Adrenal corticosteroids are the mainstay of therapy in dermatomyositis. Unfortunately, about one fifth of the patients, primarily those with the acute form of the disease, do not respond to steroid therapy1 or are unable to tolerate the required dosage level. Improvement in steroid-refractory myositis has been reported after the addition of the folic acid antagonist, methotrexate.2-6 We describe a patient with dermatomyositis who failed to maintain a response with prednisone but underwent complete remission after the addition of oral methotrexate therapy.
Report of a Case
A 67-year-old woman had an eight-month history of swelling and erythema of the hands, feet, and periorbital regions. Progressive symmetrical proximal muscle weakness of the extremities also developed. The patient was unable to comb her hair or lift her arms above her head. Dysphagia, facial muscle weakness, Raynaud's phenomenon, and arthritis were absent. An endometrial carcinoma of the uterus had been successfully treated
Giannini M, Callen JP. Treatment of Dermatomyositis With Methotrexate and Prednisone. Arch Dermatol. 1979;115(10):1251-1252. doi:10.1001/archderm.1979.04010100055023