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Oto Y, Yoshida K, Fukuda T, Fukuda T, Ukichi T, Noda K, Ito H, Kurosaka D. Intramuscular lesions in musculoskeletal MRI as a favourable prognostic sign in patients with anti-MDA5 antibody-positive dermatomyositis. RMD Open 2023; 9:e003271. [PMID: 37640514 PMCID: PMC10462980 DOI: 10.1136/rmdopen-2023-003271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Anti-differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis, which has been described as clinically amyopathic dermatomyositis, complicates rapidly progressive interstitial lung disease (ILD). Owing to the absence of significant muscle symptoms, musculoskeletal MRI is often not performed. In this study, we aimed to devise a simple evaluation method using musculoskeletal MRI findings to elucidate the relationship between MRI findings and ILD prognosis and development. METHODS The medical records and MRI scans of the proximal muscles at the time of diagnosis were retrospectively reviewed for 28 patients with anti-MDA5 antibody-positive dermatomyositis who were admitted to The Jikei University Hospital and The Jikei University Kashiwa Hospital between January 2008 and March 2022. Three observers evaluated nine proximal muscles for high signals on either short-tau inversion recovery images and/or fat-saturated gadolinium-enhanced T1-weighted images in the fascia and/or in the margins of the muscles in contact with the fascia (fascial pattern), and/or high signals in the muscles away from the fascia (intramuscular pattern), and a consensus was reached. RESULTS Of the 28 patients, 15 presented with 'radiological myositis', where an intramuscular pattern was observed at any site. Patients with radiological myositis had significantly higher survival rates than those without radiological myositis, despite the lower rate of triple therapy with prednisolone, calcineurin inhibitors and cyclophosphamide. The spread of ILD on chest CT negatively and significantly correlated with the proportion of intramuscular lesions. CONCLUSION The detection of intramuscular lesions on musculoskeletal MRI using our novel evaluation method could be clinically useful as a favourable prognostic marker.
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Affiliation(s)
- Yohsuke Oto
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Ken Yoshida
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Taiki Fukuda
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Taro Ukichi
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Kentaro Noda
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruyasu Ito
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Daitaro Kurosaka
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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2
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Zubair AS, Salam S, Dimachkie MM, Machado PM, Roy B. Imaging biomarkers in the idiopathic inflammatory myopathies. Front Neurol 2023; 14:1146015. [PMID: 37181575 PMCID: PMC10166883 DOI: 10.3389/fneur.2023.1146015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) are a group of acquired muscle diseases with muscle inflammation, weakness, and other extra-muscular manifestations. IIMs can significantly impact the quality of life, and management of IIMs often requires a multi-disciplinary approach. Imaging biomarkers have become an integral part of the management of IIMs. Magnetic resonance imaging (MRI), muscle ultrasound, electrical impedance myography (EIM), and positron emission tomography (PET) are the most widely used imaging technologies in IIMs. They can help make the diagnosis and assess the burden of muscle damage and treatment response. MRI is the most widely used imaging biomarker of IIMs and can assess a large volume of muscle tissue but is limited by availability and cost. Muscle ultrasound and EIM are easy to administer and can even be performed in the clinical setting, but they need further validation. These technologies may complement muscle strength testing and laboratory studies and provide an objective assessment of muscle health in IIMs. Furthermore, this is a rapidly progressing field, and new advances are going to equip care providers with a better objective assessment of IIMS and eventually improve patient management. This review discusses the current state and future direction of imaging biomarkers in IIMs.
