Childhood dermatomyositis and polymyositis. Treatment with methotrexate and prednisone
T. J. Fischer, G. S. Rachelefsky, R. B. Klein, H. E. Paulus and E. R. Stiehm
The conditions of three children with dermatomyositis and one child with
polymyositis were treated for nine to 31 months with combined prednisone
and intravenous methotrexate (1 mg/kg/wk) when prednisone alone was
ineffective in controlling the disease or when there were substantial
steroid-related toxic effects. All children showed a major clinical
improvement within three months despite concomitant reduction of the
prednisone dose. Three children completely recovered; one patient relapsed
and died. The toxic effects of methotrexate included elevated liver
transaminases (3/4), nausea (2/4), abdominal pain (2/4), bone pain (2/4),
mild neutropenia (1/4), and mild pruritus (1/4). Intravenous methotrexate
is an effective adjunct to steroid therapy in the treatment of
steroid-resistant or life-threatening dermatomyositis-polyositis or
dermatomyositis-polymyositis complicated by severe steroid-related effects.
