皮肌炎/多发性肌炎86例的甲状腺功能分析

目的探讨皮肌炎/多发性肌炎(DM/PM)合并甲状腺功能异常的临床特点及其意义。方法回顾性分析86例DM/PM患者的甲状腺功能检测指标及其临床资料,依据其甲状腺功能检测结果是否正常进行分组、比较。结果 86例DM/PM患者中,甲状腺激素检测结果异常者54例(62.79%);其中甲状腺机能正常的病态综合征发生率最高(51.85%),其他依次为亚临床甲减、临床型甲减、亚临床甲亢、桥本甲状腺炎。与正常组相比,甲状腺激素异常组患者多见合并发热、胸膜炎/胸腔积液,也常出现CRP升高、低蛋白血症、血钙下降(P均0.05)。结论 DM/PM患者合并甲状腺激素异常的发生率高,其中尤以甲状腺机能正常的病态综合征最为多见。     

女性外阴硬化性苔藓与甲状腺功能和抗体的相关性研究

目的:探讨女性外阴硬化性苔藓患者甲状腺功能或抗体指标异常发生率及其影响因素。方法:收集2016年1月～2018年6月于我院就诊的136例女性外阴硬化性苔藓患者作为观察组,60例体检健康人员为对照组,分析并比较两组受试者甲状腺功能或抗体指标的差异,采用Logistic回归分析外阴硬化性苔藓患者发生甲状腺功能或抗体指标异常的影响因素。结果:女性外阴硬化性苔藓患者发病年龄以50岁以上居多,平均病史为(6. 83±1. 28)年,皮损部位常位于大小阴唇及阴道口,且皮损形态多呈现色素脱失或减退并伴有一定程度萎缩,临床症状多以瘙痒为主。外阴硬化性苔藓患者甲状腺功能或抗体异常发生率为16. 91%(23/136),明显高于对照组且差异具有统计学意义(χ2=5. 13,P=0. 02)。外阴硬化性苔藓患者的病程(OR=4. 27)、复发(OR=3. 56)及合并自身免疫性疾病(OR=8. 11)是发生甲状腺功能或抗体异常的影响因素。结论:外阴硬化性苔藓患者甲状腺功能或抗体异常发生率明显升高,临床医生应对外阴硬化性苔藓患者行甲状腺激素和抗体水平检查,对继发性甲状腺疾病进行提早干预,以避免不良事件的发生。     

皮肌炎107例患者肌电图与临床特征的回顾性分析

目的：分析皮肌炎（DM）患者肌电图（EMG）的表现和临床特征,为DM患者的临床诊治和预后提供参考依据。方法：回顾性分析2013年6月—2020年10月于昆明医科大学第二附属医院行EMG检查并被确诊为DM患者的住院病历资料。根据EMG结果分为EMG正常组和EMG异常组,对两组临床资料、EMG特点、实验室检查及并发症进行统计学分析。结果：共收集107例DM患者,EMG正常组18例,EMG异常组89例,其中肌源性损害者74例,近端肌肉受累者55例。EMG正常组住院天数比EMG异常组更长,发病年龄更大,且EMG正常组间质性肺疾病的发生率高于EMG异常组,差异均有统计学意义（P<0.05）。两组间其他发病情况、皮损特点、肌肉症状及肿瘤发生率的差异均无统计学意义（P>0.05）。EMG正常组红细胞、血红蛋白及血清IgA水平均高于EMG异常组（P<0.05）;EMG异常组红细胞沉降率（ESR）高于EMG正常组（P<0.05）。两组患者激素使用情况及用量、免疫抑制剂的使用情况之间差异无统计学意义。结论：EMG异常组的DM患者多为四肢近端的肌源性损害,且合并间质性肺疾病的发生率更...     

