miR-125b, miR-200c Are Correlated with the Severity of Interstitial Lung Disease in Dermatomyositis/Polymyositis

Objective: To explore the correlations between miR-125b, miR-200c, and the severity of interstitial lung disease associated with dermatomyositis/polymyositis (DM/PM-ILD). Methods: 30 consecutive patients with DM/PM and 23 healthy controls were recruited into current study. Anti-JO-1, anti-SSA, muscle enzymes, the data of chest HRCT and pulmonary function test were collected. 9 consecutive DM/PM-ILD patients underwent bronchoalveolar lavage (BAL). TGF-β1 and surfactant protein D (SP-D) in BAL fluid (BALF) and plasma were detected by ELISA. miR-125b and miR-200c in PBMCs and bronchoalveolar cells were detected by QRT-PCR. All patients were classified into three groups: Mild or non-ILD group, moderate ILD group, and severe ILD group. The correlations between miRNAs and the severity of ILD, the lung damage markers, auto-antibodies, were analyzed. Results: The levels of miR-125b and miR-200c in bronchoalveolar cells were higher than in PBMCs, and the levels of TGF-β1 and SP-D were higher in BALF than in plasma in DM/PM-ILD patients. There were positive correlations between miR-125b, miR-200c in bronchoalveolar cells and SP-D in BALF. The levels of miR-125b and miR-200c in severe ILD group were higher than in mild or non-ILD and moderate ILD groups. There were negative correlations between miR-125b, miR-200c, and FEV1, and between miR-200c and DLCO. The patients with anti-JO-1 antibody had higher levels of miR-125b and miR-200c, and had more severe condition of ILD. Conclusion: miR-125b and miR-200c were positively correlated with the lung damage and severity of ILD in DM/PM, which could be important markers for judgement of disease condition in clinic.

Muscular involvement of extranodal natural killer/T cell lymphoma misdiagnosed as polymyositis: A case report and review of literature

BACKGROUND Natural killer(NK)/T cell lymphoma is a rare and highly aggressive malignant tumor,and is a special form of non-Hodgkin's lymphoma.Although extranodal involvement is frequently found in tissues such as the skin,testicular and gastrointestinal tract etc,its presence in skeletal muscle has scarcely been reported in the literature.CASE SUMMARY We report a case of extranodal NK/T cell lymphoma with muscle swelling as the first clinical manifestation.A 42-year-old man,who initially presented with localized swelling in the double lower extremities,demonstrated gradual facial and eyelid swelling,and his imaging results showed multiple sites of muscle damage throughout the body.The final pathological results suggested NK/T cell lymphoma,and immunohistochemistry showed CD20(-),CD3(+),CD30(+),CD56(-),EBER(+),Ki67(60%),TIA-1(+)and CD68(±)staining.The muscle swelling significantly improved after treatment with chemotherapy regimens.CONCLUSION This disease is difficult to diagnose and highly invasive,and should be included in the differential diagnosis of unexplained muscle swelling.

An Unusual Paraneoplastic Syndrome of Synchronous Bladder Tumor and Prostate Cancer: Polymyositis

Introduction: Polymyositis (PM) is a type of inflammatory myopathy that is associated with a broad range of malignant disorders. An association of PM with synchronous carcinoma of the bladder and prostate is extremely rare. Case: A 65-year-old man admitted to hematology with complaints of severe progressive weakness of lower extremities, hematuria and irritative urinary symptoms lasting for a month. The hemogram and erythrocyte sedimentation rate were normal. ALT was normal but AST was 405.56 U/l. There was marked elevation of serum creatine kinase (CK) and lactate dehydrogenase, which were 14,065.15 U/l and 1267.50 U/l, respectively. PSA was 4.28 and DRE was positive. The abdominal ultrasound revealed a 24 × 20 mm soft tissue echogenicity lesion at the right wall and a 35 × 21 mm soft tissue echogenicity lesion at the left wall of the bladder. The rest of the abdominal viscera were normal. Computed tomography found, two 6 mm solid lesions at left anterolateral and a 18 × 12 mm solid lesion at inferoanterior bladder wall in addition to the above findings. Patient counseled to us. We resected all of the bladder masses with transurethral (TUR-BT) way and pathology revealed T2 high grade bladder tumor. Two days after TUR-BT, we performed a trans rectal ultrasonography guided prostate biopsy and pathology revealed a Gleason 3 + 4 prostate cancer. EMG showed sensorimotor polyneuropathy at the lower extremities, sustaining polymyozitis. Biopsy of the right peroneus brevis muscle showed no vasculitis with low grade neurologic changes. We offered to perform a radical cystoprostatectomy operation but the patient prefered chemotherapy. Two months after his initial presentation at the second cure of the chemotherapy all muscle weaknesses showed a dramatic regression. Conclusion: This case report indicates that both bladder carcinoma and prostate cancer should be kept in mind in elderly PM patients presenting with lower urinary tract symptoms and hematuria.

