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Corticosteroid-Induced Myopathy Follow-up

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

Deterrence/Prevention

Consider the judicious use of steroids.

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Complications

Although prior studies have reported full motor recovery, some patients may be left with varying degrees of residual weakness.

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Prognosis

In chronic (classic) steroid myopathy, recovery from weakness may take weeks to months following discontinuation or dose reduction of the corticosteroid.

In acute steroid myopathy, recovery may be prolonged (>6 mo).

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Patient Education

Inform patients of the potential of development of myopathy when starting high-dose or long-term corticosteroid therapy.

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Medicolegal Diagnostic Concerns

The main potential pitfall in diagnosing steroid myopathy relates to patients with polymyositis/dermatomyositis, which typically is treated with corticosteroids. The main symptom of polymyositis/dermatomyositis is proximal upper and lower extremity weakness. When these patients, while being treated with corticosteroids, develop increasing weakness, it can be difficult to determine whether the weakness is secondary to the polymyositis or to steroid myopathy.

Laboratory studies can aid in differentiating between the 2 conditions. Creatine kinase typically is elevated significantly in polymyositis/dermatomyositis. In steroid myopathy, it typically has been described that, although there is elevated urinary creatinine excretion, the serum creatine kinase is not significantly elevated.[1, 17] However, some studies have reported elevations of creatine kinase in some cases of the previously described acute form of steroid myopathy.

On electrodiagnostic study, polymyositis typically demonstrates normal NCS results, as, commonly, does steroid myopathy. On EMG study, however, polymyositis demonstrates abnormal spontaneous activity and increased polyphasic waveforms with short durations. The classic form of steroid myopathy has been described as not demonstrating significantly abnormal EMG findings. Again, some studies have described an acute form of steroid myopathy that can demonstrate abnormal spontaneous activity, an early recruitment pattern, and small, polyphasic waveforms.[16, 17]

The initial recommendation is to decrease or discontinue the use of the corticosteroid.[20] If the weakness improves, then steroid myopathy is the most likely diagnosis. If the weakness persists or worsens, then the most likely diagnosis is worsening of the polymyositis.

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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
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