| Objective:Analysis of clinical data of 75 adult myositis,to conclude the antibody,muscular imaging and pathological characteristics of the disease.It is helpful for the early diagnosis and classification of myositis,as well as for the prediction of complications and prognosis.Method:75 adult myositis patients who diagnosed in the First Hospital of Jilin University from January 2017 to December 2019 were selected for the study.The clinical data such as gender,age of onset,clinical symptoms,biochemiscal and electrophysiological examination,imaging examination,and muscle pathology were collected.Statistical description and correlation analysis of the collected data.Result:1.A total of 75 with adult myositis were recruited in this study,including 32 males and 43 females,the male: female ratio was 1:1.34.The age of onset was 20-73 years old,the mean age of symptom onset was 50.9±13.4 years old.The median course was 2 months.There was no family history.Myasthenia(78.67%)and myalgia(58.67%)were the main clinical manifestations.Interstitial lung disease(46.67%)was the most common complication.Other complications include joint symptoms,dry mouth/dry eyes,dysphagia,etc.Serious pulmonary infectious diseases may be one of the causes of death.The positive rate of myositis specific antibodies(MSAs)was 77.33%.The anti-Jo-1 antibody and anti-MDA5 antibody were the most common in all types of MSAs,with positive rate of 16.00%.The positive rate of MAAs was 58.67%,of which anti-SSA/ Ro52 antibody was the most common(53.33%).The positive rate of EMG was 65.63%.Group analysis: Patients with overlap myositis were more likely to have interstitial lung disease and joint symptoms(P < 0.05).Patients with immune-mediated necrotizing myopathy had the highest serum creatine kinase level and the most serious muscle damage(P < 0.05).2.Anti-Jo-1 antibody,anti-MDA5 antibody and anti-SSA/Ro52 antibody positive were correlated with interstitial lung disease(P < 0.05).Logistic regression analysis: anti-MDA5 antibody and anti-SSA/Ro52 antibody positive were independent risk factors for interstitial lung disease.Anti-Jo-1 antibody and anti-SSA/Ro52 antibody positive were correlated with joint symptoms(P < 0.05).Logistic regression analysis:Anti-Jo-1 antibody positive was an independent risk factor for joint symptoms.3.The positive rate of muscle MRI was 84.85%.The main characteristics were inflammatory muscle edema(84.85%),myofascial inflammatory edema(30.30%),muscle atrophy and fatty infiltration(27.27%),subcutaneous connective tissue edema(6.06%).Inflammatory muscle edema can be found in all types of myositis,myofascial inflammatory edema and subcutaneous connective tissue edema were mainly found in patients with dermatomyositis and anti-synthetase syndrome,muscle atrophy and fatty infiltration were mainly found in patients with immune-mediated necrotizing myopathy.The most frequently involved muscles in the thigh were adductor major,lateral femoris and medial femoris muscle.4.The positive rate of skeletal muscle biopsy was 74.67%.Necrosis,and regeneration of muscle fibers,perifascicular atrophy(24.14%)were typical pathological characteristics of dermatomyositis.Necrosis and regeneration of muscle fibers in different stages,without or with a small amount of macrophage infiltration were typical pathological characteristics of immune-mediated necrotizing myopathy.Scattered necrotic and regenerated muscle fibers with inflammatory cell infiltration were typical pathological manifestations of overlap myositis.Conclusion:1.The level of serum creatine kinase was the highest and the muscle damage was the most serious in immune-mediated necrotizing myopathy.Overlapping myositis is easy to involve extramuscular organs such as lungs and joints.2.Anti-MDA5 antibody and anti-SSA/Ro52 antibody were independent risk factors for adult myositis with interstitial lung disease.Anti-Jo-1 antibody positive was an independent risk factor for adult myositis with joint symptoms.3.The main manifestations of myositis in muscle MRI were inflammatory muscle edema,myofascial inflammatory edema,muscle atrophy and fatty infiltration,subcutaneous connective tissue edema;in addition,muscle MRI can be used to monitor the therapeutic effect.4.The pathological characteristics of dermatomyositis was perifascicular atrophy;the pathological characteristics of immunemediated necrotizing myopathy was necrosis and regeneration of muscle fibers in different stages,without or with a small amount of macrophage infiltration;the pathological characteristics of overlapping myositis was scattered necrosis and regeneration of muscle fibers,with inflammatory cell infiltration. |
PDF Full Text Request