Muskelschmerz

Zusammenfassung

Myalgien zählen zu den häufigsten Gründen für eine Vorstellung beim Rheumatologen oder Orthopäden. Die Ursachen einer Myalgie sind vielfältig und können ein Trauma, übermäßige körperliche Anstrengung und virale Infekte ebenso umfassen wie eine Genese auf der Basis ernsthafter, nicht entzündlicher Myopathien oder Myositiden. In dieser Übersichtsarbeit richten wir einen Fokus sowohl auf die Diagnostik von häufig auftretenden und damit auch fachübergreifend gut bekannten Krankheitsbildern als auch auf solche, die seltener im rheumatologischen Alltag vorkommen. Vom recht geläufigen chronischen Schmerzsyndrom Fibromyalgie bis hin zum seltenen Krankheitsbild des Antisynthetase-Syndroms werden hier neben den klinischen Bildern neue Daten zu laborchemischen, histologischen und radiologischen Auffälligkeiten der wichtigsten rheumatologischen Erkrankungen diskutiert, welche charakteristisch mit Myalgien einhergehen. Im Rahmen dieser Arbeit wird eines deutlich: Die Komplexität dieser Krankheitsbilder und der Umfang aktueller Forschungsergebnisse fordern die kontinuierliche Schulung der behandelnden Ärzte und eine enge interdisziplinäre Zusammenarbeit der unterschiedlichen Fachdisziplinen.

Summary

Myalgia is one of the most common reasons for visiting a rheumatologist or an orthopaedic surgeon. Causes of myalgia are diverse and can vary from trauma, excess physical strain and viral infections to more serious conditions such as non-inflammatory myopathies or myositides. This review article will focus on the diagnostics of both common (and thus well known) and more rare myalgia-associated rheumatic diseases. From the familiar to the rheumatologist chronic widespread pain syndrome ‘‘fibromyalgia’’ to the rare entity of antisynthetase syndrome, herein we will discuss not only clinical pictures, but also new laboratory, histological and radiological data of the most important rheumatic diseases which are typically accompanied by myalgias. Through this work one could come to the conclusion: complexity of discussed diseases and big amount of new research results demand continuous training of the treating physicians and a interdisciplinary cooperation of many different medical specialists.

