[The treatment of inflammatory muscle diseases].
THE TREATMENT OF DM AND PM: Among primary inflammatory muscle diseases, there are three principle subsets depending on immuno-histochemical and clinical aspects: dermatomyositis (DM), polymyositis (PM) and inclusion body myositis (IBM). Despite their physiopathogenic differences, the treatment of PM and DM is very similar. It relies on principally on oral corticosteroid therapy, occasionally initiated via the intravenous route and which is active in 50 to 70% of cases. In patient with primary or secondary resistance, intolerance or dependence regarding corticosteroids, a second treatment line with immunosuppressive agents or intravenous immunoglobulin should be added.


CONCLUSIONS
Methrotrexate or azathioprine are still the most commonly used immunosuppressors today. However, the imminent launch of new molecules such as anti-TNF agents and new immunosuppressors suggest that interesting therapeutic alternatives may soon be available. INCONSISTENT EFFICACY IN IBM: However, the treatment of IBM remains controversial. Physiotherapy is crucial. The moderate and inconsistent efficacy with corticosteroids and various immunomodulators suggests a predominately degenerative physiopathogenic mechanism, and/or reflects the far too late onset of treatment at the muscular involvement stage of the disease.
Cherin
Patrick
P
Service de médecine interne I, Hôpital Salpétrière, Paris. patrick.cherin@psl.ap-hop-paris.fr
D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003882:Dermatomyositis / Q000628:therapy*; D006801:Humans; D007249:Inflammation / Q000628:therapy; D007275:Injections, Intravenous; D017285:Polymyositis / Q000628:therapy*; D019966:Substance-Related Disorders / Q000209:etiology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones