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Liang J, Wan L, Yao Y, Cui X, He Y, Li S, Jiang M, Sun Y, Cao H, Lin J. An externally validated clinical-laboratory nomogram for myocardial involvement in adult idiopathic-inflammatory-myopathy patients. Clin Rheumatol 2024; 43:1959-1969. [PMID: 38587715 PMCID: PMC11111495 DOI: 10.1007/s10067-024-06948-x] [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: 05/12/2023] [Revised: 01/09/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES This study aimed at identifying clinical and laboratory risk factors for myocardial involvement (MI) in idiopathic inflammatory myopathies (IIMs) patients as well as constructing a risk-predicted nomogram for prediction and early identification of MI. METHODS An IIMs cohort in southeastern China was constructed, including 504 adult IIMs patients who met the inclusion and exclusion criteria, and were hospitalized at four divisions of the First Affiliated Hospital, Zhejiang University School of Medicine from January 1st 2018 to April 30st 2022. After dividing patients into the training cohort and the validation cohort, risk factors for MI were identified through least absolute shrinkage and selection operator regression and multivariate logistic regression. A risk-predicted nomogram was established and validated internally and externally for discrimination, calibration and practicability. RESULTS In this cohort, 17.7% of patients developed MI and the survival was significantly inferior to that of IIMs patients without MI (P < 0.001). In the training cohort, age > 55 years old (P < 0.001), disease activity > 10 points (P < 0.001), interleukin-17A (IL-17A) > 7.5 pg/ml (P < 0.001), lactic dehydrogenase (LDH) > 425 U/L (P < 0.001), anti-mitochondrial antibodies (AMAs, P = 0.017), and anti-MDA5 antibody (P = 0.037) were significantly correlated with development of MI. A nomogram was established by including the above values to predict MI and was found efficient in discrimination, calibration, and practicability through internal and external validation. CONCLUSION This study developed and validated a nomogram model to predict the risk of MI in adult IIMs patients, which can benefit the prediction and early identification of MI as well as timely intervention in these patients.
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Affiliation(s)
- Junyu Liang
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Liyan Wan
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Yake Yao
- Department of Respiratory Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Cui
- Department of Cardiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ye He
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Shuangshuang Li
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Mengdi Jiang
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Yiduo Sun
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Heng Cao
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China.
| | - Jin Lin
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China.
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Dong J, Meng X, Xu H, Yang H, Yang J, Zhou J, Zhao L. Cluster analysis of clinical phenotypes in idiopathic inflammatory myopathy patients complicated with cardiac involvement. Clin Rheumatol 2024:10.1007/s10067-024-06986-5. [PMID: 38761246 DOI: 10.1007/s10067-024-06986-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/14/2024] [Accepted: 04/25/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE This study aimed to classify idiopathic inflammatory myopathy (IIM) patients with cardiac involvement (IIM-CI) into different categories based on their clinical phenotypes via cluster analysis and to explore their differences in outcomes. METHODS IIM-CI patients admitted to Peking Union Medical College Hospital from January 2015 to June 2021 were retrieved. The clinical data, laboratory examinations, and treatment were retrospectively reviewed, and the outcome was traced. A second-order clustering method was employed for categorization. RESULTS A total of 88 IIM-CI patients were enrolled in this study and were classified into two categories through cluster analysis. Category I consisted of patients who exhibited distinct cardiac structural and functional changes, such as enlargement of atriums and/or ventricles, along with the remarkable heart insufficiency biomarkers, whereas patients of category II displayed more widely systemic injuries and intensive skeletal muscle weakness. In comparison, pulmonary hypertension (58.8% vs 16.7%, p < 0.01), arrhythmia (82.4% vs 27.8%, p < 0.01), and positive serum anti-mitochondrial-M2 antibody (52.9% vs 5.6%, p < 0.01) were more prevalent in category I than in category II, and serum N-terminal pro-B-type natriuretic peptide levels (1703.5 pg/L vs 364.0 pg/L, p = 0.02) were significantly elevated in category I, whereas skeletal muscle weakness (50.0% vs 74.1%, p = 0.02), interstitial lung disease (20.6% vs 63.0%, p < 0.01), skin rash (11.8% vs 48.1%, p < 0.01), arthralgia (2.9% vs 27.8%, p < 0.01), fever (2.9% vs 27.8%, p < 0.01), and dysphagia (2.9% vs 22.2%, p < 0.01) were more common in category II patients. Heart failure was the primary cause of death in category I, but severe pneumonia was predominantly responsible for deaths in category II. CONCLUSION Two categories of IIM-CI were identified based on clinical features with distinctive characteristics. Two categories exhibited differences in clinical manifestations, autoantibody profiles, and the primary cause of death.
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Affiliation(s)
- Jianling Dong
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
- Department of Rheumatology, Mianyang Central Hospital, Mianyang, 621000, China
| | - Xia Meng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Haojie Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Huaxia Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Jing Yang
- Department of Rheumatology, Mianyang Central Hospital, Mianyang, 621000, China
| | - Jiaxin Zhou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China.
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China.
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China.
| | - Lidan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China.
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China.
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China.
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Suzuki K, Akiyama M, Saito S, Kaneko Y. Successful high-dose glucocorticoid therapy for anti-mitochondrial antibody-positive myocarditis arising during tocilizumab and low-dose glucocorticoid therapy for rheumatoid arthritis. Immunol Med 2024:1-5. [PMID: 38578159 DOI: 10.1080/25785826.2024.2336689] [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: 02/05/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
Anti-mitochondrial antibody (AMA)-positive myopathy, a recently identified condition with significant cardiac involvement, poses a serious challenge in treatment consensus due to its extreme rarity. While several studies demonstrate the efficacy of high-dose prednisolone in managing this disease, the current literature lacks substantial evidence regarding the effectiveness of biologic therapy or low-dose prednisolone for remission induction. Here, we present a case of AMA-positive myocarditis that emerged during rheumatoid arthritis treatment with tocilizumab (TCZ) and low-dose prednisolone (PSL). Successfully, intensive immunosuppressive therapy with high-dose PSL proved effective in stabilizing this condition. Our case highlights the necessity of a robust immunosuppressive approach, favoring high-dose PSL over the combination of low-dose PSL and TCZ in this disease.
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Affiliation(s)
- Koji Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Akiyama
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuntaro Saito
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Zhang L, Peng L, Zhou S, Wu C, Wang Q, Li M. Comment on: The diagnostic value of sST2 for myocardial fibrosis in idiopathic inflammatory myopathies in subclinical stage of cardiac involvement. Rheumatology (Oxford) 2024; 63:e136-e137. [PMID: 37995290 DOI: 10.1093/rheumatology/kead580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/04/2023] [Indexed: 11/25/2023] Open
Affiliation(s)
- Lixi Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Liying Peng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Shuang Zhou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Chanyuan Wu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Chen Y, Zhang W, Lv H, Wang Z, Hao H, Yuan Y, Zheng Y. Pathological findings with vacuoles in anti-mitochondrial antibody-positive inflammatory myopathy. BMC Musculoskelet Disord 2024; 25:257. [PMID: 38566087 PMCID: PMC10985968 DOI: 10.1186/s12891-023-06941-6] [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: 02/28/2023] [Accepted: 10/06/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND A few patients with inflammatory myopathy showed anti-mitochondrial antibody (AMA) positivity. This study aimed to report the clinical and pathological findings with vacuoles in 3 cases of such patients. METHODS Three cases with myositis from the Myositis Clinical Database of Peking University First Hospital were identified with AMA positivity. Their clinical records were retrospectively reviewed and the data was extracted. All the 3 cases underwent muscle biopsy. RESULTS Three middle-aged patients presented with chronic-onset weakness of proximal limbs, marked elevation of creatine kinase, and AMA-positivity. Two of the 3 cases meet the criteria of primary biliary cholangitis. All the 3 cases presented with cardiac involvement and proteinuria. Two cases developed type 2 respiratory failure. MRI of the thigh muscle showed multiple patches of edema bilaterally in both cases, mostly in the adductor magnus. Pathological findings include degeneration of muscle fibers, diffused MHC-I positivity, and complement deposits on cell membranes. Vacuoles without rims of different sizes were discovered under the membrane of the muscle fibers. A few RBFs were discovered in case 1, while a diffused proliferation of endomysium and perimysium was shown in case 2. CONCLUSIONS AMA-positive inflammatory myopathy is a disease that could affect multiple systems. Apart from inflammatory changes, the pathological findings of muscle can also present vacuoles.
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Affiliation(s)
- Yuanchong Chen
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Department of Radiology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - He Lv
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Hongjun Hao
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yiming Zheng
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Wang Y, Huang Z, Lei J, Lu X, Li S, Wang G, Xie S, Zhang L. Fatty infiltration in the posterior muscles of the lower extremities as an MRI feature in antimitochondrial antibody-associated myopathy. Clin Rheumatol 2024; 43:1127-1133. [PMID: 38285373 DOI: 10.1007/s10067-024-06877-9] [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: 05/03/2023] [Revised: 12/05/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Idiopathic inflammatory myopathy (IIM) with antimitochondrial M2 antibody (AMA-M2) has been associated with distinct clinical characteristics. In this study, we explore the magnetic resonance imaging (MRI) findings of the muscles of the lower extremities in AMA-M2-positive IIM to gain more insight. METHODS MRI of 22 lower extremity muscles was retrospectively evaluated in 14 patients with AMA-M2-positive IIM and 37 age- and sex-matched patients with AMA-M2-negative IIM. Muscles with inflammatory edema and fatty infiltration were assessed according to the Stramare and Mercuri criteria. RESULTS Patients with AMA-M2-positive IIM had significantly higher incidence of MRI involvement with fatty infiltration in five lower extremity muscles, namely the adductor magnus (AM) (13/14 VS 14/37, p < 0.001), semimembranosus (SM) (13/14 VS 17/37, p = 0.002), biceps femoris (BF) (12/14 VS 15/37, p = 0.004), soleus (13/14 VS 23/37, p = 0.041), and the medial head of the gastrocnemius (Gastroc M) (13/14 VS 17/37, p = 0.002) than patients with AMA-M2-negative IIM. Furthermore, the severity scores of fatty infiltrations of the above five muscles in AMA-M2-positive IIM were significantly higher than those in patients with AMA-M2-negative IIM (p < 0.001). CONCLUSIONS Severe fatty infiltrations of the AM, SM, BF, soleus, and Gastroc M in the posterior muscles of the lower extremities are dominant MRI features in our patients with AMA-M2-positive IIM. This unique muscle MRI character may be a helpful indicator in clinical practice for patients with AMA-M2-positive IIM. Key Points • Striking involvement and prominent fatty infiltrations of five lower extremity muscles (adductor magnus, semimembranosus, biceps femoris, soleus, and the medial head of the gastrocnemius) are interesting MRI performances. • Severe fatty infiltrations in the posterior muscles of the lower extremities are dominant MRI features in AMA-M2-positive IIM. • This unique muscle MRI character may be very helpful for the diagnosis of the AMA-M2-positive IIM.
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Affiliation(s)
- Yuli Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zhenguo Huang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jieping Lei
- Department of Clinical Research and Data Management, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xin Lu
- Department of Rheumatology, China-Japan Friendship Hospital, 2 Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Sizhao Li
- Department of Rheumatology, China-Japan Friendship Hospital, 2 Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, 2 Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Lu Zhang
- Department of Rheumatology, China-Japan Friendship Hospital, 2 Yinghua Road, Chaoyang District, Beijing, 100029, China.
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Tanaka R, Ota S, Taniguchi M, Koh J, Ito H, Murata S, Tanaka A. Recovery of cardiac metabolic function after high-dose prednisolone in a patient with inflammatory myopathy associated with anti-mitochondrial antibody. J Cardiol Cases 2024; 29:85-88. [PMID: 38362584 PMCID: PMC10865124 DOI: 10.1016/j.jccase.2023.10.014] [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: 08/29/2023] [Revised: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 02/17/2024] Open
Abstract
Myocardial complications in the setting of inflammatory myopathy associated with anti-mitochondrial antibody (AMA) cause various cardiovascular complications. A 64-year-old Japanese man was diagnosed with inflammatory myopathy associated with AMA, and three years after diagnosis, the patient was referred to our hospital with leg edema and dyspnea on exertion. Right ventricular endomyocardial biopsy showed no disease-specific findings, with neither inflammatory cell infiltration nor non-caseating epithelioid cell granuloma, and only mild fibrosis; therefore, we finally diagnosed this patient with cardiac involvement in inflammatory myopathy associated with AMA. 123I-β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) cardiac scintigraphy showed decreased uptake in wider areas discordant with late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR). One month after starting prednisolone (PSL), the symptoms of congestive heart failure and left ventricular (LV) systolic function had improved. Additionally, BMIPP uptake in the LV myocardium significantly improved compared to that before PSL administration, although decreased BMIPP uptake remained in areas concordant with LGE on CMR. Moreover, it is suggested that recovery of cardiac metabolic function after high-dose PSL administration, which was confirmed through improvement in BMIPP uptake in the LV myocardium, may have led to the improvement in both LV systolic function and heart failure. Learning objective Although the definitive diagnosis of cardiac involvement in inflammatory myopathy associated with anti-mitochondrial antibody is difficult because of the rarity of this condition and no disease-specific findings in imaging and histology, physicians should consider this in patients with cardiac dysfunction and muscle weakness. 123I-β-methyl-p-iodophenyl-pentadecanoic acid scintigraphy should be used to assess cardiac metabolic function and treatment efficacy and should be considered for patient management.
