1.1 What kind of disease is it?
Juvenile Idiopathic Inflammatory Myopathies (JIIMs) are a group of autoimmune conditions that are characterized by the presence of myositis, which means inflammation in the muscles. Idiopathic means that their cause is unknown. Usually the immune system helps us to fight infections, but in autoimmune diseases the immune system mistakenly attacks its own tissue, such as skeletal muscle in JIIM. This immune system reaction leads to inflammation, which causes tissues to swell and can lead to possible tissue and organ damage.
Juvenile dermatomyositis (JDM) is the most common among the JIIMs, but is a rare disease. JDM affects skin (derm) and muscles (myo). Other JIIMs – that are much more rare – include polymyositis (in which the skin is not affected), anti-synthetase syndrome, Immune Mediated Necrotising Myopathy (IMNM), and overlap syndrome (JDM in addition to another autoimmune condition). As JDM is much more frequent than the other forms of JIIMs, the information you will find in the following paragraphs refer specifically to this disease. Although very rare, scientific evidence regarding other forms of JIIMs is gradually increasing thanks to advances in scientific research.
In JDM, the small blood vessels in the skin and the muscles are affected. This leads to problems such as muscle weakness or pain, especially in the muscles of the trunk and those around the hips, shoulders and neck. Most patients have typical skin rashes as well. These rashes can affect several areas of the body: face, eyelids, knuckles, knees and elbows. The skin rash does not always occur at the same time as the muscle weakness: it can develop before or after it. In rare cases, small blood vessels in other organs can also be involved.
Children, adolescents and adults can all develop dermatomyositis. A disease is defined as “juvenile” when it starts before the age of 16. There are some differences between adult and juvenile dermatomyositis. In ~30% of adults with dermatomyositis, there is a relation to cancer ( = malignancy), whereas in JDM there is no association with cancer.
1.2 How common is it?
JDM is a rare disease. Approximately 2-4 per 1 million children will develop JDM each year. It is more common in girls than in boys. It most often starts between the ages of 4 and 10 years, but children of any age can develop JDM. Children from all around the world and from all ethnic backgrounds can develop JDM.
1.3 What causes it? Is it inherited or related to genetic changes? Can it be prevented?
The exact cause of JDM is not yet known. In this disease, the immune system becomes overactive and damages the muscles and skin. Doctors describe this condition as an autoimmune disease. Autoimmune diseases such as JDM do not develop because of a single cause. In some children, the immune system is more sensitive than in others. This is called genetic susceptibility. However, this susceptibility alone does not mean that the disease will develop. Usually, several factors need to come together for the disease to occur. When this susceptibility comes together with factors such as infections or ultraviolet (UV) light, it may make it easier for the disease to develop.Every child plays outside on sunny days, every child has common respiratory infections, and every child is exposed to some degree of environmental pollution. Therefore, this process is not related to anything parents did or did not do.
Families often wonder whether the disease is inherited. JDM is not a condition that runs in families, and in most families only one child is affected. For this reason, doctors usually do not recommend special tests or genetic counselling for family members of a child diagnosed with JDM. It is not expected that a person who has had JDM will have children who develop this disease more often. The disease is not passed from one generation to the next. This information is reassuring for both affected children and their families when thinking about the future.
JDM does not create an additional risk when making plans to have a family later in life. However, in some families, other autoimmune conditions such as diabetes or rheumatic diseases may occur. Your doctor will inform you if this is relevant.
At present, we do not know of any definite way to prevent JDM or to predict in advance who will develop the disease. There is no special diet, lifestyle change, or preventive measure that can stop the disease from starting. For this reason, it is very important that families do not blame themselves. Nothing parents did or did not do caused this disease.
1.4 Is it infectious or contagious?
JDM is not an infectious disease. Germs do not cause this condition, and it does not spread from one person to another. Children with JDM can go to school, spend time with friends, and take part in social activities. Staying involved in daily life can help a child feel better and may support recovery. During treatment, it is important to follow basic hygiene measures, such as washing hands frequently and wearing a mask when advised. Your doctor will guide you on the precautions to follow during this time.
1.5 What are the main symptoms of the disease?
Patients with JDM may experience different symptoms.
