Presentation, treatment, and prognosis of idiopathic inflammatory muscle disease in a rural hospital.

Twenty-seven adult patients with dermatomyositis or polymyositis were retrospectively evaluated over a mean of four and a half years. Eighty-five percent (23) met the suggested criteria of Bohan and Peter (New England Journal of Medicine, 1975) for definite or probable disease, while 15 percent had possible disease. Upper and lower limb girdle strength was given a value (0 to 5) and averaged. Initially, 26 percent were severely weak and 59 percent moderately weak. All patients were treated with steroids. Within three months, 64 percent had little to no weakness and no patients were severely impaired. These proportions remained relatively constant throughout the study. Eight less severely ill patients received alternate-day prednisone. Only two still require treatment; the remainder have been in remission for a mean period of 19 months. Of 19 who received daily prednisone, five also required cytotoxic drugs and 11 still require treatment. A comparison of the results of this study with those of major urban referral centers reveals that the patients in this study constituted a generally less ill population with a better prognosis. Forty-one percent (11) of patients were able to discontinue all forms of therapy and remain in remission. Thirty percent (eight) achieved remission with only alternate-day steroid therapy, an approach that has been discouraged in the past. Two patients (7 percent) had overt malignancies within one year before to three years after diagnosis of myositis. However, in no instance did a search for occult malignancy give positive results. Cancer detection was accomplished by following clues from history and physical examinations. It is questioned whether extensive evaluations for occult malignancies in patients with idiopathic myositis are cost-effective.