1
|
Samad A, Wobma H, Casey A. Innovations in the care of childhood interstitial lung disease associated with connective tissue disease and immune-mediated disorders. Pediatr Pulmonol 2024. [PMID: 38837875 DOI: 10.1002/ppul.27068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
Childhood interstitial lung disease (chILD) associated with connective tissue and immune mediated disorders is the second most common chILD diagnostic category. As knowledge of the molecular and genetic underpinnings of these rare disorders advances, the recognized clinical spectrum of associated pulmonary manifestations continues to expand. Pulmonary complications of these diseases, including ILD, confer increased risk for morbidity and mortality and contribute to increased complexity for providers tasked with managing the multiple organ systems that can be impacted in these systemic disorders. While pulmonologists play an important role in diagnosis and management of these conditions, thankfully they do not have to work alone. In collaboration with a multidisciplinary team of subspecialists, the pulmonary and other systemic manifestations of these conditions can be managed effectively together. The goal of this review is to familiarize the reader with the classic patterns of chILD and other pulmonary complications associated with primary immune-mediated disorders (monogenic inborn errors of immunity) and acquired systemic autoimmune and autoinflammatory diseases. In addition, this review will highlight current, emerging, and innovative therapeutic strategies and will underscore the important role of multidisciplinary management to improving outcomes for these patients.
Collapse
Affiliation(s)
- Aaida Samad
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Holly Wobma
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alicia Casey
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Alhassan E, Yi BY, Rodman J, Weisman MH, Crew A, Wise L. Unique characteristics of anti-MDA-5 associated dermatomyositis in Southern California with a large Hispanic population. Semin Arthritis Rheum 2024; 66:152434. [PMID: 38503149 DOI: 10.1016/j.semarthrit.2024.152434] [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: 10/08/2023] [Revised: 02/08/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES There is little to no data about the presentation and clinical course of anti-melanoma differentiation-associated gene-5 antibody (anti-MDA-5) dermatomyositis in a primarily U.S. Hispanic population. We describe the clinical course of anti-MDA-5 dermatomyositis in our majority Hispanic population. METHODS This is a multicenter, retrospective case series of anti-MDA-5 dermatomyositis. Patients diagnosed with anti-MDA-5 dermatomyositis from June 2015 to March 2023 at four medical centers in Los Angeles, California, were included. Demographics and clinical characteristics were obtained. Descriptive statistics, Pearson's chi-squared, Fisher's exact, Wilcoxon rank sum, and Kruskal-Wallis tests were performed as applicable. RESULTS Thirty anti-MDA-5 dermatomyositis patients were included. Twenty-two (73 %) were Hispanic. Twenty-one patients (70 %) were female, with a median age of 40.5 years. Hispanic patients were diagnosed with anti-MDA-5 dermatomyositis at a younger age than non-Hispanic patients (p = 0.025). Inflammatory arthritis was prominent; more males were affected than females (p = 0.027). Thirteen patients (43 %) were amyopathic. Twenty-five patients (83.3 %) had evidence of interstitial lung disease (ILD), and a higher ferritin level was associated with ILD (p = 0.049). There were six deaths (20 %); five (17 %) were ascribed to rapidly progressive ILD. CONCLUSION ILD was the most common presentation of anti-MDA-5 dermatomyositis in our cohort and was associated with higher ferritin levels. Hispanic patients had a younger age of diagnosis than non-Hispanic patients. Necrotic skin lesions and inflammatory arthritis were frequently seen. This is the first study looking at clinical phenotypes and outcomes of anti-MDA-5 dermatomyositis in a primarily Hispanic U.S. POPULATION Future studies are needed to better understand the clinical manifestations (to promptly recognize and treat) of this population of anti-MDA-5 dermatomyositis.