The most common are the following:
- Muscle weakness
The muscle groups that are mostly affected by weakness are those closest to the trunk, in particular the upper arms, the thighs, the neck and the abdominals. In the most severe cases, weakness can also involve additional muscle groups, causing breathing difficulties, swallowing or feeding problems and a change in voice tone, which becomes nasal. Muscle inflammation can also cause muscle pain, cramps and contractures (the inflamed muscles become tight and shorten, leading to difficulties in fully straightening the affected limb). Since the degree of muscle weakness can vary greatly, doctors must perform regular tests to assess how strong the child is. In milder cases, weakness may only be evident upon testing, but in general children with JDM might begin to refuse to walk long distances, struggle to climb stairs or get up from the floor, or ask to be carried around more frequently. In younger children, muscle weakness can lead to regression in the acquisition of motor development milestones.
- Skin manifestations and calcinosis
The rashes seen in JDM usually affect the face, knuckles, elbows, and knees. Sometimes the rash is so mild that it is hardly noticeable. It is not uncommon for JDM rashes to be photosensitive, meaning they worsen after exposure to the sun. On the face, children may present with swelling around the eyes (periorbital oedema), a red purplish discoloration of the eyelids (heliotrope rash), and redness over the cheeks (malar rash). Redness might also be apparent on the top of the knuckles, knees and elbows, where the skin can become dry and thickened (so called Gottron’s papules and patches). Sometimes, the area around the nails becomes red and swollen, and doctors can notice red dots, which are enlarged blood vessels, in the nail beds or on the eyelids of children. Swelling can also happen in other parts of the body, as fluid collects in the inflamed tissues. The medical term for this is oedema.
Among the skin manifestations that children with JDM may show there are also the so called “calcinosis”, that are small hard lumps developing under the skin due to calcium build-up. Even if they can be present at disease onset, they are more common during disease course, especially in case of ongoing inflammation. Calcinosis may complicate with ulceration (the skin over the lump can break, and a milky liquid made of calcium can drain out) and infection. When calcinosis appear, treatment may need to be intensified
In the most severe cases, ulcers can develop within the skin rashes. They can be of different sizes and depths, and can hurt.
- Fatigue (tiredness)
Children with JDM tend to get tired easily. They often lack the energy for day-to-day activities, which can make it hard for them to keep up with friends. Sometimes, they can only walk short distances, and exercise may become more challenging. It is worth noting that regaining normal stamina can take time, even once muscle strength has normalised.
- Irritability and fever
Here are some other, less common symptoms of the disease that are nonetheless important to recognise:
- Joint pain, joint swelling and stiffness
Children with JDM may experience joint inflammation, which can result in swelling, pain and stiffness. Both large and small joints can be affected. Fortunately, treatment is usually effective in alleviating joint symptoms, so joint damage is uncommon.
- Abdominal pain (tummy ache)
Children with JDM may also show signs of bowel involvement, such as tummy ache or constipation. It is rare, but the blood vessels can get inflamed and this can cause gut perforation.
- Lung involvement
Children with JDM may develop cough or shortness of breath, either because of muscle weakness or because of inflammation in the lungs. When lung involvement is mild, it may only show up in certain tests.
- Raynaud’s phenomenon
Some children with JDM may experience a change in colour in their fingers when it is cold. This is called Raynaud’s phenomenon.
1.6 Is the disease the same in every child?
The severity of JDM varies from child to child. Some children may only experience skin symptoms and no muscle weakness, a condition known as amyopathic dermatomyositis or dermatomyositis sine myositis. In other cases, the muscle weakness may be very mild and only apparent upon testing. In some cases, the rash appears after the onset of muscle weakness. However, if any skin manifestation appears, it is more probable that the child is affected by a different form of JIIM. In severe cases, different organs of the body in addition to the muscles and skin may also be involved, such as the heart, lungs, intestines and joints. Regardless of how severe the condition is, treatment is usually necessary to halt disease activity and prevent progression and future complications.
2.1 Is it different in children compared to adults?
JDM is similar to adult dermatomyositis in many ways, but there are important differences.
In adults, dermatomyositis can sometimes be linked to cancer. This association is not seen in children with JDM. Parents are often understandably worried about this, but cancer screening is not routinely needed in children with JDM unless there are specific concerns.
Adults can also develop a muscle-only form of the disease called polymyositis. This is very rare in children. In children, skin involvement is usually present at some stage.
Blood tests can show certain antibodies linked to dermatomyositis. Some antibodies commonly found in adults are less frequent in children. In recent years, researchers have identified several antibodies that are specific to juvenile forms of the disease. These antibodies can sometimes help doctors understand how the disease might behave.
