ACCORDING to the first evidence-based guideline, it is advised that all patients diagnosed with idiopathic inflammatory myopathies (IIM) are screened for difficulties in swallowing.
The guideline, which includes a total of 13 recommendations, has been developed by a working group within the British Society for Rheumatology (BSR). They recommend that all patients who have received an IIM diagnosis should have their myositis antibody levels checked, and should also undergo an assessment to establish their overall wellbeing. The guideline also advises that all patients should receive glucocorticoids in order to reduce inflammation of muscles, and that conventional synthetic disease-modifying antirheumatic drugs should be used in long-term treatment plans.
The publication of this guidance has taken 4 years. Senior guideline author Hector Chinoy, Professor of Rheumatology and Neuromuscular Disease, University of Manchester, and Consultant at Salford Royal Hospital, Manchester, UK, believes that it will offer a breakthrough in treatment of related disorders: “Finally, now, we’re able to standardise the way we treat adults and children with IIM.”
The framework used was patient or population, intervention, comparison, and outcome (PICO). All recommendations were graded based on the quality of the evidence available, before being voted on by members of the working group. A checklist has been included in the guideline, which will allow practitioners to follow the recommendations.
The aim of the BSR is that this guideline can be followed by every clinician who cares for patients with IIM. This includes paediatric and adult rheumatologists, dermatologists, respiratory experts, oncologists, neurologists, gastroenterologists, and cardiologists. The guideline is also applicable to other healthcare professionals, such as nurses working in rheumatology and neurology, speech therapists, psychologists, podiatrists, physiotherapists, occupational therapists, and pharmacists who specialise in rheumatology.
Liza McCann, Consultant Paediatric Rheumatologist, Alder Hey Children’s Hospital, Liverpool, and Honorary Clinical Lecturer at the University of Liverpool, UK, who co-led the development of the guideline, commented that it covers the necessity “to address psychological wellbeing as an integral part of treatment, in parallel with pharmacological therapies.”
The guideline does have some limitations, as highlighted by Chinoy. He remarked that they do not cover “diagnosis, classification, or the investigation of suspected IIM.” However, they provide a valuable framework for a multidisciplinary group of specialists working with patients diagnosed with IIM.
