Polymyositis and dermatomyositis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*Pharmacologic medical therapies for polymyositis and dermatomyositis include corticosteroids and disease modifying antirheumatic drugs (DMARDs). | *Pharmacologic medical therapies for polymyositis and dermatomyositis include corticosteroids and disease-modifying antirheumatic drugs (DMARDs).<ref name="KhanChristopher-Stine2011">{{cite journal|last1=Khan|first1=Sabiha|last2=Christopher-Stine|first2=Lisa|title=Polymyositis, Dermatomyositis, and Autoimmune Necrotizing Myopathy: Clinical Features|journal=Rheumatic Disease Clinics of North America|volume=37|issue=2|year=2011|pages=143–158|issn=0889857X|doi=10.1016/j.rdc.2011.01.001}}</ref><ref name="DoblougGaren2015">{{cite journal|last1=Dobloug|first1=Cecilie|last2=Garen|first2=Torhild|last3=Bitter|first3=Helle|last4=Stjärne|first4=Johan|last5=Stenseth|first5=Guri|last6=Grøvle|first6=Lars|last7=Sem|first7=Marthe|last8=Gran|first8=Jan Tore|last9=Molberg|first9=Øyvind|title=Prevalence and clinical characteristics of adult polymyositis and dermatomyositis; data from a large and unselected Norwegian cohort|journal=Annals of the Rheumatic Diseases|volume=74|issue=8|year=2015|pages=1551–1556|issn=0003-4967|doi=10.1136/annrheumdis-2013-205127}}</ref><ref name="ChinoyFertig2007">{{cite journal|last1=Chinoy|first1=H.|last2=Fertig|first2=N.|last3=Oddis|first3=C. V|last4=Ollier|first4=W. E R|last5=Cooper|first5=R. G|title=The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis|journal=Annals of the Rheumatic Diseases|volume=66|issue=10|year=2007|pages=1345–1349|issn=0003-4967|doi=10.1136/ard.2006.068502}}</ref><ref name="DalakasHohlfeld2003">{{cite journal|last1=Dalakas|first1=Marinos C|last2=Hohlfeld|first2=Reinhard|title=Polymyositis and dermatomyositis|journal=The Lancet|volume=362|issue=9388|year=2003|pages=971–982|issn=01406736|doi=10.1016/S0140-6736(03)14368-1}}</ref><ref name="DouglasTazelaar2001">{{cite journal|last1=Douglas|first1=William W.|last2=Tazelaar|first2=Henry D.|last3=Hartman|first3=Thomas E.|last4=Hartman|first4=Robert P.|last5=Decker|first5=Paul A.|last6=Schroeder|first6=Darrell R.|last7=Ryu|first7=Jay H.|title=Polymyositis–Dermatomyositis-associated Interstitial Lung Disease|journal=American Journal of Respiratory and Critical Care Medicine|volume=164|issue=7|year=2001|pages=1182–1185|issn=1073-449X|doi=10.1164/ajrccm.164.7.2103110}}</ref> | ||
*Patients with polymyositis and dermatomyositis might require long term treatment. However, if there are no disease flares during the course of the taper, glucocorticoids could be discontinued at 9 to 12 months. DMARDs might be discontinued at 6 months. | *Patients with polymyositis and dermatomyositis might require long-term treatment. However, if there are no disease flares during the course of the taper, glucocorticoids could be discontinued at 9 to 12 months. DMARDs might be discontinued at 6 months. | ||
===Polymyositis and dermatomyositis=== | ===Polymyositis and dermatomyositis=== | ||
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::* Alternative regimen (1): Hydroxychloroquine 200-400 mg PO qd (for controlling skin disease) | ::* Alternative regimen (1): Hydroxychloroquine 200-400 mg PO qd (for controlling skin disease) | ||
* 2 '''Recurrent disease''' | * 2 '''Recurrent disease''' | ||
** 2.1 Patients with flare of polymyositis and dermatomyositis requires following actions: | ** 2.1 Patients with a flare of polymyositis and dermatomyositis requires following actions: | ||
*** Adding methotrexate or azathioprine if they are not receiving any of them | *** Adding methotrexate or azathioprine if they are not receiving any of them | ||
*** Increasing the dose of prednisone to 1 mg/kg/day | *** Increasing the dose of prednisone to 1 mg/kg/day | ||
Revision as of 14:48, 18 April 2018
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Polymyositis and dermatomyositis Microchapters |
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Differentiating Polymyositis and dermatomyositis from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Polymyositis and dermatomyositis medical therapy On the Web |
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American Roentgen Ray Society Images of Polymyositis and dermatomyositis medical therapy |
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Polymyositis and dermatomyositis medical therapy in the news |
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Risk calculators and risk factors for Polymyositis and dermatomyositis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Medical Therapy
- Pharmacologic medical therapies for polymyositis and dermatomyositis include corticosteroids and disease-modifying antirheumatic drugs (DMARDs).[1][2][3][4][5]
- Patients with polymyositis and dermatomyositis might require long-term treatment. However, if there are no disease flares during the course of the taper, glucocorticoids could be discontinued at 9 to 12 months. DMARDs might be discontinued at 6 months.
