The Childhood Arthritis and Rheumatology Research Alliance developed the following three treatment plans for patients with juvenile dermatomyositis and persistent skin rash: intravenous immunoglobulin; mycophenolate mofetil; and cyclosporine.
Researchers used a combination of two Delphi surveys and four group meetings held from 2011 through 2015 to develop a consensus that accurately reflected typical treatment, with the assumption that patients were already receiving methotrexate and corticosteroids. Adam M. Huber, MD, at Dalhousie University in Nova Scotia, and colleagues wrote that patients not previously treated with IV immunoglobulin should try 3 doses of 2g/kg (maximum 70 g) of IV immunoglobulin for every 2 weeks, then monthly. The second treatment plan included 10 mg/kg or 600 mg/m2 (maximum 1,500 mg) of mycophenolate mofetil and the third plan called for at least 3 mg/kg of cyclosporine. For mycophenolate mofetil and cyclosporine, patients can continue receiving no more than 2 mg/kg per day (maximum 60 mg) of corticosteroids, methotrexate and intravenous immunoglobulin.
To receive treatment, patients should have skin that has not improved for at least 3 months after resolution of previous muscle involvement. In addition, patients should have no ulcerative skin disease, calcinosis that is more than mild or any medical condition that would influence treatment outcome.
“[These] treatment plans may not be relevant for some providers and some patients,” the researchers wrote. “However, it is expected that these treatment plans would represent a reasonable approximation of typical treatment for the majority of patients with this phenotype by the majority of providers.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.