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Affiliation(s)
- Adeel S. Zubair
- Division of Neuromuscular Diseases, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Sharfaraz Salam
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mazen M. Dimachkie
- Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Pedro M. Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom
| | - Bhaskar Roy
- Division of Neuromuscular Diseases, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
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3
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Malartre S, Bachasson D, Mercy G, Sarkis E, Anquetil C, Benveniste O, Allenbach Y. MRI and muscle imaging for idiopathic inflammatory myopathies. Brain Pathol 2021; 31:e12954. [PMID: 34043260 PMCID: PMC8412099 DOI: 10.1111/bpa.12954] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 12/22/2022] Open
Abstract
Although idiopathic inflammatory myopathies (IIM) are a heterogeneous group of diseases nearly all patients display muscle inflammation. Originally, muscle biopsy was considered as the gold standard for IIM diagnosis. The development of muscle imaging led to revisiting not only the IIM diagnosis strategy but also the patients' follow-up. Different techniques have been tested or are in development for IIM including positron emission tomography, ultrasound imaging, ultrasound shear wave elastography, though magnetic resonance imaging (MRI) remains the most widely used technique in routine. Whereas guidelines on muscle imaging in myositis are lacking here we reviewed the relevance of muscle imaging for both diagnosis and myositis patients' follow-up. We propose recommendations about when and how to perform MRI on myositis patients, and we describe new techniques that are under development.
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Affiliation(s)
- Samuel Malartre
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Damien Bachasson
- Neuromuscular Physiology Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Guillaume Mercy
- Department of Medical Imaging, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles-Foix, Sorbonne Université, Paris, France
| | - Elissone Sarkis
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Céline Anquetil
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
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4
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Kobayashi I, Akioka S, Kobayashi N, Iwata N, Takezaki S, Nakaseko H, Sato S, Nishida Y, Nozawa T, Yamasaki Y, Yamazaki K, Arai S, Nishino I, Mori M. Clinical practice guidance for juvenile dermatomyositis (JDM) 2018-Update. Mod Rheumatol 2020; 30:411-423. [PMID: 31955618 DOI: 10.1080/14397595.2020.1718866] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Juvenile dermatomyositis is the most common type of juvenile idiopathic inflammatory myopathy mainly affecting the skin and proximal muscles. We have published the Japanese version of 'Clinical practice guidance for juvenile dermatomyositis (JDM) 2018 'consisting of a review of articles in the field and evidence-informed consensus-based experts' opinion on the treatment strategy in collaboration with The Pediatric Rheumatology Association of Japan and The Japan College of Rheumatology under the financial support by 'Research on rare and intractable diseases, Health and Labor Sciences Research Grants'. This article is a digest version of the Japanese guidance.
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Affiliation(s)
- Ichiro Kobayashi
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Shinji Akioka
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Norimoto Kobayashi
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | | | - Haruna Nakaseko
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Satoshi Sato
- Division of Infectious Disease and Immunology, Saitama Children's Medical Center, Omiya, Japan
| | - Yutaka Nishida
- Department of Pediatrics, School of Medicine, Gunma University, Maebashi, Japan
| | - Tomo Nozawa
- Department of Pediatrics, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yuichi Yamasaki
- Department of Pediatrics, Kagoshima University Hospital, Kagoshima, Japan
| | - Kazuko Yamazaki
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital, Tokyo, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaaki Mori
- Lifetime Clinical Immunology, Tokyo Medical and Dental University, Tokyo, Japan
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5
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Poliachik SL, Friedman SD, Carter GT, Parnell SE, Shaw DW. Skeletal Muscle Edema in Muscular Dystrophy: Clinical and Diagnostic Implications. Phys Med Rehabil Clin N Am 2012; 23:107-22, xi. [DOI: 10.1016/j.pmr.2011.11.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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6
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Davis WR, Halls JE, Offiah AC, Pilkington C, Owens CM, Rosendahl K. Assessment of active inflammation in juvenile dermatomyositis: a novel magnetic resonance imaging-based scoring system. Rheumatology (Oxford) 2011; 50:2237-44. [DOI: 10.1093/rheumatology/ker262] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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7
