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Idiopathic inflammatory myopathy: Treatment options

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Abstract

Idiopathic inflammatory myopathy (IIM) comprises a group of rare disorders in which there is an immune-mediated attack on skeletal muscle, the consequence of which is muscle damage and weakness in the patient. As in other inflammatory diseases, the general approach to therapy is use of immunosuppressive agents. Many options exist for IIM treatment, but therapeutic approaches are based mostly on empirical evidence and small studies, many of which are uncontrolled. Recently, new agents have been designed to target specific components of the immune response, and they offer hope for more effective or safer IIM therapy.

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References and Recommended Reading

  1. Dalakas MC: Inflammatory disorders of muscle: progress in polymyositis, dermatomyositis and inclusion body myositis. Curr Opin Neurol 2004, 17: 561–567.

    Article  PubMed  CAS  Google Scholar 

  2. Baer AN: Differential diagnosis of idiopathic inflammatory myopathies. Curr Rheumatol Rep 2006, 8: 178–187.

    Article  PubMed  Google Scholar 

  3. Baer AN, Wortmann RL: Myotoxicity associated with lipidlowering drugs. Curr Opin Rheumatol 2007, 19: 67–73.

    PubMed  CAS  Google Scholar 

  4. Levine SM: Cancer and myositis: new insights into an old association. Curr Opin Rheumatol 2006, 18: 620–624.

    Article  PubMed  CAS  Google Scholar 

  5. Hengstman GJ, van Engelen BG, van Venrooij WJ: Myositis specific autoantibodies: changing insights in pathophysiology and clinical associations. Curr Opin Rheumatol 2004, 16: 692–699.

    PubMed  Google Scholar 

  6. Rider LG, Giannini EH, Harris-Love M, et al.: Defining clinical improvement in adult and juvenile myositis. J Rheumatol 2003, 30: 603–617.

    PubMed  Google Scholar 

  7. Isenberg DA, Allen E, Farewell V, et al.: International consensus outcome measures for patients with idiopathic inflammatory myopathies. Development and initial validation of myositis activity and damage indices in patients with adult onset disease. Rheumatology (Oxford) 2004, 43: 49–54.

    Article  CAS  Google Scholar 

  8. Oddis CV, Medsger TA: Current management of polymyositis and dermatomyositis. Drugs 1989, 37: 382–390.

    PubMed  CAS  Google Scholar 

  9. Neeck G: Fifty years of experience with cortisone therapy in the study and treatment of rheumatoid arthritis. Ann N Y Acad Sci 2002, 966: 28–38.

    PubMed  CAS  Google Scholar 

  10. 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 

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

    PubMed  CAS  Google Scholar 

  12. Amato AA, Griggs RC: Treatment of idiopathic inflammatory myopathies. Curr Opin Neurol 2003, 16: 569–575.

    Article  PubMed  CAS  Google Scholar 

  13. Nzeusseu A, Brion F, Lefebvre C, et al.: Functional outcome of myositis patients: can a low-dose glucocorticoid regimen achieve good functional results? Clin Exp Rheumatol 1999, 17: 441–446.

    PubMed  CAS  Google Scholar 

  14. Oddis CV: Idiopathic inflammatory myopathies: a treatment update. Curr Rheumatol Rep 2003, 5: 431–436.

    Article  PubMed  Google Scholar 

  15. Laxer RM, Stein LD, Petty RE: Intravenous pulse methylprednisolone treatment of juvenile dermatomyositis. Arthritis Rheum 1987, 30: 328–334.

    Article  PubMed  CAS  Google Scholar 

  16. Bolosiu HD, Man L, Rednic S: The effect of methylprednisone pulse therapy in polymyositis/dermatomyositis. Adv Exp Med Biol 1999, 455: 349–357.

    PubMed  CAS  Google Scholar 

  17. Matsubara S, Sawa Y, Takamori M, et al.: Pulsed intravenous methylprednisolone combined with oral steroids as the initial treatment of inflammatory myopathies. J Neurol Neurosurg Psychiatry 1994, 57: 1008.

