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Nainia K, Aouzal MA, Ouafik I, Charhbili M, Bouchhab A, Daoudi A, Tizki S, Chakiri R. Juvenile dermatomyositis with Anti-SAE antibodies in a Moroccan child associated with pseudo-angioedema: a case report. Pediatr Rheumatol Online J 2024; 22:57. [PMID: 38773611 PMCID: PMC11107000 DOI: 10.1186/s12969-023-00921-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/02/2023] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Juvenile Dermatomyositis (JDM) is the leading cause of non-infectious inflammatory myopathy in children. It is a heterogeneous group of autoimmune diseases characterized by a variable combination of muscular, dermatological, and visceral involvement. Myositis-specific autoantibodies help define homogeneous subgroups with common clinical characteristics and prognoses. Anti-SAE (small ubiquitin-like modifier 1 (SUMO-1) activating enzyme) antibodies are among the most recently discovered specific autoantibodies. The presence of these antibodies is very rare, making it challenging to define clinical features and prognosis in the juvenile form. We report the first case of an African patient with juvenile dermatomyositis and positive anti-SAE antibodies. CASE REPORT A 5-year-3-month-old Moroccan boy presented to the pediatric emergency department with dysphagia that had been evolving for two days, preceded two months earlier by facial erythema associated with fatigue, lower limb pain, difficulty walking, and progressive inflammatory polyarthralgia. On admission, the child had a heliotrope rash with predominant pseudo-angioedema on the lips, periungual telangiectasia, and Gottron's papules over the bilateral interphalangeal and metatarsophalangeal joints. The patient had a more pronounced proximal muscle weakness in the lower limbs. He had no urticaria, fever, arthritis, calcinosis, cutaneous ulcers, or lipodystrophy. The Joint examination was normal, as was the pleuropulmonary examination. The electroneuromyography showed myogenic changes in all four limbs. Laboratory findings showed elevated levels of creatine phosphokinase and lactate dehydrogenase and a mild inflammatory syndrome. The electrocardiogram was normal. The anti-SAE antibodies were positive. The boy was diagnosed with juvenile dermatomyositis. He received methylprednisolone bolus therapy followed by oral prednisone. The latter was gradually tapered in combination with weekly intramuscular methotrexate. As a result, dysphagia disappeared within 48 h. After two weeks, there was an improvement in the muscular score and a significant regression of facial pseudo-angioedema. CONCLUSION We report the first African patient with anti-SAE autoantibody-positive JDM. He had a typical dermatological manifestation of JDM associated with pseudo-angioedema predominant on the lips; a rarely reported sign in DM and JDM patients. The patient responded well to corticosteroid therapy and methotrexate.
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Affiliation(s)
- Khalila Nainia
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco.
| | - Mohamed Amine Aouzal
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Imane Ouafik
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Mariyam Charhbili
- Pediatrics department, Regional hospital HASSAN II Agadir, Agadir, Morocco
| | - Amal Bouchhab
- Pediatrics department, Regional hospital HASSAN II Agadir, Agadir, Morocco
| | - Abdellatif Daoudi
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Samira Tizki
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Radia Chakiri
- Dermatology department, CHU SOUSS-MASSA, Agadir, Morocco
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2
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Bennett R, Bradley K, Stevanovic M, McFadden JR, Chaudhari AS, Ramos-Rodriguez AJ, Yan S, Momtahen S, LeBlanc RE, Cloutier JM, Salem I, Grand DG, Hodson EL, Sriharan A. Anti-PL-7, anti-Ro/SSA, anti-Mi-2, and anti-TIF1-γ correlate with specific patterns of histopathologic features in dermatomyositis: An analysis of 39 skin biopsy specimens from 25 patients. J Cutan Pathol 2024; 51:317-326. [PMID: 38158735 DOI: 10.1111/cup.14578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND In dermatomyositis (DM), myositis-specific and myositis-associated antibodies have been correlated with clinical features. It is unknown if histopathologic findings in lesional skin biopsies correlate with serologic subtypes of DM. METHODS A retrospective chart review of patients with DM was performed. Patients with myositis antibodies and DM lesional skin biopsies were included in the study. Skin biopsies were reviewed by blinded dermatopathologists for 20 histopathologic features. RESULTS There was a statistically significant (p < 0.05) association between anti-PL-7 serology and decreased degree of vacuolar degeneration, necrotic keratinocytes, and thickening of the epidermal basement membrane. Anti-aminoacyl tRNA synthetase (anti-ARS) antibodies had the same significant negative association with degree of vacuolar degeneration, necrotic keratinocytes, and thickening of the epidermal basement membrane. A similar pattern was seen with an anti-cytoplasmic serology; where there was a significant association with an increased degree of vacuolar degeneration and necrotic keratinocytes, and a nonsignificant trend of minimally thickened epidermal basement membrane. There was a statistically significant association between anti-Ro/SSA serology and increased degree of vacuolar degeneration. Anti-TIF1-γ serology was significantly associated with the increased presence of necrotic keratinocytes and pigment incontinence, and displayed a pattern of increased neutrophils. There was a significant association between anti-Mi-2 antibodies and pigment incontinence, as well as between myositis-specific antibodies and pigment incontinence. A statistically significant positive association was found between nuclear antibodies and degree of vacuolar degeneration, thickened epidermal basement membrane, pigment incontinence, and epidermal atrophy. CONCLUSION In patients with DM, some specific serotypes, including anti-PL-7, anti-Ro/SSA, anti-Mi-2, and anti-TIF1-γ, may have characteristic histopathologic features.
