The heterogeneity of juvenile myositis

Abstract

Juvenile myositis is a heterogeneous group of systemic autoimmune diseases, in which clinical and serologic subgroups result in subsets of patients with distinct clinical manifestations, disease courses, immunogenetic associations, responses to therapy, and prognoses. A newly identified autoantibody of unknown specificity, anti-p155, is myositis-associated and seen in up to 20-30% of juvenile and adult DM patients. HLA DRB1*0301 and its linked allele DQA1*0501 have been identified as the major immunogenetic risk factor for juvenile and adult DM in both European- and African-American patients, and DQA1*0301 is an additional risk factor in European-American patients. Several DQA1 alleles also are protective for juvenile DM. Environmental risk factors are poorly understood, but growing evidence suggests a role for infectious agents and ultraviolet radiation. The current therapy of juvenile DM consists of corticosteroids and other immunosuppressive agents, with the adjunctive treatment of cutaneous manifestations and rehabilitation. Therapeutic trials of biologic agents, including anti-TNFalpha and anti-CD20, may aid in developing promising new therapies for these disorders.

Figure 1. Therapeutic algorithm for the treatment of juvenile dermatomyositis

Adjunctive therapies not pictured include photoprotective measures, physical therapy, calcium and vitamin D to prevent osteoporosis, and topical therapies, as well as hydroxychloroquine, to treat the skin rashes.