Schlüsselwörter

Muskelschmerz - Myositis - Polymyalgia rheumatica - Fibromyalgie-Syndrom

Keywords

Muscle pain - myositis - polymyalgia rheumatica - fibromyalgia

• Literatur

• 1 Rosendal M, Carlsen AH, Rask MT, Moth G. Symptoms as the main problem in primary care: A cross-sectional study of frequency and characteristics. Scand J Prim Health Care [Internet] 2015; 33 (02) 91-99.
• 2 Bohan A, Peter JB. Polymyositis and dermatomyositis. N Engl J Med 1975; 292 (07) 344-347.
• 3 Lundberg IE, Tjärnlund A, Bottai M. et al. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Annals of the rheumatic diseases 2017; 1955-1964.
• 4 Dimitri D, Dubourg O, Maisonobe T. et al. Distal inflammatory myopathy: Unusual presentation of polymyositis or new entity?. Neuromuscul Disord 2008; 18 (06) 493-500.
• 5 Kassardjian CD, Lennon VA, Alfugham NB. et al. Clinical features and treatment outcomes of necrotizing autoimmune myopathy. JAMA Neurol 2015; 72 (09) 996-1003.
• 6 Fernández-Serna M, Arboleya L, Alonso S. et al. Dropped head syndrome in a patient with scleromyositis. J Clin Rheumatol 2013; 19 (01) 32-34.
• 7 Garcin B, Lenglet T, Dubourg O. et al. Dropped head syndrome as a presenting sign of scleromyositis. J Neurol Sci 2010; 292 (1–2): 101-103.
• 8 Barsotti S, Bruni C, Cometi L. et al. One year in review 2017: Idiopathic inflammatory myopathies. Clin Exp Rheumatol. 2017 35. (06):
• 9 Deveza LMA, Miossi R, De Souza FHC. et al. Electrocardiographic changes in dermatomyositis and polymyositis. Rev Bras Reumatol 2016; 56 (02) 95-100.
• 10 Zhang L, Wu G, Gao D. et al. Factors associated with interstitial lung disease in patients with polymyositis and dermatomyositis: A systematic review and meta-analysis. PLoS One. 2016 11. (05):
• 11 Bartoloni E, Gonzalez-Gay MA, Scirè C. et al. Clinical follow-up predictors of disease pattern change in anti-Jo1 positive anti-synthetase syndrome: Results from a multicenter, international and retrospective study. Autoimmunity Reviews 2017; 253-257.
• 12 Altmeyer P. Dermatomyositis (Übersicht). Enzyklopädie. 2018
• 13 Cavagna L, Nuño L, Scirè CA. et al. Clinical Spectrum Time Course in Anti Jo-1 Positive Antisynthetase Syndrome. Medicine (Baltimore) [Internet] 2015; 94 (32) e1144.
• 14 Triantafyllias K, Specker C, Cavagna L. et al. Klinische Follow-up-Prädiktoren für Veränderungen des Erkrankungsmusters von Anti-Jo1-positivem Antisynthetase Syndrom: Ergebnisse einer multizentrischen, internationalen retrospektiven Studie. DGRh-Kongress, Frankfurt. 2016
• 15 Triantafyllias K, Specker C, Cavagna L. et al. Zeitlicher Verlauf klinischer Manifestationen bei Jo1-negativen Antisynthetase-Syndrom Patienten. DGRh-Kongress, Frankfurt. 2016
• 16 Müller-Felber W, Schoser B, Pongratz D. et al. Idiopathische CK-Erhöhung. Nervenheilkunde 2006; 25 (07) 577-578.
• 17 De La Torre IG. Clinical usefulness of autoantibodies in idiopathic inflammatory myositis. Front Immunol. 2015 06. (JUN).
• 18 Dalakas MC. Polymyositis, Dermatomyositis, and Inclusion-Body Myositis. N Engl J Med [Internet] 1991; 325 (21) 1487-1498.
• 19 Hoogendijk JE, Amato AA, Lecky BR. et al. 119th ENMC international workshop: Trial design in adult idiopathic inflammatory myopathies, with the exception of inclusion body myositis, 10–12 October 2003, Naarden, The Netherlands. Neuromuscular Disorders 2004; 337-345.
• 20 Dalakas MC. Pathophysiology of inflammatory and autoimmune myopathies. Presse Medicale. 2011
• 21 Dalakas MC, Hohlfeld R. Polymyositis and dermatomyositis. Lancet 2003; 362 (9388): 971-982.
• 22 Catalán M, Selva-O’Callaghan A, Grau JM. Diagnosis and classification of sporadic inclusion body myositis (sIBM). Autoimmunity Reviews 2014; 363-366.
• 23 Allenbach Y, Benveniste O. Acquired necrotizing myopathies. Current Opinion in Neurology 2013; 554-560.
• 24 Chung T, Christopher-Stine L, Paik JJ. et al. The composition of cellular infiltrates in anti-HMGCoA reductase-associated myopathy. Muscle and Nerve 2015; 52 (02) 189-195.
• 25 Milone M. Diagnosis and Management of Immune-Mediated Myopathies. Mayo Clinic Proceedings 2017; 826-837.
