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What Causes Muscle Weakness In The Arms?
Question: I have muscle weakness in my arms , I cant lift them to fix my hair or carry anything above my head , have difficulty climbing stairs and my cpk is up to 7thousand
Brief Answer:
Myositis
Detailed Answer:
good evening..
thank. you for writing on health care magic.
Well it seems you do have myositis going on and you have been tried with steroids and rituximab. I would like to know a few more details...
1. How long has the disease duration been
2. how much dose of prednisolone are you on
3. What is the dose of rituximab you were given .. when was the last dose received
4. Has the CPK levels come down after rituximab..
since your muscle weakness has persisted, we need to see which treatment needs to be modified..
do let me know these queries..would guide you further
regards.
Dr naval
Myositis
Detailed Answer:
good evening..
thank. you for writing on health care magic.
Well it seems you do have myositis going on and you have been tried with steroids and rituximab. I would like to know a few more details...
1. How long has the disease duration been
2. how much dose of prednisolone are you on
3. What is the dose of rituximab you were given .. when was the last dose received
4. Has the CPK levels come down after rituximab..
since your muscle weakness has persisted, we need to see which treatment needs to be modified..
do let me know these queries..would guide you further
regards.
Dr naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Rituximab only received twice two weeks apart and now I have to wait 6 month cpk came down to 5thousand but I am not feeling better. Prednisone is 5 milligram but I don't take every day just when I am in pain along with Meloxican . Muscle weekness started in August but Cpk has been High since May this Year , symptoms started with rashes and joint pain , red eyes etc
Brief Answer:
Myositis
Detailed Answer:
good evening
Well, that is something where we need to modify. Prednisolone is still the drug of choice for myositis. Only reason for using rituximab is when we are not able to taper steroids and the Cpk shoots up on reducing it.
What I would suggest is to be on continuous dose of prednisolone. that is one drug we can't afford to go off. Make it Daily. For now I would suggest you can even Increase the dose to 20 mg till the action of rituximab comes...
Secondly I would. consider adding methotrexate along with it, as it helps prolong the action of rituximab. we prefer using it in combination.
Thirdly, considering you had skin rashes.. I am not sure what your rheumatologist has labelled it. but it does look like dermatomyositis. So hydroxychloroquine would help in your rashes as well...
I hope you are doing physiotherapy along side as recovery will depend on it
do let me known for more queries
regards.
Dr naval
Myositis
Detailed Answer:
good evening
Well, that is something where we need to modify. Prednisolone is still the drug of choice for myositis. Only reason for using rituximab is when we are not able to taper steroids and the Cpk shoots up on reducing it.
What I would suggest is to be on continuous dose of prednisolone. that is one drug we can't afford to go off. Make it Daily. For now I would suggest you can even Increase the dose to 20 mg till the action of rituximab comes...
Secondly I would. consider adding methotrexate along with it, as it helps prolong the action of rituximab. we prefer using it in combination.
Thirdly, considering you had skin rashes.. I am not sure what your rheumatologist has labelled it. but it does look like dermatomyositis. So hydroxychloroquine would help in your rashes as well...
I hope you are doing physiotherapy along side as recovery will depend on it
do let me known for more queries
regards.
Dr naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
the pain in my shoulders is part of the polymyositis ? Also I am very concern about climbing stairs , I feel like a 90 years old lady , will I ever be able to go back to normal?
Brief Answer:
POlymyositis
Detailed Answer:
Good evening
Well, yes dear the pain in the shoulders is due to the disease itself and the difficulty in climbing stairs is due to your hip muscle involvement which again is a part of the disease.
You will eventually feel normal, but it just depends on how good your treatment is suiting you and the ongoing physiotherapy. Physio has a big role to play in muscle recovery. Medicines will only halt the disease process, rebuilding will depend on exercise.
But for now, make your steroids daily...Maybe at a bit higher dose to stop the damage...Little bit of treatment modification is needed
Hope the information was useful
Do let me know for more queries
Regards
Dr Naval
POlymyositis
Detailed Answer:
Good evening
Well, yes dear the pain in the shoulders is due to the disease itself and the difficulty in climbing stairs is due to your hip muscle involvement which again is a part of the disease.
