Mimura T, Kanda H, Kubo K
Departments of Allergy/Rheumatology and Nephrology/Endocrinology, University of Tokyo.
Nihon Rinsho. 2001 Oct;59(10):2062-70.
It is well known that a certain percentage of patients with polymyositis and dermatomyositis (PM/DM) is corticosteroid resistant. Established and novel approaches to steroid-resistant PM/DM are discussed in this review. Methotrexate (MTX) is a first-line treatment in the case that steroid therapy fails. Azathioprine and cyclophosphamide also fall into this category. Cyclosporine, a specific inhibitor of calcineurin, has been reported almost as effective as MTX. Tacrolimus, also a calcineurin inhibitor, and mycophenolate mofetil could be additional alternatives for the treatment. Several clinical trials have demonstrated that high-dose intravenous immunoglobulin is promising. Recently favorable data have been published using intravenous high-dose pulse cyclophosphamide or cyclosporine for the poorly prognostic interstitial pneumonitis or pulmonary fibrosis accompanied with PM/DM.
众所周知，一定比例的多发性肌炎和皮肌炎（PM/DM）患者对皮质类固醇耐药。本综述讨论了针对类固醇耐药性PM/DM的既定方法和新方法。在类固醇治疗失败的情况下，甲氨蝶呤（MTX）是一线治疗药物。硫唑嘌呤和环磷酰胺也属于这一类。环孢素是钙调神经磷酸酶的特异性抑制剂，据报道其疗效几乎与MTX相同。他克莫司也是一种钙调神经磷酸酶抑制剂，霉酚酸酯可能是另外的治疗选择。多项临床试验表明，大剂量静脉注射免疫球蛋白很有前景。最近，关于使用静脉大剂量脉冲环磷酰胺或环孢素治疗预后不良的间质性肺炎或伴有PM/DM的肺纤维化的有利数据已发表。