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Affiliation(s)
- Raven Bennett
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | | | | | - Jason R McFadden
- National Institutes of Health, National Human Genome Research Institute, Undiagnosed Diseases Program, Rockville, Maryland, USA
| | | | - Alvaro J Ramos-Rodriguez
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Shaofeng Yan
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Shabnam Momtahen
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Robert E LeBlanc
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jeffrey M Cloutier
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Iman Salem
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - David G Grand
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Emma L Hodson
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Aravindhan Sriharan
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Farhat M, Soutou B. Case report: A case of resistant anti-SAE1 dermatomyositis with severe periorbital edema after hydroxychloroquine that responded to adalimumab. Int J Rheum Dis 2024; 27:e15125. [PMID: 38501604 DOI: 10.1111/1756-185x.15125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Maria Farhat
- Dermatology Department, Faculty of Medicine, Saint Joseph University, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Boutros Soutou
- Dermatology Department, Faculty of Medicine, Saint Joseph University, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
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Fujisaki M, Kasamatsu H, Nishimura K, Yoshida Y, Muneishi Y, Yamaguchi T, Nishino I, Konishi R, Ichimura Y, Okiyama N, Oyama N, Hasegawa M. A case of anti-SAE1/2 antibody-positive dermatomyositis with extensive panniculitis: A possible cutaneous manifestation of treatment resistance. J Dermatol 2024; 51:301-306. [PMID: 37830399 DOI: 10.1111/1346-8138.17000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
Dermatomyositis constitutes a heterogeneous group of autoimmune inflammatory conditions with a wide variety of clinical outcomes. The symptomatic heterogeneity carries skin, muscle, and joint manifestations; pulmonary and cardiac involvements; and concomitant malignancy. Any of these symptoms often appear at different combinations and time courses, thus posing difficulty in early diagnosis and appropriate treatment choice. Recent progress in laboratory investigations explored the identification of several myositis-specific autoantibodies (MSAs) and myositis-associated autoantibodies, allowing precise characterization for a clinical perspective of the disease. MSAs can be detectable in approximately 80% of patients with whole dermatomyositis, some of which closely reflect unique clinical features in the particular disease subset(s), including the distribution and severity of organ involvement, treatment response, and prognosis. However, only limited evidence has been available in dermatomyositis-associated panniculitis, mostly that in anti- melanoma differentiation-associated protein 5 antibody-positive disease. We present a rare case of a patients with dermatomyositis with extensive panniculitis on the trunk whose serum IgG autoantibodies reacted with both subunits of small ubiquitin-like modifier activating enzymes (SAEs), SAE1 and SAE2. The onset of panniculitis coincided with increased disease activity, including disease-related skin manifestations, fever, dysphagia, and muscle weakness in the extremities. These symptoms responded well to a high dose of systemic steroid, but even upon receiving a high-dose intravenous immunoglobulin, the panniculitic lesions and pruritic erythema flared with tapering of steroid dose, further requiring tacrolimus and mycophenolate mofetil to achieve disease remission. To our knowledge, this is the third reported case of anti-SAE autoantibody-positive dermatomyositis with panniculitis. We aim to extend the understanding of the current limitation and further perspective in the clinical management of the extremely rare skin manifestation associated with dermatomyositis.
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Affiliation(s)
- Misako Fujisaki
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroshi Kasamatsu
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kentarou Nishimura
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yasuyuki Yoshida
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoriko Muneishi
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tomohisa Yamaguchi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Risa Konishi
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Ichimura
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoko Okiyama
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noritaka Oyama
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Mammen AL. Paraneoplastic myopathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:327-332. [PMID: 38494286 DOI: 10.1016/b978-0-12-823912-4.00022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This chapter reviews the association between cancer and the idiopathic inflammatory myopathies (IIM), which includes dermatomyositis (DM), antisynthetase syndrome (ASyS), immune-mediated necrotizing myopathy (IMNM), and inclusion body myositis (IBM). Accumulating evidence shows that the risk of a coexisting malignancy is high in patients with DM, especially among those with anti-Tif1γ autoantibodies. Patients with IMNM and no defined autoantibodies also have an increased risk of malignancy. Recent evidence demonstrates that many IBM patients have increased numbers of circulating CD57+ CD8+ T cells, consistent with a diagnosis of large granular lymphocytic leukemia. In contrast, IMNM patients with anti-SRP or anti-HMGCR autoantibodies as well as patients with ASyS syndrome do not have a definitively increased risk of cancer. Patients who have a cancer treated with one of the immune checkpoint inhibitors can develop myositis (ICI-myositis), sometimes along with myasthenia gravis and/or myocarditis.