Collapse
Affiliation(s)
- Eaman Alhassan
- Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Belina Y Yi
- Division of Rheumatology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jack Rodman
- Clinical & Translational Science Institute, University of Southern California, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ashley Crew
- Department of Dermatology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Leanna Wise
- Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
3
|
Yatabe R, Iio K, Akamine K. Inverse Gottron Papules and Auricular Red-Violaceous Macules: Anti-MDA5-Antibody-Positive Juvenile Dermatomyositis. J Pediatr 2024; 272:114102. [PMID: 38762065 DOI: 10.1016/j.jpeds.2024.114102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/11/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Reiko Yatabe
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Kazuki Iio
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Keiji Akamine
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| |
Collapse
|
4
|
David P, Sinha S, Iqbal K, De Marco G, Taheri S, McLaren E, Maisuria S, Arumugakani G, Ash Z, Buckley C, Coles L, Hettiarachchi C, Payne E, Savic S, Smithson G, Slade M, Shah R, Marzo-Ortega H, Keen M, Lawson C, Mclorinan J, Nizam S, Reddy H, Sharif O, Sultan S, Tran G, Wood M, Wood S, Ghosh P, McGonagle D. MDA5-autoimmunity and interstitial pneumonitis contemporaneous with the COVID-19 pandemic (MIP-C). EBioMedicine 2024; 104:105136. [PMID: 38723554 PMCID: PMC11090026 DOI: 10.1016/j.ebiom.2024.105136] [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: 11/03/2023] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Anti-MDA5 (Melanoma differentiation-associated protein-5) positive dermatomyositis (MDA5+-DM) is characterised by rapidly progressive interstitial lung disease (ILD) and high mortality. MDA5 is an RNA sensor and a key pattern recognition receptor for the SARS-CoV-2 virus. METHODS This is a retrospective observational study of a surge in MDA5 autoimmunity, as determined using a 15 muscle-specific autoantibodies (MSAs) panel, between Janurary 2018 and December 2022 in Yorkshire, UK. MDA5-positivity was correlated with clinical features and outcome, and regional SARS-CoV-2 positivity and vaccination rates. Gene expression patterns in COVID-19 were compared with autoimmune lung disease and idiopathic pulmonary fibrosis (IPF) to gain clues into the genesis of the observed MDA5+-DM outbreak. FINDINGS Sixty new anti-MDA5+, but not other MSAs surged between 2020 and 2022, increasing from 0.4% in 2019 to 2.1% (2020), 4.8% (2021) and 1.7% (2022). Few (8/60) had a prior history of confirmed COVID-19, peak rates overlapped with regional SARS-COV-2 community positivity rates in 2021, and 58% (35/60) had received anti-SARS-CoV-2 vaccines. 25/60 cases developed ILD which rapidly progression with death in 8 cases. Among the 35/60 non-ILD cases, 14 had myositis, 17 Raynaud phenomena and 10 had dermatomyositis spectrum rashes. Transcriptomic studies showed strong IFIH1 (gene encoding for MDA5) induction in COVID-19 and autoimmune-ILD, but not IPF, and IFIH1 strongly correlated with an IL-15-centric type-1 interferon response and an activated CD8+ T cell signature that is an immunologic hallmark of progressive ILD in the setting of systemic autoimmune rheumatic diseases. The IFIH1 rs1990760TT variant blunted such response. INTERPRETATION A distinct pattern of MDA5-autoimmunity cases surged contemporaneously with circulation of the SARS-COV-2 virus during COVID-19. Bioinformatic insights suggest a shared immunopathology with known autoimmune lung disease mechanisms. FUNDING This work was supported in part by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), and in part by the National Institutes of Health (NIH) grant R01-AI155696 and pilot awards from the UC Office of the President (UCOP)-RGPO (R00RG2628, R00RG2642 and R01RG3780) to P.G. S.S was supported in part by R01-AI141630 (to P.G) and in part through funds from the American Association of Immunologists (AAI) Intersect Fellowship Program for Computational Scientists and Immunologists.
