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Dermatomyositis — SCE Dermatology MCQ

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ModerateConnective Tissue & VasculitisDermatomyositisSCE Dermatology

A 48-year-old woman with dermatomyositis has the V-sign (erythema on the anterior chest in a V-distribution) and the Shawl sign (erythema over the upper back and shoulders). She has proximal muscle weakness. CK is 2500 U/L. What is the recommended first-line systemic treatment?

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Correct answer: B — Oral Prednisolone 0.5-1 mg/kg/day

First-line systemic treatment for dermatomyositis is high-dose oral Prednisolone (0.5-1 mg/kg/day), initiated once diagnosis is confirmed with clinical features, raised CK, and supportive EMG/MRI/biopsy findings. A steroid-sparing immunosuppressant (Methotrexate or Azathioprine) is typically added early to facilitate steroid tapering. For refractory disease, IVIG, Rituximab, or Mycophenolate may be used. Hydroxychloroquine alone is useful for cutaneous DM features but does not adequately treat myositis. Physiotherapy alongside pharmacotherapy is essential. Malignancy screening must be completed.

Reference: BAD 2016 DM Guidelines; EULAR/ACR 2017