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Affiliation(s)
- Andrew L Mammen
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States; Departments of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Tseng CW, Satoh M, Hasegawa T, Tanaka S, Chen YM. Analytic and Clinical Validity of Myositis-Specific Antibodies by Line-Blot Immunoassay Is Essential. J Clin Rheumatol 2024; 30:e23-e28. [PMID: 37983669 DOI: 10.1097/rhu.0000000000002043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVES This study assessed the concordance between line blot (LB) and immunoprecipitation (IP) assays for detecting myositis-specific antibodies (MSAs) in idiopathic inflammatory myopathies (IIMs) and their association with IIM subtypes. METHODS One hundred patients with IIM were enrolled, and MSA was detected using LB and IP. The IIM subtypes, including immune-mediated necrotizing myopathy-like, anti-tRNA synthetase syndrome-like, and clinically amyopathic dermatomyositis-like, were clinically diagnosed. The validity and reliability of the LB compared with the IP were evaluated. Optimal cutoff levels for LB were determined using various statistical methods including Cohen κ, Gwet's AC, diagnostic odds ratios, and receiver operating characteristic analysis. RESULTS Line blot exhibited lower specificity and accuracy than IP in predicting IIM subtypes. Some MSAs performed better at higher LB cutoff values. Anti-signal recognition particle antibodies showed poor performance in predicting the immune-mediated necrotizing myopathy-like subtype using LB. Raising the cutoffs improved the reliability of anti-threonyl-tRNA synthetase and anti-signal recognition particle antibodies. Anti-histidyl-tRNA synthetase antibodies performed well at lower positivity, whereas diagnostic odds ratios increased for anti-transcription intermediary factor 1γ and anti-nuclear matrix protein 2 with higher cutoffs. CONCLUSIONS Inconsistencies between LB and IP have been observed in patients with IIM. Individual optimal cutoffs for MSA by LB correlating with IP were determined. Rheumatologists should consider the differences between LB and IP results when classifying IIM subtypes.
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Affiliation(s)
| | | | - Tomoko Hasegawa
- Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shin Tanaka
- Departments of Human, Information, and Life Sciences
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Pruneda C, Reddy SA, Buckingham H, Tarbox M. Adverse cutaneous reaction to hydroxychloroquine in a patient with anti-SAE-1-positive dermatomyositis and a history of diffuse large B-cell lymphoma. Proc AMIA Symp 2023; 37:158-161. [PMID: 38174019 PMCID: PMC10761009 DOI: 10.1080/08998280.2023.2274231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/16/2023] [Indexed: 01/05/2024] Open
Abstract
This case report details the cutaneous findings of a patient with a history of diffuse B-cell lymphoma and SAE-1-positive dermatomyositis who developed an adverse cutaneous reaction after initiation of treatment with hydroxychloroquine. This adds to the sparse literature available detailing the correlation between anti-SAE-1 autoantibodies in dermatomyositis and the unique adverse cutaneous reactions in patients taking hydroxychloroquine. Additionally, our patient developed dermatomyositis years after a diagnosis of lymphoma. This report highlights the utility of the myositis-specific antibody panel to guide diagnosis and management, as well as the potential for developing dermatomyositis years after a lymphoma diagnosis.
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Affiliation(s)
- Corley Pruneda
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Soumya A. Reddy
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Hannah Buckingham
- School of Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Michelle Tarbox
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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8
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Demortier J, Vautier M, Chosidow O, Gallay L, Bessis D, Berezne A, Cordel N, Schmidt J, Smail A, Duffau P, Jachiet M, Begon E, Gottlieb J, Chasset F, Graveleau J, Marque M, Cesbron E, Forestier A, Josse S, Kluger N, Beauchêne C, Le Corre Y, Pagis V, Rigolet A, Guillaume-Jugnot P, Authier FJ, Guilain N, Streichenberger N, Leonard-Louis S, Boussouar S, Landon-Cardinal O, Benveniste O, Allenbach Y. Anti-SAE autoantibody in dermatomyositis: original comparative study and review of the literature. Rheumatology (Oxford) 2023; 62:3932-3939. [PMID: 37010495 DOI: 10.1093/rheumatology/kead154] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/26/2023] [Accepted: 03/10/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Among specific autoantibodies in DM, the anti-small ubiquitin-like modifier activating enzyme (SAE) antibody is rare. We aim to describe the clinical characteristics, cancer prevalence, and muscle pathology of anti-SAE-positive DM. METHODS Patients with a diagnosis of DM and sera positive for the anti-SAE antibody were recruited from 19 centres in this retrospective observational study. The available muscular biopsies were reviewed. We conducted a comparison with anti-SAE-negative DM and a review of the literature. RESULTS Of the patients in the study (n = 49), 84% were women. Skin involvement was typical in 96% of patients, with 10% having calcinosis, 18% ulceration and 12% necrosis; 35% presented with a widespread skin rash. Muscular disease affected 84% of patients, with mild weakness [Medical Research Council (MRC) scale 4 (3, 5)], although 39% of patients had dysphagia. Muscular biopsies showed typical DM lesions. Interstitial lung disease was found in 21% of patients, mainly with organizing pneumonia pattern, and 26% of patients showed dyspnoea. Cancer-associated myositis was diagnosed in 16% of patients and was responsible for the majority of deaths, its prevalence being five times that of the general population. IVIG therapy was administered to 51% of the patients during the course of the disease. Comparison with anti-SAE-negative DM (n = 85) showed less and milder muscle weakness (P = 0.02 and P = 0.006, respectively), lower creatinine kinase levels (P < 0.0001) and less dyspnoea (P = 0.003). CONCLUSION Anti-SAE positive DM is a rare subgroup associated with typical skin features but a potentially diffuse rash, a mild myopathy. Interstitial lung disease defines an organizing pneumonia pattern. Cancer associated DM prevalence is five times that of the general population. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT04637672.
