Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (5): 1012-1016. doi: 10.19723/j.issn.1671-167X.2021.05.034

Previous Articles    

  

  • Received:2020-07-22 Online:2021-10-18 Published:2021-10-11
  • Supported by:
    Natural Science Foundation of Fujian Province(2017J01170);Natural Science Foundation of Fujian Province(2019J01184)

RICH HTML

  

CLC Number: 

  • R593.26

Figure 1

Representative rash in Case 1 A, Gottron’s sign, skin ulcers of metacarpophalangeal joints; B, heliotrope rash and erythema on the face and neck."

Table 1

Clinical manifestations before treatment with TOF"

Items Case 1 Case 2 Case 3 Case 4 Case 5
Gender Female Female Female Female Male
Age/years 44 47 37 36 56
Clinical characteristics
Rash +++ ++ +++ ++ +++
Muscle weakness + - + - +
Arthritis - - + - +
Fever + - + - +
Course of dyspnea/weeks 2 4 4 2 2
Course of RP-ILD/weeks 2 4 4 2 2
Classification of ILD NSIP+DAD NSIP+UIP NSIP+OP NSIP NSIP+DAD
Quantitative score of HRCT 22 13 19 10 25
Laboratory results
Lymphocyte/(×109/L) 0.8 0.7 0.8 1.4 0.8
CK/(IU/L) 52 19 42 84 195
LDH/(IU/L) 668 217 218 360 444
AST/(IU/L) 61 42 33 54 57
Anti-MDA5 antibody + + + + +
Anti-Ro-52 antibody + + + - +
EMG Normal Normal Not done Normal Not done
BALF examination
Cytological examination Neu, 6%;
Lym, 81%;
Mac, 12%
Neu, 8%;
Lym, 31%;
Mac, 42%
Not done Neu, 5%;
Lym, 21%;
Mac, 74%
Neu, 22%;
Lym, 10%;
Mac, 68%
mNGS Pneumocystis jiroveci 603 - - - -
Pre-hospital medication MP+CTX +CSA MP+CTX MP+CTX None None

Figure 2

Pulmonary HRCT in Case 1"

Table 2

Results of relevant indexes of survived patients before and after treatment (n=4)"

