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Sabaté-Ortega J, Bujons-Buscarons E, Fina-Planas C, Vilanova-Anducas N, Vidal-Sarró N, Sala-González N. Paraneoplastic dermatomyositis associated with urothelial cancer: report of a case and systematic review of the literature. Front Oncol 2023; 13:1223627. [PMID: 38023222 PMCID: PMC10644711 DOI: 10.3389/fonc.2023.1223627] [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: 05/23/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background The idiopathic inflammatory myopathies (IIM) are a collection of autoimmune diseases that have a substantial impact on the entire body and include conditions such as dermatomyositis (DM), polymyositis (PM), sporadic inclusion body myositis, and immune-mediated necrotizing myopathy. These disorders are characterized by symptoms such as muscular weakness, pain, and dermal rash. This systematic review is intended to explore the potential link between bladder cancer and DM/PM. Methods We performed a comprehensive systematic search on PubMed and Scopus until August 2022 to identify relevant research studies. The studies that met our inclusion criteria focused on patients with urinary bladder cancer and dermatomyositis, and/or polymyositis. Results The patients' median age was 65.5 years (47-79), with the majority being male (15, 39.47%). Bladder cancer manifested before PM/DM in 5 (13.15%) patients, while in the majority of cases occurred after the cancer diagnosis. The stage of cancer at the time of the initial PM/DM diagnosis were mostly locally (11/20, 50%).During the first presentation, the patients had a median creatine kinase level of 2227 U/L, ranging between 44 and 10471. In one case, anti-TIF-1γ antibodies were found to be present. Among the cases with reported medical history (20/38), treatment immediately improved DM symptoms in 16 patients(53.8%) and in 3 patients(15%), symptoms of DM resurfaced during the period after the operation. Death was reported in 14 (36.8%) patients. Conclusion In conclusion, our study provides knowledge and understanding for identifying specific risk factors in patients with the coexistence of bladder cancer and DM/PM and their management. During the initial and follow-up screening, age, gender, and the clinicopathological subgroup of myositis should be considered to ensure proper management of the condition.
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Affiliation(s)
- Josep Sabaté-Ortega
- Oncology Department, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Elisabet Bujons-Buscarons
- Oncology Department, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Clàudia Fina-Planas
- Oncology Department, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | | | - Noemí Vidal-Sarró
- Department of Pathology, Hospital Universitari de Bellvitge.L’Hospitalet, Barcelona, Spain
| | - Núria Sala-González
- Oncology Department, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
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2
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Grover KM, Sripathi N. Prevention of Adverse Outcomes and Treatment Side Effects in Patients with Neuromuscular Disorders. Semin Neurol 2022; 42:594-610. [PMID: 36400111 DOI: 10.1055/s-0042-1758779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this article, we review prevention of serious adverse clinical outcomes and treatment side effects in patients with neuromuscular disorders including myopathies and myasthenia gravis. While neither of these entities is preventable, their course can often be modified, and severe sequelae may be prevented, with the identification of risk factors and proactive attention toward treatment planning.
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Affiliation(s)
- Kavita M Grover
- Department of Neurology, Henry Ford Medical Group, Wayne State University, Detroit, Michigan
| | - Naganand Sripathi
- Department of Neurology, Henry Ford Medical Group, Wayne State University, Detroit, Michigan
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3
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Gutierrez D, Svigos K, Femia A, Brinster NK, Lo Sicco K. Prominent dyspigmentation in a patient with dermatomyositis and TIF1-γ autoantibodies. JAAD Case Rep 2022; 22:107-109. [PMID: 35355654 PMCID: PMC8958465 DOI: 10.1016/j.jdcr.2022.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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4
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Hodgkinson LM, Wu TT, Fiorentino DF. Dermatomyositis autoantibodies: how can we maximize utility? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:433. [PMID: 33842654 PMCID: PMC8033377 DOI: 10.21037/atm-20-5175] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The past 15 years has seen significant advances in the characterization of myositis-specific autoantibodies (MSAs) and their associated phenotypes in patients with dermatomyositis (DM). As more careful studies are performed, it is clear that unique combinations of clinical and pathological phenotypes are associated with each MSA, despite the fact that there is considerable heterogeneity within antibody classes as well as overlap across the groups. Because risk for interstitial lung disease (ILD), internal malignancy, adverse disease trajectory, and, potentially response to therapy differ by DM MSA group, a deeper understanding of MSAs and validation and standardization of assays used for detection are critical for optimizing diagnosis and treatment. Like any test, the diagnostic sensitivity and specificity of assays for various MSAs is not perfect. Currently tests for MSAs are helpful at minimum for a clinician to assess relative risk or contribute to diagnosis and perhaps counsel the appropriate patient about what to expect. With international standardization and larger studies it is likely that more antibody tests will make their way into formal schemata for diagnosis and actionable risk assessment in DM. In this review, we summarize key considerations for interpreting the clinical and pathologic associations with MSA in DM and identify critical gaps in knowledge and practice that will maximize their clinical utility and utility for understanding disease pathogenesis.
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Affiliation(s)
| | - Tiffany Tingshuen Wu
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
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5
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Lambert-Eaton Myasthenic Syndrome and Dermatomyositis With Anti-TIF1-gamma Autoantibody: A Unique Association of Autoimmune Neuromuscular Conditions Without Malignancy. J Clin Neuromuscul Dis 2021; 22:164-168. [PMID: 33596001 DOI: 10.1097/cnd.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Lambert-Eaton myasthenic syndrome (LEMS) is a presynaptic neuromuscular junction disorder, and dermatomyositis (DM) is an idiopathic inflammatory myopathy. LEMS and DM are uncommon conditions that can present similarly and are often associated with autoantibodies. Concomitant LEMS and DM have only been reported a few times, and most of those cases were paraneoplastic. We present the first reported case of a patient with antivoltage gated calcium channel antibody positive LEMS who subsequently developed DM with antitranscription intermediary factor 1-gamma (anti-TIF1-γ) antibodies. Interestingly, both conditions occurred without evidence of malignancy. This diagnosis of LEMS and DM with characteristic clinical, electrodiagnostic, and histopathological evidence led to a beneficial modification of the patient's therapeutic regimen. Due to the fact that overlapping concurrent neuromuscular conditions are rare, a high clinical suspicion is needed to identify, evaluate (including appropriate cancer screenings), and appropriately treat these patients.
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6
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De Vooght J, Vulsteke JB, De Haes P, Bossuyt X, Lories R, De Langhe E. Anti-TIF1-γ autoantibodies: warning lights of a tumour autoantigen. Rheumatology (Oxford) 2020; 59:469-477. [PMID: 31883334 DOI: 10.1093/rheumatology/kez572] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/25/2019] [Indexed: 11/14/2022] Open
Abstract
Anti-transcription intermediary factor 1 (TIF1)-γ autoantibodies are robustly linked with cancer-associated DM in adults. This review aims to give an overview of the physiological context of TIF1-γ and to determine whether there is a pathophysiological link between anti-TIF1-γ autoantibodies and the occurrence of cancer. Detection of anti-TIF1-γ autoantibodies has a high sensitivity and specificity for cancer-associated DM in adults and is therefore useful for both diagnosis and cancer risk stratification. The function of the autoantigen, TIF1-γ, may provide insight into the mechanism behind this association. TIF1-γ is a ubiquitously present protein involved in various biological pathways, including TGF-β signalling. In cancer, it can act either as a tumour suppressor or promoter, depending on the cellular context and cancer stage. Evolving data provide pathophysiological insights, linking anti-TIF1-γ autoantibodies to both the anti-tumour response and to muscle and skin damage. TIF1-γ expression is increased in muscle and skin tissue of patients with DM. Mutations or loss-of-heterozygosity in TIF1-γ alleles in malignant tissue may result in the expression of tumour-specific neo-antigens stimulating autoantibody production. The newly formed autoantibodies are hypothesized to cross-react with antigens in muscle and skin, driving the development of DM. Based on the current evidence, anti-TIF1-γ autoantibodies should be considered warning lights of a potential tumour autoantigen and should alert the physician to the possibility of an underlying cancer.
