What is the treatment of calcinosis in Dermatomyositis?
Cutaneous calcinosis sometimes severe and painful, is occasionally seen in adults, (calcinosis is more common in juvenile-DM). NXP2 associated with calcinosis. Extensive calcinosis located under the skin of the torso in an adult patient with dermatomyositis led to problems with movement and with breathing
In JDM, early escalation of immuno suppression in patients with persistent syndrome disease is advised to prevent calcinosis.
It is a difficult condition to treat. Specific guidelines are lacking for calcinosis cutis management.
“Based on previous case reports, case series, cohort studies, and limited controlled studies, medications including diltiazem, bisphosphonates, sodium thiosulfate, aluminum hydroxide, warfarin, probenecid, colchicine, minocycline, and intravenous immunoglobulins have been used to control calcinosis progression in dermatomyositis”
IVIg has been reported as effective on calcinosis complicating IIMs (Anh-Tu HS et al, 2017).
Biologic therapies including infliximab, abatacept, rituximab, anakinra, and JAK inhibitor -tofacitinib have been used to control dermatomyositis-associated calcinosis in case reports and series.
When drug treatment fails, it is possible to remove some calcifications surgically In some cases calcinosis is diffuse and no surgical removal is possible.
Chung, M., Chung, L. Management of Calcinosis Associated with Dermatomyositis. Curr Treat Options in Rheum 5, 242–257 (2019). https://doi.org/10.1007/s40674-019-00134-w