Table of ContentsView AllTable of ContentsTypesSymptomsCausesDiagnosisTreatmentCoping and Outlook
Table of ContentsView All
View All
Table of Contents
Types
Symptoms
Causes
Diagnosis
Treatment
Coping and Outlook
Juvenile myositis (JM) affects those under the age of 18 years. JM is known for causing muscle inflammation and skin rashes. These symptoms are the result of ongoinginflammationand swelling of the blood vessels under the skin and in the muscles.
This article will explain what juvenile myositis is, how it’s broken down into different types, and what causes it. It also discusses the signs and symptoms, diagnosis, and treatment of juvenile myositis.
John Fedele/ Getty Images
Types of Juvenile Myositis
The most common form of JM is juveniledermatomyositis(JDM). Juvenilepolymyositis(JPM) can also occur in children, but it is much rarer. Benign acute childhood myositis, also called viral myositis, can also affect children.
Juvenile myositis affects two to four of every one million children, according to The Myositis Foundation, with girls more often affected than boys.
What Are the Symptoms of Juvenile Myositis?
Juvenile Dermatomyositis
Early on, JDM may cause some or all of the following symptoms:
Symptoms in a child may not be obvious at first. Muscle pain and weakness usually start slowly.
The skin rash comes on a few weeks after muscle symptoms start. The muscle pains and rashes may be non-specific at onset, making early detection of the disease difficult.
Symptoms of JDM can be mild to life-threatening. Serious symptoms of JDM include joint pain and stiffness, contractures, ulcers, and calcium deposits. There are also times when a child can experience remission—a period of mild or no symptoms.
Skin Rash
Skin rashes will show up slowly. The first signs of myositis parents may notice are rashes on their child’s eyelids and cheeks. Rashes may also appear on the nails, elbows, knees, chest, and back.
Red patches of dry skin appearing on the knuckles might be mistaken for eczema.The rash is photosensitive (reactive to light) and extremely itchy.
Muscle Weakness and Pain
Common movements—like climbing stairs—become harder and your child may complain that their muscles hurt. Your child may also have less energy.
In severe cases of JDM, the muscles responsible for breathing and swallowing may be affected. That means a child may experience choking while eating or they may easily become short of breath. JDM can also cause the voice to become hoarse.
Call your child’s healthcare provider immediately if you notice any of these severe symptoms.
Joint Pain and Stiffness
Your child may complain of red, sore, stiff, and painful joints.This type of inflammation can be managed with treatment and usually doesn’t cause severe joint damage.
Growing Pains in Children
Contractures
A contracture is a condition that causes shortening and hardening of the joints, muscles, tendons, and/or other issues, often resulting in deformity.This can happen with JDM both early on and during treatment.
When muscles heal, scarring may occur, but stretching exercises through a physical therapy program early on can help reduce the risk of contractures.
Ulcers
If your child develops a skin ulcer, regardless of how small, tell your child’s healthcare provider right away. Severe abdominal pain or bloody stools should also be reported immediately.
Calcium Deposits
Some children with JDM may develop calcium deposits—also called calcium nodules—below their skin and in their muscles. These vary in size and feel like firm, small pebbles under the skin.
These nodules may cause muscle movement problems or break through the skin and drain. Contact your child’s healthcare provider if a nodule becomes sore or begins to drain.
Juvenile Polymyositis
More severe symptoms of JPM include:
Benign Acute Childhood Myositis
Also called viral myositis, benign acute childhood myositis is a mild and limited sudden onset condition that causes lower extremity pain during or following a viral illness. Symptoms include a tiptoe gait, muscle pain, or refusal to walk (due to pain), and low extremity pain that resolves in a matter of days.
Benign acute childhood myositis is usually not serious. It often causes mild symptoms and resolves on its own.
What Are the Causes of Juvenile Myositis?
The causes of myositis in children are similar to the causes in adults. But regardless of the type ofmyositisa child has, something happens that causes the immune system to attack its own healthy muscle tissue.
Events that set off this immune system response include infections, inflammatory conditions, medications, injuries, and a condition calledrhabdomyolysis.
Infections
Viruses, such as the flu and thecommon cold, have long been connected to myositis.
Medications
Many different medications can cause temporary muscle inflammation and damage. Although this is much rarer in children—because medications that cause muscle inflammation and damage are usually not prescribed to children—the most common medications that may cause myositis are cholesterol-lowering drugs calledstatins.
Injury
Sometimes, vigorous exercise can lead to muscle pain and weakness that can last for hours or days. Inflammation is usually the culprit. Myositis symptoms after an injury or exercise tend to resolve quickly with rest and time.
