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Steroids for myositis

Page history last edited by PBworks 15 years, 3 months ago

Prednisolone 60 mg daily for 6 weeks

Target is 5 mg after 26 weeks

Reduce by 10 mg each week until a dose of 40 mg/day.

After one week on 40 mg, reduce by 5 mg each week until 20 mg/day.

After one week on 20 mg, reduce by 2.5 mg each week until 10 mg/day.

After one week on 10 mg/day, reduce by 1 mg every two weeks until 5 mg/day.

If cannot tolerate dose reduction, introduce steroid sparing agent and start reduction again after 12 weeks.

Up to 50% of patients may fail to respond to glucocorticoid monotherapy. Most will respond to high doses but if the dose cannot be reduced, introduce a steroid sparing agent and start reduction again after 12 weeks.

Methotrexate or Azathioprine are appropriate steroid sparing agents

Check TPMT before using Azathioprine

Remember Osteoporosis prophylaxis. Do not use oral bisphosphonates if there is dysphagia, or a known oesophageal motility problem.