Long-Term Outcome of Polymyositis Treated with High Single-Dose Alternate-Day Prednisolone Therapy

Uchino, Makoto; Yamashita, Satoshi; Uchino, Katsuhisa; Hara, Akio; Koide, Tatsuya; Suga, Tomohiro; Hirahara, Tomoo; Kimura, En; Yamashita, Taro; Ueda, Akihiko; Kurisaki, Ryoichi; Suzuki, Junko; Honda, Shoji; Maeda, Yasushi; Hirano, Teruyuki

doi:10.1159/000338474

Cited by 11 publications

(3 citation statements)

References 53 publications

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“…Treatment with glucocorticosteroids on alternating days can be a useful alternative with less long-term side-effects and – at the same time–possibly an even higher efficacy [ 135 ]. The alternate day regimen was even associated with a higher long-term survival rate compared to daily application [ 136 ]. A third regimen of steroids in myositis is the monthly oral pulse treatment with 4 days of 40 mg/day dexamethasone [ 137 ].…”

Section: Disease Course and Treatment Of Dm Pm Nm And Ommentioning

confidence: 99%

Current Classification and Management of Inflammatory Myopathies

Schmidt

2018

JND

229

199

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Inflammatory disorders of the skeletal muscle include polymyositis (PM), dermatomyositis (DM), (immune mediated) necrotizing myopathy (NM), overlap syndrome with myositis (overlap myositis, OM) including anti-synthetase syndrome (ASS), and inclusion body myositis (IBM). Whereas DM occurs in children and adults, all other forms of myositis mostly develop in middle aged individuals. Apart from a slowly progressive, chronic disease course in IBM, patients with myositis typically present with a subacute onset of weakness of arms and legs, often associated with pain and clearly elevated creatine kinase in the serum. PM, DM and most patients with NM and OM usually respond to immunosuppressive therapy, whereas IBM is largely refractory to treatment. The diagnosis of myositis requires careful and combinatorial assessment of (1) clinical symptoms including pattern of weakness and paraclinical tests such as MRI of the muscle and electromyography (EMG), (2) broad analysis of auto-antibodies associated with myositis, and (3) detailed histopathological work-up of a skeletal muscle biopsy. This review provides a comprehensive overview of the current classification, diagnostic pathway, treatment regimen and pathomechanistic understanding of myositis.

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Section: Disease Course and Treatment Of Dm Pm Nm And Ommentioning

confidence: 99%

Current Classification and Management of Inflammatory Myopathies

Schmidt

2018

JND

229

199

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“…Studies have indicated the maintenance of the initial dose over a period of 4 to 8 weeks with monitoring of serum CK levels and muscle strength in addition to other disease manifestations [41,92,93]. After this period of time, as long as the disease has been controlled, GC dose can be reduced by 20 to 25% every four weeks until the daily dose of 5 to 10 mg is reached, at which point a stable dose of GC is maintained for another year, depending on the clinical course (C) [41,92,93].…”

Section: What Initial Dose Of Gc Should Be Used and For How Long In Pmentioning

confidence: 99%

“…In severe cases, MP pulse therapy should be considered (1 g/day for three consecutive days followed by a regimen with oral GC) (C) [41,42,92,93] (B) [41-44, 49, 93, 94].…”

Section: What Initial Dose Of Gc Should Be Used and For How Long In Pmentioning

confidence: 99%

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

et al. 2019

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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.

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Myositiden

Rösler

Jacobs

2015

Z Rheumatol

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This article gives a review of the classification, diagnostic procedures and treatment of idiopathic inflammatory myopathies from a neurological point of view. The myositis syndromes can be subdivided into four groups, polymyositis (PM), dermatomyositis (DM), inclusion body myositis (IBM) and necrotizing myopathy (NM), which substantially differ clinically and pathophysiologically. Myositis may also occur in association with cancer or autoimmune systemic diseases (overlap syndrome). Diagnosis of inflammatory myopathies is based on clinical symptoms, determination of creatine phosphokinase and acute phase parameters in blood (e.g. C-reactive protein and erythrocyte sedimentation rate), electromyography results and findings of magnetic resonance imaging (MRI) in muscle. A muscle biopsy is mandatory to confirm the diagnosis. High quality randomized controlled trials of treatment regimens for inflammatory myopathies are sparse; however, empirical experience indicates a clear effectiveness of immunosuppressive treatment of PM, DM and NM.

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Long-Term Outcome of Polymyositis Treated with High Single-Dose Alternate-Day Prednisolone Therapy

Cited by 11 publications

References 53 publications

Current Classification and Management of Inflammatory Myopathies

Current Classification and Management of Inflammatory Myopathies

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

Myositiden

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