Myositis Treatment

Myositis treatment depends on the cause and subtype, but typically involves a combination of medication, physical therapy, and lifestyle adjustments. The goal is to reduce inflammation, preserve muscle strength, and maintain quality of life.

Medications

• For polymyositis, dermatomyositis, and immune-mediated necrotizing myopathy (IMNM), treatment usually begins with a corticosteroid such as prednisone to calm the immune system. If that is not enough, doctors may add disease-modifying drugs such as methotrexate or azathioprine. Other immunosuppressants — including mycophenolate mofetil or calcineurin inhibitors like tacrolimus or cyclosporine — are also options.
• IVIg (intravenous immunoglobulin), which is FDA-approved for dermatomyositis, delivers concentrated antibodies to help regulate the immune system and is used for other subtypes off-label as well. For cases that don’t respond to standard treatments, biologic therapies such as rituximab may be considered. Although new treatments are currently in clinical trials, there is not yet an FDA-approved biologic specifically for myositis.
• Over-the-counter pain relievers such as NSAIDs may help manage pain and discomfort alongside prescription treatments.
• For myositis caused by a medication — such as statins or immune checkpoint inhibitors — the first step is stopping the medication. In some cases, a corticosteroid is prescribed to help with recovery. Note that anti-HMGCR myopathy (a rare statin-triggered form of IMNM) does not resolve on its own when the statin is stopped and requires ongoing immunosuppressive treatment.
• For infection-related myositis, treatment targets the underlying infection. Flu-related myositis typically resolves on its own with rest and fluids. Trichinosis is treated with antiparasitic medication, and pyomyositis (staph bacterial infection of the muscle) may require drainage of the abscess along with antibiotics.

Inclusion Body Myositis (IBM): IBM does not currently respond well to immunosuppressive medications. At this time, exercise and physical therapy are considered the most effective tools for slowing the disease’s progression and maintaining function. Research into targeted therapies for IBM is actively ongoing.

Physical Therapy and Exercise: Exercise plays an important role in myositis care across all subtypes. A physical therapist or rehabilitation specialist can design a program tailored to your current abilities and goals. The best routine is often one you can consistently incorporate into daily life — whether that’s water exercise, yoga, or walking. The key is knowing your limits and avoiding pushing yourself to the point of exhaustion.

Occupational Therapy: Occupational therapy can be a valuable part of myositis care, particularly as muscle weakness begins to affect daily tasks. An occupational therapist can help you find new ways to do everyday activities — like getting dressed, cooking, or writing — and recommend assistive tools or adaptations that make those tasks easier and safer. For people with hand and grip weakness, such as those with inclusion body myositis, occupational therapy can be especially helpful in maintaining independence.

Skin Care for Dermatomyositis: For people with dermatomyositis, managing the skin rash is an important part of treatment. Because UV exposure is a known trigger, daily sunscreen and sun-protective clothing are strongly recommended, along with other treatments.