Guidelines on dermatomyositis – excerpt from the interdisciplinary S2k guidelines on myositis syndromes by the German Society of Neurology
Identifieur interne : 000E11 ( Main/Exploration ); précédent : 000E10; suivant : 000E12Guidelines on dermatomyositis – excerpt from the interdisciplinary S2k guidelines on myositis syndromes by the German Society of Neurology
Auteurs : Cord Sunderkötter [Allemagne] ; Alexander Nast [Allemagne] ; Margitta Worm [Allemagne] ; Reinhard Dengler [Allemagne] ; Thomas Dörner [Allemagne] ; Horst Ganter ; Reinhard Hohlfeld [Allemagne] ; Arthur Melms [Allemagne] ; Nico Melzer [Allemagne] ; Kai Rösler [Suisse] ; Jens Schmidt [Allemagne] ; Michael Sinnreich [Suisse] ; Maggi C. Walter [Allemagne] ; Julia Wanschitz [Autriche] ; Heinz Wiendl [Allemagne]Source :
- JDDG: Journal der Deutschen Dermatologischen Gesellschaft [ 1610-0379 ] ; 2016-03.
Abstract
The present guidelines on dermatomyositis (DM) represent an excerpt from the interdisciplinary S2k guidelines on myositis syndromes of the German Society of Neurology (available at www.awmf.org). The cardinal symptom of myositis in DM is symmetrical proximal muscle weakness. Elevated creatine kinase, CRP or ESR as well as electromyography and muscle biopsy also provide important diagnostic clues. Pharyngeal, respiratory, cardiac, and neck muscles may also be affected. Given that approximately 30 % of patients also develop interstitial lung disease, pulmonary function tests should be part of the diagnostic workup. Although the cutaneous manifestations in DM are variable, taken together, they represent a characteristic and crucial diagnostic criterion for DM. Approximately 5–20 % of individuals exhibit typical skin lesions without any clinically manifest muscle involvement (amyopathic DM). About 30 % of adult DM cases are associated with a malignancy. This fact, however, should not delay the treatment of severe myositis. Corticosteroids are the therapy of choice in myositis (1–2 mg/kg). Additional immunosuppressive therapy is frequently required (azathioprine, for children methotrexate). In case of insufficient therapeutic response, the use of intravenous immunoglobulins is justified. The benefit of rituximab has not been conclusively ascertained yet. Acute therapeutic management is usually followed by low‐dose maintenance therapy for one to three years. Skin lesions do not always respond sufficiently to myositis therapy. Effective treatment for such cases consists of topical corticosteroids and sometimes also calcineurin inhibitors. Systemic therapies shown to be effective include antimalarial agents (also in combination), methotrexate, and corticosteroids. Intravenous immunoglobulins or rituximab may also be helpful. UV protection is an important prophylactic measure.
Url:
DOI: 10.1111/ddg.12909
Affiliations:
- Allemagne, Autriche, Suisse
- Basse-Saxe, Bavière, Berlin, Canton de Berne, District de Haute-Bavière, District de Moyenne-Franconie, District de Münster, Rhénanie-du-Nord-Westphalie
- Berlin, Berne, Erlangen, Göttingen, Munich, Münster
- Université Louis-et-Maximilien de Munich
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Walter</name><affiliation wicri:level="4"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Friedrich‐Baur Institute, Ludwig Maximilians University, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Wanschitz, Julia" sort="Wanschitz, Julia" uniqKey="Wanschitz J" first="Julia" last="Wanschitz">Julia Wanschitz</name><affiliation wicri:level="1"><country xml:lang="fr">Autriche</country><wicri:regionArea>Department of Neurology, University Hospital Innsbruck, Innsbruck</wicri:regionArea><wicri:noRegion>Innsbruck</wicri:noRegion></affiliation></author><author><name sortKey="Wiendl, Heinz" sort="Wiendl, Heinz" uniqKey="Wiendl H" first="Heinz" last="Wiendl">Heinz Wiendl</name><affiliation wicri:level="3"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University Hospital, Münster</wicri:regionArea><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Münster</region><settlement type="city">Münster</settlement></placeName></affiliation><affiliation></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Allemagne</country></affiliation><affiliation></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Allemagne</country></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">JDDG: Journal der Deutschen Dermatologischen Gesellschaft</title><title level="j" type="alt">JDDG: JOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT</title><idno type="ISSN">1610-0379</idno><idno type="eISSN">1610-0387</idno><imprint><biblScope unit="vol">14</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="321">321</biblScope><biblScope unit="page" to="338">338</biblScope><biblScope unit="page-count">18</biblScope><date type="published" when="2016-03">2016-03</date></imprint><idno type="ISSN">1610-0379</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1610-0379</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">The present guidelines on dermatomyositis (DM) represent an