Effective treatment of myositis: A Synthesis of Findings from 15 Studies

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Original Abstract of the Article

Key Research Findings

Myositis, a group of inflammatory muscle diseases, can be challenging to treat. 2 , 11 , 15 , 13 , 14 While traditional treatments like corticosteroids and immunosuppressants often help, some patients don't respond well or experience side effects. 2 , 11 , 15 , 13 , 14 Researchers are exploring new treatment strategies like mesenchymal stem cells, 2 and stromal vascular fraction (SVF) extracted from adipose tissue. 2 SVF has shown promise in other autoimmune conditions, but its specific benefits and mechanisms in myositis require further study. 2

Some studies have investigated new combinations of cytotoxic drugs for refractory myositis. A randomized crossover study compared a combination of oral methotrexate and azathioprine (MTX/AZA) with intravenous methotrexate (I.V. MTX). 11 While neither treatment showed a clear superiority, the study suggests that oral MTX/AZA might be beneficial for some patients, including those who didn't respond well to either drug alone. 11

Biologic disease-modifying drugs (bDMARDs) are also being investigated for myositis. 15 While many patients are treated with TNF-α inhibitors, 15 other bDMARDs like rituximab 15 and tocilizumab 15 show promise in specific cases. 15 However, research on the effectiveness of these bDMARDs in myositis is still ongoing.

Immune checkpoint inhibitors (ICIs) are a relatively new class of drugs used to treat cancer. 10 9 While they can be effective in fighting cancer, 10 they can also cause side effects like myositis. 10 9 This highlights the importance of careful monitoring and understanding the potential risks associated with these therapies.

Treatment Summary

Myositis treatment often involves a combination of approaches: corticosteroids, immunosuppressants, and biologic disease-modifying drugs (bDMARDs) are common, but may not be effective for all patients. 2 , 11 , 15 , 13 , 14 Some patients may benefit from new combinations of cytotoxic drugs, like oral methotrexate and azathioprine. 11 Research is exploring the potential of bDMARDs, like rituximab and tocilizumab, 15 and newer treatments like stromal vascular fraction (SVF) and immune checkpoint inhibitors (ICIs). 2 10 9 However, the use of ICIs in myositis comes with potential risks that need careful consideration. 10 9

Benefits and Risks

Benefit Summary

Myositis treatment aims to improve muscle strength, reduce inflammation, and improve overall quality of life. 2 , 11 , 15 , 13 , 14 , 10 , 9 Treatments like corticosteroids, immunosuppressants, bDMARDs, SVF, and ICIs may help achieve these goals. 2 , 11 , 15 , 13 , 14 , 10 , 9 Rehabilitation and exercise can also play a vital role in improving muscle function and daily living. 5 , 7

Risk Summary

Myositis treatments can cause side effects. 2 , 11 , 15 , 13 , 14 , 10 , 9 Corticosteroids can lead to weight gain, bone thinning, and other issues. 2 , 11 , 15 , 13 , 14 Immunosuppressants increase the risk of infections. 2 , 11 , 15 , 13 , 14 bDMARDs can also increase infection risk. 15 ICIs can cause myositis and other serious side effects. 10 9 It's crucial to be aware of these potential risks and discuss them with your doctor.

Comparison of Studies

Similarities

Many studies agree that corticosteroids, immunosuppressants, and bDMARDs are commonly used in myositis treatment. 2 , 11 , 15 , 13 , 14 There is also consensus that rehabilitation and exercise are helpful in managing myositis. 5 , 7

Differences

Different studies may highlight varying treatment effectiveness and side effect profiles. 2 , 11 , 15 , 13 , 14 , 10 , 9 , 5 , 7 This underscores the importance of personalized medicine, tailoring treatment to individual patients and their needs.

Consistency and Inconsistencies in Findings

Myositis research findings are sometimes consistent, while other times they are contradictory. 2 , 11 , 15 , 13 , 14 , 10 , 9 , 5 , 7 This reflects the complexity of myositis and the variability in patient responses. 2 , 11 , 15 , 13 , 14 , 10 , 9 , 5 , 7 It is important to work closely with a doctor to determine the best treatment approach for your individual needs and circumstances.

Real-World Application Notes

Myositis treatment is a personalized journey, and different approaches may work better for some patients than others. 2 , 11 , 15 , 13 , 14 , 10 , 9 , 5 , 7 Working closely with a doctor to determine the best treatment plan is essential. 2 , 11 , 15 , 13 , 14 , 10 , 9 , 5 , 7 Additionally, it's important to be informed about the potential risks associated with each treatment and discuss them openly with your doctor.

