Favorable outcome of juvenile dermatomyositis treated without systemic corticosteroids.
OBJECTIVE
To describe the course of patients with juvenile dermatomyositis (JDM) treated effectively without systemic corticosteroids.


METHODS
A retrospective study of 38 patients with JDM treated at a tertiary care children's hospital identified 8 patients who had never received corticosteroids. Disease presentation and course, pharmacologic, and ancillary treatments were recorded.


RESULTS
Patients in the no corticosteroid group were followed for a median of 2.8 years (range, 2.1 to 9.5 years). Treatment was primarily with intravenous immunoglobulin (IVIG) (75%) and methotrexate (50%), with favorable response in all. No serious treatment complications were observed; headaches were reported by 3 patients receiving IVIG. Two patients had a myositis flare after discontinuing all medications for more than 1 year; complete resolution of symptoms was observed after either 1 or 2 further doses of IVIG. Two patients had calcinosis (at 1 and 9 years of disease); however, no patient had joint contractures, muscle atrophy, lipodystrophy, or functional limitations.


CONCLUSIONS
Systemic corticosteroids can be avoided in a select group of patients with JDM. Alternative agents such as methotrexate and IVIG may be prescribed to effectively treat JDM and prevent complications.
Levy
Deborah M
DM
Department of Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway, CHN 106, New York, NY 10032, USA. dm2051@columbia.edu
Bingham
C April
CA
Kahn
Philip J
PJ
Eichenfield
Andrew H
AH
Imundo
Lisa F
LF
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003882:Dermatomyositis / Q000628:therapy*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D003879:Dermatologic Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D008727:Methotrexate