Farrow Matthew, Biglands John, Alfuraih Abdulrahman M, Wakefield Richard J, Tan Ai Lyn
Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, United Kingdom.
NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Front Med (Lausanne). 2020 Aug 12;7:434. doi: 10.3389/fmed.2020.00434. eCollection 2020.
In recent years, imaging has played an increasing role in the clinical management of patients with rheumatic diseases with respect to aiding diagnosis, guiding therapy and monitoring disease progression. These roles have been underpinned by research which has enhanced our understanding of disease pathogenesis and pathophysiology of rheumatology conditions, in addition to their key role in outcome measurement in clinical trials. However, compared to joints, imaging research of muscles is less established, despite the fact that muscle symptoms are very common and debilitating in many rheumatic diseases. Recently, it has been shown that even though patients with rheumatoid arthritis may achieve clinical remission, defined by asymptomatic joints, many remain affected by lingering constitutional systemic symptoms like fatigue, tiredness, weakness and myalgia, which may be attributed to changes in the muscles. Recent improvements in imaging technology, coupled with an increasing clinical interest, has started to ignite new interest in the area. This perspective discusses the rationale for using imaging, particularly ultrasound and MRI, for investigating muscle pathology involved in common inflammatory rheumatic diseases. The muscles associated with rheumatic diseases can be affected in many ways, including myositis-an inflammatory muscle condition, and myopathy secondary to medications, such as glucocorticoids. In addition to non-invasive visual assessment of muscles in these conditions, novel imaging techniques like shear wave elastography and quantitative MRI can provide further useful information regarding the physiological and biomechanical status of the muscle.
近年来，在风湿性疾病患者的临床管理中，影像学在辅助诊断、指导治疗和监测疾病进展方面发挥着越来越重要的作用。这些作用得到了研究的支持，这些研究不仅增强了我们对风湿病发病机制和病理生理学的理解，还凸显了其在临床试验结果测量中的关键作用。然而，与关节相比，尽管肌肉症状在许多风湿性疾病中非常常见且使人衰弱，但肌肉的影像学研究却不太成熟。最近有研究表明，尽管类风湿关节炎患者可能实现临床缓解（以无症状关节为定义），但许多患者仍受疲劳、疲倦、虚弱和肌痛等持续存在的全身性症状的影响，这些症状可能归因于肌肉的变化。影像学技术的最新进展，加上临床兴趣的增加，已开始引发该领域的新关注。本文观点讨论了使用影像学（尤其是超声和磁共振成像）来研究常见炎症性风湿性疾病中涉及的肌肉病理学的基本原理。与风湿性疾病相关的肌肉可能会以多种方式受到影响，包括肌炎（一种炎症性肌肉疾病）以及继发于药物（如糖皮质激素）的肌病。除了对这些情况下的肌肉进行非侵入性视觉评估外，诸如剪切波弹性成像和定量磁共振成像等新型成像技术还可以提供有关肌肉生理和生物力学状态的更多有用信息。
