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Leflunomide as a remission-maintaining therapy in difficult-to-treat dermatomyositis
  1. V S Sangle,
  2. S R Sangle,
  3. D P D’Cruz
  1. Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London SE1 7EH, UK
  1. Dr D P D’Cruz, MD FRCP, Consultant in Rheumatology, Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London SE1 7EH; david.d'cruz{at}kcl.ac.uk

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Dermatomyositis (DM) is an autoimmune disorder affecting skeletal muscles and skin with a female preponderance.1 Classification for DM by Bohan and Peter is still in use today.2

A 54-year-old woman presented with a facial rash, joint pains, generalised weakness and breathlessness. Clinically she had Gottron’s sign, mechanic’s hands, a heliotropic rash and weakness in her quadriceps grade 3 and neck muscles grade 4, on a five-point system. She had raised creatinine kinase (CK) >3000 u/l (normal 25–200 u/l), positive Rose–Waaler titre of 1:8 and Jo-1 antibodies. Electromyography showed typical myositic features and muscle biopsy showed perivascular …

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