皮肌炎并发间质性肺病32例分析

目的 探讨皮肌炎(DM)并发间质性肺病(ILD)的临床特点和意义。方法 收集北京协和医院1970-1997年门诊和住院长期随诊的216例DM患者,符合Bohan和Peter1975年诊断标准。随诊2~27年,平均(5.8±4.7)年。DM合并ILD32例,DM无ILD184例。比较两组临床资料和实验室各指标,以这些参数作统计学分析。结果 DM患者中,ILD组初发症状中发热(28.2%)显著多于无ILD组(6.5%),P<0.01。病程中ILD组的发热、关节炎、皮肤溃疡和类风湿因子阳性明显增高,分别为71.9%、62.5%、31.3%和24.1%,无ILD组分别为34.2%、8.7%、8.1%,两组比较,P均<0.01或<0.05。而两组患者眼睑紫红斑、Gottron征、吞咽困难、肌肉痛、肌无力、抗核抗体阳性和肌电图肌源性改变发生率差异均无显著性(P均>0.05)。ILD组32例中死亡13例(40.6%),病情改善15例(46.9%),缓解而停用皮质类固醇4例(12.5%)。184例DM无ILD者死亡30例(16.3%),两组死亡率差异有显著性(P<0.01)。结论 DM患者有ILD者发热、关节炎、皮肤溃疡和类风湿因子阳性明显增多。这组患者治疗困难,死亡率高。     

临床无肌病性皮肌炎与皮肌炎临床差异的探究

目的通过对本研究中临床无肌病性皮肌炎(CADM)及皮肌炎(DM)的回顾性对比分析,加深对CADM与DM各方面差别的了解。方法回顾性研究郑州大学第一附属医院2014年1月1日-2016年1月1日期间入院治疗的111例皮肌炎患者,对30例CADM及81例DM患者进行对比分析。结果 CADM组合并肺间质病变和关节炎的比例显著高于DM组,在发病年龄、始发症状、血脂水平等方面两组间差异有统计学意义(P0.05);而在抗核抗体谱、ESR、CRP水平方面两组间差异无统计学意义;两组在糖皮质激素用量方面差异无统计学意义。结论 CADM较DM有更高的肺间质病变、关节炎及恶性肿瘤的发生率,DM有更高的血脂异常的发生率。     

保存膀胱颈完整性在经尿道前列腺等离子电切术中对低龄患者勃起功能的影响

目的:探究保存膀胱颈完整性在经尿道前列腺等离子电切术中对低龄患者勃起功能的影响。方法:选取2012年1月至2014年1月期间榆林市第一医院接受治疗的76例前列腺增生症患者,采用随机数表法将76例患者分为观察组和对照组,各38例。给予两组患者经尿道前列腺等离子电切术治疗,但是观察组患者在手术过程中保存膀胱颈完整性。对比两组患者术前、术后国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、生活质量评估(QOL)的变化情况,逆行射精发生率和术后勃起功能障碍发生率。结果:两组患者的Qmax评分和QOL评分较术前均显著升高,IPSS较术前显著降低,且观察组患者的变化幅度显著高于对照组患者,比较两组间差异具有统计学意义(P0.05)。术后3个月观察组患者逆行性射精发生率为55.3%(21/38),对照组患者逆行性射精发生率为28.9%(11/38),比较两组间差异具有统计学意义(P0.05)。观察组患者术后3个月的勃起功能障碍发生率为44.7%(17/38),对照组患者术后3个月的勃起功能障碍发生率为47.3%(18/38),比较两组间差异具有统计学意义(P0.05)。结论:给予前列腺增生症患者经尿道前列腺等离子电切术时保持膀胱颈的完整性能够有效保护患者术后勃起功能,可以在临床上进一步推广和使用。     

