Complete and sustained remission of juvenile dermatomyositis resulting from aggressive treatment
Kim S et al. – Findings suggest that aggressive treatment of juvenile dermatomyositis (DM) aimed at achieving rapid, complete control of muscle weakness and inflammation improves outcomes and reduces disease-related complications, leading into prolonged, medication-free remission within a median of 38 months from the time of diagnosis.Methods- An assessment of the time needed to achieve sustained, medication-free remission in pts with juvenile DM receiving a stepwise, aggressive treatment protocol
- 49 children with juvenile DM received standardized therapy with steroids and methotrexate
- If a pt's strength or muscle enzyme levels did not normalize with this initial therapy, additional medications were added in rapid succession to the treatment regimen
- Primary outcome measure: time to complete remission
- Additional outcome measures: onset of calcinosis, effect of treatment on height, and complications resulting from medications
Results- 49 pts were followed up for a mean of 48 mo
- All but 1 patient received ≥2 medications simultaneously
- Transient localized calcifications occurred in 8%, and 4% additional had persistent calcinosis
- Despite the aggressive therapy, complications associated with treatment were mild and were primarily attributable to steroids
- No persistent effect on longitudinal growth was observed
- A complete, medication-free remission was achieved in 28 pts
- Median time to achievement of CR was 38 mo
- None of these pts experienced a disease flare that required resumption of medications during the subsequent period of observation
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