Guidelines of the Brazilian Society of Rheumatology for the treatment of systemic autoimmune myopathies

Abstract

Background: Recommendations of the Myopathy Committee of the Brazilian Society of Rheumatology for the management and therapy of systemic autoimmune myopathies (SAM). Main body: The review of the literature was done in the search for the Medline (PubMed), Embase and Cochrane databases including studies published until June 2018. The Prisma was used for the systematic review and the articles were evaluated according to the levels of Oxford evidence. Ten recommendations were developed addressing the management and therapy of systemic autoimmune myopathies. Conclusions: Robust data to guide the therapeutic process are scarce. Although not proven effective in controlled clinical trials, glucocorticoid represents first-line drugs in the treatment of SAM. Intravenous immunoglobulin is considered in induction for refractory cases of SAM or when immunosuppressive drugs are contra-indicated. Consideration should be given to the early introduction of immunosuppressive drugs. There is no specific period determined for the suspension of glucocorticoid and immunosuppressive drugs when individually evaluating patients with SAM. A key component for treatment in an early rehabilitation program is the inclusion of strengthbuilding and aerobic exercises, in addition to a rigorous evaluation of these activities for remission of disease and the education of the patient and his/her caregivers.

Tofacitinib as a Treatment for Refractory Dermatomyositis: A Case Report

“…Alternatively, previous study showed good skin response to leflunomide use in refractory patients with DM [9]. The greatest evidence for immunobiologicals' efficacy is the use of rituximab [8]. Our described patient was actually refractory to multiple immunosuppressive drugs and high doses of immunoglobulin-associated glucocorticoid, including two immunobiological agents (rituximab and abatacept).…”

“…Although there are no controlled clinical trials, glucocorticoid drugs representing a first-line treatment of DM [8] associated or unassociated with intravenous human immunoglobulin [8] followed by a high dose of oral glucocorticoid should be considered. In clinical practice methotrexate, azathioprine and/or cyclosporine are most frequently used [8]. Alternatively, previous study showed good skin response to leflunomide use in refractory patients with DM [9].…”

Autoimmune Idiopathic Inflammatory Myopathies: Pharmacological Differences and Similarities by Type of Myositis and by Sociodemographic Variables

“…In addition, inflammation of the skeletal tissue can occur in the context of other connective tissue diseases, such as systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, and systemic sclerosis, a condition called overlap myositis [ 3 , 5 ]. Its management seeks to control the inflammatory process and prevent damage to skeletal muscle or extramuscular organs [ 2 ]. Depending on the type of autoimmune IIM and its severity and complications, systemic glucocorticoids, conventional disease-modifying antirheumatic drugs (DMARDs) (especially azathioprine or methotrexate), or immunosuppressants (primarily cyclophosphamide, cyclosporine, human mycophenolate mofetil, or gamma-globulin) are prescribed.…”

“…Depending on the type of autoimmune IIM and its severity and complications, systemic glucocorticoids, conventional disease-modifying antirheumatic drugs (DMARDs) (especially azathioprine or methotrexate), or immunosuppressants (primarily cyclophosphamide, cyclosporine, human mycophenolate mofetil, or gamma-globulin) are prescribed. Biological DMARDs (mainly rituximab) [ 2 – 4 , 6 , 10 ] are given, but the response to treatment varies [ 3 ].…”

Systemic autoimmune myopathies: a prospective phase 4 controlled trial of an inactivated virus vaccine against SARS-CoV-2

“…More than a half of patients with SAMs had underlying cardiovascular risk factors and frequently required an increase in drug therapy due to worsening in health-related problems during the pandemic, resulting in a high risk for severe COVID-19 infection. Moreover, patients with SAMs are susceptible to general or opportunistic infections [ 11 , 12 ]. The use of high doses of glucocorticoids and immunosuppressive drugs are potential risk factors associated with these complications [ 11 ].…”