Treatment
Of Dermatomyositis With dermatomyositis there is inflammatory reaction,
autoimmune disease, muscle weakness, which is what is being treated as follows. These points below are guidelines to treatment. 1.
Prednisone (a corticosteroid) is usually used as the drug of choice with
high doses of 40 to 60 mg per day in adults or even higher. Repeat measurements
of the muscle enzyme creatinine kinase, also called the CK titer, are usually
used to monitor the success of this therapy and when stable low levels are reached
after 10 to 12 weeks, the prednisone dosage is slowly reduced to the maintenance
dose of about 10 to 15mg per day. 2. It is often not possible to stop
the prednisone in adults in contrast to children, where it can often be stopped
after 1 or 2 years of remission. 3. One major side-effect of chronic
corticosteroid therapy is a myopathy. This is characterized by generalized
muscle weakness. In these cases the corticosteroid must be discontinued and alternative
therapy given. 4. Immunosuppressive therapy has been successful
in controlling the autoimmune disease dermatomyositis by interfering with the
autoantibody synthesis and cytotoxic lymphocyte (CD8 cells) production. Methotrexate,
chlorambucil, cyclosporine and azathioprine have all been used for that purpose
(Ref. 1,3 and 4). 5. Myositis that is caused by paraneoplastic
substances from a hidden cancer, which causes cross reacting autoimmune antibodies
with muscle cells, is much more difficult to treat. If at all possible, identification
of the hidden cancer should be undertaken, and it should be attempted to remove
the tumor. If this is not possible, then treatment by a cancer expert will likely
contain the tumor with cyclosporine or a similar drug. This can often stabilize
the condition. 6. The latest therapy is high dose intravenous immunoglobulin
therapy (Ref. 5). Here several mechanisms seem to be utilized to interfere
with the autoimmune response that causes dermatomyositis. Those cases that have
more muscle related symptoms are doing particularly well on this therapy. The
only problem is that this therapy is expensive. The other problem is that Gamimune,
Gammagard and Sandoglobulinit, as some of the brand names are called, have to
be given intravenously on a monthly basis. | 