Children are more likely than adults to develop calcinosis, which are small lumps of calcium that form under the skin. These can appear during the course of the illness and can sometimes be uncomfortable.
Overall, although the disease process is similar, JDM behaves differently in children, and long-term outcomes are generally better than in adults.
2.2 How is it diagnosed? What are the tests?
There is no single test that proves a child has JDM. The diagnosis is made by carefully combining information from the medical history, physical examination, blood tests and imaging.
Doctors look for a typical pattern of muscle weakness, especially in the thighs and upper arms, together with characteristic skin rashes. When this pattern is clear, the diagnosis can often be made with confidence.
Blood tests
Blood tests are used to look for signs of muscle inflammation. When muscles are inflamed, certain proteins leak into the bloodstream. These are called muscle enzymes and include CK, LDH, AST, ALT and aldolase. At least one of these is raised in many children, but not always. Blood tests can also measure inflammation levels and look for specific antibodies linked to JDM. Blood tests are commonly used to assess how active the disease is and to assess the response to treatment at follow-up (see below). Other laboratory tests can help in the diagnosis. These include antinuclear antibodies (ANA), myositis-specific antibodies (MSA) and myositis-associated antibodies (MAA). ANA and MAA may be positive in other autoimmune diseases.
Magnetic Resonance Imaging (MRI) scans are very helpful because they can show muscle inflammation. MRI has reduced the need for muscle biopsies in many children.
Other muscle tests
In some cases, a small sample of muscle (a muscle biopsy) may be taken to confirm the diagnosis, especially if the presentation is unusual. In addition, a biopsy can be a research tool for better understanding the disease.
The functional changes in the muscle can be measured with special electrodes that can be inserted as needles into the muscles (electromyography, EMG). This investigation can be useful to distinguish JDM from some congenital muscle diseases, but it is not always needed in straightforward cases.
Other tests
Other tests can be performed to detect involvement of other organs. Electrocardiography (ECG) and heart ultrasound (ECHO) are useful for heart disease, while chest X-rays or CT scan together with pulmonary function tests may reveal lung involvement. X-ray of the swallowing process using a special opaque liquid (contrast medium) detects involvement of muscles in the throat and oesophagus. Ultrasound of the abdomen may be used for gut involvement. These investigations are important not only to confirm the diagnosis but also to assess how active the disease is and to monitor response to treatment.
2.3 What is the importance of the tests?
The tests used in JDM help doctors in several ways. Typical cases of JDM can be diagnosed from the pattern of the muscle weakness (involvement of muscles in thighs and upper arms) and the classic skin rashes. Tests are then used to confirm the diagnosis, assess how active the inflammation is, and guide treatment decisions. Muscle disease in JDM can be assessed by standardized muscle testing scores (childhood myositis assessment scale, CMAS; Manual Muscle Testing 8, MMT8) and blood tests (looking for elevated muscle enzymes and inflammation). Blood tests and muscle strength assessments are repeated during follow-up to see whether treatment is working. MRI can sometimes be repeated if there is uncertainty about disease activity.
Testing also helps identify complications early, so they can be treated promptly.
It is important to remember that no single test tells the whole story. Doctors look at the overall picture — how your child feels, how strong they are, how their skin looks, and what the tests show — before making decisions about treatment changes.
2.4 Therapy
JDM is a treatable condition. While there is currently no cure, modern treatments are very effective at controlling inflammation (get the disease into remission) and preventing long-term damage. Treatment is tailored to each child depending on how severe the disease is and which parts of the body are affected. The main goal is to control inflammation quickly, prevent muscle and skin damage, and allow the child to return to normal activities.
Corticosteroids
Corticosteroids are usually the first treatment. These drugs are excellent for controlling inflammation quickly. Sometimes corticosteroids are given via a vein (through an intravenous or IV line) to get the medication into the body quickly. This can be lifesaving. Over time, the dose is gradually reduced.
Long-term high-dose steroid use can cause side effects. The side effects of corticosteroids include problems with growth, increased risk of infection, high blood pressure and weaker bones (osteoporosis). Doctors aim to use the lowest effective dose.
Corticosteroids suppress the body’s own steroids (cortisol), and this can cause serious, even life-threatening problems, if the medication is suddenly stopped. That is why corticosteroids need to be reduced slowly. In combination with corticosteroids, other immune suppressive medication (such as methotrexate) may be initiated to help control the inflammation long-term. For more information, see drug therapy below.
