Muscle Strength and Muscle Endurance During the First Year of Treatment of Polymyositis and Dermatomyositis: A Prospective Study
Muscle Strength and Muscle Endurance During the First Year of Treatment of Polymyositis and Dermatomyositis: A Prospective Study
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DOI：
10.3899/jrheum.161183
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发表时间：
2018-04-01
影响因子：
3.9
通讯作者：
Lundberg, Ingrid E.
中科院分区：
文献类型：
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作者：
Alexanderson, Helene;Regardt, Malin;Lundberg, Ingrid E.
Objective.研究多发性肌炎（PM）和皮肌炎（DM）诊断后第一年内的肌肉损伤（等长和动态）和疾病活动性，并研究肌肉损伤、患者报告的健康状况和疾病活动性之间的关系。前瞻性随访了2003-2010年入组瑞典肌炎登记的72例患者。在诊断时以及6个月和12个月后检索手动肌肉测试（MMT-8;等长肌力）、肌炎功能指数测试（FI-2;动态重复肌肉功能）和疾病活动（6项核心集）。在12个月时检索自我报告的健康状况（医学结局研究简表-36; SF-36）。诊断时，FI-2的中位数（Q1-Q3）为最大评分的27.2%（7.9-60.5%），而最大MMT-8为93.8%（92.5-98.8%）。12个月时，FI-2和MMT-8分别改善至29.4%（16.5-60.7%; p < 0.05）和96.1%（88.1-99.4%）（p < 0.01）。在12个月时，45%的患者FI-2评分改善≥ 20%，27%恶化≥ 20%，而MMT-8评分改善≥ 20%的患者为10%。12个月时，医生的整体视觉模拟评分（VAS）、健康评估问卷和肌酸磷酸激酶水平显著改善（p < 0.05-0.001），而患者的整体和肌外VAS保持不变。SF-36躯体功能与FI-2呈强相关（r（s）= 0.74; CI 0.55-0.85），与MMT呈中度相关（r（s）= 0.54; CI 0.27-0.73），肌肉功能与SF-36其他领域的相关性较低。PM/DM患者的特征是与患者报告的身体功能相关的动态重复肌肉功能（DRMF）受损。DRMF评估增加了这些患者肌肉损伤的相关信息。
Objective. To investigate muscle impairment (isometric and dynamic) and disease activity during the first year after diagnosis of polymyositis (PM) and dermatomyositis (DM), and to study the relationship between muscle impairment, patient-reported health, and disease activity.Methods. Seventy-two patients enrolled in the Swedish Myositis Register, 2003-2010, were followed prospectively. The Manual Muscle test (MMT-8; isometric muscle strength), the Functional Index of myositis test (FI-2; dynamic, repetitive muscle function), and disease activity (6-item core set) were retrieved at the time of diagnosis, and after 6 and 12 months. Self-reported health (Medical Outcomes Study Short Form-36; SF-36) was retrieved at 12 months.Results. At the time of diagnosis, median (Q1-Q3) for the FI-2 was 27.2% (7.9-60.5%) of maximal score compared to 93.8% (92.5-98.8%) of maximal MMT-8. At 12 months, the FI-2 and the MMT-8 improved to 29.4% (16.5-60.7%; p < 0.05) and 96.1% (88.1-99.4%), respectively (p < 0.01). At 12 months, 45% of patients improved >= 20%, and 27% worsened >= 20% in FI-2 score, while 10% improved >= 20% in MMT-8. Physician's global visual analog scale (VAS), Health Assessment Questionnaire, and creatine phosphokinase levels improved significantly at 12 months (p < 0.05-0.001) while patient's global and extramuscular VAS remained unchanged. The SF-36 physical function correlated strongly with the FI-2 (r(s) = 0.74; CI 0.55-0.85) and moderately with the MMT (r(s) = 0.54; CI 0.27-0.73), with lower correlations between muscle function and other SF-36 domains.Conclusion. Patients with PM/DM were characterized by impaired dynamic repetitive muscle function (DRMF) that correlated well with patient-reported physical function. Assessment of DRMF adds information regarding muscle impairment in these patients.