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Management of Calcinosis Associated with Dermatomyositis

  • Other CTD: Inflammatory Myopathies and Sjogren's (P Basharat and JFL Albayda, Section Editors)
  • Published:
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Abstract

Purpose of review

Calcinosis cutis, or dystrophic soft-tissue calcification, is a common and debilitating complication of adult and juvenile dermatomyositis. Dermatomyositis-associated calcinosis is difficult to treat and is associated with significant morbidity. The purpose of this review is to provide an update of treatment modalities for calcinosis in dermatomyositis based on published studies.

Recent findings

Specific guidelines are lacking for calcinosis cutis management. Based on previous case reports, case series, cohort studies, and limited controlled studies, medications including diltiazem, bisphosphonates, sodium thiosulfate, aluminum hydroxide, warfarin, probenecid, colchicine, minocycline, and intravenous immunoglobulins have been used to control calcinosis progression in dermatomyositis, but no treatment has convincingly prevented or reduced calcinosis. Surgical excision of large or symptomatic calcium deposits remains the mainstay of treatment. Biologic therapies including infliximab, abatacept, rituximab, anakinra, and the oral JAK inhibitor tofacitinib have been used to control dermatomyositis-associated calcinosis in case reports and series.

Summary

Pharmacological treatment aimed to reduce calcinosis is challenging given that no therapies have consistently been found to be effective and few studies have a high level of evidence. Randomized controlled trials using novel outcome measures are necessary to evaluate the efficacy of proposed and emerging therapies.

Trial registration: clinicaltrials.gov NCT03639779 and NCT03267277

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Gutierrez A, Wetter DA. Calcinosis cutis in autoimmune connective tissue diseases. Dermatol Ther. 2012;25(2):195–206.

    PubMed  Google Scholar 

  2. Rider LG, Shah M, Mamyrova G, et al. The myositis autoantibody phenotypes of the juvenile idiopathic inflammatory myopathies. Medicine (Baltimore). 2013;92(4):223–43.

    CAS  Google Scholar 

  3. Fredi M, Bartoli F, Cavazzana I, et al. Calcinosis in poly-dermatomyositis: clinical and laboratory predictors and treatment options. Clin Exp Rheumatol. 2017;35(2):303–8.

    PubMed  Google Scholar 

  4. Reiter N, El-Shabrawi L, Leinweber B, Berghold A, Aberer E. Calcinosis cutis: part I. Diagnostic pathway. J Am Acad Dermatol. 2011;65(1):1–12 quiz 13–14.

    PubMed  CAS  Google Scholar 

  5. Boulman N, Slobodin G, Rozenbaum M, Rosner I. Calcinosis in rheumatic diseases. Semin Arthritis Rheum. 2005;34(6):805–12.

    PubMed  Google Scholar 

  6. Balin SJ, Wetter DA, Andersen LK, Davis MD. Calcinosis cutis occurring in association with autoimmune connective tissue disease: the Mayo Clinic experience with 78 patients, 1996–2009. Arch Dermatol. 2012;148(4):455–62.

    PubMed  CAS  Google Scholar 

  7. Matthew L, Shufeng L, Lorinda C, David F. Dermatomyositis associated with anti-melanoma differentiation-associated gene 5 antibodies: a longitudinal analysis. Arthritis Rheum. 2015;67:suppl 10.

    Google Scholar 

  8. Cook CD, Rosen FS, Banker BQ. Dermatomyositis and focal scleroderma. Pediatr Clin N Am. 1963;10:979–1016.

    CAS  Google Scholar 

  9. Chander S, Gordon P. Soft tissue and subcutaneous calcification in connective tissue diseases. Curr Opin Rheumatol. 2012;24(2):158–64.

    PubMed  CAS  Google Scholar 

  10. Valenzuela A, Chung L, Casciola-Rosen L, Fiorentino D. Identification of clinical features and autoantibodies associated with calcinosis in dermatomyositis. JAMA Dermatol. 2014;150(7):724–9.

