Adult dermatomyositis is an inflammatory condition of muscle and skin requiring prompt, coordinated management. This protocol addresses the first-line approach to bringing active disease under control and sustaining remission.
Management begins with corticosteroid therapy combined with a disease-modifying agent to address active inflammation and support long-term remission. A specialist physiotherapist-led exercise programme and protective measures for the skin are also integral parts of the regimen.
The target is substantial improvement in disease activity across all domains — typically assessed around 6 weeks after treatment initiation.
DOI: 10.1093/rheumatology/keac115
High dose glucocorticoids should be used to treat active muscle inflammation at time of treatment induction.
Disease modifying anti-rheumatic drugs should be used to reduce muscle inflammation, achieve clinical remission and reduce steroid burden.
Management of IIM should include a safe and appropriate exercise programme led and monitored by a specialist physiotherapist and/or a specialist occupational therapist to improve quality of life and function.
Sun avoidance and regular use of high factor broad spectrum sun cream is to be considered to reduce likelihood of a disease flare affecting skin or muscle.
Glucocorticoid dose should be weaned when disease activity, considered across all domains, substantially improves, usually after around 6 weeks of treatment initiation.
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