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Affiliation(s)
- Rikuya Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mana Taniguchi
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - Jinsoo Koh
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - Hidefumi Ito
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - Shinichi Murata
- Department of Human Pathology and Diagnostic Pathology, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Wang H, Zhu Y, Hu J, Jin J, Lu J, Shen C, Cai Z. Associations between anti-mitochondrial antibodies and cardiac involvement in idiopathic inflammatory myopathy patients : A systematic review and meta-analysis. Z Rheumatol 2024; 83:214-221. [PMID: 35575829 DOI: 10.1007/s00393-022-01216-2] [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] [Accepted: 04/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objectives of this study are to analyze the association between anti-mitochondrial antibody (AMA) and cardiac involvement in idiopathic inflammatory myopathy (IIM) and to evaluate the diagnostic value of AMA for cardiac involvement in IIM patients. METHODS We conducted a comprehensive search in PubMed, Web of Science, EMBASE, and the Cochrane Library to identify English-language studies published before November 19, 2021. Stata 12.0 software (Stata Corp., College Station, TX, USA) was used for the statistical analyses. We used the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and summary receiver operating characteristic (SROC) curve to evaluate the diagnostic value of AMA for cardiac involvement in IIM patients. Statistical heterogeneity of studies was assessed using the I2 statistic with 95% confidence intervals (95% CIs). RESULTS Seven studies were included in the final analyses, with a total of 2308 IIM patients (including 171 AMA-positive and 2137 AMA-negative patients). The pooled sensitivity of AMA for cardiac involvement in IIM patients was 0.29 (95% CI: 0.19-0.43) and specificity was 0.92 (95% CI: 0.88-0.96). The pooled PLR was 3.9 (95% CI: 2.82-5.38), NLR was 0.76 (95% CI: 0.66-0.88), and the diagnostic odds ratio (DOR) was 5 (95% CI: 3-7). The area under the SROC curve was 0.76 (95% CI: 0.72-0.79). CONCLUSION The overall diagnostic value of AMA may not be very high for cardiac involvement in IIM patients.
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Affiliation(s)
- Hui Wang
- Department of Hangzhou Third People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuan Zhu
- Department of Hangzhou Third People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jingjing Hu
- Department of Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, Zhejiang, China
| | - Jieni Jin
- Department of Hangzhou Third People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jun Lu
- Department of Hangzhou Third People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Cong Shen
- Department of Hangzhou Third People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhaobin Cai
- Department of Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, Zhejiang, China.
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Ishizuka K, Ohira Y. Antimitochondrial Antibody-Positive Myositis. Am J Med 2024; 137:e38-e39. [PMID: 37871730 DOI: 10.1016/j.amjmed.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan.
| | - Yoshiyuki Ohira
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Tsuzuki Wada T, Yokota K, Inayoshi F, Sakai S, Okumura N, Matsuda M, Osawa I, Araki Y, Funakubo Asanuma Y, Akiyama Y, Mimura T. New-onset Immune-mediated Necrotizing Myopathy and Trigeminal Neuropathy after SARS-CoV-2 mRNA Vaccination in a Patient with Rheumatoid Arthritis and Sjögren's Syndrome. Intern Med 2023; 62:3699-3706. [PMID: 37839879 PMCID: PMC10781545 DOI: 10.2169/internalmedicine.2551-23] [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: 06/30/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
We present the case of a 42-year-old woman with rheumatoid arthritis and Sjögren's syndrome treated with adalimumab who developed immune-mediated necrotizing myopathy (IMNM) and trigeminal neuropathy after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccination. Trigeminal neuralgia and elevated serum creatine kinase levels emerged 12 days post-vaccination, followed by myalgia in the femoral muscles. IMNM was histologically diagnosed. The pathogenesis may involve molecular mimicry between the SARS-CoV-2 spike glycoprotein and autologous tissues triggered by vaccination. This case emphasizes the association between SARS-CoV-2 vaccination, tumor necrosis factor inhibitor, IMNM, and trigeminal neuropathy, as well as the importance of monitoring immune-mediated adverse events following SARS-CoV-2 vaccination in patients with autoimmune disease.
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Affiliation(s)
- Takuma Tsuzuki Wada
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Kazuhiro Yokota
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Fumito Inayoshi
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Sakon Sakai
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Nobuhito Okumura
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Mayumi Matsuda
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Iichiro Osawa
- Department of Radiology, Saitama Medical University Hospital, Japan
| | - Yasuto Araki
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Yu Funakubo Asanuma
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Yuji Akiyama
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Toshihide Mimura
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
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11
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Wang Y, Zhao Y, Yu M, Wei L, Zhang W, Wang Z, Yuan Y. Clinicopathological and circulating cell-free DNA profile in myositis associated with anti-mitochondrial antibody. Ann Clin Transl Neurol 2023; 10:2127-2138. [PMID: 37723899 PMCID: PMC10647000 DOI: 10.1002/acn3.51901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE Anti-mitochondrial antibodies (AMAs) are associated with idiopathic inflammatory myopathies (IIMs). We aimed to summarize the clinicopathological characteristics, assess circulating cell-free mitochondrial DNA (ccf-mtDNA), and circulating cell-free nuclear DNA (ccf-nDNA) in AMA-associated IIMs. METHODS Medical records of 37 IIMs patients with AMAs were reviewed. Circulating cell-free mtDNA and ccf-nDNA levels in sera from IIMs patients with AMAs (n = 21), disease controls (n = 66) and healthy controls (HCs) (n = 23) were measured and compared. Twenty-eight immune-mediated necrotizing myopathy (IMNM) patients, 23 dermatomyositis (DM) patients, and 15 anti-synthetase syndrome (ASS) patients were enrolled as disease controls. Correlations between variables were analyzed. RESULTS Limb weakness was observed in 75.7% and neck weakness in 56.8% of patients. Cardiac involvement occurred in 51.4% of patients. Muscle pathology revealed 81.1% of IMNM, 5.4% polymyositis, and 13.5% nonspecific myositis. Microinfarction was observed in 8.1% of patients. Serum ccf-mtDNA levels in AMA-associated IIMs were significantly higher than those in HCs (p < 0.001), but no significant differences between AMA-associated IIMs and IMNM, DM, or ASS. Serum ccf-nDNA levels in AMA-associated IIMs were significantly higher than those in HCs (p = 0.02), and significantly lower than those in DM (p = 0.02). Serum ccf-nDNA levels correlated negatively with MMT8 total scores (rs = -0.458, p = 0.037) and positively with mRS scores (rs = 0.486, p = 0.025). Serum ccf-nDNA levels were significantly higher in the non-remission group (p < 0.01). INTERPRETATION AMA-associated IIMs exhibit distinct clinicopathological features. Serum ccf-nDNA may serve as a potential marker for disease severity and prognosis in AMA-associated IIMs.
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Affiliation(s)
- Yikang Wang
- Department of NeurologyPeking University First HospitalBeijing100034China
| | - Yawen Zhao
- Department of NeurologyPeking University First HospitalBeijing100034China
| | - Meng Yu
- Department of NeurologyPeking University First HospitalBeijing100034China
| | - Luhua Wei
- Department of NeurologyPeking University First HospitalBeijing100034China
| | - Wei Zhang
- Department of NeurologyPeking University First HospitalBeijing100034China
- Beijing Key Laboratory of Neurovascular Disease DiscoveryBeijing100034China
| | - Zhaoxia Wang
- Department of NeurologyPeking University First HospitalBeijing100034China
- Beijing Key Laboratory of Neurovascular Disease DiscoveryBeijing100034China
- Key Laboratory for Neuroscience, National Health Commission of the People's Republic of ChinaPeking UniversityBeijing100083China
| | - Yun Yuan
- Department of NeurologyPeking University First HospitalBeijing100034China
- Beijing Key Laboratory of Neurovascular Disease DiscoveryBeijing100034China
- Key Laboratory for Neuroscience, National Health Commission of the People's Republic of ChinaPeking UniversityBeijing100083China
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Shah M, Shinjo SK, Day J, Gupta L. Cardiovascular manifestations in idiopathic inflammatory myopathies. Clin Rheumatol 2023; 42:2557-2575. [PMID: 37148365 PMCID: PMC10497702 DOI: 10.1007/s10067-023-06599-4] [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] [Received: 03/17/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 05/08/2023]
Abstract
Cardiovascular involvement in idiopathic inflammatory myopathies (IIM) is an understudied area which is gaining increasing recognition in recent times. Recent advances in imaging modalities and biomarkers have allowed the detection of subclinical cardiovascular manifestations in IIM. However, despite the availability of these tools, the diagnostic challenges and underestimated prevalence of cardiovascular involvement in these patients remain significant. Notably, cardiovascular involvement remains one of the leading causes of mortality in patients with IIM. In this narrative literature review, we outline the prevalence and characteristics of cardiovascular involvement in IIM. Additionally, we explore investigational modalities for early detection of cardiovascular involvement, as well as newer approaches in screening to facilitate timely management. Key points • Cardiac involvement in IIM in majority cases is subclinical and a major cause of mortality. • Cardiac magnetic resonance imaging is sensitive for detection of subclinical cardiac involvement.
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Affiliation(s)
- Meera Shah
- Department of Rheumatology, Indraprastha Apollo Hospital, New Delhi, Delhi, 110076, India
| | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK.
- Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK.
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Shi Y, Zhang H, Qiu Z, Chen Y, Su X, Chi H, Feng T, Sun Y, Liu H, Cheng X, Ye J, Shi H, Hu Q, Zhou Z, Meng J, Teng J, Yang C, Su Y, Jin W. Value of the HFA-PEFF diagnostic algorithms for heart failure with preserved ejection fraction to the inflammatory myopathy population. Arthritis Res Ther 2023; 25:141. [PMID: 37542301 PMCID: PMC10401815 DOI: 10.1186/s13075-023-03131-6] [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] [Received: 06/07/2023] [Accepted: 07/29/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES The HFA-PEFF score has been validated to hold great diagnostic and prognostic utility for heart failure with preserved ejection fraction (HFpEF). Idiopathic inflammatory myopathy (IIM) is recognized as one of the potential etiologies underlying HFpEF. Here, we intended to investigate the real prevalence of HFpEF in IIM via the HFA-PEFF score and explore the prognostic value of this score. METHODS Two hundred twenty IIM patients were enrolled for assessment. The cohort was divided into low, intermediate and high tertiles of the HFA-PEFF score. Spearman's correlation analysis was used to explore the association between the score and disease activity. Chi-square test was applied to investigate the distribution discrepancy of HFA-PEFF tertiles among patients with different myositis-specific antibodies (MSAs) or myositis-associated antibodies (MAAs). Univariate and multivariate ordinal regression analyses were performed to screen risk factors for high HFA-PEFF scores. Survival curves were obtained using the Kaplan-Meier method and log-rank tests. RESULTS In total, 79 (35.9%), 107 (48.6%) and 34 (15.5%) patients were rated low, intermediate and high probability of HFpEF, respectively. The HFA-PEFF score correlated well with disease activity. Patients with positive AMA-M2 scored higher in the HFA-PEFF score (p = 0.011). During follow-up, patients with positive AMA-M2 or anti-SRP antibody developed an inclination towards concentric hypertrophy on echocardiography. Additionally, palpitation symptom, AMA-M2 positivity and elevated serum levels of LDH, cTnI were independent risk factors for high HFA-PEFF scores. Finally, a high-tertile HFA-PEFF score was related to lower overall survival rate (p < 0.001). Patients with positive AMA-M2 had poorer outcomes (p = 0.002). CONCLUSION HFpEF was prevailing in IIM patients according to the HFA-PEFF score. The HFA-PEFF score correlated well with disease activity and held significant prognostic value. Patients with AMA-M2 antibody were prone to have poor outcomes.