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Affiliation(s)
- Juliette Demortier
- Department of Dermatology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - Mathieu Vautier
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Olivier Chosidow
- Department of Dermatology, Henri Mondor University Hospital, Université Paris-Est Créteil, AP-HP, Créteil, France
| | - Laure Gallay
- Department of Internal Medicine and Clinical Immunology, Edouard Herriot University Hospital, Claude Bernard University Lyon1, Lyon, France
| | - Didier Bessis
- Department of Dermatology, University Hospital Center of Montpellier, Montpellier, France
| | - Alice Berezne
- Department of Internal Medicine, CHR Annecy-Genevois, Annecy, France
| | - Nadège Cordel
- Department of Dermatology and Clinical Immunology, Guadeloupe University Hospital, Pointe-à-Pitre, Guadeloupe and Normandie University, UNIROUEN, IRIB, Inserm, U1234, Rouen, France
| | - Jean Schmidt
- Department of Internal Medicine and Clinical Immunology, Amiens-Picardie Nord University Hospital, Amiens, France
| | - Amar Smail
- Department of Internal Medicine and Clinical Immunology, Amiens-Picardie Nord University Hospital, Amiens, France
| | - Pierre Duffau
- Department of Internal Medicine, Saint André, Bordeaux University Hospital, Bordeaux, France
| | - Marie Jachiet
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris, France
| | - Edouard Begon
- Department of Dermatology, René Dubos Hospital, Pontoise, France
| | - Jeremy Gottlieb
- Department of Internal Medicine and Clinical Immunology, Bicêtre Hospital, Université Paris-Sud, AP-HP, Le Kremlin-Bicêtre Cedex, France
| | - François Chasset
- Department of Dermatology, Tenon Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Julie Graveleau
- Department of Internal Medicine, CH de St Nazaire, St Nazaire, France
| | - Myriam Marque
- Department of Dermatology, Caremeau Hospital, Nîmes University Hospital, Nîmes, France
| | - Elise Cesbron
- Department of Dermatology, Le Mans Hospital Center, Le Mans, France
| | - Amandine Forestier
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Séverine Josse
- Department of Internal Medicine and Clinical Immunology, Dieppe Hospital, Dieppe, France
| | - Nicolas Kluger
- Department of Dermatology, Helsinki University Hospital, Helsinki, Finland
| | | | - Yannick Le Corre
- Department of Dermatology, Angers University Hospital, Angers, France
| | - Valentine Pagis
- Department of Internal Medicine and Clinical Immunology, Beaujon Hospital, AP-HP, Paris, France
| | - Aude Rigolet
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Perrine Guillaume-Jugnot
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - François-Jérôme Authier
- Department of Pathology, Henri-Mondor University Hospital, Institut Mondor de Recherche Biomédicale, INSERM, Centre de Reference pour les Maladies Neuromusculaires of Nord-Est-Île de France, Université Paris-Est Créteil, AP-HP, Créteil, France
| | - Nelly Guilain
- Department of Pathology, Amiens Picardie University Hospital, Amiens, France
| | | | - Sarah Leonard-Louis
- Neuropathology Department, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Samia Boussouar
- ICT Cardiothoracic Imaging Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre Hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
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Chaudhry S, Christopher-Stine L. Myositis interstitial lung disease and autoantibodies. Front Med (Lausanne) 2023; 10:1117071. [PMID: 37384043 PMCID: PMC10296774 DOI: 10.3389/fmed.2023.1117071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/15/2023] [Indexed: 06/30/2023] Open
Abstract
The aim of this review is to examine and evaluate published literature associated with idiopathic inflammatory myopathies (IIM) and interstitial lung disease (ILD) based on myositis specific autoantibodies (MSA) and the potential clinical significance of each autoantibody subtype for the practicing clinician. The review is a comprehensive search of literature published in PubMed from the year 2005 and onward coinciding with the surge in the discovery of new MSAs. Additionally, we comment on recommended multidisciplinary longitudinal care practices for patients with IIM-ILD with regard to imaging and other testing. Treatment is not covered in this review.
