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Myopathy
Specialty	Rheumatology

In medicine, a myopathy is a muscular disease in which the muscle fibers do not function for any one of many reasons, resulting in muscular weakness. "Myopathy" simply means muscle disease (myo- Greek μυο "muscle" + pathos -pathy Greek "suffering"). This meaning implies that the primary defect is within the muscle, as opposed to the nerves ("neuropathies" or "neurogenic" disorders) or elsewhere (e.g., the brain etc.). Muscle cramps, stiffness, and spasm can also be associated with myopathy.

Muscular disease can be classified as neuromuscular or musculoskeletal in nature. Some conditions, such as myositis, can be considered both neuromuscular and musculoskeletal.

Classes

There are many types of myopathy. ICD-10 codes are provided here where available.

Inherited forms

• (G71.0) Dystrophies (or muscular dystrophies) are a subgroup of myopathies characterized by muscle degeneration and regeneration. Clinically, muscular dystrophies are typically progressive, because the muscles' ability to regenerate is eventually lost, leading to progressive weakness, often leading to use of a wheelchair, and eventually death, usually related to respiratory weakness.
• (G71.1) Myotonia
  • Neuromyotonia
• (G71.2) The congenital myopathies do not show evidence for either a progressive dystrophic process (i.e., muscle death) or inflammation, but instead characteristic microscopic changes are seen in association with reduced contractile ability of the muscles. Congenital myopathies include, but are not limited to:
  • (G71.2) nemaline myopathy (characterized by presence of "nemaline rods" in the muscle),
  • (G71.2) multi/minicore myopathy (characterized by multiple small "cores" or areas of disruption in the muscle fibers),
  • (G71.2) centronuclear myopathy (or myotubular myopathy) (in which the nuclei are abnormally found in the center of the muscle fibers), a rare muscle wasting disorder
• (G71.3) Mitochondrial myopathies, which are due to defects in mitochondria, which provide a critical source of energy for muscle
• (G72.3) Familial periodic paralysis
• (G72.4) Inflammatory myopathies, which are caused by problems with the immune system attacking components of the muscle, leading to signs of inflammation in the muscle
• (G73.6) Metabolic myopathies, which result from defects in biochemical metabolism that primarily affect muscle
  • (G73.6/E74.0) Glycogen storage diseases, which may affect muscle
  • (G73.6/E75) Lipid storage disorder

Acquired

• (G72.0 - G72.2) External substance induced myopathy
  • (G72.0) Drug-induced myopathy
    • Glucocorticoid myopathy is caused by this class of steroids increasing the breakdown of the muscle proteins leading to muscle atrophy.
  • (G72.1) Alcoholic myopathy
  • (G72.2) Myopathy due to other toxic agents
• (M33.0-M33.1)
  • Dermatomyositis produces muscle weakness and skin changes. The skin rash is reddish and most commonly occurs on the face, especially around the eyes, and over the knuckles and elbows. Ragged nail folds with visible capillaries can be present. It can often be treated by drugs like corticosteroids or immunosuppressants. (M33.2)
  • Polymyositis produces muscle weaknesss. It can often be treated by drugs like corticosteroids or immunosuppressants.
  • Inclusion body myositis is a slowly progressive disease that produces weakness of hand grip and straightening of the knees. No effective treatment is known.
• (M61) Myositis ossificans
• (M62.89) Rhabdomyolysis and (R82.1) myoglobinurias

The Food and Drug Administration is recommending that physicians restrict prescribing high-dose Simvastatin (Zocor, Merck) to patients, given an increased risk of muscle damage. The FDA drug safety communication stated that physicians should limit using the 80-mg dose unless the patient has already been taking the drug for 12 months and there is no evidence of myopathy. "Simvastatin 80 mg should not be started in new patients, including patients already taking lower doses of the drug," the agency states.

Differential diagnosis of systemic myopathy based on age of onset

Myopathies presenting at birth:- None as systemic causes; mainly hereditary

Myopathies presenting in childhood:-

        Inflammatory myopathies – dermatomyositis, polymyositis (rarely)

        Infectious myopathies

        Endocrine and metabolic disorders – hypokalemia, hypocalcemia, hypercalcemia

Myopathies presenting in adulthood

        Inflammatory myopathies – polymyositis, dermatomyositis, inclusion body myositis, viral (HIV)

        Infectious myopathies

        Endocrine myopathies – thyroid, parathyroid, adrenal, pituitary disorders

        Toxic myopathies – alcohol, corticosteroids, narcotics, colchicines, chloroquine

        Critical illness myopathy

Metabolic myopathies

Paraneoplastic myopathy

Symptoms

• Common muscle weakness. Also (R25.2) cramps (M25.6) stiffness, and (R29.0) tetany

Treatments

Because different types of myopathies are caused by many different pathways, there is no single treatment for myopathy. Treatments range from treatment of the symptoms to very specific cause-targeting treatments. Drug therapy, physical therapy, bracing for support, surgery, massage, and even acupuncture are all current treatments for a variety of myopathies.

References

1. "Myopathy - Definition from the Merriam-Webster Online Dictionary".
2. Seene T (1994). "Turnover of skeletal muscle contractile proteins in glucocorticoid myopathy". J. Steroid Biochem. Mol. Biol. 50 (1–2): 1–4. PMID 8049126. {{cite journal}}: Unknown parameter |month= ignored (help)
3. "Sytemic Myopathy". Retrieved 4 May 2012. {{cite web}}: |first= missing |last= (help)

External links

• GeneReviews/NCBI/NIH/UW entry on Myopathy with Deficiency of ISCU
• See http://neuromuscular.wustl.edu/ for medical descriptions.

Template:Medical conditions

• Disorders of muscles