What type of specialist treats myositis?

Rheumatologists Are the Primary Specialists for Treating Myositis

Rheumatologists are the primary specialists who treat myositis, as they have expertise in diagnosing and managing inflammatory muscle diseases. 1, 2

Specialist Referral Based on Myositis Severity

• For mild myositis (Grade 1): Primary care management with rheumatology consultation is appropriate if symptoms persist or worsen 3
• For moderate myositis (Grade 2): Early referral to a rheumatologist is recommended for proper diagnosis and treatment planning 3
• For severe myositis (Grade 3-4): Urgent referral to a rheumatologist is essential due to potential life-threatening complications 3

Multidisciplinary Care Team

• Neurologists may be consulted, particularly when:

  • Diagnostic uncertainty exists between myositis and other neuromuscular disorders 3
  • Electromyography (EMG) or nerve conduction studies are needed 3
  • There is overlap with neurologic syndromes such as myasthenia gravis 3

• Cardiologists should be involved when:

  • There are signs of myocardial involvement (elevated troponin, abnormal ECG) 3, 2
  • Cardiac MRI or echocardiogram is needed to assess cardiac function 3

• Dermatologists may be needed for:

  • Management of skin manifestations in dermatomyositis 1
  • Skin biopsies when cutaneous involvement is present 1

Diagnostic Approach

• Rheumatologists coordinate comprehensive diagnostic workup including:
  • Blood testing for muscle enzymes (CK, aldolase, transaminases, LDH) 3, 1
  • Autoantibody testing (myositis-specific and myositis-associated antibodies) 3, 1
  • Inflammatory markers (ESR, CRP) 3, 1
  • Imaging studies such as MRI of affected muscles 3, 2
  • Muscle biopsy when diagnosis is uncertain 3

Treatment Coordination

• Rheumatologists typically manage immunosuppressive therapy:

  • First-line corticosteroids (prednisone 0.5-1 mg/kg/day) 1, 2
  • Steroid-sparing agents (methotrexate, azathioprine, mycophenolate mofetil) 2, 4
  • Biologics and other advanced therapies for refractory cases 2, 5

• Physical therapists and rehabilitation specialists are essential for:

  • Preventing muscle atrophy and joint contractures 1
  • Maintaining and improving muscle strength and function 2, 6

Special Considerations

• For immune checkpoint inhibitor-related myositis, oncologists work closely with rheumatologists 3
• For overlap syndromes with other autoimmune diseases, rheumatologists coordinate care with relevant specialists 7
• Early diagnosis and treatment by appropriate specialists significantly improves outcomes and reduces long-term damage 6

Pitfalls to Avoid

• Delaying specialist referral can lead to irreversible muscle damage and poorer outcomes 1, 6
• Failing to recognize potential cardiac involvement, which can be fatal if not detected early 3, 2
• Not distinguishing between true muscle weakness (characteristic of myositis) and pain-limited movement (seen in other conditions) 1