How do you approach the use of steroids for active muscle disease in patients with scleroderma-myositis overlap syndromes?  

For patients with mild myopathy (mild weakness and CPK elevation), I tend to avoid steroids altogether if I can and just treat them with other therapy (like MMF or MTX). For patients with severe myopathy, particularly if they are very weak or have oropharyngeal weakness and at risk for aspiration, I...