The pathogenic mechanisms in the Idiopathic Inflammatory Myopathies are not entirely Autoinflammatory and Autoimmune. Metabolic pathways may be involved to varying degrees, depending on the type of myositis/myopathy. As such, immunomodulatory treatment alone is not adequate.
That said, it's time with understand this rapidly evolving basic science better, so as to more logically and effectively treat our patients. The discovery of numerous new autoantibodies in recent years has enabled us to better phenotype and stratify patients to receive the appropriate intensity of more targeted immunosuppression.