TY - JOUR
T1 - Favorable Outcome of Juvenile Dermatomyositis Treated without Systemic Corticosteroids
AU - Levy, Deborah M.
AU - Bingham, C. April
AU - Kahn, Philip J.
AU - Eichenfield, Andrew H.
AU - Imundo, Lisa F.
PY - 2010/2
Y1 - 2010/2
N2 - Objective: To describe the course of patients with juvenile dermatomyositis (JDM) treated effectively without systemic corticosteroids. Study design: A retrospective study of 38 patients with JDM treated at a tertiary care children's hospital identified 8 patients who had never received corticosteroids. Disease presentation and course, pharmacologic, and ancillary treatments were recorded. Results: Patients in the no corticosteroid group were followed for a median of 2.8 years (range, 2.1 to 9.5 years). Treatment was primarily with intravenous immunoglobulin (IVIG) (75%) and methotrexate (50%), with favorable response in all. No serious treatment complications were observed; headaches were reported by 3 patients receiving IVIG. Two patients had a myositis flare after discontinuing all medications for more than 1 year; complete resolution of symptoms was observed after either 1 or 2 further doses of IVIG. Two patients had calcinosis (at 1 and 9 years of disease); however, no patient had joint contractures, muscle atrophy, lipodystrophy, or functional limitations. Conclusions: Systemic corticosteroids can be avoided in a select group of patients with JDM. Alternative agents such as methotrexate and IVIG may be prescribed to effectively treat JDM and prevent complications.
AB - Objective: To describe the course of patients with juvenile dermatomyositis (JDM) treated effectively without systemic corticosteroids. Study design: A retrospective study of 38 patients with JDM treated at a tertiary care children's hospital identified 8 patients who had never received corticosteroids. Disease presentation and course, pharmacologic, and ancillary treatments were recorded. Results: Patients in the no corticosteroid group were followed for a median of 2.8 years (range, 2.1 to 9.5 years). Treatment was primarily with intravenous immunoglobulin (IVIG) (75%) and methotrexate (50%), with favorable response in all. No serious treatment complications were observed; headaches were reported by 3 patients receiving IVIG. Two patients had a myositis flare after discontinuing all medications for more than 1 year; complete resolution of symptoms was observed after either 1 or 2 further doses of IVIG. Two patients had calcinosis (at 1 and 9 years of disease); however, no patient had joint contractures, muscle atrophy, lipodystrophy, or functional limitations. Conclusions: Systemic corticosteroids can be avoided in a select group of patients with JDM. Alternative agents such as methotrexate and IVIG may be prescribed to effectively treat JDM and prevent complications.
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U2 - 10.1016/j.jpeds.2009.09.008
DO - 10.1016/j.jpeds.2009.09.008
M3 - Article
C2 - 19846111
AN - SCOPUS:74649086300
SN - 0022-3476
VL - 156
SP - 302
EP - 307
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 2
ER -