What’s Behind Your Muscle Pain
How Is Juvenile Myositis Diagnosed?
The diagnosis of childhood myositis is made the same way an adult diagnosis is made, starting with a medical history and physical exam.
Medical History
Your child’s healthcare provider will ask about the child’s general health, including the child’s medical and family history. The child’s healthcare provider may ask the child to describe their symptoms, including the exact locations of weakness and pain, and how long these have gone on.
The pediatrician may also want to know if specific things—like food, activity, and weather—make symptoms better or worse, or whether the child had an infection or illness at the time symptoms started.
Physical Examination
The pediatric healthcare provider will examine the child’s skin and test their muscle strength. They will want to know if certain activities are difficult because of muscle weakness. This would include activities like walking up steps and lifting the arms over the head.
Testing and Imaging
In addition to the medical history and physical exam, the child’s healthcare provider may request testing, including:
Blood tests: Bloodwork can look for certain muscle enzymes in the blood from inflamed muscle tissue, as well as specific antibodies that contribute to muscle inflammation and weakness.
Imaging:Magnetic resonance imaging(MRI) can detect inflammation levels in the muscle early on and locate where inflammation is occurring. An electromyogram (EMG) may be done to look for any nerve or muscle damage. Another important modality is an FDG PET CT, which uses nuclear imagining techniques.
Other diagnostic testing: Other tests may be done to confirm a diagnosis of myositis or to rule out other conditions that may have similar symptoms.
How Is Juvenile Myositis Treated?
There is no cure for JM, but the condition is treatable. Treatments can reduce or eliminate symptoms and help your child to lead an active and healthy life. Research on follow-up in adulthood finds people diagnosed with JM generally have favorable outcomes, even in instances where disease-related damage occurred.
The goals of treatment for JM are to reduce muscle inflammation, maintain and restore muscle strength, and prevent disability.
Another goal is to help your child learn to live with JM. Your child’s treating healthcare provider will work with your family to find the best plan for your child. Treatment will include medication, physical therapy, and education.
Medication
Some common medications for treating JM include:
Immunosuppressants: Immunosuppressant medications, such as methotrexate, azathioprine, and cyclosporine, work to quiet the immune system. They may be given alone or with hydroxychloroquine (ananti-malaria drug) and mycophenolate mofetil.
Intravenous immune globulin(IVIG): IVIG therapy can slow down the body’s autoimmune response and block harmful antibodies responsible for the inflammation that attacks the muscles and skin.
Other medications: Another medicine used to treat JM includes ananti-TNF biologic drug, rituximab.
Physical Therapy
Physical therapyand physical activity are important for children with JM. They can help a child to maintain and increase muscle strength and flexibility. This prevents muscle wasting and stiffness.
Education
Family education on JM may include advice about using sunscreen to prevent irritation and damage to the child’s skin. UV light from the sun can trigger symptom flare-ups, so you may want to limit your child’s exposure to the sun. You should applysunscreento your child’s skin and have them wear protective clothing when outdoors.
Education for the family also includes ways to keep your child active at home and school. Discussions with a dietitian about healthy and safe eating are also vital because JM can affect chewing and swallowing.
Treating Benign Acute Childhood Myositis
For benign acute childhood myositis, medication can be given to manage muscle pain. However, no other treatment is necessary for the myositis because symptoms will improve within a few days.
Call your child’s healthcare provider if weakness and pain continue, the rash doesn’t go away, or you see any muscle lumps. You should get immediate medical attention if your child has a fever with muscle pain and weakness; a hot, swollen, and stiff muscle; severe leg pain; or continuing problems with walking.
Fortunately, for most children with viral myositis, outcomes tend to be good, and the children are back to walking and playing normally within a few days.
Children with JM can live life as normally as possible. They can attend school, play sports, and participate in family activities. Exercise will not harm your child and there are no limitations on activities as long as those activities are safe. In fact, being active can help increase muscle strength and endurance, and boost the child’s energy levels.
There is no specific diet that a child with JM should follow or any specific foods that may make symptoms worse. Your child can follow a standard, healthy diet.
How Long Can Myositis Last?Juvenile myositis is a chronic condition, but it affects all children differently. Some children see their symptoms disappear after starting physical therapy and may not need medication or treatments after a few years. Other children may require life-long treatment to manage myositis symptoms.
How Long Can Myositis Last?
Juvenile myositis is a chronic condition, but it affects all children differently. Some children see their symptoms disappear after starting physical therapy and may not need medication or treatments after a few years. Other children may require life-long treatment to manage myositis symptoms.
