Relevance of ultrasonography in assessing disease activity in patients with idiopathic inflammatory myopathies

Abstract

Aim: Idiopathic inflammatory myopathies (IIM) comprise a group of rare and heterogeneous diseases difficult to diagnose and follow up. Precise measures for assessing disease activity are not available at the moment. Our objective was to evaluate the usefulness of ultrasonography (US) as a monitoring tool in IIM. Method:The study evaluated IIM patients diagnosed and followed up from 2005 to 2015 in our department. Fifteen patients with a mean age of 52.2 AE 22.09 years and mean disease duration of 4.6 AE 3.20 years were included. Physical examination including muscle strength tests, laboratorial analysis and a selective muscle US assessment were performed for each patient at a scheduled visit.Results: Nine of the 15 patients were in clinical remission and US assessment revealed a preserved muscle pattern. Symmetrical proximal muscle atrophy was found on US in one patient with longstanding polymyositis (PM) with proximal weakness. Inflammation and focal or generalized muscle edema were present on US in the remaining five patients with muscular weakness suggesting active disease. One of these patients in acute flare presented with atrophy changes in addition to edema. Early untreated myositis presented in one patient with moderate power Doppler (PD) signal. Conclusion:As far as muscle US assessment is concerned, a single specific pattern was not observed in our study. A mixture of muscle edema and atrophy was detected depending on disease activity and duration. US findings seem to correlate well with disease activity, suggested by clinical data, and may be a useful tool to complement patient evaluation.

Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

“…No differences in PD signal were seen between healthy controls and people with IIM. A single previous published study reported increased PD signal in acute IIM [ 45 ]. A few possibilities could explain this discordance.…”

Neuromuscular ultrasound in clinical practice: A review

“…In addition to supporting a diagnosis, ultrasound has potential as an indicator of disease activity in inflammatory myopathy. This is often a clinically difficult question since weakness in these patients may be due to active inflammation, but may also be due to corticosteroid use, chronic atrophy, or a comorbid condition (Sousa Neves et al, 2018). The sensitivity of muscle ultrasound in detecting histopathologically proven inflammatory myopathy has been reported as high as 82.9% (Reimers et al, 1993).…”

“…Muscle edema on NMUS appears to be specific to acute myositis. This is seen as focal or generalized hypoechogenicity and increased muscle thickness (Reimers et al, 1993, Sousa Neves et al, 2018). However, the more common finding appears to be hyperechogenicity with normal or increased muscle thickness, with the increased in echogenicity suspected to be due to inflammation and edema (Mittal et al, 2003, Sousa Neves et al, 2018).…”

Muscle Ultrasound in Inflammatory Myopathies: A Critical Review

“…It can also normalize after start of treatment, paralleling improvement in clinical condition [38]. A recent study with mostly PM/DM patients found that US findings correlated well with disease activity [42]. Stonecipher, et al has described an increase in echo intensity of deltoid, biceps and triceps muscles in patients with DM even when muscle enzymes were normal [36].…”