National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.
Best Pract Res Clin Rheumatol. 2020 Feb;34(1):101486. doi: 10.1016/j.berh.2020.101486. Epub 2020 Feb 13.
The idiopathic inflammatory myopathies are a group of heterogeneous autoimmune connective tissue diseases. Despite increase in the understanding of these conditions, securing a timely diagnosis and accurate subtype classification remains difficult in some cases. This has important implications for patients, where delayed or inappropriate treatments can have a negative effect on outcomes. Several conditions can mimic myositis, including metabolic myopathies, genetic myopathies and neurological disease. In addition, the heterogeneity within the idiopathic inflammatory myopathy spectrum can also create diagnostic confusion, referred to here as 'myositis chameleons'. This includes inclusion body myositis, immune-mediated necrotizing myopathy, hypomyopathic variants of anti-synthetase syndrome and overlap disease. We highlight the importance of a thorough diagnostic workup, refer to updated classification criteria and emphasize the importance of myositis autoantibody testing. Where diagnostic doubt exists, the involvement of a specialist centre and a multidisciplinary team is vital.
特发性炎性肌病是一组异质性自身免疫性结缔组织疾病。尽管对这些疾病的认识有所增加，但在某些情况下，仍难以及时诊断和准确地进行亚型分类。这对患者有重要的影响，因为延迟或不适当的治疗可能对结果产生负面影响。有几种疾病可以模仿肌炎，包括代谢性肌病、遗传性肌病和神经疾病。此外，特发性炎性肌病谱内的异质性也会造成诊断上的混淆，这里称为“肌炎变色龙”。这包括包涵体肌炎、免疫介导的坏死性肌病、抗合成酶综合征的低肌病变体和重叠疾病。我们强调了彻底的诊断性检查的重要性，提到了更新的分类标准，并强调了肌炎自身抗体检测的重要性。在存在诊断疑虑的情况下，专科中心和多学科团队的参与至关重要。
