Coordinated Management
Multidisciplinary Management
Dermatomyositis (DM) is most effectively managed by a multidisciplinary team in cases of multi-organ involvement and commonly require referral to a tertiary care center. As most patients initially present to a rheumatologist, internist, family physician, or pediatrician, different physicians must be able to recognize the typical presentation of DM. A multidisciplinary approach typically can involve a rheumatologist, pulmonologist, physical therapist, dermatologist, and family physician. Other specialists may be involved, depending on the patient’s disease.
Primary care physicians play a key role in diagnosing and managing DM. They evaluate patients for underlying conditions and prescribe medications and therapies to help with symptoms before referring them to a specialist.
In addition to a comprehensive evaluation, referral for consultations with other specialties may be indicated depending on the type of associated complications.
- Rheumatologists are important…
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Multidisciplinary Management
Dermatomyositis (DM) is most effectively managed by a multidisciplinary team in cases of multi-organ involvement and commonly require referral to a tertiary care center. As most patients initially present to a rheumatologist, internist, family physician, or pediatrician, different physicians must be able to recognize the typical presentation of DM. A multidisciplinary approach typically can involve a rheumatologist, pulmonologist, physical therapist, dermatologist, and family physician. Other specialists may be involved, depending on the patient’s disease.
Primary care physicians play a key role in diagnosing and managing DM. They evaluate patients for underlying conditions and prescribe medications and therapies to help with symptoms before referring them to a specialist.
In addition to a comprehensive evaluation, referral for consultations with other specialties may be indicated depending on the type of associated complications.
- Rheumatologists are important in the management of disease since DM is an autoimmune disease that can affect muscles, skin, and joints.
- Oncologists should see patients with underlying malignancy.
- Consultations with pulmonology, gastroenterology, cardiology, and speech therapy may be needed in patients with extra muscular manifestations.
- Dermatologists should perform assessment, management, and follow up of patients with skin rash.
Dermatologists can play an important role in the diagnosis and management of the cutaneous manifestations of DM. The role of the dermatologist is especially important in management of patients with CADM, as many providers have difficulty recognizing DM in the absence of muscle involvement. This often leads to misdiagnosis and contributes to delays in treatment, cancer screening, and an appropriate initial workup.
Early recognition, multidisciplinary care, and prompt initiation of treatment can reduce morbidity and mortality of patients.
Patient Advocacy and Support
Some resources that connect patients with DM to advocacy groups and clinical trials include:
- The Myositis Association: An organization that offers resources and support for people with myositis, including DM. Advocacy initiatives by the Myositis Association to raise awareness of myositis includes public educational events, lobbying, and media events.
- Myositis Support Group: A support group based in the United Kingdom that offers support and advice for people with DM. The organization offers resources and support for finding clinical trials and understanding the process of clinical trial enrollment.
- International Myositis Assessment & Clinical Studies Group (IMACS): A group that has been involved in clinical trials for DM.
- Leapcure: A patient-centric organization that connects people with resources, research, and support groups for DM.
- Muscular Dystrophy Association (MDA): An organization that provides resources and support for people with muscle diseases, including DM.
Online support groups and forums can also help people with DM connect with others who understand their experiences.
References
- Aggarwal, R., Schessl, J., Charles-Schoeman, C. et al. Safety and tolerability of intravenous immunoglobulin in patients with active dermatomyositis: results from the randomised, placebo-controlled ProDERM study. Arthritis Res Ther 26, 27 (2024).
- ArgenX Press Release. Argenx Advances Clinical Development of Efgartigimod SC in Idiopathic Inflammatory Myopathies. November 20, 2024. https://argenx.com/content/dam/argenx-corp/newsroom/press-release-pdfs/PressRelease_argenx_ALKIVIA_Ph2_20241120.pdf.coredownload.inline.pdf
