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목적 : To describe the clinical and laboratory charateristics of Graves' orbitopathy (GO) patients showing progressive myopathy and consider whether modified clinical activity score is useful indicator to forecast myopathy progression.
방법 : The medical records and images of GO patients showing progressive myopathy during at least 1 year of follow up period were retrospectively reviewed. Clinical parameters, including 7 score of modified clinical activity score (CAS), modified NOSPECS score, exophthalmometry results, degree of restrictive myopathy, and prevalence of optic neuropathy were evaluated. The positivity and levels of TRAb were investigated. Extraocular muscle (EOM) analyses of maximum recti muscle diameters, EOM index in computed tomography(CT) were determined.
결과 : Of the 435 patients reviewed, a total of 63 patients with GO were found to present progressive myopathy and 44.4%(28/63) of patients had low CAS, less than 3. In subgroup analysis, grouped by modified CAS(Group 1: CAS <3 ,Group 2: CAS≥3), mean modified NOSPECS score, mean value of exophthalmos value were significantly both higher in group 2 than in group 1. Degree of restrictive myopathy, prevalence of optic neuropathy, positive rate and level of TRAb were not significant different between two groups. EOM analyses were not significantly different between the two groups.
결론 : Restrictive myopathy may progress even in patients with low modified CAS. Especially in mild to moderate GO with low NOSPECS and exophthalmos value, CAS may not reflect inflammatory activity of myopathy, thus careful follow up of patients to find the change of diplopia by using other subjective and objective measures.
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