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Sanner H, Kirkhus E, Merckoll E, Tollisen A, Røisland M, Lie BA, Taraldsrud E, Gran JT, Flatø B. Long-term muscular outcome and predisposing and prognostic factors in juvenile dermatomyositis: A case-control study. Arthritis Care Res (Hoboken) 2010; 62:1103-11. [PMID: 20506141 DOI: 10.1002/acr.20203] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare muscle strength, physical health, and HLA-DRB1 allele carriage frequencies in patients with longstanding juvenile dermatomyositis (DM) with that of controls, and to determine the presence of and risk factors for muscle weakness and magnetic resonance imaging (MRI)-detected muscle damage in juvenile DM patients. METHODS Fifty-nine patients with juvenile DM examined a median of 16.8 years (range 2.0-38.1 years) after disease onset were compared with 59 age- and sex-matched controls. Muscle strength/endurance was measured by manual muscle testing (MMT) and the Childhood Myositis Assessment Scale (CMAS); health status was measured by the Short Form 36. HLA-DRB1 alleles were determined by sequencing in patients and 898 healthy controls. In patients, disease activity/damage was measured by the Disease Activity Score (DAS), Myositis Damage Index (MDI), Health Assessment Questionnaire/Childhood Health Assessment Questionnaire, and MRI scans of the thigh muscles. Early disease characteristics were obtained by chart review. RESULTS Patients had lower muscle strength/endurance (P < 0.001 for both) and physical health (P = 0.014) and increased HLA-DRB1*0301 (P = 0.01) and DRB1*1401 (P = 0.003) compared with controls. In patients, persistent muscle weakness was found in 42% with MMT (score <78) and in 31% with the CMAS (score <48), whereas MRI-detected muscle damage was found in 52%. Muscle weakness and MRI-detected muscle damage were predicted by MDI muscle damage and a high DAS 1 year postdiagnosis. CONCLUSION A median of 16.8 years after disease onset, juvenile DM patients were weaker than the controls; muscle weakness/reduced endurance was found in 31-42% of patients and MRI-detected muscular damage was found in 52% of patients. The outcomes were predicted by high disease activity and muscle damage present 1 year postdiagnosis.
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Affiliation(s)
- Helga Sanner
- University of Oslo, Oslo University Hospital, Rikshospitalet, Norway.
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8
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Huber AM. Update on the assessment of children with juvenile idiopathic inflammatory myopathy. Curr Rheumatol Rep 2010; 12:204-12. [PMID: 20425522 DOI: 10.1007/s11926-010-0103-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The availability of validated measurement tools to assess children with juvenile idiopathic inflammatory myopathies is critical to clinical care and to ongoing research into new therapeutic modalities and approaches. Recent work has led to the development of tools for assessment of muscle strength and physical function, skin disease, global disease activity and damage, extramuscular disease, and quality of life. Ongoing work is attempting to integrate these assessments into core sets and definitions of improvement and flare. Future work will refine these assessments and definitions and--where there are multiple choices--determine which tools constitute an optimal assessment.
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Affiliation(s)
- Adam M Huber
- IWK Health Centre, 5850 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada.
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9
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Rider LG, Koziol D, Giannini EH, Jain MS, Smith MR, Whitney-Mahoney K, Feldman BM, Wright SJ, Lindsley CB, Pachman LM, Villalba ML, Lovell DJ, Bowyer SL, Plotz PH, Miller FW, Hicks JE. Validation of manual muscle testing and a subset of eight muscles for adult and juvenile idiopathic inflammatory myopathies. Arthritis Care Res (Hoboken) 2010; 62:465-72. [PMID: 20391500 DOI: 10.1002/acr.20035] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To validate manual muscle testing (MMT) for strength assessment in juvenile and adult dermatomyositis (DM) and polymyositis (PM). METHODS Patients with PM/DM (73 children and 45 adults) were assessed at baseline and reevaluated 6-9 months later. We compared Total MMT (a group of 24 proximal, distal, and axial muscles) and Proximal MMT (7 proximal muscle groups) tested bilaterally on a 0-10 scale with 144 subsets of 6 and 96 subsets of 8 muscle groups tested unilaterally. Expert consensus was used to rank the best abbreviated MMT subsets for face validity and ease of assessment. RESULTS The Total, Proximal, and best MMT subsets had excellent internal reliability (Total MMT r(s) = 0.91-0.98), and consistency (Cronbach's alpha = 0.78-0.97). Inter- and intrarater reliability were acceptable (Kendall's W 0.68-0.76, r(s) = 0.84-0.95). MMT subset scores correlated highly with Total and Proximal MMT scores and with the Childhood Myositis Assessment Scale, and correlated moderately with physician global activity, functional disability, magnetic resonance imaging, and axial and distal MMT scores, and, in adults, with creatine kinase level. The standardized response mean for Total MMT was 0.56 in juveniles and 0.75 in adults. Consensus was reached to use a subset of 8 muscles (neck flexors, deltoids, biceps, wrist extensors, gluteus maximus and medius, quadriceps, and ankle dorsiflexors) that performed as well as the Total and Proximal MMT, and had good face validity and ease of assessment. CONCLUSION These findings aid in standardizing the use of MMT for assessing strength as an outcome measure for myositis.
