Leflunomide as a remission-maintaining therapy in difficult-to-treat dermatomyositis

Dermatomyositis (DM) is an autoimmune disorder affecting skeletal muscles and skin with a female preponderance.1 Classification for DM by Bohan and Peter is still in use today.2 A 54-year-old woman presented with a facial rash, joint pains, generalised weakness and breathlessness. Clinically she had Gottron’s sign, mechanic’s hands, a heliotropic rash and weakness in her quadriceps grade 3 and neck muscles grade 4, on a five-point system. She had raised creatinine kinase (CK) >3000 u/l (normal 25–200 u/l), positive Rose–Waaler titre of 1:8 and Jo-1 antibodies. Electromyography showed typical myositic features and muscle biopsy showed perivascular …