Immunomodulatory treatment for dermatomyositis

Abstract

Dermatomyositis and polymyositis are classified as members of idiopathic inflammatory myopathies. It has recently become evident that the pathogenesis of the muscle disease for these two entities is likely not the same. Despite this observation, therapies directed at the muscle disease are similar, although therapy for the skin differs slightly. Corticosteroids remain the initial approach to management. The systemic dose of corticosteroids needed to control the disease, particularly the skin disease, is quite high; therefore, most authorities add a corticosteroid-sparing agent early. Some patients will naturally "burn out" the inflammatory component of their disease, but many have continuing disease activity that requires maintenance therapy. In this article, we briefly define the disease state of dermatomyositis, discuss the associated systemic manifestations, and update the selection and evaluation of immunomodulatory, corticosteroid-sparing agents.

Management of cutaneous dermatomyositis

“…There have been no reported studies specifically evaluating the effect of AZA on skin disease in DM although anecdotal evidence and case reports suggest that it is relatively ineffective in this regard . Several studies have evaluated this drug for the myopathy in PM and/or DM and demonstrated variable results .…”

Dermatomyositis in Patients with Rheumatoid Arthritis During Adalimumab Therapy

“…They also stated that there was no improvement after 6 weeks of treatment with prednisone and methotrexate, while DM improved after withdrawal of adalimumab. However, it requires longer than 6 weeks to assess whether or not treatment with corticosteroids and/or methotrexate will be effective for DM 8 .…”