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Treatment of inflammatory myopathies

Identifieur interne : 001C35 ( Main/Exploration ); précédent : 001C34; suivant : 001C36

Treatment of inflammatory myopathies

Auteurs : A C Cordeiro [Portugal] ; D A Isenberg [Royaume-Uni]

Source :

RBID : ISTEX:3E7DCE19899094B15707AA842F2646C4DAB01915

English descriptors

Abstract

Idiopathic inflammatory myopathies, notably polymyositis and dermatomyositis are comparatively uncommon diseases and few randomised, double blind placebo controlled trials have been done. Final validation of measures to assess outcome and response to treatment is awaited. Corticosteroids are an effective initial treatment, although rarely tested in randomised controlled trials. Unfortunately, not all patients respond to them and many develop undesirable side effects. There is thus a need for second line agents notably immunosuppressives or intravenous immunoglobulin. There are no defined guidelines or best treatment protocols agreed internationally and so the medical approach must be individualised, based on the severity of clinical presentation, disease duration, presence of extramuscular features, and prior therapy and contraindications to particular agents. There is still a significant percentage of non-responders (around 25%) and clinical relapses. Novel therapeutic approaches are now directed towards cytokine modulation and the use of monoclonal antibodies targeting B and T cells.

Url:
DOI: 10.1136/pgmj.2005.038455


Affiliations:


Links toward previous steps (curation, corpus...)


Le document en format XML

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<term>ALT, alanine aminotransferase</term>
<term>AST, aspartate aminotransferase</term>
<term>AZA, azathioprine</term>
<term>CK, creatine kinase</term>
<term>CyA, cyclosporine A</term>
<term>CyC, cyclophosphamide</term>
<term>DM, dermatomyositis</term>
<term>IBM, inclusion body myositis</term>
<term>IDL, interstitial lung disease</term>
<term>IVIG, intravenous immunoglobulin</term>
<term>JDM, juvenile dermatomositis</term>
<term>LDH, lactate dehydrogenase</term>
<term>MTX, methotrexate</term>
<term>PDN, prednisolone</term>
<term>PM, polymyositis</term>
<term>dermatomyositis</term>
<term>polymyositis</term>
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<keywords scheme="Teeft" xml:lang="en">
<term>Acad dermatol</term>
<term>Active disease</term>
<term>Alanine aminotransferase</term>
<term>Amyopathic dermatomyositis</term>
<term>Arthritis</term>
<term>Arthritis rheum</term>
<term>Aspartate aminotransferase</term>
<term>Avenida torrado</term>
<term>Bone marrow suppression</term>
<term>Bone marrow toxicity</term>
<term>Calcinosis</term>
<term>Case reports</term>
<term>Cell transplantation</term>
<term>Clin</term>
<term>Clinical effects</term>
<term>Clinical features</term>
<term>Clinical studies group</term>
<term>Clinical trials</term>
<term>Consecutive days</term>
<term>Cordeiro</term>
<term>Corticosteroid</term>
<term>Corticosteroid reduction</term>
<term>Curr opin rheumatol</term>
<term>Cutaneous</term>
<term>Cutaneous lesions</term>
<term>Cutaneous manifestations</term>
<term>Cyclophosphamide</term>
<term>Cyclosporin</term>
<term>Cytokine modulation</term>
<term>Daily dose</term>
<term>Dalakas</term>
<term>Damage assessment</term>
<term>Dermatol</term>
<term>Dermatomyositis</term>
<term>Disease activity</term>
<term>Dos</term>
<term>Effective agent</term>
<term>Extramuscular features</term>
<term>First line</term>
<term>Functional tests</term>
<term>Gastrointestinal intolerance</term>
<term>Global disease activity</term>
<term>Good results</term>
<term>Good validity</term>
<term>Higher doses</term>
<term>Hospital garcia</term>
<term>Idiopathic</term>
<term>Immunoglobulin</term>
<term>Immunosuppressive</term>
<term>Immunosuppressive agent</term>
<term>Immunosuppressive agents</term>
<term>Immunosuppressive therapies</term>
<term>Inclusion body myositis</term>
<term>Inflammation</term>
<term>Inflammatory</term>
<term>Inflammatory muscle diseases</term>
<term>Inflammatory myopathies</term>
<term>Inflammatory myositis</term>
<term>International myositis</term>
<term>Interstitial</term>
<term>Interstitial lung disease</term>
<term>Interstitial pneumonitis</term>
<term>Intravenous</term>
<term>Intravenous immunoglobulin</term>
<term>Intravenous methylprednisolone pulses</term>
<term>Isenberg</term>
<term>Ivig</term>
<term>Juvenile dermatomyositis</term>
<term>Laboratory evaluation</term>
<term>Laboratory tests</term>
<term>Lactate dehydrogenase</term>
<term>Liver toxicity</term>
<term>Lupus</term>
<term>Methotrexate</term>
<term>Mofetil</term>
<term>Monoclonal antibodies</term>
<term>Muscle atrophy</term>
<term>Muscle biopsies</term>
<term>Muscle diseases</term>
<term>Muscle enzymes</term>
<term>Muscle fibres</term>
<term>Muscle function</term>
<term>Muscle nerve</term>
<term>Muscle strength</term>
<term>Mycophenolate</term>
<term>Mycophenolate mofetil</term>
<term>Myopathy</term>
<term>Myositis</term>
<term>Myositis patients</term>
<term>Neurol</term>
<term>Ongoing inflammation</term>
<term>Open label pilot study</term>
<term>Open study</term>
<term>Optimal dose</term>
<term>Other immunosuppressives</term>
<term>Physical function</term>
<term>Pilot study</term>
<term>Plasma exchange</term>
<term>Polymyositis</term>
<term>Prednisolone</term>
<term>Progressive disease</term>
<term>Promising results</term>
<term>Randomised</term>
<term>Refractory</term>
<term>Refractory cases</term>
<term>Refractory dermatomyositis</term>
<term>Refractory myositis</term>
<term>Refractory polymyositis</term>
<term>Regimen</term>
<term>Rheum</term>
<term>Rheumatoid arthritis</term>
<term>Rheumatol</term>
<term>Rheumatology</term>
<term>Second line agent</term>
<term>Severe cases</term>
<term>Side effects</term>
<term>Small group</term>
<term>Small number</term>
<term>Study group</term>
<term>Successful treatment</term>
<term>Sucessful treatment</term>
<term>Systemic lupus erythematosus</term>
<term>Tacrolimus</term>
<term>Topical tacrolimus</term>
<term>Total body irradiation</term>
<term>Uncontrolled studies</term>
<term>Weekly dose</term>
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<div type="abstract" xml:lang="en">Idiopathic inflammatory myopathies, notably polymyositis and dermatomyositis are comparatively uncommon diseases and few randomised, double blind placebo controlled trials have been done. Final validation of measures to assess outcome and response to treatment is awaited. Corticosteroids are an effective initial treatment, although rarely tested in randomised controlled trials. Unfortunately, not all patients respond to them and many develop undesirable side effects. There is thus a need for second line agents notably immunosuppressives or intravenous immunoglobulin. There are no defined guidelines or best treatment protocols agreed internationally and so the medical approach must be individualised, based on the severity of clinical presentation, disease duration, presence of extramuscular features, and prior therapy and contraindications to particular agents. There is still a significant percentage of non-responders (around 25%) and clinical relapses. Novel therapeutic approaches are now directed towards cytokine modulation and the use of monoclonal antibodies targeting B and T cells.</div>
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