Idiopathic Inflammatory Myositis
Özet
Idiopathic inflammatory myositis (IIM) is a systemic autoimmune disease with heterogeneous subgroups, mainly characterized by muscle pain and muscle weakness caused by muscle inflammation. IIM diagnoses are based on clinical, laboratory, radiological, electrophysiological, and histopathological findings. IIM can be divided into subgroups in tight of new myositis-specific autoantibodies (MSA), histopathological developments, and classification criteria. These are dermatomyositis (DM), immune-mediated necrotizing myopathy (IMNM), overlap myositis (OM), inclusion body myositis (ICM), amyopathic dermatomyositis (ADM), polymyositis (PM), and cancer-associated myositis. Different subgroups have different clinical, histopathological findings, autoantibody profiles, prognosis, and treatment responses. 30-40% of patients achieve clinical remission with treatment, but 10% have recurrent disease. Mortality is usually due to cardiac (22%), pulmonary complications (22%), infections (15%),and malignancy (11%). IIM is related to an increased risk of heart disease, but the prevalence remains unclear. Approximately 70% of patients may have only subclinical symptoms. The three main causes of cardiac mortality in IIM patients are congestive heart failure, myocardial infarction, and arrhythmias. Evaluation of cardiac function at the time of diagnosis and during follow-up in every patient with myositis is important for early diagnosis and treatment, even in patients with remission.
İdiyopatik inflamatuar miyozit (İİM), esas olarak kas iltihabının neden olduğu kas ağrısı ve kas güçsüzlüğü ile karakterize, heterojen alt gruplara sahip sistemik bir otoimmün hastalıktır. İİM tanıları klinik, laboratuvar, radyolojik, elektrofizyolojik ve histopatolojik bulgulara dayanmaktadır. İİM, yeni miyozite özgü otoantikorlar (MSA), histopatolojik gelişmeler ve sınıflandırma kriterlerine göre alt gruplara ayrılabilir. Bunlar dermatomiyozit (DM), immün aracılı nekrotizan miyopati (İMNM), overlap miyozit (OM), inklüzyon cisimcikli miyozit (İKM), amiyopatik dermatomiyozit (ADM), polimiyozit (PM) ve kanserle ilişkili miyozittir. Farklı subgrupların farklı klinik, histopatolojik bulguları, otoantikor profilleri, prognoz ve tedavi yanıtları vardır. Hastaların %30-40'ı tedavi ile klinik remisyona ulaşır, ancak %10'unda relaps görülür. Mortalite genellikle kardiyak (%22), pulmoner komplikasyonlar (%22), enfeksiyonlar (%15) ve malignite (%11) nedeniyledir. İİM kalp hastalığı riskinin artmasıyla ilişkilidir, ancak yaygınlığı belirsizliğini korumaktadır. Hastaların yaklaşık %70'inde yalnızca subklinik semptomlar olabilir. İİM hastalarında kardiyak mortalitenin üç ana nedeni konjestif kalp yetmezliği, miyokard enfarktüsü ve aritmilerdir. Miyozitli her hastada tanı anında ve takip sırasında kardiyak fonksiyonun değerlendirilmesi erken tanı ve tedavi için önemlidir.
Referanslar
Selva-O'Callaghan A, Pinal-Fernandez I, Trallero-Araguás E, et al. Classification and management of adult inflammatory myopathies. Lancet Neurol. 2018 Sep;17(9):816-828.
Meyer A, Meyer N, Schaeffer M, et al. Incidence and prevalence of inflammatory myopathies: a systematic review. Rheumatology (Oxford). 2015 Jan;54(1):50-63.
Khadilkar SV, Dhamne MC. What is New in Idiopathic Inflammatory Myopathies: Mechanisms and Therapies. Ann Indian Acad Neurol. 2020 Jul-Aug;23(4):458-467.
Leclair V, Notarnicola A, Vencovsky J, et al. Polymyositis: does it really exist as a distinct clinical subset? Curr Opin Rheumatol. 2021 Nov 1;33(6):537-543.
Malik A, Hayat G, Kalia JS, et al. Idiopathic Inflammatory Myopathies: Clinical Approach and Management. Front Neurol. 2016 May 20;7:64.
Mariampillai K, Granger B, Amelin D, et al. Development of a New Classification System for Idiopathic Inflammatory Myopathies Based on Clinical Manifestations and Myositis-Specific Autoantibodies. JAMA Neurol. 2018 Dec 1;75(12):1528-1537
McHugh NJ, Tansley SL. Autoantibodies in myositis. Nat Rev Rheumatol. 2018 Apr 20;14(5):290-302.
Bohan A, Peter JB. Polymyositis and dermatomyositis. N Engl J Med. 1975;292:403–7.
Lundberg IE, Tjarnlund A, Bottai M, et al. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Arthritis Rheumatol. 2017;69:2271–82
Waldman R, DeWane ME, Lu J. Dermatomyositis: Diagnosis and treatment. J Am Acad Dermatol. 2020 Feb;82(2):283-296.
Pinal-Fernandez I, Casal-Dominguez M, Mammen AL. Immune-Mediated Necrotizing Myopathy. Curr Rheumatol Rep. 2018 Mar 26;20(4):21.
Jabari D, Vedanarayanan VV, Barohn RJ, et al. Update on Inclusion Body Myositis. Curr Rheumatol Rep. 2018 Jun 28;20(8):52.
Lepreux S, Hainfellner JA, Vital A. Idiopathic inflammatory myopathies overlapping with systemic diseases. Clin Neuropathol. 2018 Jan/Feb;37(1):6-15.
Qiang JK, Kim W B, Baibergenova A,et al. Risk of Malignancy in Dermatomyositis and Polymyositis. J Cutan Med Surg.2017;21(2):131-
Baig S, Paik JJ. Inflammatory muscle disease - An update. Best Pract Res Clin Rheumatol. 2020 Feb;34(1):101484.
de Souza FHC, de Araújo DB, Vilela VS, et al. Guidelines of the Brazilian Society of Rheumatology for the treatment of systemic autoimmune myopathies. Adv Rheumatol. 2019 Jan 22;59(1):6
Schwartz T, Diederichsen LP, Lundberg IE, et al. Cardiac involvement in adult and juvenile idiopathic inflammatory myopathies. RMD Open. 2016 Sep 27;2(2):e000291.
Opinc AH, Makowski MA, Łukasik ZM, et al. Cardiovascular complications in patients with idiopathic inflammatory myopathies: does heart matter in idiopathic inflammatory myopathies? Heart Fail Rev. 2021 Jan;26(1):111-125.
