Journal of Diagnostics Concepts & Practice ›› 2021, Vol. 20 ›› Issue (01): 8-14.doi: 10.16150/j.1671-2870.2021.01.002
• Experts forum • Previous Articles Next Articles
Received:
2021-01-05
Online:
2021-02-25
Published:
2021-02-25
CLC Number:
建议综合管理 | RG | |
---|---|---|
联合疗法 | 抗MDA5抗体阳性DM(或CADM)合并RPILD患者应首选联合疗法 | D |
1 | 糖皮质激素(激素)加钙调磷酸酶抑制剂(环孢素A或他克莫司)的联合疗法,或在此基础上加用静脉滴注环磷酰胺a) 的三联疗法,均被认为是较好的初始选择 | D |
a环孢素A和他克莫司疗效均好,临床选择基于其药物安全性及患者特征 | √ | |
b建议监测钙调磷酸酶抑制剂的血药浓度以调整剂量,减少毒副作用 | √ | |
2 | 当钙调磷酸酶抑制剂不可行时,应考虑糖皮质激素联合其他免疫抑制剂[如环磷酰胺b)和(或)吗替麦考酚酯],或将 利妥昔单抗b)加到任一先前的治疗方案中 | D |
a这些药物的选择基于患者的个体特征及医生的临床经验 | √ | |
难治性DM(或CADM)合并RPILD患者的治疗 | ||
1 | 对激素联合免疫抑制剂治疗无效的患者,应考虑以下替代方案 | |
a在当前治疗方案中加用以下任一免疫抑制剂:环磷酰胺、吗替麦考酚酯、利妥昔单抗、巴利昔单抗或托法替布 | D | |
b换用另一种免疫抑制剂 | √ | |
2 | 对激素联合免疫抑制剂治疗无反应的患者,可单独或依次采用以下替代疗法 | |
a多黏菌素B血液灌流 | D | |
b 血浆置换 | D | |
c 静脉注射免疫球蛋白 | √ | |
3 | 对出现危及生命的严重和(或)难治性呼吸功能不全的患者,应考虑使用ECMO来维持患者的生命,等待患者对 强化联合免疫抑制疗法的临床反应或作为肺移植前的桥梁阶段 | √ |
4 | 对难治性患者应考虑肺移植,在诊断RPILD后应尽早转诊,进行移植资格评估 | √ |
其他治疗选择 | ||
1 | 不建议将硫唑嘌呤、氨甲蝶呤和来氟米特用于治疗此类患者 | √ |
2 | 不建议在治疗中使用英夫利昔单抗 | √ |
3 | 尽管在肺纤维化的数据中,吡非尼酮已经被添加到CADM相关的亚急性ILD的常规免疫抑制治疗中,但专家组可 能并不建议 | √ |
[1] |
Hirakata M, Nagai S. Interstitial lung disease in polymyositis and dermatomyositis[J]. Curr Opin Rheumatol, 2000, 12(6):501-508.
pmid: 11092199 |
[2] |
Cao H, Parikh TN, Zheng J. Amyopathic dermatomyositis or dermatomyositis-like skin disease: retrospective review of 16 cases with amyopathic dermatomyositis[J]. Clin Rheumatol, 2009, 28(8):979-984.
doi: 10.1007/s10067-009-1152-9 URL |
[3] |
Hamaguchi Y, Fujimoto M, Matsushita T, et al. Common and distinct clinical features in adult patients with anti-aminoacyl-tRNA synthetase antibodies: heterogeneity within the syndrome[J]. PLoS One, 2013, 8(4):e60442.
doi: 10.1371/journal.pone.0060442 URL |
[4] |
Sato S, Hirakata M, Kuwana M, et al. Autoantibodies to a 140-kd polypeptide, CADM-140, in Japanese patients with clinically amyopathic dermatomyositis[J]. Arthritis Rheum, 2005, 52(5):1571-1576.
