Department of Endocrinology, Diabetology, and Rheumatology, Heinrich Heine University, Düsseldorf, Germany.
Clin Rheumatol. 2010 May;29(5):555-8. doi: 10.1007/s10067-009-1367-9. Epub 2010 Jan 27.
Adult inflammatory myopathies are rare conditions. Amongst them, inclusion body myositis (IBM) is considered to be the most common acquired myopathy in adults above 50 years of age, follows a slowly progressive course, and ultimately leads to severe disability. The case of a 57-year-old patient with long standing rheumatoid arthritis (RA) who developed muscle wasting and weakness of the quadriceps femoris after initiation of anti-TNFalpha treatment is presented. Further workup including muscle biopsy revealed IBM. Initiation of rituximab for continuing synovial inflammation led to remission of RA, but no amelioration of muscle weakness was noted. Although cases of IBM in patients with autoimmune disorders have occasionally been reported and are believed to more favourably respond to immunosuppressive treatment, our patient was unresponsive to glucocorticoids. Furthermore, deterioration of muscle strength was noted with both adalimumab and etanercept treatment. Rituximab, not previously used in IBM, successfully controlled RA, but showed no effect on muscle strength. The present case underlines the therapeutic difficulties in IBM and suggests that anti-TNFalpha therapy might even be deleterious. While an early trial of the lymphocyte-depleting antibody alemtuzumab in IBM showed promising results, selective anti-B-cell-therapy remained without effect in our patient.
成人炎性肌病较为罕见。其中，包涵体肌炎（IBM）被认为是 50 岁以上成年人中最常见的获得性肌病，呈缓慢进展性病程，最终导致严重残疾。本文报道了 1 例 57 岁患者，该患者患有长期类风湿关节炎（RA），在开始抗 TNF-α 治疗后出现股四头肌肌肉萎缩和无力。进一步的检查包括肌肉活检提示 IBM。为控制持续性滑膜炎而开始使用利妥昔单抗治疗后，RA 缓解，但肌肉无力无改善。尽管偶尔有报道称自身免疫性疾病患者中存在 IBM，且据信此类患者对免疫抑制治疗反应更好，但该患者对糖皮质激素无反应。此外，阿达木单抗和依那西普治疗均导致肌肉力量恶化。利妥昔单抗以前未用于 IBM，但成功控制了 RA，但对肌肉力量无影响。本病例强调了 IBM 的治疗困难，并提示抗 TNF-α 治疗甚至可能有害。虽然 IBM 早期的临床试验显示淋巴细胞耗竭抗体阿仑单抗有良好的效果，但选择性抗 B 细胞治疗对该患者无效。