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Affiliation(s)
- Yunjing Shi
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, 149 S. Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Hao Zhang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Zeping Qiu
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, 149 S. Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Yanjia Chen
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, 149 S. Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Xiuxiu Su
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, 149 S. Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Huihui Chi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Tienan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Sun
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Honglei Liu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Xiaobing Cheng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Junna Ye
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Qiongyi Hu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Zhuochao Zhou
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Jianfen Meng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Jialin Teng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Yutong Su
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, People's Republic of China.
| | - Wei Jin
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, 149 S. Chongqing Road, Shanghai, 200025, People's Republic of China.
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Chung MP, Lovell J, Kelly W, Mecoli CA, Albayda J, Christopher-Stine L, Gilotra NA, Paik JJ. Myocarditis in Patients With Idiopathic Inflammatory Myopathies: Clinical Presentation and Outcomes. J Rheumatol 2023; 50:1039-1046. [PMID: 37003604 PMCID: PMC10523850 DOI: 10.3899/jrheum.220989] [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] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To determine the clinical phenotype and outcomes of patients with idiopathic inflammatory myopathies (IIMs) and myocarditis. METHODS Using the Johns Hopkins Myositis Center Research Registry, we identified 31 adult patients with IIM-out of a total of 3082 with confirmed or suspected muscle disease-with an encounter code of myocarditis from 2004 to 2021. Of these, 14 adult patients with IIM were adjudicated to have clinical myocarditis. Information about demographics, autoantibodies, and clinical outcomes was retrospectively collected and analyzed. RESULTS Of 14 patients with IIM with clinical myocarditis, the median age at IIM diagnosis was 49 (IQR 35-56) years, and the median age at myocarditis diagnosis was 54 (IQR 36-61) years. The median duration between IIM diagnosis and myocarditis was 3 (IQR 2-9) years. The majority of patients were female (8/14, 57%) and Black (10/14, 71%). Antisynthetase syndrome was the most common IIM subtype (9/14, 64%). Anti-Jo1 (n = 4) and anti-PL12 (n = 3) were the most frequent autoantibodies. At myocarditis diagnosis, most patients (11/14, 79%) had active myositis, defined as elevated creatine kinase and/or muscle weakness; required hospitalization (13/14, 93%); and had reduced left ventricular ejection fraction (LVEF < 50%; 10/14, 71%). Despite intensification of immunosuppression, the 5-year overall survival rate from IIM diagnosis was 84%, and the 5-year overall survival rate from myocarditis diagnosis was 53%. Systolic dysfunction (LVEF < 40%) at final evaluation was observed in all expired patients (n = 6). CONCLUSION Clinical presentations of myocarditis in this select cohort of patients with IIM were severe and heterogeneous with poor outcomes despite intensification of immunosuppression, potentially reflecting late detection of myocarditis.
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Affiliation(s)
- Melody P Chung
- M.P. Chung, MD, MS, W. Kelly, BS, C.A. Mecoli, MD, MHS, J. Albayda, MD, L. Christopher-Stine, MD, MPH, J.J. Paik, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine;
| | - Jana Lovell
- J. Lovell, MD, N.A. Gilotra, MD, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William Kelly
- M.P. Chung, MD, MS, W. Kelly, BS, C.A. Mecoli, MD, MHS, J. Albayda, MD, L. Christopher-Stine, MD, MPH, J.J. Paik, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Christopher A Mecoli
- M.P. Chung, MD, MS, W. Kelly, BS, C.A. Mecoli, MD, MHS, J. Albayda, MD, L. Christopher-Stine, MD, MPH, J.J. Paik, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Jemima Albayda
- M.P. Chung, MD, MS, W. Kelly, BS, C.A. Mecoli, MD, MHS, J. Albayda, MD, L. Christopher-Stine, MD, MPH, J.J. Paik, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Lisa Christopher-Stine
- M.P. Chung, MD, MS, W. Kelly, BS, C.A. Mecoli, MD, MHS, J. Albayda, MD, L. Christopher-Stine, MD, MPH, J.J. Paik, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Nisha A Gilotra
- J. Lovell, MD, N.A. Gilotra, MD, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie J Paik
- M.P. Chung, MD, MS, W. Kelly, BS, C.A. Mecoli, MD, MHS, J. Albayda, MD, L. Christopher-Stine, MD, MPH, J.J. Paik, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine
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15
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Trybuch A, Tarnacka B. Cardiac involvement in polymyositis and dermatomyositis: diagnostic approaches. Reumatologia 2023; 61:202-212. [PMID: 37522146 PMCID: PMC10373167 DOI: 10.5114/reum/168362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 08/01/2023] Open
Abstract
Polymyositis (PM) and dermatomyositis (DM) are rare idiopathic inflammatory myopathies (IIM). Myocardial involvement in patients with IIM is an unfavorable prognostic factor and one of the most common cause of mortality in this group of patients. The purpose of this review is to present current knowledge on cardiovascular manifestations observed in IIM. Data published in English until December 2021 were selected. Clinical symptoms suggesting cardiac involvement are non-specific and require a differential diagnosis in accordance with cardiological guidelines. Troponin I is specific to cardiac injury and should be preferred to other markers to evaluate the myocardium in IIM. Abnormalities in electrocardiography are common in IIM, especially non-specific changes of the ST-T segment. In standard echocardiography left ventricular diastolic dysfunction is reported frequently. New diagnostic technologies can reveal clinically silent myocardial abnormalities. However, the prognostic value of subclinical impairment of myocardial function require further studies.
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Affiliation(s)
- Agnieszka Trybuch
- Department of Rehabilitation, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, Poland
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16
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Ishiguro M, Nagatomo Y, Inoue K, Yoshikawa T, Yoshizawa S, Oya Y, Nishino I, Isobe M. Sick sinus syndrome concomitant with myopathy associated with anti-mitochondrial antibodies: a case report. Eur Heart J Case Rep 2023; 7:ytac158. [PMID: 37323533 PMCID: PMC10261722 DOI: 10.1093/ehjcr/ytac158] [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: 08/26/2021] [Revised: 10/18/2021] [Accepted: 04/06/2022] [Indexed: 06/17/2023]
Abstract
Background Anti-mitochondrial antibody (AMA)-associated myopathy is known to be concomitant with primary biliary cirrhosis and to cause both skeletal muscle disorders and arrhythmias, myocardium disorders, and respiratory muscle disorders. We report a case of AMA-associated myopathy in which the bradycardia-related symptoms preceded the skeletal muscle symptoms. Case summary A 59-year-old woman visited the emergency room in our hospital following a syncopal event. The patient was bradycardiac (45 b.p.m.) with a junctional rhythm resulting from sick sinus syndrome (SSS) and was suffering from heart failure. Blood tests revealed elevated creatine kinase (CK) and hepatic enzymes. She underwent permanent pacemaker implantation. However, it proved difficult to detect the electrical potential in the right atrium. Although successful atrial pacing was achieved at the lower right atrial septum, the atrial threshold was markedly high and she depended on ventricular pacing. One year later, neurological examination and muscle biopsy confirmed the diagnosis of AMA-associated myopathy. Following this diagnosis, steroid pulse therapy was initiated. Steroid administration relieved her symptoms and lowered the CK levels but the atrial standstill persisted. The patient takes low-dose prednisolone and has had an uneventful course for 3 years. Discussion To the best of our knowledge, this is the first case of AMA-associated myopathy diagnosed by the first symptom related to bradycardia due to SSS. Patients with AMA-associated myopathy can experience a variety of cardiac symptoms, including arrhythmias, and initially complain of cardiac symptoms without symptoms of skeletal myopathy. This disease should be considered when diagnosing patients with arrhythmia and elevated CK.
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Affiliation(s)
- Maya Ishiguro
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Yuji Nagatomo
- Corresponding author. Tel: +81 4 2995 1597, Fax: +81 4 3996 5200,
| | - Kanki Inoue
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Tsutomu Yoshikawa
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Saeko Yoshizawa
- Department of Pathology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Yasushi Oya
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
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Abstract
INTRODUCTION Idiopathic inflammatory myopathies (IIMs) represent a diverse group of systemic autoimmune disorders with variable clinical manifestations and disease course. Currently, the challenges of IIMs are multifold, including difficulties in timely diagnosis owing to clinical heterogeneity, limited insights into disease pathogenesis, as well as a restricted number of available therapies. However, advances utilizing myositis-specific autoantibodies (MSAs) have facilitated the definition of subgroups as well as prediction of clinical phenotypes, disease course, and response to treatment. AREAS COVERED Herein we provide an overview of the clinical presentations of dermatomyositis (DM), anti-synthetase syndrome (ASyS), immune-mediated necrotizing myopathy (IMNM) and inclusion body myositis (IBM). We then provide an updated review of available and promising therapies for each of these disease groups. We synthesize current treatment recommendations in the context of case-based construct to facilitate application to patient care. Finally, we provide high-yield, clinical pearls relevant to each of the subgroups that can be incorporated into clinical reasoning. EXPERT OPINION There are many exciting developments on the horizon for IIM. As insights into pathogenesis evolves, the therapeutic armamentarium is expanding with many novel therapies in development, holding promise for more targeted treatment approaches.
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Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Kainaga M, Sasaki T, Kitamura M, Nakayama T, Masuda K, Kakuta Y, Nishino I, Imafuku I. Inflammatory Myopathy Associated with Anti-mitochondrial Antibody-negative Primary Biliary Cholangitis Diagnosed by a Liver Biopsy. Intern Med 2023; 62:797-802. [PMID: 35945026 PMCID: PMC10037005 DOI: 10.2169/internalmedicine.9666-22] [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] [Indexed: 11/06/2022] Open
Abstract
Anti-mitochondrial antibody (AMA)-associated myopathies represent a homogeneous disease entity with severe arrhythmia and slowly progressive proximal muscle weakness with lordotic posture, irrespective of the presence of primary biliary cholangitis (PBC). We herein report a case of myositis associated with PBC without AMAs. A 48-year-old woman presented with clinical features very similar to AMA-associated myositis, despite negative AMAs. PBC, ascertained by a liver biopsy performed based on mildly elevated liver enzymes, and the efficacy of steroid therapy on muscle weakness confirmed the diagnosis of immune-mediated myositis. When AMAs are negative, a liver biopsy is indispensable for diagnosing treatable PBC-associated myositis.
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Affiliation(s)
- Mitsuhiro Kainaga
- Department of Neurology, Yokohama Rosai Hospital, Japan
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Takuya Sasaki
- Department of Neurology, Yokohama Rosai Hospital, Japan
| | | | | | - Keita Masuda
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Japan
| | - Yukio Kakuta
- Department of Pathology, Yokohama Rosai Hospital, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Center of Neurology and Psychiatry, Japan
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Chompoopong P, Liewluck T. Granulomatous myopathy: Sarcoidosis and beyond. Muscle Nerve 2023; 67:193-203. [PMID: 36352751 DOI: 10.1002/mus.27741] [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: 06/22/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
Non-necrotizing granulomatous inflammation is a rare but easily recognized histopathological finding in skeletal muscle biopsy. A limited number of diseases are known to be associated with non-necrotizing granulomatous myopathy. Once identified, a careful evaluation for evidence of extramuscular granulomatosis and other signs suggestive of sarcoidosis is warranted as about half of the patients have sarcoid myopathy. In addition, the presence of granulomatous myopathy should trigger a search for clinical and pathological clues of inclusion body myositis (IBM), which accounts for most of the remaining patients and can coexist with sarcoidosis. Recognizing the features of IBM in patients with granulomatous myopathy can potentially spare the patients from unnecessary exposure to immunosuppressive therapies. In patients whose granulomatous myopathy remain unexplained, further investigations should aim at identifying myasthenia gravis and other autoimmune disorders, especially those known to cause granulomatous inflammation in other organs. Laboratory investigations should include acetylcholine receptor, antimitochondrial, antineutrophil cytoplasmic, thyroglobulin, and thyroid peroxidase autoantibodies. In the appropriate clinical context, exposure to immune checkpoint inhibitors and chronic graft-vs-host disease can be causes of granulomatous myopathy. In cases of unexplained granulomatous myopathy, natural killer/T-cell lymphoma should be considered and careful histopathological examination for atypical cells and appropriate immunostaining is crucial. Identifying the etiology of granulomatous myopathy in each patient can guide appropriate treatment.
