Although there is currently no cure for inflammatory myositis, it can be treated effectively so that patients lead healthy lives. Treatment strategies focus on alleviating symptoms and managing the progression of the condition. Compliance with treatment is very important.
For dermatomyositis and polymyositis, doctors usually start with high-dose corticosteroids (e.g. prednisolone) for about 4 to 6 weeks. When the condition improves the dosage is then slowly reduced. Other immunosuppressive treatments may be added (e.g. methotrexate).
Intravenous immunoglobulin (IVIG) (an injection of antibodies) may occasionally be effective in cases that fail the above first-line treatments. If IVIG is effective, it needs to be continued on a long term basis, although in lower doses to maintain the effect.
Another form of treatment in patients who do not respond well to conventional drugs is plasmapheresis or plasma exchange. This is a type of blood cleansing in which the damaging antibodies are removed from the blood. Often the effect is temporary.
In patients who are refractory to these treatments, intravenous rituximab (a monoclonal antibody which depletes B cells from the circulation) may be considered.
In patients with drug-induced myositis, the medication causing the inflammatory myositis will need to be stopped and replaced with an alternative. At the moment there is no effective treatment for inclusion body myositis.
Physical therapy and specially designed exercise programmes are very important for recovery of muscle strength.
3. Dermatomyositis associated with cancer
Treatment of the underlying cancer should take priority either by surgery, chemotherapy or radiotherapy.
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