Treatment of inflammatory myopathies

Abstract

The treatment of the immune‐mediated inflammatory myopathies remains largely empirical. Corticosteroids are usually effective in polymyositis and dermatomyositis but may need to be combined with methotrexate or azathioprine in some patients. Intravenous immunoglobulin (IVIg) is effective as add‐on therapy in some patients not adequately controlled with steroids or immunosuppressive agents, but further controlled trials of IVIg are necessary to define the indications and optimal dose regimens. Cyclophosphamide, cyclosporin, or chlorambucil may be effective in patients with refractory polymyositis or dermatomyositis. Low‐dose whole body or lymphoid irradiation is a last option in severely disabled patients resistant to all other treatments. As a small proportion of patients with inclusion body myositis respond to corticosteroid or immunosuppressive therapy, a 3–6‐month trial of such therapy is justified in this condition. More specific immunotherapy for these disorders awaits identification of the target antigens and further clarification of the immunopathogenetic mechanisms. © 1997 John Wiley & Sons, Inc. Muscle Nerve 20:651–664, 1997.

Inflammatory Muscle Disease, 15-Year Experience at Tertiary Centers

“…We identified that patients who received steroids exhibited an impressive improvement in their symptoms (71.4%; p=0.023) reinforcing the most favorable outcome achieved with steroid treatment [10,11]. The percentage of patients treated with methotrexate was higher than previous study (57% of our patients compared with 34% in other study [54]).…”

“…Modalities of treatment used for IIM: steroids, methotrexate, azathioprine, cyclophosphamide, chlorambucil, intravenous immunoglobulin (IVIG), and rituximab as the approved treatment for IIM [10,11]. The course and outcome of the disease: the outcome of patients was classified into respondent and resistant.…”

“…Many reports proved the effectiveness of corticosteroids in most of the cases, with some patients requiring a combined therapy of corticosteroid with methotrexate or azathioprine [10,11].…”

Immunotherapies for Immune-Mediated Myopathies: A Current Perspective

“…Previous reviews have discussed the practical aspects of managing ongoing therapy and have emphasized the importance of not continuing high doses of steroids for too long and balancing this against not tapering the dose too quickly. They advocate the introduction of an immunosuppressive agent such as methotrexate, azathioprine, or mycophenolate earlier rather than later as a steroid-sparing strategy [34,[38][39][40][41]. Oral pulse therapy with dexamethasone (monthly cycles of 40 mg/ day for 4 consecutive days) has been suggested as an alternative to prednisolone and has been shown to be as effective in a RCT and to have a more favorable side effect profile, but the time to relapse was shorter with dexamethasone [42].…”

Análise imunocitoquímica do infiltrado inflamatório na miosite com corpos de inclusão citoplasmática e em outras doenças neuromusculares com vacúolos marginados

“…Este resultado vem ao encontro de outros estudos em doenças neuromusculares e em doenças do colágeno com envolvimento muscular, em que as alterações encontradas pelos diversos autores são consideradas inespecíficas, podendo ocorrer em casos de lesões das fibras musculares de diversas etiologias 49,50 . A simples deposição, ou a presença desses complexos imunes, não é suficiente para determinar a lesão podendo não ter relação com os achados anatomopatológicos 49,[51][52][53] .…”