II. Management: General Measures
- Prevent atrophy and contractures in Myositis
- Passive Stretching and Splinting
- Strength-building after inflammation decreases
-
Dermatomyositis
- Skin Lesions
- See Pruritus Management
- Consider high potency Topical Corticosteroid
- Avoid Sun Exposure (especially in photosensitivity)
- Sunscreen
- Protective clothing
- Skin Lesions
III. Management: Systemic Medications
-
Prednisone
- Dose
- Adults: 40-60 mg/day
- Children: 1 to 2 mg/kg/day
- Protocol
- Administer bid until serum Creatine Kinase normal
- Convert to single daily dose
- Reduce dose by 25% every 4 weeks down to 10 mg/day
- Continue low dose (5-10 mg in adults) for 1 year
- Dose
- Other Immunosuppressants
- Indications
- Strength refractory to Prednisone after 3 months
- No improvement in objective Muscle Strength
- Differentiate from steroid Myopathy
- Neck flexor strength unchanged steroid Myopathy
- Immunosuppressant Options
- Methotrexate
- Azathioprine (Imuran)
- Other agents in refractory cases (TNF-alpha inhibitors, Cytoxan)
- Indications
- Other medications
- IVIG
- Calcinosis management