Steroids, in particular corticosteroids, can cause various kinds of side effects. One such obnoxious consequence is steroid-induced myopathy (SIM). Below we will describe its nature, symptoms and how to deal with it.
What Does Steroid Induced Myopathy Imply?
Steroid myopathy is a disorder, which manifests itself in the musculature diminishing, losing its tone and strength. It occurs in patients who experience:
- prolonged taking of drugs (exogenous exposure caused by outside, environmental reasons), or
- endogenous, that is internal (internal or biological agents, for example, the case of Cushing’s syndrome) exposure to glucocorticoids.
These factors may also be the reason of steroid-induced psychosis.
For the development of myopathy, in addition to the preparation’s kind, the dose of the therapeutic agent also matters. This importance is emphasized by the fact that the dysfunction most often appears in individuals with clear symptoms of hypercorticism triggered by the treatment, and these phenomena are a sign of an overdose of corticosteroids. All this suggests that the artificially induced corticosteroid myopathy is identical to that occurring with Cushing’s disease. Myopathy most often affects women, regardless of the underlying disease that has been treated with corticosteroids. This condition is common. According to scientists, it is observed in 2% of representatives of both sexes, who used these medicaments.
It is generally believed inhaled steroids are safer than systemic corticosteroids. Nevertheless, some experts assure that the persons, who have received regular corticosteroid treatment (steroid pills or steroid injections) have the same moderate signs of the myopathy as those, who have been prescribed inhaled meds.
Systemic side effects of steroids (corticosteroids) are more likely to be pronounced in individuals whose weight is insufficient. Patients who are extremely obese can not face weakness in their legs or any muscle deformation even after a long-lasted cycle. It’s explained by the distributing of the substance in the organism’s tissues. Hence, there is no significant concentration in a particular area. Earlier we wrote, “Do cortisone shots cause weight gain?”
Steroid [Proximal] Myopathy Symptoms
From the point of view of pathology, steroid myopathy symptoms include degenerate changes in muscle fibers, and abnormalities in their size, thickness, and striation. These impairments are not limited to sheer physical manifestations. It can cause discomfort and dysfunction in regular health. The inflammatory reaction is observed only when it occurs from the underlying disease (for instance, rheumatoid arthritis, acute collagenosis, etc.). In such cases, the histological test shows a predomination of the degenerative processes.
Acute forms of the disorder are associated with the weakness in the proximal muscles, extremities, myalgia with an increase in creatinine in the urine. As the condition has a negative impact on the predominantly proximal musculature, it is sometimes called steroid induced proximal myopathy. Polunina AG, Isaev FV, Dem’ianova MA (2012) reported that most frequently, SIM is manifested by weakness and hypotrophy of lower limbs, weakness of respiratory musculature, and dysphonia (difficulty in speaking).
Some scientists claim that the severe steroid myopathy may lead to the reduction of the thigh quadriceps muscle’s power by up to 46%. Gradual corticosteroids dose decline contributes to the slow enhance in strength in the legs’ muscles compared to respiratory ones.
Elliot M. Silver and William Ochoa (University of California Riverside, 2018) concluded that elucidating the etiology of progressive neuromotor deficit in immunosuppressed persons (by corticosteroids) can be arduous. As seen from the study by Izumi Y, Miyashita T, Kitajima T, Yoshimura S et al. (NHO National Nagasaki Medical Center, 2015), SIM may be accompanied with refractory polymyositis (myositis).
Steroid Myopathy Treatment — How to Fight It?
In general, the treatment includes withholding steroids and other similar management methods. Here is a list of allowed methods (according to Polunina et al., 2012):
Lowering the number of steroids or termination of the cycle. After the withholding of corticosteroids, the improvement of motor function will happen. Those, who suffer from severe myopathy, motor functionality will restore within a month.
Physical activity, active lifestyle. It has a beneficial influence on the patient’s state. The experiment proves that intensive exercising (running at least 3 times every week) prevents muscle malnutrition in animals, who have been taking dexamethasone daily for a month period.
Vitamin D. Numerous studies have revealed that the proper level of this vitamin stimulates muscles capabilities. The regression of myopathy in those who avoid direct sunrays, wear closed clothing and consume a poor quantity of fats under the effect of intensive therapy, consuming vitamin D is described. Consequently, this nutrient can be applied for averting the problem in pulmonology patients.
Amino acids. The intake of mixtures of amino acids stimulates the synthesis of proteins and slows down the adverse catabolic effects of corticosteroids. Apparently, leucine and glutamine have the greatest positive impact on muscle protein synthesis. Leucine is an amino acid belonging to the group of amino acids, which are called “essential” because our body is not capable of producing them from other substances. The main natural sources of BCAA are protein products (meat, eggs).
A Japonic scientist Kohsaka H (2013) at Tokyo Medical and Dental University (TMDU) introduced novel tactic methods involving BCAAs that aim at SIM treatment. The additional intake of the above-mentioned supplements positively affects the health of patients. Glutamine is nonessential but is also useful. By the way, BCAA and natural testosterone boosters are very popular in sports.
In addition, Anu Gupta and Yashdeep Gupta (PGIMER, Chandigarh, 2013) named switching to a non-fluorinated agent as a method of SIM treatment.