Ytterberg Steven R
Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Curr Rheumatol Rep. 2006 Jun;8(3):167-73. doi: 10.1007/s11926-996-0021-7.
Polymyositis (PM) and dermatomyositis (DM) are autoimmune inflammatory diseases that primarily target muscle. Although similar, PM and DM have different pathophysiologic mechanisms. Current therapy for PM and DM does not take into account these pathophysiologic differences. Recent work has started to define outcome measures to apply to future therapeutic trials, which will allow better comparison of treatment outcomes. For patients who are unresponsive to standard therapy with high dose prednisone supplemented by methotrexate and/or azathioprine it is not clear what represents the next best choice for therapy. Although there are few controlled studies in the area, there is reason to be optimistic for use of intravenous methylprednisolone pulses, intravenous gammaglobulin, cyclosporine A, tacrolimus, mycophenolate mofetil, and rituximab for nonresponding patients. Better understanding of the underlying pathophysiology of PM and DM, as well as carefully performed multicenter clinical trials is going to be necessary to make better recommendations in the future.
多发性肌炎（PM）和皮肌炎（DM）是主要累及肌肉的自身免疫性炎症性疾病。虽然PM和DM相似，但它们有不同的病理生理机制。目前针对PM和DM的治疗并未考虑到这些病理生理差异。最近的研究已开始确定适用于未来治疗试验的疗效指标，这将有助于更好地比较治疗结果。对于对高剂量泼尼松联合甲氨蝶呤和/或硫唑嘌呤的标准治疗无反应的患者，尚不清楚接下来最佳的治疗选择是什么。尽管该领域的对照研究较少，但对于无反应患者使用静脉注射甲泼尼龙冲击治疗、静脉注射免疫球蛋白、环孢素A、他克莫司、霉酚酸酯和利妥昔单抗，仍有理由感到乐观。未来要做出更好的推荐，有必要更好地了解PM和DM的潜在病理生理学，并开展精心实施的多中心临床试验。