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Affiliation(s)
- Shire Chaudhry
- Department of Medicine, Luminis Health Anne Arundel Medical Center, Annapolis, MD, United States
| | - Lisa Christopher-Stine
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Mecoli CA, Igusa T, Chen M, Wang X, Albayda J, Paik JJ, Tiniakou E, Adler B, Richardson C, Kelly W, Danoff S, Mammen AL, Platz EA, Rosen A, Christopher-Stine L, Casciola-Rosen L, Shah AA. Subsets of Idiopathic Inflammatory Myositis Enriched for Contemporaneous Cancer Relative to the General Population. Arthritis Rheumatol 2023; 75:620-629. [PMID: 35878018 PMCID: PMC9873833 DOI: 10.1002/art.42311] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/17/2022] [Accepted: 07/13/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study investigates cancer risk in idiopathic inflammatory myopathy (IIM) relative to the general population. METHODS We conducted a single-center, retrospective cohort study of IIM patients and malignancy. Myositis-specific and -associated autoantibodies were determined by Euroimmun line blot, enzyme-linked immunosorbent assay, and immunoprecipitation. We calculated standardized prevalence ratios (SPRs) and adjusted for calendar year, age, sex, race, and ethnicity by comparing observed cancers in IIM patients versus expected cancers in the general population using the Surveillance, Epidemiology, and End Results registry. RESULTS Of 1,172 IIM patients, 203 (17%) patients with a cancer history were studied. Over a median follow-up of 5.2 years, the observed number of IIM patients diagnosed with cancer was increased 1.43-fold (SPR 1.43 [95% confidence interval (95% CI) 1.15-1.77]; P = 0.002). Within 3 years of IIM symptom onset, an increased SPR was observed for anti-transcription intermediary factor 1γ (anti-TIF1γ)-positive patients for ovarian and breast cancer (ovarian SPR 18.39 [95% CI 5.01-47.08], P < 0.001; breast SPR 3.84 [95% CI 1.99-6.71], P < 0.001). As expected, anti-TIF1γ positivity was associated with a significantly elevated SPR; however, only 55% (36 of 66) of all cancers within 3 years of dermatomyositis onset were observed in anti-TIF1γ-positive patients. Other myositis-specific autoantibodies, including anti-Mi-2, anti-small ubiquitin-like modifier activating enzyme (SAE), and anti-nuclear matrix protein 2 (NXP-2), accounted for 26% (17 of 66) of cancers diagnosed within 3 years of dermatomyositis onset. No cancer association, positive or negative, was observed for patients with antisynthetase, anti-melanoma differentiation-associated protein 5 (anti-MDA-5), or anti-hydroxymethylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies. CONCLUSION In a tertiary referral center population, anti-TIF1γ was most strongly associated with breast and ovarian cancer. Patients with antisynthetase, anti-MDA-5, or anti-HMGCR antibodies had the same cancer risk as the general population.
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Affiliation(s)
- Christopher A Mecoli
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tak Igusa
- Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Mengkun Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - XingYao Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jemima Albayda
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie J Paik
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni Tiniakou
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brittany Adler
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carrie Richardson
- Feinberg School of Medicine, Northwestern University, Division of Rheumatology, Chicago, Illinois
| | - Will Kelly
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sonye Danoff
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew L Mammen
- Department of Medicine and Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, and Muscle Disease Unit, National Institute of Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Antony Rosen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Christopher-Stine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Livia Casciola-Rosen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ami A Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Vignesh P, Barman P, Basu S, Mondal S, Ishran B, Kumrah R, Dod A, Garg R, Rawat A, Singh S. Juvenile dermatomyositis associated with autoantibodies to small ubiquitin-like modifier activating enzyme: a report of 4 cases from North India and a review of literature. Immunol Res 2023; 71:112-120. [PMID: 36278969 DOI: 10.1007/s12026-022-09334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/17/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is the commonest inflammatory myositis in children. The clinical phenotype is often characterized by the presence of myositis-specific antibodies (MSA). Antibodies to small ubiquitin-like modifier activating enzyme (SAE) are amongst the rarest MSA reported in children. MATERIALS AND METHODS A review of medical records of all patients diagnosed to have JDM during the period January 1992-April 2022 in our institute was done. Case records of children with JDM who had significant positivity for anti-SAE antibody by myositis immunoblot were analysed in detail. RESULTS Of the 140 children with JDM, MSA immunoblot was carried out in 53 patients-4 (7.5%) amongst these had significant positivity for anti-SAE antibodies. Median age of onset of symptoms was 5.5 years (range: 5-11 years). Clinical features at presentation included fever, photosensitivity, heliotrope rash, and Gottron papules. Clinically significant proximal muscle weakness was noted in 3/4 patients; 1 had no discernible weakness but had radiological evidence of myositis. None of the 4 patients had evidence of interstitial lung disease or calcinosis. All patients were treated with intravenous pulse methylprednisolone: subcutaneous weekly methotrexate and hydroxychloroquine. One patient received mycophenolate mofetil because of a relapse of muscle disease, while none received cyclophosphamide or biologics. Median follow-up duration was 21.5 months (range: 6-39 months). CONCLUSION Anti-SAE antibodies were found in 4/53 (7.5%) of North Indian children with JDM. All 4 patients had predominant cutaneous manifestations followed by muscle disease. Response to treatment was brisk and sustained. None had developed calcinosis in the follow-up. KEY MESSAGES 1. We report high prevalence of anti-SAE antibody positivity (7.5%) in North Indian cohort of JDM. 2. Cutaneous disease precedes muscle weakness in children with anti-SAE positive JDM. 3. No evidence of interstitial lung disease/calcinosis was seen in these children.
