The effectiveness of treating juvenile dermatomyositis with methotrexate and aggressively tapered corticosteroids.
OBJECTIVE
Childhood dermatomyositis (DM) is often a chronic disease, lasting many years. It has traditionally been treated with long-term corticosteroid therapy; side effects are often seen. For more than a decade, methotrexate (MTX) has been safely used for the treatment of juvenile arthritis. Here, we report use of MTX as first-line therapy for DM, along with aggressively tapered corticosteroids, in an attempt to reduce treatment-related side effects.


METHODS
We studied an inception cohort of 31 children with DM who were rigorously followed up in our myositis clinic, and compared them with a control group of 22 patients with incident cases of juvenile DM who received treatment just before we instituted a policy of first-line therapy with MTX. The mean starting dosage of MTX in the study group was 15 mg/m(2)/week.


RESULTS
Both groups had similar improvement in strength and physical function; however, the median time during which patients in the study group received corticosteroids was 10 months, compared with 27 months for controls (P < 0.0001). As a result, the cumulative prednisone dose in the study group was approximately half that in the control group (7,574 mg versus 15,152 mg; P = 0.0006). The study group had greater height velocity during the first year of treatment and a smaller increase in the body mass index over the first 2 years. In the control group, the relative risk of cataracts developing was 1.95 (95% confidence interval 1.05-4.17). Side effects of MTX were rarely observed.


CONCLUSIONS
Use of MTX in conjunction with an aggressively tapered course of prednisone may be as effective as traditional long-term corticosteroid therapy for children with DM, while decreasing the cumulative dose of corticosteroids.
Ramanan
A V
AV
Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
Campbell-Webster
N
N
Ota
S
S
Parker
S
S
Tran
D
D
Tyrrell
P N
PN
Cameron
B
B
Spiegel
L
L
Schneider
R
R
Laxer
R M
RM
Silverman
E D
ED
Feldman
B M
BM
D003882:Dermatomyositis / Q000188:drug therapy* / Q000503:physiopathology; D004185:Disability Evaluation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use*; D006304:Health Status; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008727:Methotrexate / Q000627:therapeutic use*; D018908:Muscle Weakness / Q000188:drug therapy / Q000503:physiopathology; D018482:Muscle, Skeletal; D011241:Prednisone / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011241:Prednisone; D008727:Methotrexate