Polymyositis-like syndrome with rhabdomyolysis in association with brucellosis

Diffuse myositis with progression to rhabdomynlysis has been reported in association with wide range of viral infections.We report a case of polvmvosilis-like svndrome complicated by rhabdomyolysis secondary to brucellosis.This case report thus contributes yet another atypical presentation to a disease already infamous for its protean manifestations.

A Survey on TCM Treatment of Polymyositis and Dermatomyositis

Polymyositis is an illness characterized by inflammation of the muscle(s) with uncertain etiological causes. Most of the physicians think that viral infection, disturbances of immune functions and/or pathological vascular changes might be responsible for the condition.

Pulmonary hypertension,nephrotic syndrome,and polymyositis due to hepatitis C virus infection:A case report

BACKGROUND Hepatitis C infection not only damages the liver but also often accompanies many extrahepatic manifestations.Incidences of pulmonary hypertension(PH)caused by hepatitis C are rare,and incidences of concurrent nephrotic syndrome and polymyositis are even rarer.CASE SUMMARY Herein we describe the case of a 57-year-old woman who was admitted to our department for intermittent chest tightness upon exertion for 5 years,aggravated with dyspnea for 10 d.After relevant examinations she was diagnosed with PH,nephrotic syndrome,and polymyositis due to chronic hepatitis C infection.A multi-disciplinary recommendation was that the patient should be treated with sildenafil and macitentan in combination and methylprednisolone.During treatment autoimmune symptoms,liver function,hepatitis C RNA levels,and cardiac parameters of right heart catheterization were monitored closely.The patient showed significant improvement in 6-min walking distance from 100 to 300 m at 3-mo follow-up and pulmonary artery pressure drops to 50 mmHg.Long-term follow-up is needed to confirm further efficacy and safety.CONCLUSION Increasing evidence supports a relationship between hepatitis C infection and diverse extrahepatic manifestations,but it is very rare to have PH,nephrotic syndrome,and polymyositis in a single patient.We conducted a literature review on the management of several specific extrahepatic manifestations of hepatitis C.

Anterior segment parameters associated with extramuscular manifestations in polymyositis and dermatomyositis

AIM:To evaluate detailed anterior segment parameters of patients with idiopathic inflammatory myopathies(IIM),including polymyositis(PM),and dermatomyositis(DM),and to clarify the associations between these data and clinical variables of IIM.METHODS:Totally 57 PM,41 DM patients and 62 controls were enrolled in this cross-sectional,observational,case-control study.All study participants underwent Pentacam evaluation.Laboratory investigations consisted of different antibody assays,while extramuscular clinical assessments included Raynaud’s phenomenon,dysphagia,interstitial lung disease,arthritis/arthralgia,and weight loss.Objective signs and subjective symptoms of dry eye disease(DED)were also evaluated.RESULTS:All pachymetric parameters[center,apex,thinnest and maximal keratometry(Kmax)]and corneal volume(CV)of both sides of PM patients proved to be significantly lower.Some pachymetric data were also noticed as significantly decreased compared to those of controls.Several significant differences were traced between anterior segment values and extramuscular manifestations of myositis,largely in case of arthritis/arthralgia and weight loss,whereas associations between anterior segment parameters and antibodies were weak.Objective clinical tests of DED were also significantly decreased in IIM patients.CONCLUSION:The results suggest that all IIM patients have thinner corneas compared with those of controls,and decreased corneal parameters are significantly associated with the occurrence of some extramuscular manifestations.In addition,IIM patients tend to develop objective signs of DED.

