EpistemisSubacute fluctuating generalized weakness predominantly proximal
Specialty: General.
Why it occurs
- Active polymyalgia rheumatica (inflammatory disease of vessels and tissues that causes pain and apparent limiting weakness in the shoulders, neck and hips for weeks)
- Myopathy due to corticosteroids or drugs (statins combined with fibrates that cause predominantly proximal protein degradation with a subacute and fluctuating course)
- Incipient autoimmune inflammatory myopathies (polymyositis or inclusion body myopathy in early phases of slow progression)
- Severe decompensated primary hypothyroidism (Hoffman hypothyroid myopathy with symmetrical proximal weakness and stiffness)
- Myasthenia gravis of atypical proximal presentation (where muscle fatigue mainly affects the deltoid and iliopsoas muscles in a fluctuating manner).
Initial workup
Determination of total CPK, serum aldolase, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), TSH and free T4, needle electromyography of proximal muscles (deltoid and iliopsoas), and MRI of the thighs to evaluate inflammation or muscle atrophy.
red flags
Appearance of dysphagia (difficulty swallowing) that generates cough, limiting dyspnea at rest or when speaking, sudden inability to get up from a low chair without the help of the arms, or intense myalgia accompanied by dark urine (myoglobinuria).
Standard management
- Prednisone — 15 to 20 mg orally per day in a single morning dose if polymyalgia rheumatica is confirmed, with usually spectacular clinical and analytical response in 48-72 hours
- Suspension or change of statins or myotoxic medications involved under medical indication
- Calcium combined with Vitamin D3 as a concomitant bone prophylactic measure.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- General
- Listed causes
- 5
- Treatment options
- 3