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Hamsho S, Sleiay B, Sleiay M, Batrash O, Alabdullah H, Aboud M. A 30-year-old female with dermatomyositis without high elevation of muscle enzymes: a rare case report from Syria. Ann Med Surg (Lond) 2024; 86:2167-2171. [PMID: 38576947 PMCID: PMC10990297 DOI: 10.1097/ms9.0000000000001682] [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: 10/06/2023] [Accepted: 12/24/2023] [Indexed: 04/06/2024] Open
Abstract
Introduction and importance Dermatomyositis (DM), sometimes referred to as inflammatory and degenerative changes in the skin and muscles, is a rare autoimmune disorder. DM is distinguished by myopathic disease, symmetrical proximal muscle weakness, and increased creatine kinase (CK). Case presentation A 30-year-old-female presented to the department of dermatology with a history of chronic right hand pain spreading to the shoulder, severe tachycardia, and dyspenia that increased during routine tasks like using the bathroom. What makes this case unique is that the CPK developed without doubling, and the final concentration was 207 ng/ml. Other common clinical symptoms include amyopathic/hypomyopathic muscle involvement and DM-specific rash (Gottron's papules, heliotrope rash), and these manifestations were in our patients. Sun protection, topical treatment with corticosteroids and/or calcineurin inhibitors, and systemic medication should be utilized for all individuals with nonvasculopathic disease. In our case, the patient stopped using azathioprine and began taking methotrexate. Clinical discussion Sun protection, topical therapy with corticosteroids and/or calcineurin inhibitors, and systemic medication should be utilized in layers for all individuals with nonvasculopathic illnesses. Mycophenolat Mofetil is beneficial in treating refractory illnesses as well as individuals with interstitial lung disease or substantial skin disease. Conclusion Even if test findings are not conclusive, dermatomyositis should always be considered when muscular weakness manifests. It's important to distinguish the disorder from connective tissue diseases like lupus erythematosus. In fact, to correctly diagnose DM, if there are any doubts, a muscle biopsy is required.
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Affiliation(s)
- Suaad Hamsho
- Department of Rheumatology, Faculty of Medicine, Damascus University, Damascus
| | - Bilal Sleiay
- Faculty of Medicine, Hama University, Hama, Syria
| | | | | | | | - Majed Aboud
- Department of Rheumatology, Faculty of Medicine, Damascus University, Damascus
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2
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Ujiie H, Rosmarin D, Schön MP, Ständer S, Boch K, Metz M, Maurer M, Thaci D, Schmidt E, Cole C, Amber KT, Didona D, Hertl M, Recke A, Graßhoff H, Hackel A, Schumann A, Riemekasten G, Bieber K, Sprow G, Dan J, Zillikens D, Sezin T, Christiano AM, Wolk K, Sabat R, Kridin K, Werth VP, Ludwig RJ. Unmet Medical Needs in Chronic, Non-communicable Inflammatory Skin Diseases. Front Med (Lausanne) 2022; 9:875492. [PMID: 35755063 PMCID: PMC9218547 DOI: 10.3389/fmed.2022.875492] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
An estimated 20-25% of the population is affected by chronic, non-communicable inflammatory skin diseases. Chronic skin inflammation has many causes. Among the most frequent chronic inflammatory skin diseases are atopic dermatitis, psoriasis, urticaria, lichen planus, and hidradenitis suppurativa, driven by a complex interplay of genetics and environmental factors. Autoimmunity is another important cause of chronic skin inflammation. The autoimmune response may be mainly T cell driven, such as in alopecia areata or vitiligo, or B cell driven in chronic spontaneous urticaria, pemphigus and pemphigoid diseases. Rare causes of chronic skin inflammation are autoinflammatory diseases, or rheumatic diseases, such as cutaneous lupus erythematosus or dermatomyositis. Whilst we have seen a significant improvement in diagnosis and treatment, several challenges remain. Especially for rarer causes of chronic skin inflammation, early diagnosis is often missed because of low awareness and lack of diagnostics. Systemic immunosuppression is the treatment of choice for almost all of these diseases. Adverse events due to immunosuppression, insufficient therapeutic responses and relapses remain a challenge. For atopic dermatitis and psoriasis, a broad spectrum of innovative treatments has been developed. However, treatment responses cannot be predicted so far. Hence, development of (bio)markers allowing selection of specific medications for individual patients is needed. Given the encouraging developments during the past years, we envision that many of these challenges in the diagnosis and treatment of chronic inflammatory skin diseases will be thoroughly addressed in the future.