A case of polymyositis with ophthalmoplegia Laboratory examinations

OBJECTIVE： Polymyositis （PM） mainly involves proximal limb and trunk muscles. Ocular muscles are not affected, except in rare cases with both PM and myasthenia gravis （MG）. Thus, the results of laboratory examinations in such a patient deserve to be reported. METHODS： To analyze the clinical, imaging and pathology datas on a 65-year-old woman patient with PM with complex symptoms, who presented mainly ophthalmoplegia. The patient consented to all examinations and the hospital Ethics Committee approved the study. The laboratory examinations included creatine kinase （CK）, ENA, tumor marker, function of thyroid, cranial MRI, and electromyogram （EMG）. Biopsy of the left quadriceps femoris was performed, frozen specimens were stained with hematoxylin and eosin, ATPase, NADH tetrazolium reductase, periodic acid Schiff, oil red O, modified Gomory trichrome and MHC-I, to investigate the pathology of muscle fibers RESULTS： Laboratory results showed： CK, 108.32μ kat/L; antinuclear antibody： （＋）; ENA, （-）; tumor marker, （-）; normal thyroid function, MRI showed no abnormal signals in brain and extraocular muscles. Electromyography of the bilateral deltoid, biceps brachii, musculus quadriceps fexoris, anterior tibialis showed fibrillation potentials, positive potentials and short-duration, small-amplitude polyphasic potentials on voluntary movements with a full interference pattern on mild exertion. Repetitive stimulation did not result in any increment or decrement in these potentials. A muscle biopsy of the left quadriceps femoris showed many small round muscle fibers without peripheral bundle distribution and apparent myofiber degeneration, necrosis and phagocytosis. There were several focal lymphocyte infiltrations. MHC-I immunohistochemical staining was positive in most fibers revealing inflammatory infiltration of normal fibers with MHC-I expression. CONCLUSION： This patient showed increased CK, typical triad of myopathy in EMG, and apparent degeneration and necrosis in biopsy of quadriceps femoris. Therefore, the diagnosis of PM and involvement of extraocular muscles were definite.

IMMUNOGLOBULIN DEPOSITIONS IN PERIPHERAL NERVES IN POLYMYOSITIS

An immunocytochemical study was performed in 6 peripheral nerve specimens from 6 cases of polymyositis. The results revealed that depositions of IgG, IgM, IgA and C3 were found in the epineurium, perineurium and the walls of capillaries. These findings demonstrated that depositions of immunoglobulins and the complement-mediated immunoreaction may play an important role in pathogenesis of polymyositis with peripheral nerve involvements.

Dermatomyositis and polymyositis in total hip arthroplasty

BACKGROUND Idiopathic inflammatory myopathies(IIM)are systemic autoimmune disorders such as dermatomyositis(DM),polymyositis(PM),inclusion body myopathy,and autoimmune necrotizing myopathy that,similar to osteoarthritis,affect quality of life and activities of daily living.Moreover,these patients are often burdened with chronic pain and disability;however,the outcomes and risk of total hip arthroplasty(THA)in this patient population remain unclear.AIM To evaluate 90-d complications and costs in patients with these conditions.METHODS A retrospective case control study was designed by accessing data from the Medicare dataset available on the PearlDiver server.Patients with IIM,here,those with DM and PM were matched based on possible confounding variables to a cohort without these diseases and with the same 10-year risk of mortality as defined by the Charlson Comorbidity Index Score(CCI).Univariate and multivariate analysis were performed to evaluate complications and t-tests to evaluate 90-d Medicare reimbursements as markers of costs after THA.RESULTS The total sample was 1090 patients with each cohort comprised of 545.Females were 74.9%of the population.The mean CCI was 5.89(SD 2.11).Those with IIM had increased rates of pneumonia[odds ratio(OR)1.45,P<0.001]and pulmonary embolism(OR 1.46,P=0.035)and decreased hematoma risks(OR 0.58,P=0.00).90-d costs were on average$1411 greater for those with IIM yet not significantly different(P=0.034).CONCLUSION Patients with IIM have an increased 90-d rate of pneumonia and pulmonary embolism concomitant with a decreased hematoma rate consistent with their procoagulatory state.Further attention to increased resource utilization in these patients is also warranted.