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Affiliation(s)
- Lisa G Rider
- Environmental Autoimmunity Group, Office of Clinical Research, National Institute of Environmental Health Sciences/NIH, 10 Center Drive, Bethesda, MD 20892-1301, USA.
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10
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Abstract
Juvenile dermatomyositis (JDM) is a rare, presumably autoimmune illness that causes proximal muscle weakness and a variety of typical cutaneous features. The study of this illness has been hampered by its rarity but, in recent years, important developments have increased our understanding of JDM. Genetic factors are likely important in the pathogenesis of JDM. These include several Human Leukocyte Antigen alleles, in particular those associated with the 8.1 ancestral haplotype and the tumor necrosis factor-alpha gene 308 polymorphism. Microchimerism, activation of plasmacytoid dendritic cells, and upregulation of type-1 interferon inducible genes also appear to play an important role in the pathogenesis of JDM. The study of JDM has also been limited by a lack of validated assessment tools. Recent work has validated the Childhood Myositis Assessment Scale and the Childhood Health Assessment Questionnaire as measures of muscle strength and function, and the Cutaneous Assessment Tool as a measure of skin disease activity and damage. Development of core sets of tools that should be used in all JDM studies has also been an important step. The use of magnetic resonance imaging and novel laboratory assessments (such as type-1 interferon inducible gene products, peripheral blood B cell and natural killer cell numbers, and myositis-associated and myositis-specific autoantibodies) are also playing an increasing role in the diagnosis and assessment of JDM. Current treatment is with corticosteroids, frequently in combination with other medications such as methotrexate or intravenous gammaglobulin. Newer therapies, such as anti-tumor necrosis factor agents and rituximab are currently being evaluated; it is not clear what role these medications will have in the future.
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Affiliation(s)
- Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
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11
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Rider LG, Lachenbruch PA, Monroe JB, Ravelli A, Cabalar I, Feldman BM, Villalba ML, Myones BL, Pachman LM, Rennebohm RM, Reed AM, Miller FW. Damage extent and predictors in adult and juvenile dermatomyositis and polymyositis as determined with the myositis damage index. ACTA ACUST UNITED AC 2010; 60:3425-35. [PMID: 19877055 DOI: 10.1002/art.24904] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We undertook this study to validate the Myositis Damage Index (MDI) in juvenile and adult myositis, to describe the degree and types of damage and to develop predictors of damage. METHODS Retrospective MDI evaluations and prospective assessment of disease activity and illness features were conducted. Patients with juvenile-onset disease (n = 143) were evaluated a median of 18 months after diagnosis; 135 patients were assessed 7-9 months later, and 121 were last assessed a median of 82 months after diagnosis. Ninety-six patients with adult-onset dermatomyositis or polymyositis had a baseline assessment a median of 30 months after diagnosis; 77 patients had a 6-month followup evaluation, and 55 had a final assessment a median of 60 months after diagnosis. RESULTS Damage was present in 79% of juvenile patients and in 97% of adult patients. In juveniles, scarring, contractures, persistent weakness, muscle dysfunction, and calcinosis were most frequent (23-30%) at the last evaluation. In adults, muscle atrophy, muscle dysfunction, and muscle weakness were most frequent (74-84%). MDI severity correlated with physician-assessed global damage, serum creatinine, and muscle atrophy on magnetic resonance imaging, and in juveniles also with functional disability and weakness. MDI damage scores and frequency were highest in patients with a chronic illness course and in adult patients who died. Predictors of damage included functional disability, duration of active disease, disease severity at diagnosis, physician-assessed global disease activity, and illness features, including ulcerations in children and pericarditis in adults. CONCLUSION Damage is common in myositis after a median duration of 5 years in patients with adult-onset disease and 6.8 years in patients with juvenile-onset disease. The MDI has good content, construct, and predictive validity in juvenile and adult myositis.