excerpt from the interdisciplinary S2k guidelines on myositis syndromes of the German Society of Neurology (available at www.awmf.org). The cardinal symptom of myositis in DM is symmetrical proximal muscle weakness. Elevated creatine kinase, CRP or ESR as well as electromyography and muscle biopsy also provide important diagnostic clues. Pharyngeal, respiratory, cardiac, and neck muscles may also be affected. Given that approximately 30 % of patients also develop interstitial lung disease, pulmonary function tests should be part of the diagnostic workup. Although the cutaneous manifestations in DM are variable, taken together, they represent a characteristic and crucial diagnostic criterion for DM. Approximately 5–20 % of individuals exhibit typical skin lesions without any clinically manifest muscle involvement (amyopathic DM). About 30 % of adult DM cases are associated with a malignancy. This fact, however, should not delay the treatment of severe myositis. Corticosteroids are the therapy of choice in myositis (1–2 mg/kg). Additional immunosuppressive therapy is frequently required (azathioprine, for children methotrexate). In case of insufficient therapeutic response, the use of intravenous immunoglobulins is justified. The benefit of rituximab has not been conclusively ascertained yet. Acute therapeutic management is usually followed by low‐dose maintenance therapy for one to three years. Skin lesions do not always respond sufficiently to myositis therapy. Effective treatment for such cases consists of topical corticosteroids and sometimes also calcineurin inhibitors. Systemic therapies shown to be effective include antimalarial agents (also in combination), methotrexate, and corticosteroids. Intravenous immunoglobulins or rituximab may also be helpful. UV protection is an important prophylactic measure.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Autriche</li><li>Suisse</li></country><region><li>Basse-Saxe</li><li>Bavière</li><li>Berlin</li><li>Canton de Berne</li><li>District de Haute-Bavière</li><li>District de Moyenne-Franconie</li><li>District de Münster</li><li>Rhénanie-du-Nord-Westphalie</li></region><settlement><li>Berlin</li><li>Berne</li><li>Erlangen</li><li>Göttingen</li><li>Munich</li><li>Münster</li></settlement><orgName><li>Université Louis-et-Maximilien de Munich</li></orgName></list><tree><noCountry><name sortKey="Ganter, Horst" sort="Ganter, Horst" uniqKey="Ganter H" first="Horst" last="Ganter">Horst Ganter</name></noCountry><country name="Allemagne"><region name="Rhénanie-du-Nord-Westphalie"><name sortKey="Sunderkotter, Cord" sort="Sunderkotter, Cord" uniqKey="Sunderkotter C" first="Cord" last="Sunderkötter">Cord Sunderkötter</name></region><name sortKey="Dengler, Reinhard" sort="Dengler, Reinhard" uniqKey="Dengler R" first="Reinhard" last="Dengler">Reinhard Dengler</name><name sortKey="Dorner, Thomas" sort="Dorner, Thomas" uniqKey="Dorner T" first="Thomas" last="Dörner">Thomas Dörner</name><name sortKey="Hohlfeld, Reinhard" sort="Hohlfeld, Reinhard" uniqKey="Hohlfeld R" first="Reinhard" last="Hohlfeld">Reinhard Hohlfeld</name><name sortKey="Melms, Arthur" sort="Melms, Arthur" uniqKey="Melms A" first="Arthur" last="Melms">Arthur Melms</name><name sortKey="Melzer, Nico" sort="Melzer, Nico" uniqKey="Melzer N" first="Nico" last="Melzer">Nico Melzer</name><name sortKey="Nast, Alexander" sort="Nast, Alexander" uniqKey="Nast A" first="Alexander" last="Nast">Alexander Nast</name><name sortKey="Schmidt, Jens" sort="Schmidt, Jens" uniqKey="Schmidt J" first="Jens" last="Schmidt">Jens Schmidt</name><name sortKey="Sunderkotter, Cord" sort="Sunderkotter, Cord" uniqKey="Sunderkotter C" first="Cord" last="Sunderkötter">Cord Sunderkötter</name><name sortKey="Sunderkotter, Cord" sort="Sunderkotter, Cord" uniqKey="Sunderkotter C" first="Cord" last="Sunderkötter">Cord Sunderkötter</name><name sortKey="Walter, Maggi C" sort="Walter, Maggi C" uniqKey="Walter M" first="Maggi C." last="Walter">Maggi C. Walter</name><name sortKey="Wiendl, Heinz" sort="Wiendl, Heinz" uniqKey="Wiendl H" first="Heinz" last="Wiendl">Heinz Wiendl</name><name sortKey="Wiendl, Heinz" sort="Wiendl, Heinz" uniqKey="Wiendl H" first="Heinz" last="Wiendl">Heinz Wiendl</name><name sortKey="Wiendl, Heinz" sort="Wiendl, Heinz" uniqKey="Wiendl H" first="Heinz" last="Wiendl">Heinz Wiendl</name><name sortKey="Worm, Margitta" sort="Worm, Margitta" uniqKey="Worm M" first="Margitta" last="Worm">Margitta Worm</name></country><country name="Suisse"><region name="Canton de Berne"><name sortKey="Rosler, Kai" sort="Rosler, Kai" uniqKey="Rosler K" first="Kai" last="Rösler">Kai Rösler</name></region><name sortKey="Sinnreich, Michael" sort="Sinnreich, Michael" uniqKey="Sinnreich M" first="Michael" last="Sinnreich">Michael Sinnreich</name></country><country name="Autriche"><noRegion><name sortKey="Wanschitz, Julia" sort="Wanschitz, Julia" uniqKey="Wanschitz J" first="Julia" last="Wanschitz">Julia Wanschitz</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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