Q: My 45 years old father is suffering from muscle weakness (legs, thighs) for the last three months. He can't climb stairs and can’t get-up from a sitting position. Now, he is unable to get-up from sleeping position too and needs someone to hold his hand and assist him in getting up. What causes muscle weakness? Is he suffering from polymyositis? He also suffered from Dengue fever recently.

A:Your father is 45 years old with a history of weakness of 3 months’ duration. You are worried about polymyositis as a possible cause. Polymyositis is an uncommon condition which can present with symmetric weakness and usually difficulty in getting up from chairs and climbing stairs. Hand functions are usually not affected. The muscles involved may be painful and tender s (pain on pressure). In addition, the patient may have malaise, fever and painful joints. These are all non- specific symptoms and none of these are diagnostic of the condition. It is usually a diagnosis of exclusion where the treating physician excludes various conditions that can present in a similar manner... Rarely, some malignancies may also present like this (for example, lymphomas, some tumours of large intestine, etc.). It is, therefore, useful to have an experienced physician examine the patient thoroughly.

Your father also had dengue recently. Was it confirmed by biochemical tests? If so, occasionally patients have joint pains which persist for a long time after the fever subsides. However, these are joint pains and not muscle weakness.

Laboratory investigations that gives a clue to polymyositis is an enzyme in blood called CK (creatine kinase), which is elevated several times the normal. Once there is a suspicion, the confirmation can be done by a muscle biopsy.

Oral steroids are usually the treatment of choice to start with. Many patients need additional drugs that suppress the body’s immunity (immune suppression drugs).

The bottom line in managing such conditions is a good clinical examination by an experienced internal physician, appropriate investigation and follow-up treatment which is not just for a short term but on a longer term basis.