Jeju National University College of Medicine, Jeju, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Clin Rheumatol. 2024 Nov;43(11):3379-3387. doi: 10.1007/s10067-024-07120-1. Epub 2024 Oct 1.
To identify the risk factors for relapse of idiopathic inflammatory myopathies (IIMs).
Patients who were newly diagnosed with IIMs and underwent muscle biopsy between 2000 and 2017 at Asan Medical Center were retrospectively reviewed. The relapse of IIMs was defined as the recurrence of muscle or cutaneous manifestations with a ≥50% increase in glucocorticoid dosage after reaching the low-dose glucocorticoid phase with clinically significant improvement. The factors associated with the relapse of IIMs were investigated by Cox proportional hazards analysis.
Of 105 patients with IIMs, relapse was observed in 65 patients (62%). The titer of antinuclear antibody (ANA) was higher in the relapse group than in the non-relapse group (P = 0.033). Multivariable analysis showed that the relapse of IIMs was significantly associated with histopathologic features consistent with IIMs (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.01-2.83, P = 0.045) and the use of immunosuppressants before relapse (HR, 0.50; 95% CI, 0.29-0.86, P = 0.013). Doubling of ANA titer was also associated with relapse, albeit without statistical significance (HR, 1.13; 95% CI, 1.00-1.27, P = 0.052).
In patients with IIMs, the use of immunosuppressants had a significant negative association with relapse. Administering immunosuppressants from the early period during the initial glucocorticoid tapering phase may be useful in reducing the risk of relapse in patients with IIMs. Key Points • Since idiopathic inflammatory myopathies (IIMs) have a low prevalence, it is poorly understood which factors are associated with the relapse of IIMs. • In this study, about two-thirds of 105 patients with IIMs experienced a relapse of IIMs. • The risk of relapse in patients with IIMs was negatively associated with the use of immunosuppressants during glucocorticoid tapering and low-dose glucocorticoid phase. • Even in less severe cases, the use of immunosuppressants might be a good option for the management of IIMs.
确定特发性炎性肌病（IIM）复发的危险因素。
回顾性分析 2000 年至 2017 年期间在我院经肌肉活检新诊断为 IIM 并接受治疗的患者。IIM 复发定义为在达到临床显著改善的低剂量糖皮质激素阶段后，由于肌肉或皮肤表现复发，糖皮质激素剂量增加≥50%。采用 Cox 比例风险分析调查与 IIM 复发相关的因素。
在 105 例 IIM 患者中，65 例（62%）出现复发。复发组的抗核抗体（ANA）滴度高于未复发组（P=0.033）。多变量分析显示，特发性炎性肌病的组织病理学特征与 IIM 一致（风险比[HR]，1.69；95%置信区间[CI]，1.01-2.83，P=0.045）和复发前使用免疫抑制剂（HR，0.50；95%CI，0.29-0.86，P=0.013）与 IIM 的复发显著相关。ANA 滴度加倍与复发也相关，但无统计学意义（HR，1.13；95%CI，1.00-1.27，P=0.052）。
在特发性炎性肌病患者中，免疫抑制剂的使用与复发有显著的负相关。在初始糖皮质激素减量阶段的早期使用免疫抑制剂可能有助于降低特发性炎性肌病患者的复发风险。
由于特发性炎性肌病（IIM）的患病率较低，因此尚不清楚哪些因素与 IIM 的复发有关。
在这项研究中，大约三分之二的 105 例 IIM 患者经历了 IIM 的复发。
IIM 患者的复发风险与糖皮质激素减量和低剂量糖皮质激素阶段使用免疫抑制剂呈负相关。
即使在病情较轻的情况下，使用免疫抑制剂也可能是治疗 IIM 的一种较好的选择。