Previous Pulmonary Fibrosis in Dermatomyositis/Polymyositis: A Predictive Factor for Pulmonary and Extra-Pulmonary Tuberculosis

Objective: With scant studies in the literature, little is known about the risk factors for tuberculosis in patients with dermatomyositis/polymyositis. Therefore, the aim of the present study was to analyze the predictive factors for tuberculosis development in dermatomyositis/polymyositis. Methods: This single-center, retrospective, cohort study initially included 290 patients with dermatomyositis/polymyositis, from 2002 to 2016. Tuberculosis (pulmonary and/or extra-pulmonary) was confirmed after dermatomyositis/polymyositis diagnosis in 12 patients (4.1%) (Tuberculosis+ group). For the control group (Tuberculosis&#8722;), 24 patients without tuberculosis were arbitrarily selected in the same period and matched for age, ethnicity, gender, age at disease diagnosis, disease duration and type (dermatomyositis or polymyositis). Results: Tuberculosis occurred for a median of 16 months after dermatomyositis/polymyositis diagnosis. Clinical, laboratory and treatment features were similar in Tuberculosis+ and Tuberculosis&#8722;groups (P > 0.05). However, previous pulmonary fibrosis in dermatomyositis/polymyositis was more prevalent in the Tuberculosis+ group (41.7 vs. 8.3%;P = 0.029). Moreover, on a multivariate logistic regression model, pulmonary fibrosis was significantly associated with Tuberculosis (Odds ratio: 9.59, 95% confidence interval: 1.17 - 78.82). Tuberculosis affected 3 dermatomyositis cases for every 1 polymyositis case, with predominantly pulmonary followed by extra-pulmonary involvement (pleura, cutaneous, muscular, joint, soft tissue and hematologic). Two or more sites were affected in 41.7% of cases. Conclusions: Previous pulmonary fibrosis in dermatomyositis/polymyositis was a predictive factor associated with tuberculosis development. Further studies are needed to confirm these results.

Nodular Amyloidosis Overlapping and Polymyositis in a Patient with Skin Manifestations Lupus Fax: Case Report

Amyloidosis is the result of fibrous and insoluble amyloid protein deposition in extracellular spaces of tissues and organs, including the skin. Through the analysis of medical records, clinical condition and laboratory tests, this article proposes a rare case report of an adult patient with symptoms and diagnosis of polymyositis, histopathology of nodular amyloidosis with skin lesions suggestive of lupus. The patient is still being followed at the dermatology clinic of Valen&ccedil;a Medical School, in order to improve the prognosis and prevent the progression of existing symptoms.

Predictive factors and unfavourable prognostic factors of interstitial lung disease in patients with polymyositis or dermatomyositis： a retrospective study

Background Interstitial lung disease （ILD） is a serious lung complication in polymyositis （PM） and dermatomyositis （DM） which affects prognosis and requires a more aggressive approach in therapy. This study investigated the prevalence, characteristics, predictive factors and unfavourable prognostic factors of ILD in newly diagnosed PM, DM and amyopathic DM （ADM）. Methods From January 2000 to December 2008, the medical records of 197 consecutive PM and DM patients at the Second Affiliated Hospital of Sun Yat-Sen University were reviewed excluding overlapping, juvenile, and malignancy-associated cases. The patients were assigned to an ILD （69 patients） and a non-lLD group （128 patients）. The clinical features, laboratory findings, and prognosis were compared. Results The multivariate analysis indicated that older age at onset （OR 1.033, 95%C/1.009-1.058, P=0.007）, fever （OR 4.109, 95%CI 1.926-8.767, P 〈0.001） and arthritis/arthralgia （OR 2.274, 95%C/1.101-4.695, P=0.026） were the independent predictive factors for developing ILD in PM/DM after excluding anti-Jo-1. Regarding anti-Jo-1, fever （OR 4.912, 95%CI 2.121-11.376, P 〈0.001） was associated with ILD. Poor survival in ILD patients was associated with ILD clinical subset （RR 0.122, 95%CI 0.049-0.399, P 〈0.001）, ADM/DM/PM-ILD （RR 0.140, 95%C/0.031-0.476, P=0.002）, cardiac involvement （RR 4.654, 95%CI 1.391-15.577, P=-0.013） and serum albumin level （RR 0.910, 95%CI 0.831-0.997, P=-0.042）. Conclusions Patients who presented with fever tended to have a higher frequency of PM/DM-associated ILD. A Hamman-Rich-like presentation, ADM-ILD, cardiac involvement and hypoalbuminemia were poor prognostic factors in ILD-PM/DM.

