Glucocorticoid-induced myopathy: a comprehensive review

Abstract

Background: Glucocorticoid-induced myopathy (GIM) is a prevalent and often underdiagnosed condition that significantly impacts the quality of life and functional capabilities of affected individuals. This review summarises the current understanding of GIM, focussing on its pathophysiology, diagnostic challenges, and emerging therapeutic strategies.

Methods: A comprehensive review of the literature was conducted to identify relevant studies on GIM. Databases, such as PubMed, Embase, and Web of Science, were searched using keywords related to GIM, pathophysiology, diagnosis, and treatment. Studies were selected based on their relevance to the topic and the quality of their methodologies.

Results: GIM is characterised by proximal muscle weakness, atrophy, persistent fatigue, and reduced muscular endurance, predominantly affecting the lower limbs. The pathophysiology involves both catabolic and anti-anabolic mechanisms, leading to the degradation of muscle proteins and inhibiting protein synthesis. Diagnostic challenges include the nonspecific nature of symptoms and the lack of sensitive biomarkers. Emerging therapeutic strategies include the use of growth hormones, insulin-like growth factor-1, branched-chain amino acids, and creatine although their efficacy in humans requires further validation. Physical therapy, particularly resistance and aerobic exercise, has shown promise in managing GIM.

Conclusions: The diagnosis and management of GIM require a multifaceted approach, including early diagnosis, optimised corticosteroid use, and targeted therapies. Future research should focus on developing improved biomarkers for early detection, exploring genetic susceptibility, and validating the efficacy of emerging therapeutic interventions to improve outcomes for patients with GIM.

Keywords: Biomarkers; Diagnosis; Genetic susceptibility; Glucocorticoid-induced myopathy; Pathophysiology; Treatment.