Corticosteroids are commonly used as first-line treatment with fairly rapid results in dermatomyositis, polymyositis, necrotizing myopathy, and juvenile myositis. Corticosteroids, such as prednisone, slow the body’s immune system and stop the inflammatory attack on muscle, skin, and other body systems. These medicines control the inflammation, ease pain, and increase muscle strength.
The specific dose varies from patient to patient, but doctors tend to prescribe relatively high doses (40-80mg/day) and decrease the dose very slowly as the symptoms improve. Doses depend on patient’s weight and disease severity. Prednisone can be given orally (as a pill) or intravenously (given through a needle into a vein). Often, doctors begin patients, especially children, on high-dose intravenous corticosteroids followed by regular oral doses.
While corticosteroids are very effective, they come with severe side effects, some of which can become permanent conditions, especially with high doses and long-term treatment. They include brittle bones (osteoporosis), cataracts and glaucoma, stomach upset, weight gain, mood swings, diabetes, adrenal insufficiency, a condition known as Cushing’s syndrome (round red face, a fatty lump between the shoulders, abdominal weight gain, acne), and other symptoms. Long-term use of corticosteroids in children may cause problems with growth and development.
Doctors monitor patients closely for these side effects. A variety of blood tests may done, including fasting blood sugar to look for indications of diabetes. Frequent blood pressure checks will be done to be sure it is staying in the normal range. A bone density scan may be ordered to check for signs of osteoporosis, and frequent eye exams should check intraocular (inside the eye) pressure that may indicate the development of glaucoma. Supplements of vitamin D and calcium/magnesium are usually recommended. And patients are advised to eat a diet that is high in protein, low in carbohydrates, and avoids sodium.
To reduce these complications, doctors try to taper the dose as quickly as possible while still effectively combating the symptoms. Nevertheless, this tapering usually takes months and should not be rushed, because tapering too quickly can cause symptoms to flare. Many physicians will start patients on another anti-inflammatory medication while they taper off prednisone to avoid causing symptoms to flare.
In some cases, patients may not be able to stop taking corticosteroids completely. Many myositis patients must continue to take 5-10 mg of prednisone a day to control their symptoms. This low dose can be maintained indefinitely with few severe side effects.
You should never discontinue or reduce your dose of corticosteroids without checking with your physician. Tapering or slowly lowering your dose is essential to allow your body to begin cortisol production on its own.
Acthar is a synthetic, long-acting form of corticotropin hormone, also known as adrenocorticotropic hormone (ACTH). It is injected either subcutaneously (under the skin) or intramuscularly (into the muscle) to treat polymyositis and dermatomyositis. It is the only drug that is approved by the FDA for treating myositis diseases other than corticosteroids.
It is a naturally occurring hormone produced in the pituitary gland and causes the release of cortisol from a patient’s adrenal glands, thus mimicking the effects of taking corticosteroids by mouth. ACTH also interacts at a number of receptors throughout the immune system and may reduce immune overactivity responsible for causing dermatomyositis and polymyositis.
Patients should be monitored closely for side effects, which are similar to corticosteroids those found in long-term corticosteroid use.