Collapse
Affiliation(s)
- Paula David
- Leeds Teaching Hospitals NHS Trust, Rheumatology Department, Leeds, United Kingdom; University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom; Internal Medicine B, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Saptarshi Sinha
- Department of Cellular and Molecular Medicine, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Khizer Iqbal
- Leeds Teaching Hospitals NHS Trust, Rheumatology Department, Leeds, United Kingdom
| | - Gabriele De Marco
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom; Mid Yorkshire Teaching NHS Trust, Rheumatology, Wakefield, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Sahar Taheri
- Department of Computer Science and Engineering, Jacob's School of Engineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ella McLaren
- Department of Cellular and Molecular Medicine, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Sheetal Maisuria
- Leeds Teaching Hospitals NHS Trust, Pathology, Leeds, United Kingdom
| | - Gururaj Arumugakani
- Leeds Teaching Hospitals NHS Trust, Pathology, Leeds, United Kingdom; University of Leeds, Immunology, Leeds, United Kingdom
| | - Zoe Ash
- Bradford Teaching Hospitals NHS Foundation Trust, Rheumatology, Bradford, United Kingdom
| | - Catrin Buckley
- Leeds Teaching Hospitals NHS Trust, Rheumatology Department, Leeds, United Kingdom
| | - Lauren Coles
- Leeds Teaching Hospitals NHS Trust, Rheumatology Department, Leeds, United Kingdom
| | | | - Emma Payne
- Leeds Teaching Hospitals NHS Trust, Pathology, Leeds, United Kingdom
| | - Sinisa Savic
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Gayle Smithson
- Mid Yorkshire Teaching NHS Trust, Rheumatology, Wakefield, United Kingdom
| | - Maria Slade
- Mid Yorkshire Teaching NHS Trust, Rheumatology, Wakefield, United Kingdom
| | - Rahul Shah
- Leeds Teaching Hospitals NHS Trust, Rheumatology Department, Leeds, United Kingdom
| | - Helena Marzo-Ortega
- Leeds Teaching Hospitals NHS Trust, Rheumatology Department, Leeds, United Kingdom; University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Mansoor Keen
- Bradford Teaching Hospitals NHS Foundation Trust, Rheumatology, Bradford, United Kingdom
| | - Catherine Lawson
- Harrogate and District NHS Foundation Trust, Rheumatology, Harrogate, United Kingdom
| | - Joanna Mclorinan
- Leeds Teaching Hospitals NHS Trust, Rheumatology Department, Leeds, United Kingdom
| | - Sharmin Nizam
- Mid Yorkshire Teaching NHS Trust, Rheumatology, Wakefield, United Kingdom
| | - Hanu Reddy
- Airedale NHS Foundation Trust, Rheumatology, Steeton with Eastburn, United Kingdom
| | - Omer Sharif
- Calderdale and Huddersfield NHS Foundation Trust, Rheumatology, Huddersfield and Halifax, United Kingdom
| | - Shabina Sultan
- Airedale NHS Foundation Trust, Rheumatology, Steeton with Eastburn, United Kingdom
| | - Gui Tran
- Harrogate and District NHS Foundation Trust, Rheumatology, Harrogate, United Kingdom
| | - Mark Wood
- Leeds Teaching Hospitals NHS Trust, Rheumatology Department, Leeds, United Kingdom
| | - Samuel Wood
- Leeds Teaching Hospitals NHS Trust, Rheumatology Department, Leeds, United Kingdom
| | - Pradipta Ghosh
- Department of Cellular and Molecular Medicine, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA; Department of Medicine, School of Medicine, and Veterans Affairs Medical Center, University of University of California San Diego, La Jolla, CA, 92093, USA.
| | - Dennis McGonagle
- Leeds Teaching Hospitals NHS Trust, Rheumatology Department, Leeds, United Kingdom; University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom.
