Adult idiopathic inflammatory myopathies (IIM) are systemic connective tissue diseases that include adult polymyositis (PM), adult dermatomyositis (DM), myositis associated with cancer or another connective tissue disease (CTD), and inclusion body myositis (IBM). The treatment of myositis is challenging for both internists and rheumatologists and its rarity and heterogeneity add further complexity. IBM is very different clinically from adult PM and DM and will not be discussed in this review.