    PubMed  PubMed Central  Google Scholar 

  11. Hoeltzel MF, Oberle EJ, Robinson AB, Agarwal A, Rider LG. The presentation, assessment, pathogenesis, and treatment of calcinosis in juvenile dermatomyositis. Curr Rheumatol Rep. 2014;16(12):467.

    PubMed  PubMed Central  Google Scholar 

  12. Fisler RE, Liang MG, Fuhlbrigge RC, Yalcindag A, Sundel RP. Aggressive management of juvenile dermatomyositis results in improved outcome and decreased incidence of calcinosis. J Am Acad Dermatol. 2002;47(4):505–11.

    PubMed  Google Scholar 

  13. Shinjo SK, Souza FH. Update on the treatment of calcinosis in dermatomyositis. Rev Bras Reumatol. 2013;53(2):211–4.

    PubMed  Google Scholar 

  14. Reiter N, El-Shabrawi L, Leinweber B, Berghold A, Aberer E. Calcinosis cutis: part II. Treatment options. J Am Acad Dermatol. 2011;65(1):15–22 quiz 23–14.

    PubMed  Google Scholar 

  15. Bienvenu B. Treatment of subcutaneous calcinosis in systemic disorders. Rev Med Interne. 2014;35(7):444–52.

    PubMed  CAS  Google Scholar 

  16. Vinen CS, Patel S, Bruckner FE. Regression of calcinosis associated with adult dermatomyositis following diltiazem therapy. Rheumatology (Oxford). 2000;39(3):333–4.

    CAS  Google Scholar 

  17. Torralba TP, Li-Yu J, Navarra ST. Successful use of diltiazem in calcinosis caused by connective tissue disease. J Clin Rheumatol. 1999;5(2):74–8.

    PubMed  CAS  Google Scholar 

  18. Bertorini TE, Sebes JI, Palmieri GM, Igarashi M, Horner LH. Diltiazem in the treatment of calcinosis in juvenile dermatomyositis. J Clin Neuromuscul Dis. 2001;2(4):191–3.

    PubMed  CAS  Google Scholar 

  19. Oliveri MB, Palermo R, Mautalen C, Hübscher O. Regression of calcinosis during diltiazem treatment in juvenile dermatomyositis. J Rheumatol. 1996;23(12):2152–5.

    PubMed  CAS  Google Scholar 

  20. Mori H, Okada Y, Yamaoka K, Saito K, Tanaka Y. Marked improvement of calcinosis in adult dermatomyositis with etidronate therapy. J Bone Miner Metab. 2012;30(1):114–8.

    PubMed  CAS  Google Scholar 

  21. Wakabayashi T, Sasaki N, Chinen N, Suzuki Y. Dramatic improvement of subcutaneous calcinosis by intermittent, high-dose etidronate plus cimetidine in a patient with juvenile dermatomyositis. Case Rep Rheumatol. 2015;2015:817592.

    PubMed  PubMed Central  Google Scholar 

  22. Metzger AL, Singer FR, Bluestone R, Pearson CM. Failure of disodium etidronate in calcinosis due to dermatomyositis and scleroderma. N Engl J Med. 1974;291(24):1294–6.

    PubMed  CAS  Google Scholar 

  23. Weinstein RS. Focal mineralization defect during disodium etidronate treatment of calcinosis. Calcif Tissue Int. 1982;34(3):224–8.

    PubMed  CAS  Google Scholar 

  24. Ambler GR, Chaitow J, Rogers M, McDonald DW, Ouvrier RA. Rapid improvement of calcinosis in juvenile dermatomyositis with alendronate therapy. J Rheumatol. 2005;32(9):1837–9.

    PubMed  Google Scholar 

  25. Tayfur AC, Topaloglu R, Gulhan B, Bilginer Y. Bisphosphonates in juvenile dermatomyositis with dystrophic calcinosis. Mod Rheumatol. 2015;25(4):615–20.

    PubMed  CAS  Google Scholar 

  26. Saini I, Kalaivani M, Kabra SK. Calcinosis in juvenile dermatomyositis: frequency, risk factors and outcome. Rheumatol Int. 2016;36(7):961–5.