Increased Expression of the NOD-like Receptor Family, Pyrin Domain Containing 3 Inflammasome in Dermatomyositis and Polymyositis is a Potential Contributor to Their Pathogenesis

Background： Dermatomyositis （DM） and polymyositis （PM） are common inflammatory myopathies whose immunopathogenic mechanisms remain poorly understood. The NOD-like receptor family, pyrin domain containing 3 （NLRP3） inflammasome is a type of cytoplasmic multiprotein inflammasome and is responsible for the activation of inflammatory reactivations. Responding to a wide range of exogenous and endogenous microbial or sterile stimuli, NLRP3 inflammasomes can cleave pro-caspase- 1 into active caspase- 1, which processes the pro-infammatory cytokines pro-interleukin （IL）-1 β and pro-IL-18 into active and secreted IL-1β and I L-18. The NLRP3 inflammasome is implicated in infectious and sterile inflammatory diseases. However, it remains unclear whether it is involved in the pathogenesis of DM/PM, which we aim to address in our research. Methods： In this study, 22 DM/PM patients and 24 controls were recruited. The protein and RNA expression of IL-113, IL-18, NLRP3, and caspase-1 in serum and muscle samples were tested and compared between the two groups. Results： The serum IL-1 β and IL-18 levels were significantly higher in DM/PM patients than those in the controls by enzyme linked immunosorbent assay （EL1SA, DM vs. control, 25.02 ± 8.29 ng/ml vs. 16.49 ± 3.30 ng/ml, P 〈 0.001 ; PM vs. control, 26.49±7.79 ng/ml vs. 16.49 ± 3.30 ng/ml, P 〈 0.001）. Moreover, the real-time quantitative reverse transcription-polymerase chain reaction （qRT-PCR） showed that DM/PM patients exhibited higher RNA expression of IL-lβ, IL-18, and NLRP3 in the muscle （for IL-1 β, DM vs. control, P 0.0012, PM vs. control, P = 0.0021 ; for IL- 18, DM vs. control, P = 0.0045, PM vs. control, P 0.0031 ; for NLRP3, DM vs. control, P = 0.0017, PM vs. control, P 0.0006）. Moreover, the protein expression of NLRP3 and caspase- 1 in muscle samples of DM/PM patients were also significantly elevated compared to that in the muscles of the controls. Conclusions： Our findings demonstrate that the NLRP3 inflammasome is implicated in the pathogenesis of DM/PM. High NLRP3 expression led to elevated levels of IL-l13 and IL-18 and could be one of the factors promoting disease progress.

Upregulation of Interleukin 21 and Interleukin 21 Receptor in Patients with Dermatomyositis and Polymyositis

Background：The immunopathologic mechanism underlying dermatomyositis （DM） and polymyositis （PM） remains poorly understood.Many cytokines play a pathogenic role in DM and PM.lnterleukin 21 （IL-21） has a pleiotropic effect on inflammation regulation.This study aimed to detect the serum IL-21 level and investigate the expression of IL-21 and IL-21 receptor （IL-21 R） in muscle tissues of patients with DM and PM.Methods：Biopsied muscle samples were obtained from 11 patients with DM,12 with PM,and six controls;mRNA levels of IL-21 and IL-21 R were analyzed by real-time quantitative reverse transcription-polymerase chain reaction;and immunohistochemical staining was used to evaluate the protein expression of IL-21 and IL-21R.Serum samples were obtained from 36 patients with DM,19 with PM,and 20 healthy controls.The serum IL-21 level was detected by enzyme-linked immunosorbent assay.Results：The expression of IL-21 was upregulated in patients with DM and PM.The IL-21 mRNA level was significantly increased in muscle tissues of patients with DM and PM （DM vs.control,P =0.001;PM vs.control,P =0.001）,whereas IL-21R mRNA level in patients with DM/PM was not statistically different from that of healthy controls.Immunohistochemical staining showed both I L-21 and IL-21R were significantly expressed in the inflammatory cells in muscle tissues of patients with DM and PM.The serum IL-21 level was also significantly higher in patients with DM/PM than in controls （DM vs.control,49.12 [45.28,60.07] pg/ml vs.42.54 [38.69,48.85] pg/ml,P =0.00l;PM vs.control,50.77 [44.19,60.62] pg/ml vs.42.54 [38.69,48.85] pg/ml,P =0.005）.Conclusions：IL-21 expression is upregulated in patients with DM and PM in both muscle tissue and serum.In addition,IL-21R protein is highly expressed in affected muscle tissues of patients with DM and PM.IL-21 may play a pathogenic role through IL-21R in patients with DM and PM.

