Which history findings are characteristic of chronic (classic) corticosteroid-induced myopathy?

Updated: Sep 10, 2019
  • Author: Patrick M Foye, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Chronic (classic) steroid myopathy history findings are as follows:

  • This form is the classic presentation of steroid myopathy.

  • This condition can develop after prolonged administration of prednisone at a dose of 40-60 mg/d. [5, 6] Although there is no clear length of time, onset of weakness has been found to occur within weeks to years following initiation of corticosteroid administration.

  • Several studies have suggested that the risk for steroid-induced myopathy is greater in severely asthmatic patients who use oral steroids. [12] One study, however, found no significant difference in the prevalence of myopathy in oral steroid users and inhaled steroid users.

  • A report by Stanton et al indicated that in 43 patients with asthma, a statistically significant association existed between inhaled corticosteroid dose and patient voice scores obtained using the GRBAS (grade-roughness-breathiness-asthenicity-strain) system. [13] Despite this apparent relationship, however, evidence of steroid-induced myopathy was found in only 2 of the 43 patients.

  • Fluorinated steroids seem to produce weakness and myopathy more frequently than do nonfluorinated ones.

  • The insidious onset of proximal muscle weakness of the upper and lower limbs is a prominent clinical feature.

  • Progressive proximal muscle weakness of the upper and lower limbs is reported.

  • Patients typically complain of a progressive inability to rise from chairs, climb stairs, and perform overhead activities.

  • Patients initially note little difficulty with hand strength.

  • The facial and sphincter muscles usually are spared.

  • Myalgias can become a prominent feature with time.

  • Contrary to previous beliefs, several studies have shown involvement of the respiratory muscles (eg, the diaphragm); thus, pulmonary symptoms may be present. [11]


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