Recent advances in the management of adult myositis

Standard drug therapy of adult polymyositis, dermatomyositis and inclusion body myositis includes high-dose corticosteroids and cytotoxic drugs (metho trexate, azathioprine (AZA) and cyclophosphamide). Recent data are in favou r of the early introduction of a cytotoxic or immunomodulating drug in addi tion to corticosteroid therapy. In patients with corticosteroid- and cytoto xic-resistant myositis, promising novel approaches to management include: i v. megadose pulse methylprednisolone combined with cytotoxic drugs, combina tion therapy with both methotrexate and AZA, cyclosporin, tacrolimus, fluda rabine and iv. immunoglobulin (IVIG). Recent advances in the understanding of the role of cytokines and complement, in the pathogenesis of myositis, h ave led to preliminary therapeutic trials of three biological agents: etane rcept, infliximab and anti-C5 monoclonal antibody.