History
Chronic (classic) steroid myopathy history findings are as follows:
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This form is the classic presentation of steroid myopathy.
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Several studies have suggested that the risk for steroid-induced myopathy is greater in severely asthmatic patients who use oral steroids. [16] One study, however, found no significant difference in the prevalence of myopathy in oral steroid users and inhaled steroid users.
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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. [17] Despite this apparent relationship, however, evidence of steroid-induced myopathy was found in only 2 of the 43 patients.
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Fluorinated steroids seem to produce weakness and myopathy more frequently than do nonfluorinated ones.
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The insidious onset of proximal muscle weakness of the upper and lower limbs is a prominent clinical feature.
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Progressive proximal muscle weakness of the upper and lower limbs is reported.
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Patients typically complain of a progressive inability to rise from chairs, climb stairs, and perform overhead activities.
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Patients initially note little difficulty with hand strength.
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The facial and sphincter muscles usually are spared.
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Myalgias can become a prominent feature with time.
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Contrary to previous beliefs, several studies have shown involvement of the respiratory muscles (eg, the diaphragm); thus, pulmonary symptoms may be present. [4]
Acute steroid myopathy history findings are as follows:
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This form is encountered less frequently than is the chronic type.
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Acute, generalized weakness, including weakness of the respiratory muscles, typically occurs 5-7 days after the onset of treatment with high-dose corticosteroids. [4] Some case reports describe the development of muscle weakness after the administration of a single dose of corticosteroid.
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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.
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Previous systemic corticosteroid use does not appear to contribute to the development of myopathy.
Physical
Chronic (classic) steroid myopathy physical findings are as follows:
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Proximal muscle weakness is more pronounced than is distal muscle weakness; however, severe relative weakness of the anterior tibialis muscle can be found.
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Pelvic girdle muscles usually are affected more severely and earlier than are pectoral girdle muscles.
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Muscle bulk typically is normal, but muscle atrophy can occur.
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Muscle stretch reflexes typically are normal.
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Sensory examination should be normal.
Acute steroid myopathy physical findings are as follows:
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Generalized muscle weakness, not limited to a more proximal distribution, is noted.
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Muscle stretch reflexes typically are normal.
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Sensory examination should be normal.
