What is the first-line pharmacologic therapy for polymyositis?

What is the first-line pharmacologic therapy for polymyositis?

• A. Methotrexate
• B. IV immunoglobulin
• C. High-dose corticosteroids
• D. Azathioprine

Answer: (C)

High-dose systemic corticosteroids are the first-line treatment for polymyositis because they rapidly suppress the autoimmune inflammation driving proximal muscle weakness. A typical approach is prednisone at about 1 mg/kg per day, continued until strength improves and CK levels fall, then gradually tapered over several months while monitoring for relapse and adverse effects. If steroid therapy alone is insufficient or if long-term steroid exposure needs to be minimized, add steroid-sparing immunosuppressants such as methotrexate, azathioprine, or mycophenolate to help maintain control and facilitate tapering. IV immunoglobulin is considered for refractory cases or when rapid improvement is needed, but not as initial therapy. Throughout treatment, manage and monitor for corticosteroid side effects like hyperglycemia, osteoporosis, hypertension, and infection risk.

High-dose systemic corticosteroids are the first-line treatment for polymyositis because they rapidly suppress the autoimmune inflammation driving proximal muscle weakness. A typical approach is prednisone at about 1 mg/kg per day, continued until strength improves and CK levels fall, then gradually tapered over several months while monitoring for relapse and adverse effects. If steroid therapy alone is insufficient or if long-term steroid exposure needs to be minimized, add steroid-sparing immunosuppressants such as methotrexate, azathioprine, or mycophenolate to help maintain control and facilitate tapering. IV immunoglobulin is considered for refractory cases or when rapid improvement is needed, but not as initial therapy. Throughout treatment, manage and monitor for corticosteroid side effects like hyperglycemia, osteoporosis, hypertension, and infection risk.