培养的自体黑素细胞移植治疗伴自身免疫性甲状腺疾病的非节段型白癜风患者的疗效及安全性随访

【摘要】 目的 探讨培养的自体黑素细胞移植治疗伴自身免疫性甲状腺疾病的白癜风患者的临床疗效及安全性。方法 回顾2008年5月至2018年12月杭州市第三人民医院行培养的自体黑素细胞移植治疗的2 284例非节段型白癜风,其中伴自身免疫性甲状腺疾病75例,包括甲状腺功能亢进42例,甲状腺功能减退18例,桥本甲状腺炎15例。比较伴自身免疫性甲状腺疾病组与不伴自身免疫性甲状腺疾病组的疗效及安全性。计数资料的比较采用χ2检验。结果 2 284例患者中,男1 085例,女1 199例,年龄（25.0 ± 1.2）岁,病程（5.1 ± 2.3）年。术后6个月,2 209例不伴自身免疫性甲状腺疾病组中1 873例有效（84.8%）、1 162例痊愈（52.6%）;伴自身免疫性甲状腺疾病组46例有效（61.3%）、20例痊愈（26.7%）,伴自身免疫性甲状腺疾病组有效率及痊愈率均低于不伴自身免疫性甲状腺疾病组（χ2值分别为29.72、19.54,均P < 0.001）。甲状腺功能减退组有效率低于甲状腺功能亢进组（χ2 = 6.61,P = 0.010）。伴自身免疫性甲状腺疾病组供皮区同形反应发生率（9.3%）高于不伴自身免疫性甲状腺疾病组（4.3%,χ2 = 4.31,P = 0.038）,且移植部位1、3、5及10年白斑复发率（6.7%、14.7%、17.3%、8.7%）均高于不伴自身免疫性甲状腺疾病组（0.7%、1.4%、2.1%、3.6%,χ2值分别为29.96、70.69、67.23、41.61;均P < 0.001）。结论 伴发自身免疫性甲状腺疾病对于白癜风的自体黑素细胞移植治疗具有负相关效应,针对该类患者更应积极采取有效的预防同形反应和移植区复发的手段。     

血清促甲状腺激素、甲状腺过氧化物酶抗体联合指导妊娠期亚临床甲状腺功能减退症治疗及妊娠结局预测价值

目的探讨血清促甲状腺激素(TSH)联合甲状腺过氧化物酶抗体(TPO-Ab)对妊娠期亚临床甲状腺功能减退症(SCH)治疗的指导意义及对妊娠结局的预测价值。方法选取2015年2月至2020年3月在徐州医科大学附属淮安医院建立生育档案、产检并分娩的100例妊娠期SCH患者的临床资料作为研究对象。根据是否遵医嘱接受左旋甲状腺素(L-T_4)治疗分为治疗组(n=68)和未治疗组(n=32);另选取同期检查显示甲状腺功能正常的孕妇35例作为对照组。比较三组基线资料、TSH水平及妊娠结局;比较治疗组中TPO-Ab阳性和阴性患者TSH水平和药物剂量;分别比较治疗组和未治疗组中TPO-Ab阳性、阴性患者的TSH水平和妊娠结局。结果未治疗组TSH水平随妊娠期的增加不断升高,且高于对照组和治疗组(P0.05)。未治疗组妊娠期糖尿病、贫血、早产、胎儿宫内窘迫发生率高于对照组和治疗组(P0.05)。TPO-Ab阳性患者TSH水平和L-T_4用药剂量高于TPO-Ab阴性患者(P0.05)。TPO-Ab阳性患者中,未治疗组不同妊娠期TSH水平、妊娠期糖尿病和妊娠期高血压发生率高于治疗组(P0.05)。TPO-Ab阴性患者中,未治疗组不同妊娠期TSH水平、早产发生率高于治疗组(P0.05)。结论 TPO-Ab阳性的妊娠期SCH患者应及早补充甲状腺激素并及时调整药物剂量使TSH尽快达标,进而改善甲状腺功能和不良妊娠结局;TPO-Ab阴性的妊娠期SCH患者给予甲状腺激素治疗后,甲状腺功能和妊娠结局较好。     

