Myopathies in palliative care

Patients with palliative care needs can experience a variety of myopathies that contribute to muscle weakness. Causes of myopathies include:

• cancer (idiopathic inflammatory myopathies)
• drugs (eg corticosteroids, statins)
• inflammatory conditions (eg systemic lupus erythematosus, vasculitis)
• rhabdomyolysis (eg associated with trauma).

Myopathy caused by ongoing corticosteroid use is common and presents with proximal muscle weakness and wasting of upper and lower limbs. Lower limbs are predominantly affected, which causes difficulty step-climbing or moving from sitting to standing positions. Shoulder girdle muscles are the main muscles affected in the upper limbs; however, accessory respiratory muscles may also be affected, leading to breathlessness and potentially respiratory failure. The risk of corticosteroid-induced myopathy can be reduced by using the lowest effective dose for the shortest possible time.

For management of motor weakness in palliative care, see Motor weakness in palliative care.

The Neurology and Rheumatology guidelines provide advice on diagnosing muscle diseases, and outlines additional causes of myopathy and their management; see Diagnosing muscle diseases, Managing inherited and acquired myopathies and Idiopathic inflammatory myopathies. Follow the principles of symptom management when managing myopathy in palliative care.