New insights into the treatment of myositis

Abstract

The myositis syndromes include polymyositis, dermatomyositis (DM), necrotizing myopathy, inclusion body myositis (IBM), antisynthetase syndrome and overlap syndromes with myositis. These syndromes mostly occur in middle-aged patients, while juvenile DM occurs in children and adolescents. Patients mostly show a subacute weakness and myalgia in the upper and lower limbs, the diagnosis is based upon these clinical findings in combination with muscle biopsy results and specific serum autoantibodies. In recent years, research achieved a better understanding about the molecular mechanism underlying the myositis syndromes, as well as disease progress and extramuscular organ manifestations, such as interstitial lung disease and association with neoplasias. Treatment mainly consists of glucocorticosteroids and immunosuppressants. IBM is usually refractory to treatments. This review provides an overview of the current standards of treatment and new treatment options like monoclonal antibodies and new molecular therapies and their first results from clinical trials.

Keywords: antisynthetase syndrome; dermatomyositis; inclusion body myositis; myositis; necrotizing myopathy; overlap syndrome; polymyositis.

Figure 1.

Overview of treatment essentials in PM, DM, NM, ASS and OM. ASS, antisynthetase syndrome; DM, dermatomyositis; IL, interleukin; i.v.; intravenous; IVIg, intravenous immunoglobulin; JAK, Janus kinase; NM, necrotizing myopathy; OM, overlap myositis; PM, polymyositis; TNFα, tumor necrosis factor alpha.