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Affiliation(s)
- Pandiarajan Vignesh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Prabal Barman
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Suprit Basu
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sanjib Mondal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Bhoomika Ishran
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rajni Kumrah
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aditya Dod
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ravinder Garg
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Amit Rawat
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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12
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Zhao Y, Su H, Yin X, Hou H, Wang Y, Xu Y, Li X, Zhang N, Sun W, Wei W. Cancer associated autoantibodies in idiopathic inflammatory myopathies: A retrospective cohort from a single center in China. Med Clin (Barc) 2023; 160:10-16. [PMID: 35842306 DOI: 10.1016/j.medcli.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Idiopathic inflammatory myopathies (IIMs) are systemic, heterogeneous diseases, which mainly affect skeletal muscle. Myositis with cancer is often referred to as cancer-associated myositis (CAM), which is associated with poor prognosis. This study aimed to determine the cancer associated myositis-specific autoantibodies (MSAs) and to elucidate their associations with clinical features in Chinese patients with IIMs. METHODS This retrospective study enrolled 312 patients with IIMs who were treated at Tianjin Medical University General Hospital, China, from January 2015 to December 2020. Clinical data were collected. Serum MSAs, including anti-Mi-2, anti-TIF1-γ, anti-NXP2, anti-SAE, anti-MDA5, anti-SRP, anti-Jo-1, anti-PL-7, anti-PL-12, anti-OJ, anti-EJ and anti-HMGCR antibodies were detected. Cancer-associated MSAs, their phenotypic and survival features were estimated through SPSS 20.0. RESULTS The results revealed that anti-TIF1-γ antibody and anti-SAE antibody were cancer-associated autoantibodies with odds ratios (95% CI) of 8.70 (3.35-22.64) and 22.31 (4.32-115.05), respectively. Skin lesions, proximal weakness, dysphagia and dysarthria were observed more frequently in patients carrying anti-TIF1-γ antibody. By contrast, patients with anti-TIF1-γ antibody had a lower frequencies of fever, arthritis/arthralgia and interstitial lung disease (ILD). Anti-TIF1-γ antibody positive CAM comprised about half of CAM entities and had the characteristic of close temporal association with cancer detection/recurrence. Female-dominant, common reproductive system tumors were other clinical features of this subset. Besides, patients with anti-TIF1-γ antibody positive had significantly lower survival rates than the anti-TIF1-γ antibody negative group. CONCLUSIONS Anti-TIF1-γ antibody and anti-SAE antibody were cancer-associated autoantibodies. Anti-TIF1-γ antibody positive CAM was a subset that comprised about half of CAM entities and had the characteristic of poor prognosis.
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Affiliation(s)
- Yin Zhao
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Haiyuan Su
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Xiaoyang Yin
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Hou Hou
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Ying'ai Wang
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Yong Xu
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Xin Li
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Nang Zhang
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Wenwen Sun
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Wei Wei
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China.
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Manousakis G. Inflammatory Myopathies. Continuum (Minneap Minn) 2022; 28:1643-1662. [PMID: 36537973 DOI: 10.1212/con.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW This article outlines the salient clinical, serologic, electrophysiologic, imaging, and histopathologic findings and treatment options for the idiopathic inflammatory myopathies, including those related to immune checkpoint inhibitors and SARS-CoV-2. RECENT FINDINGS The classification of idiopathic inflammatory myopathies has improved with the integration of myositis-specific antibodies and histopathologic findings. Characteristic features of immune checkpoint inhibitor-related myositis have been identified, allowing early recognition and treatment of the syndrome. The COVID-19 pandemic has had a profound impact on the care of patients with idiopathic inflammatory myopathies, and several mechanisms of virus-related muscle injury have been proposed. SUMMARY A comprehensive evaluation including clinical examination, EMG, imaging, antibody testing, muscle biopsy, and cancer screening, when appropriate, can lead to an earlier accurate diagnosis and an individualized treatment approach for patients with idiopathic inflammatory myopathies.