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Affiliation(s)
- Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - David Rosmarin
- Department of Dermatology, Tufts Medical Center, Boston, MA, United States
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Katharina Boch
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Martin Metz
- Institute for Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute for Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Diamant Thaci
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Connor Cole
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States.,Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Kyle T Amber
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States.,Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Andreas Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Graßhoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Alexander Hackel
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Anja Schumann
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Gant Sprow
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Joshua Dan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Tanya Sezin
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Angela M Christiano
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Kerstin Wolk
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Sabat
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Ralf J Ludwig
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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3
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Fan W, Li Z, Wang Y, Zhang C, Liu H, Wang D, Bai Y, Luo S, Li Y, Qin Q, Chen W, Yong L, Zhen Q, Yu Y, Ge H, Mao Y, Cao L, Zhang R, Hu X, Yu Y, Li B, Sun L. Imputation of the major histocompatibility complex region identifies major independent variants associated with bullous pemphigoid and dermatomyositis in Han Chinese. J Dermatol 2022; 49:998-1004. [PMID: 35751838 DOI: 10.1111/1346-8138.16499] [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: 01/08/2022] [Revised: 04/29/2022] [Accepted: 06/05/2022] [Indexed: 11/27/2022]
Abstract
As autoimmune skin diseases, both bullous pemphigoid (BP) and dermatomyositis (DM) show significant associations with the major histocompatibility complex (MHC) region. In fact, the coexistence of BP and DM has been previously reported. Therefore, we hypothesized that there may be a potential genetic correlation between BP and DM. Based on data for 312 BP patients, 128 DM patients, and 6793 healthy control subjects, in the MHC region, we imputed single-nucleotide polymorphisms (SNP), insertions and deletions (INDEL), and copy number variations (CNV) using the 1KGP phase 3 dataset and amino acids (AA) and SNP using a Han-MHC reference database. An association study revealed the most significant SNP associated with BP, namely, rs580921 (p = 1.06E-08, odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.37-1.90), which is located in the C6orf10 gene, and the most significant classic human leukocyte antigen (HLA) allele associated with DM, namely, HLA-DPB1*1701 (p = 6.56E-10, OR = 3.61, 95% CI = 2.40-5.42). Further stepwise regression analyses with rs580921 identified a threonine at position 163 of the HLA-B gene as a new independent disease-associated AA, and HLA-DPB1*1701 indicated that no loci were significant. Three-dimensional ribbon models revealed that the HLA-B AA position 163 (p = 3.93E-07, OR = 1.64, 95% CI = 1.35-1.98) located in the α2 domain of the HLA-B molecule was involved in the process of specific antigen presentation. The calculations showed that there was no significant genetic correlation between BP and DM. Our study identified three significant loci in the MHC region, proving that the HLA region was significantly correlated with BP and DM separately. Our research highlights the key role of the MHC region in disease susceptibility.
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Affiliation(s)
- Wencheng Fan
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Zhuo Li
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yirui Wang
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Chang Zhang
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Hao Liu
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Daiyue Wang
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yuanming Bai
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Sihan Luo
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yuanyuan Li
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Qin Qin
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Weiwei Chen
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Liang Yong
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Qi Zhen
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yafen Yu
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Huiyao Ge
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yiwen Mao
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Lu Cao
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Ruixue Zhang
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Xia Hu
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yanxia Yu
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Bao Li
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,The Comprehensive Lab, College of Basic Medicine, Anhui Medical University, Hefei, China
| | - Liangdan Sun
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
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4
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Dalakas MC. Complement in autoimmune inflammatory myopathies, the role of myositis-associated antibodies, COVID-19 associations, and muscle amyloid deposits. Expert Rev Clin Immunol 2022; 18:413-423. [PMID: 35323101 DOI: 10.1080/1744666x.2022.2054803] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The inflammatory myopathies (IM) have now evolved into distinct subsets requiring clarification about their immunopathogenesis to guide applications of targeted therapies. AREAS COVERED Immunohistopathologic criteria of IM with a focus on complement, anti-complement therapeutics, and other biologic immunotherapies. The COVID19-triggered muscle autoimmunity along with the correct interpretation of muscle amyloid deposits is discussed. EXPERT OPINION The IM, unjustifiably referred as idiopathic, comprise Dermatomyositis (DM), Necrotizing Autoimmune Myositis (NAM), Anti-synthetase syndrome-overlap myositis (Anti-SS-OM), and Inclusion-Body-Myositis (IBM). In DM, complement activation with MAC-mediated endomysial microvascular destruction and perifascicular atrophy is the fundamental process, while innate immunity activation factors, INF1 and MxA, sense and secondarily enhance inflammation. Complement participates in muscle fiber necrosis from any cause and may facilitate muscle-fiber necrosis in NAM but seems unlikely that myositis-associated antibodies participate in complement-fixing. Accordingly, anti-complement therapeutics should be prioritized for DM. SARS-CoV-2 can potentially trigger muscle autoimmunity, but systematic studies are needed as the reported autopsy findings are not clinically relevant. In IBM, tiny amyloid deposits within muscle fibers are enhanced by inflammatory mediators contributing to myodegeneration; in contrast, spotty amyloid deposits in the endomysial connective tissue do not represent 'amyloid myopathy' but only have diagnostic value for amyloidosis due to any cause.
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Affiliation(s)
- Marinos C Dalakas
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.,University of Athens Medical School, Neuroimmunology Unit, National and Kapodistrian University, Athens, Greece
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5
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Kus KJB, LaChance AH, Vleugels RA. Recognition and Management of Cutaneous Connective Tissue Diseases. Med Clin North Am 2021; 105:757-782. [PMID: 34059249 DOI: 10.1016/j.mcna.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Connective tissue diseases (CTDs) encompass a broad spectrum of clinical presentations that involve multidisciplinary management. Cutaneous findings are common in CTD and careful examination of these features aids in appropriate diagnosis and subsequent evaluation. Thorough work-up of CTD is crucial to properly identify disease subtypes and systemic involvement. Management plans can be developed based on diagnosis and systemic manifestations of disease. Disease management often requires treatment with pharmacotherapies with potential for toxicities, further underscoring the importance of diagnostic accuracy in this patient population. Evolving research strives to better elucidate the pathogenic mechanisms of CTDs allowing for more targeted treatment modalities.
