From the Guidelines
The treatment for calcific myopathy should prioritize a multidisciplinary approach, including physiotherapy, and consideration of immunosuppressive therapy intensification in the presence of developing or established calcinosis, as recommended by the consensus-based guidelines for the management of juvenile dermatomyositis 1.
Key Considerations
- The primary goal of treatment is to manage symptoms, address underlying calcium deposits, and improve quality of life.
- A multidisciplinary team, including a physiotherapist and specialist nurse, should be involved in the care of patients with calcific myopathy.
- Physical therapy is essential to maintain muscle function and prevent contractures, with sessions recommended 2-3 times weekly.
- In cases where calcifications are large or particularly symptomatic, surgical excision may be necessary.
- Underlying conditions like hyperparathyroidism or vitamin D disorders must be identified and treated.
- Regular monitoring of kidney function is important as calcific myopathy can affect renal health.
Treatment Options
- Immunosuppressive therapy intensification should be considered in the presence of developing or established calcinosis 1.
- Methotrexate (MTX) should be started at a dose of 15–20 mg/m2/week (max absolute dose of 40 mg /week) preferably administered subcutaneously at disease onset 1.
- Mycophenolate mofetil (MMF) may be a useful therapy for muscle and skin disease (including calcinosis) 1.
- Intravenous immunoglobulin may be a useful adjunct for resistant disease, particularly when skin features are prominent 1.
Important Recommendations
- Sun protection, including the routine use of sunblock on sun-exposed areas, should be encouraged for patients with calcific myopathy 1.
- Treatment of calcific myopathy should include a safe and appropriate exercise programme, monitored by a physiotherapist 1.
- Corticosteroid dose should be weaned as the patient shows clinical improvement 1.
- Addition of MTX or ciclosporin A leads to better disease control than prednisolone alone; safety profiles favour the combination of methotrexate and prednisolone 1.
From the Research
Treatment for Calcific Myopathy
There are no research papers specifically addressing the treatment for calcific myopathy. However, we can look at the treatment approaches for other types of myopathies:
- The management of myopathies often involves a comprehensive approach focused on limiting the secondary effects of skeletal muscle weakness, managing comorbidities, and optimizing patients' functional abilities and quality of life 2.
- A multidisciplinary approach to the management of myopathies is recommended, including strength therapies, supportive care, symptomatic therapies, and psychological support 2.
- Physical therapy can be beneficial for patients with idiopathic inflammatory myopathies, with a focus on endurance training and possibly resistance training 3.
- Non-pharmacologic treatment modalities such as acupuncture, massage, and transcutaneous electrical stimulation may offer relief to some patients with myofascial pain syndrome 4.
- Early and consistent physical therapy and rehabilitation can help achieve optimal strength and function in patients with idiopathic inflammatory myopathies 5.
- The use of anti-inflammatory drugs in muscle repair is complicated, with potential beneficial effects in the early phase after injury but possible long-term repair deficits 6.