doi: 10.1002/art.21023 URL |
[5] |
Sato S, Hoshino K, Satoh T, et al. RNA helicase encoded by melanoma differentiation-associated gene 5 is a major autoantigen in patients with clinically amyopathic dermatomyositis: association with rapidly progressive interstitial lung disease[J]. Arthritis Rheum, 2009, 60(7):2193-2200.
doi: 10.1002/art.24621 URL |
[6] |
Nakashima R, Imura Y, Kobayashi S, et al. The RIG-I-like receptor IFIH1/MDA5 is a dermatomyositis-specific autoantigen identified by the anti-CADM-140 antibody[J]. Rheumatology (Oxford), 2010, 49(3):433-440.
doi: 10.1093/rheumatology/kep375 pmid: 20015976 |
[7] |
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 URL |
[8] |
Wu Q, Wedderburn LR, McCann LJ. Juvenile dermatomyositis: latest advances[J]. Best Pract Res Clin Rheumatol, 2017, 31(4):535-557.
doi: 10.1016/j.berh.2017.12.003 URL |
[9] |
Tansley SL, Betteridge ZE, Gunawardena H, et al. Anti-MDA5 autoantibodies in juvenile dermatomyositis identify a distinct clinical phenotype: a prospective cohort study[J]. Arthritis Res Ther, 2014, 16(4):R138.
doi: 10.1186/ar4600 URL |
[10] |
Kobayashi I, Okura Y, Yamada M, et al. Anti-melanoma differentiation-associated gene 5 antibody is a diagnostic and predictive marker for interstitial lung diseases associated with juvenile dermatomyositis[J]. J Pediatr, 2011, 158(4):675-677.
doi: 10.1016/j.jpeds.2010.11.033 URL |
[11] |
DeWane ME, Waldman R, Lu J. Dermatomyositis: clinical features and pathogenesis[J]. J Am Acad Dermatol, 2020, 82(2):267-281.
doi: 10.1016/j.jaad.2019.06.1309 URL |
[12] |
Moghadam-Kia S, Oddis CV, Sato S, et al. Antimelanoma Differentiation-associated gene 5 antibody: expanding the clinical spectrum in North American patients with dermatomyositis[J]. J Rheumatol, 2017, 44(3):319-325.
doi: 10.3899/jrheum.160682 pmid: 28089977 |
[13] | Chen Z, Cao M, Plana MN, et al. Utility of anti-melanoma differentiation-associated gene 5 antibody measurement in identifying patients with dermatomyositis and a high risk for developing rapidly progressive interstitial lung disease: a review of the literature and a meta-analysis[J]. Arthritis Care Res(Hoboken), 2013, 65(8):1316-1324. |
[14] |
Takeuchi O, Akira S. MDA5/RIG-I and virus recognition[J]. Curr Opin Immunol, 2008, 20(1):17-22.
doi: 10.1016/j.coi.2008.01.002 pmid: 18272355 |
[15] |
Yoneyama M, Kikuchi M, Matsumoto K, et al. Shared and unique functions of the DExD/H-box helicases RIG-I, MDA5, and LGP 2 in antiviral innate immunity[J]. J Immunol, 2005, 175(5):2851-2858.
doi: 10.4049/jimmunol.175.5.2851 URL |
[16] |
Nishina N, Sato S, Masui K, et al. Seasonal and residential clustering at disease onset of anti-MDA5-associated interstitial lung disease[J]. RMD Open, 2020, 6(2):e001202.
doi: 10.1136/rmdopen-2020-001202 URL |
[17] |
Fiorentino D, Chung L, Zwerner J, et al. The mucocutaneous and systemic phenotype of dermatomyositis patients with antibodies to MDA5(CADM-140): a retrospective study[J]. J Am Acad Dermatol, 2011, 65(1):25-34.
doi: 10.1016/j.jaad.2010.09.016 pmid: 21531040 |
[18] |
Narang NS, Casciola-Rosen L, Li S, et al. Cutaneous ulceration in dermatomyositis: association with anti-melanoma differentiation-associated gene 5 antibodies and interstitial lung disease[J]. Arthritis Care Res (Hoboken), 2015, 67(5):667-672.
