Background The inflammatory myopathies are a heterogeneous group of connective tissue diseases characterized by muscle weakness and inflammation. Corticosteroids are the standard main treatment for inflammatory myopathies. However, steroid therapy often causes a wide range of side effects. Although immunosuppressive drugs are used as steroid-sparing agents in an effort to prevent disease recurrence, the appropriate duration of steroid use remains unclear.
Objectives We investigated whether steroid therapy can be safely withdrawn in patients with inflammatory myopathies followed in a single center.
Methods We retrospectively reviewed clinical charts of 71 consecutive patients (age 51.9±15.7 y.o., female 69%) who met Bohan and Peter criteria for polymyositis (PM)/dermatomyositis (DM) and modified Sontheimer's criteria for clinically amyopathic dermatomyositis (ADM), respectively. Steroid free remission was defined as a 3-month consecutive period of no disease activity without corticosteroid treatment. Factors associated with steroid free remission were examined.
Results Of 71 identified patients, 29 patients (40%) were DM, 15 patients (21%) were PM, 9 patients (13%) were overlap myositis, and 18 patients (25%) were ADM. Thirty-seven patients (52%) had muscle weakness, 5 patients (7%) had malignancies and 43 patients (61%) had signs of interstitial lung disease. With a mean follow-up of 6.6±5.0 years, 9 patients (13%) died during follow-up period. The remaining 62 patients were treated with corticosteroids alone or in combination with immunosuppressants. Steroid-free remission was achieved in 21 of 62 patients (34%) patients with a mean time to steroid withdrawal of 5.5±4.0 years. Six of 21 patients (29%) relapsed 1.7±1.7 years after steroid withdrawal. There were no differences in onset of age, disease duration, positive ANA, positive Anti Jo-1 antibodies, serum creatine kinase levels, maximum dose of corticosteroids, skin, joint and lung involvement between steroid-free group and non-steroid-free group. Elevated inflammatiory markers were associated with long-term steroid use (p=0.038). Concominant immunosuppressants were more frequently used in non-steroid-free group than steroid-free group (p=0.002).
Conclusions Steroid-free remission might be achieved in some patients with inflammatory myopathies.
Disclosure of Interest None declared
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