Polymyositis and dermatomyositis medical therapy
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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).
- 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 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 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)