| |
Collapse
|
5
|
Tansley SL, McMorrow F, Cotton CV, Adamali H, Barratt SL, Betteridge ZE, Perurena-Prieto J, Gibbons MA, Kular R, Loganathan A, Lamb JA, Lu H, New RP, Pratt D, Rivera-Ortega P, Sayers R, Steward M, Stranks L, Vital E, Spencer LG, McHugh NJ, Cooper RG. Identification of connective tissue disease autoantibodies and a novel autoantibody anti-annexin A11 in patients with "idiopathic" interstitial lung disease. Clin Immunol 2024; 262:110201. [PMID: 38575043 DOI: 10.1016/j.clim.2024.110201] [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: 01/17/2024] [Revised: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Autoantibodies are a hallmark feature of Connective Tissue Diseases (CTD). Their presence in patients with idiopathic interstitial lung disease (ILD) may suggest covert CTD. We aimed to determine the prevalence of CTD autoantibodies in patients diagnosed with idiopathic ILD. METHODS 499 patient sera were analysed: 251 idiopathic pulmonary fibrosis (IPF), 206 idiopathic non-specific interstitial pneumonia (iNSIP) and 42 cryptogenic organising pneumonia (COP). Autoantibody status was determined by immunoprecipitation. RESULTS 2.4% of IPF sera had a CTD-autoantibody compared to 10.2% of iNSIP and 7.3% of COP. 45% of autoantibodies were anti-synthetases. A novel autoantibody targeting an unknown 56 kDa protein was found in seven IPF patients (2.8%) and two NSIP (1%) patients. This was characterised as anti-annexin A11. CONCLUSION Specific guidance on autoantibody testing and interpretation in patients with ILD could improve diagnostic accuracy. Further work is required to determine the clinical significance of anti-annexin A11.
Collapse
Affiliation(s)
- Sarah L Tansley
- Department of Life Sciences, University of Bath, Bath, UK; Royal National Hospital for Rheumatic Diseases, Bath, UK.
| | | | | | - Huzaifa Adamali
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | - Shaney L Barratt
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | | | | | - Michael A Gibbons
- College of Medicine & Health, University of Exeter; Royal Devon University Hospitals Foundation NHS Trust
| | - Raman Kular
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Janine A Lamb
- Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Hui Lu
- Department of Life Sciences, University of Bath, Bath, UK
| | - Robert P New
- Division of Musculoskeletal and dermatological Sciences, University of Manchester, UK
| | - Diane Pratt
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | | | - Ross Sayers
- College of Medicine & Health, University of Exeter
| | | | | | - Edward Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lisa G Spencer
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Neil J McHugh
- Department of Life Sciences, University of Bath, Bath, UK
| | - Robert G Cooper
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
6
|
Peringeth G, Abbi B, Mahmood S. Treatment of myopathy and cutaneous ulcers in anti-MDA5-positive dermatomyositis with triple therapy. BMJ Case Rep 2024; 17:e253960. [PMID: 38514155 PMCID: PMC10961521 DOI: 10.1136/bcr-2022-253960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Antimelanoma differentiation-associated protein 5 positive dermatomyositis (MDA5 DM) is a rare subtype of idiopathic inflammatory myopathy. There are limited data available regarding the cutaneous manifestations of MDA5 DM in the African American population. We presented the case of a male patient in his early 20s who presented with debilitating cutaneous ulceration and myopathy. Workup revealed interstitial lung disease (ILD) and positive MDA5 serology consistent with MDA5 DM. He made a remarkable recovery in terms of myopathy and cutaneous ulcerations with a multipronged regimen of prednisone, intravenous immunoglobulin and mycophenolate mofetil. However, there was a progression of ILD on this regimen which warranted use of rituximab.
