What management strategies should I implement for a patient diagnosed with inflammatory myopathy?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Management of inflammatory myopathy should begin with prompt initiation of immunosuppressive therapy, primarily high-dose corticosteroids, to control muscle inflammation and improve strength. This is the cornerstone of treatment and should be started as early as possible to prevent irreversible muscle damage. Adjunctive immunosuppressive agents such as methotrexate or azathioprine are commonly introduced early to allow corticosteroid tapering and reduce long-term steroid toxicity. In cases of refractory or severe disease, intravenous immunoglobulin (IVIG) or biologic therapies like rituximab may be considered, especially in immune-mediated necrotizing myopathy or dermatomyositis with systemic involvement.

Supportive management includes physical therapy to maintain muscle function and prevent contractures, alongside monitoring and managing extramuscular manifestations such as interstitial lung disease or malignancy screening, which are important in certain subtypes. Regular assessment of muscle enzymes, strength, and functional status guides treatment adjustments.

Overall, a multidisciplinary approach involving rheumatology, neurology, physiotherapy, and sometimes dermatology or respiratory specialists is essential for optimal outcomes. Emerging therapies and tailored pharmacological strategies are under investigation, but current management remains centred on immunosuppression combined with supportive care.

Related Knowledge Topics

Educational content only. Always verify information and use clinical judgement.