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Affiliation(s)
| | - Jean-Baptiste Vulsteke
- Division of Rheumatology, University Hospitals Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Belgium
| | - Petra De Haes
- Division of Dermatology, University Hospitals Leuven, Belgium
| | - Xavier Bossuyt
- Clinical and Diagnostic Immunology, Department of Microbiology and Immunology, KU Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, Clinical and Diagnostic Immunology, KU, Leuven, Leuven, Belgium
| | - Rik Lories
- Division of Rheumatology, University Hospitals Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Belgium
| | - Ellen De Langhe
- Division of Rheumatology, University Hospitals Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Belgium
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7
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Alter M, Mengoni M, Gaffal E. Hautveränderungen bei internen Neoplasien. J Dtsch Dermatol Ges 2020; 18:456-471. [DOI: 10.1111/ddg.14093_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/08/2020] [Indexed: 12/01/2022]
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8
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Alter M, Mengoni M, Gaffal E. Cutaneous manifestations of internal malignancy. J Dtsch Dermatol Ges 2020; 18:456-469. [PMID: 32311823 DOI: 10.1111/ddg.14093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/08/2020] [Indexed: 12/13/2022]
Abstract
Skin lesions associated with internal malignancy may present as cutaneous metastases or as typical lesions occurring in the context of certain cancer-associated genetic syndromes. Paraneoplastic syndromes, on the other hand, are only indirectly associated with an underlying malignancy and are not malignant per se. Historically, a distinction has been made between "obligate" and "facultative" paraneoplastic disorders, depending on the likelihood with which they are potentially associated with malignancy. In addition, there are nonspecific cutaneous manifestations that are only rarely associated with an underlying malignancy. Another possible classification is based on the pathophysiological mechanisms underlying the cutaneous lesions. In everyday practice, it is essential that dermatologists recognize potentially cancer-associated dermatoses, as this will frequently contribute to the initial diagnosis of an underlying neoplasm.
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Affiliation(s)
- Mareike Alter
- Department of Dermatology, University Medical Center, Magdeburg, Germany
| | - Miriam Mengoni
- Department of Dermatology, University Medical Center, Magdeburg, Germany
| | - Evelyn Gaffal
- Department of Dermatology, University Medical Center, Magdeburg, Germany
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9
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The cancer immunotherapy environment may confound the utility of anti-TIF-1γ in differentiating between paraneoplastic and treatment-related dermatomyositis. Report of a case and review of the literature. Contemp Oncol (Pozn) 2020; 24:75-78. [PMID: 32514241 PMCID: PMC7265958 DOI: 10.5114/wo.2020.94727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/28/2020] [Indexed: 01/06/2023] Open
Abstract
With the advent of immunotherapy and with the expanding spectrum of malignancies treated with immunomodulatory agents, a new kind of adverse events has come under the spotlight. Clinicians have to be aware of immune-related adverse events and their clinical manifestations. Immunotherapy has been strongly associated with endocrinopathies, gastrointestinal, pulmonary, cutaneous, and renal toxicities but the incidence of rheumatologic adverse events is lower compared to the aforementioned systems. Dermatomyositis is an autoimmune myopathy which has been correlated to underlying evident or occult malignancies. Apart from its characteristic symptoms and signs, the presence of specific antibodies such as anti-transcriptional intermediary factor 1γ (anti-TIF 1γ) usually supports the diagnosis of paraneoplastic nature of the disease. However, a solid distinction between paraneoplastic syndrome and immune-related adverse event is still missing and remains to be elucidated. We here present a case of dermatomyositis in a male patient who underwent four cycles of combined ipilimumab and nivolumab immunotherapy. This is, to our knowledge, the first case of dermatomyositis following combined immune checkpoint inhibition therapy.
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10
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Allenbach Y, Benveniste O. Miopatie infiammatorie. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)43301-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Brickman ZJ, Coomes EA, Stroud L. Erythrodermic paraneoplastic dermatomyositis. CMAJ 2019; 190:E1453. [PMID: 30530613 DOI: 10.1503/cmaj.180868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | - Eric A Coomes
- Department of Medicine, University of Toronto, Toronto, Ont.
| | - Lynfa Stroud
- Department of Medicine, University of Toronto, Toronto, Ont
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12
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Labrador-Horrillo M, Selva-O'Callaghan A. Cancer-associated Dermatomyositis: Does the PD-1 Checkpoint Pathway Play a Role? J Rheumatol 2019; 45:731-732. [PMID: 29858454 DOI: 10.3899/jrheum.180007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Moises Labrador-Horrillo
- Systemic Autoimmune Diseases Unit, Vall D'Hebron General Hospital, Internal Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Vall D'Hebron General Hospital, Internal Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain
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13
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Selva-O'Callaghan A, Ros J, Gil-Vila A, Vila-Pijoan G, Trallero-Araguás E, Pinal-Fernandez I. Malignancy and myositis, from molecular mimicry to tumor infiltrating lymphocytes. Neuromuscul Disord 2019; 29:819-825. [PMID: 31635909 DOI: 10.1016/j.nmd.2019.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 01/21/2023]
Abstract
Cancer-associated dermatomyositis provides a unique opportunity to explore the relationship between autoimmunity and cancer. In this review, we describe the related epidemiological issues, considering the various currently accepted myositis phenotypes, their link with cancer, and the possible mechanisms leading to this relationship. We discuss current evidence regarding the role of molecular mimicry, somatic DNA tumor mutations, and the PD-1/PD-L1 pathway in the association between cancer and myositis. We also review tumor-infiltrating lymphocytes as a relevant factor to be evaluated in cancer-associated myositis, their interaction with tumor neoantigens, and the tumor mutational burden, all of which have implications for the treatment of these patients with immunotherapy. Finally, we discuss clinical scenarios related to the relationship between cancer and myositis, delineating a comprehensive theory linking autoimmunity and cancer.
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Affiliation(s)
- Albert Selva-O'Callaghan
- Internal Medicine Department, Autoimmune Systemic Diseases Unit, Vall d'Hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Javier Ros
- Medical Oncology Department, Vall d'Hebron General Hospital, Barcelona, Spain
| | - Albert Gil-Vila
- Internal Medicine Department, Autoimmune Systemic Diseases Unit, Vall d'Hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Gemma Vila-Pijoan
- Immunology Department, Vall d'Hebron General Hospital, Barcelona, Spain
| | | | - Iago Pinal-Fernandez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Johns Hopkins University School of Medicine, Baltimore, United States
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14
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Abstract
Rheumatic paraneoplastic syndromes are paraneoplastic arthritis, palmar fasciitis and polyarthritis syndrome, remitting seronegative symmetrical synovitis with pitting edema, pancreatic panniculitis with polyarthritis, paraneoplastic vasculitis, cancer-associated myositis, hypertrophic osteoarthropathy (Marie-Bamberger disease) and tumor-induced osteomalacia. Typical clinical manifestations, pathogenesis, prognosis, and treatment of this entity are presented. Knowledge of these disease entities can lead to timely diagnosis of the underlying malignant disease and to a higher probability of a cure. Response of the paraneoplastic inflammatory manifestations to corticosteroids, non-steroidal anti-inflammatory drugs or immunosuppressants is often insufficient. Curative removal of the malignant disease is crucial for the course of the paraneoplastic syndrome. When a paraneoplastic etiology of rheumatic symptoms is suspected, a step-wise diagnostic strategy is advisable.
