especially with high doses. 

What diet should be consumed by patients suffering from myositis?

Though there is no specific diet for patients with myositis, a healthy diet is important for general well-being.

What are the complications of myositis?

Some people with myositis may not respond well to treatment, as a result of which their everyday life is affected. Through exercise, they can improve muscle strength. 

People with severe myositis may develop breathing and swallowing problems. For these patients whose ability to communicate is affected and have difficulty swallowing, speech and language therapy may be recommended.

In rare cases, myositis may be associated with cancer. 

Since steroids and immunosuppressive therapies in low doses are required for several years, they can lead to an increased risk of infection. 

There is no cure for myositis. However, patients can manage their symptoms using existing therapies. 

Samantha Ruth Prabhu wrote in her posts that her doctors are confident she will make a complete recovery soon.