Lee Jung Sun, Lee Jung Eun, Hong Seokchan, Lee Chang-Keun, Yoo Bin, Oh Ji Seon, Kim Yong-Gil
Division of Rheumatology, Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea.
Asan Institute of Life Sciences, Asan Medical Centre, Seoul, Korea.
Ther Adv Musculoskelet Dis. 2020 Oct 16;12:1759720X20936822. doi: 10.1177/1759720X20936822. eCollection 2020.
Several studies have been conducted on factors associated with mortality in idiopathic inflammatory myopathies (IIMs), but few studies have assessed prognostic factors for steroid-free remission in IIM. We investigated the various clinical factors, including body measurements, that affect IIM treatment outcomes.
Patients who were newly diagnosed with IIM between 2000 and 2018 were included. Steroid-free remission was defined as at least 3 months of normalisation of muscle enzymes and no detectable clinical disease activity. The factors associated with steroid-free remission were evaluated by a Cox regression analysis.
Of the 106 IIM patients, 35 displayed steroid-free remission during follow-up periods. In the multivariable Cox regression analyses, immunosuppressants' early use within 1 month after diagnosis [hazard ratio (HR) 6.21, 95% confidence interval (CI) 2.61-14.74, < 0.001] and sex-specific height quartiles (second and third quartiles first quartile, HR 3.65, 95% CI 1.40-9.51, = 0.008 and HR 2.88, 95% CI 1.13-7.32, = 0.027, respectively) were positively associated with steroid-free remission. Polymyositis dermatomyositis (HR 0.21, 95% CI 0.09-0.53, = 0.001), presence of dysphagia (HR 0.15, CI 0.05-0.50, = 0.002) and highest lowest quartile of waist circumference (WC; HR 0.24, 95% CI 0.07-0.85, = 0.027) were negatively associated with steroid-free remission.
The early initiation of immunosuppressant therapy, type of myositis and presence of dysphagia are strong predictors of steroid-free remission in IIM; moreover, height and WC measurements at baseline may provide additional important prognostic value.
关于特发性炎症性肌病（IIM）死亡相关因素已开展多项研究，但很少有研究评估IIM中无激素缓解的预后因素。我们调查了包括身体测量指标在内的各种临床因素对IIM治疗结果的影响。
纳入2000年至2018年间新诊断为IIM的患者。无激素缓解定义为肌肉酶正常化至少3个月且无可检测到的临床疾病活动。通过Cox回归分析评估与无激素缓解相关的因素。
106例IIM患者中，35例在随访期间出现无激素缓解。在多变量Cox回归分析中，诊断后1个月内早期使用免疫抑制剂[风险比（HR）6.21，95%置信区间（CI）2.61 - 14.74，P < 0.001]以及按性别划分的身高四分位数（第二和第三四分位数对比第一四分位数，HR分别为3.65，95% CI 1.40 - 9.51，P = 0.008和HR 2.88，95% CI 1.13 - 7.32，P = 0.027）与无激素缓解呈正相关。多发性肌炎/皮肌炎（HR 0.21，95% CI 0.09 - 0.53，P = 0.001）、存在吞咽困难（HR 0.15，CI 0.05 - 0.50，P = 0.002）以及腰围（WC）最高四分位数对比最低四分位数（HR 0.24，95% CI 0.07 - 0.85，P = 0.027）与无激素缓解呈负相关。
免疫抑制剂治疗的早期启动、肌炎类型和吞咽困难的存在是IIM无激素缓解的有力预测因素；此外，基线时的身高和WC测量可能提供额外的重要预后价值。
