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Management of Calcinosis Associated with Dermatomyositis

  • Melody Chung
  • Lorinda ChungEmail author
Other CTD: Inflammatory Myopathies and Sjogren's (P Basharat and JFL Albayda, Section Editors)
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Part of the following topical collections:
  1. Topical Collection on Other CTD: Inflammatory Myopathies and Sjogren's

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

Keywords

Calcinosis cutis Dermatomyositis Myositis Therapy Juvenile 

Notes

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.

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

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© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.Division of Immunology and RheumatologyStanford University School of MedicinePalo AltoUSA
  2. 2.VA Palo Alto Health Care SystemPalo AltoUSA

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