How would you approach a patient with refractory polymyositis (elevated CK, weakness) despite MMF, IVIG, and moderate dose prednisone?  

This is a tricky question as true "polymyositis" is exceedingly rare. In most cases, inflammatory myositis without a rash can be further categorized as an immune-mediated necrotizing myopathy, antisynthetase/overlap myositis, or IBM. So when faced with a refractory polymyositis, the first thing I wo...

A key in evaluating "refractory" polymyositis is the certainty of diagnosis, as @Jemima F. Albayda astutely emphasizes. We often perform second-opinion evaluations for patients who were initially labeled as "refractory" autoimmune polymyositis, but further workup finds the true diagnosis is myodystr...