There have been few randomized treatment trials, due to the relative rarity of<unk> es. The goal of treatment is<unk> provement in activities of daily living and muscle strength. Suppression of<unk> mune system activity <unk> munosuppression) is the treatment strategy. Patients with PM or DM almost always<unk> prove to some degree in response to treatment, at least initially, and many recover fully with maintenance therapy. (If there is no initial<unk> provement from treatment of PM or DM, the diagnosis should be carefully re-examined.) There is no proven effective therapy for IBM, and most IBM patients will need assistive devices such as a cane, a walking frame or a wheelchair. The later in life IBM arises, the more aggressive it appears to be. Polymyositis and dermatomyositis In severe cases of PM and DM with systemic signs, an initial three to five days on intravenous corticosteroid (methylprednisolone) may be used; but normally treatment begins with a single daily (after breakfast) high dose of oral corticosteroid (prednisone). After a month or so the strength of every second day's dose is very gradually reduced over three to four months, to minimize the negative effects of the prednisone. When a high dose of prednisone cannot be reduced without losing muscle strength, or when prednisone is effective but it is producing significant complications, "steroid sparing" oral<unk> munosuppressants such as azathioprine, mycophenolate mofetil, methotrexate and cyclosporine, may be used in combination with reduced prednisone. Some of these steroid sparing drugs can take several months to demonstrate an effect. To minimize side effects, patients on corticosteroids should follow a strict high-protein, low-carbohydrate, low-salt diet; and with long-term corticosteroid use a daily calcium supplement and weekly vitamin D supplement (and a weekly dose of Fosamax for postmenopausal women) should be considered. For patients not responding to this approach there is weak evidence supporting the use of intravenous<unk> munoglobulin, ciclosporin, tacrolimus, mycophenolate mofetil and other agents; and trials of rituximab have indicated a potential therapeutic effect. Inclusion-body myositis Despite its very similar clinical presentation to PM, IBM does not respond to the drugs that effectively treat PM, and there is no proven effective therapy for IBM. Alemtuzumab is being studied but as of May 2013 it had not demonstrated clinical effectiveness in IBM. Dysphagia (difficulty swallowing) may be<unk> proved by intravenous<unk> munoglobulin, though more trials are needed. Non-fatiguing, systematic strength-building exercise has demonstrated benefit. Occupational and rehabilitation therapists can offer good advice on walking without falling and performing fine motor tasks, and can provide appropriate canes, braces and wheelchairs. Speech pathologists can provide advice on preventing choking episodes and reducing the anxiety of an<unk> manent aspiration for both patients and carers.
Inflammatory myopathy
Metabolic myopathy
Acquired non-inflammatory myopathy
Nemaline myopathy
Polyradiculoneuropathy
Centronuclear myopathy
Polymyositis
Polyneuropathy