Recent developments on treatment strategies and the prognosis of dermatomyositis: a review.

Dermatomyositis is an autoimmune disease affecting both skin and muscle. Steroids are the first line treatment. However, no consensus regarding dosing, length of treatment, tapering speed, or when to add which immunosuppressant in case of steroid resistance, has been reached, as randomized-controlled trials are scarce. Especially data on long-term treatment is lacking in order to decide on the most effective treatment for long-term remission. Empiric evidence suggests that with an initially aggressive treatment with oral steroids followed by a slow taper, during which disease activity is adequately controlled, patients can be off therapy within typically 24-48 months, and remain disease-free without medication for over 20 years. Biologics such as rituximab have shown good results in the treatment of refractory DM. New, targeted therapies have been reported to improve DM in single cases or case series, but have to be evaluated for efficacy in randomized controlled trials.