Idiopathic granulomatous mastitis in seventy seven-female patients: Management, follow up of an overlooked immune-mediated disease, and review of literature

Background

Idiopathic granulomatous mastitis (IGM) cases have been increasingly recognized in the context of autoimmune diseases. Hence rheumatologists need to be acquainted with IGM detection and management. Although studies evaluating the response to the emerging immunosuppressive drugs were promising, prospective studies still remain scarce.

Aim of the work

This prospective study aimed to evaluate previous immunosuppressive regimens in the management of IGM cases.

Patients and methods

Seventy seven female IGM patients were followed up, and stratified into 2 groups based on the treatment modalities received: double therapy (Group D, n = 17) who received steroids and methotrexate (MTX), and triple therapy (Group T, n = 60) who received steroids, MTX and mycophenolate mofetil (MMF). Each group was followed up monthly till the end of treatment then every 3 months after stopping treatment for at least 2 years, and the patients' data were recorded on 3 visits (V1, V2, and V3).

Results

Female patients mean age was 33.9±6.2 years. IGM lesions improved in the form of pain relief, resolution of lumps; replacement of inflammatory lesions by granulation tissue, with superiority of triple therapy group T over double therapy in group D regarding significantly shorter duration of treatment (26.5±3.1 vs 18.1±4.4 months)(p < 0.001), and decreased time needed to steroid tapering (14.1±3.6 vs 5.5±5.2 months)(p < 0.001). No recurrence was noticed.

Conclusions

Treatment of IGM has been successful using MTX, or MTX and MMF besides to steroid therapy. Triple therapy was significantly superior with shorter duration of treatment and faster feasibility of steroid tapering.