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.
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
Deborah M
DM
Levy
C April
CA
Bingham
Philip J
PJ
Kahn
Andrew H
AH
Eichenfield
Lisa F
LF
Imundo
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