Calcinosis in dermatomyositis: Origins and possible therapeutic avenues.

Calcinosis in dermatomyositis: Origins and possible therapeutic avenues.
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DOI:
10.1016/j.berh.2022.101768
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发表时间:
2022-06
影响因子:
5.2
通讯作者:
Chung, Lorinda
Chung, Lorinda
中科院分区:
医学2区
文献类型:
--
作者:
Davuluri, Srijana;Duvvuri, Bhargavi;Lood, Christian;Faghihi-Kashani, Sara;Chung, Lorinda

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钙质沉着症是一种沉积在皮肤和其他组织中的不溶性钙化合物,是皮肌炎的严重后遗症。与持续的炎症、缺血、反复创伤和某些自身抗体相关的长期疾病与钙质沉着症有关。在这里,我们描述了潜在的致病机制,包括线粒体钙化的作用。目前还没有广泛有效的治疗钙质沉着症的方法。我们综述了现有的钙质沉着症的药物治疗,包括针对钙和磷代谢的药物;免疫抑制/抗炎治疗;以及血管扩张剂。越来越多的证据支持使用不同配方的硫代硫酸钠治疗钙质沉着症。虽然早期实施积极的免疫抑制可以预防青少年皮肌炎的钙质沉着,但只有有限的数据支持它一旦发展起来就可以改善。米诺环素对周围炎症相关的皮损尤其有用。强大的血管扩张剂,如前列环素类似物,可能在治疗钙质沉着症方面有希望,但还需要进一步的研究。手术切除病变时顺从是我们的治疗选择。
Calcinosis, insoluble calcium compounds deposited in skin and other tissues, is a crippling sequela of dermatomyositis. Prolonged disease associated with ongoing inflammation, ischemia, repetitive trauma and certain autoantibodies are associated with calcinosis. Herein, we describe potential pathogenic mechanisms including the role of mitochondrial calcification. There are no widely effective treatments for calcinosis. We review available pharmacologic therapies for calcinosis including those targeting calcium and phosphorus metabolism; immunosuppressive/anti-inflammatory therapies; and vasodilators. Mounting evidence supports the use of various formulations of sodium thiosulfate in the treatment of calcinosis. Although early institution of aggressive immunosuppression may prevent calcinosis in juvenile dermatomyositis, only limited data support improvement once it has developed. Minocycline can be useful particularly for lesions associated with surrounding inflammation. Powerful vasodilators, such as prostacyclin analogues, may have promise in the treatment of calcinosis but further studies are necessary. Surgical removal of lesions when amenable is our treatment of choice.
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