Polymyositis: Part V
There have been very few randomised trials studying the optimum management of polymyositis. This is primarily because it is a very rare disease. Hence all treatment is empirical and steroids form the first line of management.
Prednisolone is usually started at a dose of 1 mg/kg per day either as a single dose or in divided doses. This dose is continued for 4-8 weeks during which the response is assessed both clinically and biochemically. Clinical signs of improvement include an increased sense of well being, improved muscle strength, objective increase in power and reduced pain and systemic symptoms. Creatinine kinase should be monitored regularly during therapy.
After the initial high dose, the steroids can be slowly tapered to lower doses and finally the patient should be transferred to the lowest dose possible. CareClosest Supplements to steroids for Sale must be taken to prevent the complications of steroid use like osteoporosis, hypertension and diabetes.
Steroid myopathy is a condition which can complicate the treatment with steroids. It will usually manifest as worsening of the symptoms on treatment. It is necessary to differentiate between steroid myopathy and a worsening of the disease itself. Steroid myopathy is usually not associated with inflammation on biopsy and biopsy typically shows type II atrophy. Also the CK is within normal limits and the disease worsens with steroid use.
Immunosuppressant medication may be required, especially in severe cases of muscle weakness. The commonly used drugs are cyclophosphamide, methotrexate and azathioprine.
The systemic manifestations of PM, namely fever, stiffness and joint symptoms are usually reduced by steroid use. Arthritis may require use of methotrexate for treatment.
TNF α inhibitors, CD20 Monoclonal antibody (rituximab) and Interferon α-2a are being studied in the management of PM and have shown some promise.