    PubMed  CAS  Google Scholar 

  27. Marco Puche A, Calvo Penades I, Lopez Montesinos B. Effectiveness of the treatment with intravenous pamidronate in calcinosis in juvenile dermatomyositis. Clin Exp Rheumatol. 2010;28(1):135–40.

    PubMed  CAS  Google Scholar 

  28. Slimani S, Abdessemed A, Haddouche A, Ladjouze-Rezig A. Complete resolution of universal calcinosis in a patient with juvenile dermatomyositis using pamidronate. Joint Bone Spine. 2010;77(1):70–2.

    PubMed  Google Scholar 

  29. Palaniappan P, Lionel AP, Kumar S. Successful treatment of calcinosis cutis in juvenile dermatomyositis with pamidronate. J Clin Rheumatol. 2014;20(8):454–5.

    PubMed  Google Scholar 

  30. Topham C, Haynes D, Frigerio A, Hull C. Linear amyopathic dermatomyositis with calcinosis cutis responsive to topical sodium thiosulfate. Pediatr Dermatol. 2019;36(4):e102–3.

    PubMed  Google Scholar 

  31. Pagnini I, Simonini G, Giani T, et al. Sodium thiosulfate for the treatment of calcinosis secondary to juvenile dermatomyositis. Clin Exp Rheumatol. 2014;32(3):408–9.

    PubMed  CAS  Google Scholar 

  32. Del Barrio-Díaz P, Moll-Manzur C, Álvarez-Veliz S, Vera-Kellet C. Topical sodium metabisulfite for the treatment of calcinosis cutis: a promising new therapy. Br J Dermatol. 2016;175(3):608–11.

    PubMed  Google Scholar 

  33. Arabshahi B, Silverman RA, Jones OY, Rider LG. Abatacept and sodium thiosulfate for treatment of recalcitrant juvenile dermatomyositis complicated by ulceration and calcinosis. J Pediatr. 2012;160(3):520–2.

    PubMed  PubMed Central  Google Scholar 

  34. Mageau A, Guigonis V, Ratzimbasafy V, et al. Intravenous sodium thiosulfate for treating tumoral calcinosis associated with systemic disorders: report of four cases. Joint Bone Spine. 2017;84(3):341–4.

    PubMed  CAS  Google Scholar 

  35. Goossens J, Courbebaisse M, Caudron E, et al. Efficacy of intralesional sodium thiosulfate injections for disabling tumoral calcinosis: two cases. Semin Arthritis Rheum. 2017;47(3):451–5.

    PubMed  CAS  Google Scholar 

  36. Aihara Y, Mori M, Ibe M, et al. A case of juvenile dermatomyositis with calcinosis universalis--remarkable improvement with aluminum hydroxide therapy. Ryumachi. 1994;34(5):879–84.

    PubMed  CAS  Google Scholar 

  37. Wang WJ, Lo WL, Wong CK. Calcinosis cutis in juvenile dermatomyositis: remarkable response to aluminum hydroxide therapy. Arch Dermatol. 1988;124(11):1721–2.

    PubMed  CAS  Google Scholar 

  38. Nakagawa T, Takaiwa T. Calcinosis cutis in juvenile dermatomyositis responsive to aluminum hydroxide treatment. J Dermatol. 1993;20(9):558–60.

    PubMed  CAS  Google Scholar 

  39. Berger RG, Featherstone GL, Raasch RH, McCartney WH, Hadler NM. Treatment of calcinosis universalis with low-dose warfarin. Am J Med. 1987;83(1):72–6.

    PubMed  CAS  Google Scholar 

  40. Matsuoka Y, Miyajima S, Okada N. A case of calcinosis universalis successfully treated with low-dose warfarin. J Dermatol. 1998;25(11):716–20.

    PubMed  CAS  Google Scholar 

  41. Lassoued K, Saiag P, Anglade MC, Roujeau JC, Touraine RL. Failure of warfarin in treatment of calcinosis universalis. Am J Med. 1988;84(4):795–6.

    PubMed  CAS  Google Scholar 

  42. Moore SE, Jump AA, Smiley JD. Effect of warfarin sodium therapy on excretion of 4-carboxy-L-glutamic acid in scleroderma, dermatomyositis, and myositis ossificans progressiva. Arthritis Rheum. 1986;29(3):344–51.

