FAILURE OF PULSE INTRAVENOUS METHYLPREDNISOLONE TREATMENT IN JUVENILEDERMATOMYOSITIS

Objective. To review the experience with high-dose intravenous pulse m ethylprednisolone (IVMP) therapy in patients with juvenile dermatomyos itis (JDM) in our institution. Study design. We reviewed the charts of seven consecutive patients (four female subjects; three male subjects ; age 3 to 18 years (mean age 8 years)) treated for JDM between 1989 a nd 1999. Results. All patients met the criteria of Bohan and Peter for JDM and were treated within 3 months of onset of weakness, All receiv ed initial treatment with IVMP, 30 mg/kg per day for 3 days, administe red weekly for between 1 and 4 weeks. Treatment with orally administer ed prednisone was required because of deteriorating muscle strength an d persistent elevation of creatine kinase activity despite IVMP in fiv e patients, increased skin vasculitis in one patient, and elevated cre atine kinase activity with no improvement in strength in one patient. Conclusion. We conclude that muscle strength in patients with JDM may deteriorate during pulse IVMP therapy when this is used alone as initi al treatment, even early in the course of the illness, We recommend ei ther conventional high doses of orally administered corticosteroids or IVMP with oral corticosteroid therapy as initial treatment of JDM.