American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the initial treatment for polymyositis or dermatomyositis?

1. Physical therapy

2. Glucocorticoids

3. Immunosuppressants

4. Biologic therapy

The correct answer is: Glucocorticoids

The initial treatment for polymyositis or dermatomyositis focuses on controlling the inflammatory process associated with these conditions. Glucocorticoids, such as prednisone, are considered the first-line therapy due to their ability to rapidly reduce inflammation and improve muscle strength. In patients with polymyositis and dermatomyositis, the immune system inappropriately attacks the muscle fibers, leading to muscle weakness and, in dermatologic involvement, skin rashes. Glucocorticoids help in dampening this autoimmune response. They are effective in alleviating symptoms and improving muscle function, making them essential in the initial management of these diseases. While additional immunosuppressive medications may be used later if there is insufficient response to glucocorticoids or for long-term management, starting treatment with glucocorticoids is standard practice. Physical therapy plays a significant role in the overall management plan to maintain function and mobility; however, it is not considered an initial treatment for addressing the underlying inflammatory process. Immunosuppressants and biologic therapies may be incorporated later, depending on the patient's response to glucocorticoids and the severity of the disease.