DM and PM with glucocorticoids treatment

[MudPhud20XX]

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So Firecracker says that you would treat Dermatomyositis (DM) and Polymyositis (PM) with glucocorticoids (eg, prednisone) with or without glucocorticoid-sparing agents (azathioprine, methotrexate)

So you would use glucocorticoid-sparing agents when you think patients are immuno-compromised or have infection, correct? Is it that straight-forward?

Considering that glucocorticoids will suppress immune system and you wouldn't want your patient to get infection, you would always want to use glucocorticoid-sparing agents right? But then will using them reduce the effectiveness in reducing inflammation?

So the mechanism of glucocorticoid-sparing agent is to suppress inflammation without putting a patient in danger of infection, correct? But how does it work? Can you have these two conflicting consequences at the same time as we know that blocking the inflammation pathway will most likely to affect our body to react to infection, right?

 

[Transposony]

Glucocorticoids are non-specific while glucocorticoid-sparing agents (azathioprine, methotrexate) are cell cycle specific.

Therefore, glucocorticoid-sparing agents (azathioprine, methotrexate) are EITHER used instead of glucocorticoids (to avoid multiple side effects like Cushing's. osteoporosis, etc) OR they are used to lower the dose of glucocorticoids in patients on long term therapy to decrease above mentoined side effects of glucocorticoids.

BOTH cause immunosuppresion.

 

[ChessMaster3000]

Great thing to think about, but I think it is very situation specific. I wouldn't be surprised to find that kind of question on rheumatology boards questions (when to use or not to use sparing agents)