Younes M, Béjia I, Moussa A, Touzi M, Zrour S, Haddada F, Zakhama A, Bergaoui N
Service de rhumatologie, EPS Monastir 5000, Tunisie.
Rev Med Interne. 2004 Nov;25(11):829-32. doi: 10.1016/j.revmed.2004.07.012.
Oculomotor muscles (OMM) involvement in dermatomyositis (DM) and in rheumatoid arthritis (RA) is unusual. The DM always leads to OMM inflammation, whereas the RA particularly leads to tenosynovitis of the superior oblique muscle referred to as the Brown syndrome.
The patient is a 43-year-old woman who gives a 17-year-history of severe seropositive RA with bilateral coxite. She was hospitalized for acute painful proptosis. The clinical examination revealed an orbital erythema and a muscular rhizomelic weakness. The muscular enzymes were increased. The orbital CT revealed in the right side, an enlargement of the superior rectus muscle that was enhanced after intravenous injection, which is compatible with myositis involvement. The muscular biopsy practiced at the level of the calf showed the specific histological signs of the DM. This orbital involvement was resolved with a high dose of corticosteroids.
Our observation has the specificity of associating RA with DM with an involvement of the superior rectus muscle, which is due to the DM rather than the RA.
动眼肌（OMM）受累于皮肌炎（DM）和类风湿关节炎（RA）的情况并不常见。皮肌炎总是导致动眼肌炎症，而类风湿关节炎特别导致上斜肌腱鞘炎，即布朗综合征。
患者为一名43岁女性，有17年严重血清阳性类风湿关节炎伴双侧髋关节炎病史。她因急性疼痛性眼球突出入院。临床检查发现眼眶红斑和近端肌无力。肌酶升高。眼眶CT显示右侧上直肌增粗，静脉注射后增强，符合肌炎受累表现。小腿部位的肌肉活检显示了皮肌炎的特异性组织学特征。高剂量皮质类固醇治疗后眼眶受累情况得到缓解。
我们的观察具有将类风湿关节炎与皮肌炎相关联且累及上直肌的特异性，这是由皮肌炎而非类风湿关节炎所致。