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MESH Headings
- Adult
- Comorbidity
- Connective Tissue Diseases/complications
- Connective Tissue Diseases/diagnosis
- Connective Tissue Diseases/drug therapy
- Connective Tissue Diseases/pathology
- Dermatomyositis/diagnosis
- Dermatomyositis/etiology
- Dermatomyositis/pathology
- Diagnosis, Differential
- Drug Therapy/methods
- Drug Therapy/statistics & numerical data
- Drug-Related Side Effects and Adverse Reactions
- Early Diagnosis
- Female
- Humans
- Interdisciplinary Communication
- Lupus Erythematosus, Cutaneous/diagnosis
- Lupus Erythematosus, Cutaneous/etiology
- Lupus Erythematosus, Cutaneous/pathology
- Lupus Erythematosus, Discoid/diagnosis
- Lupus Erythematosus, Discoid/etiology
- Lupus Erythematosus, Discoid/pathology
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/etiology
- Lupus Erythematosus, Systemic/pathology
- Male
- Patient Care Management/methods
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/etiology
- Scleroderma, Systemic/pathology
- Vasculitis/diagnosis
- Vasculitis/etiology
- Vasculitis/pathology
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Affiliation(s)
- Kylee J B Kus
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309-4482, USA
| | - Avery H LaChance
- Connective Tissue Disease Clinic, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
| | - Ruth Ann Vleugels
- Autoimmune Skin Disease Program, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
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6
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Lin TL, Wu CY, Juan CK, Chang YT, Chen YJ. Long-Term Risk of Autoimmune Diseases other than Systemic Lupus Erythematosus in Cutaneous Lupus Erythematosus-Alone Patients: A 10-Year Nationwide Cohort Study. Dermatology 2021; 238:92-100. [PMID: 34062538 DOI: 10.1159/000515524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Up to 25% of patients with cutaneous lupus erythematosus (CLE) can develop systemic lupus erythematosus (SLE). However, the risk of autoimmune diseases other than SLE in CLE patients who have only skin manifestations (CLE-alone) has rarely been explored. OBJECTIVE To investigate the long-term risk and independent factors of non-SLE autoimmune diseases among CLE-alone patients. METHOD A nationwide cohort study using the Taiwanese National Health Insurance Research Database 1997-2013. CLE patients and matched subjects were included. Cumulative incidences of autoimmune diseases after 1 year of CLE-alone diagnosis were compared. Cox proportional hazard model was also performed. RESULTS A total of 971 CLE-alone patients and 5,175 reference subjects were identified. The 10-year cumulative incidence of autoimmune diseases other than SLE was significantly elevated in the CLE-alone cohort (9.00%, 95% confidence interval [CI] 6.72-11.29) than in the reference cohort (4.20%, 95% CI 3.53-4.87%) (p < 0.001). CLE-alone was independently associated with non-SLE autoimmune diseases (adjusted hazard ratio 1.55, 95% CI 1.10-2.18). Among CLE-alone patients, females and those taking long-term systemic corticosteroids (a proxy for extensive disease) were associated with non-SLE autoimmune diseases after adjusting for the number of repeated autoimmune laboratory tests. CONCLUSION CLE-alone is independently associated with future non-SLE autoimmune diseases.
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Affiliation(s)
- Teng-Li Lin
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Ying Wu
- Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Translational Medicine, Department of Medicinal Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan.,Department of Public Health and Graduate Institute of Clinical Medical Sciences, China Medical University, Taichung, Taiwan.,Department of Life Sciences and Rong Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan.,Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Chao-Kuei Juan
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Ting Chang
- Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
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7
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Hodgkinson LM, Wu TT, Fiorentino DF. Dermatomyositis autoantibodies: how can we maximize utility? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:433. [PMID: 33842654 PMCID: PMC8033377 DOI: 10.21037/atm-20-5175] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The past 15 years has seen significant advances in the characterization of myositis-specific autoantibodies (MSAs) and their associated phenotypes in patients with dermatomyositis (DM). As more careful studies are performed, it is clear that unique combinations of clinical and pathological phenotypes are associated with each MSA, despite the fact that there is considerable heterogeneity within antibody classes as well as overlap across the groups. Because risk for interstitial lung disease (ILD), internal malignancy, adverse disease trajectory, and, potentially response to therapy differ by DM MSA group, a deeper understanding of MSAs and validation and standardization of assays used for detection are critical for optimizing diagnosis and treatment. Like any test, the diagnostic sensitivity and specificity of assays for various MSAs is not perfect. Currently tests for MSAs are helpful at minimum for a clinician to assess relative risk or contribute to diagnosis and perhaps counsel the appropriate patient about what to expect. With international standardization and larger studies it is likely that more antibody tests will make their way into formal schemata for diagnosis and actionable risk assessment in DM. In this review, we summarize key considerations for interpreting the clinical and pathologic associations with MSA in DM and identify critical gaps in knowledge and practice that will maximize their clinical utility and utility for understanding disease pathogenesis.
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Affiliation(s)
| | - Tiffany Tingshuen Wu
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
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Castillo RL, Femia AN. Covert clues: the non-hallmark cutaneous manifestations of dermatomyositis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:436. [PMID: 33842657 PMCID: PMC8033358 DOI: 10.21037/atm-20-5252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Dermatomyositis (DM) is a strikingly heterogenous disease characterized by a broad and ever-evolving spectrum of cutaneous manifestations that transcend the classic “hallmarks” defined by Peter and Bohan in 1975. Despite the increasing preponderance and ubiquity of autoantibody, radiologic, and electrophysiologic testing, the diagnosis of DM still hinges largely on prompt detection of cutaneous manifestations of this condition. While pathognomonic cutaneous features of DM are more readily recognizable, many patients present with subtle and/or atypical skin manifestations, and diagnosis of DM may require clinician identification of these cutaneous clues. In this review, we highlight several of the lesser-known skin manifestations of DM, specifically, panniculitis, diffuse subcutaneous edema, erythroderma, calcinosis, ulceration, flagellate erythema, Wong-type DM, gingival telangiectasias, and the ovoid palatal patch. We describe the clinical and histopathologic presentation of these cutaneous findings. While manifesting less frequently than the heliotrope rash, Gottron’s papules, and Gottron’s sign, these cutaneous clues are equally important for clinicians to recognize in order to facilitate timely diagnosis and early intervention.
