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Clinical characteristics of patients with myalgia as the initial manifestation of small and medium-sized vasculitis: a retrospective study

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Abstract

Myalgia is a common symptom in small and medium-sized systemic vasculitis, sometimes occurring as the initial or only clinical manifestation of vasculitis. This study investigated the clinical features and diagnostic process in patients presenting with myalgia as the initial symptom of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) or polyarteritis nodosa (PAN). We included 93 patients diagnosed with AAV or PAN by retrospectively reviewing their clinical records at the initial diagnosis. Clinical findings and diagnostic methods were assessed in patients with myalgia. Of 93 patients, myalgia was observed in 21 (22.6%) patients, with diagnostic classifications of microscopic polyangiitis (MPA) in 12 (52.4%), granulomatosis with polyangiitis in 2 (9.5%), eosinophilic granulomatosis with polyangiitis in 2 (9.5%), and PAN in 5 (23.8%). Myalgia was present in the lower extremities of all patients; more than 80% of patients had pain in the calf muscle. In 10 patients with myalgia, including 7 with MPA and 3 with PAN, muscle biopsy was performed because myalgia was the main symptom and no other impaired organs were suitable for biopsy. Consequently, 8 patients had necrotizing vasculitis, leading to MPA or PAN diagnosis, although muscle pathology was not evaluated in patients without myalgia. Muscle magnetic resonance imaging was useful in determining the biopsy site. Myalgia, especially in the lower limbs, may be an initial clinical sign of vasculitis, particularly in MPA or PAN patients. Moreover, the histological evidence of muscular vasculitis can contribute to a definite diagnosis especially in patients presenting with myalgia as an early symptom of AAV or PAN.

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Acknowledgements

We wish to thank the members of the Department of Medicine (Neurology and Rheumatology) for their efforts in providing medical care. We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan

    Satoru Ushiyama, Yasuhiro Shimojima, Ken-ichi Ueno, Dai Kishida, Daigo Miyazaki & Yoshiki Sekijima

  2. Institute for Biomedical Sciences, Shinshu University, 3-1-1 Asahi, Matsumoto, 390-8621, Japan

    Yoshiki Sekijima

Authors
  1. Satoru Ushiyama
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  2. Yasuhiro Shimojima
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  5. Daigo Miyazaki
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  6. Yoshiki Sekijima
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Contributions

Diagnosis and medical care were performed by all authors. SU, KU, and DM made muscle biopsy specimens. YS conceived of and designed this study. YS, SU, DK analyzed the data. YS and SU prepared the draft of this manuscript. YS and YS revised the manuscript. All authors approved the final manuscript and agreed to be responsible for all aspects of this study.

Corresponding author

Correspondence to Yasuhiro Shimojima.

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The authors declare that they have no financial or personal conflicts of interest.

Ethical approval

The present study was approved by the Local Ethics Committee of Shinshu University (approved number 614 and 3907), and informed consent was obtained from all participants.

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Ushiyama, S., Shimojima, Y., Ueno, Ki. et al. Clinical characteristics of patients with myalgia as the initial manifestation of small and medium-sized vasculitis: a retrospective study. Rheumatol Int 40, 1667–1674 (2020). https://doi.org/10.1007/s00296-020-04652-y

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  • DOI: https://doi.org/10.1007/s00296-020-04652-y

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