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Dziwis J, Agnihothri R, Lieberman A, Richardson CT. A unique case of dermatomyositis associated with anti-TIF1γ antibody and chondrosarcoma. JAAD Case Rep 2019; 5:828-830. [PMID: 31517008 PMCID: PMC6731355 DOI: 10.1016/j.jdcr.2019.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Jennifer Dziwis
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ritesh Agnihothri
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Alicia Lieberman
- Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, New York
| | - Christopher T. Richardson
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
- Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, New York
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16
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Martis N, Viau P, Zenone T, Andry F, Grados A, Ebbo M, Castela E, Brihaye B, Denis E, Liguori S, Audemard A, Schoindre Y, Morin AS, Terrier B, Marcq L, Mounier N, Lidove O, Chaborel JP, Quinsat D. Clinical value of a [18F]-FDG PET-CT muscle-to-muscle SUV ratio for the diagnosis of active dermatomyositis. Eur Radiol 2019; 29:6708-6716. [PMID: 31250167 DOI: 10.1007/s00330-019-06302-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/11/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study a muscle-to-muscle standardised uptake value (SUV) ratio with FDG-PET/CT (FDG-PET) as a marker for the detection of disease activity in dermatomyositis (DM). METHODS Patients with DM (n = 24) who met the European Neuro-Muscular Centre diagnostic criteria were retrospectively identified over a 3-year period through a national survey. Muscle biopsy was performed in all patients. Maximum SUV was measured in proximal muscles (SUVPROX) that had the highest radiotracer uptake on visual grading as well as in the musculus longissimus thoracis (SUVMLT), whereas mean SUV was measured for the liver (SUVLIV). Muscle-to-liver SUV ratios for either muscle group were compared and a SUVPROX/SUVMLT ratio was calculated. SUVPROX/SUVMLT of DM patients were compared with age- and sex-matched control subjects (n = 24) with melanoma who had received FDG-PET scans. RESULTS DM patients presented with proximal and symmetrical muscle uptake. Differences in SUVPROX/SUVLIV and SUVMLT/SUVLIV ratios in DM subjects were significant (p < 0.001). SUVPROX/SUVMLT ratios in DM and their controls also differed significantly (p = 0.0012). The SUVPROX/SUVMLT ratio threshold between DM subjects and controls was 1.73 with a sensitivity of 50% (CI95%, 29.1 to 70.9%) and specificity at 83.3% (CI95%, 62.6 to 95.3%). When amyopathic DM patients were removed from the analysis, specificity was increased to 95% (CI95%, 75.1 to 99.9%) with a likelihood ratio of 10 and an AUC of 83.4% (CI95%, 71.4 to 95.4%). CONCLUSION A muscle-to-muscle SUVPROX/SUVMLT ratio with a cut-off value of 1.73 in FDG-PET imaging might serve as a non-invasive marker to determine disease activity in dermatomyositis. KEY POINTS • [18F]-FDG PET-scanner standardised uptake value (SUV) could reflect disease activity in dermatomyositis (DM). • A ratio of SUV in proximal muscles (SUVPROX) to SUV in musculus longissimus thoracis (SUVMLT) could be used to determine active DM. • Active disease is suspected for SUV PROX /SUV MLT ratios greater than 1.73.
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Affiliation(s)
- Nihal Martis
- Service de Médecine Interne, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France.
| | - Philippe Viau
- Service de Médecine Nucléaire, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France
| | - Thierry Zenone
- Service de Médecine Interne, CH de Valence, Valence, France
| | - Fanny Andry
- Service de Médecine Interne, CHU Michallon, Grenoble, France
| | - Aurélie Grados
- Service de Médecine Interne, Hôpital La Timone, AP-HM, Marseille, France
| | - Mikael Ebbo
- Service de Médecine Interne, Hôpital La Timone, AP-HM, Marseille, France
| | - Emeline Castela
- Service de Médecine Interne, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France
| | - Benoit Brihaye
- Service de Médecine Interne, CH Saint-Quentin, Saint-Quentin, France
| | - Eric Denis
- Service de Médecine Interne, CH d'Antibes-Juan-les-Pins, Antibes, France
| | - Stéphane Liguori
- Service de Biologie Médicale, CH d'Antibes-Juan-les-Pins, Antibes, France
| | | | - Yoland Schoindre
- Service de Médecine Interne, Hôpital de la Pitié Salpêtrière, AP-HP, Paris, France
| | - Anne-Sophie Morin
- Service de Médecine Interne, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, AP-HP, Paris, France
| | - Laurent Marcq
- Service de Médecine Interne, CH d'Antibes-Juan-les-Pins, Antibes, France
| | - Nicolas Mounier
- Service d'Onco-Hématologie, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France
| | - Olivier Lidove
- Service de Médecine Interne, CH Croix St-Simon, Paris, France
| | | | - Denis Quinsat
- Service de Médecine Interne, CH d'Antibes-Juan-les-Pins, Antibes, France
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17
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Stuhlmüller B, Schneider U, González-González JB, Feist E. Disease Specific Autoantibodies in Idiopathic Inflammatory Myopathies. Front Neurol 2019; 10:438. [PMID: 31139133 PMCID: PMC6519140 DOI: 10.3389/fneur.2019.00438] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/10/2019] [Indexed: 01/21/2023] Open
Abstract
Idiopathic inflammatory myopathies represent still a diagnostic and therapeutic challenge in different disciplines including neurology, rheumatology, and dermatology. In recent years, the spectrum of idiopathic inflammatory myopathies has been significantly extended and the different manifestations were described in more detail leading to new classification criteria. A major breakthrough has also occurred with respect to new biomarkers especially with the characterization of new autoantibody-antigen systems, which can be separated in myositis specific antibodies and myositis associated antibodies. These markers are detectable in approximately 80% of patients and facilitate not only the diagnostic procedures, but provide also important information on stratification of patients with respect to organ involvement, risk of cancer and overall prognosis of disease. Therefore, it is not only of importance to know the significance of these markers and to be familiar with the optimal diagnostic tests, but also with potential limitations in detection. This article focuses mainly on antibodies which are specific for myositis providing an overview on the targeted antigens, the available detection procedures and clinical association. As major tasks for the near future, the need of an international standardization is discussed for detection methods of autoantibodies in idiopathic inflammatory myopathies. Furthermore, additional investigations are required to improve stratification of patients with idiopathic inflammatory myopathies according to their antibody profile with respect to response to different treatment options.