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Affiliation(s)
- Lisa G Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, NIH, Bethesda, MD 20892-1301, USA.
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12
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Abstract
Juvenile dermatomyositis, the most common inflammatory myopathy of childhood, is a rare systemic autoimmune vasculopathy that is characterised by weakness in proximal muscles and pathognomonic skin rashes. The length of time before the initiation of treatment affects presenting symptoms, laboratory measures, and pathophysiology. It also affects disease outcomes, including the development of pathological calcifications, which are associated with increased morbidity. Both genetic and environmental risk factors seem to have a role in the cause of juvenile dermatomyositis; HLA B8-DRB1*0301 ancestral haplotype is a strong immunogenetic risk factor, and antecedent infections and birth seasonality suggest that environmental stimuli might increase risk. Activation of dendritic cells with upregulation of genes induced by type-1 interferon (alpha) in muscle and peripheral blood seems to be central to disease pathogenesis. Treatment often includes combinations of corticosteroids, methotrexate, and other immunosuppressive agents. Disease outcome, if treatment is initiated early, is generally good. Randomised controlled trials are needed to define the most effective treatments.
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Affiliation(s)
- Brian M Feldman
- Departments of Pediatrics, Health Policy Management and Evaluation, and Public Health Sciences, University of Toronto, Division of Rheumatology, Hospital for Sick Children, Toronto, ON, Canada.
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13
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Johnson K, Davis PJC, Foster JK, McDonagh JE, Ryder CAJ, Southwood TR. Imaging of muscle disorders in children. Pediatr Radiol 2006; 36:1005-18. [PMID: 16775740 DOI: 10.1007/s00247-006-0166-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 02/14/2006] [Accepted: 02/16/2006] [Indexed: 11/28/2022]
Abstract
Muscle inflammation is a relatively common pathological process in childhood. The diagnosis of the underlying cause relies on an appreciation of the pattern of clinical features, as well as the results of biochemical, histological and radiological investigations. Often the clinical and biochemical features are non-specific and insensitive. Consequently, the radiological abnormalities are very important in establishing a diagnosis and an understanding of the imaging features of muscle inflammatory disorders in childhood is needed. Some of the imaging protocols needed to investigate a variety of muscle and soft-tissue inflammatory conditions in childhood are reviewed in this article. Those features that are helpful in narrowing the differential diagnosis are indicated and a logical approach to the investigation of affected children is provided. The value of MR imaging is highlighted.
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Affiliation(s)
- Karl Johnson
- Department of Radiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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14
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Maillard SM, Jones R, Owens CM, Pilkington C, Woo PM, Wedderburn LR, Murray KJ. Quantitative assessments of the effects of a single exercise session on muscles in juvenile dermatomyositis. ACTA ACUST UNITED AC 2005; 53:558-64. [PMID: 16082634 DOI: 10.1002/art.21332] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the short-term effects of exercise on muscle inflammation in children with juvenile dermatomyositis (juvenile DM). Magnetic resonance imaging (MRI), muscle strength, and blood parameters were used as outcome measures. METHODS Children with active juvenile DM, inactive juvenile DM, and healthy children were assessed for muscle strength (using myometry) and function, and MRI T2-weighted relaxation time measurement; blood was obtained from patients with juvenile DM. A standardized physiotherapy-led exercise program was completed, and the MRI was performed immediately afterwards. All children were reassessed with myometry and MRI at 30 minutes and 60 minutes, and repeat blood tests were performed at 60 minutes for the patients with juvenile DM. RESULTS Ten children with active juvenile DM, 10 with inactive juvenile DM, and 20 healthy controls completed the study. Muscle inflammation assessed by MRI, myometry, and blood parameters did not change significantly in response to exercise either immediately after or up to 60 minutes after the exercise program in any group. CONCLUSION In the short term, a single bout of exercise does not change the degree of inflammation within the muscles of children with active or inactive juvenile DM or in healthy children. The data suggest that, at least in this time period, there is no evidence that exercise increases the inflammation within the muscles. We propose therefore that a moderate exercise program is safe for children with juvenile DM.