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Affiliation(s)
- Rochelle L Castillo
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Alisa N Femia
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
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Dalakas MC. Inflammatory myopathies: update on diagnosis, pathogenesis and therapies, and COVID-19-related implications. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2020; 39:289-301. [PMID: 33458584 PMCID: PMC7783437 DOI: 10.36185/2532-1900-032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
The inflammatory myopathies constitute a heterogeneous group of acquired myopathies that have in common the presence of endomysial inflammation. Based on steadily evolved clinical, histological and immunopathological features and some autoantibody associations, these disorders can now be classified in five characteristic subsets: Dermatomyositis (DM) Polymyositis (PM), Necrotizing Autoimmune Myositis (NAM), Anti-synthetase syndrome-overlap myositis (Anti-SS-OM), and Inclusion-Body-Myositis (IBM). Each inflammatory myopathy subset has distinct immunopathogenesis, prognosis and response to immunotherapies, necessitating the need to correctly identify each subtype from the outset to avoid disease mimics and proceed to early therapy initiation. The review presents the main clinicopathologic characteristics of each subset highlighting the importance of combining expertise in clinical neurological examination with muscle morphology and immunopathology to avoid erroneous diagnoses and therapeutic schemes. The main autoimmune markers related to autoreactive T cells, B cells, autoantibodies and cytokines are presented and the concomitant myodegenerative features seen in IBM muscles are pointed out. Most importantly, unsettled issues related to a role of autoantibodies and controversies with reference to possible triggering factors related to statins are clarified. The emerging effect SARS-CoV-2 as the cause of hyperCKemia and potentially NAM is addressed and practical guidelines on the best therapeutic approaches and concerns regarding immunotherapies during COVID-19 pandemic are summarized.
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Affiliation(s)
- Marinos C Dalakas
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA USA and the Neuroimmunology Unit, National and Kapodistrian University University of Athens Medical School, Athens, Greece
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10
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Cheng H, Huo L, Wang D, Xiang Y. Concurrence of ovarian cancer and dermatomyositis: a propensity score analysis. J Gynecol Oncol 2020; 30:e99. [PMID: 31576691 PMCID: PMC6779614 DOI: 10.3802/jgo.2019.30.e99] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/13/2019] [Accepted: 05/18/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To analyze the clinical characteristics, prognosis and parallel clinical course of ovarian cancer (OC) and dermatomyositis (DM). METHODS The medical records of 23 consecutive patients who were diagnosed with OC and DM and were treated at Peking Union Medical College Hospital (PUMCH) between 2002 and 2017 were reviewed. Propensity score matching method was used to match control group (OC patients without DM) at a ratio of 1:5. The correlation between OC and DM was measured using the Pearson correlation scatter plot and Pearson's r. Kaplan-Meier survival analysis and Cox proportional hazard regression analysis were performed to evaluate the prognostic factors. RESULTS After matching, 23 patients who have the concurrence of OC and DM (DM group) and 115 patients diagnosed with OC alone (No DM group) were included. The 5-year overall survival rates (71.6% vs. 51.8%, p=0.020) and 5-year progression-free survival (30.5% vs. 0%, p=0.018) were poorer in DM group. Correlation between serum cancer antigen 125 (CA 125) and creatine kinase (CK) level was observed in 12 patients. The time between OC and DM diagnosis is significant through univariable analysis (p=0.021) but not in multivariable analysis in patients who have the concurrence of OC and DM. CONCLUSION The concurrence of OC and DM as a paraneoplastic syndrome is rare and has a poor prognosis. The risk for patients diagnosed with DM is highest within 3 years before or after OC diagnosis. A correlation and a parallel clinical course exist between these 2 diseases.
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Affiliation(s)
- Hongyan Cheng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR, China
| | - Lanqing Huo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR, China
| | - Dan Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR, China.
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11
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Abstract
Dermatomyositis is a rare inflammatory disease with characteristic cutaneous findings and varying amounts of systemic involvement. Patients may present with skin disease alone, have concomitant muscle disease, or have extracutaneous manifestations such as pulmonary disease or an associated malignancy. Given such diverse presentations, dermatomyositis is both a diagnostic and therapeutic challenge. However, a prompt diagnosis is of utmost importance to institute adequate therapy and screen patients for an associated malignancy. Dermatologists should play a crucial role in the diagnosis and management of patients with dermatomyositis as cutaneous disease tends to be chronic, negatively impact quality of life, and be more recalcitrant to therapy. In this review, we discuss diagnosis, with a focus on myositis-specific antibodies and their associated phenotypes. We also review therapies available for this often refractory skin disease.
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Affiliation(s)
- Gabriela A Cobos
- Autoimmune Skin Disease Program, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Alisa Femia
- Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Ruth Ann Vleugels
- Autoimmune Skin Disease Program, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.
