Physical therapy improves motion in a patient with inclusion body myositis – A case report

Jelena B Stevanović; Maja Vulović; Danijela Pavićević; Mihailo Bezmarević; Anđelka Stojković; Aleksandar Radunović; Miljana Aksić; Bojan Milošević; Aleksandar Cvetković; Milan Jovanović; Anita Ivošević

doi:10.2298/VSP171110165S

Jelena B Stevanović Department of Physical medicine and rehabilitation, Faculty of Medical Sciences, University of Kragujevac
Maja Vulović University of Kragujevac, Faculty of Medical Sciences, Department of Anatomy
Danijela Pavićević Military Medical Academy, Department of Physical Medicine and Rehabilitation
Mihailo Bezmarević Military Medical Academy, Clinic for General Surgery
Anđelka Stojković University of Kragujevac, Faculty of Medical Sciences, Department of Pediatrics
Aleksandar Radunović Military Medical Academy, Clinic for Orthopedic Surgery
Miljana Aksić University of Kragujevac, Faculty of Medical Sciences, Kragujevac
Bojan Milošević University of Kragujevac, Faculty of Medical Sciences, Department of Surgery
Aleksandar Cvetković Clinical Center Kragujevac, General and Thoracic Surgery Department
Milan Jovanović Clinical Center Kragujevac, Department of Physical Medicine and Rehabilitation
Anita Ivošević University of Kragujevac, Faculty of Medical Sciences Department of Internal Medicine, Kragujevac

DOI: https://doi.org/10.2298/VSP171110165S

Keywords: myositis, inclusion body;, muscle weakness;, physical therapy modalities;, biopsy;, diagnosis;, treatment outcome

Abstract

Introduction. Inclusion body myositis (IBM) is a rare form of inflammatory myopathy with a slowly progressive course. It is manifested by early weakness and atrophy of skeletal muscles, especially forearm muscles and the quadriceps. At the very beginning of the disease, clinical symptoms are not pronounced, therefore it is difficult to diagnose. Case report. A forty-eight-year-old female patient visited her doctor due to the weakness of muscles in arms and legs. Five years prior to this, she was treated by a neurologist and a physiatrician on several occasions with different diagnoses for progressive muscle weakness. During the last hospitalization, IBM was diagnosed after the muscle biopsy findings. After the diagnosis, the patient underwent intensive physical therapy in order to preserve the ability to independently perform everyday activities and stability of walk. Conclusion. IBM is a rare clinical entity which often takes several years to be diagnosed. Progressive muscle weakness in elderly should point to possible IBM diagnosis, which is only confirmed by muscle biopsy. Physical therapy has a significant role in the treatment as it leads to improvement of functional abilities of the patients in their daily activities, thus reducing the disability degree.

References

Vattemi G, Mirabella M, Guglielmi V, Lucchini M, Tomelleri G, Ghirardello A, et al. Muscle biopsy features of idiopathic in-flammatory myopathies and differential diagnosis. Auto Immun Highlights 2014; 5(3): 77–85.

Dimachkie M, Barohn R. Inclusion Body Myositis. Semin Neurol 2012; 32(3): 237‒45.

Garlepp MJ, Mastaglia FL. Inclusion body myositis: new in-sights into pathogenesis. Curr Opin Rheumatol 2008; 20(6): 662‒8.

Dalakas MC. Sporadic inclusion body myositis – diagnosis, pathogenesis and therapeutic strategies. Nat Clin Pract Neurol 2006; 2(8): 437‒47.

Needham M, Mastaglia FL. Sporadic inclusion body myositis: a continuing puzzle. Neuromuscul Disord 2008; 18(1): 6‒16.

Dalakas MC. Inflammatory, immune and viral aspects of in-clusion-body myositis. Neurology 2006; 66(2 Suppl 1): S33‒8.

Engel WK, Askanas V. Inclusion-body myositis. Clinical, di-agnostic, and pathologic aspects. Neurology 2006; 66(2 Suppl 1): 20‒9.

Shams F, Cauchi P. Lagophthalmos and Ptosis in Inclusion Body Myositis. Ophthal Plast Reconstr Surg 2017; 33(3S Suppl 1): S161‒2.

Mastaglia FL, Needham M. Inclusion body myositis: a review of clinical and genetic aspects, diagnostic criteria and thera-peutic approaches. J Clin Neurosci 2015; 22(1): 6‒13.

Iaccarino L, Shoenfeld N, Rampudda M, Zen M, Gatto M, Ghirardello A, et al. The olfactory function is impaired in pa-tients with idiopathic inflammatory myopathies. Immunol Res 2014; 60(2‒3): 247‒52.

De Andrade DC, de Magalhães Souza SC, de Carvalho JF, Taka-yama L, Borges CT, Aldrighi JM, et al. High frequency of os-teoporosis and fractures in women with dermatomyo-sitis/polymyositis. Rheumatol Int 2012; 32(6): 1549‒53.

Alfano LN, Lowes LP, Dvorchik I, Yin H, Maus EG, Flanigan KM, et al. The 2-min walk test is sufficient for evaluating walking abilities in sporadic inclusion bodymyositis. Neu-romuscul Disord 2014; 24(3): 222‒6.

Lundberg IE, Vencovsky J, Alexanderson H. Therapy of myo-sitis: biological and physical. Curr Opin Rheumatol 2014; 26(6): 704‒11.

Alexanderson H. Exercise in Inflammatory Myopathies, In-cluding Inclusion Body Myositis. Curr Rheumatol Rep 2012; 14(3): 244‒51.

Machado PM, Ahmed M, Brady S, Gang Q, Healy E, Morrow JM, et al. Ongoing developments in sporadic inclusion body myositis. Curr Rheumatol Rep 2014; 16(12): 477.