Corticosteroid-Induced Myopathy Clinical PresentationSkeletal muscle myopathy corticosteroid-indkced a well-known side-effect corticosteroid-induced myopathy systemically administered myopathh. In recent years renewed attention is corticosteroid-induced myopathy paid to the involvement of the respiratory muscles and its consequent significance in pulmonary patients. Two different clinical patterns of steroid-induced muscular changes are known. Corticosteroid-induced myopathy acute myopathy and atrophy after short term treatment with high doses of steroids, generalized muscle atrophy and rhabdomyolysis occur, including the respiratory muscles. Chronic steroid myopathy, occurring after prolonged treatment with moderate doses, is characterized by the gradual onset of proximal limb muscle weakness and may be accompanied by reduced respiratory muscle force.
Corticosteroid-Induced Myopathy Clinical Presentation: History, Physical
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Branched-chain amino acids protect against dexamethasone-induced soleus muscle atrophy in rats. The untoward effects of steroid treatment on the musculoskeletal system and what to do about them. Received salary from Medscape for employment. Sign Up It's Free! If you log out, you will be required to enter your username and password the next time you visit. Share Email Print Feedback Close. History Chronic classic steroid myopathy history findings are as follows: This form is the classic presentation of steroid myopathy.
Several studies have suggested that the risk for steroid-induced myopathy is greater in severely asthmatic patients who use oral steroids. 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. 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. Contrary to previous beliefs, several studies have shown involvement of the respiratory muscles eg, the diaphragm ; thus, pulmonary symptoms may be present.
This form is encountered less frequently than is the chronic type. Acute, generalized weakness, including weakness of the respiratory muscles, typically occurs days after the onset of treatment with high-dose corticosteroids.
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.
Previous systemic corticosteroid use does not appear to contribute to the development of myopathy. 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.