Dermatomyositis — SCE Dermatology MCQ

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EasyConnective Tissue & VasculitisDermatomyositisSCE Dermatology

A 50-year-old woman with dermatomyositis has elevated CK and active muscle disease. She is started on high-dose Prednisolone. At what point should a steroid-sparing agent be initiated?

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Correct answer: D — Early — ideally within the first few weeks of treatment to facilitate steroid tapering and reduce steroid-related morbidity

BAD and EULAR guidelines recommend early initiation of a steroid-sparing immunosuppressive agent (Methotrexate, Azathioprine, or Mycophenolate mofetil) alongside or shortly after starting high-dose Prednisolone for DM. This facilitates steroid tapering, reduces cumulative steroid exposure and associated morbidity (osteoporosis, diabetes, cataracts, weight gain, steroid myopathy), and provides sustained disease control. Waiting months before adding a steroid-sparing agent results in unnecessarily prolonged high-dose steroid use. For severe disease (rapidly progressive ILD, dysphagia), more aggressive upfront combination therapy (IV Methylprednisolone + calcineurin inhibitor + cyclophosphamide) may be needed.

Reference: BAD 2016 DM Guidelines; EULAR 2017