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[肌炎:从诊断到治疗]

[Myositis: from diagnosis to treatment].

作者信息

Schmidt Jens, Müller-Felber Wolfgang

机构信息

Abteilung für Neurologie und Schmerztherapie, Immanuel Klinik Rüdersdorf, Universitätsklinikum, Medizinische Hochschule Brandenburg Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Deutschland.

Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf, Deutschland.

出版信息

Nervenarzt. 2023 Jun;94(6):510-518. doi: 10.1007/s00115-023-01490-8. Epub 2023 May 24.

Abstract

BACKGROUND

Inflammatory diseases of the skeletal muscle are important, often severe diseases with a considerable impact on the quality of life. In addition to muscle weakness there is often involvement of other organs, such as the heart, lungs and esophagus with symptoms such as dyspnea or dysphagia.

PURPOSE

A fast and effective treatment is only possible by an early and reliable diagnosis according to current national and international standards.

METHODS

The diagnostic repertoire includes autoantibody testing, imaging, muscle biopsy, detection of extramuscular manifestations, e.g., by high-resolution lung computed tomography (CT) and an individualized tumor search. An optimal treatment and the avoidance of irreversible damage, such as a loss of walking ability, are only possible through a good interdisciplinary cooperation including neurology or pediatrics, rheumatology, dermatology, neuropathology, pulmonology and cardiology.

RESULTS

In addition to standard immunosuppression with glucocorticosteroids, azathioprine or methotrexate, escalation treatment with rituximab is now well established. Interdisciplinary treatment according to national and international standards, such as guidelines on myositis, should be coordinated at qualified centers of excellence.

DISCUSSION

Helpful resources are the MYOSITIS NETZ ( www.myositis-netz.de ) and the International Myositis Society (iMyoS; www.imyos.org ).

摘要

背景

骨骼肌炎性疾病很重要,通常是严重疾病,对生活质量有相当大的影响。除肌肉无力外,其他器官也常受累,如心脏、肺和食管,出现呼吸困难或吞咽困难等症状。

目的

只有根据当前国家和国际标准进行早期且可靠的诊断,才有可能实现快速有效的治疗。

方法

诊断方法包括自身抗体检测、影像学检查、肌肉活检、检测肌肉外表现,如通过高分辨率肺部计算机断层扫描(CT)和个体化肿瘤筛查。只有通过良好的跨学科合作,包括神经科或儿科、风湿病科、皮肤科、神经病理学、肺病科和心脏病科,才能实现最佳治疗并避免不可逆转的损害,如丧失行走能力。

结果

除了使用糖皮质激素、硫唑嘌呤或甲氨蝶呤进行标准免疫抑制外,现在利妥昔单抗的强化治疗已得到充分确立。应在合格的卓越中心协调根据国家和国际标准进行的跨学科治疗,如关于肌炎的指南。

讨论

有用的资源有肌炎网络(www.myositis-netz.de)和国际肌炎协会(iMyoS;www.imyos.org)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160d/10208204/958cfa360e11/115_2023_1490_Fig1_HTML.jpg

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