What is Polymyositis and Dermatomyositis?
Polymyositis is one of a group of muscle diseases known as the inflammatory myopathies, which are characterized by chronic muscle inflammation accompanied by muscle weakness. Polymyositis affects skeletal muscles (those involved with making movement) on both sides of the body. It is rarely seen in persons under age 18; most cases are in adults between the ages of 31 and 60. Progressive muscle weakness starts in the proximal muscles (muscles closest to the trunk of the body) which eventually leads to difficulties climbing stairs, rising from a seated position, lifting objects, or reaching overhead. People with polymyositis may also experience arthritis, shortness of breath, difficulty swallowing and speaking, and heart arrhythmias. In some cases of polymyositis, distal muscles (muscles further away from the trunk of the body, such as those in the forearms and around the ankles and wrists) may be affected as the disease progresses. Polymyositis may be associated with collagen-vascular or autoimmune diseases, such as lupus. Polymyositis may also be associated with infectious disorders, such as HIV-AIDS.
When polymyositis is accompanied by a certain kind of skin rash, it is called dermatomyositis.
There is no cure for polymyositis, but the symptoms can be treated. Options include medication, physical and occupational therapy, exercise, heat therapy (including microwave and ultrasound), orthotics and assistive devices, and rest. The standard treatment for polymyositis is a corticosteroid drug, given either in pill form or intravenously. Immunosuppressant drugs, such as azathioprine and methotrexate, may reduce inflammation in people who do not respond well to prednisone. Periodic treatment using intravenous immunoglobulin can also improve recovery. Other immunosuppressive agents used to treat the inflammation associated with polymyositis include cyclosporine A, cyclophosphamide, and tacrolimus. Physical therapy is usually recommended to prevent muscle atrophy and to regain muscle strength and range of motion. Occupational therapists can prepare an assessment of daily activities to help address issues such as bathing and eating.
The prognosis for polymyositis varies. Most people respond fairly well to therapy, but some have a more severe disease that does not respond adequately to therapies and are left with significant disability. In rare cases individuals with severe and progressive muscle weakness will develop respiratory failure or pneumonia. Difficulty swallowing may cause weight loss and malnutrition.
Disability Benefits Related to Polymyositis and Dermatomyositis.
Muscle weakness is typically the reason why most patients with polymyositis and dermatomyositis apply for long-term disability benefits either with the Social Security Administration (SSDI) or through an employer-sponsored group disability plan (ERISA).
Muscle weakness, usually in the arms and legs, may impair standing and walking, or even sitting. If the muscle weakness is such that an applicant is unable to stand/walk for 2 hours or more out of an 8 hour work day, or if he or she is unable to sit for 6 hours or more, or if muscle weakness prevents lifting or carrying 10 lbs or more, then that person may be unable to perform even a sedentary ("desk") job.
Polymyositis and dermatomyositis may cause disabling lung disease, which can result in shortness of breath, breathlessness, fatigue, cough, and other symptoms.
Even with treatment, the lung disease ("interstitial lung disease" or ILD) may become progressive and continue to worsen.
Approximately 10% of patients with polymyositis and dermatomyositis unfortunately develop a malignancy of some sort. Proper monitoring for that is important.
While some neurologists treat polymyositis and dermatomyositis, it's usually a rheumatologist that is the most qualified to diagnose and treat these conditions, and to help document your disability claim.
Essential Medical Documentation of Polymyositis/Dermatomyositis for Disability Benefits Needed:
- How far can you walk?
- How long can you stand? Do you need a cane/walker to ambulate?
- How much can you lift and carry?
- Do you have difficulty reaching, bending, squatting, stooping? Describe.
- Do you have grabbing or grasping difficulty (dropping things)?
- What medications do you take? Side effects of medication?
- Do you have objective tests confirming your diagnosis, such as an EMG, muscle bioopsy, lab tests, x-rays/MRIs
- Do you have documented muscle weakness on examination?
- Are you doing physical therapy?
SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).
SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work.
SSA has its own forms that are used for Physical RFC here and for Mental RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.
SSA "Listing" or "Blue Book" description of polymyositis can be found here (See 14.05)
Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records. At Law Med that's what we do.