Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Corticosteroid-Induced Myopathy Clinical Presentation

  • Author: Patrick M Foye, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
 
Updated: Jun 22, 2015
 

History

Chronic (classic) steroid myopathy history findings are as follows:

  • This form is the classic presentation of steroid myopathy.
  • This condition can develop after prolonged administration of prednisone at a dose of 40-60 mg/d.[5, 6] Although there is no clear length of time, onset of weakness has been found to occur within weeks to years following initiation of corticosteroid administration.
  • Several studies have suggested that the risk for steroid-induced myopathy is greater in severely asthmatic patients who use oral steroids.[11] One study, however, found no significant difference in the prevalence of myopathy in oral steroid users and inhaled steroid users.
  • A report by Stanton et al indicated that in 43 patients with asthma, a statistically significant association existed between inhaled corticosteroid dose and patient voice scores obtained using the GRBAS (grade-roughness-breathiness-asthenicity-strain) system.[12] Despite this apparent relationship, however, evidence of steroid-induced myopathy was found in only 2 of the 43 patients.
  • Fluorinated steroids seem to produce weakness and myopathy more frequently than do nonfluorinated ones.
  • The insidious onset of proximal muscle weakness of the upper and lower limbs is a prominent clinical feature.
  • Progressive proximal muscle weakness of the upper and lower limbs is reported.
  • Patients typically complain of a progressive inability to rise from chairs, climb stairs, and perform overhead activities.
  • Patients initially note little difficulty with hand strength.
  • The facial and sphincter muscles usually are spared.
  • Myalgias can become a prominent feature with time.
  • Contrary to previous beliefs, several studies have shown involvement of the respiratory muscles (eg, the diaphragm); thus, pulmonary symptoms may be present.[10]

Acute steroid myopathy history findings are as follows:

  • This form is encountered less frequently than is the chronic type.
  • Acute, generalized weakness, including weakness of the respiratory muscles, typically occurs 5-7 days after the onset of treatment with high-dose corticosteroids.[10] Some case reports describe the development of muscle weakness after the administration of a single dose of corticosteroid.
  • One study indicates a possible correlation between the occurrence of acute steroid myopathy and the total dose of steroid administered; acute atrophy was encountered with total doses of greater than 5.4 g of hydrocortisone in 6 days, whereas no signs of myopathy were noted with total doses of less than 4 g.
  • Previous systemic corticosteroid use does not appear to contribute to the development of myopathy.
Next

Physical

Chronic (classic) steroid myopathy physical findings are as follows:

  • Proximal muscle weakness is more pronounced than is distal muscle weakness; however, severe relative weakness of the anterior tibialis muscle can be found.
  • Pelvic girdle muscles usually are affected more severely and earlier than are pectoral girdle muscles.
  • Muscle bulk typically is normal, but muscle atrophy can occur.
  • Muscle stretch reflexes typically are normal.
  • Sensory examination should be normal.

Acute steroid myopathy physical findings are as follows:

  • Generalized muscle weakness, not limited to a more proximal distribution, is noted.
  • Muscle stretch reflexes typically are normal.
  • Sensory examination should be normal.
Previous
 
 
Contributor Information and Disclosures
Author

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Coauthor(s)

Steven S Lim, MD, MD 

Steven S Lim, MD, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Leia Rispoli Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.

Gloria E Hwang, MD, MPA Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kat Kolaski, MD Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Patrick J Potter, MD, FRCSC Associate Professor, Department of Physical Medicine and Rehabilitation, University of Western Ontario School of Medicine; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre

Patrick J Potter, MD, FRCSC is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, College of Physicians and Surgeons of Ontario, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Acknowledgements

Dena Abdelshahed Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.

Debra Ibrahim New York College of Osteopathic Medicine

Disclosure: Nothing to disclose.

Evish Kamrava St George's University School of Medicine

Disclosure: Nothing to disclose.

Cyrus Kao St George's University School of Medicine

Disclosure: Nothing to disclose.

Dev Sinha, MD American University of Antigua School of Medicine and Health Sciences

Disclosure: Nothing to disclose.

References
  1. Askari A, Vignos PJ Jr, Moskowitz RW. Steroid myopathy in connective tissue disease. Am J Med. 1976 Oct. 61(4):485-92. [Medline].

  2. Yamaguchi M, Niimi A, Minakuchi M, et al. Corticosteroid-induced myopathy mimicking therapy-resistant asthma. Ann Allergy Asthma Immunol. 2007 Oct. 99(4):371-4. [Medline].

  3. Lacomis D, Smith TW, Chad DA. Acute myopathy and neuropathy in status asthmaticus: case report and literature review. Muscle Nerve. 1993 Jan. 16(1):84-90. [Medline].

