Low-dose methotrexate administered weekly is an effective corticosteroid-sparing agent for the treatment of the cutaneous manifestations of dermatomyositis☆,☆☆
Section snippets
PATIENTS AND METHODS
All charts of patients with a diagnosis of dermatomyositis from January 1988 to June 1994 were retrospectively reviewed. A total of 22 patients fulfilled at least three of the five diagnostic criteria proposed by Bohan and Peter. 10 To be included in this study we required that patients have cutaneous disease recalcitrant to other therapies and that they had been treated with methotrexate. Thirteen of the 22 patients met these inclusion criteria. The remaining nine patients had not been treated
RESULTS
Patient characteristics, maximal methotrexate dose, and previous treatments are listed in Table I . The mean age at presentation of the 13 patients was 48 years. Mild to moderate muscle disease was present in eight patients during the study, and the remaining five patients were free of muscle disease. Antimalarial therapy (eight patients) was discontinued when methotrexate was started. The maximal methotrexate dose varied from 2.5 to 30 mg per week. The average maximal dose was 7.5 mg per week.
DISCUSSION
The 13 patients in this study had clinical clearing (of varying degrees) of their cutaneous disease associated with dermatomyositis when low-dose methotrexate administered weekly was added to their treatment. Each patient had moderate to no muscle involvement and a cutaneous disease that had been unresponsive to prednisone and, in some cases, to antimalarials and azathioprine. In the nine patients taking prednisone at the time of initial therapy with methotrexate, tapering of the prednisone was
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