Dermatomyositis/polymyositis is a systemic autoimmune disease characterized by a specific rash and muscle weakness in the proximal extremities. The cause of the disease is unknown and may be related to genetics and immune dysfunction.
Early and regular treatment can enable the majority of patients to have their disease effectively controlled, and although it cannot be cured, the current treatment methods and strategies are fully capable of achieving symptom-free, disease-carrying survival. (i.e. lifelong concomitant disease)
Treatment goals
1.Disease control (no symptoms, no evidence of organ damage and normal inflammatory index)
2.Basic disease control (no symptoms, basic normal or stable organ damage index, normal inflammatory index)
Treatment features: “Combined cycle, immunomodulation”
New concept, new method
Treatment plan: Induction of remission is the key
Maintenance treatment is the guarantee
I. Induction of remission (to achieve the above treatment goals in the shortest possible time)
1. Hormones prednisone, dexamethasone, methylprednisolone and depo-prednisone
Features: as a bridge treatment is a necessary means to quickly improve symptoms and control the disease, but to bear more side effects, high dose use for as short a time as possible, as early as possible to reduce the drug.
2.Intravenous gammaglobulin
Features: Immunosuppression is fast-acting and has the effect of increasing the patient’s ability to resist disease. It is often used in critically ill patients, such as those with important organ damage, low immune function and significantly reduced platelets.
3.Immunosorbent and plasma exchange
Characteristics: Fast onset of action, but easy to rebound and expensive. It is an alternative for critically ill patients, such as those with important organ damage, organism immunocompromised and significantly reduced platelets, and often plays a crucial role.
4.Biological agent Meroval
Characteristics: Rapid relief and small side effects are its outstanding advantages, and it is an alternate choice in treatment, but it is more expensive and may be ineffective in a small number of patients, and can be chosen if economic conditions allow.
Second, maintenance treatment (is to prevent relapse to achieve long-term survival guarantee)
1.Hormone prednisone, methylprednisolone, etc.
Features: After 1 to 2 months of induced remission, the drug can be reduced under the guidance of the doctor. The principle is to start fast and then slow, and as the dose decreases, the rate of reduction slows down until the small dose is maintained, and some patients can stop the drug.
2. Immunosuppressants cyclophosphamide, vincristine, leflunomide, mycophenolate, methotrexate, azathioprine, hydroxychloroquine sulfate, tacrolimus and cyclomycin.
Features: slow onset of action, need to cycle combined long-term medication, but the dose and interval of medication can be adjusted according to the changes of the disease and immune function, in principle, the smallest dose, the least number of times to maintain remission, some patients can stop the drug, but long-term follow-up observation.
Follow-up plan: Close follow-up is the key to the treatment of dermatomyositis/polymyositis, and in principle, patients must be followed up “once every three weeks”. If the patient has been treated for more than 1 year, the follow-up period can be extended according to the condition.
Follow-up period
Examination items
Remarks
Every 3 weeks
Blood count, blood sedimentation, urine routine
Every 3-4 months
Liver and kidney function
Every 6 months
Immune function, CD4+ Th cell subpopulation
Every 1 year
Comprehensive autoantibody review
Precautions.
I. Functional exercise
1.Increase the level of biological hormones in the patient’s body, which plays a certain therapeutic role and can reduce the amount of medication.
2.Prevent osteoporosis.
3.Maintain and improve joint function.
4.Pleasant mood, enhance physical fitness.
Exercise method: choose one of the ways
1.Swim 1000 meters continuously every day (can be gradual).
2.Walking 1 hour per day (continuous).
3, running 30 minutes a day (continuous).
2. Avoid direct sunlight, do not dye your hair and use less cosmetics.
Third, no special dietary contraindications, but should avoid taking immunity-enhancing health products or proprietary Chinese medicine.
Fourth, female patients with fertility needs should stop using immunosuppressive drugs for six months before pregnancy, and the whole process of pregnancy should be closely followed.