Limitations of Current Research

There's still much we don't know about myositis and its treatment. 2 , 11 , 15 , 13 , 14 , 10 , 9 , 5 , 7 We need more research to understand the underlying causes of myositis, develop more effective treatments, and better assess the risks and benefits of existing therapies. 2 , 11 , 15 , 13 , 14 , 10 , 9 , 5 , 7

Future Research Directions

The field of myositis research is actively seeking to develop new treatments, improve the evaluation of existing therapies, and unravel the complexities of this disease. 2 , 11 , 15 , 13 , 14 , 10 , 9 , 5 , 7 Continued research is essential to bring hope and improved outcomes for those living with myositis.

Conclusion

Myositis is a complex condition with a variety of treatment options available. 2 , 11 , 15 , 13 , 14 , 10 , 9 , 5 , 7 However, research is still uncovering the best ways to manage this condition. 2 , 11 , 15 , 13 , 14 , 10 , 9 , 5 , 7 If you are living with myositis, it is important to work closely with your doctor to find the treatment plan that is right for you. 2 , 11 , 15 , 13 , 14 , 10 , 9 , 5 , 7 Be sure to discuss any potential risks and benefits of the treatments with your doctor, and stay informed about new developments in myositis research.

List of Treatments

  • Corticosteroids
  • Immunosuppressants
  • Biologic disease-modifying drugs (bDMARDs)
  • Stromal vascular fraction (SVF)
  • Immune checkpoint inhibitors (ICIs)
  • Rehabilitation
  • Exercise
Literature analysis of 15 papers
Positive Content
10
Neutral Content
1
Negative Content
4
Article Type
2
1
4
10
15
1.

Successful Outpatient Treatment of Severe Diabetic-Foot Myositis and Osteomyelitis Caused by Extensively Drug-Resistant Enterococcus faecalis with Teicoplanin plus Rifampicin: A Case Report.

Author: PapaetisGeorgios S, DoukanarisPanagiotis T, StylianouEleni S, NeofytouMichalis S

Diabetic foot ulcers
Osteomyelitis
Sepsis

This case report describes a 76-year-old man with long-standing type 2 diabetes who developed drug-resistant *Enterococcus faecalis* diabetic foot myositis and osteomyelitis associated with sepsis. The patient was successfully treated with surgical debridement and a 12-week course of teicoplanin plus rifampicin. The report highlights the importance of early diagnosis and proper treatment of diabetic foot osteomyelitis to reduce the risk of amputation and mortality.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

3.

Exploring challenges in the management and treatment of inclusion body myositis.

Author: SkolkaMichael P, NaddafElie

Increased morbidity
Increased mortality
Progressive myopathy

Inclusion body myositis (IBM) is a slowly progressive myopathy with no definitive cure. While several clinical trials have failed, close monitoring of swallowing and respiratory function, adapting an exercise routine, and addressing mobility issues remain the mainstay of management.

ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

4.

Treatment with add-on IVIg in Myositis Early In the diSease course May be sUperior to Steroids alone for reaching CLinical improvEment (TIME IS MUSCLE): study protocol of a phase-2 double-blind placebo-controlled randomised trial.

Author: KampermanRenske G, BogaardsJohannes A, EversSanne W, WalterHannah A W, de VisserMarianne, de BorgieCorianne, Colen-de KoningJantine C A, VerhammeCamiel, MaasMario, EftimovFilip, van SchaikIvo N, van der KooiAnneke J, RaaphorstJoost

Muscle strength
Myositis treatment

High-dose glucocorticoids are the standard initial treatment for idiopathic inflammatory myopathies (IIM), but improvement in muscle strength is slow. This study explores the potential of "hit-early, hit-hard" treatment approaches using intravenous immunoglobulin (IVIg) in addition to standard glucocorticoids to induce faster disease activity reduction and prevent chronic disability due to muscle damage.

Clinical Trial ProtocolA plan for conducting a clinical trial. It describes in detail the purpose, design, methodology, and statistical considerations of the trial, ensuring the transparency and consistency of the trial.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

5.

[Myositis: from diagnosis to treatment].

Author: SchmidtJens, Müller-FelberWolfgang

Effective treatment

Inflammatory diseases of the skeletal muscle are serious conditions with significant impact on quality of life. Early diagnosis and treatment are crucial for optimal outcomes. The diagnostic approach involves autoantibody testing, imaging, muscle biopsy, and detection of extramuscular manifestations. Interdisciplinary treatment with glucocorticosteroids, azathioprine, methotrexate, and rituximab is recommended, and should be coordinated at qualified centers of excellence.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : German

6.

