Management of Calcinosis Associated with Dermatomyositis
- 6 Downloads
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.
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.
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
KeywordsCalcinosis cutis Dermatomyositis Myositis Therapy Juvenile
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.
Compliance with ethical standards
Conflict of interest
Melody Chung declares that she has no conflict of interest. Lorinda Chung declares that she has no conflict of interest.
Human and animal rights and informed consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 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
- 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.Google Scholar
- 51.Shahani L. Refractory calcinosis in a patient with dermatomyositis: response to intravenous immune globulin. BMJ Case Rep. 2012;2012.Google Scholar
- 61.Dubos M, Ly K, Martel C, Fauchais AL. Is rituximab an effective treatment of refractory calcinosis? BMJ Case Rep. 2016;2016.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.