    PubMed  CAS  Google Scholar 

  43. •• Traineau H, Aggarwal R, Monfort JB, et al. Treatment of calcinosis cutis in systemic sclerosis and dermatomyositis: a review of the literature. J Am Acad Dermatol. 2019; This systematic literature review highlights the efficacy and tolerability of available treatments for calcinosis cutis secondary to systemic sclerosis and dermatomyositis, with ratings on the level of evidence. In total, 30 studies (288 patients) were included and eleven therapeutic classes, surgery, and physical treatments were identified as potential treatments for calcinosis.

  44. Harel L, Harel G, Korenreich L, Straussberg R, Amir J. Treatment of calcinosis in juvenile dermatomyositis with probenecid: the role of phosphorus metabolism in the development of calcifications. J Rheumatol. 2001;28(5):1129–32.

    PubMed  CAS  Google Scholar 

  45. Eddy MC, Leelawattana R, McAlister WH, Whyte MP. Calcinosis universalis complicating juvenile dermatomyositis: resolution during probenecid therapy. J Clin Endocrinol Metab. 1997;82(11):3536–42.

    PubMed  CAS  Google Scholar 

  46. Nakamura H, Kawakami A, Ida H, Ejima E, Origuchi T, Eguchi K. Efficacy of probenecid for a patient with juvenile dermatomyositis complicated with calcinosis. J Rheumatol. 2006;33(8):1691–3.

    PubMed  Google Scholar 

  47. Skuterud E, Sydnes OA, Haavik TK. Calcinosis in dermatomyositis treated with probenecid. Scand J Rheumatol. 1981;10(2):92–4.

    PubMed  CAS  Google Scholar 

  48. Fuchs D, Fruchter L, Fishel B, Holtzman M, Yaron M. Colchicine suppression of local inflammation due to calcinosis in dermatomyositis and progressive systemic sclerosis. Clin Rheumatol. 1986;5(4):527–30.

    PubMed  CAS  Google Scholar 

  49. Taborn J, Bole GG, Thompson GR. Colchicine suppression of local and systemic inflammation due to calcinosis universalis in chronic dermatomyositis. Ann Intern Med. 1978;89(5 Pt 1):648–9.

    PubMed  CAS  Google Scholar 

  50. Robertson LP, Marshall RW, Hickling P. Treatment of cutaneous calcinosis in limited systemic sclerosis with minocycline. Ann Rheum Dis. 2003;62(3):267–9.

    PubMed  PubMed Central  CAS  Google Scholar 

  51. Shahani L. Refractory calcinosis in a patient with dermatomyositis: response to intravenous immune globulin. BMJ Case Rep. 2012;2012.

  52. Peñate Y, Guillermo N, Melwani P, Martel R, Hernández-Machín B, Borrego L. Calcinosis cutis associated with amyopathic dermatomyositis: response to intravenous immunoglobulin. J Am Acad Dermatol. 2009;60(6):1076–7.

    PubMed  Google Scholar 

  53. Galimberti F, Li Y, Fernandez AP. Intravenous immunoglobulin for treatment of dermatomyositis-associated dystrophic calcinosis. J Am Acad Dermatol. 2015;73(1):174–6.

    PubMed  Google Scholar 

  54. Liniger P, Slongo T, Eckhardt O. Tumoral calcinosis and atypical juvenile dermatomyositis: case report. Eur J Pediatr Surg. 1998;8(6):382–4.

    PubMed  CAS  Google Scholar 

  55. Touimy M, Janani S, Rachidi W, Etaouil N, Mkinsi O. Calcinosis universalis complicating juvenile dermatomyositis: improvement after intravenous immunoglobulin therapy. Joint Bone Spine. 2013;80(1):108–9.

    PubMed  Google Scholar 

  56. Riley P, McCann LJ, Maillard SM, Woo P, Murray KJ, Pilkington CA. Effectiveness of infliximab in the treatment of refractory juvenile dermatomyositis with calcinosis. Rheumatology (Oxford). 2008;47(6):877–80.

