title: Failure of pulse intravenous methylprednisolone treatment in juvenile dermatomyositis.
abstract: OBJECTIVE
  To review the experience with high-dose intravenous pulse methylprednisolone (IVMP) therapy in patients with juvenile dermatomyositis (JDM) in our institution.
  
  
  METHODS
  We reviewed the charts of seven consecutive patients (four female subjects; three male subjects; age 3 to 18 years (mean age 8 years) treated for JDM between 1989 and 1992.
  
  
  RESULTS
  All patients met the criteria of Bohan and Peter for JDM and were treated within 3 months of onset of weakness. All received initial treatment with IVMP, 30 mg/kg per day for 3 days, administered weekly for between 1 and 4 weeks. Treatment with orally administered prednisone was required because of deteriorating muscle strength and persistent elevation of creatine kinase activity despite IVMP in five patients, increased skin vasculitis in one patient, and elevated creatine kinase activity with no improvement in strength in one patient.
  
  
  CONCLUSIONS
  We conclude that muscle strength in patients with JDM may deteriorate during pulse IVMP therapy when this is used alone as initial treatment, even early in the course of the illness. We recommend either conventional high doses of orally administered corticosteroids or IVMP with oral corticosteroid therapy as initial treatment of JDM.
authors.affiliation: Department of Pediatrics, Izaak Walton Killam Children's Hospital, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Lang
authors.forename: J
authors.initials: J
authors.lastname: Dooley
mesh_terms: D000284:Administration, Oral; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D003402:Creatine Kinase / Q000378:metabolism; D003882:Dermatomyositis / Q000188:drug therapy* / Q000503:physiopathology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D009119:Muscle Contraction / Q000502:physiology; D009132:Muscles / Q000503:physiopathology; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000893:Anti-Inflammatory Agents; D003402:Creatine Kinase; D011241:Prednisone; D008775:Methylprednisolone