Nerve conduction studies in patients with dermatomyositis or polymyositis

Background Involvement of peripheral nerves in dermatomyositis （DM） and polymyositis （PM） is less well known. In the present study we retrospectively analyzed the clinical and electrophysiological records of hospital inpatients with a diagnosis of DM or PM to investigate the association of DM/PM and peripheral neuropathy. Methods The data of inpatients diagnosed with DM or PM were collected in Peking Union Medical College Hospital, and 186 patients （118 patients with DM and 68 with PM） were retrospectively analyzed. Nerve conduction studies （NCSs） of the median nerve, ulnar nerve, posterior tibial nerve, and common peroneal nerve were examined simultaneously. Results There were 71 （38.2%） patients with abnormal NCS findings, 37 （19.9%） with pure motor involvement （decreased compound muscle action potential, CMAP）, and 34 （18.3%） with peripheral neuropathy. Of the 34 peripheral neuropathy patients, 14 （7.5%） had polyneuropathy, 1 （0.5%） had multiple mononeuropathy, 16 （8.6%） had carpal tunnel syndrome （CTS）, 1 （0.5%） had trigeminal sensory neuropathy, 1 （0.5%） had ulnar sensory neuropathy, and 1 （0.5%） had brachial plexus involvement. The prevalence of malignant disease （3/34, 8.8%）, other connective tissue diseases （CTDs） （7/34, 20.6%） and diabetes （6/34, 17.6%） was significantly greater in DM/PM patients with peripheral neuropathy （X2=15.855, P=0.000） compared with DM/PM patients without involvement of peripheral nerves （5/115, 4.3% and 7/115, 6.1%, respectively）. Conclusions Peripheral neuropathy in DM/PM often suggests a complication with cancer, other CTDs, diabetes or CTS. From a practical point of view, NCS for DM/PM may help find the underlying disorders.

疼痛科多发性肌炎和皮肌炎病例报道

多发性肌炎（polymyositis,PM）/皮肌炎（dermatomyositis,DM）是以四肢近端肌肉受累为突出表现的异质性疾病。我国PM/DM的发病率尚不十分清楚,国外报告的发病率约为0.6~1/万,属少见、罕见病。其特征性表现为对称性四肢近端肌无力,约50%的病人可同时伴有肌痛或肌压痛。部分病人因此就诊于疼痛科。因该病发病率低,疼痛科医生对该病往往认识不足，易忽视或延误病情。本文就我科2016年6月收治多发性肌炎，2016年7月收治皮肌炎病人各一名进行报道并复习文献，旨在提高疼痛科医师对该疾病的认识，减少误诊，缩短诊断时间，提高诊断准确率。

炎症性肌病患者的康复治疗研究进展

炎症性肌病为一组少见的、慢性炎症性肌肉病变,与自身免疫紊乱相关,广义上分为多发性肌炎（polymyositis,PM）、皮肌炎（dermatomyositis,DM）与包涵体肌炎（inclusion body myositis,IBM）三类,以对称性四肢近端肌无力为典型表现,肌肉活检示肌肉内有炎症细胞浸润,并可累及肺脏、心脏等内脏器官。

多发性肌炎合并肌纤维脂质增多1例报告

特发性炎性肌病（idiopathic inflammatory moypathy,IIM）是一组免疫介导的获得性肌肉疾病,包括：皮肌炎（dermatomyositis,DM）、多发性肌炎（polymyositis,PM）、散发性包涵体肌炎（sporadic inclusionbody myositis,s IBM）和免疫介导坏死性肌病（IMNM）。

儿童特发性炎症性肌炎/幼年皮肌炎研究进展

儿童特发性炎症性肌炎（idiopathic inflammatory mvopathies,IIMs）是一组罕见、复杂,且存在潜在不良预后的自身免疫性疾病。IIMs分类包括：多肌炎（polymyositis,PM）、幼年皮肌炎（juvenile dermatomyositis,JDM）、无肌病性皮肌炎（amyopathic dermatomyositis,ADM）与包涵体肌炎（inclusion body myositis,IBM）、恶性肿瘤相关的皮肌炎等。