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Affiliation(s)
- Bruno Stuhlmüller
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin, Germany
| | - Udo Schneider
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin, Germany
| | - José-B González-González
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin, Germany.,Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin, Germany
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18
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Lin C, Ying Z, Sijing C. Spontaneous resolution of dermatomyositis associated with fallopian-tube carcinoma following staging surgery: A case report. Medicine (Baltimore) 2019; 98:e14530. [PMID: 30855437 PMCID: PMC6417515 DOI: 10.1097/md.0000000000014530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Paraneoplastic dermatomyositis (DM) is an inflammatory disease of the connective tissue caused by immunologic events in the presence of malignant tumors, which are typically related to ovarian, pancreatic, stomach, and colon cancer. Traditional treatment of paraneoplastic DM includes combination therapy for the underlying malignancy with systemic steroids. PATIENT CONCERNS A 41-year-old woman presented with facial erythema and myalgia of the extremities. DIAGNOSIS The patient was diagnosed with DM associated with a fallopian-tube carcinoma. INTERVENTIONS The cancer staging surgery was performed via muilt-port laparoscope and administered 6 cycles of adjuvant chemotherapy with paclitaxel (210 mg) and carboplatin (600 mg) right ovary and the left fallopian tube were removed laparoscopically. OUTCOMES The DM healed spontaneously without the use of general glucocorticoids after the cancer staging surgery. During the 9-month follow-up, no recurrence of DM or neoplasm was observed. LESSONS This case highlights the fact that paraneoplastic DM can heal spontaneously after therapy for the underlying neoplasm, thereby avoiding the use of systemic steroids and their side effects. Moreover, DM can be an initial symptom for gynecological cancer such as fallopian-tube cancer. Thus, if DM is refractory to standard treatment, gynecological neoplasms should be considered.
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Affiliation(s)
- Chen Lin
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Disease of Women and Children, Sichuan University, Ministry of Education, People's Republic of China
| | - Zheng Ying
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Disease of Women and Children, Sichuan University, Ministry of Education, People's Republic of China
| | - Chen Sijing
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Disease of Women and Children, Sichuan University, Ministry of Education, People's Republic of China
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Pearse R, Visagan R, Reddy K, Dev S. Drug-induced paraspinal myositis mimicking acute bilateral sciatica. BMJ Case Rep 2019; 12:12/2/bcr-2018-224480. [PMID: 30796068 DOI: 10.1136/bcr-2018-224480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although cocaine induced myopathy and myotoxicity are described in the literature, we report a rare case of cocaine induced paraspinal myositis presenting with acute sciatic symptoms. A 35-year-old man presented with acute left-sided sciatica and was discharged from the emergency department (ED). He subsequently attended ED the following day in severe pain and bilateral sciatic symptoms, but denied symptoms of neurogenic bowel/bladder disturbance. Clinical examination was limited by severe pain: focal midline lumbar tenderness was elicited on palpation, per rectal and limb examinations were within normal limits with no significant neurological deficit. He was admitted for observation and pain management. His blood tests revealed a leucocyte count of 21.5×109/L, C reactive protein of 89 mg/L and deranged renal function with creatinine of 293 μmol/L. An urgent lumbar spine MRI was arranged to rule out a discitis or epidural abscess. Lumbar MRI did not demonstrate any features of discitis but non-specific appearances of paraspinal inflammation raised the suspicion of a paraspinal myositis. Creatinekinase (CK) was found to be 66329 IU/L and a detailed history revealed he was a cocaine user. Paraspinal muscle biopsy confirmed histological features compatible with myositis. Other serological tests were negative, including anti-GBM, ANCA, ANA, Rheumatoid factor, Hep B, Hep C, myositis specific ENA, Treponema pallidum, Borrelia burgdorferi, Rickettsia, Leptospira, EBV and CMV. There was good clinical response to treatment with prednisolone 20 mg OD with an improvement in renal function, CK levels and CRP. He had resumed normal activities and return to work at 6-week follow-up. A detailed social history including substance misuse is important in patients presenting to the ED-especially in cases of severe musculoskeletal pain with no obvious localising features. Drug induced myotoxicity, although rare, can result in symptomatic patients with severe renal failure.
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Affiliation(s)
- Richard Pearse
- Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Ravindran Visagan
- Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Kiran Reddy
- Radiology Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Shumontha Dev
- Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
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Pawaskar A, Basu S, Jahangiri P, Alavi A. In Vivo Molecular Imaging of Musculoskeletal Inflammation and Infection. PET Clin 2018; 14:43-59. [PMID: 30420221 DOI: 10.1016/j.cpet.2018.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In vivo molecular imaging detects biologic processes at molecular level and provides diagnostic information at an earlier time point during disease onset or repair. It offers definite advantage over anatomic imaging in terms of improved sensitivity and ability to quantify. Radionuclide molecular imaging has been widely used in clinical practice. This article discusses the role of radionuclide imaging in various infective and inflammatory diseases affecting musculoskeletal system with a focus on PET. It appears that, as more data become available, combined PET/MR imaging could emerge as a front runner in the imaging of musculoskeletal infection and inflammation.
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Affiliation(s)
- Alok Pawaskar
- Oncolife Cancer Centre, Satara, Maharashtra 415519, India; Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Parel, Mumbai, Maharashtra 400012, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Parel, Mumbai, Maharashtra 400012, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Pegah Jahangiri
- Division of Nuclear Medicine, Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Division of Nuclear Medicine, Hospital of University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Inflammatory disorders of the skeletal muscle include polymyositis (PM), dermatomyositis (DM), (immune mediated) necrotizing myopathy (NM), overlap syndrome with myositis (overlap myositis, OM) including anti-synthetase syndrome (ASS), and inclusion body myositis (IBM). Whereas DM occurs in children and adults, all other forms of myositis mostly develop in middle aged individuals. Apart from a slowly progressive, chronic disease course in IBM, patients with myositis typically present with a subacute onset of weakness of arms and legs, often associated with pain and clearly elevated creatine kinase in the serum. PM, DM and most patients with NM and OM usually respond to immunosuppressive therapy, whereas IBM is largely refractory to treatment. The diagnosis of myositis requires careful and combinatorial assessment of (1) clinical symptoms including pattern of weakness and paraclinical tests such as MRI of the muscle and electromyography (EMG), (2) broad analysis of auto-antibodies associated with myositis, and (3) detailed histopathological work-up of a skeletal muscle biopsy. This review provides a comprehensive overview of the current classification, diagnostic pathway, treatment regimen and pathomechanistic understanding of myositis.
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Affiliation(s)
- Jens Schmidt
- Department of Neurology, Muscle Immunobiology Group, Neuromuscular Center, University Medical Center Göttingen, Göttingen, Germany,Correspondence to: Prof. Dr. Jens Schmidt, MD, FEAN, FAAN, Muscle Immunobiology Group, Neuromuscular Center, Department of Neurology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Tel.: +49 551 39 22355; Fax: +49 551 39 8405; E-mail:
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23
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Best M, Jachiet M, Molinari N, Manna F, Girard C, Pallure V, Cosnes A, Lipsker D, Hubiche T, Schmutz JL, Le Corre Y, Cordel N, Dandurand M, Dereure O, Guillot B, Du-Thanh A, Bulai Livideanu C, Chasset F, Bouaziz JD, Francès C, Bengoufa D, Vincent T, Bessis D. Distinctive cutaneous and systemic features associated with specific antimyositis antibodies in adults with dermatomyositis: a prospective multicentric study of 117 patients. J Eur Acad Dermatol Venereol 2018; 32:1164-1172. [PMID: 29237090 DOI: 10.1111/jdv.14759] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/29/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Identification of myositis-specific autoantibodies (MSAs) for dermatomyositis (DM) could allow the characterization of an antibody-associated clinical phenotype. OBJECTIVE We sought to define the clinical phenotype of DM and the risk of cancer, interstitial lung disease (ILD) and calcinosis based on MSA. METHODS A 3.5-year multicentre prospective study of adult DM patients was conducted to determine the clinical phenotype associated with MSAs and the presence of cancer, ILD and calcinosis. RESULTS MSAs were detected in 47.1% of 117 included patients. Patients with antimelanoma differentiation-associated protein-5 antibodies (13.7%) had significantly more palmar violaceous macules/papules [odds ratio (OR) 9.9], mechanic's hands (OR 8), cutaneous necrosis (OR 3.2), articular involvement (OR 15.2) and a higher risk of ILD (OR 25.3). Patients with antitranscriptional intermediary factor-1 antibodies (11.1%), antinuclear matrix protein-2 antibodies (6.8%) and antiaminoacyl-transfer RNA synthetase (5.1%) had, respectively, significantly more poikiloderma (OR 5.9), calcinosis (OR 9.8) and articular involvement (OR 15.2). Cutaneous necrosis was the only clinical manifestation significantly associated with cancer (OR 3.1). CONCLUSION Recognition of the adult DM phenotype associated with MSAs would allow more accurate appraisal of the risk of cancer, ILD and calcinosis.