• 26 May DA, Disler DG, Jones EA. et al. Abnormal Signal Intensity in Skeletal Muscle at MR Imaging: Patterns, Pearls, and Pitfalls. Radio Graphics [Internet] 2000; 20 (Suppl. 01) S295-S315.
• 27 Del Grande F, Carrino JA, Del Grande M. et al. Magnetic resonance imaging of inflammatory myopathies. Top Magn Reson Imaging [Internet] 2011; 22 (02) 39-43.
• 28 Van De Vlekkert J, Maas M, Hoogendijk JE. et al. Combining MRI and muscle biopsy improves diagnostic accuracy in subacute-onset idiopathic inflammatory myopathy. Muscle and Nerve 2015; 51 (02) 253-258.
• 29 Elessawy SS, Abdelsalam EM, Abdel ERazek, Tharwat S. Whole-body MRI for full assessment and characterization of diffuse inflammatory myopathy. Acta Radiol Open [Internet] 2016; 05 (09) 205846011666821.
• 30 Barsotti S, Zampa V, Talarico R. et al. Thigh magnetic resonance imaging for the evaluation of disease activity in patients with idiopathic inflammatory myopathies followed in a single center. Muscle Nerve [Internet] 2016; 54 (04) 666-672.
• 31 Pipitone N, Notarnicola A, Levrini G. et al. Do dermatomyositis and polymyositis affect similar thigh muscles? A comparative MRI-based study. Clin Exp Rheumatol 2016; 34 (06) 1098-1100.
• 32 Pinal-Fernandez I, Casal-Dominguez M, Carrino JA. et al. Thigh muscle MRI in immune-mediated necrotising myopathy: Extensive oedema, early muscle damage and role of anti-SRP autoantibodies as a marker of severity. Ann Rheum Dis 2017; 76 (04) 681-687.
• 33 Gutiérrez-Gutiérrez G, Barbosa CLópez, Navacerrada F, Miralles AMartínez. Use of electromyography in the diagnosis of inflammatory myopathies. Reumatol Clin [Internet] 2012; 08 (04) 195-200.
• 34 Milisenda JC, Selva-O’Callaghan A, Grau JM. The diagnosis and classification of polymyositis. J Autoimmun 2014; 48–49: 118-121.
• 35 Tateyama M, Fujihara K, Misu T. et al. Clinical values of FDG PET in polymyositis and dermatomyositis syndromes: Imaging of skeletal muscle inflammation. BMJ Open. 2015 05. (01):
• 36 Owada T, Maezawa R, Kurasawa K. et al. Detection of inflammatory lesions by f-18 fluorodeoxyglucose positron emission tomography in patients with polymyositis and dermatomyositis. J Rheumatol [Internet] 2012; 39 (08) 1659-1665.
• 37 Manfredi A, Sebastiani M, Cassone G. et al. Nailfold capillaroscopic changes in dermatomyositis and polymyositis. Clin Rheumatol 2015; 34 (02) 279-284.
• 38 Ganczarczyk ML, Lee P, Armstrong SK. Nailfold capillary microscopy in polymyositis and dermatomyositis. Arthritis Rheum 1988; 31 (01) 116-119.
• 39 Selva-O’Callaghan A, Fonollosa-Pla V, TralleroAraguás E. et al. Nailfold capillary microscopy in adults with inflammatory myopathy. Seminars in Arthritis and Rheumatism 2010; 398-404.
• 40 Mercer LK, Moore TL, Chinoy H. et al. Quantitative nailfold video capillaroscopy in patients with idiopathic inflammatory myopathy. Rheumatology 2010; 49 (09) 1699-1705.
• 41 Dasgupta B, Salvarani C, Schirmer M. et al. Developing classification criteria for polymyalgia rheumatica: Comparison of views from an expert panel and wider survey. J Rheumatol 2008; 35 (02) 270-277.
• 42 Dasgupta B, Cimmino MA, Maradit-Kremers H. et al. 2012 Provisional classification criteria for polymyalgia rheumatica: A European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2012; 71 (04) 484-492.
• 43 Schmidt WA. Neue Klassifikationskriterien der Polymyalgia rheumatica. Zeitschrift fur Rheumatologie 2012; 911-912.
• 44 Macchioni P, Boiardi L, Catanoso M. et al. Performance of the new 2012 EULAR/ACR classification criteria for polymyalgia rheumatica: Comparison with the previous criteria in a singlecentre study. Ann Rheum Dis 2014; 73 (06) 1190-1193.
• 45 Seitz M. Polymyalgia rheumatica. Z Rheumatol 2015; 74 (06) 507-510.
• 46 Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. The Lancet 2008; 234-245.
• 47 Salvarani C, Cantini F, Macchioni P. et al. Distal musculoskeletal manifestations in polymyalgia rheumatica: A prospective followup study. Arthritis Rheum 1998; 41 (07) 1221-1226.
• 48 Schmidt WA. Myalgien bei polymyalgia rheumatica, arteriitis temporalis und anderen Vaskulitiden. Zeitschrift fur Rheumatologie 2009; 446-450.
