Department of Internal Medicine and Clinical Immunology, National Reference Center of Neuromuscular disorders, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France.
Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, Dijon, France.
J Neuromuscul Dis. 2019;6(1):99-107. doi: 10.3233/JND-180358.
Manual muscle testing has been widely used for the evaluation of muscle strength in myositis, yet less attention has been devoted to the evaluation of muscle function and endurance.
Our objective was therefore to compare the responsiveness to change of muscle strength, endurance and functional testing following induction therapy for severe myositis flare (requiring high-dose corticosteroids and combined immunotherapy) in patients with a diagnosis of dermatomyositis, immune-mediated necrotizing myopathy, or overlap myositis.
Muscle status was assessed at baseline and after mean 6.4±1.9 months, using the MRC-5 scale, along with endurance (Barre and Mingazzini maneuvers) and functional evaluation (e.g. chair rise) and responsiveness to change was evaluated using the Standardized Response Mean (SRM) and Standardized Mean Difference.
Among the 49 patients included, the strongest responsiveness to change was observed in the muscle testing of the psoas and deltoids (SRM: 1.23 and 1.16, respectively). Noticeably, endurance testing also demonstrated strong responsiveness (SRM: 1.05 and 0.96, respectively), compensating for the poor discriminatory ability of muscle testing and permitting to overcome its ceiling effect.
Functional and endurance testing provide simple and reliable measures complementing the testing of select proximal muscle groups to evaluate responsiveness to intervention in myositis patients in daily clinical practice. Interest of functional and endurance testing should be evaluated prospectively as outcome measures in myositis clinical trials.
肌肉力量的评估在肌炎中广泛应用于手动肌肉测试，但对于肌肉功能和耐力的评估关注较少。
因此，我们的目的是比较在严重肌炎发作（需要大剂量皮质类固醇和联合免疫疗法）后，皮肌炎、免疫介导的坏死性肌病或重叠性肌炎患者的肌肉力量、耐力和功能测试的变化反应性。
使用 MRC-5 量表评估基线和平均 6.4±1.9 个月后的肌肉状态，以及耐力（Barre 和 Mingazzini 动作）和功能评估（例如椅子上升），并使用标准化反应均值（SRM）和标准化均数差评估变化的反应性。
在纳入的 49 名患者中，腰大肌和三角肌的肌肉测试显示出最强的变化反应性（SRM：分别为 1.23 和 1.16）。值得注意的是，耐力测试也显示出很强的反应性（SRM：分别为 1.05 和 0.96），弥补了肌肉测试的较差鉴别能力，并能够克服其上限效应。
功能和耐力测试提供了简单可靠的措施，补充了选择的近端肌肉群的测试，以评估日常临床实践中肌炎患者的干预反应性。在肌炎临床试验中，应前瞻性评估功能和耐力测试作为结局指标的兴趣。
