Skip to main content

Advertisement

Log in

Idiopathic inflammatory myopathies: A treatment update

  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Inflammatory myopathies encompass a variety of syndromes with protean manifestations. Although the mainstay of therapy continues to include corticosteroids, there are a multitude of agents available for treating patients with myositis. These include many different immunosuppressive agents alone or in combination with each other, as well as an increasing array of novel and exciting biologic agents targeting molecules implicated in the pathogenesis of inflammatory myopathy. The systemic manifestations of myositis, particularly pulmonary involvement, are especially challenging to treat and contribute significantly to the morbidity and mortality of patients with polymyositis and dermatomyositis. Rehabilitative measures are often overlooked in the treatment of myositis, but may significantly improve the functional outcome of patients with these disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. van der Meulen MFG, Bronner IM, Hoogendijk JE, et al.: Polymyositis: an overdiagnosed entity. Neurology 2003, 61:316–321.

    PubMed  Google Scholar 

  2. Miller FW, Rider LG, Chung Y-L, et al.: Proposed preliminary core set measures for disease outcome assessment in adult and juvenile idiopathic inflammatory myopathies. Rheumatology 2001, 40:1262–1273. This paper describes measures used to assess outcome in patients with IIM and will be important in future clinical trials of patients with myositis.

    Article  PubMed  CAS  Google Scholar 

  3. Bunch TW, Worthington JW, Combs JJ, et al.: Azathioprine with prednisone for polymyositis: a controlled, clinical trial. Ann Intern Med 1980, 2:365–369.

    Google Scholar 

  4. Miller FW, Leitman SF, Cronin ME, et al.: Controlled trial of plasma exchange and leukapheresis in polymyositis and dermatomyositis. N Engl J Med 1992, 326:1380–1384.

    Article  PubMed  CAS  Google Scholar 

  5. Dalakas MC, Illa I, Dambrosia JM, et al.: A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis. N Engl J Med 1993, 329:1993–2000.

    Article  PubMed  CAS  Google Scholar 

  6. Dalakas MC, Sonies B, Dambrosia J, et al.: Treatment of inclusion-body myositis with IVIg: a double-blind, placebo-controlled study. Neurology 1997, 48:712–716.

    PubMed  CAS  Google Scholar 

  7. Walter MC, Lochmuller H, Toepfer M, et al.: High-dose immunoglobulin therapy in sporadic inclusion body myositis: a double-blind, placebo-controlled study. J Neurol 2000, 247:22–28.

    Article  PubMed  CAS  Google Scholar 

  8. Dalakas MC, Koffman B, Fujii M, et al.: A controlled study of intravenous immunoglobulin combined with prednisone in the treatment of IBM. Neurology 2001, 56:323–327.

    PubMed  CAS  Google Scholar 

  9. The Muscle Study Group: Randomized pilot trial of bINF1a (Avonex) in patients with inclusion body myositis. Neurology 2001, 57:1566–1570.

    Google Scholar 

  10. Dalakas M: Treatment of polymyositis and dermatomyositis. Curr Opin Rheumatol 1989, 1:443–449.

    Article  PubMed  CAS  Google Scholar 

  11. Nzeusseu A, Brion F, Lefebvre C, et al.: Functional outcome of myositis patients: can a low-dose glucocorticoid regimen achieve good functional results? Clin Exper Rheumatol 1999, 17:441–446. This retrospective review of high-dose versus low-dose corticosteroidtreated patients with myositis emphasizes that patients receiving a lower dose regimen achieved a similar outcome to those treated with higher doses of corticosteroid.

    CAS  Google Scholar 

  12. Bunch TW: Prednisone and azathioprine for polymyositis: long-term follow-up. Arthritis Rheum 1981, 24:45–48.

    Article  PubMed  CAS  Google Scholar 

  13. Joffe MM, Love LA, Leff RL, et al.: Drug therapy of the idiopathic inflammatory myopathies: predictors of response to prednisone, azathioprine, and methotrexate and a comparison of their efficacy. Am J Med 1993, 94:379–387.

    Article  PubMed  CAS  Google Scholar 

  14. Villalba L, Hicks JE, Adams EM, et al.: Treatment of refractory myositis: a randomized crossover study of two new cytotoxic regimens. Arthritis Rheum 1998, 41:392–399.

    Article  PubMed  CAS  Google Scholar 

  15. Zeller V, Cohen P, Prieur A-M, et al.: Cyclosporin A therapy in refractory juvenile dermatomyositis: experience and longterm follow-up of 6 cases. J Rheumatol 1996, 23:1424–1427.

    PubMed  CAS  Google Scholar 

  16. Vencovsky J, Jarosova K, Machacek S, et al.: Cyclosporine A versus methotrexate in the treatment of polymyositis and dermatomyositis. Scand J Rheumatol 2000, 29:95–102.

    Article  PubMed  CAS  Google Scholar 

  17. Oddis CV, Sciurba FC, Elmagd KA, et al.: Tacrolimus in refractory polymyositis with interstitial lung disease. Lancet 1999, 353:1762–1763.

    Article  PubMed  CAS  Google Scholar 

  18. Adams EM, Pucino F, Yarboro C, et al.: A pilot study: use of fludarabine for refractory dermatomyositis and polymyositis, and examination of endpoint measures. J Rheumatol 1999, 26:352–360.

    PubMed  CAS  Google Scholar 

  19. Cronin ME, Miller FW, Hicks JE, et al.: The failure of intravenous cyclophosphamide therapy in refractory idiopathic inflammatory myopathy. J Rheumatol 1989, 16:1225–1228.

