Ab0202 dysphagia: Poor Prognosis in Idiopathic Inflammatory Myopathies

Abstract

BackgroundDysphagia has been reported to occur in 10% to 73% of these patients and can be present at any time during the disease process (1).ObjectivesThe primary objective of the study was to evaluate the prevalence of dysphagia in a cohort of patients with idiopathic inflammatory myopathy (MII) and to evaluate factors associated with the presence of dysphagia. The secondary objective was to evaluate the factors associated with severe dysphagia.MethodsRetrospective, observational study, which included patients with a diagnosis of MII according to modified classification criteria of Bohan and Peter (1992-2018). Demographic data, clinical characteristics, laboratory data, autoantibodies, imaging studies, videodeglution, muscle biopsy and EMG were recorded.Severe dysphagia was considered: one in which oral feeding was contraindicated and/or which required nasogastric tube feeding (SNG) either by clinical evaluation or by videodeglution study. The rest of the patients with dysphagia who did not present a contraindication to oral intake during the course of the disease were considered mild/moderate dysphagia.Results94/110 patients were included, 76% female, mean age at diagnosis: 48 years (SD ± 14). Idiopathic dermatomyositis was the most frequent subtype of myopathy (64%). Dysphagia occurred in 53/94 patients (56.4%) and it was presented at the beginning of the disease in 31/94 (32%). Severe dysphagia was found in (22/94) 23%.When analyzing the clinical features of patients with myopathy and dysphagia, it was found that Idiopathic dermatomyositis was the most frequent MII in these patients (71%). Patients with dysphagia presented: proximal muscle weakness 90%, neck muscles weakness 47%, and respiratory muscle weakness 27%.Treatment received: 90/94 (97%) oral glucocorticoids, mean dose 48 mg of prednisone (Range 4 -100 mg.), pulses of Intravenous methylprednisolone was indicated in 25 patients (27.5%).The main steroid sparing agents used were: 72% methotrexate, followed by 33% azathioprine.Significant association was found between dysphagia and weakness of neck muscles, respiratory muscles, of glucocorticoid pulses, gamma globulin and mortality (data not shown). In the Logistic Regression analysis, no variable was independently associated with the presence of dysphagia.When analyzing the relationship of severe dysphagia and factors associated, a significant association was found with the requirement of mechanical ventilation, hospitalization in an intensive care unit, serious infections, neoplasia and mortality (Table 1). In the multivariate analysis: no associated factors were found independently.Table 1Variable severe dysphagia (present) n=22 (%) severe dysphagia (absent) n=72 (%) p ORIC Weak neck muscles 15 (68%) 18 (25%) <0.001 8.86 2.75-8.86 Weakness of respiratory muscles 10 (45%) 6 (8%) <0.001 9.5 2.8-32 pulses of corticosteroids 17 (77%) 8 (11%) <0.001 25 7.5-89.5 intravenous gammaglobulin 10 (45%) 7 (9%) <0.001 7.73 2.46-24 intensive care unit 8 (36%) 8 (11%) <0.001 4.57 1.46-14.2...

Clinical spectrum and outcomes of idiopathic inflammatory myopathies in South Africans

“…On the other hand, PM had more severe disease. Dysphagia, which has been shown previously to be associated with weakness of neck and respiratory muscles ( 12 ), was common in PM patients. Like in the above study, our patients with dysphagia were more likely to have pulse IV corticosteroid therapy.…”