Monitoring

Monitoring for disease control

  • Patients with muscle involvement require regular specialist review to monitor muscle strength and biochemical markers of disease activity. In addition to regular dermatologic assessment, patients with amyopathic DM require regular screening for the development of myositis.[82]

  • All patients should be periodically assessed for the development of cardiac or pulmonary involvement.

Monitoring for malignancy

  • Most cancers are diagnosed within the first 3 years of onset.[4][203]

  • Screening should be performed at presentation and, if no malignancy is identified, annually for 3 years following diagnosis.

  • In addition, all patients treated with chronic immunosuppressive therapies should have periodic careful assessment for cancer.

  • Anti‐transcription intermediary factor 1 gamma is strongly associated with malignancy and therefore an intensive search for cancer and careful follow‐up is recommended.[45]

Monitoring for drug toxicity (monitoring requirements are drug specific and individual guidelines should be followed)[165][219][220]​​

  • Antimalarials: ophthalmologic screening within 4 months of initiating treatment and at regular intervals to screen for retinopathy.

  • Corticosteroids:

    • Bone density is measured at baseline and periodically during corticosteroid treatment. Osteoporosis prophylaxis should be considered with long-term use of systemic corticosteroids, typically with calcium and vitamin D in adults at low fracture risk, as well as a bisphosphonate in those with higher fracture risk.[220] ​See Osteoporosis.​

    • Initial fasting blood glucose and regular blood glucose levels are recommended in chronic corticosteroid treatment.

    • Ophthalmologic screening is performed periodically to check for cataracts and glaucoma. Serum potassium levels are monitored.

  • Immunosuppressants:

    • Methotrexate requires regular monitoring of complete blood count (CBC) and liver function tests (LFTs). Prescription of oral folic acid once weekly reduces risk of hematologic toxicity.

    • Azathioprine requires regular monitoring of CBC and LFTs.

    • Treatment with cyclosporine requires monitoring of renal function and blood pressure regularly.

  • Anti-inflammatory agents (thalidomide and dapsone): peripheral neuropathy is a potential serious adverse effect of treatment with thalidomide and should be actively sought with serial neurophysiologic assessment.[176]

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