    PubMed  CAS  Google Scholar 

  20. Sinoway PA, Callen JP: Chlorambucil: an effective corticosteroid- sparing agent for patients with recalcitrant dermatomyositis. Arthritis Rheum 1993, 36:319–324.

    Article  PubMed  CAS  Google Scholar 

  21. Chaudhry V, Cornblath DR, Griffin JW, et al.: Mycophenolate mofetil: a safe and promising immunosuppressant in neuromuscular diseases. Neurology 2001, 56:94–96.

    PubMed  CAS  Google Scholar 

  22. Gelber AC, Nousari HC, Wigley FM: Mycophenolate mofetil in the treatment of severe skin manifestations of dermatomyositis: a series of 4 cases. J Rheumatol 2000, 27:1542–1545.

    PubMed  CAS  Google Scholar 

  23. Cherin P, Piette JC, Wechsler B, et al.: Intravenous gamma globulin as first line therapy in polymyositis and dermatomyositis: an open study in 11 adult patients. J Rheumatol 1994, 21:1092–1097.

    PubMed  CAS  Google Scholar 

  24. Cherin P, Pelletier S, Teixeira A, et al.: Results and long-term follow-up of intravenous immunoglobulin infusions in chronic, refractory polymyositis. Arthritis Rheum 2002, 46:467–474.

    Article  PubMed  CAS  Google Scholar 

  25. Danieli MG, Malcangi G, Palmieri C, et al.: Cyclosporin A and intravenous immunoglobulin treatment in polymyositis/ dermatomyositis. Ann Rheum Dis 2002, 61:37–41.

    Article  PubMed  CAS  Google Scholar 

  26. Lundberg IE: The role of cytokines, chemokines, and adhesion molecules in the pathogenesis of idiopathic inflammatory myopathies. Curr Rheum Rep 2000, 2:216–224.

    CAS  Google Scholar 

  27. Saadeh CK: Etanercept is effective in the treatment of polymyositis/dermatomyositis which is refractory to conventional therapy. Arthritis Rheum 2001, 43(suppl):S193.

    Google Scholar 

  28. Hengstman GJ, van den Hoogen FH, van Engelen BG, et al.: Anti-TNF blockade with infliximab in polymyositis and dermatomyositis. Arthritis Rheum 2000, 43(suppl):S193.

    Google Scholar 

  29. Kazuki T, Bookbinder S, Furie R, et al.: A pilot study of eculizumab in patients with dermatomyositis. Arthritis Rheum 2002, 46(suppl):S489.

    Article  Google Scholar 

  30. Levine T: A pilot study of rituximab therapy for refractory dermatomyositis. Arthritis Rheum 2002, 46(suppl):S488.

    Google Scholar 

  31. The Muscle Study Group: Randomized pilot trial of beta-INF1a (Avonex) in patients with inclusion body myositis. Neurology 2001, 57:1566–1570.

    Google Scholar 

  32. Clawson K, Oddis CV: Adult respiratory distress syndrome in polymyositis patients with the anti-Jo-1 antibody. Arthritis Rheum 1995, 35:1519–1523.

    Article  Google Scholar 

  33. Baron F, Ribbens C, Kaye O, et al.: Effective treatment of Jo-1 associated polymyositis with T-cell-depleted autologous peripheral blood stem cell transplantation. Br J Haematol 2000, 110:339–342.

    Article  PubMed  CAS  Google Scholar 

  34. Bingham S, Griffiths B, McGonagle D, et al.: Autologous stem cell transplantation for rapidly progressive Jo-1-positive polymyositis and long-term follow-up. Br J Haematol 2001, 113:840–841.

    Article  PubMed  CAS  Google Scholar 

  35. Yoshimasu T, Ohtani T, Sakamoto T, et al.: Topical FK506 (tacrolimus) therapy for facial erythematous lesions of cutaneous lupus erythematosus and dermatomyositis. Eur J Dermatol 2002, 12:50–52.

    PubMed  Google Scholar 

  36. Sadayama T, Miyagawa S, Shirai T: Low-dose intravenous immunoglobulin therapy for intractable dermatomyositis skin lesions. J Dermatol 1999, 26:457–459.

    PubMed  CAS  Google Scholar 

  37. Peake MF, Perkins P, Elston DM, et al.: Cutaneous ulcers of refractory adult dermatomyositis responsive to intravenous immunoglobulin. Cutis 1998, 62:89–93.

    PubMed  CAS  Google Scholar 

  38. Marie I, Hachulla E, Levesque H, et al.: Intravenous immunoglobulin as treatment of life threatening esophageal involvement in polymyositis and dermatomyositis. J Rheumatol 1999, 26:2706–2709.

    PubMed  CAS  Google Scholar 

  39. Mahowald ML: The benefits and limitations of a physical training program in patients with inflammatory myositis. Curr Rheum Rep 2001, 3:317–324.

    Article  Google Scholar 

  40. Alexanderson H, Stenstrom CH, Jenner G, et al.: The safety of a resistive home exercise program in patients with recent onset active polymyositis or dermatomyositis. Scand J Rheumatol 2000, 29:295–301.

    Article  PubMed  CAS  Google Scholar 

  41. Wiesinger GF, Quittan M, Aringer M, et al.: Improvement of physical fitness and muscle strength in polymyositis/ dermatomyositis patients by a training program. Br J Rheumatol 1998, 37:196–200.

    Article  PubMed  CAS  Google Scholar 

  42. Sonies BC: Evaluation and treatment of speech and swallowing disorders associated with myopathies. Curr Opin Rheum 1997, 9:486–495.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oddis, C.V. Idiopathic inflammatory myopathies: A treatment update. Curr Rheumatol Rep 5, 431–436 (2003). https://doi.org/10.1007/s11926-003-0053-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-003-0053-1

Keywords

Navigation