Polymyositis is the name for a group of rare conditions that can cause muscle weakness, fatigue and pain. It can also sometimes cause muscle hypertrophy. For most people, symptoms will be mild and won’t last long. In rare cases, there can be some serious complications. Of the main muscles affected by myositis are around the shoulders, hips and thighs. But sometimes, myositis can affect muscles that perform important tasks such as breathing and swallowing.

One of the reasons why myositis patients feel overwhelmed is that their muscles are weakened by the disease. Movement depends on many muscles working together. Therefore, when one muscle or muscle group becomes weak, the other muscles must work harder to compensate and this causes fatigue .

It is normal to avoid movement when the muscles are sore and tired. Sometimes people fear that exercise will cause damage or further advance the disease process. But this is a misconception and avoiding movement makes pain and weakness worse. Muscles that you don’t move regularly become weaker and can atrophy. Muscles will begin to lose strength within 24-48 hours of inactivity, and maximum muscle strength will be lost within the first six weeks. The only way to restore muscle strength is by using your muscles, because in the event of atrophy of your muscles they cannot be rebuilt again. This is why exercise is so important, as exercise prevents weak muscles from atrophy and helps the body compensate for weakness by strengthening the surrounding muscles.

Treatment of myositis:

1. The most commonly used drugs to treat myositis:

Although there is no cure for myositis, for most patients, treatment can effectively control and improve symptoms. Ongoing research continues to add new drug options to treat inflammatory muscle diseases. It gives patients and doctors choices in determining the best medications based on the balance of risks and benefits for that individual.

Although most of these drugs are not approved by the FDA. All are approved for other uses and are used “off the label” for myositis. However, their use in myositis depends on research. Including small clinical trials, and individual reports that have proven effective in treating polymyositis.

• Corticosteroids, also called adrenal corticosteroids such as prednisone, methylprednisolone, prednisolone, are used to effectively treat sore myositis .
• Immunosuppressants : they are drugs that inhibit the activity of the immune system. Immunosuppressants used in the treatment of methotrexate myositis include azathioprine, mofetil mycophenolates, cyclosporine, tacrolimus, cyclophosphamide, and hydroxychloroquine.

There are somedietary considerations especially for those taking corticosteroids:

1. People who should take corticosteroids (prednisone). Especially in high doses and longer periods of time, face a number of complications that carry considerations for what you are taking, theprednisone increases appetite. To avoid weight gain, avoid eating high-calorie foods. Eating small, frequent meals to help keep blood sugar levels steady and doing plenty of exercise will also help.
2. To reduce the risk of high blood pressure and fluid retention, limit salt consumption to less than 1,500 mg per day. You can do this by eating fresh foods instead of processed or canned foods and avoiding adding salty foods. And if you are taking medication for high blood pressure, you may need to increase your intake of potassium-rich foods. Such as bananas, apricots, cantaloupe, baked potatoes, tomatoes.
3. Prednisone can cause stomach irritation, so it is important to take it with food and not on an empty stomach .
4. Diabetes is also a risk when taking corticosteroids. To keep blood sugar levels within the normal range, avoid foods high in simple carbohydrates such as sugar and keep carbohydrate intake to between 45 and 60 mg per day.

2. Physiotherapy sessions :

Physiotherapy sessions are important for the treatment of myositis. Where the physiotherapist uses some devices such as infrared, ultrasound. Or go down in a water bath with a specialist who helps you perform some movements inside the water, which helps you reduce inflammation and prepare your muscles to practice some therapeutic exercises without these exercises causing you pain.

Some guidelines to consider before starting a physiotherapy program:

• Ask your doctor to prepare you for exercise, ask expert guidance from a physiotherapist, have your therapist work with you to develop an individualized treatment plan.
• Do not start exercise if you have acute inflammation .
• Learn how to do the exercises correctly. After that, maybe you can do it on your own.
• Each person should find the right exercise program that suits their situation .
• The exercise should be designed to strengthen the muscles while protecting the muscles affected by the disease .
• The right program means that you will notice improved efficiency with basic daily activities and be able to perform those activities without overusing the muscles involved. And if you find that you work harder in order to carry out normal daily functional activities. Exercise is likely to cause unnecessary stress on the muscle groups involved. You should consult a physiotherapist to find out the best way to change the program.

