ARTHRITIS AND ITS TREATMENT
11. POLYMYOSITIS AND DERMATOMYOSITIS
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Patient with dry eyes require artificial tears regularly. In those experiencing dry mouth, frequent sips of water are helpful. Pilocarpine hydrochloride pellets may increase salivary secretions in some patients.
Gastrointestinal symptoms may be amenable to certain measures such as elevation of head end of the bed, eating small, frequent meals in upright posture and taking an early dinner. Proton pump inhibitors such as omeprazole have revolutionized the management of reflux esophagitis. Metoclopramide and domperidon may also be useful. Esophageal strictures may need periodic dilatations. Chronic diarrhea due to small bowel stasis and bacterial overgrowth responds to broad spectrum antibiotic.
Steroids and cyclophosphamide may arrest the progression of active interstitial lung disease. No specific treatment is recommended for mild non-progressive interstitial lung disease. Advanced lung fibrosis may demand nothing short of lung transplantation. Pulmonary hypertension is a dreaded complication of scleroderma and tends to be refractory to treatment.
Scleroderma renal crisis develops suddenly and requires prompt treatment. The drug of choice is rapidly acting ACE inhibitor captopril. Angiotensin-receptor blockade does not appear to be as effective.
10.1 Experimental Therapy
High-dose immunosuppressive therapy followed by autologous stem-cell transplan- tation is being tried in scleroderma but is presently experimental.
ARTHRITIS AND ITS TREATMENT 131 is confirmed, then addition of either azathioprine 2–3 mg/kg/d or methotrexate 7.5–15 mg weekly is helpful. These drugs are also helpful as alternatives in patients who do not tolerate the side effects of steroids. In severe cases there may be rapid deterioration at the initiation of therapy with acute respiratory failure or myocarditis. In some cases, IV methylprednisolone 20 mg/kg for 3–5 days can be life saving. In case of respiratory muscle involvement, intubation and venti- latory therapy may be required. IV immunoglobulins and cyclosporine have been useful in juvenile PM/DM. Patients with interstitial lung disease may benefit from aggressive treatment with cyclophosphamide. Plasmapheresis and leukapheresis are not effective in PM/DM.
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