臨床検査67巻11号

2023年11月発行

今月の特集 腫瘍随伴症候群 免疫学的機序によるもの

悪性腫瘍に合併する筋炎（主に皮膚筋炎）

著者： 近藤泰¹ 金子祐子¹

所属機関： ¹慶應義塾大学医学部リウマチ・膠原病内科

ページ範囲：P.1284 - P.1290

Point

●特発性炎症性筋疾患（IIM）は骨格筋を傷害する原因不明の炎症性疾患で，多発性筋炎（PM）と皮膚筋炎（DM）は代表的疾患であり，その一部は傍悪性腫瘍症候群として認識されている．

●悪性腫瘍に合併する筋炎（CAM）の特徴として，皮膚症状の強いDMで，嚥下障害など筋炎症状も強く，抗TIF-1γ抗体陽性例が多い．

●筋炎発症から1年以内が最も悪性腫瘍の発生頻度が高いことが知られていることから，発症3年を目安にCTや，婦人科検診を含めた悪性腫瘍検索を行うことが望ましい．

●CAMの治療予後は，悪性腫瘍が最も影響しているが，その治療に筋炎の病勢が影響を与えてしまう場合などは，ステロイドなどの治療を優先する場合もある．

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37）厚生労働科学研究費補助金難治性疾患等政策研究事業自己免疫疾患に関する調査研究班診療ガイドライン作成委員会（編）：多発性筋炎・皮膚筋炎診療ガイドライン（2020年暫定版），2020