宫腔镜下刮匙刮除术对子宫内膜息肉不孕患者疗效及子宫内膜厚度的影响

目的:探讨宫腔镜下刮匙刮除术和电切除术对子宫内膜息肉的疗效。方法:将2010年8月至2013年8月医院收治的120例子宫内膜息肉不孕患者按照随机数字表法分为刮匙组60例和电切组60例,刮匙组在宫腔镜下行刮匙刮除术,电切组在宫腔镜下行电切除术。记录两组患者手术一般情况;术后随访1年,记录两组患者术后月经量、排卵期子宫内膜厚度及卵泡呈典型"三线征"比例,并记录两组患者术后1年内复发率和妊娠率。结果:两组患者手术时间、术中出血量、住院时间比较差异无统计学意义,两组患者术后并发症发生率比较差异亦无统计学意义(P>0.05)。两组患者术后月经量均显著高于手术前(P<0.05),术后各时段刮匙组月经量亦显著高于电切组(P<0.05),术后各时段刮匙组排卵期子宫内膜厚度均显著低于电切组(P<0.05);术后3个月刮匙组子宫内膜"三线征"比例显著高于电切组,术后6、12个月电切组子宫内膜"三线征"比例显著高于刮匙组,各组间比较差异具有统计学意义(P<0.05)。随访1年内,两组患者半年复发率比较差异无统计学意义(P>0.05),刮匙组1年复发率显著高于电切组(P<0.05);刮匙组半年妊娠率显著高于电切组(P<0.05),两组患者1年妊娠率比较差异无统计学意义(P>0.05)。结论:宫腔镜下刮匙刮除术和电切除术对子宫内膜息肉均可以取得满意效果;对于有生育要求的患者,可以优先考虑刮匙刮除术;对于无生育要求的患者,可以优先考虑电切除术。     

经尿道前列腺剜除术与电切术治疗良性前列腺增生患者术后射精功能对比

目的:探讨经尿道前列腺剜除术与电切术对男性射精功能的影响。方法:选取2012年11月至2015年6月我院收治的良性前列腺增生需行经尿道手术的患者,其中术前有正常阴茎勃起及规律性生活的患者68例,行前列腺电切术32例,行前列腺剜除术36例,术后随访患者阴茎勃起及射精情况。结果:前列腺电切术组,术后勃起功能正常者29例,逆行射精15例。前列腺剜除术组,勃起功能正常者32例,逆行射精5例。两组间逆行射精发生率比较,差异具有显著性。结论:经尿道前列腺剜除术与传统经尿道前列腺电切术相比,因保留完整膀胱颈,可有效保护患者的射精功能。     

Thyroid dysfunction in patients with psoriasis: Higher prevalence of thyroid dysfunction in patients with generalized pustular psoriasis

The association of psoriasis with thyroid dysfunction has been investigated; however, it remains controversial. Some papers indicate it, and others do not. Thereby, we investigated the prevalence of thyroid dysfunction in patients with psoriasis vulgaris (PsV), psoriatic arthritis (PsA) and generalized pustular psoriasis (GPP), and the relationship between the severity of psoriasis with serum free triiodothyronine (fT3), free thyroxine (fT4) and thyroid-stimulating hormone levels. Data on 85 psoriatic patients visiting our hospital from January 2015 to November 2017 (54 men and 31 women; 51 PsV, 23 PsA 23 and 11 GPP) were retrospectively analyzed. Fourteen percent of psoriatic patients had thyroid dysfunction. The percentage of patients with thyroid dysfunction was the highest in those with GPP (45% GPP, 13% PsA, 8% PsV). Patients with thyroid dysfunction demonstrated significantly higher Psoriasis Area and Severity Index scores and elevated serum C-reactive protein (CRP) levels than those without thyroid dysfunction. A significant negative correlation was observed between the serum levels of CRP and fT3 (P = 0.0032, r = −0.4635). Our data indicate that thyroid dysfunction in patients with psoriasis is associated with inflammation caused by psoriasis.     

Vitiligo in children and adolescents: association with thyroid dysfunction

Background The clinical characteristics of vitiligo in children and adolescents with an emphasis on thyroid dysfunction have only been reported in a few studies. Objective The purpose of this study was to examine the characteristics of children and adolescents with vitiligo and compare the incidence of thyroid dysfunction between them and controls without vitiligo at the same age. Methods A retrospective analysis of 324 Korean children and adolescents with vitiligo was performed. The results of thyroid function screening tests in them (n = 254) were compared with controls (n = 122). Results Of the total 324 children and adolescents with vitiligo, vitiligo vulgaris was the most common type (42.3%) and the most commonly involved site was the face (54.6%). A total of 15 of 254 (5.9%) patients screened for thyroid function were diagnosed with thyroid disease (four had Hashimoto’s thyroiditis; two, Graves’ disease; seven, subclinical hypothyroidism; and two, subclinical hyperthyroidism). None of the 50 patients with segmental vitiligo showed any thyroid dysfunction (P = 0.047). There was no significant difference in the incidence of thyroid disease between children and adolescents with vitiligo and the control group, in which seven of 122 (5.7%) showed thyroid dysfunction. Conclusion In this study, we demonstrated the characteristics of children and adolescents with vitiligo and also observed no significant difference in the incidence of thyroid disease between children and adolescents with vitiligo and the control group.     