Collapse
Affiliation(s)
- Gopisree Peringeth
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Bhavna Abbi
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Rheumatology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Shereen Mahmood
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
7
|
Ciaglia K, Ghawji M, Caraballo M, Sloan E. Successful Treatment of Rapidly Progressive Interstitial Lung Disease in Juvenile Dermatomyositis. Pediatrics 2024; 153:e2023063268. [PMID: 38361479 DOI: 10.1542/peds.2023-063268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/17/2024] Open
Abstract
Juvenile dermatomyositis (JDM) is a rare systemic autoimmune disease characterized by cutaneous findings, muscle inflammation, and vasculopathy. Patients with antimelanoma differentiation associated gene 5 (anti-MDA5) JDM may have subtle muscle weakness, absence of pathognomonic rashes, and more polyarthritis and ulcerative skin lesions when compared with other JDM subtypes. Although there is a known association of rapidly progressive interstitial lung disease (RP-ILD) in patients with anti-MDA5 dermatomyositis, few case reports describe this association in the pediatric literature. Even fewer reports describe successful treatment. We report an unusual case of RP-ILD in a pediatric patient with a hypomyopathic presentation complicated by prolonged intubation and pulmonary hemorrhage. A 4-year-old underweight female presented in respiratory distress and quickly progressed to severe hypoxic and hypercarbic respiratory failure requiring intubation. She experienced fatigue, intermittent fever, and transaminitis. The diagnosis was delayed because of recent travel history and a lack of typical cutaneous features of JDM, except a small erythematous papule on her antihelix. Her pulmonary hemorrhage and ear lesion prompted additional rheumatic workup. The myositis-specific antibody panel revealed high positive anti-MDA5 antibodies that prompted aggressive combination therapy with plasmapheresis, systemic steroids, inhibitors of Janus kinase, agents to deplete B-cells, and intravenous immunoglobulin. The patient responded well to treatment and was ultimately extubated and discharged. To our knowledge, this is the first thoroughly documented case of anti-MDA5 JDM with RP-ILD presenting with pulmonary hemorrhage and lacking typical cutaneous features. Early recognition of this highly fatal condition is important for improved prognosis.
Collapse
Affiliation(s)
- Kristina Ciaglia
- Children's Medical Center, Dallas, Texas
- Univeristy of Texas Southwestern Medical Center, Dallas, Texas
- Scottish Rite Hospital for Children, Dallas, Texas
| | - Maria Ghawji
- Children's Medical Center, Dallas, Texas
- Univeristy of Texas Southwestern Medical Center, Dallas, Texas
| | - Michelle Caraballo
- Children's Medical Center, Dallas, Texas
- Univeristy of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth Sloan
- Children's Medical Center, Dallas, Texas
- Univeristy of Texas Southwestern Medical Center, Dallas, Texas
- Scottish Rite Hospital for Children, Dallas, Texas
| |
Collapse
|
8
|
Hu M, Shen C, Zheng F, Zhou Y, Teng L, Zheng R, Hu B, Wang C, Lu M, Xu X. Clinical nomogram assisting in discrimination of juvenile dermatomyositis-associated interstitial lung disease. Respir Res 2023; 24:286. [PMID: 37974162 PMCID: PMC10652466 DOI: 10.1186/s12931-023-02599-9] [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: 07/26/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To establish a prediction model using non-invasive clinical features for early discrimination of DM-ILD in clinical practice. METHOD Clinical data of pediatric patients with JDM were retrospectively analyzed using machine learning techniques. The early discrimination model for JDM-ILD was established within a patient cohort diagnosed with JDM at a children's hospital between June 2015 and October 2022. RESULTS A total of 93 children were included in the study, with the cohort divided into a discovery cohort (n = 58) and a validation cohort (n = 35). Univariate and multivariate analyses identified factors associated with JDM-ILD, including higher ESR (OR, 3.58; 95% CI 1.21-11.19, P = 0.023), higher IL-10 levels (OR, 1.19; 95% CI, 1.02-1.41, P = 0.038), positivity for MDA-5 antibodies (OR, 5.47; 95% CI, 1.11-33.43, P = 0.045). A nomogram was developed for risk prediction, demonstrating favorable discrimination in both the discovery cohort (AUC, 0.736; 95% CI, 0.582-0.868) and the validation cohort (AUC, 0.792; 95% CI, 0.585-0.930). Higher nomogram scores were significantly associated with an elevated risk of disease progression in both the discovery cohort (P = 0.045) and the validation cohort (P = 0.017). CONCLUSION The nomogram based on the ESIM predictive model provides valuable guidance for the clinical evaluation and long-term prognosis prediction of JDM-ILD.
