Myositis Steroid Tapering — SCE Rheumatology MCQ

Correct answer: A — Once CK normalises AND muscle strength improves usually after 4-8 weeks of treatment

Glucocorticoid tapering in myositis should begin once both CK normalisation and clinical improvement in muscle strength are achieved (not CK alone as steroid myopathy can cause weakness with normal CK). Tapering should be gradual (typically reducing by 5-10 mg every 2-4 weeks once below 20 mg then slower reductions below 10 mg). The steroid-sparing agent (Methotrexate Azathioprine or Mycophenolate) should be at therapeutic dose before aggressive steroid tapering. Relapse risk increases with faster tapering. Monitoring both CK and muscle strength (MMT or functional assessment) guides the tapering schedule.

Reference: BSR 2022 myositis guidelines