Magnetic resonance imaging and p‐31 magnetic resonance spectroscopy provide unique quantitative data useful in the longitudinal management of patients with dermatomyositis

Park, Jane H.; Vital, Terri L.; Ryder, Nova M.; Hernanz‐Schulman, Marta; Partain, C. Leon; Price, Ronald R.; Olsen, Nancy J.

doi:10.1002/art.1780370519

Cited by 124 publications

(103 citation statements)

References 24 publications

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“…Prednisone and immunosuppressive therapy often improve the clinical and metabolic status in DM and JDM patients (7). The current investigation shows that concentrations of Mg-ATP are also significantly increased with treatment ( Figure 6).…”

Section: Discussionsupporting

confidence: 54%

“…During exercise and recovery, these patients demonstrate inefficient utilization and regeneration of ATP and PCr (1,5,6). Since MRI and MRS are noninvasive procedures with no known side effects, these techniques may be used to quantitatively evaluate the patients' responses to therapy on a longitudinal basis (7).…”

Section: Conclusion Low Levels Of Mg-atp and Free Mgmentioning

confidence: 99%

“…The phasing of the spectra was performed with zeroorder and first-order corrections of the Fourier-transformed free induction decay (FID), and baseline corrections were made using the parabolic method (1,(5)(6)(7). Resonance areas of inorganic phosphate (Pi), PCr, and ATP were corrected for saturation effects determined in the resting quadriceps muscles of healthy subjects.…”

Section: Niermann Et Almentioning

confidence: 99%

“…Three patients had elevated serum creatine kinase (CK) levels. Evaluation of disease activity by serum CK activity has limited value, however, since some patients never show an elevation of this enzyme and low CK levels may be associated with a poor prognosis (7,22).…”

mentioning

confidence: 99%

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Magnesium abnormalities of skeletal muscle in dermatomyositis and juvenile dermatomyositis

Niermann

Olsen

Park

2002

Arthritis & Rheumatism

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Objective. To characterize abnormalities in magnesium levels in the muscles of patients with dermatomyositis (DM) and juvenile dermatomyositis (JDM) and to evaluate the beneficial effects of prednisone and immunosuppressive therapy in elevating free magnesium (Mg 2؉ ) and ATP-bound magnesium (Mg-ATP).Methods. The study groups consisted of 12 adult patients with DM and 10 juvenile patients with JDM. The 2 control groups were 11 normal adults and 6 healthy children. Levels of total ATP in the quadriceps muscles of the subjects were determined during rest, exercise, and recovery, using noninvasive P-31 magnetic resonance spectroscopy (MRS). Concentrations of the biologically active free Mg 2؉ and the enzymatically active Mg-ATP complex were determined from the spectroscopy data by calculation of the chemical shifts of the ␤-phosphate peak of ATP.Results. Mg-ATP levels in DM and JDM myopathic muscles were at least 37% lower than those in normal muscles during rest, exercise, and recovery from exercise (P < 0.0005). Free Mg 2؉ levels were normal in DM and JDM myopathic muscles at rest, but were significantly lower than control values during exercise and recovery (P < 0.029 and P < 0.005 for DM and JDM, respectively). Prednisone and immunosuppressive therapy partially reversed the magnesium abnormalities, as evidenced by elevation of the levels of Mg-ATP and free Mg 2؉ .Conclusion. Low levels of Mg-ATP and free Mg 2؉ are concordant with weakness and fatigue observed in DM and JDM patients. Immunosuppressive therapy alleviates, in part, the magnesium deficits in the diseased muscles. Therefore, Mg-ATP and free Mg 2؉ may play a significant role in the pathophysiology of these diseases.Dermatomyositis (DM) and juvenile dermatomyositis (JDM) are similar yet distinct autoimmune diseases characterized by an erythematous rash and severe proximal muscle weakness. The classic diagnoses of DM and JDM are based on the findings of clinical evaluation, elevated serum levels of muscle enzymes, abnormal electromyographic results, and muscle inflammation on biopsy. More recently, magnetic resonance imaging (MRI) and P-31 magnetic resonance spectroscopy (MRS) have been employed as noninvasive techniques for the evaluation of patients with adult and juvenile DM (1-5).MRI has proven to be a reliable indicator of the extent and severity of muscle inflammation. P-31 MRS monitors metabolic status by determining the levels of the high-energy phosphate compounds ATP and phosphocreatine (PCr), which are required for muscle contraction. These compounds are greatly reduced in the affected muscles of patients with DM and JDM (1,4-6). During exercise and recovery, these patients demonstrate inefficient utilization and regeneration of ATP and PCr (1,5,6). Since MRI and MRS are noninvasive procedures with no known side effects, these techniques may be used to quantitatively evaluate the patients' responses to therapy on a longitudinal basis (7).In the present study, we used P-31 MRS to investigate the abnormalities in magnesium levels in the diseas...

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Section: Discussionsupporting

confidence: 54%

Section: Conclusion Low Levels Of Mg-atp and Free Mgmentioning

confidence: 99%

Section: Niermann Et Almentioning

confidence: 99%

mentioning

confidence: 99%

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Magnesium abnormalities of skeletal muscle in dermatomyositis and juvenile dermatomyositis

Niermann

Olsen

Park

2002

Arthritis & Rheumatism

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“…In addition to these changes, metabolic disturbances within the affected muscles have been suggested as possible explanations for their impairment, based on ATP and phosphocreatine levels as well as increased urinary secretion of phosphocreatine as determined by magnetic resonance spectroscopy (MRS) (1,(4)(5)(6). Although data are limited, they suggest that metabolic status according to P-31 MRS correlated with clinical outcome measurements (7).…”

Section: Polymyositis (Pm) and Dermatomyositis (Dm)mentioning

confidence: 99%

Vascular endothelial growth factor is highly expressed in muscle tissue of patients with polymyositis and patients with dermatomyositis

Grundtman¹,

Tham²,

Ulfgren³

et al. 2008

Arthritis & Rheumatism

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Objective. To investigate the expression of vascular endothelial growth factor (VEGF) in muscle biopsy specimens and serum from patients with polymyositis and patients with dermatomyositis compared with that in healthy control subjects.Methods. Muscle biopsy specimens from 33 patients with polymyositis or dermatomyositis and 15 healthy control subjects and serum samples from 56 patients and 56 healthy control subjects were analyzed. Patients were categorized into 3 groups, depending on disease duration and the presence or absence of inflammatory infiltrates. The expression of VEGF and the vessel marker CD31 in muscle was analyzed by immunohistochemistry, the expression of VEGF messenger RNA (mRNA) was analyzed by in situ hybridization, and serum levels of VEGF were determined by enzymelinked immunosorbent assay.Results. Patients with polymyositis or dermatomyositis in the early or chronic phase without inflammatory infiltrates had a decreased total number of capillaries compared with healthy individuals. In patients with early disease without inflammatory infil-

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Dermatomyositis without muscle weakness. Long-term follow-up of 12 patients without systemic corticosteroids

Cosnes¹

1995

Archives of Dermatology

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Magnetic resonance imaging and p‐31 magnetic resonance spectroscopy provide unique quantitative data useful in the longitudinal management of patients with dermatomyositis

Cited by 124 publications

References 24 publications

Magnesium abnormalities of skeletal muscle in dermatomyositis and juvenile dermatomyositis

Magnesium abnormalities of skeletal muscle in dermatomyositis and juvenile dermatomyositis

Vascular endothelial growth factor is highly expressed in muscle tissue of patients with polymyositis and patients with dermatomyositis

Dermatomyositis without muscle weakness. Long-term follow-up of 12 patients without systemic corticosteroids

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