TREATMENT OF INFLAMMATORY MYOPATHIES

The treatment of the immune-mediated inflammatory myopathies remains l argely empirical. Corticosteroids are usually effective in polymyositi s and dermatomyositis but may need to be combined with methotrexate or azathioprine in some patients, Intravenous immunoglobulin (IVIg) is e ffective as add-on therapy in some patients not adequately controlled with steroids or immunosuppressive agents, but further controlled tria ls of IVIg are necessary to define the indications and optimal dose re gimens. Cyclophosphamide, cyclosporin, or chlorambucil may be effectiv e in patients with refractory polymyositis or dermatomyositis. Low-dos e whole body or lymphoid irradiation is a last option in severely disa bled patients resistant to all other treatments. As a small proportion of patients with inclusion body myositis respond to corticosteroid or immunosuppressive therapy, a 3-6-month trial of such therapy is justi fied in this condition. More specific immunotherapy for these disorder s awaits identification of the target antigens and further clarificati on of the immunopathogenetic mechanisms. (C) 1997 John Wiley & Sons, I nc.