Items Baseline After treatment
1 month 3 months 6 months
Quantitative score of HRCT 16.00±2.74 12.50±1.66 7.75±1.93 6.75±3.20
Oxygenation index 257.30±48.71 344.30±31.93 442.50±14.36 448.00±13.86
6-minute walk test/m 150.00±88.98 290.00±42.03 390.00±23.80 435.00±22.40
Pulmonary function index
FVC% 54.50%±4.56% 74.41%±1.16% 74.90%±1.76%
TLC% 52.88%±4.04% 76.45%±4.24% 80.10%±6.67%
DLCO% 52.58%±2.20% 64.33%±1.73% 66.53%±2.67%
ESR/(mm/h) 42.50±19.65 23.50±4.84 11.25±1.49 10.25±2.50
CRP/(mg/L) 9.70±5.52 1.50 (1.32-3.44) 1.00±0.24 1.24±0.69
Serum ferritin/(μg/L) 957.30±168.20 407.50±86.83 153.30±62.65 72.50±32.35
[1] Nakashima R, Hosono Y, Mimori T. Clinical significance and new detection system of autoantibodies in myositis with interstitial lung disease [J]. Lupus, 2016, 25(8):925-933.
doi: 10.1177/0961203316651748 pmid: 27252271
[2] 陈芳, 王冬雪, 舒晓明, 等. 血清抗黑色素瘤分化相关基因抗体检测在多发性肌炎/皮肌炎患者中的意义 [J]. 中华风湿病学杂志, 2012, 16(1):13-18.
[3] Chen Z, Wang X, Ye S. Tofacitinib in amyopathic dermatomyo-sitis-associated interstitial lung disease [J]. N Engl J Med, 2019, 381(3):291-293.
doi: 10.1056/NEJMc1900045
[4] Lundberg IE, Tjärnlund A, Bottai M, et al. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups [J]. Ann Rheum Dis, 2017, 76(12):1955-1964.
doi: 10.1136/annrheumdis-2017-211468 pmid: 29079590
[5] Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias [J]. Am J Respir Crit Care Med, 2013, 188(6):733-748.
doi: 10.1164/rccm.201308-1483ST
[6] Goldin JG, Lynch DA, Strollo DC, et al. High-resolution CT scan findings in patients with symptomatic scleroderma-related interstitial lung disease [J]. Chest, 2008, 134(2):358-367.
doi: 10.1378/chest.07-2444
[7] 卢昕, 王国春. 重视新型肌炎特异性自身抗体的临床应用 [J]. 中华风湿病学杂志, 2015, 19(3):145-147.
[8] Cao H, Pan M, Kang Y, et al. Clinical manifestations of dermatomyositis and clinically amyopathic dermatomyositis patients with positive expression of anti-melanoma differentiation-associated gene 5 antibody [J]. Arthritis Care Res (Hoboken), 2012, 64(10):1602-1610.
doi: 10.1002/acr.21728
[9] Ye S, Chen XX, Lu XY, et al. Adult clinically amyopathic dermatomyositis with rapid progressive interstitial lung disease: A retrospective cohort study [J]. Clin Rheumatol, 2007, 26(10):1647-1654.
doi: 10.1007/s10067-007-0562-9
[10] Kurasawa K, Arai S, Namiki Y, et al. Tofacitinib for refractory interstitial lung diseases in anti-melanoma differentiation-associated 5 gene antibody-positive dermatomyositis [J]. Rheumatology (Oxford), 2018, 57(12):2114-2119.
doi: 10.1093/rheumatology/key188
[11] 许文英, 梅焕平. 生物制剂在多肌炎皮肌炎并发间质性肺病的治疗进展 [J]. 中华风湿病学杂志, 2016, 20(7):489-492.
[12] 黄慧, 邵池, 徐作军. 美国胸科协会官方指南: 支气管肺泡灌洗液的细胞学分析在间质性肺疾病中的临床应用(摘译本) [J]. 中华结核和呼吸杂志, 2012, 35(9):650-654.
[13] Kono M, Miyashita K, Hirama R, et al. Prognostic significance of bronchoalveolar lavage cellular analysis in patients with acute exa-cerbation of interstitial lung disease [J]. Respir Med, 2021, 186:106534.
doi: 10.1016/j.rmed.2021.106534
[14] Salonen J, Lampela H, Keskitalo E, et al. Bronchoalveolar lavage differential cell count on prognostic assessment of patients with stable or acute interstitial lung disease: A retrospective real-life study [J]. Clin Immunol, 2020, 220:108594.
doi: 10.1016/j.clim.2020.108594
[15] Xu Y, Yang CS, Li YJ, et al. Predictive factors of rapidly progressive-interstitial lung disease in patients with clinically amyopathic dermatomyositis [J]. Clin Rheumatol, 2016, 35(1):113-116.
doi: 10.1007/s10067-015-3139-z pmid: 26660480
[1] Zhanhong LAI,Jiachen LI,Zelin YUN,Yonggang ZHANG,Hao ZHANG,Xiaoyan XING,Miao SHAO,Yuebo JIN,Naidi WANG,Yimin LI,Yuhui LI,Zhanguo LI. A unicenter real-world study of the correlation factors for complete clinical response in idiopathic inflammatory myopathies [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 284-292.
[2] Xiao-yan XING,Jun-xiao ZHANG,Feng-yun-zhi ZHU,Yi-fan WANG,Xin-yao ZHOU,Yu-hui LI. Clinical analysis of 5 cases of dermatomyositis complicated with macrophage activation syndrome [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1214-1218.
[3] ZHANG Pu-li,YANG Hong-xia,ZHANG Li-ning,GE Yong-peng,PENG Qing-lin,WANG Guo-chun,LU Xin. Value of serum YKL-40 in the diagnosis of anti-MDA5-positive patients with dermatomyositis complicated with severe pulmonary injury [J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1055-1060.
[4] XIAO Yun-shu,ZHU Feng-yun-zhi,LUO Lan,XING Xiao-yan,LI Yu-hui,ZHANG Xue-wu,SHEN Dan-hua. Clinical and immunological characteristics of 88 cases of overlap myositis [J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1088-1093.
[5] Yu-zhou GAN,Yu-hui LI,Li-hua ZHANG,Lin MA,Wen-wen HE,Yue-bo JIN,Yuan AN,Zhan-guo LI,Hua YE. Comparison of clinical and immunological features between clinically amyopathic dermatomyositis and typical dermatomyositis [J]. Journal of Peking University (Health Sciences), 2020, 52(6): 1001-1008.
[6] Hong-xia YANG,Xiao-lan TIAN,Wei JIANG,Wen-li LI,Qing-yan LIU,Qing-lin PENG,Guo-chun WANG,Xin LU. Clinical and pathological characteristics of immune mediated necrotizing myopathy [J]. Journal of Peking University(Health Sciences), 2019, 51(6): 989-995.
[7] Jing XU,Jing XU,He LI,Jie TANG,Jian-long SHU,Jing ZHANG,Lian-jie SHI,Sheng-guang LI. Dermatomyositis combined with IgA vasculitis: A case report [J]. Journal of Peking University(Health Sciences), 2019, 51(6): 1173-1177.
[8] Yi-ying YANG,Xiao-xia ZUO,Hong-lin ZHU,Si-jia LIU. Advances in epigenetic markers of dermatomyositis/polymyositis [J]. Journal of Peking University(Health Sciences), 2019, 51(2): 374-377.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!