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12
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Kuhn A. Characterizing clinicopathological and immunohistochemical findings in dermatomyositis panniculitis. J Eur Acad Dermatol Venereol 2020; 32:1231-1232. [PMID: 31211464 DOI: 10.1111/jdv.15149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Kuhn
- University Hospital Muenster, Muenster, Germany
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13
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Alenzi FM. Myositis Specific Autoantibodies: A Clinical Perspective. Open Access Rheumatol 2020; 12:9-14. [PMID: 32021502 PMCID: PMC6969688 DOI: 10.2147/oarrr.s231195] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/10/2019] [Indexed: 12/22/2022] Open
Abstract
Dermatomyositis (DM) is an idiopathic inflammatory condition characterized by myositis and variable skin manifestation. The existence of myositis specific autoantibodies usually manifests with varying degrees of skin or muscle inflammations. The condition has a well-established association with most clinical phenotypes, and these autoantibodies are useful in informing the diagnosis, management and prognosis of the disease. DM-specific autoantibodies include anti-MDA5, anti-NXP2, anti-SAE, anti-Mi-2, anti-ARS, anti-TIF1-gamma. Anti-Mi-2 antibodies are widely associated with DM cases that exhibit mainly cutaneous symptoms, such as cuticular overgrowths, Gottron's papules while being less susceptible to complications like interstitial lung disease or malignancy. The most distinct clinical features of patients with anti-SAE antibodies are their high prevalence of dysphagia and cutaneous manifestations that antecede the development of myopathies. In addition, DM patients with positive anti-PL-7 antibodies tend to have milder myositis characterized by low levels of creatine kinase as compared to patients with positive anti-Jo-1 antibodies. The anti-NXP2 antibodies are associated with transcriptional regulation and production of various proteins targeted by other DM antibodies, while anti- TIF1-γ. facilitates the transcription of deoxyribonucleic acids and regulates the growth and subsequent differentiation of body cells by controlling the signaling of TGF-β. The present review targets DM specific autoantibodies, considering their association, significance, and clinical presentation.
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Affiliation(s)
- Fahidah M Alenzi
- Department of Clinical Science, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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14
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Affiliation(s)
- Cristina Thomas
- From the Departments of Medicine (C.T., D.J.K., B.L., J.L.) and Dermatology (C.T., R.A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Ruth Ann Vleugels
- From the Departments of Medicine (C.T., D.J.K., B.L., J.L.) and Dermatology (C.T., R.A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - David J Kwiatkowski
- From the Departments of Medicine (C.T., D.J.K., B.L., J.L.) and Dermatology (C.T., R.A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Bruce Levy
- From the Departments of Medicine (C.T., D.J.K., B.L., J.L.) and Dermatology (C.T., R.A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Joseph Loscalzo
- From the Departments of Medicine (C.T., D.J.K., B.L., J.L.) and Dermatology (C.T., R.A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston
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15
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Gonzalez CD, Hansen C, Clarke JT. Adverse cutaneous drug reactions with antimalarials in cutaneous lupus and dermatomyositis: A retrospective cohort study. J Am Acad Dermatol 2019; 81:859-860. [DOI: 10.1016/j.jaad.2019.04.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 12/26/2022]
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16
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Laidler NK. Dermatomyositis as a paraneoplastic phenomenon in oesophageal cancer. BMJ Case Rep 2018; 11:11/1/e227387. [PMID: 30567206 DOI: 10.1136/bcr-2018-227387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dermatomyositis is a multisystem disease manifesting as an idiopathic inflammatory myopathy, characterised predominantly by cutaneous and muscular abnormalities. Patients with dermatomyositis display characteristic skin changes in addition to muscle weakness. Many consider dermatomyositis a paraneoplastic syndrome, as up to 32% of patients with dermatomyositis will develop cancer. Discussed here is the case of a 69-year-old man with a new diagnosis of dermatomyositis who was referred to a tertiary institution with an 8-month history of rash, proximal muscle weakness, fatigue and weight loss. In the absence of clinical symptoms, negative cancer markers and a negative CT chest, abdomen and pelvis, positron emission tomography-CT prompted a gastroscopy, which led to the discovery of a stage T1b oesophageal adenocarcinoma. The oesophageal adenocarcinoma was treated with a gastrointestinal endoscopic mucosal resection and subsequent oesophajectomy. The patient's dermatomyositis was treated successfully with oral prednisolone and methotrexate.
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Abstract
PURPOSE OF REVIEW The purpose of this review was to give an update on treatment modalities for patients with idiopathic inflammatory myopathies, or shortly myositis, excluding the subgroup inclusion body myositis, based on a literature survey on therapies used in myositis. Few controlled trials have been performed in patients with myositis; therefore, we also included a summary of open-label trials, case series, and case reports. RECENT FINDINGS Glucocorticoid (GC) in high doses is still the first-line treatment of patients with myositis. There is a general recommendation to combine GCs with another immunosuppressive agent in the early phase of disease to better control disease activity and possibly to reduce the risk for GC-related side effects. Furthermore, combining pharmacological treatment with individualized and supervised exercise can be recommended based on evidence. There is some evidence for the effect of rituximab in patients with certain myositis-specific autoantibodies, whereas other biologic agents are currently being tested in clinical trials. SUMMARY Immunosuppressive treatment in combination with exercise is recommended for patients with myositis to reduce disease activity and improve muscle performance. Subgrouping of patients into clinical and serological subtypes may be a way to identify biomarkers for response to specific immunosuppressive and biological agents and should be considered in future trials.
