Change in muscle volume after steroid therapy in patients with myositis assessed using cross-sectional computed tomography

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Change in muscle volume after steroid therapy in

patients with myositis assessed using

cross-sectional computed tomography.

CT

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øï÷

øî÷

øí÷

(3)

2015 2017

7 8

3 1 skeletal muscle area 2 low muscle

attenuation rate CT

skeletal muscle area p=0.0156 low muscle attenuation rate p=0.0781

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1 2 3-6 BIA X DXA CT MRI 7-10 CT

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øï÷

2015 2017 0.7 mg/kg Bohan Peter 11 7 5 2 4 55 1 0.7 mg/kg 8 2 2 2 1 1 6 70 2

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6 CT CT 2

-29 150 Hounsfield units (HU) CT skeletal muscle area 1 -29 30 HU CT

low muscle attenuation rate

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rate

1 3 skeletal muscle area

øí÷

± SD

2 Cohen

2 skeletal muscle area low muscle attenuation rate

Skeletal muscle area low muscle attenuation rate

U

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2 skeletal muscle area low muscle attenuation rate 0.89 0.99 7 1948±1855 U/L 75±74 U/L p=0.0156 1 4 57% 3 skeletal muscle area -25.6±14.4% p=0.0156 -12.6±14.6% p=0.0391 2 skeletal muscle area

p=0.121 3 skeletal muscle area p=0.0571 4 Low muscle attenuation rate

7.3±8.5% p=0.0781 5.4±6.6% p=0.0547 5

Skeletal muscle area low muscle attenuation rate

1 skeletal muscle area low muscle attenuation rate

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2. skeletal muscle area a p=0.0156 b p=0.0391 p 0.05

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4. skeletal muscle area a COPD p=0.0571 b p=0.114 c ILD :p=0.629

5. low muscle attenuation rate a p=0.0781 b p=0.0547

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1 2 13 14-16 17 17 HSPA5 Grp78

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HSPA5 HSPA5

19

17

low muscle attenuation rate skeletal muscle area

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ïò

Patient Age

(years)

Sex Diagnosis Max glucocorticoid

(mg/day)a Duration between the start of treatment and second CT (months)b Dose of glucocorticoid at second CT (mg/day) Cumulative doses of glucocortico id (g)c MMT (before after)d Serum level of CK (U/L) (before after) Daily intake of protein in hospital (g/day) 1 26 M DM mPSL PSL: 60 3 PSL: 25 PSL: 4.3 3+/3+ 4+/4 102 21 80.0 2 58 F DM PSL: 40 2 PSL: 20 PSL: 1.7 4-/4- 4/4- 500 17 54.0 3 74 F DM PSL: 45 2.5 PSL: 18 PSL: 2.3 4-/3+ 4/4 3677 55 67.5 4 70 M DM mPSL sPSL: 100 4 PSL: 22.5 PSL: 6.1 3-/3- 4+/4+ 5149 22 65.0 5 70 M DM PSL: 60 7.5 PSL: 12 PSL: 6.0 4+/4 5/5 1119 122 75.0 6 15 F MCTD PSL: 50 1 PSL: 50 PSL: 1.4 5-/5 5/5 876 219 70.0 7 69 F MCTD PSL: 40 3 PSL: 20 PSL: 2.7 4/4- 5-/5- 2210 69 65.0

M: male, F: female, DM: dermatomyositis, MCTD: mixed connective tissue disease, PSL: prednisolone, mPSL: methylprednisolone, sPSL: soluble prednisolone, MMT: manual muscle test, CK: creatine kinase.

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îò

Patient Age

(years)

Sex Diagnosis Max glucocorticoid

(mg/day) a

Duration between the start of treatment and second CT (months) b Dose of glucocorticoid at second CT (mg/day) Cumulative doses of glucocorticoid (g)c,d 1 70 M MCNS PSL: 40 1.5 PSL: 25 PSL: 1.4 2 66 F LN mPSL PSL: 35 2.5 PSL: 20 PSL: 2.4 3 46 F LN mPSL mPSL: 32 3 mPSL: 12 PSL: 2.2 4 57 F EPGA mPSL PSL: 50 3 PSL: 25 PSL: 3.4 5 80 M MPA mPSL PSL: 30 2.5 PSL: 15 PSL: 1.3 6 86 F MPA mPSL mPSL: 32 1.5 mPSL: 20 PSL: 1.5 7 79 F MCNS mPSL: 32 1.5 mPSL: 16 PSL: 2 PSL: 1.6 8 76 F HSPN mPSL: 32 5.0 mPSL: 8 PSL: 2.6

M: male, F: female, MCNS: minimal change nephrotic syndrome, LN: lupus nephritis, EPGA: eosinophilic granulomatosis with polyangiitis, MPA: microscopic polyangiitis, HSPN: Henoch-Schönlein purpura nephritis, PSL: prednisolone, mPSL: methylprednisolone. a_{Initial mPSL dose was 500 mg×3 d, except for Patient 3 (1 g×3 d) and Patients 7 and 8 (reported in table).} b_{The first}

CTs were performed within 6 weeks before the initial steroid therapy. c_{Steroid taken using steroid pulse was excluded from cumulative}

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íò Myositis (n = 7) Control (n = 8) COPD 4 (57%) 2 (25%) ILD 4 (57%) 4 (50%) CKD 1 (14%) 6 (75%) Cancer 3 (43%) 0 (0%)

COPD: chronic obstructive pulmonary disease, ILD: interstitial lung disease, CKD: chronic kidney disease.

Takashi Nawata, Makoto Kubo, Takafumi Nomura, Keiji Oishi, Kosaku Shiragami, Tadayoshi Ikegami, Munemasa Okada, Shigeki Kobayashi, Masafumi Yano. Change in muscle volume after steroid therapy in patients with myositis assessed using cross-sectional computed tomography. BMC Musculoskeletal Disorders 2018; 19(1):93. doi: 10.1186/s12891-018-2008-8.