A patient with dermatomyositis repos improvement of symptoms on steroids for last 6 months. Labs did today show Creatine kinase of 1300 Units/L. What is the next step in the management?
The main objective of treatment in dermatomyositis is to improve muscle strength and reduce extra-muscular symptoms. Serum CK levels are monitored however dose adjustment of Steroids and other immuno-therapies are primarily based on the clinical examination and not CK levels. When no response is noted after adequate pharmacotherapy, alternative diagnoses and repeat muscle biopsy is considered. Hence in the case given above since symptomatic improvement has occurred though CK levels are highly elevated, oral prednisolone dose should remain the same. Mycophenolate: 2nd line drug. staed when there is no/less response to oral steroids.
Continue the same dose of steroids
Raise dose of steroids
Sta mycophenolate
Perform muscle biopsy
Channelopathies and Neuropathies