title: Successful combination therapy of cyclosporine and methotrexate for refractory polymyositis with anti-Jo-1 antibody: a case report.
abstract: Although corticosteroids have been the initial agent for the treatment of inflammatory myopathies (IM), immunosuppressive agents such as azathioprine, methotrexate, cyclophosphamide, or cyclosporine are commonly required to control the disease except mild cases. On the other hand, the efficacy of combination therapy of cyclosporine and methotrexate in severe rheumatoid arthritis has been proven without serious side effects. However, in treatment-resistant myositis, the experience of such a therapy is very limited, and has not been described in refractory polymyositis with anti-Jo-1 antibody. Here, we report a young female patient with recalcitrant polymyositis and anti-Jo-1 antibody who was successfully treated with the combination therapy of cyclosporine and methotrexate. At first, the myositis did not respond to several agents, such as corticosteroid, monthly pulse cyclophosphamide, azathioprine, or cyclosporine. Methotrexate was initially avoided as treatment regimen because of its potential pulmonary toxicity in the case with preexisting lung disease.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Dankook University Hospital, College of Medicine, 16-5 Anseo-dong, Cheonan 330-715, Korea. hanks22@dankook.ac.kr
authors.forename: Hyun Kyu
authors.initials: HK
authors.lastname: Chang
authors.forename: Deok Hee
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood*; D001324:Autoantigens / Q000276:immunology; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006643:Histidine-tRNA Ligase / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D017285:Polymyositis / Q000188:drug therapy* / Q000276:immunology
chemical_list: D000974:Antibodies, Antinuclear; D001324:Autoantigens; D007166:Immunosuppressive Agents; C046750:Jo-1 antibody; D016572:Cyclosporine; D006643:Histidine-tRNA Ligase; D008727:Methotrexate