磁共振成像显示的新发多肌痛性风湿症局部肌筋膜炎症及托珠单抗治疗的效果
Localized Myofascial Inflammation Revealed by Magnetic Resonance Imaging in Recent-onset Polymyalgia Rheumatica and Effect of Tocilizumab Therapy.
作者信息
Laporte Jean-Patrick, Garrigues Florent, Huwart Anaïs, Jousse-Joulin Sandrine, Marhadour Thierry, Guellec Dewi, Cornec Divi, Devauchelle-Pensec Valérie, Saraux Alain
机构信息
From the Radiology department, Centre Hospitalier Universitaire (CHU) de Brest; Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest; INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest, Brest, France.
J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest.
出版信息
J Rheumatol. 2019 Dec;46(12):1619-1626. doi: 10.3899/jrheum.180958. Epub 2019 Mar 15.
OBJECTIVE
To assess the prevalence of myofascial inflammatory lesions visible by magnetic resonance imaging (MRI) and their changes after tocilizumab (TCZ) therapy in active polymyalgia rheumatica (PMR).
METHODS
We conducted a posthoc analysis of data from the TENOR study of TCZ monotherapy in PMR. The 18 patients each received TCZ injections at weeks 0, 4, and 8. The shoulder and pelvic girdles were assessed at baseline then at weeks 2 and 12 using T1- and T2- short-tau inversion recovery-weighted MRI. Radiologists blinded to patient data assessed each muscle group for localized myofascial inflammation on baseline, Week 2, and Week 12 MRI. Reproducibility was estimated by having 2 radiologists assess the Week 2 MRI of 13 patients, then computing the κ coefficient.
RESULTS
For myofascial lesion detection, intraobserver reproducibility was almost perfect (κ = 0.890) and interobserver reproducibility was substantial (κ = 0.758). At baseline, all patients had at least 1 inflammatory myofascial lesion; sites involved were the shoulder in 10 (71.4%) patients, hip in 13 (86.7%), ischial tuberosity in 9 (60.0%), and pubic symphysis in 12 (80.0%). Sites involved at Week 12 were the shoulder in 8 patients (53.3%), hip in 5 (33.3%), ischial tuberosity in 1, and pubic symphysis in 3 (20.0%). At Week 12, of 103 muscle groups studied in all, 43 (41.7%) had no inflammatory lesions, compared to 33 at baseline (p = 0.002); improvements were noted in 66 (64.1%) muscle groups, worsening in 2 (1.9%), no change in 35 (34.0%; p 0.034).
CONCLUSION
Localized myofascial inflammatory lesions are common in recent-onset PMR and improve during TCZ therapy. Clinicaltrials.gov (NCT01713842).
目的
评估在活动期风湿性多肌痛（PMR）中，磁共振成像（MRI）可见的肌筋膜炎性病变的患病率及其在托珠单抗（TCZ）治疗后的变化。
方法
我们对PMR中TCZ单药治疗的TENOR研究数据进行了事后分析。18例患者分别在第0、4和8周接受TCZ注射。在基线时以及第2周和第12周使用T1加权和T2加权短反转恢复序列MRI对肩胛带和骨盆带进行评估。对患者数据不知情的放射科医生在基线、第2周和第12周的MRI上评估每个肌肉群的局限性肌筋膜炎症。通过让2名放射科医生评估13例患者的第2周MRI，然后计算κ系数来估计可重复性。
结果
对于肌筋膜病变检测，观察者内可重复性几乎完美（κ = 0.890），观察者间可重复性较高（κ = 0.758）。在基线时，所有患者至少有1个炎性肌筋膜病变；受累部位为肩部的有10例（71.4%）患者，髋部的有13例（86.7%），坐骨结节的有9例（60.0%），耻骨联合的有12例（80.0%）。第12周时受累部位为肩部的有8例患者（53.3%），髋部的有5例（33.3%），坐骨结节的有1例，耻骨联合的有3例（20.0%）。在第12周时，在总共研究的103个肌肉群中，43个（41.7%）没有炎性病变，而基线时为33个（p = 0.002）；66个（64.1%）肌肉群有改善，2个（1.9%）恶化，35个（34.0%）无变化（p < 0.034）。
结论
局限性肌筋膜炎性病变在近期发病的PMR中很常见，且在TCZ治疗期间有所改善。Clinicaltrials.gov（NCT01713842）。
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