Collapse
Affiliation(s)
- Minfei Hu
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Chencong Shen
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Fei Zheng
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Yun Zhou
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Liping Teng
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Rongjun Zheng
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Bin Hu
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Chaoying Wang
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Meiping Lu
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Xuefeng Xu
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China.
| |
Collapse
|
9
|
Iqbal K, Sinha S, David P, De Marco G, Taheri S, McLaren E, Maisuria S, Arumugakani G, Ash Z, Buckley C, Coles L, Hettiarachchi C, Smithson G, Slade M, Shah R, Marzo-Ortega H, Keen M, Lawson C, Mclorinan J, Nizam S, Reddy H, Sharif O, Sultan S, Tran G, Wood M, Wood S, Ghosh P, McGonagle D. MDA5-autoimmunity and Interstitial Pneumonitis Contemporaneous with the COVID-19 Pandemic (MIP-C). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.03.23297727. [PMID: 37961408 PMCID: PMC10635254 DOI: 10.1101/2023.11.03.23297727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Anti-MDA5 (Melanoma differentiation-associated protein-5) positive dermatomyositis (MDA5 + -DM) is characterised by rapidly progressive interstitial lung disease (ILD) and high mortality. MDA5 senses single-stranded RNA and is a key pattern recognition receptor for the SARS-CoV-2 virus. Methods This is a retrospective observational study of a surge in MDA5 autoimmunity, as determined using a 15 muscle-specific autoantibodies (MSAs) panel, between Janurary 2018-December 2022 in Yorkshire, UK. MDA5-positivity was correlated with clinical features and outcome, and regional SARS-CoV-2 positivity and vaccination rates. Gene expression patterns in COVID-19 were compared with autoimmune lung disease and idiopathic pulmonary fibrosis (IPF) to gain clues into the genesis of the observed MDA5 + -DM outbreak. Results Sixty new anti-MDA5+, but not other MSAs surged between 2020-2022, increasing from 0.4% in 2019 to 2.1% (2020), 4.8% (2021) and 1.7% (2022). Few (8/60) had a prior history of confirmed COVID-19, peak rates overlapped with regional SARS-COV-2 community positivity rates in 2021, and 58% (35/60) had received anti-SARS-CoV-2 RNA vaccines. Few (8/60) had a prior history of COVID-19, whereas 58% (35/60) had received anti-SARS-CoV-2 RNA vaccines. 25/60 cases developed ILD which rapidly progression with death in 8 cases. Among the 35/60 non-ILD cases, 14 had myositis, 17 Raynaud phenomena and 10 had dermatomyositis spectrum rashes. Transcriptomic studies showed strong IFIH1 (gene encoding for MDA5) induction in COVID-19 and autoimmune-ILD, but not IPF, and IFIH1 strongly correlated with an IL-15-centric type-1 interferon response and an activated CD8+ T cell signature that is an immunologic hallmark of progressive ILD in the setting of systemic autoimmune rheumatic diseases. The IFIH1 rs1990760TT variant blunted such response. Conclusions A distinct pattern of MDA5-autoimmunity cases surged contemporaneously with circulation of the SARS-COV-2 virus during COVID-19. Bioinformatic insights suggest a shared immunopathology with known autoimmune lung disease mechanisms.