Methotrexate
Methotrexate is commonly added early in treatment. It helps control the immune system and reduces the need for high-dose steroids. It usually takes several weeks to start working (6 to 8 weeks) and is usually given over a long period of time. Most children tolerate it well, although some may experience side effects. Its main side effect is feeling sick (nausea) around the time it is given. Occasionally mouth ulcers, mild thinning of the hair, a drop in white blood cells or a rise in liver enzymes may develop. The liver problems are mild, but they can be made much worse by alcohol. Adding folic or folinic acid, a vitamin, diminishes the risk of side effects especially on liver function. There is a theoretical increased risk of infections, although in practice, problems have not been seen except with chickenpox. While on treatment, pregnancy must be avoided because of the effects of methotrexate on the foetus.
If the disease is not controlled by the combination of corticosteroids and methotrexate, several other therapies are possible, often in combination.
Other immunosuppressive drugs
Cyclosporin, like methotrexate, is usually given over a long period of time. Its long-term side effects include raised blood pressure, increase in body hair, gum enlargement and kidney problems.
Mycophenolate mofetyl is also used long-term. It is generally well tolerated. Its main side effects are abdominal pain, diarrhoea and an increased risk of infections.
Cyclophosphamide may be indicated in severe cases or in disease resistant to treatment.
Intravenous Immunoglobulin (IVIG)
Intravenous immunoglobulin (IVIG) may also be used, particularly if the disease is difficult to control. This contains human antibodies concentrated from blood. It is usually given into a vein and works in some patients through effects on the immune system, causing less inflammation. The exact mechanism of how it works is unknown.
Newer Treatments
In recent years, newer targeted treatments have become available for children whose disease does not respond well to standard therapy. These include biologic medicines such as rituximab and abatacept, and tablets known as JAK inhibitors (for example tofacitinib or baricitinib). These treatments target specific parts of the immune system and are used in more resistant cases.
- Rituximab and abatacept are given by infusion and target specific parts of the immune system. They are used in severe cases or when other treatments do not work.
- JAK inhibitors (tofacitinib, baricitinib): These are pills that block certain inflammation pathways and are used if standard treatments are not enough.
Physiotherapy and exercise
Common physical symptoms of JDM are muscle weakness and joint stiffness, resulting in reduced mobility and fitness. Shortening of affected muscles can lead to restriction in movement. These problems can be helped through regular physiotherapy sessions. The physiotherapist will teach both children and parents a series of appropriate stretching, strengthening and fitness exercises. The aim of treatment is to build up muscle strength and stamina, and to improve and maintain the range of movement of the joints. It is extremely important that parents are involved in this process to help their child maintain the exercise program. Physiotherapy is a vital part of treatment. Regular stretching and strengthening exercises help rebuild muscle strength, prevent stiffness and improve endurance. Parents play an important role in encouraging consistent exercise at home.
Adjunctive Therapies:
Supplements: Calcium and vitamin D help keep bones healthy, especially when children are taking corticosteroids.
Sun protection: Regular use of sunscreen and sun-protective clothing is important because UV radiation can trigger or worsen symptoms in children with JDM.
Psychological support: Living with a long-term illness can be stressful, so emotional support for children and families is important.
2.5 How long should treatment last?
The length of treatment is different for each child. It will depend on how JDM is affecting the child. Most children with JDM have treatment for at least 1-2 years, but some children will need treatment for many years. The aim of treatment is to control the disease. Treatment is usually reduced gradually once the disease has been inactive for several months. Doctors make this decision carefully, based on muscle strength, skin findings, blood tests and overall wellbeing. Stopping medication too quickly can increase the risk of a flare, so treatment reduction is always done slowly and under close medical supervision.
2.6 What about unconventional or complementary therapies?
There are many complementary and alternative therapies available, and this can be confusing for patients and their families. Most therapies are not proven to be effective. Think carefully about the risks and benefits of trying these therapies as there is little proven benefit and they can be costly in terms of money, time and burden to the child. If you want to explore complementary and alternative therapies, it is wise to discuss these options with your paediatric rheumatologist. Some therapies can interact with conventional medications. Most doctors will not be opposed to complementary therapies, provided you follow medical advice. It is very important not to stop taking your prescribed medications. When medications, such as corticosteroids, are needed to keep JDM under control, it can be very dangerous to stop taking them if the disease is still active. Please discuss concerns about medication with your child’s doctor.
