Clinical and Laboratory Observations
New insight into calcinosis of juvenile dermatomyositis: A study of composition and treatment

https://doi.org/10.1067/mpd.2001.112473Get rights and content

Abstract

Milk of calcium developed in 2 children with juvenile dermatomyositis. The fluid of the collection contained macrophages, interleukin-6, IL-1, and tumor necrosis factor. The patient who had dystrophic calcinosis had a dramatic improvement with the introduction of alendronate. These findings suggest that calcinosis of juvenile dermatomyositis may be mediated by activated macrophages and that alendronate can be an effective treatment for this condition. (J Pediatr 2001;138:763-6)

Section snippets

Patient 1

This 14-year-old boy had had chronic JDM since the age of 10 years and was steroid-dependent. Remission had been achieved after 2.5 years with cyclosporine treatment (blood levels 150 to 200 mg/mL). Mild calcinosis had developed around the knee, and there was a painful, gradually increasing fluid collection on the left elbow that limited the patient’s movements.

Surgical drainage was required for treatment. There was no cellulitis at the time of the procedure. Twenty milliliters of aseptic fluid

Discussion

Examination of the chemical composition of the calcinosis of JDM showed that the nucleus consists of hydroxyapatite, although other impurities such as calcium oxalate and uric acid may be present in the crystal. The mineral has been identified previously as calcium apatite.4 The presence of macrophages and IL-6, IL-1β, and TNF-α in the milk of calcium, together with the detectable levels of IL-1β in the serum, suggests that activated macrophages play an important role in the calcinosis of JDM.

Acknowledgements

We are grateful for the editorial and secretarial help of Gloria Ginzach and Melanie Kawe.

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