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Affiliation(s)
- M Best
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France
| | - M Jachiet
- Department of Dermatology, AP-HP, University of Paris VII Sorbonne Paris City and Saint-Louis Hospital, Paris, France
| | - N Molinari
- Department of Statistics, Montpellier University Hospital, Montpellier, France.,IMAG, CNRS, University of Montpellier, Montpellier, France
| | - F Manna
- Department of Statistics, Montpellier University Hospital, Montpellier, France
| | - C Girard
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France
| | - V Pallure
- Department of Internal Medicine and Dermatology, Perpignan Hospital, Perpignan, France
| | - A Cosnes
- Department of Dermatology, Henri-Mondor Hospital, Créteil, France
| | - D Lipsker
- Faculty of Medicine, University of Strasbourg and Dermatologic Clinic, Strasbourg University Hospital, Strasbourg, France
| | - T Hubiche
- Department of Dermatology and Infectious Diseases, Fréjus Hospital, Fréjus, France
| | - J-L Schmutz
- Department of Dermatology, Brabois Hospital, Nancy University Hospital, Nancy, France
| | - Y Le Corre
- Department of Dermatology, Angers University Hospital, Angers, France
| | - N Cordel
- Unit of Dermatology and Internal Medicine, Guadeloupe University Hospital, Pointe-à-Pitre, Guadeloupe, France
| | - M Dandurand
- Department of Dermatology, Caremeau Hospital, Nîmes, France
| | - O Dereure
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1058, Montpellier, France
| | - B Guillot
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1058, Montpellier, France
| | - A Du-Thanh
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1058, Montpellier, France
| | - C Bulai Livideanu
- Department of Dermatology, Toulouse University Hospital, Toulouse, France
| | - F Chasset
- AP-HP, Department of Dermatology and Allergology, Faculty of Medicine, Tenon Hospital, Sorbonne University, Paris, France
| | - J-D Bouaziz
- Department of Dermatology, AP-HP, University of Paris VII Sorbonne Paris City and Saint-Louis Hospital, Paris, France
| | - C Francès
- AP-HP, Department of Dermatology and Allergology, Faculty of Medicine, Tenon Hospital, Sorbonne University, Paris, France
| | - D Bengoufa
- Department of Immunology, Saint-Louis Hospital, Paris, France
| | - T Vincent
- Department of Immunology, Saint Eloi Hospital, and Montpellier University, Montpellier, France
| | - D Bessis
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1058, Montpellier, France
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25
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Dutton K, Soden M. Malignancy screening in autoimmune myositis among Australian rheumatologists. Intern Med J 2017; 47:1367-1375. [DOI: 10.1111/imj.13556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/15/2017] [Accepted: 07/18/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Katherine Dutton
- Department of Rheumatology; Royal Brisbane & Women's Hospital; Brisbane Queensland Australia
| | - Muriel Soden
- Department of Rheumatology; Townsville Hospital; Townsville Queensland Australia
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Dermatomyositis - key to diagnosing ovarian cancer, monitoring treatment and detecting recurrent disease: Case report. Gynecol Oncol Rep 2017; 23:1-3. [PMID: 29255784 PMCID: PMC5725216 DOI: 10.1016/j.gore.2017.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/22/2017] [Accepted: 11/25/2017] [Indexed: 01/30/2023] Open
Abstract
Young women with dermatomyositis are at high risk for underlying ovarian cancer. Dermatomyositis symptoms can be used to assess treatment and recurrence of disease. Immunosuppression can complicate postoperative recovery in ovarian cancer patients. Ovarian cancer patients with dermatomyositis should have genetic testing.
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27
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Hendren E, Vinik O. Idiopathic Inflammatory Myopathies and Malignancy. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2017. [DOI: 10.1007/s40674-017-0075-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Sunderkötter C, Nast A, Worm M, Dengler R, Dörner T, Ganter H, Hohlfeld R, Melms A, Melzer N, Rösler K, Schmidt J, Sinnreich M, Walter MC, Wanschitz J, Wiendl H. Guidelines on dermatomyositis--excerpt from the interdisciplinary S2k guidelines on myositis syndromes by the German Society of Neurology. J Dtsch Dermatol Ges 2016; 14:321-38. [PMID: 26972210 DOI: 10.1111/ddg.12909] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The present guidelines on dermatomyositis (DM) represent an excerpt from the interdisciplinary S2k guidelines on myositis syndromes of the German Society of Neurology (available at www.awmf.org). The cardinal symptom of myositis in DM is symmetrical proximal muscle weakness. Elevated creatine kinase, CRP or ESR as well as electromyography and muscle biopsy also provide important diagnostic clues. Pharyngeal, respiratory, cardiac, and neck muscles may also be affected. Given that approximately 30% of patients also develop interstitial lung disease, pulmonary function tests should be part of the diagnostic workup. Although the cutaneous manifestations in DM are variable, taken together, they represent a characteristic and crucial diagnostic criterion for DM. Approximately 5-20% of individuals exhibit typical skin lesions without any clinically manifest muscle involvement (amyopathic DM). About 30% of adult DM cases are associated with a malignancy. This fact, however, should not delay the treatment of severe myositis. Corticosteroids are the therapy of choice in myositis (1-2 mg/kg). Additional immunosuppressive therapy is frequently required (azathioprine, for children methotrexate). In case of insufficient therapeutic response, the use of intravenous immunoglobulins is justified. The benefit of rituximab has not been conclusively ascertained yet. Acute therapeutic management is usually followed by low-dose maintenance therapy for one to three years. Skin lesions do not always respond sufficiently to myositis therapy. Effective treatment for such cases consists of topical corticosteroids and sometimes also calcineurin inhibitors. Systemic therapies shown to be effective include antimalarial agents (also in combination), methotrexate, and corticosteroids. Intravenous immunoglobulins or rituximab may also be helpful. UV protection is an important prophylactic measure.
