Targoff I N, Miller F W, Medsger T A, Oddis C V
VA Medical Center, Oklahoma City, OK, USA.
Curr Opin Rheumatol. 1997 Nov;9(6):527-35. doi: 10.1097/00002281-199711000-00008.
Inasmuch as the clinical features of the idiopathic inflammatory myopathies are not easily differentiated from those of other similar rheumatic and neurologic conditions, diagnosis is often difficult. Various classification criteria for polymyositis and dermatomyositis have been suggested by a number of investigators. The most commonly accepted and used criteria include symmetric proximal muscle weakness, serum elevations of muscle enzymes, the classic electromyographic and muscle biopsy findings of inflammatory myopathy, and the typical skin rash of dermatomyositis. Although these criteria are clinically useful, they can result in misdiagnoses and inappropriate therapies. They also result in heterogeneous patient groups being selected for clinical and laboratory studies. Furthermore, they do not include recent findings related to the myositis-specific autoantibodies and magnetic resonance imaging of muscle that have been found to be important adjuncts in assessing patients with muscle weakness or elevations of muscle enzymes. A modification to the Bohan and Peter criteria is proposed to include myositis-specific autoantibodies and magnetic resonance imaging. This proposal could initiate productive discussions and investigations of the sensitivity and specificity of new classification criteria for myositis and could ultimately enhance our treatment capabilities.
由于特发性炎性肌病的临床特征不易与其他类似的风湿性和神经疾病相区分，诊断往往很困难。许多研究者提出了多种关于多发性肌炎和皮肌炎的分类标准。最常被接受和使用的标准包括对称性近端肌无力、肌肉酶血清升高、炎性肌病的典型肌电图和肌肉活检结果，以及皮肌炎的典型皮疹。尽管这些标准在临床上有用，但它们可能导致误诊和不恰当的治疗。它们还导致在临床和实验室研究中选择了异质性的患者群体。此外，它们没有包括与肌炎特异性自身抗体和肌肉磁共振成像相关的最新发现，而这些发现已被证明是评估肌无力或肌肉酶升高患者的重要辅助手段。有人提议对博汉和彼得标准进行修改，纳入肌炎特异性自身抗体和磁共振成像。这一提议可能引发关于肌炎新分类标准的敏感性和特异性的富有成效的讨论和研究，并最终提高我们的治疗能力。