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Affiliation(s)
- Susan M Maillard
- Juvenile Dermatomyositis Research Centre, Institute of Child Health, University College of London, London, United Kingdom.
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15
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Abstract
Imaging techniques have assumed increasing importance in the diagnostic approach to patients with muscle disease. These techniques include computed tomography, ultrasound, and magnetic resonance imaging (MRI). For most disorders of muscle, ultrasound and MRI are more useful than computed tomography. Advantages of ultrasound include accessibility at the bedside and lower cost. However, MRI remains the gold standard for detecting changes in muscle tissue. In some cases, MRI examinations can take the place of muscle biopsy for diagnosis. New advances in MRI include diffusion-weighted imaging, which permits assessment of fluid motion in muscles, and blood-oxygen-level-dependent imaging to evaluate tissue oxygenation.
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Affiliation(s)
- Nancy J Olsen
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
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16
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Chung YL, Rider LG, Bell JD, Summers RM, Zemel LS, Rennebohm RM, Passo MH, Hicks J, Miller FW, Scott DL. Muscle metabolites, detected in urine by proton spectroscopy, correlate with disease damage in juvenile idiopathic inflammatory myopathies. ACTA ACUST UNITED AC 2005; 53:565-70. [PMID: 16082628 DOI: 10.1002/art.21331] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess for novel markers of muscle damage using urinary muscle metabolites by 1H magnetic resonance spectroscopy in patients with juvenile idiopathic inflammatory myopathy (IIM). METHODS Creatine (Cr), choline (Cho), betaine (Bet), glycine (Gly), trimethylamine oxide (TMAO), and several other metabolites were measured in first morning void urine samples from 45 patients with juvenile IIM and from 35 healthy age-matched controls, and correlated with measures of myositis disease activity and damage. Urinary metabolite to age-adjusted creatinine (Cn) ratios were examined. RESULTS Age-adjusted initial Cr:Cn, Cho:Cn, Bet:Cn, Gly:Cn, and TMAO:Cn ratios were higher in patients with juvenile IIM than controls (P < 0.01). Cr:Cn ratios showed significant correlations with physician-assessed global disease damage (Spearman rs = 0.37; P = 0.01), Steinbrocker functional class (rs = 0.35; P = 0.02), serum Cr (rs = 0.72; P = 0.001), and lactate dehydrogenase (rs = 0.34; P = 0.03) levels. Cho:Cn (rs = 0.3; P = 0.05), Gly:Cn (rs = 0.33; P = 0.03), and TMAO:Cn (rs = 0.36; P = 0.02) ratios showed a significant correlation with serum aldolase levels. Cho:Cn ratios also showed a significant correlation with aspartate aminotransferase levels (rs = 0.35; P = 0.02). A linear regression model was used to evaluate the factors influencing urinary Cr:Cn ratios in the 43 patients with data sets available at the initial visit. The regression model explained 73% of the variation in Cr:Cn ratios. The most significant factor was the physician-assessed global disease damage (R2 = 0.50, P = 0.015). CONCLUSION Urinary Cr:Cn, Cho:Cn, Bet:Cn, Gly:Cn, and TMAO:Cn ratios are elevated in juvenile IIM and Cr:Cn correlates strongly with global disease damage. The Cr:Cn ratio may have potential utility as a marker of myositis disease damage.
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Affiliation(s)
- Y-L Chung
- GKT School of Medicine, Imperial College School of Medicine, Hammersmith Hospital Campus, London, United Kingdom.
