What Is The Treatment For Juvenile Dermatomyositis (JDM)?
Treatment for juvenile dermatomyositis uses a multidisciplinary approach and studies have shown that the earlier treatment starts after disease onset the better. The dilemma of treating patients with JDM is judging the severity of disease as under-treatment can lead to long term disability. The principle behind current treatments is to induce symptom remission as rapidly as possible. Once the diagnostic investigations have been performed and juvenile dermatomyositis has been confirmed, treatment can proceed.
The first line of treatment is the use of Corticosteroids; these can be given intravenously (into a vein) or by mouth. Disease modifying anti-rheumatic drugs (DMARDS) are added to control the disease long-term, as evidence suggests better disease control is achieved when these drugs are used in conjunction with corticosteroids.
DMARDS prescribed may be one or more of:
Supplements such as Folic acid, Calcium and Vitamin D may also be prescribed.
Apart from medication, exercise plays a very important part in the treatment of JDM patients. Muscle pain and fatigue are common symptoms in JDM. Exercise plays an essential role in reducing these symptoms as well as promoting recovery while being of general benefit to the child’s wellbeing.
Children should be assessed by a specialist physiotherapist who will use special tests to ascertain muscle strength and function. They will be given an exercise program designed specifically for them after the physiotherapist has decided on the specific goals each child needs to achieve. During active disease, the aim of treatment should be to maintain muscle length, movement and function, and to minimize atrophy (muscle wasting).
As disease control is gained by medication, the focus will change to increasing muscle strength and improving muscle endurance.
The type of exercises given will be both specific and functional and should be progressed (made more difficult) regularly (at least once a week). As strength returns the exercises should increase in their repetitions and in the resistance used. A programme incorporating high repetitions (eg 30) and low weights (eg up to 2.5kg) is an ideal way of progressing the programme.
The programme should provide a combination of stretching exercises as well as strengthening exercises ans should include abdominal strengthening that includes neck strengthening as these are muscles that get weak initially and are the slowest to return.
Sport should be limited during the active disease as the muscles will not protect the joints effectively and injuries may occur. However when the disease is well controlled and the muscles have regained their strength then sport will be actively encouraged again.
A mother of a child with JDM has highlighted the importance of exericse in the article below:
“As with the majority of JDM patients at the height of his illness Patrick’s mobility was severely affected and he could barely walk. However, during our stay in GOSH the importance of regular exercise was drummed into us and we tried to keep Patrick as active as possible – one of his favourite games was trying to scare away the pigeons at the park by waving his legs in his buggy as I ran around pushing him. Luckily as Patrick got better his was able to take part in sporting activities both in and out of school.
Since last summer Patrick has been rowing for his school which involves training three times a week, I have to say he is enormously proud of his “six pack”! Keeping active and exercising regularly has brought tremendous results over the last 10 years, starting from being able to walk again and then climb stairs again through to reaching near perfect fitness today. Obviously, with JDM, the worry that the disease could return is often in our thoughts but knowing that Patrick is keeping as fit as possible helps us all to stay positive”.