New paradigm in the treatment of myositis-associated interstitial lung disease.

Author: GonoTakahisa, KuwanaMasataka

Improved ILD management
Variable clinical characteristics

Interstitial lung disease (ILD) is a serious complication of idiopathic inflammatory myopathies or myositis, with variable clinical characteristics, progression, and response to treatment. Standardized management practices for ILD in myositis patients have not yet been established.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Testosterone treatment combined with exercise to improve muscle strength, physical function and quality of life in men affected by inclusion body myositis: A randomised, double-blind, placebo-controlled, crossover trial.

Author: ConnorSophia G, FairchildTimothy J, LearmonthYvonne C, BeerKelly, CooperIan, BoardmanGlenn, TeoShaun Y M, ShatahmassebBehnaz, ZhangRui, HiscockKrystyne, CoudertJerome D, YeapBu B, NeedhamMerrilee

IBM treatment

This study investigates the effects of testosterone supplementation and exercise training on muscle strength, physical function, and quality of life in men with inclusion body myositis (IBM). The study aims to determine if the combination of testosterone and exercise is more effective than exercise alone in improving these outcomes.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

10.

Myasthenia gravis, myositis and myocarditis: a fatal triad of immune-related adverse effect of immune checkpoint inhibitor treatment.

Author: SomanBiji, DiasMaria Cecilia, RizviSyed Azhar J, KardosAttila

Effective cancer treatment
Myasthenia gravis
Myocarditis
Myositis

A woman in her 70s treated with pembrolizumab (ICI) for non-small-cell lung cancer developed myasthenia gravis, myocarditis, and myositis, a life-threatening complication of ICI therapy.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

11.

Treatment of refractory myositis: a randomized crossover study of two new cytotoxic regimens.

Author: VillalbaL, HicksJ E, AdamsE M, ShermanJ B, GourleyM F, LeffR L, ThorntonB C, BurgessS H, PlotzP H, MillerF W

IV MTX may benefit patients
MTX/AZA may benefit patients
Adverse events

Oral methotrexate combined with azathioprine showed a trend toward greater benefit in patients with treatment-resistant myositis compared to intravenous methotrexate with leucovorin rescue. Both treatments showed effectiveness in some patients.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

12.

Immunosuppressant and immunomodulatory treatment for dermatomyositis and polymyositis.

Author: ChoyE H S, HoogendijkJ E, LeckyB, WinerJ B

Improved inflammatory myopathy treatment
Reduced long-term corticosteroid side effects
Corticosteroid side effects
Idiopathic inflammatory myopathies

Idiopathic inflammatory myopathies are chronic muscle diseases with significant risks despite treatment with corticosteroids. Immunosuppressants and other immune-modulating therapies are used to manage the disease and reduce the long-term effects of corticosteroids. However, the best treatment approach is still uncertain.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

13.

WITHDRAWN: Immunosuppressant and immunomodulatory treatment for dermatomyositis and polymyositis.

Author: ChoyErnest Hs, HoogendijkJessica E, LeckyBryan, WinerJohn B, GordonPatrick

Myopathy treatment

Idiopathic inflammatory myopathies are chronic muscle diseases with significant risks despite treatment with corticosteroids. Immunosuppressants and other immune-modulating therapies are used to manage the disease and reduce the long-term effects of corticosteroids. However, the best treatment approach is still uncertain.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

14.

Immunosuppressant and immunomodulatory treatment for dermatomyositis and polymyositis.

Author: GordonPatrick A, WinerJohn B, HoogendijkJessica E, ChoyErnest H S

Improved muscle strength
Lack of high quality research
Significant side effects

There is a lack of high-quality randomized controlled trials (RCTs) to assess the efficacy and toxicity of immunosuppressants in inflammatory myositis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

15.

The role of bDMARDs in idiopathic inflammatory myopathies: A systematic literature review.

Author: GrazziniSilvia, RizzoChiara, ConticiniEdoardo, D'AlessandroRoberto, La BarberaLidia, D'AlessandroMiriana, FalsettiPaolo, BargagliElena, GugginoGiuliana, CantariniLuca, FredianiBruno

IIM treatment
bDMARD effectiveness

This systematic literature review examines the current evidence regarding the use of biologic disease modifying drugs (bDMARDs) in Idiopathic Inflammatory Myopathies (IIM), highlighting their effectiveness in treating refractory manifestations.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

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