Myositis   

Especially in an inpatient setting when EMG is not immediately available.

The patient was treated with two doses of Rituximab and on MMF. Now with stable lung function and normalized CK.

Do you taper one DMARD as you uptitrate another versus do you stop the first DMARD and quickly uptitrate another one?

MRI with muscle edema but biopsy pending. Would you consider this overlap myositis even though muscle enzymes are normal? 

Will you still favor starting with steroids and traditional immunosuppressive agents, move IVIG earlier in your treatment strategy, or start with IVIG...

Given that antibody levels seem to fluctuate with disease activity in a subset of patients would you assume that prednisone therapy could turn an HMGC...

Given poor pulmonary outcomes in people with anti-PL12 antibodies, would you recommend more aggressive therapy? The patient was diagnosed with onset o...

How would you treat a patient with necrotizing myopathy with positive anti-HMHCoR Ab (and low TIF1 gamma) that failed prednisone + Cellcept, IVIG + Ce...

The patient was diagnosed with statin-induced necrotizing myopathy (HMGCR +) and received RTX  and IVIG (one cycle over 3 days) but developed bra...

Patient with dermatomyositis on rituximab with refractory inflammatory arthritis. Intolerant of traditional DMARDs such as methotrexate, leflunomide, ...

There is no history of trauma or substance abuse.

For example, in the setting of cirrhosis incidentally found on imaging.

Is there a role of immunosuppression or treating underlying malignancy will be enough?

Any indications for triple therapy in the patients with subclinical ILD associated with MDA-5 dermatomyositis?

In the absence of rhabdomyolysis is there still a need to protect the kidneys when patients with inflammatory myositis have CK over 5000 or 10000?

Would you consider EMG, muscle biopsy, repeat myositis panel? Would you consider starting immunosuppression?

In patients presenting with likely statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy - how do you approach the decision re...

How do you counsel young adults with antibody-negative necrotizing myopathy on prognosis, risk of recurrence, and long-term monitoring/treatment?

Would you consider adding tacrolimus in this situation?

Specifically, how do you treat the delayed headache, not the headache that develops during the infusion where pre-hydration and slowing down the rate ...

Is there a role for immunomodulatory therapy?

Myositis specific antibodies and pathology results often take weeks to result.  In which cases do you start therapy before the diagnosis is solid...

E.g., inflammatory polyarthritis or inflammatory myopathy with onset within 2 weeks of documented COVID infection

Muscle disease is quiescent and no other manifestations such as ILD

Cyclophosphamide/tacrolimus and Rituximab have been used in conjunction with steroids in case series.

i.e., Troponin I, Troponin T, and CK-MB