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Affiliation(s)
- Cord Sunderkötter
- Department of Dermatology, University Hospital Münster, and Department of Translational Dermatoinfectiology, Medical Faculty of the University of Münster and University Hospital, Münster, Germany
| | - Alexander Nast
- Division of Evidence-based Medicine (dEBM), Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center Berlin, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology, and Allergology, Charité, Berlin, Germany
| | - Reinhard Dengler
- Department of Neurology, Medical University Hanover, Hanover, Germany
| | - Thomas Dörner
- Department of Medicine, Division of Rheumatology and Clinical Immunology, Charité - University Medical Center Berlin, German Rheumatism Research Center, Berlin, Germany
| | - Horst Ganter
- German Association for Muscular Dystrophy (Executive Director)
| | - Reinhard Hohlfeld
- Institute for Clinical Neuroimmunology, Ludwig Maximilians University, Munich, Germany
| | - Arthur Melms
- Medical Park Bad Rodach and Department of Neurology, University of Erlangen, Erlangen, Germany
| | - Nico Melzer
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Kai Rösler
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Jens Schmidt
- Department of Neurology, University Hospital Göttingen, Göttingen, Germany
| | - Michael Sinnreich
- Neuromuscular Center, Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Maggi C Walter
- Friedrich-Baur Institute, Ludwig Maximilians University, Munich, Germany
| | - Julia Wanschitz
- Department of Neurology, University Hospital Innsbruck, Innsbruck, Austria
| | - Heinz Wiendl
- Department of Neurology, University Hospital, Münster, Germany
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Fujimoto M, Murakami A, Kurei S, Okiyama N, Kawakami A, Mishima M, Sato S, Seishima M, Suda T, Mimori T, Takehara K, Kuwana M. Enzyme-linked immunosorbent assays for detection of anti-transcriptional intermediary factor-1 gamma and anti-Mi-2 autoantibodies in dermatomyositis. J Dermatol Sci 2016; 84:272-281. [DOI: 10.1016/j.jdermsci.2016.09.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/17/2016] [Accepted: 09/23/2016] [Indexed: 10/21/2022]
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Ceribelli A, Isailovic N, De Santis M, Generali E, Fredi M, Cavazzana I, Franceschini F, Cantarini L, Satoh M, Selmi C. Myositis-specific autoantibodies and their association with malignancy in Italian patients with polymyositis and dermatomyositis. Clin Rheumatol 2016; 36:469-475. [DOI: 10.1007/s10067-016-3453-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/05/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
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Clinical manifestations and long-term outcome of anti-Jo1 antisynthetase patients in a large cohort of Spanish patients from the GEAS-IIM group. Semin Arthritis Rheum 2016; 46:225-231. [DOI: 10.1016/j.semarthrit.2016.03.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 03/25/2016] [Indexed: 11/24/2022]
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Kang EH, Lee SJ, Ascherman DP, Lee YJ, Lee EY, Lee EB, Song YW. Temporal relationship between cancer and myositis identifies two distinctive subgroups of cancers: impact on cancer risk and survival in patients with myositis. Rheumatology (Oxford) 2016; 55:1631-41. [PMID: 27247435 DOI: 10.1093/rheumatology/kew215] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim was to compare standardized incidence ratios (SIRs) of cancers temporally related and unrelated to active myositis in patients with myositis. METHODS Fifty-two cancer cases were identified in 281 myositis patients. SIRs of cancers having temporal overlap with the active phase of myositis [cancers concurrent with active myositis (CAM), n = 30] and cancers not having such temporal overlap [cancers non-concurrent with active myositis (CNM), n = 22] were compared in 281 patients. RESULTS Patients with CAM were older at diagnosis of myositis, had a greater tendency to be male, more frequent dysphagia and less frequent interstitial lung disease than patients with CNM. CAM SIR (95% CI) was 1.78 (1.19, 2.56) and CNM SIR 1.23 (0.75, 1.90). The peak SIR was observed in the seventh decade of life for CAM and in the third decade for CNM. When stratified by myositis-cancer intervals, CAM SIR was 9.94 (6.43, 14.67) within 1 year of myositis diagnosis, whereas no temporal relationship was found for CNM. Elevated SIRs were observed for oesophageal cancer [57.77 (11.91, 168.82)], non-Hodgkin's lymphoma [41.43 (13.45, 96.69)], adenocarcinoma of unknown primary origin [67.6 (18.42, 173.07]), lung cancer [7.27 (1.98, 18.61)] and ovarian cancer [19.15 (2.32, 69.17)] within 3 years of CAM diagnosis. The cancer stage at the time of diagnosis was more advanced in CAM than CNM (P < 0.001), with a correspondingly increased hazard ratio of mortality [4.3 (1.5, 12.7)] in patients with CAM vs CNM. CONCLUSION A significantly elevated SIR was found for CAM, whereas there was a comparable SIR for CNM relative to the general population. Multiple types of cancers showed elevated SIRs among CAM, but none among CNM. Given that cancer stages in CAM were far advanced at diagnosis, mortality risk was greater in patients with CAM.
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Affiliation(s)
- Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Sang Jin Lee
- Division of Rheumatology, Department of Internal Medicine Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Dana P Ascherman
- Division of Rheumatology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine
| | - Eun Bong Lee
- Division of Rheumatology, Department of Internal Medicine
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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Clinical characteristics of patients with anti-TIF1-γ antibodies. Reumatologia 2016; 54:14-8. [PMID: 27407271 PMCID: PMC4847327 DOI: 10.5114/reum.2016.58756] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/26/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Inflammatory myopathies are a group of idiopathic, heterogeneous systemic diseases affecting predominantly skeletal muscles, though they can also involve the skin and internal organs. The association between cancer and idiopathic inflammatory myopathies, particularly dermatomyositis, which is termed cancer-associated myositis (CAM), has been reported in the medical literature. A newly described autoantibody to a 155-kDa nuclear protein, identified as transcription intermediary factor 1-gamma (TIF1-γ), has proven useful for cancer screening in patients with dermatomyositis. MATERIAL AND METHODS Based on our database of laboratory results, between November 2014 and January 2016, we found 80 patients with a positive autoimmune inflammatory myopathy immunoblot profile. RESULTS Eleven of 80 patients revealed the presence of anti-TIF1-γ antibodies: 8 women and 3 men with average age 54.2 years. Dermatomyositis (DM) was diagnosed in 6 cases, polymyositis in 1 case, myositis limited to ocular muscles and rhabdomyolysis in 1 case each, and undifferentiated connective tissue disease in 2 cases. Neoplasm was found in 4 cases. All of those patients had DM. The average time between DM and diagnosis of neoplasm was 7.5 months (from 1 to 18 months). CONCLUSIONS The association between cancer and idiopathic inflammatory myopathies, particularly DM, is well known, and cancer screening should be obligatory in such patients. So far there is no consensus as to the method or frequency with which patients with an idiopathic inflammatory myopathy should be tested to rule out neoplasm. Detection of anti-TIF1-γ antibodies in patients with DM gives the clinicians the very important suggestion of CAM. It seems reasonable that these patients should have more detailed and often repeated differential diagnostics.