Collapse
|
10
|
Papadopoulou C, Chew C, Wilkinson MGL, McCann L, Wedderburn LR. Juvenile idiopathic inflammatory myositis: an update on pathophysiology and clinical care. Nat Rev Rheumatol 2023; 19:343-362. [PMID: 37188756 PMCID: PMC10184643 DOI: 10.1038/s41584-023-00967-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
The childhood-onset or juvenile idiopathic inflammatory myopathies (JIIMs) are a heterogenous group of rare and serious autoimmune diseases of children and young people that predominantly affect the muscles and skin but can also involve other organs, including the lungs, gut, joints, heart and central nervous system. Different myositis-specific autoantibodies have been identified that are associated with different muscle biopsy features, as well as with different clinical characteristics, prognoses and treatment responses. Thus, myositis-specific autoantibodies can be used to subset JIIMs into sub-phenotypes; some of these sub-phenotypes parallel disease seen in adults, whereas others are distinct from adult-onset idiopathic inflammatory myopathies. Although treatments and management have much improved over the past decade, evidence is still lacking for many of the current treatments and few validated prognostic biomarkers are available with which to predict response to treatment, comorbidities (such as calcinosis) or outcome. Emerging data on the pathogenesis of the JIIMs are leading to proposals for new trials and tools for monitoring disease.
Collapse
Affiliation(s)
- Charalampia Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
| | - Christine Chew
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Meredyth G Ll Wilkinson
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Lucy R Wedderburn
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK.
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK.
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK.
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK.
| |
Collapse
|
11
|
Cho SK, Casciola-Rosen L, Kapoor P, Chung L, Fiorentino D. Cessation of Immunomodulatory Medication Use in Dermatomyositis: A Single-Center Cohort Study. Arthritis Care Res (Hoboken) 2023; 75:1376-1381. [PMID: 35792485 DOI: 10.1002/acr.24980] [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: 09/29/2021] [Revised: 06/18/2022] [Accepted: 07/05/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine the frequency with which adults with dermatomyositis (DM) are able to discontinue systemic immunomodulatory therapy and factors associated with medication cessation. METHODS We studied a cohort of adult DM patients seen in a rheumatology/dermatology clinic between 2013 and 2020. All patients had exposure to at least 1 systemic immunomodulatory medication for a minimum of 3 months and were followed until medications were discontinued for at least 12 months. Survival analysis was performed using Kaplan-Meier curves with log-rank analyses, and multivariate analysis was done using Cox proportional hazards models. RESULTS A total of 246 DM patients were followed up for a median time of ∼7 years (47-134 months). Forty-seven patients (19%) discontinued all immunomodulatory medications with a median follow-up of ∼3 years (interquartile range 22-108 months) following DM onset. Log-rank analysis demonstrated that those with anti-MDA5 autoantibodies discontinued medications faster compared with those without autoantibodies (P = 0.03). Multivariate modeling showed that clinically amyopathic patients were 2.7-fold (95% confidence interval [95% CI] 1.34-5.59) more likely to discontinue medications than those with muscle disease. Those with anti-MDA5, anti-NXP2, and anti-SAE1 antibodies had increased likelihood of medication cessation with hazard ratios of 9.83 (95% CI 2.00-48.2), 8.92 (95% CI 1.69-47.0), and 10.8 (95% CI 2.06-56.6), respectively, when compared with the autoantibody-negative group. CONCLUSION Approximately 20% of adult DM patients discontinued immunomodulatory medications over a median 7-year follow-up. Those with clinically amyopathic disease, anti-MDA5, anti-NXP2, and anti-SAE1 antibodies have a higher likelihood of medication cessation.