    Article  PubMed  CAS  Google Scholar 

  18. Tymms KE, Webb J: Dermatopolymyositis and other connective tissue diseases: a review of 105 cases. J Rheumatol 1985, 12: 1140–1148.

    PubMed  CAS  Google Scholar 

  19. Quinn MA, Emery P: Window of opportunity in early rheumatoid arthritis: possibility of altering the disease process with early intervention. Clin Exp Rheumatol 2003, 21: S154–157.

    PubMed  CAS  Google Scholar 

  20. Arbuckle MR, McClain MT, Rubertone MV, et al.: Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med 2003, 349: 1526–1533.

    Article  PubMed  CAS  Google Scholar 

  21. Arnett FC, Whelton JC, Zizic TM, Stevens MB: Methotrexate therapy in polymyositis. Ann Rheum Dis 1973, 32: 536–546.

    Article  PubMed  CAS  Google Scholar 

  22. Metzger AL, Bohan A, Goldberg LS, et al.: Polymyositis and dermatomyositis: combined methotrexate and corticosteroid therapy. Ann Intern Med 1974, 81: 182–189.

    PubMed  CAS  Google Scholar 

  23. 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 

  24. Bunch TW, Worthington JW, Combs JJ, et al.: Azathioprine with prednisone for polymyositis. A controlled, clinical trial. Ann Intern Med 1980, 92: 365–369.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  26. Miller J, Walsh Y, Saminaden S, et al.: Randomised double blind trial of methotrexate and steroids compared with azathioprine and steroids in the treatment of idiopathic inflammatory myopathy. J Neurol Sci 2002, 199(Suppl 1): S53.

    Google Scholar 

  27. 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 

  28. Dalakas MC: High-dose intravenous immunoglobulin in inflammatory myopathies: experience based on controlled clinical trials. Neurol Sci 2003, 24(Suppl 4): S256–259.

    Article  PubMed  Google Scholar 

  29. Cherin P, Pelletier S, Teixeira A, et al.: Results and longterm followup of intravenous immunoglobulin infusions in chronic, refractory polymyositis: an open study with thirty-five adult patients. Arthritis Rheum 2002, 46: 467–474.

    Article  PubMed  CAS  Google Scholar 

  30. Zeller V, Cohen P, Prieur AM, Guillevin L: Cyclosporin a therapy in refractory juvenile dermatomyositis. Experience and longterm followup of 6 cases. J Rheumatol 1996, 23: 1424–1427.

    PubMed  CAS  Google Scholar 

  31. Jones DW, Snaith ML, Isenberg DA: Cyclosporine treatment for intractable polymyositis. Arthritis Rheum 1987, 30: 959–960.

    Article  PubMed  CAS  Google Scholar 

  32. Qushmaq KA, Chalmers A, Esdaile JM: Cyclosporin A in the treatment of refractory adult polymyositis/dermatomyositis: population based experience in 6 patients and literature review. J Rheumatol 2000, 27: 2855–2859.

    PubMed  CAS  Google Scholar 

  33. Gelber AC, Nousari HC, Wigley FM: Mycophenolate mofetil in the treatment of severe skin manifestations of dermatomyositis: a series of 4 cases. J Rheumatol 1999, 27: 1542–1545.

    Google Scholar 

  34. Majithia V, Harisdangkul V: Mycophenolate mofetil (Cell-Cept): an alternative therapy for autoimmune inflammatory myopathy. Rheumatology (Oxford) 2005, 44: 386–389. (Published erratum appears in Rheumatology (Oxford) 2005, 44: 569.)

    Article  CAS  Google Scholar 

  35. Edge JC, Outland JD, Dempsey JR, Callen JP: Mycophenolate mofetil as an effective corticosteroid-sparing therapy for recalcitrant dermatomyositis. Arch Dermatol 2006, 142: 65–69.

