Antimalarial myopathy:: an underdiagnosed complication?: Prospective longitudinal study of 119 patients
Antimalarial myopathy:: an underdiagnosed complication?: Prospective longitudinal study of 119 patients
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DOI：
10.1136/ard.2004.023200
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发表时间：
2006-03-01
影响因子：
27.4
通讯作者：
Larrosa, M
中科院分区：
文献类型：
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作者：
Casado, E;Gratacós, J;Larrosa, M
目的：了解风湿病患者服用抗疟药后抗疟肌病的患病率和发生率。方法：对风湿病患者进行为期3年的抗疟药物治疗研究。在纳入时和此后每六个月评估一次血清肌酶。对持续性肌酶紊乱患者进行肌力、肌电(EMG)和肌肉活检检查。结果：共纳入119例患者(氯喹111例，羟氯喹8例)。其中22例(18.5%)存在持续性肌酶紊乱：乳酸脱氢酶19/22(86%)，肌酸激酶7/22(32%)，醛缩酶3/22(14%)。光镜检查发现3/15例患者(20%)有抗疟肌病的表现，所有15例患者均经电子显微镜检查。11名患者在纳入时有肌病(患病率为9.2%)，4名患者在随访期间发生了肌肉损伤(年发病率为1.2%)。在15例活检证实的肌病患者中，有8例出现肌肉无力，临床抗疟肌病的患病率为6.7%。结论：以肌酶测定作为筛查手段，抗疟肌病的患病率高于以往所认为的。当观察到持续性肌酶紊乱时，应定期进行临床和肌电检查，以检测临床肌病的发展。在临床肌病病例中，必须进行解剖病理组织研究，包括超微结构研究，以确认诊断。
Objectives: To evaluate the prevalence and incidence of antimalarial myopathy in patients with rheumatic diseases treated with antimalarial drugs.Methods: Over a three year period, all patients with rheumatic diseases who were taking antimalarial drugs were studied. Serum muscle enzymes were assessed at the time of inclusion and every six months thereafter. Muscle strength, electromyography (EMG), and muscle biopsy were assessed in patients with a persistent muscle enzyme disturbances.Results: 119 patients were included (111 chloroquine, eight hydroxychloroquine). Of these, 22 (18.5%) had a persistent muscle enzyme disturbance: lactate dehydrogenase 19/22 ( 86%); creatine kinase 7/22 (32%), and aldolase 3/22 (14%). Findings of antimalarial myopathy were detected in 3/ 15 biopsied patients (20%) by light microscopy and in all 15 by electron microscopy. Eleven patients had myopathy at the time of inclusion (prevalence 9.2%) and four patients developed muscle injury during follow up (annual incidence 1.2%). Muscle weakness was observed in 8 of 15 patients with biopsy proven myopathy, giving a prevalence of clinical antimalarial myopathy of 6.7%. All these patients also had a myopathic pattern on electromyography.Conclusions: The prevalence of antimalarial myopathy is higher than previously recognised when muscle enzyme determination is used as a screening method. When a persistent muscle enzyme disturbance is observed, clinical and electromyographic studies should be undertaken periodically to detect the development of clinical myopathy. In cases of clinical myopathy, an anatomical- pathological tissue study, including an ultrastructural study, is mandatory to confirm the diagnosis.