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Sunderkötter C, Nast A, Worm M, Dengler R, Dörner T, Ganter H, Hohlfeld R, Melms A, Melzer N, Rösler K, Schmidt J, Sinnreich M, Walter MC, Wanschitz J, Wiendl H. Leitlinie Dermatomyositis - Auszug aus der interdisziplinären S2k-Leitlinie zu Myositissyndromen der deutschen Gesellschaft für Neurologie. J Dtsch Dermatol Ges 2016. [DOI: 10.1111/ddg.12909_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Cord Sunderkötter
- Klinik für Hautkrankheiten, Universitätsklinikum Münster und Abteilung für Translationale Dermatoinfektiologie; Medizinische Fakultät der Universität Münster und Universitätsklinikum; Münster
| | - Alexander Nast
- Division of Evidence based Medicine (dEBM), Klinik für Dermatologie; Venerologie und Allergologie, Charité - Universitätsmedizin Berlin; Berlin
| | - Margitta Worm
- Klinik für Dermatologie; Venerologie und Allergologie, Charité; Berlin
| | | | - Thomas Dörner
- Med. Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie; Charité - Universitätsmedizin Berlin, Deutsches Rheumaforschungszentrum; Berlin
| | - Horst Ganter
- Deutsche Gesellschaft für Muskelkranke e.V. (Bundesgeschäftsführer)
| | - Reinhard Hohlfeld
- Institut für Klinische Neuroimmunologie, Ludwig-Maximilians-Universität; München
| | - Arthur Melms
- Medical Park Bad Rodach und Neurologische Klinik; Universität Erlangen
| | - Nico Melzer
- Klinik für Neurologie; Universitätsklinikum; Münster
| | - Kai Rösler
- Klinik für Neurologie; Universitätsspital; Bern
| | - Jens Schmidt
- Klinik für Neurologie; Universitätsmedizin; Göttingen
| | - Michael Sinnreich
- Neuromuskuläres Zentrum; Neurologische Klinik, Universitätsspital; Basel
| | - Maggi C. Walter
- Friedrich-Baur-Institut, Ludwig-Maximilians-Universität; München
| | | | - Heinz Wiendl
- Klinik für Neurologie, Universitätsklinikum; Münster
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Abstract
In common rheumatologic diseases skin findings are an important diagnostic clue for astute clinicians. Skin manifestations can help identify systemic disease or may require therapy uniquely targeted at the cutaneous problem. This article discusses 3 common rheumatologic conditions seen in adults by dermatologists: cutaneous lupus, dermatomyositis, and morphea. The focus is on the cutaneous findings and clinical presentation. Some approaches to treatment are explored. Clues to help identify systemic disease are also highlighted.
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Affiliation(s)
- Andrea Kalus
- Dermatology Division, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98115, USA.
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Selva-O’Callaghan A, Trallero-Araguás E, Martínez MA, Labrador-Horrillo M, Pinal-Fernández I, Grau-Junyent JM, Juárez C. Inflammatory myopathy: diagnosis and clinical course, specific clinical scenarios and new complementary tools. Expert Rev Clin Immunol 2015; 11:737-47. [DOI: 10.1586/1744666x.2015.1035258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Delman D, Peng X, Zedek DC, Jewells V, Chahin N, Markovic-Plese S. Dermatomyositis as a presentation of neuromyelitis optica spectrum disorder. J Neuroimmunol 2015; 278:108-11. [DOI: 10.1016/j.jneuroim.2014.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/19/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
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Nakashima R. [Rheumatology: Progress in Diagnosis and Treatments. Topics: IV. Collagen Diseases Except for Rheumatoid Arthritis and Hot Topics; 4. Polymyositis and dermatomyositis]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2014; 103:2487-2491. [PMID: 27514198 DOI: 10.2169/naika.103.2487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Pasquet F, Pavic M, Ninet J, Hot A. [Auto-immune diseases and cancers. Second part: auto-immune diseases complicating cancers and their treatment]. Rev Med Interne 2014; 35:656-63. [PMID: 25106665 DOI: 10.1016/j.revmed.2014.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 01/27/2014] [Accepted: 04/14/2014] [Indexed: 12/18/2022]
Abstract
Autoimmune diseases may reveal or occur during the course of a neoplasia or its treatment. Autoimmune cytopenia, especially haemolytic anaemia, is common in lymphoproliferative disorders such as chronic lymphoid leukemia. The link between cancer and myositis is well established. Dermatomyositis is associated with an increased relative risk of cancer of 3.4 to 4.4. A combination of detection of antibodies against p155 and TEP-computed tomography may be the best approach to ascertain the presence of occult malignancy in patients with dermatomyositis. A cutaneous or a systemic vascularitis may reveal a cancer, most often a haematological malignancy such as hairy cell leukemia. Paraneoplastic polyarthritis have been described in particular with adenocardinoma of the lungs. Underlying neoplasia should be considered in male smokers patients with new onset polyarthritis and poor health status. The prevalence of autoimmune conditions in myelodysplastic syndromes is 10 to 30%. Vasculitis and relapsing polychondritis are the most commonly reported manifestations. Immune manifestations can also be related to treatment. The most common treatment complications are autoimmune haemolytic anaemia with fludarabine and thyroiditis related to interferon and cervical radiotherapy.
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Affiliation(s)
- F Pasquet
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 108, boulevardd Pinel, 69003 Lyon, France.
| | - M Pavic
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 108, boulevardd Pinel, 69003 Lyon, France
| | - J Ninet
- Service de médecine interne, hôpital Édouard-Hérriot, 5, place d'Arsonval, 69003 Lyon cedex 03, France
| | - A Hot
- Service de médecine interne, hôpital Édouard-Hérriot, 5, place d'Arsonval, 69003 Lyon cedex 03, France
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Cuesta-Mateos C, Colom-Fernández B, Portero-Sainz I, Tejedor R, García-García C, Concha-Garzón MJ, De las Heras-Alonso ME, Martínez MA, Juarez C, Muñoz-Calleja C. Autoantibodies against TIF-1-γ and CADM-140 in Spanish patients with clinically amyopathic dermatomyositis (CADM): clinical significance and diagnostic utility. J Eur Acad Dermatol Venereol 2014; 29:482-9. [PMID: 25065441 DOI: 10.1111/jdv.12591] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 05/13/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Patients with clinically amyopathic dermatomyositis (CADM) appear to be at risk for developing cancer and interstitial lung diseases, but population data to confirm this hypothesis are limited. Moreover, CADM presents cutaneous and histological findings that may overlap with subacute cutaneous lupus erythematosus (SCLE). OBJECTIVES To determine the association between myositis-specific autoantibodies, myositis-associated autoantibodies and CADM in Spanish patients. In addition, to study the usefulness of these autoantibodies in the differential diagnosis between CADM and SCLE. METHODS Serum samples were tested for myositis-specific autoantibodies and myositis-associated autoantibodies through immunoprecipitation and other standardized methods. RESULTS Anti-CADM-p140 and anti-p155 antibodies were the only myositis-specific autoantibodies found and were associated with interstitial lung diseases and cancer respectively. No myositis-associated autoantibodies were found in CADM. Moreover, clinical subsets and proportions seemed to differ from Asian cohorts, where anti-CADM-p140 is considered a CADM hallmark antibody and a risk factor for the development of interstitial lung disease. Interestingly, anti-SSA was highly associated with SCLE, whereas no myositis-specific autoantibodies were found in this entity. LIMITATIONS OF THE STUDY Association between CADM and myositis-specific autoantibodies and differences between CADM and SCLE were tested on a relatively small cohort of patients. CONCLUSION There is an association between cancer-associated myositis and interstitial lung diseases and their hallmark autoantibodies in our cohort. In addition, the combined determination of myositis-specific autoantibodies and SSA autoantibodies may help to accurately discriminate SCLE from CADM.
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Affiliation(s)
- C Cuesta-Mateos
- Departamento de Inmunología, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa, Madrid, Spain; IMMED S.L., Immunological and Medicinal Products, Madrid, Spain
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Ungprasert P, Bethina NK, Jones CH. Malignancy and idiopathic inflammatory myopathies. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 5:569-72. [PMID: 24350067 PMCID: PMC3842696 DOI: 10.4103/1947-2714.120788] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Association between idiopathic inflammatory myopathies (IIMs) and malignancy is well known and has been extensively reported in the literature. However, in the recent years, several new studies were published allowing us to better understand the clinical characteristics and pathophysiology of cancer-associated IIMs. We conducted a literature review of cancer-associated IIMs focusing on new data that was published in the recent years.