    Article  PubMed  CAS  Google Scholar 

  36. Oddis CV, Sciurba FC, Elmagd KA, Starzl TE: Tacrolimus in refractory polymyositis with interstitial lung disease. Lancet 1999, 353: 1762–1763.

    Article  PubMed  CAS  Google Scholar 

  37. Wilkes MR, Sereika SM, Fertig N, et al.: Treatment of antisynthetase-associated interstitial lung disease with tacrolimus. Arthritis Rheum 2005, 52: 2439–2446.

    Article  PubMed  CAS  Google Scholar 

  38. Levine TD: Rituximab in the treatment of dermatomyositis: an open-label pilot study. Arthritis Rheum 2005, 52: 601–607.

    Article  PubMed  CAS  Google Scholar 

  39. Noss EH, Hausner-Sypek DL, Weinblatt ME: Rituximab as therapy for refractory polymyositis and dermatomyositis. J Rheumatol 2006, 33: 1021–1026.

    PubMed  Google Scholar 

  40. Mok CC, Ho LY, To CH: Rituximab for refractory polymyositis: an open-label prospective study. J Rheumatol 2007, 34: 1864–1868.

    PubMed  CAS  Google Scholar 

  41. Chung L, Genovese MC, Fiorentino DF: A pilot trial of rituximab in the treatment of patients with dermatomyositis. Arch Dermatol 2007, 143: 763–767.

    Article  PubMed  CAS  Google Scholar 

  42. Labioche I, Liozon E, Weschler B, et al.: Refractory polymyositis responding to infliximab: extended follow-up. Rheumatology (Oxford) 2004, 43: 531–532.

    Article  CAS  Google Scholar 

  43. Hengstman GJ, van den Hoogen FH, Barrera P, et al.: Successful treatment of dermatomyositis and polymyositis with anti-tumor-necrosis-factor-alpha: preliminary observations. Eur Neurol 2003, 50: 10–15.

    Article  PubMed  CAS  Google Scholar 

  44. Sprott H, Glatzel M, Michel BA: Treatment of myositis with etanercept (Enbrel), a recombinant human soluble fusion protein of TNF-alpha type II receptor and IgG1. Rheumatology (Oxford) 2004, 43: 524–526.

    Article  CAS  Google Scholar 

  45. Musial J, Undas A, Celinska-Lowenhoff M: Polymyositis associated with infliximab treatment for rheumatoid arthritis. Rheumatology (Oxford) 2003, 42: 1566–1568.

    Article  CAS  Google Scholar 

  46. Efthimiou P, Schwartzman S, Kagen LJ: Possible role for tumour necrosis factor inhibitors in the treatment of resistant dermatomyositis and polymyositis: a retrospective study of eight patients. Ann Rheum Dis 2006, 65: 1233–1236.

    Article  PubMed  CAS  Google Scholar 

  47. Hengstman GJ, De Bleecker JL, Feist E, et al.: Open-label trial of anti-TNF-alpha in dermato-and polymyositis treated concomitantly with methotrexate. Eur Neurol 2008, 59: 159–163.

    Article  PubMed  CAS  Google Scholar 

  48. Dastmalchi M, Grundtman C, Alexanderson H, et al.: A high incidence of disease flares in an open pilot study of infliximab in patients with refractory inflammatory myopathies. Ann Rheum Dis 2008 (Epub ahead of print).

  49. 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.

    PubMed  CAS  Google Scholar 

  50. Cherin P, Auperin I, Bussel A, et al.: Plasma exchange in polymyositis and dermatomyositis: a multicenter study of 57 cases. Clin Exper Rheumatol 1995, 13: 270–271.

    CAS  Google Scholar 

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Correspondence to Stephen J. DiMartino.

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DiMartino, S.J. Idiopathic inflammatory myopathy: Treatment options. Curr Rheumatol Rep 10, 321–327 (2008). https://doi.org/10.1007/s11926-008-0051-4

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