Expert Perspective: Management of Refractory Inflammatory Myopathy

The idiopathic inflammatory myopathies (IIMs) are chronic disorders characterized by inflammation in skeletal muscle but also other organs such as the skin, lungs, joints, gastrointestinal tract, and heart. effect of immunosuppressive treatment varies between individual patients organ manifestations within same individual. Many respond poorly to first-line with glucocorticoids agents methotrexate or azathioprine, symptoms persisting muscles, leading refractory disease. Management IIM is a clinical challenge, systematic approach proposed better understand lack response, order guide disease management. first step management recognize whether remaining caused persistent affected tissue may be attributable damage preceding inflammation. Thus, second diagnostic examination recommended. Second, particular for weakness, it important ascertain diagnosis myositis correct another underlying disorder could explain symptoms. Third, confirmation tissues, strategy change needs undertaken. Few controlled trials available our strategies. Furthermore, different subgroups benefit from therapies, therapies. In this context, subgrouping based on autoantibody profile helpful, there emerging data open studies case series support notion varying response autoantibody-defined patients.