University of Cyprus Medical School, Nicosia, Cyprus.
University of Cyprus, Palaios dromos Lefkosias Lemesou No. 215/6, Aglantzia, Nicosia, 2029, Cyprus.
Rheumatol Int. 2024 Nov;44(11):2371-2379. doi: 10.1007/s00296-024-05719-w. Epub 2024 Sep 16.
Idiopathic granulomatous mastitis (IGM) is an inflammatory breast disorder of unknown etiology. This benign condition can mimic the clinical presentation of breast cancer and is characterized by symptoms such as breast pain, erythema, and swelling. Over the past few years, Disease-Modifying Antirheumatic Drugs (DMARDs) have been increasingly used to manage this condition. However, strong evidence to support their use is lacking.
This systematic review aimed to summarize the evidence and evaluate the efficacy of DMARDs in the management of IGM.
A systematic literature review, adhering to PRISMA guidelines, was conducted across electronic databases, including PubMed, EMBASE, SCOPUS, directory of open access journals (DOAJ) and Cochrane Library from their inception until May 2024. We included retrospective and prospective studies while excluding case reports and case series of less than 10 patients.
Eighteen studies met our eligibility criteria. Fifteen studies were retrospective, while 2 were prospective. No randomized controlled trials were identified. Of these, 16 papers examined the effect of methotrexate on IGM, revealing significant disease improvement in most cases. Several of the studies indicated that patients treated with azathioprine and mycophenolate mofetil also achieved favorable responses.
Given the rarity of IGM, only a limited number of studies have explored the use of DMARDs as a pharmacological treatment option. A significant barrier to advancing our understanding is the substantial heterogeneity in the quality and volume of data provided by these studies. Therefore, there is a need for well-designed, randomized, placebo-controlled trials to rigorously assess the efficacy of DMARDs in the treatment of IGM.
特发性肉芽肿性乳腺炎（IGM）是一种病因不明的炎症性乳腺疾病。这种良性疾病可能会模仿乳腺癌的临床表现，其特征是乳房疼痛、红斑和肿胀等症状。近年来，疾病修饰抗风湿药物（DMARDs）已越来越多地用于治疗这种疾病。然而，缺乏支持其使用的有力证据。
本系统评价旨在总结 DMARDs 治疗 IGM 的证据并评估其疗效。
按照 PRISMA 指南，我们对电子数据库（包括 PubMed、EMBASE、SCOPUS、开放获取期刊目录（DOAJ）和 Cochrane 图书馆）进行了系统文献检索，检索时间从建库开始至 2024 年 5 月。我们纳入了回顾性和前瞻性研究，排除了病例报告和少于 10 例患者的病例系列研究。
符合纳入标准的研究有 18 项。其中 15 项为回顾性研究，2 项为前瞻性研究。未发现随机对照试验。在这 16 篇论文中，有 16 篇研究了甲氨蝶呤对 IGM 的影响，结果显示大多数情况下疾病均有显著改善。有几项研究表明，接受硫唑嘌呤和霉酚酸酯治疗的患者也获得了良好的反应。
由于 IGM 罕见，只有少数研究探讨了 DMARDs 作为一种药物治疗选择的效果。阻碍我们深入了解这种疾病的一个重要因素是这些研究提供的数据在质量和数量方面存在很大差异。因此，需要进行精心设计、随机、安慰剂对照试验，以严格评估 DMARDs 治疗 IGM 的疗效。