    CAS  Google Scholar 

  57. Tosounidou S, MacDonald H, Situnayake D. Successful treatment of calcinosis with infliximab in a patient with systemic sclerosis/myositis overlap syndrome. Rheumatology (Oxford). 2014;53(5):960–1.

    Google Scholar 

  58. Siddiqui NS, Altorok N. Images in clinical medicine. Diffuse soft-tissue calcinosis. N Engl J Med. 2015;373(2):173.

    PubMed  CAS  Google Scholar 

  59. Bader-Meunier B, Decaluwe H, Barnerias C, et al. Safety and efficacy of rituximab in severe juvenile dermatomyositis: results from 9 patients from the French Autoimmunity and Rituximab registry. J Rheumatol. 2011;38(7):1436–40.

    PubMed  CAS  Google Scholar 

  60. Alhemairi M, Muzaffer M. Effectiveness of rituximab therapy on severe calcinosis in 4 children with juvenile dermatomyositis. Open J Rheumatol Autoimmune Dis. 2017;7:16–29.

    Google Scholar 

  61. Dubos M, Ly K, Martel C, Fauchais AL. Is rituximab an effective treatment of refractory calcinosis? BMJ Case Rep. 2016;2016.

  62. Groh M, Rogowska K, Monsarrat O, Denoël A, Blanche P, Guillevin L. Interleukin-1 receptor antagonist for refractory anti-MDA5 clinically amyopathic dermatomyopathy. Clin Exp Rheumatol. 2015;33(6):904–5.

    PubMed  CAS  Google Scholar 

  63. Wendel S, Venhoff N, Frye BC, et al. Successful treatment of extensive calcifications and acute pulmonary involvement in dermatomyositis with the Janus-Kinase inhibitor tofacitinib - a report of two cases. J Autoimmun. 2019;100:131–6.

    PubMed  CAS  Google Scholar 

  64. Mendelson BC, Linscheid RL, Dobyns JH, Muller SA. Surgical treatment of calcinosis cutis in the upper extremity. J Hand Surg [Am]. 1977;2(4):318–24.

    CAS  Google Scholar 

  65. Carlson M, Lindseth RE, DeRosa GP. Surgical removal of soft tissue calcifications in dermatomyositis. Arch Surg. 1975;110(6):755–6.

    PubMed  CAS  Google Scholar 

  66. Radtke C, Vogt PM, Spies M. Re: Wu JJ, Metz BJ. Calcinosis cutis of juvenile dermatomyositis treated with incision and drainage. Dermatol Surg. 2009;35(2):296.

    PubMed  CAS  Google Scholar 

  67. Shearin JC, Pickrell K. Surgical treatment of subcutaneous calcifications of polymyositis or dermatomyositis. Ann Plast Surg. 1980;5(5):381–5.

    PubMed  CAS  Google Scholar 

  68. Al-Mayouf SM, Alsonbul A, Alismail K. Localized calcinosis in juvenile dermatomyositis: successful treatment with intralesional corticosteroids injection. Int J Rheum Dis. 2010;13(3):e26–8.

    PubMed  Google Scholar 

  69. Sultan-Bichat N, Menard J, Perceau G, Staerman F, Bernard P, Reguiaï Z. Treatment of calcinosis cutis by extracorporeal shock-wave lithotripsy. J Am Acad Dermatol. 2012;66(3):424–9.

    PubMed  Google Scholar 

  70. Chan AY, Li E. Electric shock wave lithotripsy (ESWL) as a pain control measure in dermatomyositis with calcinosis cutis-old method, new discovery. Clin Rheumatol. 2005;24(2):172–3.

    PubMed  Google Scholar 

  71. Mukamel M, Horev G, Mimouni M. New insight into calcinosis of juvenile dermatomyositis: a study of composition and treatment. J Pediatr. 2001;138(5):763–6.

    PubMed  CAS  Google Scholar 

  72. Valenzuela A, Baron M, Herrick AL, et al. Calcinosis is associated with digital ulcers and osteoporosis in patients with systemic sclerosis: A Scleroderma Clinical Trials Consortium study. Semin Arthritis Rheum. 2016;46(3):344–9.