You will eventually feel normal, but it just depends on how good your treatment is suiting you and the ongoing physiotherapy. Physio has a big role to play in muscle recovery. Medicines will only halt the disease process, rebuilding will depend on exercise.
But for now, make your steroids daily...Maybe at a bit higher dose to stop the damage...Little bit of treatment modification is needed
Hope the information was useful
Do let me know for more queries
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Will upload my latest blood work tomorrow so can take a look at it. Bye for today
Brief Answer:
Further course
Detailed Answer:
good evening
yeah sure, do upload it.. also upload the recent one before rituximab so I can compare the two and see...
have a good day.
regards
Dr naval
Further course
Detailed Answer:
good evening
yeah sure, do upload it.. also upload the recent one before rituximab so I can compare the two and see...
have a good day.
regards
Dr naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I sent you the reports for September 2016 before I went to take the Rituximab and I sent you October and November.
Brief Answer:
CPK Levels
Detailed Answer:
Good evening
Well, I have gone through your reports
CPK in september was soaring high( 7851). The October does show a bit better trend with it coming down to 4750 and the November one is again going up...
So, Firstly it is not very refractory disease which does not move..So the treatment from September to October was going the right way which caused CPk to fall...So you need to see What exactly was given that time...and were you following it from October to November as the November one has again shot up to 5K along with high ALT, AST>
What exactly is your rheumatologist take on it..What do they suggest...Cause we need to intervene before the december levels shoot up even more.. Moreoever your symptoms are not improving which are of more concern than the blood levels
Also, I do have a feeling you are scared of continuous steroids use..any reason in particular?
Do let me know these doubts
rEgards
Dr Naval
CPK Levels
Detailed Answer:
Good evening
Well, I have gone through your reports
CPK in september was soaring high( 7851). The October does show a bit better trend with it coming down to 4750 and the November one is again going up...
So, Firstly it is not very refractory disease which does not move..So the treatment from September to October was going the right way which caused CPk to fall...So you need to see What exactly was given that time...and were you following it from October to November as the November one has again shot up to 5K along with high ALT, AST>
What exactly is your rheumatologist take on it..What do they suggest...Cause we need to intervene before the december levels shoot up even more.. Moreoever your symptoms are not improving which are of more concern than the blood levels
Also, I do have a feeling you are scared of continuous steroids use..any reason in particular?
Do let me know these doubts
rEgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Further management
Detailed Answer:
Good evening
Sorry for the late reply. Had a long day
Well, I really dont think you have inclusion body myositis. Your age doesnt match it, and moreover you dont have any involvement of the distal muscles( hands/ankles)
Secondly, I am afraid to say but No myositis can be treated without steroids. I understand you have your concerns about it, but some disease do need steroids for treatment...It is like oxygen needed for humans for survival. So I wouldnt suggest you go for the next biopsy, rather modify treatment.
Rituximab is the last option, in more of the sense it is a good steroid sparing agent( like if we are unable to reduce steroid or Azathioprine/Methotrexate Stop working). But still we continue steroids with it , as all the studies have shown high degree of relapse when patient is off steroids. It can be as low as 2.5 mg, but some dose has to go on
I know I am focusing on one point, but that is one thing which can modify your quality of life
DO let me know for more queries
Regards
Dr Naval
Further management
Detailed Answer:
Good evening
Sorry for the late reply. Had a long day
Well, I really dont think you have inclusion body myositis. Your age doesnt match it, and moreover you dont have any involvement of the distal muscles( hands/ankles)
Secondly, I am afraid to say but No myositis can be treated without steroids. I understand you have your concerns about it, but some disease do need steroids for treatment...It is like oxygen needed for humans for survival. So I wouldnt suggest you go for the next biopsy, rather modify treatment.
Rituximab is the last option, in more of the sense it is a good steroid sparing agent( like if we are unable to reduce steroid or Azathioprine/Methotrexate Stop working). But still we continue steroids with it , as all the studies have shown high degree of relapse when patient is off steroids. It can be as low as 2.5 mg, but some dose has to go on
I know I am focusing on one point, but that is one thing which can modify your quality of life
DO let me know for more queries
Regards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Prasad
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