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- The goal of treatment is to control the disease.
As we said before, Dermatomyositis is an autoimmune disease
which means that the immune system has an abnormal response
against the normal tissues.
So the goal of treatment is to bring down the immune system
a little bit so that it stops attacking the tissues
and it gives them time to recuperate.
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Prednisone is a very good medication in the sense that
it suppresses many parts of the immune system
and acts very fast.
So it can be very effective.
However, it does have many side effects,
and especially it increases the risk
of cardiovascular disease, increases cholesterol,
it can make diabetes worse
or it can cause diabetes in patients who have
a tendency toward high blood sugars.
It can cause high blood pressure,
mood changes, osteoporosis.
And these are like a few of the side effects of prednisone.
That's why we don't keep it for a long time,
And that's why we're investigating alternative treatments.
These are all the immunosuppressive agents that we have,
they do exactly the same thing,
they suppress the immune system, but specific parts of it,
and with less side effects.
However, these tend to take a long time to start working,
usually like two to three months.
That's why we need the prednisone as a brief therapy
until the other medication kicks in.
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The most common biologic agent that we're using
in dermatomyositis is Rituximab,
which is an antibody
that is manufactured artificially,
and it's against B cells.
B cells are part of the immune system,
that make the antibodies.
So the idea behind it is that if we kill those cells
that make the antibodies,
we will not have the auto antibodies anymore
and maybe that will stop the process of the disease.
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We now see that exercise, not only is it safe
for dermatomyositis, but it has multiple benefits.
In the past we were afraid that if the patient exercises,
it can accelerate the destruction of the muscle,
but now we know that this is not true.
Exercise has been shown to reduce inflammation
and increase muscle strength in patients
with dermatomyositis.
So it's kind of a natural anti-inflammatory medication
although having said that, that is not enough
for the treatment of disease.
That's why you need the medications.
Exercise can help increase endurance.
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We definitely recommend going to physical therapy.
Besides exercise and giving them
a tailored exercise program,
they can help us in diagnosis of the disease
and monitor disease progression.
Sometimes when the patient is very strong,
we are not able to detect any weakness.
But the patient might lack endurance.
So that is where the physical therapy comes in.
They can detect earlier
an upcoming flare of the disease,
because the patient first
will lose endurance and then the muscle strength.
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As we said, dermatomyositis can affect the muscle,
the skin and the lungs,
and that's why it's a disease
that needs multi-disciplinary approach.
That means both rheumatologist, neurologist,
dermatologist and pulmonologist can be helpful
and each one brings their own expertise.
So if the patient has some lung involvement,
the patient needs to be followed by a lung doctor
to monitor disease progression.
If they have severe skin disease,
the dermatologist can also help us in treating
the local symptoms.
Another recommendation where the dermatologist can help us
is do an annual skin check.
These patients, they take immunosuppressive treatments
which by themselves can slightly increase
the risk of skin cancer, and that's why the dermatologist
can do a skin check every year and prevent progression
of any underlying pre-malignancy.
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