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Corticosteroid-Induced Myopathy Treatment & Management

  • Author: Patrick M Foye, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
 
Updated: Aug 22, 2016
 

Rehabilitation Program

Physical Therapy

Some literature suggests that aerobic exercises and resistance training may help to prevent weakness or reduce its severity. Although there are no definitive recommendations regarding therapy for steroid myopathy, it would seem reasonable to direct therapy to address the weakness and resulting impaired mobility. Range-of-motion exercises (either passive, active-assisted, or active, depending on the degree of weakness) and stretching exercises should be performed to prevent joint contractures. As a general rule, resistance exercises should be limited to muscles with greater than antigravity strength. Bed mobility, balance activities, transfer training, and gait training should be included to address decreased mobility. However, high intensity exercise should be avoided, because, according to some preliminary animal research models, it may be harmful.[19]

Occupational Therapy

Occupational therapy may focus on maximizing the patient's ability to independently perform activities of daily living. Training may include the use of assistive devices to enhance the patient's performance of self-care tasks, such as a balanced forearm orthosis to allow positioning of the upper arm in a manner that permits more independent feeding. Other adaptive equipment may include a raised toilet seat and similar devices that allow the patient to rise from a sitting position, and/or a motorized lift for ascending stairs.

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Consultations

Any adjustment of a patient's corticosteroid medications should be coordinated with the physician who has been prescribing those agents. Given reports of respiratory muscle weakness causing respiratory impairments,[10, 20] consider consultation with a pulmonologist. Consultation with a neurologist can be considered for assistance with diagnosis and for the exclusion of other potential causes of weakness. A physiatrist can also be consulted for assistance with diagnosis and with the management of a therapy program.

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Other Treatment

In cases of myopathy caused by long-term corticosteroid use, decreasing the corticosteroid dose to below a 30 mg/d threshold may result in resolution of muscle weakness. In patients in whom myopathy has resulted from a short course of high-dose corticosteroid use, partial or complete recovery has been reported following the discontinuation of steroid administration.[20]  Eddelien et al, for example, reported on a patient who, following 10 days of treatment in the intensive care unit (ICU) with methylprednisolone 240 mg/d for severe respiratory failure due to bronchospasm, awoke from sedation with quadriplegia. With glucocorticoid-induced myopathy suspected, glucocorticoid treatment was tapered; within a few months, complete recovery from quadriplegia had been attained.[21]

Preliminary studies on rats suggest that creatine plays a part in the prophylaxis of steroid-induced myopathy. Further studies are needed to explore this possible treatment/prevention option.[22]

Other experimental treatments include IGF-I, branched-chain amino acids, glutamine, and androgens such as testosterone and DHEA. Further studies are needed to correlate the benefits of such treatment.[23] One study demonstrated that the concomitant injection of branched-chain amino acids with dexamethasone seemed to reverse the reduction of total protein concentration induced by the steroid in rat muscles.[24]

Banerjee et al described the successful use of the glucocorticoid-receptor antagonist mifepristone in a pediatric patient with Cushing syndrome, with effects including a significant improvement in myopathy.[25]

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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
  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. 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].

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

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

  17. 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].

  18. Hanson P, Dive A, Brucher JM, et al. Acute corticosteroid myopathy in intensive care patients. Muscle Nerve. 1997 Nov. 20(11):1371-80. [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. Eddelien HS, Hoffmeyer HW, Lund EL, Lauritsen AO. Glucocorticoid-induced myopathy in the intensive care unit. BMJ Case Rep. 2015 May 24. 2015:[Medline].

  22. 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].

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

  24. 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].

  25. Banerjee RR, Marina N, Katznelson L, Feldman BJ. Mifepristone Treatment of Cushing's Syndrome in a Pediatric Patient. Pediatrics. 2015 Nov. 136 (5):e1377-81. [Medline].

  26. 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].

 
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