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Galluzzo C, Chiapparoli I, Corrado A, Cantatore FP, Salvarani C, Pipitone N. Rare forms of inflammatory myopathies - part I, generalized forms. Expert Rev Clin Immunol 2023; 19:169-183. [PMID: 36469633 DOI: 10.1080/1744666x.2023.2154656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The idiopathic inflammatory myopathies traditionally comprise dermatomyositis, polymyositis, immune-mediated necrotizing myopathy, anti-synthetase syndrome, and inclusion body myositis. In this review, we aimed to cover the less common forms of generalized myositis. AREAS COVERED We identified rare forms of widespread myositis on the basis of list provided by the homepage of the Neuromuscular disease center of Washington University, USA and on the basis of the authors' knowledge. We searched PubMed® and EMBASE® for relevant articles on these forms with the aim of providing as much as possible information on their clinical manifestations as well as guidance on their work-up and treatment. EXPERT OPINION There is substantial heterogeneity among the various rare forms of generalized myositis in terms of their frequency and characterization. Some forms are reasonably well defined, while others may not represent truly well-defined diseases, but rather variants of other myopathies. The landscape of rare forms appears to have evolved over time, with some forms now being better characterized, while others, such as SARS-Cov-2- and immune checkpoint inhibitor-related myositis have come to the fore only in recent years. Knowledge about rare forms of myositis can aid in their recognition and treatment.
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Affiliation(s)
- Claudio Galluzzo
- Department of internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Chiapparoli
- Department of internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ada Corrado
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesco Paolo Cantatore
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Carlo Salvarani
- Department of internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Università di Modena e Reggio Emilia, Modena, Italy
| | - Nicolò Pipitone
- Department of internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Huang R, Zhang X, Han Z, Wu X, Li G, Chen J, Xu B, Gu R, Wang L. Refractory ventricular tachycardia and heart failure due to anti-mitochondrial antibody-positive inflammatory myopathy. BMC Cardiovasc Disord 2023; 23:57. [PMID: 36721091 PMCID: PMC9890839 DOI: 10.1186/s12872-023-03057-6] [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: 02/17/2022] [Accepted: 01/10/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Anti-mitochondrial antibody (AMA)-positive inflammatory myopathy, a rare type of idiopathic inflammatory myopathy which was frequently difficult to diagnose, can affect muscles and the structure and electrical conduction of the heart. Early identification and treatment of this myopathy can prevent serious cardiovascular adverse events and improve cardiac function. CASE PRESENTATION We report a patient who experienced repeated syncope, ventricular tachycardia (VT) and heart failure accompanied by weakness and muscle atrophy. He was initially diagnosed with dilated cardiomyopathy and received implantable cardioverter-defibrillator therapy. He was subsequently misdiagnosed as muscular dystrophy due to progressive muscular atrophy. However, the patient developed repeated and refractory VT storms that were not alleviated by conventional therapy. Finally, he was diagnosed with AMA-positive inflammatory myopathy with cardiac injuries. The patient was markedly recovered by being treated with immunosuppressive and immunomodulatory therapy. CONCLUSION AMA could be screened when discovering myopathies accompanied by unexplained cardiac symptoms. Our findings provide insights into the diagnosis and therapy of this rare and severe disease.
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Affiliation(s)
- Rong Huang
- grid.412676.00000 0004 1799 0784Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xinlin Zhang
- grid.412676.00000 0004 1799 0784Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhonglin Han
- grid.412676.00000 0004 1799 0784Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiang Wu
- grid.412676.00000 0004 1799 0784Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Guannan Li
- grid.412676.00000 0004 1799 0784Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jianzhou Chen
- grid.412676.00000 0004 1799 0784Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Biao Xu
- grid.412676.00000 0004 1799 0784Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Rong Gu
- grid.412676.00000 0004 1799 0784Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lian Wang
- grid.412676.00000 0004 1799 0784Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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22
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Bharathidasan K, Evans A, Fernandez FMAO, Motes AT, Nugent K. Mitochondrial Myopathy in a 21-Year-Old Man Presenting With Bilateral Lower Extremity Weakness and Swelling. J Prim Care Community Health 2023; 14:21501319231172697. [PMID: 37162197 PMCID: PMC10184240 DOI: 10.1177/21501319231172697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Bilateral lower extremity weakness and swelling can have several causes. Although often underdiagnosed, mitochondrial myopathy is more prevalent in the general population than more commonly suspected diseases, such as Guillain-Barre syndrome. The clinical manifestations of mitochondrial disease can be broadly classified into 3 categories: chronic progressive external ophthalmoplegia, skeletal muscle-central nervous system syndromes, or pure myopathy. Cardiac abnormalities occur in 30% to 32% of cases, mostly in the form of hypertrophic cardiomyopathy, dilated cardiomyopathy, or conduction abnormalities. We report a case of a 21-year-old student who developed bilateral lower limb weakness, pain, and swelling diagnosed with mitochondrial myopathy on muscle biopsy. Initial laboratory tests revealed elevated creatinine kinase, brain natriuretic peptide, troponin, myoglobin, and lactic acid and reduced serum bicarbonate. Cardiac workup revealed systolic heart failure with a reduced ejection fraction. Endomyocardial biopsy revealed punctate foci of lymphocytic myocarditis. However, cardiac magnetic resonance imaging did not reveal either myocarditis or an infiltrative cardiac disease. An extensive autoimmune and infection work-up was negative. A muscle biopsy from the patient's rectus femoris revealed scattered ragged-blue fibers (stained with NADH dehydrogenase), scattered ragged-red fibers on modified Gomori trichrome stain, and cytochrome-c oxidase negative fibers with increased perimysial and endomysial connective tissue, consistent with active and chronic primary mitochondrial myopathy. The patient was treated successfully with furosemide, metoprolol, and methylprednisolone. Adult-onset mitochondrial myopathy is a rare clinical disorder, and our experience stresses the importance of using an inter-disciplinary team approach to diagnose uncommon clinical disorders with widely variable multisystem involvement.
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Affiliation(s)
| | - Abbie Evans
- Texas Tech University Health Science Center, Lubbock, TX, USA
| | | | | | - Kenneth Nugent
- Texas Tech University Health Science Center, Lubbock, TX, USA
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Nagai A, Nagai T, Yaguchi H, Fujii S, Uwatoko H, Shirai S, Horiuchi K, Iwata I, Matsushima M, Ura S, Anzai T, Yabe I. Clinical features of anti-mitochondrial M2 antibody-positive myositis: case series of 17 patients. J Neurol Sci 2022; 442:120391. [PMID: 36115217 DOI: 10.1016/j.jns.2022.120391] [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: 06/30/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE In 2012, a large number of myositis cases with anti-mitochondrial M2 (AMA-M2) antibody, which had well been known as the serological hallmark for primary biliary cholangitis (PBC), were reported in Japan. Recently, some case series from Japan, France, America, China and India have shown that approximately 2.5% to 19.5% of patients with myositis have AMA-M2 antibody. The objective of this study was to clarify the prevalence, clinical features, treatment outcome, and severity determinants of AMA-M2 positive myositis. METHODS This study was a multicenter observational study. We enrolled patients who were diagnosed with myositis during a ten-year period between 2012 and 2021. RESULTS Of the total of 185 patients with inflammatory myopathy, 17 patients were positive for AMA-M2 antibody. The typical symptoms were weakness mainly involving paravertebral muscles, weight loss, respiratory failure, and cardiac complications. Thirteen of the 17 patients had cardiac complications. A strong correlation was found between respiratory failure and modified Rankin Scale (mRS) score. A strong correlation was also found between respiratory failure and body weight, indicating that weight loss can be an indicator of potential progression of respiratory failure. Six of the 17 patients were complicated by malignancy. CONCLUSIONS This study showed significant correlations between % vital capacity (VC), body mass index (BMI), and mRS score in patients with AMA-M2-positive myositis. Immunotherapy often improved CK level and respiratory dysfunction. We therefore propose that %VC and BMI should be monitored as disease indicators in treatment of AMA-M2-positive myositis.
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Affiliation(s)
- Azusa Nagai
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Yaguchi
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Shintaro Fujii
- Department of Neurology, Hakodate Municipal Hospital, Japan
| | - Hisashi Uwatoko
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinichi Shirai
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Ikuko Iwata
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaaki Matsushima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigehisa Ura
- Department of Neurology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
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Fujisaki S, Tsuchida K, Sekiya Y, Oyanagi N, Tsuchiya H, Nakano K, Hayashi Y, Tanaka K, Hosaka Y, Takahashi K, Oda H. A Case of Chronic Heart Failure Complicated by Primary Biliary Cholangitis and Skeletal Myopathy. Int Heart J 2022; 63:963-969. [DOI: 10.1536/ihj.21-837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Yuka Sekiya
- Department of Cardiology, Niigata City General Hospital
| | | | | | - Kenji Nakano
- Department of Cardiology, Niigata City General Hospital
| | - Yuka Hayashi
- Department of Cardiology, Niigata City General Hospital
| | - Komei Tanaka
- Department of Cardiology, Niigata City General Hospital
| | - Yukio Hosaka
- Department of Cardiology, Niigata City General Hospital
| | | | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
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25
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Bujo S, Amiya E, Maeda MH, Ishida J, Hatano M, Ishizuka M, Uehara M, Oshima T, Kojima T, Nakanishi K, Daimon M, Shimizu J, Toda T, Komuro I. The effect of immunosuppressive therapy on cardiac involvements in anti-mitochondrial antibody-positive myositis. ESC Heart Fail 2022; 9:4112-4119. [PMID: 36068648 PMCID: PMC9773721 DOI: 10.1002/ehf2.14138] [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: 05/03/2022] [Revised: 08/17/2022] [Accepted: 08/30/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Anti-mitochondrial antibody (AMA)-positive myositis is frequently associated with various cardiac involvements, such as arrhythmia and left ventricular (LV) dysfunction. However, the efficacy of immunosuppressive therapy in these complications remains unknown. This study aimed to investigate the cardiac response to immunosuppressive therapy in patients with AMA-positive myositis. METHODS AND RESULTS The clinical data of 15 AMA-positive myositis patients with cardiac involvement were retrospectively collected at our centre. To evaluate the effects of immunosuppressive therapy, echocardiographic and laboratory data of patients who received glucocorticoid therapy with additional immunosuppressants (n = 6) and those who did not (n = 6) were compared. Also, the characteristics of patients with or without >5% LV ejection fraction (LVEF) decline during the follow-up period (n = 5 vs. n = 7) were compared. Thirteen patients (87%) had arrhythmias, and eight patients (53%) had LV wall motion abnormalities. Although arrhythmias decreased after treatment, reduced LVEF and LV wall motion abnormalities persisted. Further investigation revealed an increased LV end-systolic dimension and reduced LVEF in patients without additional immunosuppressive therapy, while those in patients with additional immunosuppressive therapy were maintained. Six of seven patients (86%) without LVEF decline received additional immunosuppressive therapy, whereas no patients with LVEF decline had additional immunosuppressive therapy. CONCLUSIONS Cardiac involvement in AMA-positive myositis may worsen even with glucocorticoid monotherapy, and there might be some associations between the change of LV function and additional immunosuppressive therapy.
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Affiliation(s)
- Satoshi Bujo
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan,Department of Therapeutic Strategy for Heart Failure, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Meiko Hashimoto Maeda
- Department of Neurology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Junichi Ishida
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan,Advanced Medical Center for Heart FailureUniversity of TokyoTokyoJapan
| | - Masato Ishizuka
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Masao Daimon
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Jun Shimizu
- Department of Physical TherapyTokyo University of TechnologyTokyoJapan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
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Mondal S, Barman P, Vignesh P. Cardiovascular Abnormalities in Juvenile Dermatomyositis: A Scoping Review for the Clinical Rheumatologists. Front Med (Lausanne) 2022; 9:827539. [PMID: 35814777 PMCID: PMC9263083 DOI: 10.3389/fmed.2022.827539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Juvenile dermatomyositis (JDM) is a common form of inflammatory myositis in children. Vasculopathy and endothelial dysfunction play significant roles in the pathogenesis of JDM. Cardiac involvement in JDM is often underestimated, and it may be a potential indicator of poor prognosis. Cardiac dysfunction in JDM can occur both in the acute and chronic stages of the disease. Amongst the acute complications, acute congestive heart failure (CHF), myocarditis, arrhythmia, and complete heart block are common. However, these remain unrecognized due to a lack of overt clinical manifestations. Increased rates of cardiovascular abnormalities have been noted with anti-SRP and anti-Jo 1 auto-antibody positivity. Long-term follow-up studies in JDM have shown an increased prevalence of hypertension, atherosclerosis, coronary artery disease, and metabolic syndrome in adolescence and adulthood. Monitoring of body-mass index, blood pressure, and laboratory evaluation of fasting glucose and lipid profile may help in identifying metabolic syndrome in children with JDM. Steroid-sparing agents, daily exercise, and a healthy diet may reduce such long-term cardiac morbidities. Current use of multimodality imaging such as stress-echocardiography, contrast-enhanced echocardiography, cardiac magnetic resonance imaging, and positron emission tomography has increased the diagnostic yield of subclinical heart disease during acute and chronic stages of JDM. This review elaborates on different aspects of cardiac dysfunction in JDM. It also emphasizes the importance of cardiac screening in long-term follow-up of children with JDM.
