Altunel Kılınç Elif, Duman Bengisu Ece, Özbek Süleyman
Department of Rheumatology, Çukurova University Faculty of Medicine, Adana, Türkiye.
Department of Internal Medicine, Çukurova University Faculty of Medicine, Adana, Türkiye.
Arch Rheumatol. 2025 Mar 17;40(1):72-79. doi: 10.46497/ArchRheumatol.2025.10989. eCollection 2025 Mar.
This study aimed to investigate the factors that lead to treatment change in patients with polymyositis (PM) and dermatomyositis (DM) and to present its contribution to our clinical approach.
A retrospective analysis was conducted on 141 patients (103 females, 38 males; mean age: 51.2±14.3 years; range, 22 to 74 years) diagnosed with PM (n=87; 61 females, 26 males; mean age: 50.2±13.4 years; range, 22 to 74 years) or DM (n=54; 42 females, 12 males; mean age: 52.7±15.8 years; range, 22 to 72 years) between January 2003 and May 2024. Patients were evaluated for treatment changes, reasons for these changes, and disease characteristics, including disease duration, creatine kinase, erythrocyte sedimentation rate, and C-reactive protein levels.
Treatment changes were observed in 86 (60.9%) patients, comprising 58 (67%) PM and 28 (33%) DM cases. The primary reasons for treatment modification included drug intolerance in nine (10.5%) patients and uncontrolled disease in 77 (89.5%) patients. Among the uncontrolled patients, 34 (44.7%) exhibited lung involvement, 16 (21%) had peripheral joint involvement, one (1.3%) cardiac involvement, and 26 (34.3%) showed increased muscular symptoms. Statistical analysis revealed that lung involvement was an independent risk factor influencing the necessity for medication changes, while other analyzed factors exhibited no significant impact.
The findings underscore the critical role of lung involvement in the management of PM and DM, highlighting the need for heightened awareness of respiratory symptoms in these patients. These results provide valuable insights for clinical practice, emphasizing the importance of individualized treatment strategies in managing PM and DM patients.
本研究旨在调查导致多发性肌炎（PM）和皮肌炎（DM）患者治疗改变的因素，并阐述其对我们临床治疗方法的贡献。
对2003年1月至2024年5月期间诊断为PM（n = 87；61名女性，26名男性；平均年龄：50.2±13.4岁；范围，22至74岁）或DM（n = 54；42名女性，12名男性；平均年龄：52.7±15.8岁；范围，22至72岁）的141例患者进行回顾性分析。评估患者的治疗变化、这些变化的原因以及疾病特征，包括病程、肌酸激酶、红细胞沉降率和C反应蛋白水平。
86例（60.9%）患者出现治疗改变，其中包括58例（67%）PM患者和28例（33%）DM患者。治疗调整的主要原因包括9例（10.5%）患者药物不耐受和77例（89.5%）患者疾病控制不佳。在疾病未得到控制的患者中，34例（44.7%）出现肺部受累，16例（21%）有外周关节受累，1例（1.3%）有心脏受累，26例（34.3%）肌肉症状加重。统计分析显示，肺部受累是影响药物改变必要性的独立危险因素，而其他分析因素未显示出显著影响。
研究结果强调了肺部受累在PM和DM管理中的关键作用，突出了对这些患者呼吸道症状提高认识的必要性。这些结果为临床实践提供了有价值的见解，强调了个体化治疗策略在管理PM和DM患者中的重要性。
