Rheumatology Advance Access published online on June 14, 2007
Rheumatology, doi:10.1093/rheumatology/kem131
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Oropharyngeal dysphagia in juvenile dermatomyositis (JDM): an evaluation of videofluoroscopy swallow study (VFSS) changes in relation to clinical symptoms and objective muscle sscores
Royal Liverpool NHS Trust, Alder Hey, Liverpool, 1Rheumatology Unit, Institute of Child Health, University College London and Great Ormond Street Hospital NHS Trust, London, 2Department of Paediatric Rheumatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK and 3Rheumatology Unit, Hospital de Niños, Sup. Sor María Ludovica, 14 #1631, La Plata CP 1900, Buenos Aires, Argentina
Correspondence to:
L. J. McCann, Rheumatology Unit, Royal Liverpool, Children's Hospital, Eaton Road, Liverpool, UK. L12 2AP; E-mail: liza.mccann{at}rlc.nhs.uk
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Abstract |
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Objective. To determine if objective, validated scores of muscle weakness and function [manual muscle testing (MMT), childhood myositis assessment scale (CMAS)] or scores of general disease activity or function [childhood health assessment questionnaire and physician global assessment of disease activity visual analogue scale (VAS)], can predict children at risk of swallow abnormalities in juvenile dermatomyositis (JDM) measured by videofluoroscopic swallow studies (VFSS).
Methods. Patients were referred for speech and language dysphagia assessment upon diagnosis of JDM or flare of disease. VFSS was used to document a swallow score indicating severity of swallow dysfunction. Clinical symptoms, examination findings and objective scores of disease activity were analysed. Any correlation was looked for using chi-squared Fisher exact test and linear regression models.
Results. Fourteen patients with inflammatory myopathy (age 2–16 years) had clinical assessments and VFSS. VFSS was abnormal in 11 children (79%). Only two children were asymptomatic at assessment, but both had swallow dysfunction, including aspiration, on VFSS. In contrast, three of the symptomatic children had a normal VFSS. No relationship was found between objective disease severity scores and VFSS swallow score.
Conclusions. This study failed to show any correlation between swallow score and objective measures of muscle strength and function (MMT/CMAS) or general disease activity and function [physician VAS/childhood health assessment questionnaire (CHAQ)]. In the absence of a more accurate assessment method to determine which children with active JDM are most at risk of swallow dysfunction and aspiration, all children with active dermatomyositis should be referred for speech and language assessment and VFSS.
Submitted 4 October 2006;
revised version accepted 11 April 2007.
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