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Liu YX, Song YJ, Liu XH, Xu SC, Kong C, Chen LF, Qian H, Wu W. PD-1 inhibitor induces myocarditis by reducing regulatory T cells, activating inflammatory responses, promoting myocardial apoptosis and autophagy. Cytokine 2022; 157:155932. [PMID: 35691121 DOI: 10.1016/j.cyto.2022.155932] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
The present study aimed to explore the pathogenesis of autoimmune myocarditis induced by PD-1 inhibitors and their potential therapeutic targets. Mouse models of autoimmune myocarditis induced by PD-1 inhibitor in mouse models of polymyositis were established. The expression level of PD-1 and regulatory T cells (Tregs), CD4, CD8 + T cells, inflammation, apoptosis and autophagy-related factors, including IL-6, TGF-β, AMA-M2, Fas/FasL, LC3 and p62 were detected in peripheral blood, muscle or myocardium of mice in each group, using ELISA, RT-PCR, Western Blot and immunofluorescence. In addition, HE and TUNEL staining and ultrastructural scanning were performed on the myocardium of mice in each group. Results showed that the expression level of PD-1 in the two myositis groups was significantly lower than that in the control group, and the level of PD-1 was lower in the myocarditis group than that in the polymyositis group. In the myocardium, TGF-β, p62, and Tregs proportion showed the same expression level trend as PD-1, while CD8, IL-6, IL-10 and LC3 showed the opposite trend. Levels of Fas/FasL were significantly higher in both myositis groups, but were slightly lower in the myocarditis group, as was AMA-M2. Inflammation, apoptosis, and autophagy were observed in both myositis groups, but were more severe in the myocarditis group. In summary, the decreased expression level of PD-1 leads to decreased Tregs level in the myocardium, aggravated inflammatory response, apoptosis and autophagy, which may be the pathological mechanism of myocarditis induced by PD-1 inhibitors.
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Affiliation(s)
- Ying-Xian Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan-Jun Song
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Hang Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Si-Chi Xu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chang Kong
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lian-Feng Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Qian
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Wu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Ikami Y, Izumi D, Hasegawa Y, Suzuki N, Sakaguchi Y, Hakamata T, Otsuki S, Yagihara N, Iijima K, Kashimura T, Chinushi M, Minamino T, Inomata T. The Risk of Ventricular Tachyarrhythmias in Patients with Antimitochondrial Antibodies-Related Noncardiac Diseases. Int Heart J 2022; 63:476-485. [PMID: 35650149 DOI: 10.1536/ihj.22-075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Antimitochondrial antibodies (AMA) are serum autoantibodies specific to primary biliary cholangitis and are linked to myopathy and myocardial damage; however, the presence of AMA as a risk factor for ventricular tachyarrhythmias (VTs) has remained unknown. This study aimed to elucidate whether the presence of AMA-related noncardiac diseases indicates VTs risk.This cohort study enrolled 1,613 patients (883 females) who underwent AMA testing to assess noncardiac diseases. The incidence of VTs and supraventricular tachyarrhythmias (SVTs) from a year before the AMA testing to the last visit of the follow-up were retrospectively investigated as primary and secondary objectives. Using propensity score matching, we extracted AMA-negative patients whose covariates were matched to those of 152 AMA-positive patients. In this propensity score-matched cohort, the incidence of VTs and SVTs in the AMA-positive patients were compared with that in AMA-negative patients.The AMA-positive patients had higher estimated cumulative incidence (log-rank, P = 0.013) and prevalence (5.9% versus 0.7%, P = 0.020) of VTs than the AMA-negative patients. The presence of AMA was an independent risk factor for VTs (hazard ratio, 4.02; 95% CI, 1.44-20.01; P = 0.005). Meanwhile, AMA were associated with atrial flutter and atrial tachycardia development. In AMA-positive patients, VTs were associated with male sex, underlying myopathy, high creatine kinase levels, presence of chronic heart failure or ischemic heart disease, left ventricular dysfunction, presence of SVTs, and the electrocardiographic parameters indicating atrial disorders.The presence of AMA-related noncardiac diseases is an independent risk factor for VTs.
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Affiliation(s)
- Yasuhiro Ikami
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Daisuke Izumi
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Yuki Hasegawa
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Naomasa Suzuki
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Yuta Sakaguchi
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Takahiro Hakamata
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Sou Otsuki
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Nobue Yagihara
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Kenichi Iijima
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Takeshi Kashimura
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Masaomi Chinushi
- School of Health Science, Faculty of Medicine, Niigata University
| | - Tohru Minamino
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences.,Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
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Gaur PS, R N, Anuja AK, Singh MK, Rai MK, Muhammed R, Sahu AK, Agarwal V, Gupta L. Anti-mitochondrial antibodies in Indian patients with idiopathic inflammatory myopathies. Int J Rheum Dis 2022; 25:659-668. [PMID: 35384316 DOI: 10.1111/1756-185x.14320] [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] [Received: 10/10/2021] [Revised: 01/27/2022] [Accepted: 03/18/2022] [Indexed: 12/01/2022]
Abstract
AIMS Anti-mitochondrial antibodies (AMAs) are associated with distinct clinical phenotypes including cardiac and hepatic manifestations in idiopathic inflammatory myopathies (IIMs). This article studies the prevalence, clinical characteristics and outcomes of AMA in Indian patients with IIM. METHODS Patients (97: 81 adult, 16 juvenile) clinically diagnosed with polymyositis or antibody-negative IIM were retrieved from the MyoCite bio-archive. They were tested for myositis-specific autoantibodies / myositis autoantibodies (MSAs/MAAs) using line immunoassay and antinuclear antibodies and AMAs using immunofluorescence assay (IFA). Patients were also screened for cardiac biomarkers (cardiac troponin I [c-TnI] and N terminal-pro brain natriuretic peptide [NT-pro-BNP] using immunometric immunoassay technique and enhanced chemiluminescence assay testing respectively) and hepatic manifestations using AMA testing. Results were formulated after carrying out analytical tests. RESULTS Of the cohort, 5 adults (6.2%) (M:F 0:1) with a median age and disease duration of 37 years and 2 months respectively, tested AMA+ while the children tested negative. Dermatomyositis was the commonest phenotype, with amyopathic forms being common, often with MSA positivity. Cancer-associated myositis and polymyositis were also seen. AMA positivity is associated with Gottron's sign and calcinosis. Comparable levels of C-TnI and NT-pro-BNP and AMA testing in patients help to rule out subclinical cardiac and hepatic involvement respectively. CONCLUSION Anti-mitochondrial antibodies are rare (6.2%) in different subtypes of IIM in the Indian population, and often coexist with MSAs. Their negative association with cardiac and hepatic involvement and probable association with Gottron's sign and calcinosis merit further investigation and long-term follow-up to understand the entire spectrum of the disease.
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Affiliation(s)
| | - Naveen R
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anamika Kumari Anuja
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mantabya Kumar Singh
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mohit Kumar Rai
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rizwan Muhammed
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ankit Kumar Sahu
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.,City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
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Ceribelli A, Isailovic N, Gorlino C, Assandri R, Vecellio M, De Santis M, Satoh M, Selmi C. Antigen Reactivity and Clinical Significance of Autoantibodies Directed Against the Pyruvate Dehydrogenase Antigen Complex in Patients With Connective Tissue Disease. Front Immunol 2022; 13:822996. [PMID: 35296099 PMCID: PMC8918651 DOI: 10.3389/fimmu.2022.822996] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Antimitochondrial antibodies (AMAs) are the hallmark of primary biliary cholangitis (PBC) but can be identified also in patients with connective tissue disease, namely, systemic sclerosis (SSc). Protein immunoprecipitation (IP) and IP-Western blot (WB) can be used to confirm AMA positivity directed at the pyruvate dehydrogenase complex (PDC) subunits E1α, E1β, E2/E3, and E3BP in patients showing a cytoplasmic reticular pattern at indirect immunofluorescence when performed in a screening setting before the onset of overt cholestasis in rheumatic patients. Patients and Methods We studied sera from 285 patients affected by connective tissue disease [SSc, n = 144; dermato/polymyositis (DM/PM), n = 56; and undifferentiated connective tissue disease (UCTD), n = 85] by indirect immunofluorescence (IIF), protein-IP, and IP-WB to identify specific PDC subunits recognized by AMA. Results Twenty percent (57/285) of sera from patients with connective tissue disease had a cytoplasmic reticular pattern at IIF, and in 77% (44/57, including 20 SSc, 12 PM/DM, and 12 UCTD) of these, we detected different titers of autoantibodies against the PDC subunits, specifically against PDC-E2. Among these sera, 4 (9%) tested positive for anti-E1α, 15 (34%) for anti-E1β, and 16 (36%) for anti-E3BP. Four of the 20 AMA-positive SSc cases (20%) had been already diagnosed with PBC, and all were positive for autoantibodies against the subunits PDC-E2, E3, and E3BP. Conclusions Using IIF and IP, we confirm that autoantibodies against the PDC components are detected in rheumatic patients with PBC or without liver dysfunction. In view of the strong predictive value of AMA for PBC, a strict follow-up of these latter patients is warranted for an early diagnosis of the disease.
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Affiliation(s)
- Angela Ceribelli
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Natasa Isailovic
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Carolina Gorlino
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Matteo Vecellio
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maria De Santis
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Carlo Selmi
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- *Correspondence: Carlo Selmi,
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Ogaki K, Fujita H, Kokubun N, Hamaguchi M, Nishino I, Suzuki K. [Anti-mitochondrial M2 antibody-positive myositis preceded by heart failure and cardiac conduction disturbance. A case report]. Rinsho Shinkeigaku 2022; 62:135-139. [PMID: 35095048 DOI: 10.5692/clinicalneurol.cn-001644] [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: 11/05/2022]
Abstract
A 69-year-old man visited our hospital complaining of fatigue in the lower extremities while walking. The patient had a two-year history of congestive heart failure and received a permanent artificial pacemaker implantation for sick sinus syndrome. Physical examination revealed proximal muscle weakness and exaggerated lumbar lordosis. Serum creatine kinase level was 1,455 U/l. The atrophies of the paraspinal muscles at thoracic to lumbar spine levels, rectus abdominis and soleus muscles were detected on computed tomography. Muscle biopsy showed mild to moderate variability in muscle fiber size with regenerating and necrotic muscle fibers. Mononuclear cell infiltration was not found. HLA-ABC expression was minimum. After anti-mitochondrial M2 antibody was detected, administration of oral prednisolone resulted in improvements in muscle strength and serum creatine kinase level. Based on the clinical course, examination and clinical findings, the patient was diagnosed as anti-mitochondrial M2 antibody positive myositis. Anti-mitochondrial M2 positive myositis is not only difficult to diagnose by muscle biopsy, but can also be preceded or complicated by fatal cardiac complications.
