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.
It is very important that the prescribed medicines are taken regularly. Medicines for JDM work in the background over time. So although your child may not notice a difference if one dose is missed, the medicines will not work as well if several doses are missed. All the medicines used to treat JDM decrease activity of the immune system. As a group, they are called ‘immunosuppressants.’ Each drug suppresses the immune system to a greater or lesser degree. Therefore, your child may be more at risk of infection and you should seek medical advice if your child becomes unwell. Some vaccinations cannot be given whilst on these medicines.
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. Supplements such as Folic acid, Calcium and Vitamin D may also be prescribed.
Here are some of the drugs that may be used. NB: This is not a complete description of the drugs and side effects and your child should be given information by your specialist doctor or nurse.
Treatment with steroids is usually associated with use of other drugs that treat JDM by suppressing (decreasing) the immune system. These drugs are called ‘Disease Modifying Drugs’. The most common drug used in addition to steroids is methotrexate. Although this works very well in 70-80% of children with JDM, some children will need alternative medicines. Different DMARDS are used in severe disease from those used in mild disease.
Methotrexate and many other DMARDS take at least 6-8 weeks to start to take effect and so steroids need to be used first to control JDM. All DMARDS work by suppressing the immune system in some way, and so your child will be more prone to infections. This is not usually too much of a problem, but you need to seek medical attention sooner than you would if your child were not taking these medicines. Some vaccinations cannot be given whilst taking these drugs. You may need to stop your child’s DMARD medicine (but not steroid) temporarily if your child is unwell with a temperature. You should seek advice from your doctor or nurse specialist if you are unsure what to do.
Other medicines that may need to be used instead of methotrexate or in addition to methotrexate are as follows:
Mycophenolate Mofetil (MMF) :
Immunoglobulins (IVIG) :