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Juvenilni dermatomiozitis
Domina Petrić
Uvod
JDM je rijetka, lako prepoznatljiva bolest kojoj
patološku osnovu čini vaskulitis u koži i
potkožnom tkivu, mišićima i GI traktu.
JDM je češći u djevojčica, a pojavljuje se
obično između 8. i 12. g. života.
Klinička slika
• Zbog sitnih, jedva vidljivih teleangiektazija
vjeđe i jagodice poprime karakterističnu
crvenoljubičastu boju.
• Prisutan je periorbitalni edem.
• Na ekstenzornim stranama MKF i proksimalnih
IF zglobova koža je eritematozna i
hiperkeratotična (Gottronove papule).
Gottronove papule
Wikipaedia.org
IMACS pictures
Periorbitalno crvenilo
Medscape.com
Klinička slika
• Katkad postoji eritem na dijelu vrata koji
je izložen svjetlosti.
• Drugi vodeći simptom je simetrična
mišićna slabost u proksimalnim
mišićnim skupinama udova koja se
razvija vrlo postupno i pritajeno.
Klinička slika
• Tek kad dijete više ne može obavljati neke
dnevne radnje (češljanje, odijevanje,
uspinjanje uza stube), roditelji potraže
pomoć liječnika.
• Katkad postoji bolnost i otvrdnuće
zahvaćenih mišića.
Klinička slika
• Postoji jedan oblik bolesti akutnog
tijeka s pojavom teškoća gutanja
(zagrcavanje) i disanja pa je u tim
rijetkim slučajevima, zbog životne
ugroženosti djeteta, potrebna
hospitalizacija na JIL-u.
Klinička slika
• U 20 do 50% oboljele djece se pojavi
kalcinoza tek nakon najmanje godinu
dana trajanja bolesti.
• Kalcij se odlaže u potkožnom tkivu,
fascijama i mišićima.
Klinička slika
• Kalcifikati se mogu katkad palpirati kroz
kožu, a s vremenom mogu biti spontano
istisnuti na površinu.
• Dobro se vide na RTG-u.
• Mogu biti uzrokom kontraktura i atrofije
mišića.
Kalcinoza
LearningRadiology.com
Laboratorijske pretrage
Može se dokazati
povećanje plazmatske
aktivnosti mišićnih
enzima, CPK i LDH.
EMG
Daje obrazac
primarno miopatskih
odstupanja od
normalnog.
Biopsija mišića
Pokazuje žarišta
perifascikularne atrofije
mišićnih vlakana sa znakovima
degeneracije, intersticijskim
edemom i proliferacijom veziva.
Liječenje
• Kortikosteroidi tijekom
najmanje jedne ili dviju godina.
• U osobito teškim slučajevima
IMUNOSUPRESIVNI LIJEKOVI.
Prognoza
• Danas je smrtnost manja od 10%.
• Uz adekvatno liječenje većina se
djece potpuno oporavi nakon 2-3 g.
trajanja i liječenja bolesti.
• Literatura:
Duško Mardešić i suradnici. Pedijatrija
Školska knjiga, Zagreb, 2003.

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