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Affiliation(s)
- Keitaro Ogaki
- Department of Neurology, Dokkyo Medical University, Tochigi
| | - Hiroaki Fujita
- Department of Neurology, Dokkyo Medical University, Tochigi
| | - Norito Kokubun
- Department of Neurology, Dokkyo Medical University, Tochigi
| | - Mai Hamaguchi
- Department of Neurology, Dokkyo Medical University, Tochigi
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neurology, National Center of Neurology and Psychiatry, Tokyo.,Department of Clinical Genome Analysis, Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi
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Korsholm SS, Andersson DC, Knudsen JB, Dastmalchi M, Diederichsen ACP, Gerke O, Witting N, Jacobsen S, Pecini R, Friis T, Krogager ME, Lundberg IE, Diederichsen O. Myositis-Specific Autoantibodies and QTc Changes by ECG in Idiopathic Inflammatory Myopathies. Rheumatology (Oxford) 2022; 61:4076-4086. [PMID: 35048961 DOI: 10.1093/rheumatology/keac013] [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: 07/22/2021] [Accepted: 12/27/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate cardiac involvement detected by electrocardiography (ECG) in patients with idiopathic inflammatory myopathies (IIM) and to evaluate possible associations between autoantibody profile and ECG changes in these patients. METHODS In a Scandinavian cross-sectional study, patients were included from two Danish centres and one Swedish centre. Resting 12-lead ECG was investigated in 261 patients with IIM compared with 102 patients with systemic sclerosis (SSc) and 48 healthy controls (HCs). ECG changes were correlated to clinical manifestations and myositis-specific (MSAs) and myositis-associated (MAAs) autoantibodies. RESULTS Patients with IIM had longer mean QTc duration and more frequently presented with prolonged QTc (≥ 450 ms; p= 0.038) compared with HCs. Longer QTc duration was recorded in SSc compared with IIM (433 ± 23 ms vs 426 ± 24 ms, p= 0.011), yet, no significant difference in the fraction with prolonged QTc (SSc: 22%, IIM: 16%; p= 0.19). In multivariable regression analyses, anti-Mi2 (p= 0.01, p= 0.035) and anti-Pl-7 (p= 0.045, p= 0.014) were associated with QTc duration and prolonged QTc in IIM. Elevated CRP was associated with prolonged QTc (p= 0.041). CONCLUSION Presence of QTc abnormalities was as common in patients with IIM as in patients with SSc, including prolonged QTc seen in almost one fifth of the patients. Anti-Mi2, anti-Pl-7, and elevated CRP may serve as biomarkers for cardiac disease in IIM, but needs to be confirmed in a larger prospective study.
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Affiliation(s)
- Sine Søndergaard Korsholm
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital (CUH), Rigshospitalet, Denmark, Copenhagen.,Dept of Rheumatology, Odense University Hospital (OUH), Odense, Denmark
| | - Daniel C Andersson
- Dept of Physiology and Pharmacology, Karolinska Institute, Solna, Stockholm, Sweden.,Heart, Vascular and Neurology Theme, Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden
| | | | - Maryam Dastmalchi
- Division of Rheumatology, Dept of medicine, Solna, Stockholm, Karolinska Institutet and Rheumatology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | | | - Oke Gerke
- Dept of Nuclear Medicine, OUH, Odense, Denmark
| | | | - Søren Jacobsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital (CUH), Rigshospitalet, Denmark, Copenhagen
| | - Redi Pecini
- Dept of Cardiology, CUH, Copenhagen, Denmark
| | - Tina Friis
- Dept of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | | | - Ingrid E Lundberg
- Division of Rheumatology, Dept of medicine, Solna, Stockholm, Karolinska Institutet and Rheumatology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Ouise Diederichsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital (CUH), Rigshospitalet, Denmark, Copenhagen.,Dept of Rheumatology, Odense University Hospital (OUH), Odense, Denmark
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Colapietro F, Lleo A, Generali E. Antimitochondrial Antibodies: from Bench to Bedside. Clin Rev Allergy Immunol 2022; 63:166-177. [PMID: 34586589 PMCID: PMC8480115 DOI: 10.1007/s12016-021-08904-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 01/13/2023]
Abstract
Anti-mitochondrial antibodies (AMA) are directed against the E2 subunits of the 2-oxo acid dehydrogenase complexes (PDC-E2) and are the typical biomarkers of primary biliary cholangitis (PBC), being present in 90-95% of patients, with increasing sensitivity at increasing titers. Albeit being highly specific for PBC diagnosis, AMA can be detected in less than 1% of healthy subjects, and thus the management subjects with no sign or symptom of liver disease is still a challenge and data concerning clinical risk of developing PBC in this subgroup of patients are controversial. Moreover, AMA can also be detected in patients affected by overlap syndrome, as well as hepatic diseases (i.e., NASH and viral hepatitis), while the association with autoimmune diseases, in particular Sjögren's syndrome, systemic sclerosis, and systemic lupus erythematosus, is well established. Furthermore, new associations are being identified with inflammatory myositis and heart disease. AMA are directed towards the pyruvate dehydrogenase multi enzyme complex (PDC-E2) subunit, which represents an epithelial specific autoantigen for PBC. This review focuses on the main characteristics of AMA, their association with autoimmune diseases and liver diseases.
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Affiliation(s)
- Francesca Colapietro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.
| | - Elena Generali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
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Pathogenesis, Diagnosis and Risk Stratification in Arrhythmogenic Cardiomyopathy. CARDIOGENETICS 2021. [DOI: 10.3390/cardiogenetics11040025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetically determined myocardial disease associated with sudden cardiac death (SCD). It is most frequently caused by mutations in genes encoding desmosomal proteins. However, there is growing evidence that ACM is not exclusively a desmosome disease but rather appears to be a disease of the connexoma. Fibroadipose replacement of the right ventricle (RV) had long been the hallmark of ACM, although biventricular involvement or predominant involvement of the left ventricle (LD-ACM) is increasingly found, raising the challenge of differential diagnosis with arrhythmogenic dilated cardiomyopathy (a-DCM). A-DCM, ACM, and LD-ACM are increasingly acknowledged as a single nosological entity, the hallmark of which is electrical instability. Our aim was to analyze the complex molecular mechanisms underlying arrhythmogenic cardiomyopathies, outlining the role of inflammation and autoimmunity in disease pathophysiology. Secondly, we present the clinical tools used in the clinical diagnosis of ACM. Focusing on the challenge of defining the risk of sudden death in this clinical setting, we present available risk stratification strategies. Lastly, we summarize the role of genetics and imaging in risk stratification, guiding through the appropriate patient selection for ICD implantation.
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Fujii S, Horiuchi K, Oshima Y, Eguchi K, Nagai A, Iwata I, Matsushima M, Yabe I. Inflammatory Myopathy Associated with Anti-mitochondrial Antibody Presenting Only with Respiratory Failure. Intern Med 2021; 60:3801-3804. [PMID: 34092736 PMCID: PMC8710372 DOI: 10.2169/internalmedicine.7448-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 56-year-old woman presenting with type II respiratory failure was transferred to our hospital. She did not exhibit muscle weakness or elevated serum myogenic enzymes, but needle electromyography revealed myogenic changes in the limb muscles, and her blood tests were positive for anti-mitochondrial antibodies (AMA). Muscle histopathological findings included immune-mediated necrotizing myopathy, so she was diagnosed with inflammatory myopathy associated with AMA. After treatment with corticosteroids and noninvasive positive pressure ventilation, her symptoms improved. If a diagnosis of type II respiratory failure is difficult, inflammatory myopathy associated with AMA should be considered as a differential diagnosis.
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Affiliation(s)
- Shintaro Fujii
- Department of Neurology, Hakodate Municipal Hospital, Japan
| | | | - Yuki Oshima
- Department of Neurology, Hakodate Municipal Hospital, Japan
| | - Katsuki Eguchi
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Azusa Nagai
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Ikuko Iwata
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Masaaki Matsushima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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Hasegawa Y, Izumi D, Kashimura T, Minamino T. Life-threatening ventricular arrhythmia and left ventricular dysfunction associated with anti-mitochondrial antibody-positive myositis: a case report. Eur Heart J Case Rep 2021; 5:ytab469. [PMID: 35047730 PMCID: PMC8759524 DOI: 10.1093/ehjcr/ytab469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/17/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anti-mitochondrial antibody (AMA)-positive myositis is an atypical inflammatory myopathy characterized by chronic progression of muscle atrophy and cardiac involvement. Few detailed reports have shown the clinical course of the cardiac complications of AMA-positive myositis. CASE SUMMARY A 47-year-old man presented with shortness of breath on exertion. Cardiac dilatation was visible on chest X-ray, and echocardiography demonstrated diffuse hypokinesis with a reduced left ventricular (LV) ejection fraction of 30%. He had mild muscle weakness in the bilateral iliopsoas muscles, and his creatine kinase (CK) and anti-mitochondrial M2 antibody levels were elevated. A liver biopsy showed no findings of primary biliary cholangitis. Coronary angiography revealed normal coronary arteries. An endomyocardial biopsy showed interstitial fibrosis and marked degeneration of the mitochondria. Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography showed circumferential abnormal accumulation in the LV myocardium, and he was diagnosed with cardiomyopathy associated with AMA-positive myositis. Optimal drug therapy for heart failure was started, and a cardiac resynchronization therapy-defibrillator was implanted. However, his cardiac function did not improve, and he was hospitalized due to ventricular tachycardia storm 5 years after the diagnosis. Ventricular tachycardia was terminated by radiofrequency catheter ablation on the LV-anterior papillary muscle. Steroid therapy was initiated and resulted in a decreased uptake of FDG and a normalized CK level at 3 months after his second discharge; however, LV systolic dysfunction remained 1 year later. DISCUSSION Anti-mitochondrial antibody-positive myositis can affect the myocardium and cause severe LV dysfunction and life-threatening ventricular arrhythmia over time. KEYWORDS Anti-mitochondrial antibody-positive myositis • Endomyocardial biopsy • Ventricular tachycardia • Left ventricular dysfunction • Case report • Magnetic resonance imaging • Near-infrared spectroscopy-intravascular ultrasound.
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Affiliation(s)
- Yuki Hasegawa
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachidori, Niigata 951-8510, Japan
| | - Daisuke Izumi
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachidori, Niigata 951-8510, Japan
| | - Takeshi Kashimura
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachidori, Niigata 951-8510, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Merlonghi G, Antonini G, Garibaldi M. Immune-mediated necrotizing myopathy (IMNM): A myopathological challenge. Autoimmun Rev 2021; 21:102993. [PMID: 34798316 DOI: 10.1016/j.autrev.2021.102993] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/14/2021] [Indexed: 02/07/2023]
Abstract
This review is focused on the myopathological spectrum of immune mediated necrotizing myopathies (IMNMs) and its differentiation with other, potentially mimicking, inflammatory and non-inflammatory myopathies. IMNMs are a subgroup of idiopathic inflammatory myopathies (IIMs) characterized by severe clinical presentation with rapidly progressive muscular weakness and creatine kinase elevation, often requiring early aggressive immunotherapy, associated to the presence of muscle specific autoantibodies (MSA) against signal recognition particle (SRP) or 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). Muscle biopsy usually shows unspecific features consisting in prominent necrosis and regeneration of muscle fibres with mild or absent inflammatory infiltrates, inconstant and faint expression of major histocompatibility complex (MHC) class I and variable deposition of C5b-9 on sarcolemma. Several conditions could present similar histopathological findings leading to possible misdiagnosis of IMNM with other IIMs or non-inflammatory myopathies (nIMs) and viceversa. This review analyses the muscle biopsy data in IMNMs through a systematic revision of the literature from the last five decades. Several histopathological variables have been considered in both SRP- and HMGCR-IMNM, and compared to other IIMs - as dermatomyositis (DM) and anti-synthethase syndrome (ASS) - or other nIMs -as toxic myopathies (TM), critical illness myopathy (CIM) and muscular dystrophy (MD) - to elucidate similarities and differences among these potentially mimicking conditions. The major histopathological findings of IMNMs were: very frequent necrosis and regeneration of muscle fibres (93%), mild inflammatory component mainly constituted by scattered isolated (65%) CD68-prevalent (68%) cells, without CD8 invading/surrounding non-necrotic fibres, variable expression of MHC-I in non-necrotic fibres (56%) and constant expression of sarcoplasmic p62, confirming those that are widely considered the major histological characteristics of IMNMs. Conversely, only 42% of biopsies showed a sarcolemmal deposition of C5b-9 component. Few differences between SRP and HMGCR IMNMs consisted in more severe necrosis and regeneration in SRP than in HMGCR (p = 0.01); more frequent inflammatory infiltrates (p = 0.007) with perivascular localization (p = 0.01) and clustered expression of MHC-I (p = 0.007) in HMGCR; very low expression of sarcolemmal C5b-9 in SRP (18%) compared to HMGCR (56%) (p = 0.0001). Milder necrosis and regeneration, detection of perifascicular pathology, presence of lymphocytic inflammatory infiltrates and myofibre expression of MxA help to distinguish DM or ASS from IMNM. nIMs can present signs of inflammation at muscle biopsy. Low fibre size variability with overexpression of both MHC-I and II, associated with C5b-9 deposition, could could be observed in CIM, while increased connective tissue should lead to consider MD, or TM in absence of C5b-9 deposition. Nevertheless, these features are not constantly detected and muscle biopsy could not be diriment. For this reason, muscle biopsy should always be critically considered in light of the clinical context before concluding for a definite diagnosis of IMNM, only based on histopathological findings. More rigorous collection and analysis of muscle biopsy is warranted to obtain a higher quality and more homogeneous histopathological data in inflammatory myopathies.