    PubMed  PubMed Central  Google Scholar 

  73. Cañas CA, Bonilla-Abadía F, Mejía M, Tobón GJ. Recovery of severe muscular and fascial calcinosis after treatment with bisphosphonates in a child with juvenile dermatomyositis. J Clin Rheumatol. 2015;21(5):267–9.

    PubMed  Google Scholar 

  74. Martillotti J, Moote D, Zemel L. Improvement of calcinosis using pamidronate in a patient with juvenile dermatomyositis. Pediatr Radiol. 2014;44(1):115–8.

    PubMed  Google Scholar 

  75. Tong PL, Yu LL, Chan JJ. Drug-induced dermatomyositis after zoledronic acid. Australas J Dermatol. 2012;53(4):e73–5.

    PubMed  Google Scholar 

  76. Apalla Z, Tzellos T, Lallas A, Sotiriou E, Lefaki I. Possible zoledronic acid-induced dermatomyositis. Clin Exp Dermatol. 2012;37(3):309–11.

    PubMed  CAS  Google Scholar 

  77. Schlieper G, Brandenburg V, Ketteler M, Floege J. Sodium thiosulfate in the treatment of calcific uremic arteriolopathy. Nat Rev Nephrol. 2009;5(9):539–43.

    PubMed  CAS  Google Scholar 

  78. Raffaella C, Annapaola C, Tullio I, Angelo R, Giuseppe L, Simone C. Successful treatment of severe iatrogenic calcinosis cutis with intravenous sodium thiosulfate in a child affected by T-acute lymphoblastic leukemia. Pediatr Dermatol. 2009;26(3):311–5.

    PubMed  Google Scholar 

  79. Wolf EK, Smidt AC, Laumann AE. Topical sodium thiosulfate therapy for leg ulcers with dystrophic calcification. Arch Dermatol. 2008;144(12):1560–2.

    PubMed  Google Scholar 

  80. A comparative study of the efficacy of intralesional sodium thiosulfate versus intralesional normal saline for the treatment of dystrophic and idiopathic calcinosis cutis. In: https://ClinicalTrials.gov/show/NCT03639779.

  81. Nassim JR, Connolly CK. Treatment of calcinosis universalis with aluminium hydroxide. Arch Dis Child. 1970;45(239):118–21.

    PubMed  PubMed Central  CAS  Google Scholar 

  82. Wananukul S, Pongprasit P, Wattanakrai P. Calcinosis cutis presenting years before other clinical manifestations of juvenile dermatomyositis: report of two cases. Australas J Dermatol. 1997;38(4):202–5.

    PubMed  CAS  Google Scholar 

  83. Faust HE, Golden JA, Rajalingam R, et al. Short lung transplant donor telomere length is associated with decreased CLAD-free survival. Thorax. 2017;72(11):1052–4.

    PubMed  PubMed Central  Google Scholar 

  84. Miyamae T, Mori M, Inamo Y, et al. Multi-center analysis of calcinosis in children with juvenile dermatomyositis. Ryumachi. 2003;43(3):538–43.

    PubMed  Google Scholar 

  85. Yoshida S, Torikai K. The effects of warfarin on calcinosis in a patient with systemic sclerosis. J Rheumatol. 1993;20(7):1233–5.

    PubMed  CAS  Google Scholar 

  86. Cukierman T, Elinav E, Korem M, Chajek-Shaul T. Low dose warfarin treatment for calcinosis in patients with systemic sclerosis. Ann Rheum Dis. 2004;63(10):1341–3.

    PubMed  PubMed Central  CAS  Google Scholar 

  87. Geddes MR, Sinnreich M, Chalk C. Minocycline-induced dermatomyositis. Muscle Nerve. 2010;41(4):547–9.

    PubMed  Google Scholar 

  88. Brown RJ, Rother KI, Artman H, et al. Minocycline-induced drug hypersensitivity syndrome followed by multiple autoimmune sequelae. Arch Dermatol. 2009;145(1):63–6.

