Juvenile Dermatomyositis

Drug Type/Name(s) Dosage Possible Side Effects Cautions
Glucocorticoids
(prednisolone, prednisone, dexamethasone, methylprednisolone)

Initially high doses given until child's muscle enzyme test and strength improve. Dosage will gradually be lowered as child's condition improves. 

Can be given in pill form or as a large intravenous infusion weekly. Some doctors prefer giving a large intravenous dose initially and repeating this dose several times while giving a lower daily dose. Others prefer pills only, while another may advise both. 

Side effects are dependent on how much medication taken and for how long.

Common side effects include increased appetite, weight gain, stretch marks on the skin, round full cheeks, high blood pressure, mood changes.

Additional side effects that may occur over a long period of time include weak or damaged bones, small cataracts, slowed growth rate, greater chance of developing diabetes if hereditary. muscle enzyme test and strength improve. Dosage will gradually be lowered as child's condition improves. 

As the dose is lowered earlier symptoms of JDMS may return. This is referred to as a relapse. 

These symptoms will usually go away with a mild increase in dosage or by introducing another medication to be used in combination.
Disease-Modifying Anti-Inflammatory Drugs (DMARDS) 
(methotrexate, hydroxychloroquine, cyclosporine, sulfasalazine, doxycyline, gold compounds, azathioprine, cyclophosphamide, cyclosporine) 		Methotrexate
A low dosage commonly used in combination with prednisone. Can be administered in pill form, but most doctors recommend it be given by injection. Administered once per week in combination with daily dosage of prednisone.

Hydroxychlorethotrexate  
(Plaquenil)
Given as a pill and taken in combination with other medications.  

Cyclosporine
(neoral)
Rarely used in combination with Methotrexate.

 Methotrexate
Side effects may include increased risk of serious infection, nausea and vomiting, diarrhea, mouth sores, skin rash, damage to some internal organs such as the liver, decreased number of blood cells. These side effects rarely occur and will go away when the dose is lowered or stopped completely.  

Hydroxychlorethotrexate  
(Plaquenil)
There are no common side effects but rarely there may be upset stomach and/or eye problems. 

Cyclosporine
May cause extra hair growth on face and arms, thickening and swelling of gums, kidney problems including high blood pressure.

 Methotrexate
May cause other, more serious side effects. Doctor will take regular blood and urine tests to monitor drug's effect. 

Hydroxychlorethotrexate  
(Plaquenil)
After a long period, Plaquenil may interfere with color vision. Child should see an opthamologist every six months while taking the medication. If eye problems are detected early, they should go away when medicine is stopped.  

Cyclosporine
Reserved for children with severe DMS and should be administered only by an expert in DMS, namely, the Pediatric rheumatologist. Blood and urine must be monitored monthly.