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Affiliation(s)
- Gioia Merlonghi
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Giovanni Antonini
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Matteo Garibaldi
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy.
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Abstract
PURPOSE OF REVIEW Necrotizing myopathy is a broad term. It includes patients with the recently described immune-mediated necrotizing myopathies (IMNM) who have specific antibodies, such as anti-hydroxy-3-methylglutaryl-CoA reductase or anti-signal recognition particle, seronegative phenotypes that can be associated with cancer, and other types of myositis and connective tissue diseases involving necrotic muscle fibers as a characteristic pathologic feature. Necrotizing myopathies that are not immune-mediated, such as those caused by drugs, dystrophies, infections, or even hypothyroidism are also included. The purpose of this review is to address the differential diagnosis of these disorders. RECENT FINDINGS New IMNM have been described over the last few years, some of them related with checkpoint inhibitors, drugs that are being increasingly used in cancer treatment. Necrotizing myopathy has also been reported in association with specific phenotypes and autoantibodies (e.g. anti-Mi2 dermatomyositis, antisynthetase syndrome, and myositis associated with antimitochondrial antibodies). Rarer cases associated with graft-versus-host disease and severe acute respiratory syndrome coronavirus 2 infection are also emerging. SUMMARY Differentiation between patients with IMNM and those without the superimposed autoimmune phenomena helps clinicians determine the best individualized approach to use and the appropriate immunosuppressive therapy, whenever needed.
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Abstract
Anti-mitochondrial antibody type 2 is a diagnostic marker of primary biliary cirrhosis and complicates myositis. Myositis with anti-mitochondrial antibody type 2 is clinically characterized by slowly progressive limb, cardiac, and respiratory muscle weakness as well as serum creatinine kinase elevations. However, there has been few cases with eye symptoms. We herein report a 59-year-old woman with anti-mitochondrial antibody type 2 who presented with diplopia and ptosis. Magnetic resonance imaging revealed bilateral ocular muscle enlargement and abnormally high intensities in the lower limb muscles. Corticosteroid therapy improved these symptoms. Myositis with anti-mitochondrial antibody type 2 can present with eye symptoms.
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Affiliation(s)
- Taichi Nomura
- Department of Neurology, Kushiro Rosai Hospital, Japan
| | - Kosuke Iwami
- Department of Neurology, Kushiro Rosai Hospital, Japan
| | - Azusa Nagai
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | | | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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Ashton C, Paramalingam S, Stevenson B, Brusch A, Needham M. Idiopathic inflammatory myopathies: a review. Intern Med J 2021; 51:845-852. [PMID: 34155760 DOI: 10.1111/imj.15358] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/14/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
Idiopathic inflammatory myopathy (IIM) is the umbrella term including dermatomyositis (DM), polymyositis (PM), overlap myositis (OM), sporadic inclusion body myositis (IBM) and necrotising autoimmune myopathy (NAM), also known as immune-mediated necrotising myopathy. There is some debate as to whether PM exists as a discrete entity, or perhaps is an overly generalising term encompassing connective tissue disease associated myositis, or OM, and the previously poorly recognised NAM. As such, PM will not be covered in detail in this review. DM, OM and NAM all present similarly, with proximal weakness and elevated creatine kinase (CK) level. By contrast, IBM preferentially involves the long finger flexors and quadriceps, and presents with a normal or only mildly elevated CK. Developments in serological testing and imaging are shifting the diagnostic paradigm away from a reliance on histopathology. The therapeutic armamentarium for IIM continues to evolve, with intravenous immunoglobulin and rituximab proving to be successful for refractory disease. This review will provide a diagnostic algorithm for the clinician to help distinguish between IIM subtypes - with emphasis on clinical assessment, serology and imaging, as well as discussion of therapeutic options and escalation of immunotherapy.
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Affiliation(s)
- Catherine Ashton
- Neurology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Shereen Paramalingam
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,University of Notre Dame, Fremantle, Western Australia, Australia
| | - Brittany Stevenson
- Immunology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Immunology Department, PathWest, Perth, Western Australia, Australia
| | - Anna Brusch
- Department of Clinical Immunology, PathWest, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Merrilee Needham
- Neurology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,University of Notre Dame, Fremantle, Western Australia, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia.,Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
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Huang Y, Liu H, Wu C, Fang L, Fang Q, Wang Q, Fei Y, Guo X, Zhang S. Ventricular arrhythmia predicts poor outcome in polymyositis/dermatomyositis with myocardial involvement. Rheumatology (Oxford) 2021; 60:3809-3816. [PMID: 33369674 DOI: 10.1093/rheumatology/keaa872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/19/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Myocardial involvement (MCI) is known to increase morbidity and mortality in polymyositis (PM) and dermatomyositis (DM). This study aims to investigate whether complicating with ventricular arrhythmia (VA) predicts poor outcomes in patients with PM/DM-related myocardial involvement (PM/DM-MCI). METHODS We reviewed all PM/DM-MCI patients admitted to Peking Union Medical College Hospital from October 1997 to April 2019. VA and the other possible risk factors for the composite endpoint, including death from any cause and rehospitalization for cardiac causes, were analyzed. RESULTS A total of 75 PM/DM-MCI patients (44 PM and 31 DM) were enrolled, of which 27 (36%) met the composite endpoint during a median follow-up of 24 months. Independent prognostic factors for the composite endpoint include VA [HR 4.215, 95% CI (1.737, 10.230)], NT-proBNP > 3415 pg/ml [HR 2.606, 95% CI (1.203, 5.646)], interstitial lung disease [HR 2.688, 95% CI (1.209, 5.978)], and anti-cardiac remodelling therapy [HR 0.302, 95% CI (0.115, 0.792)]. The 3-year event-free survival rate of patients without VA was significantly higher than that of patients with VA (63.3% vs 40.7%, P = 0.034). Skin lesions [OR 0.163, 95% CI (0.051, 0.523)] and positive antimitochondrial antibody [OR 3.484, 95% CI (1.192, 10.183)] were independent predictors of VA. CONCLUSION VA provides prognostic insights for PM/DM-MCI patients and predicts poor outcome. Polymyositis and positive antimitochondrial antibody are closely associated with the presence of VA in PM/DM-MCI.
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Affiliation(s)
- Yongfa Huang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Huazhen Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chanyuan Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ligang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yunyun Fei
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxiao Guo
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Fairley JL, Wicks I, Peters S, Day J. Defining cardiac involvement in idiopathic inflammatory myopathies: a systematic review. Rheumatology (Oxford) 2021; 61:103-120. [PMID: 34273157 DOI: 10.1093/rheumatology/keab573] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Recent advances in cardiac magnetic resonance imaging (CMR) and other diagnostic techniques have made it easier to identify subclinical cardiac inflammation and dysfunction in the idiopathic inflammatory myopathies (IIM). Herein, we systematically review the literature regarding cardiac involvement in IIM. METHODS We searched Medline and EMBASE from 1990-2020 using keywords related to IIM and cardiac disease. We included English language studies in adults with any immune-mediated, inflammatory muscle pathology. RESULTS We identified 10425 potentially relevant abstracts, of which 29 were included. Most frequently these included patients with polymyositis or dermatomyositis without symptomatic myocarditis. Five categories of cardiac investigation were used in these patients: cardiac enzyme testing, electrocardiography (ECG), transthoracic echocardiography (TTE), CMR and nuclear medicine testing. Patients with clinical myocarditis had universally abnormal cardiac troponin levels and ECG. Elevated cardiac troponin T was more common than troponin I (cTnI) and may correlate with disease activity, whereas cTnI was more specific for cardiac involvement. Non-specific ECG changes were common. The major finding on TTE was abnormal ejection fraction. Gross systolic dysfunction was unusual, but subclinical systolic dysfunction was reported in several studies. Abnormal diastolic function was common and may be associated with disease duration. Late gadolinium enhancement (reflecting regional necrosis or scar) and abnormal myocardial mapping parameters (reflecting myocardial inflammation, fibrosis and oedema) were frequently identified on CMR, suggesting significant subclinical myocardial pathology (despite typically normal ejection fraction). CONCLUSION Abnormal cardiac investigations are commonly found in asymptomatic IIM patients, which has potential prognostic and treatment implications.
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Affiliation(s)
- Jessica L Fairley
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne VIC 3004 Australia
| | - Ian Wicks
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.,Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052 Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC 3052 Australia
| | - Stacey Peters
- Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.,Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052 Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC 3052 Australia
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Zhang L, Zhu H, Yang P, Duan X, Wei W, Wu Z, Fang Y, Li Q, Liu S, Shi X, Li H, Wu C, Zhou S, Leng X, Zhao J, Xu D, Wu Q, Tian X, Li M, Zhao Y, Wang Q, Zeng X. Myocardial involvement in idiopathic inflammatory myopathies: a multi-center cross-sectional study in the CRDC-MYO Registry. Clin Rheumatol 2021; 40:4597-4608. [PMID: 34184155 DOI: 10.1007/s10067-021-05828-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to investigate the associated factors of myocardial involvements (MIs) in patients with idiopathic inflammatory myopathies (IIMs). METHODS In this multi-center cross-sectional study, 1946 patients with IIMs were enrolled from Chinese Rheumatism Data Center-Myositis Registry (CRDC-MYO). A total of 108 (5.5%) patients were identified with MIs, including congestive heart failure (n = 67, 62.0%), and severe arrhythmias (n = 61, 56.5%). The other 1838 IIM patients without IMs were set as the control group. Clinical features were collected including age, gender, comorbidities, clinical symptoms, clinical signs of both IIMs and MIs, lab findings including myositis-specific antibodies (MSAs) and myositis-associated antibodies (MAAs), echocardiogram, and radiological exams. Multivariate logistic analysis was used to explore independent associated factors of MIs in patients with IIMs. RESULTS Several independent associated factors were identified in multi-variate logistic regression, including positivity for anti-mitochondrial antibody-subtype 2 (AMA-M2) (OR 5.194, 95% CI 2.509-10.753, P < 0.001), elevation of creatine kinase (CK) (OR 2.611, 95% CI 1.312-5.198, P = 0.006), elevation of C-reactive protein (CRP) (OR 2.150, 95% CI 1.211-3.818, P = 0.001), and pulmonary hypertension (OR 4.165, 95% CI 1.765-9.882, P = 0.009). AMA-M2 and pulmonary hypertension were the most consistent associated factors in the polymyositis subgroup and the dermatomyositis/clinically amyopathic dermatomyositis subgroup. CONCLUSIONS MIs are rare but serious complication of IIMs could lead to congestive heart failure and severe arrhythmias. IIM patients with AMA-M2 positivity, elevation of CK and CRP, and pulmonary hypertension are more likely to develop MI complications. Key Points • This study investigated the independent associated factors for clinically significant myocardial involvements among idiopathic inflammatory myopathies in a large-scale, nation-wide multi-center cross-sectional study.
