Treatment of inflammatory myopathies

✍ Scribed by Frank L. Mastaglia; Beverley A. Phillips; Paul Zilko

• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 257 KB
• Volume: 20
• Category: Article
• ISSN: 0148-639X
• DOI: 10.1002/(sici)1097-4598(199706)20:6<651::aid-mus1>3.0.co;2-7

✦ Synopsis

The treatment of the immune-mediated inflammatory myopa-

INVITED REVIEW

thies 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 3-6month 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.