Journal List > J Korean Rheum Assoc > v.16(4) > 1003689

Ahn, Song, Hwang, Yoo, Kim, and Kim: A Case of Resistant Polymyositis That Was Successfully Treated with Tacrolimus

Abstract

Polymyositis is one form of inflammatory myopathy. In some patients, this disease does not entirely respond to conventional initial therapy with glucocorticoid, methotrexate and azathioprine. Multiple options exist for treating these patients, but only intravenous immune globulin has been subjected to a randomized clinical trial. We report here on a case of polymyositis that did not respond to multiple drug therapy, but it did respond to tacrolimus. After treatment with tacrolimus, the patient's disease has been well controlled for many years.

References

1. Dalakas MC, Hohlfeld R. Polymyositis and dermatomyositis. Lancet. 2003; 362:971–82.
crossref
2. Plotz PH, Dalakas M, Leff RL, Love LA, Miller FW, Cronin ME. Current concepts in the idiopathic inflammatory myopathies: Polymyositis, dermatomyositis and related disorders. Ann Intern Med. 1989; 111:143–57.
crossref
3. Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med. 1975; 292:403–7.
4. Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hordinsky MK, et al. Guidelines of care for dermatomyositis. J Am Acad Dermatol. 1996; 34:824–9.
5. Troyanov Y, Targoff IN, Tremblay JL, Goulet JR, Raymond Y, Senécal JL. Novel classification of idiopathic inflammatory myopathies based on overlap syndrome features and autoantibodies: analysis of 100 French Canadian patients. Medicine (Baltimore). 2005; 84:231–49.
6. Bunch TW, Worthington JW, Combs JJ, Ilstrup DM, Engel AG. Azathioprine with prednisone for polymyositis. Ann Intern Med. 1980; 92:365–9.
crossref
7. Cherin P, Pelletier S, Teixeira A, Laforet P, Genereau T, Simon A, et al. Results and longterm followup of intravenous immunoglobulin infusions in chronic, refractory polymyositis: an open study with thirty-five adult patients. Arthritis Rheum. 2002; 46:467–74.
crossref
8. Miller FW, Leitman SF, Cronin ME, Hicks JE, Leff RL, Wesley R, et al. Controlled trial of plasma exchange and leukapheresis in polymyositis and dermatomyositis. N Engl J Med. 1992; 326:1380–4.
crossref
9. Sigurgeirsson B, Lindelof B, Edhag O, Allander E. Risk of cancer in patients with dermatomyositis or polymyositis. N Engl J Med. 1992; 326:363–7.
crossref
10. Noss EH, Hausner-Sypek DL, Weinblatt ME. Rituximab as therapy for refractory polymyositis and dermatomyositis. J Rheumatol. 2006; 33:1021–6.
11. Yamasaki Y, Yamada H, Yamasaki M, Ohkubo M, Azuma K, Matsuoka S, et al. Intravenous cyclophosphamide therapy for progressive interstitial pneumonia in patients with polymyositis/dermatomyositis. Rheumatology (Oxford). 2007; 46:124–30.
crossref
12. Oddis CV, Sciurba FC, Elmagd KA, Starzl TE. Tacrolimus in refractory polymyositis with interstitial lung disease. Lancet. 1999; 353:1762–3.
13. Takada K, Nagasaka K, Miyasaka N. Polymyositis/dermatomyositis and interstitial lung disease: a new therapeutic approach with T-cell-specific immunosuppressants. Autoimmunity. 2005; 38:383–92.
crossref

Fig. 1.
Minimal infiltration of inflammatory cells is found in the endomysial area (H&E stain, ×400).
jkra-16-301f1.tif
Fig. 2.
The serum CK and LDH levels during treatments ∗PDS (tapering from 1 mg/kg/day),IVIG (400 mg/day forCyclosporine (100§Methotrexate (10 mg/week),Cyclophosphamide (50 mg/day), 5 consecutive days), mg/day),Azathioprin (100 mg/day), ∗∗Infliximab (300 mg, 1 day),††Tacrolimus (2 mg/day), ↓: IVIG.
jkra-16-301f2.tif
TOOLS
Similar articles