From the Guidelines
Elevated CPK levels in myositis require immediate attention and treatment with immunosuppression, typically starting with prednisone at 0.5-1 mg/kg/day, and consideration of ICI withdrawal in severe cases, as recommended by the most recent guidelines 1. The management of myositis involves a comprehensive approach, including:
- Assessment of myositis-associated autoantibodies, MRI, and EMG biopsy to confirm the diagnosis
- Initiation of symptomatic treatment, such as analgesics and NSAIDs, for mild forms of arthritis or myalgia
- Use of prednisone 0.5-1 mg/kg/day for grade 2 IR-myositis, with consideration of high-dose CSs, IVIG, and/or plasma exchange in life-threatening manifestations
- Regular monitoring of CPK levels to assess disease activity and response to treatment
- Consideration of csDMARDs, such as methotrexate or azathioprine, for steroid-resistant cases or to enable steroid-sparing
- Physical therapy to rebuild strength once inflammation subsides It is essential to note that myositis can be a severe and potentially life-threatening condition, and prompt recognition and management are crucial to improve outcomes, as highlighted in recent studies 1.
From the Research
Elevated CPK Level in Myositis
- Elevated CPK (creatine phosphokinase) levels can be an indicator of idiopathic inflammatory myopathy, as seen in a case report of polymyositis 2.
- Idiopathic inflammatory myopathies, including dermatomyositis, polymyositis, and inclusion body myositis, are a heterogeneous group of diseases that can present with elevated CPK levels 3.
- The treatment of myositis typically involves glucocorticoids, with some patients requiring add-on immunosuppressive therapy due to insufficient response or relapses 4.
- Immunossuppressants such as azathioprine, mycophenolate, methotrexate, or cyclosporine may be used as steroid-sparing agents, although their effectiveness can vary 5.
- Elevated CPK levels can also be seen in other conditions, such as rhabdomyolysis, highlighting the importance of considering idiopathic inflammatory myopathy in the differential diagnosis 2.
- The prognosis and treatment response of myositis can vary depending on factors such as age, sex, and race, with younger age, female sex, and Caucasian race associated with better survival rates 6.