嚥下困難を自覚した皮膚筋炎18例の嚥下内視鏡検査

Dysphagia in adults with dermatomyositis

はじめに

　多発性筋炎および皮膚筋炎（polymyositis/dermatomyositis：PM/DM）は，対称的な近位筋炎を特徴とする自己免疫性の結合組織疾患である。臨床症状には，筋力低下，筋肉痛，皮膚症状，嚥下困難，発声困難，レイノー現象，発熱，体重減少，疲労，非びらん性炎症性多発性関節炎などがある^1,2）。筋力低下は，潜在性または亜急性に発症し，数か月かけて徐々に悪化する。特に嚥下障害は，生命を脅かす症状と認識されている^3）。本検討では，嚥下困難を自覚したDM例の嚥下機能を嚥下内視鏡検査スコア評価基準を用いて評価し，症例を提示し文献的考察を踏まえて報告する。

　Objective：The purpose of this study was to examine clinical dysphagia in patients with dermatomyositis. Methods：Participants included 18 patients with dermatomyositis who visited our department between April 2013 and August 2023. Dysphagia was evaluated using fiberoptic endoscopy evaluation of swallowing. Results：Sixteen patients（88.8％）with dysphagia showed abnormal findings on examination. Prior to treatment, three patients could not tolerate oral intake and were managed with a nasogastric tube. Four patients（22.2％）received prednisolone monotherapy and 14（77.8％）were treated with immunosuppressants. Conclusions：Dysphagia often improved with a combination of prednisolone and immunosuppressants.