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[Therapeutic strategy in inflammatory myopathies (polymyositis, dermatomyositis, overlap myositis, and immune-mediated necrotizing myopathy)].
[inclusion body myositis]
Inflammatory
myopathies
(
IM
)
are
a
heterogeneous
group
of
autoimmune
muscle
disorders
of
unknown
origin
that
share
clinical
symptoms
such
as
muscle
weakness
and
histological
features
with
the
presence
in
muscle
of
inflammatory
infiltrate
.
Based
on
clinical
,
histological
and
serological
characteristics
,
IM
can
be
divided
into
polymyositis
,
dermatomyositis
,
overlap
myositis
,
cancer
-associated
myositis
,
immune-mediated
necrotizing
myopathy
,
and
inclusion-body
myositis
.
Because
of
their
resistance
to
corticosteroids
and
immunosuppressive
drugs
,
inclusion-body
myositis
will
be
treated
separately
in
this
issue
.
Major
obstacles
in
conducting
high
quality
randomized
controlled
trials
in
inflammatory
myopathies
include
the
low
prevalence
and
the
heterogeneity
of
these
diseases
as
well
as
the
lack
of
international
consensus
on
the
outcome
measures
.
In
the
absence
of
adequate
controlled
therapeutic
trials
,
treatment
of
these
disorders
remains
largely
empirical
.
Corticosteroids
are
the
cornerstone
therapy
.
Due
to
the
chronic
course
of
the
disease
,
there
is
a
frequent
need
to
use
additional
immunosuppressive
treatment
both
to
improve
the
disease
response
and
to
reduce
the
side
effects
of
corticosteroids
.
Intravenous
immunoglobulin
infusion
is
a
costly
treatment
option
that
is
reserved
in
the
presence
of
refractory
dermatomyositis
based
on
a
trial
showing
superior
efficacy
against
control
in
patients
with
impaired
swallowing
or
with
contraindications
to
immunosuppressive
drugs
.
In
patients
who
fail
second
-line
therapy
,
which
usually
consists
of
methotrexate
plus
corticosteroids
,
the
diagnosis
should
be
carefully
reassessed
before
considering
other
treatment
options
including
methotrexate
plus
azathioprine
or
biological
agents
such
as
rituximab
.
Diseases
Validation
Diseases presenting
"controlled therapeutic trials, treatment of these disorders"
symptom
inclusion body myositis
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