Clinical Scenario

This first-line protocol is indicated for adult patients aged 18 years or older presenting with active polymyositis. It addresses both initial disease control and the longer-term management goals relevant to this population.

Treatment Approach

Management begins with high-dose glucocorticoid therapy, combined with a disease-modifying anti-rheumatic drug, and is supported throughout by a specialist-led exercise programme. The complete agent selection, tapering strategy, and monitoring criteria are contained in the full protocol.

Full regimen details, sequencing, and agent selection are not shown here.

References

DOI: 10.1093/rheumatology/keac115

High dose glucocorticoids should be used to treat active muscle inflammation at time of treatment induction.
Oral prednisolone at a dose of 0.5–1 mg/kg/day, usually 40–60 mg, is recommended.
Intravenous methylprednisolone is to be considered, especially when there are concerns about gastrointestinal absorption.
Oral prednisolone should be tapered according to clinical response.
Disease modifying anti-rheumatic drugs should be used to reduce muscle inflammation, achieve clinical remission and reduce steroid burden.
Methotrexate, azathioprine, tacrolimus, ciclosporin, and mycophenolate mofetil are to be considered for the treatment of active myositis and long-term maintenance of disease remission.
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.
Glucocorticoid dose should be weaned when disease activity, considered across all domains, substantially improves, usually after around 6 weeks of treatment initiation.

View source ↗

Treatment of Polymyositis in Adults Aged 18 Years or Older

References