Abstract

1.

• (ii)

• (iii)

• (i)

• (iv) and perhaps (i)

• (v)

• Mild allergic reactions to IVIg are common. Anaphylactic reactions are rare and occur mostly in patients with an underlying IgA deficiency. Also, IVIg may occasionally lead to renal damage.

• Methotrexate causes interstitial fibrosis and should be avoided if there is already interstitial lung disease.

• Allopurinol inhibits xanthine oxidase, leading to decreased breakdown of azathioprine. Accumulation and eventual myelosuppression results, unless the dose of azathiorpine is appropriately lowered to 25% of usual, with particularly close monitoring.

• Cyclosporine causes dose-dependent nephrotoxicity, particularly in patients with pre-existing renal failure and hypertension.

• Cyclophosphamide can cause a severe and potentially fatal haemorrhagic cystitis and so should be avoided if bladder inflammation is already present.

Further reading:

Chevrel, Goebels & Hohlfeld. (2002) Myositis: diagnosis and management. Practical Neurology, 2, 4–11.

The British National Formulary. http://www.bnf.org

2.