Dermatomyositis

Dermatomyositis (DM) is a group of systemic autoimmune inflammatory diseases primarily affecting the skin and skeletal muscles. Its symptoms are generally a skin rash and worsening muscle weakness over time. These may occur suddenly or develop over months. Other symptoms may include weight loss, fever, lung inflammation, or light sensitivity. Complications may include calcium deposits in muscles or skin. Distinct myositis-specific autoantibodies (MSA) define clinically and pathologically distinct DM subtypes, each associated with characteristic disease manifestations, prognosis, and treatment response. Eighty percent of adults and sixty percent of children with juvenile dermatomyositis have a MSA. These autoantibodies, produced by locally infiltrating plasma cells, can enter various cell types and disrupt the function of their target autoantigens, inducing cellular damage and inflammation that directly drive disease pathogenesis. Dermatomyositis may develop as a paraneoplastic syndrome associated with several malignancies, in which tumors harbor genetic alterations, including somatic mutations, in genes encoding the specific autoantigens targeted by the patient's corresponding autoantibodies. It is known to be associated with several viruses, especially coxsackievirus, but no definitive causal link has been found. Diagnosis is typically based on some combination of symptoms, blood tests, electromyography, and muscle biopsies. Current treatment of dermatomyositis relies on immunosuppressive agents such as corticosteroids, methotrexate, mycophenolate mofetil, azathioprine, tacrolimus, and cyclosporine, with intravenous immunoglobulin (IVIG) widely used for refractory or severe disease. Rituximab remains an important therapeutic option despite mixed clinical trial results. Emerging targeted therapies, including Janus kinase (JAK) inhibitors and agents targeting the type I interferon pathway, such as dazukibart, have demonstrated promising efficacy. Novel approaches such as CD19 chimeric antigen receptor (CAR) T-cell therapy, plasma cell–directed therapies, and neonatal Fc receptor (FcRn) inhibitors, such as efgartigimod, are also showing encouraging results, offering the potential for sustained treatment-free disease control in the case of CD19 CAR-T cell therapy. Overall,...