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Affiliation(s)
- Patompong Ungprasert
- Department of Internal Medicine, Bassett Medicaxl Center and Columbia University, College of Physicians and Surgeons, Cooperstown, New York 13326, USA
| | - Narandra K Bethina
- Department of Internal Medicine, Rheumatology and Clinical Immunology Division, The University of Vermont College of Medicine, Burlington 05405, USA
| | - Christine H Jones
- Department of Internal Medicine, Rheumatology and Clinical Immunology Division, The University of Vermont College of Medicine, Burlington 05405, USA
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García-Reynoso MJ, Veramendi-Espinoza LE, Ruiz-Garcia HJ. Paresia ascendente como comienzo de inusual asociación entre miopatía autoinmune necrosante y lupus eritematoso sistémico. ACTA ACUST UNITED AC 2014; 10:183-6. [DOI: 10.1016/j.reuma.2013.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 11/24/2022]
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Abstract
Paraneoplastic neurological syndromes (PNSs) rarely associate with Hodgkin lymphoma (HL) and non-HLs (NHLs). Except for paraneoplastic cerebellar degeneration (PCD) in HL and dermato/ polymyositis in both HL and NHL, other PNSs are uncommon and have only been reported as isolated case reports or short series. There are several important differences in PNSs when occurring in association with HL and NHL compared with those associated with solid tumors. First, some PNSs such as sensory neuronopathy or Lambert-Eaton myasthenic syndrome rarely occur in lymphomas, whereas others, such as granulomatous angiitis, are only described in HL. Second, onconeural antibodies are absent in most PNSs associated with lymphomas with the exceptions of Tr (δ/notch-like epidermal growth factor-related receptor) in PCD and mGluR5 in limbic encephalitis (LE). The antigens recognized by these antibodies are not expressed in lymphoma cells, suggesting the tumor itself does not trigger the PNS. Third, unlike patients with solid tumors in patients with lymphoma, the PNSs often develops at advanced stages of the disease. Furthermore, the type and frequency of PNSs are different between HL and NHL; whereas LE and PCD occur almost exclusively in patients with HL, sensorimotor neuropathies and dermatomyositis are more frequent in NHL.
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Didelot A, Honnorat J. Paraneoplastic disorders of the central and peripheral nervous systems. HANDBOOK OF CLINICAL NEUROLOGY 2014; 121:1159-1179. [PMID: 24365410 DOI: 10.1016/b978-0-7020-4088-7.00078-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Paraneoplatic neurologic syndromes (PNS) have been seminally defined as acute or subacute neurological syndromes resulting from nervous system dysfunction that is remote from the site of a malignant neoplasm or its metastases. However, in respect to our current understanding of their pathogenesis we may redefine these disorders as cancer-related dysimmune neurologic syndromes. We first deal with the epidemiology and the pathogenesis of PNS, then the different classic PNS are reviewed with clinical features according to the associated onconeuronal antibodies. Finally, therapeutic approaches are discussed.
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Affiliation(s)
- Adrien Didelot
- Centre de Référence, de Diagnostic et de Traitement des Syndromes Neurologiques Paranéoplasiques and INSERM U842, UMR-S842, Lyon, France.
| | - Jérôme Honnorat
- Centre de Référence, de Diagnostic et de Traitement des Syndromes Neurologiques Paranéoplasiques and INSERM U842, UMR-S842, Lyon, France
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Abstract
PURPOSE OF REVIEW This review describes relevant advances in paraneoplastic neurological syndromes (PNS) with emphasis on particular syndromes and the impact of antibodies against surface antigens in their management. RECENT FINDINGS PNS may present with symptoms that do not raise the suspicion of a paraneoplastic origin. The best example is anti-N-methyl-D-aspartate receptor encephalitis that in adult women frequently associates with ovarian teratoma. An electroencephalogram pattern described as 'extreme delta brush' was recently identified in 30% of patients with this disorder. Isolated myelopathy may have a paraneoplastic origin associated with amphiphysin or CV2 (CRMP5) antibodies. Jaw dystonia and laryngospasm can be the predominant symptom of the brainstem encephalitis associated with Ri antibodies. γ-Aminobutyric acid (GABA)(B) receptor antibodies are the most common antibodies found in patients with limbic encephalitis and small cell lung cancer, and contactin-associated protein 2 antibodies in patients with Morvan's syndrome and thymoma. Lastly, a recent study identified delta/notch-like epidermal growth factor-related receptor (DNER) as the target antigen of Tr antibodies, a marker of cerebellar ataxia and Hodgkin's lymphoma. SUMMARY The number of antibodies relevant to PNS is now expanded to those against surface antigens. These antibodies do not confirm the paraneoplastic origin of the syndrome but predict a better response to immunotherapy.
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Rosa F, Ferrari M, Buschiazzo A, Lanfranco E. Myopathy as paraneoplastic syndrome of colon malignancy in an elderly patient. Aging Clin Exp Res 2013; 25:221-3. [PMID: 23739910 DOI: 10.1007/s40520-013-0034-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 06/13/2012] [Indexed: 11/28/2022]
Abstract
Neoplastic diseases may be complicated by rheumatic diseases or may be occur with them. Dermatomyositis/polymyositis and polymyalgia rheumatica are described as paraneoplastic syndromes. We report a case with proximal muscular weakness as only symptom of colon cancer in the absence of other symptoms and laboratory abnormalities, and we discuss the nosological classification as a possible atypical form of polymyositis.
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Ghirardello A, Bassi N, Palma L, Borella E, Domeneghetti M, Punzi L, Doria A. Autoantibodies in Polymyositis and Dermatomyositis. Curr Rheumatol Rep 2013; 15:335. [DOI: 10.1007/s11926-013-0335-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Lazarou IN, Guerne PA. Classification, diagnosis, and management of idiopathic inflammatory myopathies. J Rheumatol 2013; 40:550-64. [PMID: 23504386 DOI: 10.3899/jrheum.120682] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The detection and characterization of a large array of autoantibodies, including at least 8 different antisynthetase, anti-SRP, -200/100 (HMGCR), -Mi-2, -CADM-140 (MDA5), -SAE, -p155, -MJ (NXP-2), and -PMS1, frequently associated with distinct and well-defined clinicopathological features, allowed for significant improvement in the definition and diagnosis of idiopathic inflammatory myopathies (IIM). Classification remains difficult, with lingering divergence between the different specialties involved in IIM care, but several categories clearly stand out, including dermatomyositis (DM), overlap myositis (OM), polymyositis, necrotizing myositis, and sporadic inclusion body myositis (s-IBM). Biopsy and histological analysis remain crucial, particularly in the absence of autoantibodies, to accurately specify the diagnosis and rule out mimics such as muscular dystrophies and metabolic myopathies. Numerous infectious agents (in particular human immunodeficiency virus and human T cell lymphotrophic virus-1) and drugs (statins, tumor necrosis factor inhibitors, and proton pump inhibitors) can cause mimic IIM that must also be excluded. Pharmacological treatment, in addition to glucocorticoids and immunoglobulins, now includes mycophenolate mofetil and rituximab, which proved helpful in resistant cases, particularly rituximab in DM and OM. Exercise, initially seen as potentially deleterious, recently was shown to be efficacious and safe. IIM can thus be reasonably well controlled in most cases, although aggressive disease remains refractory to treatment, including some cases of necrotizing myopathy. Sporadic IBM still seems resistant to all medications tested to date.
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Affiliation(s)
- Ilias N Lazarou
- Department of Rheumatology, University Hospital of Geneva, Geneva, Switzerland.
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