Background Juvenile dermatomyositis (JDM) is an inflammatory disease of unknown etiology with involvement of the skin and striated muscles. High-dose steroids are administered as first-line treatment. Prognosis in JDM has improved, and most patients eventually make a full functional recovery. However, prolonged steroid use may lead to severe adverse effects. Methotrexate, a steroid-sparing agent, has been very effective in many rheumatological conditions and recently has been used in JDM with good efficacy. We report our experience with methotrexate in our cohort of patients.
Method We reviewed case records of patients with JDM who are on follow up at the rheumatology clinic at KKH and were treated with methotrexate. Data on age and symptoms at presentation, initial and subsequent treatment regimens, clinical and biochemical response, and side effects of treatment regimens was collected and analysed.
Result We have three patients who are currently on methotrexate for treatment of JDM. These patients had presented classically with skin and muscle involvement and were treated with high doses of prednisolone. Upon weaning the dose of prednisolone they had recurrence of symptoms and were started on subcutaneous methotrexate. All patients responded well to the treatment. No adverse effects were noted.
Conclusion In our limited experience, methotrexate has been a safe and effective steroid-sparing agent in the management of JDM. However, larger studies are required to prove the safety and efficacy of methotrexate in our local population.