Steroid Myopathy There are two presentations, the acute and chronic. Steroid myopathy may be more frequent with the use of fluorinated steroids, such as dexamethasone or triamcinolone, than with nonfluorinated ones, such as prednisone or hydrocortisone. The acute presentation is associated with the administration of high dose steroids, usually with the equivalent of 5 grams of hydrocortisone over several days. Usually within the first week. It usually presents with more generalized weakness rather than focal or predominately proximal weakness, and may demonstrate elevations in labs associated with muscle breakdown (rhabdomyolosis) such as CPK and AST/ALT and myoglobinuria. EMG may show abnormal spontaneous activity (positive sharp waves and fibrillation potentials), small polyphasic motor units, and early recruitment. Occasionally a co-exisiting steroid neuropathy can be found. The chronic presentation is more insidious. The dosages of prednisone are usually within 40-60 mg per day for several weeks to years of use. The main complaint will be slowly developing weakness, perhaps with atrophy, in the proximal muscles of the shoulder girdle and hips and thighs worsening over weeks and months. The hands, face and sphincter muscles are usually spared. Myalgias (muscle pains) can develop as the condition progresses. Lab workup usually shows normal blood levels of creatine though may have elevations in urine creatine. EMG findings may be mild with normal insertional activity and only a few abnormal spontaneous potentials (positive waves and fibrillations). Muscle biopsy can also be performed. In the chronic presentation there is atrophy of type II muscle fibers without evidence of inflammation or necrosis. In the acute presentation, there is atrophy of all types of muscle fibers with necrosis. The treatment for either condition is to reduce or stop the steroids if possible, this of course depends on the reason the steroids were started in the first place. A complication occurs when steroids are being used to treat another myopathy (polymyositis) and the patient is continuing to get weaker while on treatment. The question can arise whether its the polymyositis causing the weakness or the steroids themselves. Recovery can takes weeks to months for either acute or the chronic form. Links: Emedicine article on Steriod Myopathy Return to Diseases

Steroid Myopathy

There are two presentations, the acute and chronic.

Steroid myopathy may be more frequent with the use of fluorinated steroids, such as dexamethasone or triamcinolone, than with nonfluorinated ones, such as prednisone or hydrocortisone.

The acute presentation is associated with the administration of high dose steroids, usually with the equivalent of 5 grams of hydrocortisone over several days. Usually within the first week. It usually presents with more generalized weakness rather than focal or predominately proximal weakness, and may demonstrate elevations in labs associated with muscle breakdown (rhabdomyolosis) such as CPK and AST/ALT and myoglobinuria. EMG may show abnormal spontaneous activity (positive sharp waves and fibrillation potentials), small polyphasic motor units, and early recruitment. Occasionally a co-exisiting steroid neuropathy can be found.

The chronic presentation is more insidious. The dosages of prednisone are usually within 40-60 mg per day for several weeks to years of use. The main complaint will be slowly developing weakness, perhaps with atrophy, in the proximal muscles of the shoulder girdle and hips and thighs worsening over weeks and months. The hands, face and sphincter muscles are usually spared. Myalgias (muscle pains) can develop as the condition progresses. Lab workup usually shows normal blood levels of creatine though may have elevations in urine creatine. EMG findings may be mild with normal insertional activity and only a few abnormal spontaneous potentials (positive waves and fibrillations). Muscle biopsy can also be performed. In the chronic presentation there is atrophy of type II muscle fibers without evidence of inflammation or necrosis. In the acute presentation, there is atrophy of all types of muscle fibers with necrosis.

The treatment for either condition is to reduce or stop the steroids if possible, this of course depends on the reason the steroids were started in the first place. A complication occurs when steroids are being used to treat another myopathy (polymyositis) and the patient is continuing to get weaker while on treatment. The question can arise whether its the polymyositis causing the weakness or the steroids themselves.

Recovery can takes weeks to months for either acute or the chronic form.

Links:

Emedicine article on Steriod Myopathy

Return to Diseases