Low yield of routine screening for thyroid dysfunction in asymptomatic patients with vitiligo

Background Nonsegmental vitiligo is considered to be an autoimmune disease and is known to be associated with other autoimmune diseases, particularly affecting the thyroid. Screening patients with nonsegmental vitiligo for thyroid function and for the presence of thyroid autoantibodies has been recommended. Objective To investigate the prevalence of thyroid dysfunction and thyroid peroxidase‐specific (TPO) antibodies in a large cohort of patients with nonsegmental vitiligo in order to help decide whether routine screening is justified. Methods A total of 434 adults with nonsegmental vitiligo who were referred to our institute were enrolled. Thyroid function and anti‐TPO antibody titres were assessed in those patients who had no history of thyroid disease or recent thyroid screening. Results Forty‐three patients had already been diagnosed with thyroid dysfunction, and in 27 patients the general practitioner had performed a thyroid function test with negative results < 3 months previously. In these patients, thyroid function assessment was not repeated. The remaining 364 patients were screened for thyroid dysfunction. Overt hypothyroidism was newly diagnosed in three (0·8%) patients; subclinical disease was found in 10 (2·7%) patients and increased levels of TPO antibodies, without thyroid disease, were found in 49 (13·5%) patients. An elevated risk for thyroid disease was found among older women and in women with a positive family history of thyroid disease. Conclusion The overall prevalence of thyroid dysfunction in adult patients with nonsegmental vitiligo was higher than reported in the general population. However, the number of newly diagnosed cases with overt and subclinical thyroid dysfunction in our population was low. Most patients had already been diagnosed by their general practitioner and had symptoms indicative for thyroid disease. Thyroid disease was found predominantly among older women and in subjects with a positive family history of thyroid disease. Thyroid screening including anti‐TPO antibodies is advisable in these high‐risk subpopulations.     

Thyroid autoimmunity in chronic idiopathic urticaria: implications for therapy

The association between thyroid autoimmunity and chronic idiopathic urticaria has long been recognized, although prevalence rates differ in the studies reported to date (from 12 to 29%). There is, therefore, a strong indication to screen patients affected by chronic urticaria of unknown origin for thyroid antibodies (antithyroperoxidase and antithyroglobulin) and, when positive, for serum thyrotropin to assess thyroid functional status. Less clear is the implication of thyroid autoimmunity for therapy, as most patients with urticaria who have associated thyroid autoimmunity are euthyroid. There is no doubt that cases with clinical or subclinical thyroid dysfunction should undergo treatment with either levothyroxine or antithyroid drugs for hypo- or hyper-function, respectively. Although the best remission rates for symptoms of urticaria have so far been obtained with levothyroxine in patients who are euthyroid, monitoring of thyroid function through serum thyrotropin determination is highly recommended because of the risk of hyperthyroidism, especially in the elderly.     

THYROID DYSFUNCTION AND THYROID ANTIBODIES IN IRANIAN PATIENTS WITH VITILIGO

Vitiligo is a common skin disorder, and the pathogenesis is unknown. An increased prevalence of autoimmune thyroid diseases has been described in these patients. The aim of this study is to assess the prevalence of thyroid dysfunction and hypoparathyroidism in patients with vitiligo.

Materials and Methods:

One hundred and nine patients (38 males and 71 females with vitiligo were enrolled. Thyroid physical examination was carried out. Thyroid function tests, thyroid antibodies, calcium and phosphorus were assessed. The collected data were analysed by SPSS version 11.

Results:

Thyromegaly was found in 30.1% of patients. Hypothyroidism was found in 16 (15.7%) out of 109 cases. Two of them had clinical and 14 had subclinical hypothyroidism. One patient had Grave''s disease. Antibody positivity was the most common disorder (anti-TPO and anti-tg were positive in 36.7 and 32.1%, respectively). No patient had hypoparathyroidism.