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14
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Goldman N, Han J, LaChance A. Diagnosis and Management of Cutaneous Manifestations of Autoimmune Connective Tissue Diseases. Clin Cosmet Investig Dermatol 2022; 15:2285-2312. [PMID: 36320926 PMCID: PMC9618245 DOI: 10.2147/ccid.s360801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/19/2022] [Indexed: 11/20/2022]
Abstract
The cutaneous features of autoimmune connective tissue disease pose a unique challenge to patients and clinicians managing these conditions. In this review, we outline the key elements of diagnosis and treatment of cutaneous lupus erythematosus, dermatomyositis, systemic sclerosis, and morphea. This article also aims to present an update on gold standard as well as new and emerging therapies for these conditions. Overall, dermatologists can play a key role in diagnosing and treating autoimmune connective tissue diseases and this review intends to provide an up-to-date toolkit to guide clinical dermatologists in this endeavor.
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Affiliation(s)
- Nathaniel Goldman
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,New York Medical College, School of Medicine, Valhalla, NY, USA
| | - Joseph Han
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Avery LaChance
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Correspondence: Avery LaChance, Connective Tissue Diseases Clinic, Health Policy and Advocacy, Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02215, USA, Tel +1 617-582-6060, Fax +1 617-532-6060, Email
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15
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Abstract
PURPOSE OF REVIEW This review summarizes and comments on current knowledge in dermatomyositis. RECENT FINDINGS The 2018 European Neuromuscular Centre classification of dermatomyositis has been challenging by the discovery of clinicopathological features associated with dermatomyositis-specific antibody (DMSA) that were not incorporated in the original criteria. These features include but may not be limited to the presence of perifascicular necrosis in anti-Mi-2 dermatomyositis; presence of diffuse nonperifascicular sarcoplasmic myxovirus resistance protein A expression in anti-MDA5 dermatomyositis; and dermatomyositis sine dermatitis in anti-NXP-2 dermatomyositis. Variations and subclassifications within the same DMSA subtypes are observed: anti-MDA5 dermatomyositis is clinically subcategorized into good, intermediate, and poor prognostic subgroups; concurrent anti-CCAR1 and anti-TIF1-γ positivity identify anti-TIF1-γ-positive patient with a lower risk for cancer-associated myositis. Owing to distinct IFN1-signaling pathway activation in dermatomyositis, JAK-STAT inhibitor - the pathway-targeted therapy, have been studied with promising results in refractory dermatomyositis and some new-onset dermatomyositis. In addition, the potential serum biomarkers for IFN1 pathway activation are being investigated for their performance in monitoring the disease activity and the efficacy of the treatment. SUMMARY DMSA, evidence of prominent IFN1 pathway activation, and risk/severity-associated biomarkers would likely play major roles in future dermatomyositis classification, disease monitoring, and treatment decision.
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Affiliation(s)
- Jantima Tanboon
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Neuromuscular Research, National Institute of Neuroscience (NIN), National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience (NIN), National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
- Department of Genome Medicine Development
- Department of Clinical Genome Analysis, Medical Genome Center (MGC), National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
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16
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Galindo-Feria AS, Wang G, Lundberg IE. Autoantibodies: Pathogenic or epiphenomenon. Best Pract Res Clin Rheumatol 2022; 36:101767. [PMID: 35810122 DOI: 10.1016/j.berh.2022.101767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Idiopathic inflammatory myopathies (IIM) are heterogeneous autoimmune diseases. There are distinct subgroups, including antisynthetase syndrome, dermatomyositis, polymyositis, immune-mediated necrotizing myopathy, and sporadic inclusion body myositis. In patients with IIM, autoantibodies are present in up to 80% of the patients. These autoantibodies are often characterized as myositis-specific autoantibodies (MSA) or myositis-associated autoantibodies (MAA). The recognition of the importance of autoantibodies, especially MSA, is increasing in recent years. In this chapter, we provide an overview of the MSAs, including some new autoantibodies of interest as they target mainly muscle-specific autoantigen, in clinical classification, the measurement of the disease activity, and a possible role in the pathogenesis in the patients with IIM.
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Affiliation(s)
- Angeles S Galindo-Feria
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
| | - Guochun Wang
- Department of Rheumatology, Key Laboratory of Myositis, China-Japan Friendship Hospital, Beijing, 100029, China.