2.7 Check-ups
Regular follow-up appointments are essential. During these visits, doctors assess muscle strength, skin changes and overall wellbeing. Blood tests are usually performed to monitor inflammation and check for medication side effects.
Because JDM can affect different parts of the body, doctors examine the whole child carefully at each visit. Monitoring allows early detection of flares or complications and ensures treatment is adjusted appropriately.
2.8 Prognosis (long-term outlook)
The long-term outcome for children with JDM has improved greatly over the past two decades due to earlier diagnosis and more effective treatments. JDM generally follows 3 paths:
- JDM with a monocyclic course: just one episode of disease that goes into remission (i.e. no disease activity) within 2 years after onset, without relapses.
- JDM with a polycyclic course: there may be long periods of remission (no disease activity and the child is well) alternating with periods of JDM relapses, which often occur when treatment is reduced or stopped.
- Chronic active disease: this is characterized by ongoing active JDM despite treatment (chronic remittent disease course); this last group has a higher risk of complications.
Children with JDM generally do better than adults with dermatomyositis and do not have an increased risk of cancer due to JDM. JDM can be life-threatening but this depends on how severe the disease is, including the severity of the muscle inflammation, which organs of the body are affected (lungs, heart, gut) and whether there is calcinosis (calcium lumps under the skin). Long-term problems can be caused by tight muscles (contractures), loss of muscle bulk and calcinosis. Most children with JDM do well and go on to live active, fulfilling lives. Early treatment and careful follow-up are key factors in achieving the best possible outcome.
3.1 How might the disease affect my child and my family’s daily life?
Particular attention should be given to the psychological impact of the disease on both the child and their family. A chronic condition such as JDM represents a significant and sustained challenge for the entire family. The severity of the disease often correlates directly with the emotional and practical burden experienced by the patients, their caregivers and siblings. Importantly, a child’s ability to cope effectively with a chronic disease is closely linked to the parents’ positive attitude. A supportive parental approach that fosters resilience and encourages the child’s independence, to the greatest extent possible despite challenges of the disease, is of considerable value. Such an approach helps the child manage disease- and treatment-related challenges, maintain healthy social interactions with peers, and develop into an autonomous and emotionally balanced adult. When indicated, structured psychological support should be integrated into care and can be offered by the lead paediatric rheumatology team as part of a multidisciplinary management strategy.
One of the principal therapeutic objectives in JDM is to enable the child to achieve a normal adult life and this can be achieved in the majority of the cases. Over the past decade, there have been significant advances in our understanding of the pathophysiology of JDM which will lead to developing more targeted and individualised treatment options in the future. The combined use of pharmacological therapy and structured physiotherapy rehabilitation programmes provided by the experienced physiotherapists and occupational therapists have proven effective in preventing or limiting long-term disease damage in most patients.
3.2 Can exercise and physical therapy help my child?
The purpose of exercise and physical therapy is to help the child to participate as fully as possible in all the normal daily activities of life, and to fulfil their potential within society. Exercise and physical therapy can also be used to encourage active healthy living. To be able to achieve these goals, healthy muscles are needed. Exercise and therapy can be used to achieve better muscle flexibility, muscle strength, coordination and endurance (stamina). These aspects of musculoskeletal health allow children to successfully and safely engage in kindergarten and school activities, as well as physical activities outside school, such as play and leisure time activities, and sports. Physical treatment and home exercise programs, as well as guidance in physical play activities and sports can be helpful to reach normal fitness level.
3.3 Can my child play sports?
Playing sports is an essential aspect of the everyday life of any child. One of the main aims of physical therapy is to allow children to lead a normal life and to consider themselves no different from their friends. The general advice is to let patients play the sports they want, but to instruct them to stop if muscle soreness is present, when the disease is active. This will enable the child to start early in the treatment of their disease; partially restricted sports activities are better than being excluded from exercise and playing sports with friends because of disease. When the disease is in remission, it is possible, safe and beneficial for the child to participate fully in sports and physical activity, including allowing muscle soreness from being active.
The general attitude should be to encourage the child to be independent within the limits imposed by the disease, when it is active. Exercise should be undertaken after advice from a physical therapist (and sometimes requires the supervision of a physical therapist). The physical therapist will be able to advise which exercises or sports are safe, as this will depend on how weak the muscles are. The workload should gradually increase to strengthen the muscles and improve stamina.