3. To prevent myositis, it is recommended to exercise regularly:

Exercise and physical therapy are an important part of myositis treatment plans. Physical exercise has been shown to reduce inflammation, reduce fatigue, increase endurance, and build muscle. Even in patients with myositis, exercise is currently the only therapeutic recommendation for patients with sore body muscle .

There is a strong association between aerobic capacity and overall health, both in healthy individuals and in patients with myositis. Regular physical activity and exercise can help improve an individual’s quality of life and reduce the risk of serious chronic diseases. Such as type II diabetes, osteoporosis, hypertension, cardiovascular disease. All these diseases are complications of sore myositis. Therefore, exercise is doubly important to prevent any complications.

We will clarify some tips that help you practice smart sports:

• Find an activity or exercise that is appropriate to your job level and enjoyable for you, for example, you can walk for half an hour a day, or practice swimming for an hour to move all your muscles and you can easily adapt the exercises as needed, and exercise should be integrated into your daily life and considered part of your usual routine.
• Do not exaggerate exercise, especially at the beginning, as exaggerating exercise can cause worsening of symptoms and increased pain, and if you feel severe fatigue or pain the next day, it means that you practiced the exercises wrongly or that you exaggerated in their practice.
• Take time to warm up, this gradually increases blood flow and heart rate, to allow your body to recover gradually, gradually increase the intensity and duration of the exercise to an effort rate that you find somewhat difficult but not very difficult, it may take 6 to 12 weeks to adjust to a new exercise program.
• And when the workout becomes easier and you feel better without much fatigue, you can add an extra load to the exercise, if the exercise is not easier or you end up feeling tired but recover the next morning, you may be in your ideal intensity.
• Do not continue to exercise if you have severe pain or you have high blood pressure or irregular heartbeat.

4. Diet and Nutrition:

Following a healthy diet can go a long way towards improving overall health, some TMA members have found that symptoms have improved dramatically when they rely on special diets.

• Avoid processed and fast foods, including those containing high-fructose corn syrup, artificial ingredients, and preservatives, and instead opt for a wide range of fresh fruits and vegetables and unrefined foods.
• Limit your intake of foods made with wheat flour and sugar, especially bread, pasta, and most canned snack foods, and instead choose whole-grain foods, such as brown rice, wheat, and bulgur.
• Reduce the consumption of saturated fats by eating less fat and products made from palm oil, and use extra virgin olive oil, sunflower oil, and safflower oil.
• Add omega-3 fatty acids to your diet by eating salmon, sardines and herring, black cod, hemp and flax seeds or taking fish oil supplements.
• Eat more vegetable protein, especially from beans and soybeans, choose fish, cheese, and yogurt than you choose animal proteins, avoid drinking soda, choose tea instead of coffee, and eat more chocolate (in moderation) with a minimum of 70% cocoa .

5. Take some supplements with some recommendations for those who suffer from myositis:

1. Calcium: Calcium-rich foods should be eaten, such as milk, cheese, leafy green vegetables, almonds, and broccoli, and calcium supplements are also recommended to reduce bone loss and osteoporosis.
2. Vitamin D: It is a hormone produced in the skin in response to sunlight, and it is important for the absorption of calcium and many other processes, most people who suffer from myositis need to take vitamin D supplements.
3. Folic acid: Folic acid is abundant in leafy green vegetables, such as spinach, kale, broccoli and other sources, and since methotrexate interferes with the way folic acid is used in the body, those who take this anti-inflammatory drug need folic acid more than can be consumed from food sources, so they should take folic acid supplements.
4. Omega-3 fatty acids, anti-inflammatory, and omega-6 fatty acids, pro-inflammatory, should be in balance in the body especially in people with myositis, however, most Americans eat higher amounts of foods containing omega-6 (vegetable oils, safflower oils, meat, poultry, eggs), causing a more inflammatory state. To achieve this balance, you should eat More foods that contain omega-3 fatty acids, including salmon, mackerel and sardines, green leafy vegetables, flaxseed, and walnuts.