Polymyositis Management

Prevent atrophy and contractures in Myositis
1. Passive Stretching and Splinting
2. Strength-building after inflammation decreases
Dermatomyositis
1. Skin Lesions
  1. See Pruritus Management
  2. Consider high potency Topical Corticosteroid
2. Avoid Sun Exposure (especially in photosensitivity)
  1. Sunscreen
  2. Protective clothing

Prednisone
1. Dose
  1. Adults: 40-60 mg/day
  2. Children: 1 to 2 mg/kg/day
2. Protocol
  1. Administer bid until serum Creatine Kinase normal
  2. Convert to single daily dose
  3. Reduce dose by 25% every 4 weeks down to 10 mg/day
  4. Continue low dose (5-10 mg in adults) for 1 year
Other Immunosuppressants
1. Indications
  1. Strength refractory to Prednisone after 3 months
  2. No improvement in objective Muscle Strength
  3. Differentiate from steroid Myopathy
    1. Neck flexor strength unchanged steroid Myopathy
2. Immunosuppressant Options
  1. Methotrexate
  2. Azathioprine (Imuran)
  3. Other agents in refractory cases (TNF-alpha inhibitors, Cytoxan)
Other medications
1. IVIG
2. Calcinosis management
  1. Calcium Channel Blockers (e.g. Diltiazem)
  2. Bisphosphonates