Rheumatoid myositis. Clinical and histologic features and possible pathogenesis.
Rheumatoid myositis. Clinical and histologic features and possible pathogenesis.
复制标题
类风湿性肌炎。
DOI：
10.1002/art.1780270703
复制
发表时间：
1984
影响因子：
--
通讯作者：
Schrohenloher,RE
中科院分区：
文献类型：
--
作者：
Halla,JT;Koopman,WJ;Fallahi,S;Oh,SJ;Gay,RE;Schrohenloher,RE
使用肌肉活检和肌电图连续研究了 31 名类风湿性关节炎患者的肌肉受累证据。患者最初分为4个临床类别：非活动性周围关节疾病（6名患者）；活动性周围关节疾病（10例）；全身性疾病和轻度滑膜炎 (SERD) 程度的沉降率不成比例地升高（11 名患者）；或肌酐磷酸激酶水平升高（4 名患者）。除了常规组织学检查外，还检查肌肉组织中 IgM 和 IgM 类风湿因子的从头合成，并通过间接免疫荧光检查免疫球蛋白和补体沉积物的存在。我们的研究结果表明：1）类风湿性关节炎患者经常发生肌纤维坏死； 2) 类风湿性肌炎，定义为肌纤维坏死和单核细胞浸润，是一个独特的实体，特别发生在 SERD 或肌酸酐磷酸激酶水平升高的患者中； 3）只有类风湿性肌炎患者的肌肉表现出类风湿因子的从头合成和大量的IgM，表明局部免疫事件可能在该实体的发病机制中很重要。
Thirty‐one patients with rheumatoid arthritis were consecutively studied for evidence of muscle involvement, using muscle biopsy and electromyography. The patients were initially separated into 4 clinical categories: inactive peripheral joint disease (6 patients); active peripheral joint disease (10 patients); systemic disease and a disproportionately elevated sedimentation rate for the degree of mild synovitis (SERD) (11 patients); or elevated creatinine phosphokinase level (4 patients). In addition to routine histology, muscle tissue was examined for de novo synthesis of IgM and IgM rheumatoid factor, and by indirect immunofluorescence for the presence of immunoglobulin and complement deposits. Our results indicate that: 1) muscle fiber necrosis occurs frequently in patients with rheumatoid arthritis; 2) rheumatoid myositis, defined as muscle fiber necrosis and mononuclear cell infiltration, is a distinct entity and occurs particularly in patients with SERD or an elevated creatinine phosphokinase level; and 3) only muscle from patients with rheumatoid myositis exhibited de novo synthesis of rheumatoid factor and significant quantities of IgM, indicating that local immune events may be important in the pathogenesis of this entity.