Conclusion:

According to our study, thyroid dysfunction, particulary hypothyroidism and thyroid antibodies increase in patients with vitiligo. We recommend thyroid antibodies assessment and thyroid function evaluation in these patients.     

妊娠早期甲状腺功能异常与糖代谢的相关性研究

目的探讨妊娠早期甲状腺功能异常与糖代谢的相关性研究。方法选取2018年1月至2019年3月深圳市宝安区松岗人民医院收治的200例妊娠早期亚临床型甲状腺功能减退症患者作为研究对象。将这200例患者设为观察组,同时选取50例健康妊娠早期的健康女性作为对照组。检测并对比观察组患者与对照组健康女性的外周血中测促甲状腺激素(TSH),游离甲状腺素(FT4)和游离三碘甲腺原氨酸(FT3)的表达差异,以及空腹葡萄糖水平(FPG)、糖化血红蛋白(HbA1c)、餐后2h葡萄糖水平(2hPG)及胰岛素抵抗指数(HOMA-IR)等糖代谢指标的情况。结果两组研究对象的TSH水平存在显著性的差异,且观察组患者的TSH的水平高于对照组健康女性,差异具有统计学意义(P<0.05);然而,观察组患者和对照组健康女性的FT3和FT4的水平则无显著性差异(P>0.05);此外,两组的糖代谢指标(FPG、HbA1c和HOMA-IR)存在显著性的差异,观察组的糖代谢指标高于对照组,差异具有统计学意义(P<0.05)。Pearson相关性分析结果显示,妊娠早期亚临床型甲状腺功能减退症患者TSH的水平与糖代谢指标(FPG、HbA1c和HOMA-IR)正相关,差异具有统计学意义(P<0.05)。结论妊娠早期亚临床型甲状腺功能减退症患者的TSH水平与血糖代谢密切相关,有利于进一步提示临床治疗。     

Higher prevalence of thyroid dysfunction in patients with erythrodermic psoriasis

The association of psoriasis with thyroid dysfunction has been investigated. However, it remains unclear; some papers indicate it, and others do not. In this study, we evaluate the prevalence of thyroid dysfunction in patients with psoriasis vulgaris (PsV), psoriatic arthritis (PsA), generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP), and the association of thyroid dysfunction with inflammation. Data on 201 psoriatic patients visiting our hospital from January 2014 to November 2017 (159 men and 42 women; 74 PsV, 42 PsA, 38 GPP and 47 EP) were retrospectively analyzed. Thirty-three percent of psoriatic patients had thyroid dysfunction. The percentage of patients with thyroid dysfunction was the highest in those with EP (60% EP, 42% GPP, 19% PsA, 19% PsV). The prevalence of thyroid dysfunction decreased significantly when patients switched from EP to PsV or PsA (58% vs 17%; median, 20.5; range, 4–65 months). Most of the patients with thyroid dysfunction had low thyroxine syndrome (serum levels of free thyroxine are low, but serum thyroid-stimulating hormone level is normal). Patients with thyroid dysfunction demonstrated significantly higher CD3⁺ and CD4⁺ T-cell absolute count levels than those without thyroid dysfunction. Meanwhile, patients with thyroid dysfunction demonstrated lower immunoglobulin (Ig)A and IgM levels than those without thyroid dysfunction. Finally, patients with thyroid dysfunction demonstrated higher elevated serum C-reactive protein levels than those without dysfunction in total, although there were no statistical differences. Our data indicate that thyroid dysfunction in patients with psoriasis may be associated with inflammation caused by psoriasis.     