  4. Inder WJ, Jang C, Obeyesekere VR, et al. Dexamethasone administration inhibits skeletal muscle expression of the androgen receptor and IGF-1 - implications for steroid-induced myopathy. Clin Endocrinol (Oxf). 2009 Aug 4. [Medline].

  5. Betters JL, Long JH, Howe KS, et al. Nitric oxide reverses prednisolone-induced inactivation of muscle satellite cells. Muscle Nerve. 2008 Feb. 37(2):203-9. [Medline].

  6. Kumar S. Steroid-induced myopathy following a single oral dose of prednisolone. Neurol India. 2003 Dec. 51(4):554-6. [Medline]. [Full Text].

  7. Inder WJ, Jang C, Obeyesekere VR, Alford FP. Dexamethasone administration inhibits skeletal muscle expression of the androgen receptor and IGF-1--implications for steroid-induced myopathy. Clin Endocrinol (Oxf). Jul 2010. 73(1):126-32. [Medline].

  8. Levin OS, Polunina AG, Demyanova MA, Isaev FV. Steroid myopathy in patients with chronic respiratory diseases. J Neurol Sci. 2014 Mar 15. 338(1-2):96-101. [Medline].

  9. Minetto MA, Qaisar R, Agoni V, et al. Quantitative and qualitative adaptations of muscle fibers to glucocorticoids. Muscle Nerve. 2015 Jan 16. [Medline].

  10. Dekhuijzen PN, Decramer M. Steroid-induced myopathy and its significance to respiratory disease: a known disease rediscovered. Eur Respir J. 1992 Sep. 5(8):997-1003. [Medline].

  11. Borba A, Guil D, Naveso G, et al. [Oral steroids effects on the respiratory muscles function in severe asthmatic patients.]. Rev Port Pneumol. 2006 Dec. 12(6 Suppl 1):39-40. [Medline].

  12. Stanton AE, Sellars C, Mackenzie K, et al. Perceived vocal morbidity in a problem asthma clinic. J Laryngol Otol. 2009 Jan. 123(1):96-102. [Medline].

  13. Minetto MA, Botter A, Lanfranco F, Baldi M, Ghigo E, Arvat E. Muscle fiber conduction slowing and decreased levels of circulating muscle proteins after short-term dexamethasone administration in healthy subjects. J Clin Endocrinol Metab. Apr 2010. 95(4):1663-71. [Medline].

  14. Afifi AK, Bergman RA, Harvey JC. Steroid myopathy. Clinical, histologic and cytologic observations. Johns Hopkins Med J. 1968 Oct. 123(4):158-73. [Medline].

  15. Danon MJ, Schliselfeld LH. Study of skeletal muscle glycogenolysis and glycolysis in chronic steroid myopathy, non-steroid histochemical type-2 fiber atrophy, and denervation. Clin Biochem. 2007 Jan. 40(1-2):46-51. [Medline].

  16. Dumitru D. Myopathies. Electrodiagnostic Medicine. San Antonio, Tex: University of Texas; 1995. 1031-129.

  17. Hanson P, Dive A, Brucher JM, et al. Acute corticosteroid myopathy in intensive care patients. Muscle Nerve. 1997 Nov. 20(11):1371-80. [Medline].

  18. Ahlbeck K, Fredriksson K, Rooyackers O, et al. Signs of critical illness polyneuropathy and myopathy can be seen early in the ICU course. Acta Anaesthesiol Scand. 2009 Jul. 53(6):717-23. [Medline].

  19. Uchikawa K, Takahashi H, Hase K, et al. Strenuous exercise-induced alterations of muscle fiber cross-sectional area and fiber-type distribution in steroid myopathy rats. Am J Phys Med Rehabil. 2008 Feb. 87(2):126-33. [Medline].

  20. Batchelor TT, Taylor LP, Thaler HT, et al. Steroid myopathy in cancer patients. Neurology. 1997 May. 48(5):1234-8. [Medline].

  21. Menezes LG, Sobreira C, Neder L, et al. Creatine supplementation attenuates corticosteroid-induced muscle wasting and impairment of exercise performance in rats. J Appl Physiol. 2007 Feb. 102(2):698-703. [Medline]. [Full Text].

  22. Pereira RM, Freire de Carvalho J. Glucocorticoid-induced myopathy. Joint Bone Spine. 2010 May 13. [Medline].

  23. Yamamoto D, Maki T, Herningtyas EH, Ikeshita N, Shibahara H, Sugiyama Y. Branched-chain amino acids protect against dexamethasone-induced soleus muscle atrophy in rats. Muscle Nerve. 2010 Jun. 41(6):819-27. [Medline].

  24. Hollister JR. The untoward effects of steroid treatment on the musculoskeletal system and what to do about them. J Asthma. 1992. 29(6):363-8. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.