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A non-governmental organisation tailored to the needs of Maya patients provided home intravenous pulse dose methylprednisolone in the absence of first-line biologicals. With longitudinal home-based care, she achieved symptom free recovery. The rising burden of chronic non-communicable diseases highlights shortcomings in health systems evident in this case, including lack of provider capacity, limited infrastructure to test for and treat rare diseases and poor continuity of care. We provide potential solutions to help care delivery in low-resource settings adapt to the demans of chronic disease control with particular attention to social determinants of health.<\/jats:p>","DOI":"10.1136\/bcr-2017-223886","type":"journal-article","created":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T05:35:51Z","timestamp":1550813751000},"page":"e223886","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Resistant dermatomyositis in a rural indigenous Maya woman"],"prefix":"10.1136","volume":"12","author":[{"given":"Katia","family":"Cnop","sequence":"first","affiliation":[{"name":"Wuqu' Kawoq, Maya Health Alliance, Santiago, Guatemala"},{"name":"Burrell College of Osteopathic Medicine, Las Cruces, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Martinez","sequence":"additional","affiliation":[{"name":"Wuqu' Kawoq, Maya Health Alliance, Santiago, Guatemala"},{"name":"Internal Medicine, Saint Peter\u2019s University Hospital, Rutgers University, New Brunswick, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten E","family":"Austad","sequence":"additional","affiliation":[{"name":"Wuqu' Kawoq, Maya Health Alliance, Santiago, Guatemala"},{"name":"Internal Medicine Division of Women\u2019s Health, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,2,21]]},"reference":[{"key":"2025082710020853000_12.2.e223886.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197502132920706"},{"key":"2025082710020853000_12.2.e223886.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197502202920807"},{"key":"2025082710020853000_12.2.e223886.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2012.10.017"},{"key":"2025082710020853000_12.2.e223886.4","doi-asserted-by":"crossref","unstructured":"Malik A , Hayat G , Kalia JS , et al . 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