ab17_4

Functional outcome of myositis patients: Can a low-dose glucocorticoid regimen achieve good functional results ?

A. Nzeusseu, F. Brion¹, C. Lefèbvre², P. Knoops¹1, J.-P. Devogelaer, F.A. Houssiau

Department of Rheumatology, Department of Physical Medicine¹, and Department of General Internal Medicine², Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.

ABSTRACT
Objective
During the last few years, in an attempt to reduce the side effects of glucocorticoid (GC) therapy, we have been treating polymyositis-dermatomyositis (PM-DM) patients with a lower starting dose of GC than is classically recommended. In order to validate this approach, we performed a functional re-evaluation of these PM-DM patients.

Methods
A comprehensive protocol evaluating muscle strength, muscle function, CK levels, persistence of spontaneous activity on electromyography, disability in daily life activities and degree of dependence was applied in 25 non-cancer-associated biopsy-proven PM-DM patients, 15 of whom had been treated with a high-dose regimen (i.e. > 0.5 mg prednisolone/kg/day) and 10 with a low-dose regimen (i.e. _ 0.5 mg prednisolone/kg/day).

Results
Our results indicate that the functional outcome of PM-DM patients given a low-dose starting regimen of GC does not differ from that observed in patients given higher doses. Interestingly, vertebral fractures were less common in patients treated with lower GC doses.

Conclusions
Although our analysis has certain shortcomings, including the small number of patients investigated and their uncontroled assignment to a low-dose or a high-dose GC regimen, the results of this retrospective study suggest that a low-dose starting regimen of GC can achieve a good functional outcome in PM-DM patients, with a reduction of treatment-related disability. This approach would be welcome as a step forward should it be validated by a longitudinal study.

Key words
Myositis, glucocorticoids, functional evaluation.

Please address correspondence and reprint requests to: Frédéric A. Houssiau, MD, PhD, Rheumatology Department, UCL 5390, Saint-Luc University Hospital, Louvain Medical School, Avenue Hippocrate no. 10, B-1200 Brussels, Belgium.
E-mail: houssiau@ruma.ucl.ac.be