Andi Wang1, Gabrielle A Morgan2, Amy S Paller3, Lauren M Pachman4. 1. Division of Pediatric Rheumatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 2. Cure JM Center of Excellence in Juvenile Dermatomyositis Care and Research, Stanley Manne Children's Research Institute; and The Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Cure JM Myositis Center, Chicago, Illinois. 3. Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 4. Division of Pediatric Rheumatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Cure JM Center of Excellence in Juvenile Dermatomyositis Care and Research, Stanley Manne Children's Research Institute; and The Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Cure JM Myositis Center, Chicago, Illinois. Electronic address: pachman@northwestern.edu.
Abstract
BACKGROUND: Persistent skin manifestations, especially calcinoses, contribute to morbidity in children with juvenile dermatomyositis. OBJECTIVE: To compare the course of skin and muscle involvement and document frequency of calcinosis in juvenile dermatomyositis. METHODS: Prospective cohort study of 184 untreated children with juvenile dermatomyositis (July 1971 to May 2019) at a single children's hospital. RESULTS: Disease Activity Scores (DASs) were persistently higher for skin versus muscle at all points; clinical inactivity (DAS ≤2) occurred earlier for muscle than skin. Among vascular features for DAS for skin, eyelid margin capillary dilatation was most frequent (54.3%) and persisted longest. Intravenous methylprednisolone reduced DAS for skin more than oral prednisone at 12 months (P = .04). Overall, 16.8% of patients (n = 31) had calcifications, with 4.9% at enrollment. Despite therapy, 25.0% of calcifications recurred and 22.6% failed to resolve; of the latter, 71.4% (n = 5) were present at enrollment. Children with persistent calcifications had longer duration of untreated disease than those whose calcifications resolved (mean 12.5 months) (P < .001). Hydroxychloroquine did not improve DAS for skin (P = .89). LIMITATIONS: DAS does not quantify nailfold capillary dropout. CONCLUSIONS: In juvenile dermatomyositis, skin disease presents with greater activity and is more recalcitrant to therapies than muscle disease. Early and aggressive treatment can limit the severity and persistence of calcifications identified later in the disease course.
BACKGROUND: Persistent skin manifestations, especially calcinoses, contribute to morbidity in children with juvenile dermatomyositis. OBJECTIVE: To compare the course of skin and muscle involvement and document frequency of calcinosis in juvenile dermatomyositis. METHODS: Prospective cohort study of 184 untreated children with juvenile dermatomyositis (July 1971 to May 2019) at a single children's hospital. RESULTS: Disease Activity Scores (DASs) were persistently higher for skin versus muscle at all points; clinical inactivity (DAS ≤2) occurred earlier for muscle than skin. Among vascular features for DAS for skin, eyelid margin capillary dilatation was most frequent (54.3%) and persisted longest. Intravenous methylprednisolone reduced DAS for skin more than oral prednisone at 12 months (P = .04). Overall, 16.8% of patients (n = 31) had calcifications, with 4.9% at enrollment. Despite therapy, 25.0% of calcifications recurred and 22.6% failed to resolve; of the latter, 71.4% (n = 5) were present at enrollment. Children with persistent calcifications had longer duration of untreated disease than those whose calcifications resolved (mean 12.5 months) (P < .001). Hydroxychloroquine did not improve DAS for skin (P = .89). LIMITATIONS: DAS does not quantify nailfold capillary dropout. CONCLUSIONS: In juvenile dermatomyositis, skin disease presents with greater activity and is more recalcitrant to therapies than muscle disease. Early and aggressive treatment can limit the severity and persistence of calcifications identified later in the disease course.
Authors: Cathrine Helene Mohn; Hege S Blix; Anja Maria Brænd; Per Nafstad; Ståle Nygard; Jon Anders Halvorsen Journal: Dermatol Ther (Heidelb) Date: 2022-06-28