doi: 10.1002/acr.22498 pmid: 25331610 |
[19] |
Cao H, Xia Q, Pan M, et al. Gottron papules and Gottron sign with ulceration: a distinctive cutaneous feature in a subset of patients with classic dermatomyositis and clinically amyopathic dermatomyositis[J]. J Rheumatol, 2016, 43(9):1735-1742.
doi: 10.3899/jrheum.160024 URL |
[20] |
Ono N, Kai K, Maruyama A, et al. The relationship between type 1 IFN and vasculopathy in anti-MDA5 antibody-positive dermatomyositis patients[J]. Rheumatology (Oxford), 2019, 58(5):786-791.
doi: 10.1093/rheumatology/key386 URL |
[21] |
Disdier P, Harlé JR, Chrestian MA, et al. Extensive pharyngeal necrosis: an unusual complication of dermatomyositis[J]. Rev Med Interne, 1992, 13(3):218-220.
pmid: 1410905 |
[22] |
Kurtzman DJB, Vleugels RA. Anti-melanoma differentiation-associated gene 5(MDA5) dermatomyositis: a concise review with an emphasis on distinctive clinical features[J]. J Am Acad Dermatol, 2018, 78(4):776-785.
doi: S0190-9622(17)32764-0 pmid: 29229575 |
[23] |
Allenbach Y, Leroux G, Suárez-Calvet X, et al. Dermatomyositis with or without anti-melanoma differentiation-associated gene 5 antibodies: common interferon signature but distinct NOS2 expression[J]. Am J Pathol, 2016, 186(3):691-700.
doi: 10.1016/j.ajpath.2015.11.010 pmid: 26806087 |
[24] |
Vuillard C, Pineton de Chambrun M, de Prost N, et al. Clinical features and outcome of patients with acute respiratory failure revealing anti-synthetase or anti-MDA-5 dermato-pulmonary syndrome: a French multicenter retrospective study[J]. Ann Intensive Care, 2018, 8(1):87.
doi: 10.1186/s13613-018-0433-3 URL |
[25] |
Gono T, Sato S, Kawaguchi Y, et al. Anti-MDA5 antibody, ferritin and IL-18 are useful for the evaluation of response to treatment in interstitial lung disease with anti-MDA5 antibody-positive dermatomyositis[J]. Rheumatology (Oxford), 2012, 51(9):1563-1570.
doi: 10.1093/rheumatology/kes102 URL |
[26] | Diao LC, Chen M, Lu YD, et al. Detection of serum ferritin in patients with idiopathic inflammatory myopathies and its clinical significance[J]. Clin J Dermatol, 2016, 49(6):391-395. |
[27] |
Gono T, Kawaguchi Y, Hara M, et al. Increased ferritin predicts development and severity of acute interstitial lung disease as a complication of dermatomyositis[J]. Rheumatology(Oxford), 2010, 49(7):1354-1360.
doi: 10.1093/rheumatology/keq073 URL |
[28] |
Chen M, Quan C, Diao L, et al. Measurement of cytokines and chemokines and association with clinical severity of dermatomyositis and clinically amyopathic dermatomyositis[J]. Br J Dermatol, 2018, 179(6):1334-1341.
doi: 10.1111/bjd.17079 pmid: 30101523 |
[29] | 蔡怡华, 郑捷. 血清肌酶在评价皮肌炎与多肌炎合并肺间质病变中的作用[J]. 诊断学理论与实践, 2004, 3(4):260-263. |
[30] |
Vojinovic T, Cavazzana I, Ceruti P, et al. Predictive features and clinical presentation of interstitial lung disease in inflammatory myositis[J]. Clin Rev Allergy Immunol, 2021, 60(1):87-94.