Incidence and significance of organ-specific autoimmune disorders (clinical, latent or only autoantibodies) in patients with vitiligo

The frequency of autoimmune disorders was determined in 373 vitiligo patients and in controls matched for sex, age and race. Vitiligo patients had an increased frequency of clinical autoimmune diseases of thyroid (7.5%), stomach (0.8%), parathyroid (1%), adrenal gland (1.3%). Vitiligo patients, without clinical signs of overt autoimmune diseases, also had a statistically significant increase in the frequency of gastric parietal cell (p less than 0.001), thyroid microsomal (p less than 0.05) and adrenal autoantibodies (p less than 0.05). This increased incidence of autoimmune manifestations was correlated with the duration of vitiligo. Furthermore in 94% of the patients with parietal cell autoantibodies a gastric biopsy showed atrophic gastritis. In addition, in 48% of the patients with thyroid microsomal autoantibodies and in 2 out of 6 patients with adrenal autoantibodies without overt diseases at the beginning of the study, the functional investigation of the target organs during the follow-up allowed the detection of the presence or that of the subsequent development of clinical or subclinical dysfunction.     

Cutaneous lesions of dermatomyositis with supervening fibrosis

Background: Dermatomyositis (DM) is a distinctive systemic connective tissue disease whereby the skin defines a cardinal site of involvement. There exists a body of literature, which suggests that a significant component of its clinical manifestations may be related to endothelial cell injury. We have postulated in the past that anti‐endothelial cell antibodies may be the defining trigger leading to endothelial cell dysfunction. The primary organs affected by DM are the skin and muscle. A significant albeit rare complication is pulmonary fibrosis, which our recent study postulated to be attributable to an autoimmune endothelialitis. Design: We describe six patients, four women and two men who ranged in age from 3 to 60 years, and had classic clinical presentations and cutaneous lesions of DM without any supervening clinical changes indicative of cutaneous sclerosis. Results: Skin biopsies showed cell‐poor interface dermatitis with variable dermal mucin and C5b‐9 within the cutaneous vasculature. However, at variance with classic DM was the presence of a sclerodermoid tissue reaction, which was of variable depth. All of these patients had severe muscle involvement. One pediatric patient had concomitant significant cutaneous, central nervous system and oral mucosal ischemic infarcts. Significant pulmonary disease ensued in the four adult patients, manifesting as pulmonary fibrosis in two, diffuse alveolar damage in one and diaphragmatic failure in one. In three patients, direct immunofluorescent studies were corroborative of immune‐based microvascular injury while Western blot and/or indirect immunofluorescent studies showed anti‐endothelial cell antibody activity within the serum of three patients. Conclusions: The identification of sclerosis in biopsies of skin lesions typical clinically for DM may be a harbinger for more severe autoimmune‐based endothelial cell injury phenomenon. One could speculate that its basis may be attributable to elevated serum levels of the natural fibrogenic factor, transforming growth factor β, which in turn is released from damaged endothelium.     

Dermatomyositis related to autoimmune thyroiditis

Background and objective Reports on the coexistence of dermatomyositis (DM) with autoimmune thyroiditis (AIT) are very few. Our aim is to define the relationship of the two conditions, identify clinical, laboratory, electromyographic and pathologic features of coexistent DM and AIT. Methods We underwent a MEDLINE search to identify relevant literature published in the past 30 years. Concurrently, we analysed retrospectively medical records of five patients diagnosed with DM and AIT from our hospital. Results Eleven cases were included. 90.9% of patients were female with a mean (SD) age of 44.18 (13.11) years for DM at diagnosis, and 39.00 (7.81) years for AIT. AIT can precede or parallel the diagnosis of DM. The most common comorbidities included hypothyroidism (90.9%), cardiopulmonary diseases (63.7%) and overlap syndrome (27.3%), while only one case had malignancy. The most common clinical manifestations were: muscle weakness (100%), polyarthralgia (45.5%), heliotrope rash (45.5%), myalgia (36.4%), and Raynaud’s phenomenon (27.3%). The abnormalities on electromyography and muscle/skin biopsy of DM related to AIT did not differ from those findings of DM, while none of these reports were normal. All patients received both the treatment of corticosteroids and levothyroxine, and only 27.3% of patients had a good prognosis. Conclusion Prevalence of cancer in coexistent DM and AIT may be very low. Also, it is reasonable to suggest that DM patients with AIT should be routinely evaluated for thyroid function and the emergence of comorbidities. Moreover, corticosteroids combined with levothyroxine may be useful for these patients as a standard treatment.