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I'm Dr Megan Curran I work at the University of Colorado at Children's Hospital Colorado patients come to us having struggled with getting a diagnosis for a little while some families get a diagnosis of dermatomyositis from a non-pediatric rheumatologist I would imagine that many patients have to eventually get to a pediatric rheumatologist to to get the diagnosis I I firmly feel like any patient with myositis should be treated by a pediatric rheumatologist even pediatric rheumatologists don't always know how aggressive to treat Myositis and we worry because we don't want to harm patients by over treating them we don't want to over immunosuppress but with myositis it's important for us to make sure that we understand how active the patient's disease is so that we're screening appropriately there are studies that show the longer a patient has a delayed diagnosis the harder it can be to treat their condition I would say the first step is you want to make sure that the extent of their con