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Affiliation(s)
- Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Ingrid E. Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden
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18
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Lee SF, Lam YC, Mak SM, Wong FCS. Colon cancer presenting as amyotrophic dermatomyositis. Postgrad Med J 2018; 95:49-50. [PMID: 30126929 DOI: 10.1136/postgradmedj-2018-135856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/06/2018] [Accepted: 07/28/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hong Kong, China
| | - Yip Cheung Lam
- Department of Clinical Pathology, Tuen Mun Hospital, New Territories West Cluster, Hong Kong, China
| | - Siu Ming Mak
- Department of Clinical Pathology, Tuen Mun Hospital, New Territories West Cluster, Hong Kong, China
| | - Frank Chi Sing Wong
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hong Kong, China
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20
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Kishi T, Bayat N, Ward MM, Huber AM, Wu L, Mamyrova G, Targoff IN, Warren-Hicks WJ, Miller FW, Rider LG. Medications received by patients with juvenile dermatomyositis. Semin Arthritis Rheum 2018; 48:513-522. [PMID: 29773230 DOI: 10.1016/j.semarthrit.2018.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/12/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Few controlled studies are available to guide treatment decisions in juvenile dermatomyositis (JDM). This study evaluated therapies received, changes of treatment over time, and factors associated with medication choices in JDM. METHODS We performed a retrospective analysis of the number and type of therapies and duration of treatment for 320 patients with JDM enrolled in a North American registry. Kaplan-Meier and logistic regression analysis were used to assess the association of demographic and clinical features and autoantibodies with medication usage. RESULTS High-dose oral prednisone was the primary therapy given to 99% of patients. 1997 was determined to be a threshold year for increasing usage of medications other than prednisone. The median time to half the initial oral prednisone dose was shorter in patients diagnosed after vs. before 1997 (10 vs. 19 months, P < 0.01). Patients received intravenous methylprednisolone (IVMP), methotrexate, intravenous immunoglobulin, antimalarial drugs, and combination therapy more frequently when diagnosed after 1997. IVMP was frequently received by patients with severe illness onset, anti-p155/140 (anti-TIF1) and anti-MJ (anti-NXP2) autoantibodies. Treatment with methotrexate was associated with older age at diagnosis and anti-MJ autoantibodies, while antimalarial therapy was associated with anti-p155/140 autoantibodies and mild onset severity. CONCLUSION Oral prednisone has been the mainstay of therapy in JDM, and prednisone was reduced faster in patients diagnosed after 1997 when there was also an increase in other medications. Specific medications received by patients with JDM correlated with year and age at diagnosis, myositis autoantibodies, onset severity, and illness features.
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Affiliation(s)
- Takayuki Kishi
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Building 10, Rm 4-2352, MSC 1301, 10 Center Drive, Bethesda, MD 20892-1301
| | - Nastaran Bayat
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Building 10, Rm 4-2352, MSC 1301, 10 Center Drive, Bethesda, MD 20892-1301
| | - Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Adam M Huber
- Division of Rheumatology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lan Wu
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Building 10, Rm 4-2352, MSC 1301, 10 Center Drive, Bethesda, MD 20892-1301
| | - Gulnara Mamyrova
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine, Washington, DC
| | - Ira N Targoff
- VA Medical Center, University of Oklahoma Health Sciences Center, and Oklahoma Medical Research Foundation, Oklahoma City, OK
| | | | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Building 10, Rm 4-2352, MSC 1301, 10 Center Drive, Bethesda, MD 20892-1301
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Building 10, Rm 4-2352, MSC 1301, 10 Center Drive, Bethesda, MD 20892-1301.
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22
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How I treat idiopathic patients with inflammatory myopathies in the clinical practice. Autoimmun Rev 2017; 16:999-1007. [DOI: 10.1016/j.autrev.2017.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/14/2017] [Indexed: 12/21/2022]
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23
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Hair and Nail Manifestations of Systemic Disease. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Affiliation(s)
- Sundeep Shenoy
- Inpatient Medicine, University of Arizona, Tucson, Ariz.
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25
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Udkoff J, Cohen PR. Amyopathic Dermatomyositis: A Concise Review of Clinical Manifestations and Associated Malignancies. Am J Clin Dermatol 2016; 17:509-518. [PMID: 27256496 DOI: 10.1007/s40257-016-0199-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Amyopathic dermatomyositis is a rare, idiopathic, connective tissue disease that presents with dermatologic lesions of classic dermatomyositis but lacks the myopathy of this disease. Cutaneous manifestations may include Gottron's sign, heliotrope rash, and characteristic patterns of poikiloderma. There is a substantial risk for developing interstitial lung disease or malignancy in patients with amyopathic dermatomyositis. A literature review of amyopathic dermatomyositis was performed using the PubMed medical database. The key features of amyopathic dermatomyositis, including autoantibodies, clinical presentation and dermatologic manifestations, epidemiology, history, associated malignancies, management, and pathogenesis, are summarized in this review. Cancer (solid tumor) (73/79, 89 %) and hematologic malignancies (9/79, 11 %) were reported in 79 patients, with three patients having more than one malignancy. In addition, there were six patients with amyopathic dermatomyositis who had tumor of unknown primary, and eight patients with cancer-associated amyopathic dermatomyositis for whom no additional details were provided. From the group of 73 tumors for whom primary origin and sex were available, malignancy of the genitourinary organs (24/73, 33 %), aerorespiratory organs (15/73, 21 %), and breast (14/73, 19 %) were the most commonly observed solid organ tumors. Tumors of the genitourinary organs (15/48, 31 %) and breast (14/48, 29 %) were the most frequent neoplasms in women, accounting for 29 of 48 (60 %) cancers, with the most common sites being breast (14/48, 29 %), ovary (8/48, 17 %), and cervix or uterus (5/48, 10 %). In men, tumors of the aerorespiratory (9/25, 36 %) and genitourinary (9/25, 36 %) tracts were the most common neoplasms, accounting for 72 % (18/25) of cancers; the most common sites of primary malignancy were nasopharyngeal (6/25, 24 %), bladder (4/25, 16 %), and either colorectal, lung or prostate cancer (three cancers each, 12 %). In summary, the search for an undiagnosed associated malignancy in patients with amyopathic dermatomyositis should focus towards the organs most frequently affected. Similar to classic dermatomyositis, ovarian and nasopharyngeal cancers are also common in amyopathic dermatomyositis. However, in contrast to lung cancer, which is the most frequent malignancy associated with classic dermatomyositis, breast cancer was the most common type of malignancy reported in patients with amyopathic dermatomyosotis.
