Treatment of the inflammatory myopathies: update and practical recommendations.
BACKGROUND
The inflammatory myopathies are a heterogeneous group of diseases including dermatomyositis, polymyositis, and inclusion body myositis. Clinical trials in myositis are rare, making it difficult to make clear recommendations on the treatment of these rare disorders.


OBJECTIVE
To give an overview of treatment options and strategies and to provide the clinician with a framework that can be used in treating patients with myositis.


METHODS
Results of clinical trials in myositis, case series and important case reports are presented and discussed.


CONCLUSIONS
Most patients with dermatomyositis or polymyositis require treatment with oral high-dose prednisone combined with azathioprine or methotrexate to facilitate early tapering of prednisone. In case of treatment failure, intravenous immunoglobulin can be tried, followed by rituximab, mycophenolate mofetil, or tacrolimus depending on the specific clinical situation. A treatment trial with oral prednisone combined with methotrexate is advised in a subgroup of patients with inclusion body myositis.
Hengstman
Gerald J D
GJ
Department of Neurology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands. gerald.hengstman@catharina-ziekenhuis.nl
van den Hoogen
Frank H J
FH
van Engelen
Baziel G M
BG
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009220:Myositis / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D000069283:Rituximab
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab