The treatment and prognosis of dermatomyositis: an updated review.
Dermatomyositis (DM) is an idiopathic inflammatory myopathy. The mainstay of treatment for DM is oral corticosteroids. However, the dose and length of treatment is debated. Adding to the confusion, there have been no randomized controlled studies comparing the use of various corticosteroid doses and taper rates, and no controlled long-term studies assessing the hypothesis that, unlike systemic lupus erythematous, patients with DM can often achieve long-term remission off therapy. This literature review supports an approach that prednisone should be started at about 1 mg/kg/d, which is then tapered slowly based on the response. As patients respond differently to prednisone, additional therapies may be necessary. When to initiate these therapies requires clinical judgment. In addition, as we learn more about the pathophysiology of DM, newer medications that target specific mechanisms in the immune response may help us better treat the disease. Evidence-based data with long-term follow-up will allow for selection of the best treatment to maximize long-term remission, not simply short-term lowering of the systemic corticosteroid dose.
Iorizzo
Luciano J
LJ
Department of Medicine, SUNY Upstate Medical University, Syracuse, New York 13210, USA. IorizzoL@upstate.edu
Jorizzo
Joseph L
JL
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000477:Alkylating Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D003882:Dermatomyositis / Q000628:therapy*; D004334:Drug Administration Schedule; D005081:Exercise Therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010951:Plasma Exchange; D011379:Prognosis
D000305:Adrenal Cortex Hormones; D000477:Alkylating Agents; D016756:Immunoglobulins, Intravenous; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine; D008727:Methotrexate