    PubMed  PubMed Central  Google Scholar 

  89. Schanz S, Ulmer A, Fierlbeck G. Response of dystrophic calcification to intravenous immunoglobulin. Arch Dermatol. 2008;144(5):585–7.

    PubMed  Google Scholar 

  90. Hughes M, Herrick AL. Digital ulcers in systemic sclerosis. Rheumatology (Oxford). 2017;56(1):14–25.

    CAS  Google Scholar 

  91. Kalajian AH, Perryman JH, Callen JP. Intravenous immunoglobulin therapy for dystrophic calcinosis cutis: unreliable in our hands. Arch Dermatol. 2009;145(3):334 author reply 335.

    PubMed  Google Scholar 

  92. Pachman LM, Liotta-Davis MR, Hong DK, et al. TNFalpha-308A allele in juvenile dermatomyositis: association with increased production of tumor necrosis factor alpha, disease duration, and pathologic calcifications. Arthritis Rheum. 2000;43(10):2368–77.

    PubMed  CAS  Google Scholar 

  93. Fredi M, Bartoli F, Cavazzana I. SAT0469 calcinosis cutis in poly-dermatomyositis: clinical and therapeutic study. Ann Rheum Dis. 2015;74:830–1.

    Google Scholar 

  94. Aggarwal R, Loganathan P, Koontz D, Qi Z, Reed AM, Oddis CV. Cutaneous improvement in refractory adult and juvenile dermatomyositis after treatment with rituximab. Rheumatology (Oxford). 2017;56(2):247–54.

    CAS  Google Scholar 

  95. Kahn JS, Deverapalli SC, Rosmarin DM. JAK-STAT signaling pathway inhibition: a role for treatment of discoid lupus erythematosus and dermatomyositis. Int J Dermatol. 2018;57(8):1007–14.

    PubMed  CAS  Google Scholar 

  96. Dalakas MC, Hohlfeld R. Polymyositis and dermatomyositis. Lancet. 2003;362(9388):971–82.

    PubMed  CAS  Google Scholar 

  97. Garama DJ, White CL, Balic JJ, Gough DJ. Mitochondrial STAT3: powering up a potent factor. Cytokine. 2016;87:20–5.

    PubMed  CAS  Google Scholar 

  98. Boelch SP, Barthel T, Goebel S, Rudert M, Plumhoff P. Calcinosis universalis of the elbow: a rare case with classical presentation. Case Rep Orthop. 2015;2015:505420.

    PubMed  PubMed Central  Google Scholar 

  99. Downey EC, Woolley MM, Hanson V. Required surgical therapy in the pediatric patient with dermatomyositis. Arch Surg. 1988;123(9):1117–20.

    PubMed  Google Scholar 

  100. Welborn MC, Gottschalk H, Bindra R. Juvenile dermatomyositis: a case of calcinosis cutis of the elbow and review of the literature. J Pediatr Orthop. 2015;35(5):e43–6.

    PubMed  Google Scholar 

  101. Wu JJ, Metz BJ. Calcinosis cutis of juvenile dermatomyositis treated with incision and drainage. Dermatol Surg. 2008;34(4):575–7.

    PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to thank Dr. Soumya Chatterjee from the Cleveland Clinic for permission to use the radiograph in Fig. 1d (exoskeleton), and Dr. Lisa Rider from the National Institutes of Health for reviewing this article.

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  1. Division of Immunology and Rheumatology, Stanford University School of Medicine, 1000 Welch Rd Ste 203, MC 5755, Palo Alto, CA, 94304, USA

    Melody Chung MD & Lorinda Chung MD, MS

  2. VA Palo Alto Health Care System, Palo Alto, CA, USA

    Lorinda Chung MD, MS

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Correspondence to Lorinda Chung MD, MS.

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This article is part of the Topical Collection on Other CTD: Inflammatory Myopathies and Sjogren's

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Chung, M., Chung, L. Management of Calcinosis Associated with Dermatomyositis. Curr Treat Options in Rheum 5, 242–257 (2019). https://doi.org/10.1007/s40674-019-00134-w

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