title: Intravenous immunoglobulin therapy for juvenile dermatomyositis: efficacy and safety.
abstract: OBJECTIVE
  To assess the efficacy of intravenous immunoglobulin (IVIG) for the treatment of juvenile dermatomyositis (JDM) in patients who were unresponsive to corticosteroids (steroid resistant or steroid dependent) or showed unacceptable toxicity.
  
  
  METHODS
  A retrospective chart review of the course of all patients with JDM treated with IVIG who attended the Dermatomyositis Clinic at The Hospital for Sick Children, Toronto, Canada, from August 1986 to December 1996.
  
  
  RESULTS
  Eighteen patients with JDM were treated with IVIG. Ten patients were taking additional 2nd line treatments, methotrexate, azathioprine, cyclosporine, and cyclophosphamide. The main indication for starting IVIG was the failure of steroid therapy to induce remission of JDM. Twelve patients showed clinical improvement with IVIG. In these patients, the corticosteroid dose was reduced by > 50% for > 3 months without clinical or biochemical flare. Nine of these 12 patients had IVIG alone as a 2nd line agent, whereas 3 patients were treated with additional agents. Six patients remained steroid dependent; they subsequently required multiple agents to induce remission of JDM.
  
  
  CONCLUSIONS
  Most steroid dependent or steroid resistant patients in our clinic were able to markedly reduce their dose of corticosteroid with the addition of IVIG. Given the retrospective nature of our data and the fact that multiple agents were sometimes used together, it will be important to confirm these findings in a controlled trial.
authors.affiliation: Department of Paediatrics, The Hospital for Sick Children, and the University of Toronto, Ontario, Canada.
authors.forename: S M
authors.initials: SM
authors.lastname: Al-Mayouf
authors.forename: R M
authors.initials: RM
authors.lastname: Laxer
authors.forename: R
authors.initials: R
authors.lastname: Schneider
authors.forename: E D
authors.initials: ED
authors.lastname: Silverman
authors.forename: B M
authors.initials: BM
authors.lastname: Feldman
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003882:Dermatomyositis / Q000628:therapy*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D011239:Prednisolone