The effectiveness of treating juvenile dermatomyositis with methotrexate and aggressively tapered corticosteroids

Arthritis Rheum. 2005 Nov;52(11):3570-8. doi: 10.1002/art.21378.


Objective: Childhood dermatomyositis (DM) is often a chronic disease, lasting many years. It has traditionally been treated with long-term corticosteroid therapy; side effects are often seen. For more than a decade, methotrexate (MTX) has been safely used for the treatment of juvenile arthritis. Here, we report use of MTX as first-line therapy for DM, along with aggressively tapered corticosteroids, in an attempt to reduce treatment-related side effects.

Methods: We studied an inception cohort of 31 children with DM who were rigorously followed up in our myositis clinic, and compared them with a control group of 22 patients with incident cases of juvenile DM who received treatment just before we instituted a policy of first-line therapy with MTX. The mean starting dosage of MTX in the study group was 15 mg/m(2)/week.

Results: Both groups had similar improvement in strength and physical function; however, the median time during which patients in the study group received corticosteroids was 10 months, compared with 27 months for controls (P < 0.0001). As a result, the cumulative prednisone dose in the study group was approximately half that in the control group (7,574 mg versus 15,152 mg; P = 0.0006). The study group had greater height velocity during the first year of treatment and a smaller increase in the body mass index over the first 2 years. In the control group, the relative risk of cataracts developing was 1.95 (95% confidence interval 1.05-4.17). Side effects of MTX were rarely observed.

Conclusion: Use of MTX in conjunction with an aggressively tapered course of prednisone may be as effective as traditional long-term corticosteroid therapy for children with DM, while decreasing the cumulative dose of corticosteroids.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Dermatomyositis / drug therapy*
  • Dermatomyositis / physiopathology
  • Disability Evaluation
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Glucocorticoids / therapeutic use*
  • Health Status
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Methotrexate / therapeutic use*
  • Muscle Weakness / drug therapy
  • Muscle Weakness / physiopathology
  • Muscle, Skeletal
  • Prednisone / therapeutic use*
  • Retrospective Studies
  • Treatment Outcome


  • Glucocorticoids
  • Immunosuppressive Agents
  • Prednisone
  • Methotrexate