Which treatment is considered first-line for myositis?

• A. Methotrexate.
• B. Azathioprine.
• C. IV immunoglobulin.
• D. High-dose corticosteroids.

Answer: (D)

Starting therapy with high-dose corticosteroids is the main initial step for inflammatory myopathies like polymyositis and dermatomyositis because they rapidly quell the immune-driven muscle inflammation and often lead to quicker gains in muscle strength. This early response helps prevent ongoing muscle damage and functional decline. In practice, clinicians begin prednisone (or an equivalent) around 1 mg/kg per day and then gradually taper over months as strength improves and enzymes normalize. Given the risks of long-term steroid use, immunosuppressants such as methotrexate or azathioprine are often added later as steroid-sparing agents to maintain control and reduce steroid exposure. IV immunoglobulin is typically reserved for patients who do not respond to steroids or have severe disease features, not as the first-line therapy.