Дифференциальная диагностика дерматомиозита

Классический дерматомиозит следует дифференцировать:

Амиотический дерматомиозит

  • Красная волчанка системная и подострая
  • Себорейный дерматит
  • Контатный дерматит
  • Плоский лишай
  • Псориаз
  • Полиморфный фотодерматоз
  • Эритродермия лекарственная
  • Атопический дерматит
  • Дерматит аллергический

Заболевания, проявляющиеся проксимальной мышечной слабостью, которые могут симулировать дерматомиозит/полимиозит:

  • Инфекционные миопатии: ВИЧ, человеческий Т-клеточный лимфотропный вирус 1 типа, коксаки-вирус, эквирус, вирус инфлюэнцы, вирус гепатита В, вирус Эпштейна — Барр.
  • Другие миопатии: ревматические болезни, миодистрофии, метаболические миопатии.
  • Неврологические болезни: миастения псевдопаралитическая тяжелая, латеральный амиотрофический склероз.
  • Эндокринологические расстройства: гипотиреоз и гипертиреоз, сидром Кушинга, диабетическая миопатия, гипокалиемия.
  • Лекарственные миопатии: антималярийные препараты, колхицин, глюкокортикостероиды, циклоспорин; липостатины, Д-пеницилламин, зидовудин, изотретиноин; алкоголь, наркотики (кокаин, героин).

Специфические методы диагностики

  • Тщательное обследование пациента для исключения всех причин миопатии
  • Скрининг скрытых злокачественных опухолей
  • Сывороточная альдолаза и кретинкиназа
  • Электромиограмма
  • Магнитный резонанс или ультразвуковое исследование мышц
  • Диагностика системного процесса (заболеваний легких, дисфункция пищевода, поражение сердца)
  • Выявление миозит-специфических антител

Терапия первой линии http://Lecheniya dermatomyosita

Дерматологические симптомы

  • Солнцезащитные средства
  • Кортикостероиды наружно
  • Антималярийные препараты (гидроксихлорохин, хлорохин)

Мышечные симптомы

  • Кортикостероиды системно
  • Иммуносупрессанты (метотрексат, азатиоприн)

Терапия второй линии

Дерматологические симптомы

  • Такролимус или пимекролимус
  • Метотрексат
  • Микофенолата мофетил
  • Внутривенный иммуноглобулин

Мышечные симптомы

  • Другие иммуносупрессанты (циклофосфамид, хлорамбуцил, циклоспорин)
  • Внутривенный иммуноглобулин

Терапия третьей линии

  • Дипсон (для дерматологических симптомов)
  • Дилтиазем для кальциноза
  • Этанерцепт
  • Инфликсимаб

При относительной резистентности заболевания к глюкокортикостероидной терапии или лишь кратковременном эффекте от них при достаточно высокой дозе гормонов, наличии резко повышенной СОЭ необходимо думать о паранеопластическом ДМ, хотя опухоль внутренних органов может выявиться через несколько лет от начала ДМ.

Профилактика ДМ является, главным образом, вторичной и в основном соответствует тому, что проводится при системной склеродермии. Важное значение имеет раннее выявление и лечение опухолевых процессов.

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