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Affiliation(s)
- Jeremy Udkoff
- Medical School, University of California San Diego, San Diego, CA, 92093, USA
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, 10991 Twinleaf Court, San Diego, CA, 92131, USA.
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Abstract
Treatment of skin manifestations in systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and dermatomyositis (DM) is based on the results of only few randomized controlled trials. The first-line treatment for disfiguring and widespread cutaneous involvement in SLE is antimalarials, but some patients are therapy resistant. Recently, the monoclonal antibody belimumab was approved for SLE as an adjunct therapy for patients with autoantibody-positive disease who despite standard therapy show high disease activity, intolerance of other treatments, or an unacceptably high need for corticosteroids. However, a validated skin score has not been used to confirm the efficacy of belimumab on mucocutaneous manifestations. In SSc, another multi-systemic progressive disease, involvement of the lung, kidney, and the heart is frequently treated with corticosteroids and immunosuppressives, but therapeutic modalities for cutaneous lesions, such as skin sclerosis and digital ulcers, are limited. In the past years, treatment with the endothelin-receptor antagonist bosentan has been proven to reduce the occurrence of new digital ulcers in SSc patients but has no or limited effect on healing of digital ulcers. DM is an idiopathic autoimmune disease characterized by inflammation of the muscles and skin, which is treated with immunosuppressives. Corticosteroids are the first-line treatment for muscle involvement in DM, but skin lesions often flare by reduction or discontinuation. In summary, there is a high unmet need for new therapeutic strategies focusing on skin involvement in systemic autoimmune diseases. Therefore, innovative designs of randomized controlled trials with validated skin scores are warranted to develop new therapeutic strategies for patients with cutaneous manifestations.
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Cho HG, Fiorentino D, Lewis M, Sirota M, Sarin KY. Identification of Alpha-Adrenergic Agonists as Potential Therapeutic Agents for Dermatomyositis through Drug-Repurposing Using Public Expression Datasets. J Invest Dermatol 2016; 136:1517-1520. [PMID: 26975725 DOI: 10.1016/j.jid.2016.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/23/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Hyunje Grace Cho
- School of Medicine, Stanford University, Stanford, California, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Matthew Lewis
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Marina Sirota
- Institute for Computational Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.
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28
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Abstract
The skin is often the herald of an underlying systemic illness, and gastrointestinal malignancies can present in numerous ways in the skin. Paraneoplastic phenomenon, such as acanthosis nigricans and tripe palm, may be the first indicator of a gastrointestinal malignancy. In addition, gastrointestinal cancers can metastasize to the skin, as described in the well-known Sister Mary Joseph's nodule. Inflammatory systemic conditions such as dermatomyositis and multicentric reticulohistiocytosis can be associated with underlying malignancy. Finally, in numerous genetic syndromes with underlying malignancies, such as Muir-Torre, recognition of the skin signs leads to early diagnosis and screening.
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29
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Wright NA, Vleugels RA, Callen JP. Cutaneous dermatomyositis in the era of biologicals. Semin Immunopathol 2015; 38:113-21. [DOI: 10.1007/s00281-015-0543-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/02/2015] [Indexed: 12/14/2022]
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Abstract
Idiopathic inflammatory myopathies (IIMs) involve inflammation of the muscles and are classified by the patterns of presentation and immunohistopathologic features on skin and muscle biopsy into 4 categories: dermatomyositis, polymyositis, inclusion body myositis, and immune-mediated necrotizing myopathy. Systemic corticosteroid (CS) treatment is the standard of care for IIM with muscle and organ involvement. The extracutaneous features of systemic sclerosis are frequently treated with CS; however, high doses have been associated with scleroderma renal crisis in high-risk patients. Although CS can be effective first-line agents, their significant side effect profile encourages concomitant treatment with other immunosuppressive medications to enable timely tapering.
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Affiliation(s)
- Anna Postolova
- Division of Rheumatology and Immunology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Jennifer K Chen
- Department of Dermatology, Stanford Hospital and Clinics, 450 Broadway Street, Pavilion C, Suite 242, Redwood City, CA 94063, USA
| | - Lorinda Chung
- Division of Rheumatology and Immunology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA; Division of Rheumatology, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
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31
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Lim EH, Lim SK, Im M, Seo YJ, Lee JH, Lee Y. Mycosis Fungoides Diagnosed with an Initial Sign Resembling Benign Dermatosis on the Upper Eyelids. Ann Dermatol 2015; 27:469-71. [PMID: 26273174 PMCID: PMC4530168 DOI: 10.5021/ad.2015.27.4.469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/04/2014] [Accepted: 09/11/2014] [Indexed: 12/24/2022] Open
Affiliation(s)
- Eun-Hwa Lim
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seul-Ki Lim
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Myung Im
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young-Joon Seo
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeung-Hoon Lee
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young Lee
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
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Hornung T, Wenzel J. Innate immune-response mechanisms in dermatomyositis: an update on pathogenesis, diagnosis and treatment. Drugs 2015; 74:981-98. [PMID: 24939511 DOI: 10.1007/s40265-014-0240-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dermatomyositis (DM) is an autoimmune disease mainly affecting muscle and skin. Typical clinical and laboratory findings include muscle weakness with elevated muscle enzymes, characteristic skin lesions (e.g., Gottron papules, heliotrope erythema, Shawl sign), and specific serum autoantibodies. Recent studies have highlighted the activation of the innate immune system, including high expression of interferons (IFNs) and IFN-regulated proteins, as an important pathological hallmark of DM. These findings have changed our understanding of the disease fundamentally, since inappropriate activation of the innate immune system with secondary dysregulation of the adaptive immune response is now considered to be a central pathogenetic feature of DM. In this article, we review current guidelines and standards in diagnosis and treatment. We detail evidence-based and pathophysiology-based treatment strategies, with a focus on skin as well as on muscle lesions. Particularly, we discuss how the recent advances in the understanding of the pathomechanisms of DM have altered our conception of the mode of action of established drugs such as chloroquine and methotrexate. Finally, we outline possible future treatment strategies, with a focus on the innate immune system, e.g., targeting the IFN system with the anti-IFN-α antibody sifalimumab.