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Huber AM, Feldman BM, Rennebohm RM, Hicks JE, Lindsley CB, Perez MD, Zemel LS, Wallace CA, Ballinger SH, Passo MH, Reed AM, Summers RM, White PH, Katona IM, Miller FW, Lachenbruch PA, Rider LG. Validation and clinical significance of the Childhood Myositis Assessment Scale for assessment of muscle function in the juvenile idiopathic inflammatory myopathies. ACTA ACUST UNITED AC 2004; 50:1595-603. [PMID: 15146430 DOI: 10.1002/art.20179] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the measurement characteristics of the Childhood Myositis Assessment Scale (CMAS) in children with juvenile idiopathic inflammatory myopathy (juvenile IIM), and to obtain preliminary data on the clinical significance of CMAS scores. METHODS One hundred eight children with juvenile IIM were evaluated on 2 occasions, 7-9 months apart, using various measures of physical function, strength, and disease activity. Interrater reliability, construct validity, and responsiveness of the CMAS were examined. The minimum clinically important difference (MID) and CMAS scores corresponding to various degrees of physical disability were estimated. RESULTS The intraclass correlation coefficient for 26 patients assessed by 2 examiners was 0.89, indicating very good interrater reliability. The CMAS score correlated highly with the Childhood Health Assessment Questionnaire (C-HAQ) score and with findings on manual muscle testing (MMT) (r(s) = -0.73 and 0.73, respectively) and moderately with physician-assessed global disease activity and skin activity, parent-assessed global disease severity, and muscle magnetic resonance imaging (r(s) = -0.44 to -0.61), thereby demonstrating good construct validity. The standardized response mean was 0.81 (95% confidence interval 0.53, 1.09) in patients with at least 0.8 cm improvement on a 10-cm visual analog scale for physician-assessed global disease activity, indicating strong responsiveness. In bivariate regression models predicting physician-assessed global disease activity, MMT remained significant in models containing the CMAS (P = 0.03) while the C-HAQ did not (P = 0.4). Estimates of the MID ranged from 1.5 to 3.0 points on a 0-52-point scale. CMAS scores corresponding to no, mild, mild-to-moderate, and moderate physical disability, respectively, were 48, 45, 39, and 30. CONCLUSION The CMAS exhibits good reliability, construct validity, and responsiveness, and is therefore a valid instrument for the assessment of physical function, muscle strength, and endurance in children with juvenile IIM. Preliminary data on MID and corresponding levels of disability should aid in the clinical interpretation of CMAS scores when assessing patients with juvenile IIM.
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Affiliation(s)
- Adam M Huber
- IWK Health Centre and Dalhousie University, 5850 University Avenue, Halifax, Nova Scotia B3J 3G9, Canada.
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Farber JM, Buckwalter KA. MR imaging in nonneoplastic muscle disorders of the lower extremity. Radiol Clin North Am 2002; 40:1013-31. [PMID: 12462466 DOI: 10.1016/s0033-8389(02)00049-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The exquisite tissue contrast and multiplanar capability of MRI make it the optimal imaging modality for diagnosing muscle injuries and other muscle disorders. These examinations can be performed with increasing speed because of improvements in gradient strength and software and coil design. Presently, some of the limitations of MRI of muscle relate to the lack of specificity of the findings. The advent of functional muscle MR[ will increase the understanding of human muscle diseases, and increasingly place MRI in a central role for diagnosis and follow-up analysis.
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Affiliation(s)
- Joshua M Farber
- Department of Radiology, Indiana University School of Medicine, University Hospital, 550 North University Boulevard, Room 0615, Indianapolis, IN 46202-5253, USA.
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Faingold R, Oudjhane K, Armstrong DC, Albuquerque PAB. Magnetic resonance imaging of congenital, inflammatory, and infectious soft-tissue lesions in children. Top Magn Reson Imaging 2002; 13:241-61. [PMID: 12409692 DOI: 10.1097/00002142-200208000-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging has the advantages of multiplanar capability and high degree of tissue differentiation. It is useful for assessing the extent of soft-tissue abnormalities, such as vascular malformations, inflammatory and infectious processes, muscle disorders, and limb hypertrophy. Magnetic resonance imaging is sensitive to the presence of water and edema and is a good indicator for early diagnosis of inflammation and its level of activity. Fat-saturation techniques, including T2-weighted sequences and inversion recovery imaging, optimize diagnostic accuracy. T1-weighted images are good at defining the distribution and proportion of fat in the body, so they are useful in evaluating syndromes of the limbs, including vascular malformations, as well as lipoatrophy-lipodystrophy conditions. Magnetic resonance imaging provides guidance for efficient tissue biopsy. It allows comprehensive pretherapeutic assessment of soft-tissue vascular anomalies. It constitutes a good modality for following up the natural history of soft-tissue disorders during childhood.