Summary
Juvenile myositis is treatable, and it is very possible for a child to go into remission from JM. However, some children may experience a more active disease and more severe symptoms that may not respond to medications quickly. There is no way of knowing how your child will respond to treatments and how long it will take to find one that works.
The most important thing is for your child to take all their medications and complete physical therapy. And most children—even those that face bigger challenges—will grow up to lead full and active lives.
What Are Muscular System Diseases?
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The Myositis Foundation.Juvenile myositis.American College of Rheumatology.Juvenile dermatomyositis.Papadopoulou C, McCann LJ.The vasculopathy of juvenile dermatomyositis. Front Pediatr. 2018;6:284. doi:10.3389/fped.2018.00284Magee H, Goldman RD.Viral myositis in children.Can Fam Physician.2017;63(5):365-368Chu EC, Yip AS.A rare presentation of benign acute childhood myositis. Clin Case Rep. 2019;7(3):461-464. doi:10.1002/ccr3.2001Arthritis Foundation.Juvenile dermatomyositis.Mount Sinai.Contracture deformity.Harvard Health Publishing.Myositis: What is it?University of Michigan Health C.S. Mott Children’s Hospital.Juvenile myositis.Tsaltskan V, Aldous A, Serafi S, et al.Long-term outcomes in juvenile myositis patients.Semin Arthritis Rheum. 2020;50(1):149-155. doi:10.1016/j.semarthrit.2019.06.014
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The Myositis Foundation.Juvenile myositis.American College of Rheumatology.Juvenile dermatomyositis.Papadopoulou C, McCann LJ.The vasculopathy of juvenile dermatomyositis. Front Pediatr. 2018;6:284. doi:10.3389/fped.2018.00284Magee H, Goldman RD.Viral myositis in children.Can Fam Physician.2017;63(5):365-368Chu EC, Yip AS.A rare presentation of benign acute childhood myositis. Clin Case Rep. 2019;7(3):461-464. doi:10.1002/ccr3.2001Arthritis Foundation.Juvenile dermatomyositis.Mount Sinai.Contracture deformity.Harvard Health Publishing.Myositis: What is it?University of Michigan Health C.S. Mott Children’s Hospital.Juvenile myositis.Tsaltskan V, Aldous A, Serafi S, et al.Long-term outcomes in juvenile myositis patients.Semin Arthritis Rheum. 2020;50(1):149-155. doi:10.1016/j.semarthrit.2019.06.014
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
The Myositis Foundation.Juvenile myositis.American College of Rheumatology.Juvenile dermatomyositis.Papadopoulou C, McCann LJ.The vasculopathy of juvenile dermatomyositis. Front Pediatr. 2018;6:284. doi:10.3389/fped.2018.00284Magee H, Goldman RD.Viral myositis in children.Can Fam Physician.2017;63(5):365-368Chu EC, Yip AS.A rare presentation of benign acute childhood myositis. Clin Case Rep. 2019;7(3):461-464. doi:10.1002/ccr3.2001Arthritis Foundation.Juvenile dermatomyositis.Mount Sinai.Contracture deformity.Harvard Health Publishing.Myositis: What is it?University of Michigan Health C.S. Mott Children’s Hospital.Juvenile myositis.Tsaltskan V, Aldous A, Serafi S, et al.Long-term outcomes in juvenile myositis patients.Semin Arthritis Rheum. 2020;50(1):149-155. doi:10.1016/j.semarthrit.2019.06.014
The Myositis Foundation.Juvenile myositis.
American College of Rheumatology.Juvenile dermatomyositis.
Papadopoulou C, McCann LJ.The vasculopathy of juvenile dermatomyositis. Front Pediatr. 2018;6:284. doi:10.3389/fped.2018.00284
Magee H, Goldman RD.Viral myositis in children.Can Fam Physician.2017;63(5):365-368
Chu EC, Yip AS.A rare presentation of benign acute childhood myositis. Clin Case Rep. 2019;7(3):461-464. doi:10.1002/ccr3.2001
Arthritis Foundation.Juvenile dermatomyositis.
Mount Sinai.Contracture deformity.
Harvard Health Publishing.Myositis: What is it?
University of Michigan Health C.S. Mott Children’s Hospital.Juvenile myositis.
Tsaltskan V, Aldous A, Serafi S, et al.Long-term outcomes in juvenile myositis patients.Semin Arthritis Rheum. 2020;50(1):149-155. doi:10.1016/j.semarthrit.2019.06.014
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