DESTIN, FLA. — A persistent Gottron's rash is the best predictor of childhood dermatomyositis disease course, Dr. Brian Feldman said at the annual Rheumatology on the Beach.
In a study of 81 children with this inflammatory connective tissue disease who were followed for at least 3 years, a treatment-resistant Gottron's rash at 3 months following diagnosis predicted significantly longer time to remission (84 months vs. 41 months in those with no rash at 3 months).
At 6 months, predictors of remission included persistent Gottron's rash (hazard ratio 0.5) and nail fold abnormalities (hazard ratio 0.6), and at 12 months, a combination of Gottron's rash and weakness strongly predicted a chronic disease course, said Dr. Feldman, professor at the University of Toronto.
Gastrointestinal symptoms at diagnosis predicted significantly shorter time to remission (34 months vs. 84 months). The reason for this remains unclear, but in a poster on this data presented at the annual meeting of the American College of Rheumatology in November, Dr. Feldman and his colleagues noted that specific treatment regimens used early in the course of the disease may have contributed to the findings, which will be analyzed further.
The study also showed 60% of patients had chronic disease, 37% had monocyclic disease, and 3% had polycyclic disease, suggesting in children, remission is permanent. “When it's gone, it's almost always gone, and we can tell our patients that they are likely to stay in remission for the rest of their lives,” Dr. Feldman said.
Patients in the study had a mean age of nearly 8 years and a mean follow-up of nearly 6 years. The median time to remission was 4 years. About half remitted within 41/2 years, and at 10 years, about one-third still had chronic active disease, he said.