• 49 Cantini F, Salvarani C, Olivieri I. et al. Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: A prospective follow-up study. Semin Arthritis Rheum 2000; 30 (01) 17-24.
• 50 Kreiner F, Langberg H, Galbo H. Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatica. Arthritis Rheum 2010; 62 (12) 3768-3775.
• 51 Cantini F, Salvarani C, Olivieri I. et al. Shoulder ultrasonography in the diagnosis of polymyalgia rheumatica: A case-control study. J Rheumatol 2001; 28 (05) 1049-1055.
• 52 Descamps L, Olagne L, Merlin C. et al. Utility of PET/CT in the diagnosis of inflammatory rheumatic diseases: a systematic review and metaanalysis. Ann Rheum Dis. 2017
• 53 Henckaerts L, Gheysens O, Vanderschueren S. et al. Use of 18F-fluorodeoxyglucose positron emission tomography in the diagnosis of polymyalgia rheumatica – A prospective study of 99 patients. Rheumatology. 2017
• 54 Eich W, Bär K-J, Bernateck M. et al. Definition, Klassifikation, klinische Diagnose und Prognose des Fibromyalgiesyndroms. Der Schmerz 2017; 31 (03) 231-238.
• 55 Wolfe F, Smythe HA, Yunus MB. et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33 (02) 160-172.
• 56 Jones GT, Atzeni F, Beasley M. et al. The prevalence of fibromyalgia in the general population: A comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis Rheumatol 2015; 67 (02) 568-575.
• 57 Wolfe F, Clauw DJ, Fitzcharles MA. et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016; 46 (03) 319-329.
• 58 Wolfe F, Brähler E, Hinz A, Häuser W. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: Results from a survey of the general population. Arthritis Care Res 2013; 65 (05) 777-785.
• 59 Uceyler N, Burgmer M, Friedel E. et al. [Etiology and pathophysiology of fibromyalgia syndrome: Updated guidelines 2017, overview of systematic review articles and overview of studies on small fiber neuropathy in FMS subgroups]. Schmerz 2017; 31 (03) 239-245.
• 60 Hsiao M-Y, Hung C-Y, Chang K-V. et al. Is Serum Hypovitaminosis D Associated with Chronic Widespread Pain Including Fibromyalgia? A Meta-analysis of Observational Studies. Pain Physician 2015; 18: 877-888.
• 61 Lee YC, Lu B, Boire G. et al. Incidence and predictors of secondary fibromyalgia in an early arthritis cohort. Ann Rheum Dis 2013; 72 (06) 949-954.
• 62 Dehghan M, Schmidt-Wilcke T, Pfleiderer B. et al. Coordinate-based (ALE) meta-analysis of brain activation in patients with fibromyalgia. Hum Brain Mapp 2016; 37 (05) 1749-1758.
• 63 Aoki Y, Inokuchi R, Suwa H. Reduced N-acetylaspartate in the hippocampus in patients with fibromyalgia: A meta-analysis. Psychiatry Res – Neuroimaging 2013; 213 (03) 242-248.
• 64 Üçeyler N, Zeller D, Kahn A-K. et al. Small fibre pathology in patients with fibromyalgia syndrome. Brain 2013; 136 (Pt 6): 1857-1867.
• 65 Üçeyler N, Sommer C. Fibromyalgiesyndrom. Eine Erkrankung der kleinen Nervenfasern? Z Rheumatol 2015; 74 (06) 490-495.
• 66 Hauser W, Zimmer C, Felde E, Kollner V. What are the key symptoms of fibromyalgia?. Schmerz [Internet] 2008; 22 (02) 176-183.
• 67 Auvinet B, Chaleil D. Identification of subgroups among fibromyalgia patients. Reumatismo 2012; 250-260.
• 68 Aggarwal VR, McBeth J, Zakrzewska JM. et al. The epidemiology of chronic syndromes that are frequently unexplained: Do they have common associated factors?. Int J Epidemiol 2006; 35 (02) 468-476.
• 69 Yang T-Y, Chen C-S, Lin C-L. et al. Risk for irritable bowel syndrome in fibromyalgia patients: a national database study. Medicine (Baltimore) 2015; 94 (10) e616.
• 70 Chen C-H, Yang T-Y, Lin C-L. et al. Dry Eye Syndrome Risks in Patients With Fibromyalgia: A National Retrospective Cohort Study. Medicine (Baltimore) 2016; 95 (04) e2607.
• 71 Scolnik M, Vasta B, Hart DJ. et al. Symptoms of Raynaud’s phenomenon (RP) in fibromyalgia syndrome are similar to those reported in primary RP despite differences in objective assessment of digital microvascular function and morphology. Rheumatol Int 2016; 36 (10) 1371-1377.
• 72 Alciati A, Sgiarovello P, Atzeni F, Sarzi-Puttini P. Psychiatric problems in fibromyalgia: Clinical and neurobiological links between mood disorders and fibromyalgia. Reumatismo 2012; 268-274.