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Affiliation(s)
- Thorsten Hornung
- Department of Dermatology, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
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Abstract
A 25-year-old woman with dermatomyositis suffered a right central retinal vein occlusion (CRVO) with visual acuity of 20/40. Examination of the right eye showed vitreous cells, suggesting inflammation of the central retinal vein leading to a CRVO as the presumed mechanism. She was admitted to hospital, and extensive evaluation was negative. She was maintained on corticosteroids to manage her dermatomyositis. One month later, she had macular edema and elevated intraocular pressure. Both resolved with dorzolamide, timolol, and intravitreal bevacizumab, and vision returned to 20/20 in the right eye.
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Umanoff N, Fisher A, Carlson JA. Wong-Type Dermatomyositis Showing Porokeratosis-Like Changes (Columnar Dyskeratosis): A Case Report and Review of the Literature. Dermatopathology (Basel) 2015; 2:1-8. [PMID: 27047930 PMCID: PMC4816430 DOI: 10.1159/000371573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Wong-type dermatomyositis (DM) exhibits simultaneous pityriasis rubra pilaris (PRP) features. Case Report A 50-year-old woman presented with a heliotrope rash, Gottron's papules, and a poikilodermic, erythematous rash in shawl distribution without evidence of muscle weakness. Despite topical corticosteroids, the eruption progressed 9 months later to include generalized hyperkeratotic follicular papules, islands of sparing, and atrophic macules with a collarette of scale suggestive of porokeratosis. Mild dysphonia was the only sign of muscle weakness. Serology showed positive ANA. Histopathology revealed interface dermatitis with dermal mucin and melanophages, irregular psoriasiform hyperplasia, alternating mounds of para- and orthokeratosis, and tiers of dyskeratotic cells (columnar dyskeratosis). Systemic corticosteroid therapy was not tolerated; acitretin diminished the hyperkeratosis. While hyperpigmentation persisted, no progression of cutaneous or muscular symptoms has occurred after 22 months of follow-up and cessation of the therapy. Overall, her course did not differ from the natural history documented in the literature review of Wong-type DM. The most similar case also exhibited pseudocornoid lamella changes. Conclusion Wong-type DM is a clinicopathologic DM-PRP hybrid that can also exhibit porokeratosis-like features best described as columnar dyskeratosis. Recognizing these types of lesions in DM is warranted in order to make an accurate assessment of their prognostic significance.
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Affiliation(s)
- Nicole Umanoff
- Divisions of Dermatology and Dermatopathology, Department of Pathology, Albany Medical College, Albany, N.Y., USA
| | | | - J Andrew Carlson
- Divisions of Dermatology and Dermatopathology, Department of Pathology, Albany Medical College, Albany, N.Y., USA
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Abstract
A variety of neurologic diseases have cutaneous manifestations. These may precede, coincide with, or follow the neurologic findings. An array of autoimmune, genetic, and environmental factors play a role in expression and severity of the neurologic burden in these conditions. This chapter emphasizes congenital and genetic disorders, but we also discuss the pathophysiology and manifestation of various acquired neurocutaneous disorders with an emphasis Behcet's disease, dermatomyositis, Sjögren's syndrome, systemic lupus erythematosus, scleroderma, Parry-Romberg syndrome and Degos disease.
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Affiliation(s)
- Amre Nouh
- Department of Neurology, Hartford Hospital - University of Connecticut, Hartford CT, USA
| | - Jodi Speiser
- Section of Dermatopathology, Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
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Ruhlman D, Otten C, Colella C. Dermatomyositis. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2014.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bresciani F, Zagnoli L, Fracassi F, Bianchi E, Cantile C, Abramo F, Pietra M. Dermatomyositis-like disease in a Rottweiler. Vet Dermatol 2014; 25:229-e62. [DOI: 10.1111/vde.12128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Francesca Bresciani
- Department of Veterinary Medical Sciences; University of Bologna; Via Tolara di Sopra 50 40064 Ozzano dell'Emilia (BO) Italy
| | - Laura Zagnoli
- Department of Veterinary Medical Sciences; University of Bologna; Via Tolara di Sopra 50 40064 Ozzano dell'Emilia (BO) Italy
| | - Federico Fracassi
- Department of Veterinary Medical Sciences; University of Bologna; Via Tolara di Sopra 50 40064 Ozzano dell'Emilia (BO) Italy
| | - Ezio Bianchi
- Department of Veterinary Medical Sciences; University of Parma; Via del Taglio 8 43126 Parma Italy
| | - Carlo Cantile
- Department of Veterinary Sciences; University of Pisa; Viale delle Piagge 2 56124 Pisa Italy
| | - Francesca Abramo
- Department of Veterinary Sciences; University of Pisa; Viale delle Piagge 2 56124 Pisa Italy
| | - Marco Pietra
- Department of Veterinary Medical Sciences; University of Bologna; Via Tolara di Sopra 50 40064 Ozzano dell'Emilia (BO) Italy
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Femia A, Vleugels RA. Pediatric Autoimmune Connective Tissue Diseases: An Update on Disease Characteristics, Associations, and Management. CURRENT DERMATOLOGY REPORTS 2013. [DOI: 10.1007/s13671-013-0058-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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