3.4 Can my child attend school regularly?
School provides a space where children can interact, learn to cooperate, share, and develop important social skills. Regular school attendance reduces feelings of isolation, is critical for children’s social-emotional development and can impact future opportunities and employment. Most children with JDM can attend school full-time once the treatments started, though some may require a brief period of reduced time attendance. Attending school with JDM requires a close collaboration of the family with school staff to educate child’s school/childcare personnel on JDM and to detail any specific special needs. This will allow to better manage disease-related issues such as fatigue, muscle weakness, and sun sensitivity. Common accommodations include customized physical activity, sun protection (sunscreen, UV filters, seat away from windows), potential elevator access, modified schedules to handle pain or missed days. For some children, requesting a modified physical education program or physical therapy instead of standard gym classes can be indicated. Living with a chronic illness can lead to feelings of isolation or anxiety, therefore monitoring for anxiety or depression, and address potential bullying if the child looks different or needs to limit activity is crucial.
3.5 Can diet help my child?
Even though diet can affect inflammation and immune function, there is currently no evidence that a specific diet can influence the disease process. A healthy, well-balanced diet with protein, calcium and vitamins, and avoiding processed foods as much as possible are recommended for all growing children. Overeating should be avoided in patients taking glucocorticoids, as these cause increased appetite which can easily lead to excessive weight gain, but strict diets with important calorie restriction or elimination of entire food groups are potentially dangerous and can result in missing essential nutrients. Children / young people with JDM may require vitamin D supplements since use of sunblock (and other sun avoidance measures) may potentially decrease the amount of active vitamin D in their bodies, even when dietary intake is sufficient, and use of corticosteroids may impact bone health. If you feel that you need help in managing your child’s diet, talk to your healthcare team to decide if a consultation with a dietitian is indicated.
3.6 Can climate influence the course of my child’s disease?
Current research is looking at the relationship between UV-radiation and JDM. It is recognised that UV radiation can potentially contribute to the development of JDM and trigger disease flares. To prevent rashes and disease flares caused by photosensitivity, key strategies include: daily application of broad-spectrum sunscreen (including on cloudy days and while indoors near windows), wearing protective clothing (wide-brimmed hats, sunglasses, tightly woven, dark-colored clothing or specialized UPF 50+ clothing), avoiding direct sun-exposure from 10 AM to 4 PM, and using tinting of car windows or sunshades. It is also important to be aware that UV rays reflect off sand, water, and concrete, requiring extra protection.
3.7 Can my child be vaccinated or have immunisations?
Immunisations should be discussed with your doctor,specialist nurse, pharmacist or other healthcare professional caring for you/your child, who will decide which vaccines are safe and advisable for you/your child. Vaccinations are important because of the increased risk of infections associated with the disease or medications used to treat JDM.
Ideally, vaccinations should be given when the disease is quiet (well controlled).
Non-live (or “killed”) vaccinations can safely be given to children/young people with JDM. These include: tetanus, poliomyelitis by injection, diphtheria, pneumococcus, and HPV vaccination. The annual winter flu (and influenza) vaccination is recommended, but the non-live version should be given as opposed to the live nasal flu vaccination.
Live-attenuated vaccines (such as mumps, measles, rubella, BCG, yellow fever, and varicella) have historically been avoided due to the theoretical risk of inducing infection in patients receiving high dose corticosteroids, immunosuppressive drugs, or biologic agents.
However, the second MMR vaccine (‘booster’) or varicella vaccine (which are both live) may be given under specific conditions in some patients according to more recent EULAR/PReS guidance. It is important to talk to the healthcare professional team caring for you/your child about this.
3.8 Are there problems associated with sex, pregnancy or birth control?
Puberty can be slightly delayed in some people with JDM, but young people with JDM can go on to have a healthy sex life, including the ability to have children. It is important to be aware that many of the medications used to control dermatomyositis (such as methotrexate) can cause harm to an unborn child (foetus). Sexually active patients are advised to use safe methods of birth control, and to discuss issues of contraception and pregnancy (especially before they try to conceive) with their doctor. Those wishing to conceive, are advised to plan conception whilst their disease is well controlled since there is some evidence to suggest that good dermatomyositis control is linked with better pregnancy outcomes. Conception should ideally be planned once disease remission is achieved by using medications that are known to be safe in pregnancy. Pregnancy should be managed alongside maternal medicine specialists, as there may be a slight increased risk of obstetric complications (although evidence is limited). Increased vigilance is required post-partum due to risk of disease flare.
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