MR-VISUALIZATION AS A METHOD OF DIAGNOSIS AND CONTROL OF THE EFFECTIVENESS OF TREATMENT OF PATIENTS WITH JUVENILE DERMATOMYOSITIS
Summary. Relevance. Juvenile dermatomyositis (JDM) belongs to the group of orphan diseases, at the beginning of which there may be a prolonged period of nonspecific symptoms. This is the reason for the difficulty of diagnosing this pathology at the early stages, in particular, at the level of primary care. Purpose: to highlight the possibilities of MR imaging in JDM at the early stages of the disease, as a method of confirming the diagnosis, and at the later stages — as a method for monitoring JDM activity and assessing the response to anti-inflammatory therapy. Object and methods. Modern literary data processed; doctors from 14 medical institutions of Ukraine were interviewed regarding the use of MRI in JDM, the data obtained were analyzed. A clinical case of dermatomyositis with a classical course is presented, which primary care physicians initially regarded as an allergic pathology. Results: Based on the literature data, there is a direct correlation between changes in MRI scans (in T2-STIR modes) and an increase in muscle markers in blood serum. In some patients, inflammatory changes on MRI against the background of an active course of JDM were manifested at normal levels of muscle enzymes. Later, against the background of anti-inflammatory therapy, there was a decrease in signs of edema and inflammation on MRI. According to the survey, in Ukraine only 43% of children with JDM were examined by MRI. Conclusions. The use of MRI is quite informative and — in the realities of our time — an affordable method for confirming the diagnosis of JDM, but in Ukraine the frequency of its use remains low. We can use MRI as a method for differential diagnosis between chronic degenerative and acute inflammatory myopathies, for early confirmation of the diagnosis of JDM, as a painless equivalent to invasive electromyography and muscle biopsy, even at normal muscle enzyme levels. In addition, MRI can be used as a tool to monitor disease activity.
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