doi: 10.1007/s12016-020-08814-5 URL |
[31] |
Allenbach Y, Uzunhan Y, Toquet S, et al. Different phenotypes in dermatomyositis associated with anti-MDA5 antibody: study of 121 cases[J]. Neurology, 2020, 95(1):e70-e78.
doi: 10.1212/WNL.0000000000009727 URL |
[32] |
Yamaguchi K, Yamaguchi A, Onuki Y, et al. Clinical features of dermatomyositis associated with anti-MDA5 antibodies by age[J]. Mod Rheumatol, 2021, 31(1):177-185.
doi: 10.1080/14397595.2020.1740400 URL |
[33] |
Romero-Bueno F, Diaz Del Campo P, et al. Recommendations for the treatment of anti-melanoma differentiation-associated gene 5-positive dermatomyositis-associated rapidly progressive interstitial lung disease[J]. Semin Arthritis Rheum, 2020, 50(4):776-790.
doi: 10.1016/j.semarthrit.2020.03.007 URL |
[34] | Li LB, Liu CX, Zhang YF. Comparison analysis of anti-MDA5 antibody and anti-TIF1 antibody between ELISA and line blot assay[J]. Int J Lab Med, 2019, 40(9):1028-1031. |
[1] | DIAO Xuehong, SHEN Yan, CHEN Lin, ZHAN Jia, FANG Liang, CAI Jianfei, CHEN Yue. Application of superb microvascular imaging technology in diagnosing rheumatoid arthritis in the clinical remission stage [J]. Journal of Diagnostics Concepts & Practice, 2022, 21(05): 575-580. |
[2] | . [J]. Journal of Diagnostics Concepts & Practice, 2022, 21(03): 299-303. |
[3] | . [J]. Journal of Diagnostics Concepts & Practice, 2022, 21(03): 304-311. |
[4] | ZHANG Hao, CHI Huihui, SU Yutong, YANG Chengde. Study on advances in the association between autoantibodies and clinical phenotypes in idiopathic inflammatory myopathy [J]. Journal of Diagnostics Concepts & Practice, 2022, 21(03): 408-414. |
[5] | LU Hongyu, GU Jun, WANG Jing, CAO Yafeng, SONG Luxi, FAN Jun, CHEN Mei. Sjögren′s syndrome secondary to cryptococcal meningoencephalitis: a case report and literature review [J]. Journal of Diagnostics Concepts & Practice, 2021, 20(05): 456-461. |
[6] | . [J]. Journal of Diagnostics Concepts & Practice, 2021, 20(01): 98-103. |
[7] | . [J]. Journal of Diagnostics Concepts & Practice, 2019, 18(1): 113-116. |
[8] | WANG Yanqing, HUANG Wanxue, LIANG Yuanyuan, WU Zhenzhen, WANG Xuan, TANG Jianping. Clinical and laboratory analysis of primary Sjögren′s syndrome complicated with neurological lesions [J]. Journal of Diagnostics Concepts & Practice, 2019, 18(1): 51-55. |
[9] | . [J]. Journal of Diagnostics Concepts & Practice, 2019, 18(1): 109-112. |
[10] | . [J]. Journal of Diagnostics Concepts & Practice, 2018, 17(05): 616-619. |
[11] | . [J]. Journal of Diagnostics Concepts & Practice, 2018, 17(05): 606-610. |
[12] | YUAN Yiwei, GU Juanfang, FEI Zhangli, YANG Mingfeng, WANG Yiwen, WANG Hongzhi. Level of programmed cell death factor 5 in patients with active rheumatoid arthritis [J]. Journal of Diagnostics Concepts & Practice, 2018, 17(04): 453-456. |
[13] | . [J]. Journal of Diagnostics Concepts & Practice, 2018, 17(03): 244-248. |
[14] | . [J]. Journal of Diagnostics Concepts & Practice, 2018, 17(03): 347-351. |
[15] | . [J]. Journal of Diagnostics Concepts & Practice, 2018, 17(03): 249-253. |
Viewed | ||||||
Full text |
|
|||||
Abstract |
|
|||||