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Affiliation(s)
- Lixi Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Huiyi Zhu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Pinting Yang
- Department of Rheumatology, The First Hospital of China Medical University, Shenyang, China
| | - Xinwang Duan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Wei
- Department of Rheumatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhenbiao Wu
- Department of Rheumatology, Xijing Hospital of Air Force Military Medical University, Xian, China
| | - Yongfei Fang
- Department of Rheumatology, The Southwest Hospital of Army Medical University, Chongqing, China
| | - Qin Li
- Department of Rheumatology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Shengyun Liu
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaofei Shi
- Department of Rheumatology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Hongbin Li
- Department of Rheumatology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Chanyuan Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Shuang Zhou
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xiaomei Leng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Qingjun Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xinping Tian
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yan Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Lin CY, Chen HA, Hsu TC, Wu CH, Su YJ, Hsu CY. Time-Dependent Analysis of Risk of New-Onset Heart Failure Among Patients With Polymyositis and Dermatomyositis. Arthritis Rheumatol 2021; 74:140-149. [PMID: 34180158 DOI: 10.1002/art.41907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 05/30/2021] [Accepted: 06/23/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the risk and time trends of heart failure (HF) leading to hospitalization in individuals newly diagnosed as having polymyositis/dermatomyositis (PM/DM) relative to non-PM/DM controls at the general population level. METHODS A retrospective cohort study was conducted using data from a nationwide insurance database in Taiwan. Patients with incident PM/DM and without a history of HF were selected between 2000 and 2013. Unmatched and propensity score-matched cohorts were established separately. A multivariable Cox proportional hazards regression model was used to estimate the adjusted hazard ratio (HR) for the risk of HF in the unmatched cohort. In the propensity score-matched cohort, general population controls were selected and matched at a 1:1 ratio to the patients with PM/DM based on propensity scores, which accounted for the confounding factors of age, sex, index date (year) of first diagnosis, comorbidities, and medication usage. The cumulative incidence of HF was estimated using the Kaplan-Meier method. A stratified Cox proportional hazards model was used to calculate the HR for the risk of HF events at different follow-up time points among patients with PM/DM compared with non-PM/DM controls in the propensity score-matched cohort. RESULTS In the unmatched cohort, the study assessed 2,025 patients with PM/DM and 196,109 general population controls. Results of multivariable Cox regression analysis, adjusted for age, sex, comorbidities, and medication usage, revealed a greater risk of HF leading to hospitalization in the PM/DM group than in the control group (adjusted HR 3.29, 95% confidence interval [95% CI] 2.60-4.18). After matching based on propensity score, a total of 1,997 pairs of PM/DM patients and general population controls were identified. In this propensity score-matched cohort, the cumulative incidence of HF in patients with PM/DM at 3 years, 5 years, and 10 years was 3.3%, 4.4%, and 7.4%, respectively. The absolute difference in HF risk in the PM/DM group compared with the control group was 1.8% at 3 years, 2.1% at 5 years, and 3.0% at 10 years. Compared with general population controls, patients with PM/DM exhibited an augmented risk of HF (HR 2.06, 95% CI 1.36-3.12). Analyses stratified according to follow-up time point revealed that the increased risk of HF persisted for up to 10 years after the PM/DM diagnosis. CONCLUSION These results indicate that the risk of HF leading to hospitalization was increased in patients with PM/DM throughout the study period, supporting the need for greater vigilance in the monitoring of patients with PM/DM for the development of this potentially lethal complication.
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Affiliation(s)
- Chun-Yu Lin
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-An Chen
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | | | - Chun-Hsin Wu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Jih Su
- Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Yuan Hsu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, and School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Zhang L, Yang H, Lei J, Peng Q, Yang H, Wang G, Lu X. Muscle pathological features and extra-muscle involvement in idiopathic inflammatory myopathies with anti-mitochondrial antibody. Semin Arthritis Rheum 2021; 51:741-748. [PMID: 34144384 DOI: 10.1016/j.semarthrit.2021.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/16/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Anti-mitochondrial antibodies (AMAs) can be detected in some idiopathic inflammatory myopathy (IIM) patients. We aimed to investigate the clinical features of IIM patients with AMAs. METHODS We retrospectively analysed 1,167 consecutive patients with IIM for AMA-associated myositis and compared them to age- and gender-matched AMA-negative IIM patients. RESULTS Twenty-nine patients (2.5%) were identified with AMA-positive myositis; eight of them had primary biliary cholangitis (PBC). There were no significant differences in skin rash, dysphagia, interstitial lung disease, and muscle strength between AMA-positive patients and AMA-negative patients. Of 23 cases, 12 (52.2%) showed immune-mediated necrotizing myopathy (IMNM)-like pathological features. amongst AMA-positive patients, 11 of 16 patients with isolated anti-AMAs were classified as IMNM which was significantly higher than that of patients with coexistent anti-AMAs and myositis-specific antibodies (p = 0.026). Moreover, subclinical cardiac involvement was significantly more common in AMA-positive patients than in AMA-negative patients (21/29 VS 33/116, p<0.001). In addition, patients without PBC had a significantly higher incidence of abnormal echocardiography findings than that of patients with PBC (p = 0.009). Patients without heart abnormalities took significantly less time to achieve disease remission and prednisone tapering to <10 mg than patients with heart abnormalities (p = 0.000 and p = 0.001, respectively). CONCLUSIONS IMNM was a major histopathological finding in IIM patients with isolated AMAs. AMAs were significantly associated with subclinical cardiac involvement in IIM. PBC seemed to be a protective factor for abnormal echocardiography findings in AMA-positive patients. Patients without heart involvement took less time to achieve disease remission and prednisone tapering off.
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Affiliation(s)
- Lu Zhang
- Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Hanbo Yang
- Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Jieping Lei
- Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Qinglin Peng
- Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Hongxia Yang
- Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Xin Lu
- Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China.
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Sabbagh SE, Pinal-Fernandez I, Casal-Dominguez M, Albayda J, Paik JJ, Miller FW, Rider LG, Mammen AL, Christopher-Stine L. Anti-mitochondrial autoantibodies are associated with cardiomyopathy, dysphagia, and features of more severe disease in adult-onset myositis. Clin Rheumatol 2021; 40:4095-4100. [PMID: 33851273 PMCID: PMC8463345 DOI: 10.1007/s10067-021-05730-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/25/2022]
Abstract
We analyzed the prevalence of anti-mitochondrial autoantibodies (AMA) in adult- and juvenile-onset myositis longitudinal cohorts and investigated phenotypic differences in myositis patients with AMA. We screened sera from myositis patients including 619 adult- and 371 juvenile-onset dermatomyositis (DM, JDM), polymyositis (PM, JPM), inclusion body myositis (IBM), or amyopathic DM patients and from healthy controls, including 164 adults and 92 children, for AMA by ELISA. Clinical characteristics were compared between myositis patients with and without AMA. AMA were present in 5% of adult myositis patients (16 of 216 DM, 10 of 222 PM, 4 of 140 IBM, 1 of 19 amyopathic DM), 1% of juvenile myositis patients (3 of 302 JDM, 1 of 25 JPM), and 1% of both adult and juvenile healthy controls. In patients with adult-onset myositis, AMA were associated with persistent muscle weakness, Raynaud’s phenomenon, dysphagia, and cardiomyopathy. Adult myositis patients with AMA may have more severe or treatment refractory disease, as they more frequently received glucocorticoids and intravenous immunoglobulin. In juvenile myositis, children with AMA often had falling episodes and dysphagia, but no other clinical features or medications were significantly associated with AMA. AMA are present in 5% of adult myositis patients and associated with cardiomyopathy, dysphagia, and other signs of severe disease. The prevalence of AMA is not increased in patients with juvenile myositis compared to age-matched healthy controls. Our data suggest that the presence of AMA in adult myositis patients should prompt screening for cardiac and swallowing involvement.
Key Points • Approximately 5% of a large North American cohort of adult myositis patients have anti-mitochondrial autoantibodies. • Adults with anti-mitochondrial autoantibodies often have chronic weakness, Raynaud’s, dysphagia, cardiomyopathy, and more severe disease. • Anti-mitochondrial autoantibodies are rare in juvenile myositis and not associated with a specific clinical phenotype. |
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Affiliation(s)
- Sara E Sabbagh
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.,Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Iago Pinal-Fernandez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Maria Casal-Dominguez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jemima Albayda
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie J Paik
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa Christopher-Stine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins Myositis Center, Division of Rheumatology, Johns Hopkins University School of Medicine, Bayview Medical Office, 5200 Eastern Ave #301, Baltimore, MD, 21224, USA.
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Takahashi F, Sawada J, Minoshima A, Sakamoto N, Ono T, Akasaka K, Takei H, Nishino I, Hasebe N. Antimitochondrial Antibody-associated Myopathy with Slowly Progressive Cardiac Dysfunction. Intern Med 2021; 60:1035-1041. [PMID: 33116011 PMCID: PMC8079923 DOI: 10.2169/internalmedicine.5600-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A 45-year-old woman was referred to our hospital for the evaluation of proximal muscle weakness and serum creatine kinase elevation [corrected]. She had atrial fibrillation and left ventricular asynergy. She was diagnosed with myopathy, accompanied by cardiomyopathy of unknown etiology. She was treated with prednisolone. After long-term follow-up and a detailed examination, the patient was diagnosed with antimitochondrial antibody (AMA)-associated myopathy with cardiac involvement. Although the patient received medical treatment, including beta-blockers and prednisolone, her cardiac function deteriorated progressively. Physicians should consider AMA-associated myopathy when diagnosing myopathies of unknown etiology. The presence of cardiac involvement should be proactively investigated in AMA-associated myopathy.
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Affiliation(s)
| | - Jun Sawada
- Department of the Internal Medicine, Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan
| | - Akiho Minoshima
- Department of the Internal Medicine, Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan
| | - Naka Sakamoto
- Department of the Internal Medicine, Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan
| | - Toshiyuki Ono
- Department of the Internal Medicine, Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan
| | - Kazumi Akasaka
- Department of Laboratory Medicine, Asahikawa Medical University, Japan
| | - Hidehiro Takei
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Japan
| | - Ichizo Nishino
- Department of the Neuromuscular Research, National Institute of Neuroscience, Japan
| | - Naoyuki Hasebe
- Department of the Internal Medicine, Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan
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Højgaard P, Witting N, Rossing K, Pecini R, Hartvig Lindkær Jensen T, Hasbak P, Diederichsen LP. Cardiac arrest in anti-mitochondrial antibody associated inflammatory myopathy. Oxf Med Case Reports 2021; 2021:omaa150. [PMID: 33732479 PMCID: PMC7947270 DOI: 10.1093/omcr/omaa150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
Insight into predictors of cardiac involvement in inflammatory myopathies is sparse. A negative prognostic role of anti-mitochondrial antibodies (AMA) has been noticed and is supported by the current case. We describe a male patient who at the age 40 suffered a cardiac arrest and over the following months experienced progressive heart failure, arrhythmias and proximal muscle weakness. Clinical, genetic and serologic testing and repeated imaging- and histopathological investigations resulted in a diagnosis of AMA-associated, necrotizing, inflammatory myositis with cardiac involvement. Besides a cardiac resynchronization therapy defibrillator, heart failure and antiarrhythmic drugs the patient received successive immunosuppressants, which improved skeletal muscle strength but not cardiac disease progression. At age 45 he died from end-stage heart failure. Clinicians must be aware of AMA-associated myositis as a cause of unclarified heart disease, even in patients with initially sparse extra-cardiac manifestations. Further knowledge of treatment strategies is highly needed for this disease entity.
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Affiliation(s)
- Pil Højgaard
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Denmark.,Division of Rheumatology, Department of Internal Medicine, Holbæk Hospital, Denmark
| | - Nanna Witting
- Copenhagen Neuromuscular Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Redi Pecini
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | | | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Denmark
| | - Louise P Diederichsen
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
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49
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Yokokawa T, Yoshihisa A, Misaka T, Sato T, Kaneshiro T, Oikawa M, Kobayashi A, Yamaki T, Kunii H, Takeishi Y. Anti-mitochondrial Antibodies in Patients with Dilated Cardiomyopathy. Intern Med 2021; 60:201-208. [PMID: 33456024 PMCID: PMC7872813 DOI: 10.2169/internalmedicine.5422-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective It has been reported that anti-mitochondrial antibodies (AMAs) recognize mitochondrial antigens and are associated with some diseases involving multiple organs, such as primary biliary cholangitis, Sjögren syndrome, Hashimoto's thyroiditis, systemic sclerosis, interstitial pneumoniae, dilated cardiomyopathy, and tubulointerstitial nephritis. In the current study, we examined the prevalence of AMAs in patients with dilated cardiomyopathy (DCM) and their clinical characteristics. Methods We enrolled 270 patients with DCM. We measured serum AMAs and analyzed the associated factors. Out of the 270 patients, positive AMAs were detected in 3 patients (1.1%; mean age, 68 years old; 2 men). These three patients had a significantly higher prevalence of primary biliary cholangitis and myopathy and levels of alanine alkaline phosphatase than those who were negative for said antibodies. There were no significant differences in the levels of B-type natriuretic peptide, aspartate transaminase, and left ventricular ejection fraction between these groups of patients. During the follow-up period, two of the three patients died due to respiratory failure. The other patient survived but experienced type II respiratory failure. Conclusion The prevalence of AMAs in 270 DCM patients was only 1.1%, and these patients suffered from respiratory failure.
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Affiliation(s)
- Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
- Department of Pulmonary Hypertension, Fukushima Medical University, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Japan
| | - Takamasa Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Takashi Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Hiroyuki Kunii
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
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Autoimmune skin diseases associated with inpatient primary biliary cholangitis. J Am Acad Dermatol 2020; 85:1002-1004. [PMID: 33010311 DOI: 10.1016/j.jaad.2020.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/03/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022]
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