Polymyositis and dermatomyositis
- 1 Initial disease
- 1.1 Corticosteroids
- Preferred regimen (1): Prednisone 1 mg/kg PO qd (maximum 80 mg daily) for 4-6 weeks and then prednisone should be tapered over 26 weeks to reach 5 mg/d. Prednisone should be tapered by 10 mg every week until 40 mg/day then tapered by 5 mg every week until 20 mg/d then tapered by 2.5 mg every week until 10 mg/day then tapered by 1 mg every two weeks until the patient reaches 5 mg/day.
- Alternative regimen (1): Methylprednisolone 1000 mg IV qd for 3 days
- 1.1 Corticosteroids
Note (1): The side effects of corticosteroids include weight gain, redistribution of body fat, thinning of the skin, osteoporosis, cataracts, and muscle weakness.
- 1.2 Disease modifying antirheumatic drugs (DMARDs)
- Preferred regimen (1): Azathioprine 50 mg PO qd for 2 weeks and then increase the daily dose by 50 mg each week to 1.5 mg/kg/day (maximum 2.5 mg/kg/day)
- Preferred regimen (2): Methotrexate 15 mg PO every week then increase the daily dose by 2.5 mg increments to 25 mg/week (side effects include hepatotoxicity and pulmonary toxicity.)
- Alternative regimen (1): Hydroxychloroquine 200-400 mg PO qd (for controlling skin disease)
- 2 Recurrent disease
- 2.1 Patients with a flare of polymyositis and dermatomyositis requires following actions:
- Adding methotrexate or azathioprine if they are not receiving any of them
- Increasing the dose of prednisone to 1 mg/kg/day
- Increasing the dose of azathioprine or methotrexate to the maximum
- 2.1 Patients with a flare of polymyositis and dermatomyositis requires following actions:
- 3 Recurrent disease
- 3.1 Disease modifying antirheumatic drugs (DMARDs)
- Preferred regimen (1): Rituximab 1 gr IV every 2 weeks for 2 doses
- Alternative regimen (1): Intravenous immunoglobulin (IVIg) 2 g/kg every month for 3 months
- Alternative regimen (1): Mycophenolate mofetil 1-1.5 gr PO bid
- 3.1 Disease modifying antirheumatic drugs (DMARDs)
References
- ↑ Khan, Sabiha; Christopher-Stine, Lisa (2011). "Polymyositis, Dermatomyositis, and Autoimmune Necrotizing Myopathy: Clinical Features". Rheumatic Disease Clinics of North America. 37 (2): 143–158. doi:10.1016/j.rdc.2011.01.001. ISSN 0889-857X.
- ↑ Dobloug, Cecilie; Garen, Torhild; Bitter, Helle; Stjärne, Johan; Stenseth, Guri; Grøvle, Lars; Sem, Marthe; Gran, Jan Tore; Molberg, Øyvind (2015). "Prevalence and clinical characteristics of adult polymyositis and dermatomyositis; data from a large and unselected Norwegian cohort". Annals of the Rheumatic Diseases. 74 (8): 1551–1556. doi:10.1136/annrheumdis-2013-205127. ISSN 0003-4967.
- ↑ Chinoy, H.; Fertig, N.; Oddis, C. V; Ollier, W. E R; Cooper, R. G (2007). "The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis". Annals of the Rheumatic Diseases. 66 (10): 1345–1349. doi:10.1136/ard.2006.068502. ISSN 0003-4967.
- ↑ Dalakas, Marinos C; Hohlfeld, Reinhard (2003). "Polymyositis and dermatomyositis". The Lancet. 362 (9388): 971–982. doi:10.1016/S0140-6736(03)14368-1. ISSN 0140-6736.
- ↑ Douglas, William W.; Tazelaar, Henry D.; Hartman, Thomas E.; Hartman, Robert P.; Decker, Paul A.; Schroeder, Darrell R.; Ryu, Jay H. (2001). "Polymyositis–Dermatomyositis-associated Interstitial Lung Disease". American Journal of Respiratory and Critical Care Medicine. 164 (7): 1182–1185. doi:10.1164/ajrccm.164.7.2103110. ISSN 1073-449X.