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Affiliation(s)
- Ricardo Faingold
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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Pachman LM. Juvenile dermatomyositis: immunogenetics, pathophysiology, and disease expression. Rheum Dis Clin North Am 2002; 28:579-602, vii. [PMID: 12380371 DOI: 10.1016/s0889-857x(02)00013-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Data are rapidly accumulating documenting disease susceptibility may be linked to genetic markers (DQA1*0501 or related alleles) which are associated with upregulation of IFN-alpha/beta inducible genes elicited in response to an antigen which may be viral. Continued immune-mediated inflammation, resulting in partial lipodystrophy and pathological calcifications, may be fanned by the increased production of TNF alpha usually associated with the TNF alpha-308A allele.
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Affiliation(s)
- Lauren M Pachman
- Division of Immunology/Rheumatology, Department of Pediatrics, Children's Memorial Institute for Education and Research, Feinberg School of Medicine, Northwestern University, 2300 Children's Plaza, Box #50, Chicago, IL 60614, USA.
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Abstract
Muscle derangements in athletes have a wide variety of causes, treatments, and prognoses. Given that the cause and severity of sports-related injuries may be difficult to determine clinically in some cases, MR imaging is utilized increasingly to evaluate muscle injuries in athletes. After reviewing useful MR imaging techniques, this article focuses on MR imaging of the most common causes of muscle pain and disability in athletes, including myotendinous strain, delayed onset muscle soreness, muscle contusion, myositis ossificans, muscle laceration, muscle herniation, and compartment syndrome. The differential diagnosis of various signal intensity abnormalities in muscle also is reviewed.
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Kimball AB, Summers RM, Turner M, Dugan EM, Hicks J, Miller FW, Rider LG. Magnetic resonance imaging detection of occult skin and subcutaneous abnormalities in juvenile dermatomyositis. Implications for diagnosis and therapy. ARTHRITIS AND RHEUMATISM 2000; 43:1866-73. [PMID: 10943878 DOI: 10.1002/1529-0131(200008)43:8<1866::aid-anr24>3.0.co;2-6] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the utility of magnetic resonance imaging (MRI) of skin, subcutaneous tissue, and fascia in evaluating disease activity in juvenile dermatomyositis (DM). METHODS Short tau inversion recovery (STIR) MRI of the proximal thighs and buttocks, cutaneous assessment, and other measures of disease activity were prospectively obtained in 26 children meeting criteria for probable or definite juvenile DM. Also undergoing STIR MRI assessment were 8 subjects who were being evaluated for muscle disorders and who were not diagnosed as having juvenile DM. RESULTS Skin, subcutaneous, or fascial edema of the thighs and buttocks were seen on STIR MRI in up to 85% of juvenile DM patients at baseline evaluation compared with no more than 38% of the comparison group without juvenile DM. In juvenile DM, STIR MRI skin and subcutaneous edema scores correlated (r(s) = 0.51, P = 0.008), as did fascial and muscle edema scores (r(s) = 0.58, P = 0.002). Skin global disease activity scores correlated with MRI skin edema scores (r(s) = 0.41, P = 0.04), and serum aldolase levels correlated with both MRI skin and subcutaneous edema scores (r = 0.44 and 0.40, P = 0.03 and 0.05 respectively). The extent and severity of STIR MRI changes in the skin, subcutaneous tissue, and fascia were not predicted by most other measures of juvenile DM disease activity. Five juvenile DM patients with thigh MRI subcutaneous edema developed clinically apparent calcinosis at the same location within 9 months. CONCLUSION Edema or inflammation in the skin, subcutaneous tissue, and fascia, found on STIR MRI, is common in juvenile DM patients and is often undetected by standard assessments. These MRI changes can precede the development of calcinosis. STIR MRI may be a useful adjunct for assessing disease activity and guiding the treatment of juvenile DM.
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