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
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Narayan N, Richardson CT. Multiple myositis-specific autoantibodies in dermatomyositis: two cases and review of the literature. JAAD Case Rep 2022; 25:72-74. [PMID: 35769195 PMCID: PMC9234323 DOI: 10.1016/j.jdcr.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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18
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Damoiseaux J, Mammen AL, Piette Y, Benveniste O, Allenbach Y. 256th ENMC international workshop: Myositis specific and associated autoantibodies (MSA-ab): Amsterdam, The Netherlands, 8-10 October 2021. Neuromuscul Disord 2022; 32:594-608. [DOI: 10.1016/j.nmd.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
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El-Banna G, Fiorentino D. Update on Cutaneous Signs to Assist in the Diagnosis of Dermatomyositis. Curr Rheumatol Rep 2022; 24:156-165. [PMID: 35404005 DOI: 10.1007/s11926-022-01070-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Dermatomyositis (DM) is a heterogeneous idiopathic inflammatory myopathy that can be challenging to diagnose. Learning about the cutaneous manifestations in DM can assist with prompt diagnosis as well as subgroup classification. This review highlights recent data regarding cutaneous signs in DM and their associations with myositis-specific antibodies (MSAs). RECENT FINDINGS Several novel DM skin signs have recently been reported. Novel and confirmatory data have helped to define more clearly the associations between various cutaneous manifestations and MSAs. Awareness of the diverse cutaneous phenotypes can help with the timely diagnosis of DM. As some MSAs are associated with atypical skin features and/or characteristic patterns of clinical findings, knowledge of these associations can help clinicians to recognize DM patients. Understanding how the prevalence and presentation of various cutaneous signs differ among ethnically diverse patients is a high priority for further study.
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Affiliation(s)
- Ghida El-Banna
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway, Pavilion C #C-234, Redwood City, CA, 94063, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway, Pavilion C #C-234, Redwood City, CA, 94063, USA.
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20
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Halilu F, Christopher-Stine L. Myositis-specific Antibodies: Overview and Clinical Utilization. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2022; 3:1-10. [PMID: 36467022 PMCID: PMC9524809 DOI: 10.2478/rir-2022-0001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/28/2022] [Indexed: 05/25/2023]
Abstract
Purpose of review-To review autoantibodies associated with different subtypes of idiopathic inflammatory myopathy (IIM) and their clinical applications. IIM are a heterogenous group of autoimmune disorders characterized by muscle weakness, cutaneous features, and internal organ involvement. The diagnosis and classification, which is often challenging, is made using a combination of clinical features, muscle enzyme levels, imaging, and biopsy. The landmark discoveries of novel autoantibodies specific to IIM subtypes have been one of the greatest advancements in the field of myositis. The specificity of these autoantibodies has simplified the diagnostic algorithm of IIM with their heterogenous presentation and outdated the earlier diagnostic criteria. Myositis-specific antibodies (MSAs) have improved diagnostics, clinical phenotyping, and prognostic stratification of the subtypes of IIMs. Furthermore, the levels of certain MSAs correlate with disease activity and muscle enzyme levels such that titers may be able to be used to predict disease course and treatment response.
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Affiliation(s)
- Fatima Halilu
- Department of Medicine, Greater Baltimore Medical Center, Towson, MD, USA
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Hiraiwa T, Hanami Y, Okiyama N, Konishi R, Ichimura Y, Yamamoto T. Clinically amyopathic dermatomyositis with diffuse erosive erythema in a patient with anti-small ubiquitin-like modifier activating enzyme antibody. Int J Dermatol 2022; 61:e389-e391. [PMID: 35106751 DOI: 10.1111/ijd.16124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Tomoko Hiraiwa
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Yuka Hanami
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Risa Konishi
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuki Ichimura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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22
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Marzęcka M, Niemczyk A, Rudnicka L. Autoantibody Markers of Increased Risk of Malignancy in Patients with Dermatomyositis. Clin Rev Allergy Immunol 2022; 63:289-296. [PMID: 35147864 PMCID: PMC9464248 DOI: 10.1007/s12016-022-08922-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 01/13/2023]
Abstract
Dermatomyositis is a chronic inflammatory disease involving the skin and muscles. It most commonly occurs in adults with preponderance in females, but pediatric occurrence is also possible. The risk of malignancy in adult patients with dermatomyositis was reported to be 4.66-fold higher compared to that in the general population. A significantly increased risk of malignancy was reported within the first 12 months following the diagnosis of dermatomyositis (standardized incidence ratio equaled 17). One of the characteristic laboratory findings associated with dermatomyositis is the presence of circulating autoantibodies which are classified into two subgroups: myositis-specific and myositis-associated autoantibodies. It was shown that specific types of antibodies might be associated with an increased risk of malignancy. Current literature data indicate that the strongest correlation with malignant diseases was reported in anti-TIF1-γ-positive patients who were at a 9.37-fold higher risk of cancer. A 3.68-fold increase in the risk of cancer was also reported among patients with anti-NXP2 antibodies. Malignant diseases were reported in 14-57% of patients with anti-SAE antibodies. The presence of other autoantibodies may also be associated with an increased risk of malignancy. These data indicate that patients with circulating anti-TIF1-γ, anti-NXP2, and anti-SAE should be very closely monitored for dermatomyositis-associated malignant comorbidities. The aim of this review is to summarize the current data regarding the link between malignancy and the presence of specific antibodies in patients with dermatomyositis.
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Affiliation(s)
- Milena Marzęcka
- grid.13339.3b0000000113287408Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Niemczyk
- grid.13339.3b0000000113287408Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- grid.13339.3b0000000113287408Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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