Collapse
Affiliation(s)
- Sung Kyung Cho
- Stanford University School of Medicine, Redwood City, California
| | | | - Puneet Kapoor
- Stanford University School of Medicine, Redwood City, California
| | - Lorinda Chung
- Stanford University School of Medicine, Redwood City, California
| | - David Fiorentino
- Stanford University School of Medicine, Redwood City, California
| |
Collapse
|
12
|
Xue Y, Zhang J, Li C, Liu X, Kuang W, Deng J, Wang J, Tan X, Li S, Li C. Machine learning for screening and predicting the risk of anti-MDA5 antibody in juvenile dermatomyositis children. Front Immunol 2023; 13:940802. [PMID: 36703989 PMCID: PMC9872019 DOI: 10.3389/fimmu.2022.940802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/14/2022] [Indexed: 01/11/2023] Open
Abstract
Objective The anti-MDA5 (anti-melanoma differentiation associated gene 5) antibody is often associated with a poor prognosis in juvenile dermatomyositis (JDM) patients. In many developing countries, there is limited ability to access myositis- specific antibodies due to financial and technological issues, especially in remote regions. This study was performed to develop a prediction model for screening anti-MDA5 antibodies in JDM patients with commonly available clinical findings. Methods A cross-sectional study was undertaken with 152 patients enrolled from the inpatient wards of Beijing Children's Hospital between June 2018 and September 2021. Stepwise logistic regression, least absolute shrinkage and selection operator (LASSO) regression, and the random forest (RF) method were used to fit the model. Model discrimination, calibration, and decision curve analysis were performed for validation. Results The final prediction model included eight clinical variables (gender, fever, alopecia, periungual telangiectasia, digital ulcer, interstitial lung disease, arthritis/arthralgia, and Gottron sign) and four auxiliary results (WBC, CK, CKMB, and ALB). An anti-MDA5 antibody risk probability-predictive nomogram was established with an AUC of 0.975 predicted by the random forest algorithm. The model was internally validated by Harrell's concordance index (0.904), the Brier score (0.052), and a 500 bootstrapped satisfactory calibration curve. According to the net benefit and predicted probability thresholds of decision curve analysis, the established model showed a significantly higher net benefit than the traditional logistic regression model. Conclusion We developed a prediction model using routine clinical assessments to screen for JDM patients likely to be anti-MDA5 positive. This new tool may effectively predict the detection of anti-MDA5 in these patients using a non-invasive and efficient way.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Caifeng Li
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical Universtity, National Centre for Children's Health, Beijing, China
| |
Collapse
|
13
|
Tanaka K, Yasutomi M, Kosaka T, Watanabe Y, Hasegawa M, Itoh N, Ohshima Y. Anti-MDA5 antibody in the diagnosis of unexplained oral ulcers and eruptions. Pediatr Int 2023; 65:e15539. [PMID: 36965008 DOI: 10.1111/ped.15539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/24/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Kayo Tanaka
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Motoko Yasutomi
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takuya Kosaka
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | | | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Naohiro Itoh
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yusei Ohshima
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| |
Collapse
|
14
|
Evaluation of the Performance of an Indirect Immunofluorescence Assay for the Detection of Anti-MDA5 Antibodies. Biomedicines 2022; 10:biomedicines10112969. [PMID: 36428536 PMCID: PMC9687661 DOI: 10.3390/biomedicines10112969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/27/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022] Open
Abstract
Anti-melanoma differentiation-associated protein 5 (MDA5) antibody (Ab) positive dermatomyositis (anti-MDA5 DM) is a rare systemic autoimmune disease; further, its prognosis can be rapidly fatal due to pulmonary involvement. The identification and quantification of anti-MDA5 Abs, which serve as a highly specific biomarker of the disease, is a critical step for the establishing of both the diagnosis and monitoring of the disease's activity. The development of a simple, fast, low-cost, and specific detection system of anti-MDA5 Ab is therefore highly desirable for the purposes of routine laboratory diagnosis. Here, we developed a human cell line that stably expresses MDA5 and evaluated its analytical performance in order to detect anti-MDA5 Abs by the utilization of indirect immunofluorescence (IIF). Serum samples from 23 anti-MDA5 DM patients and 22 anti-MDA5 Abs negative myositis readings, which were obtained at time of diagnosis, were analyzed by IIF on MDA5-transfected cells. The results were compared with those obtained with specific semi-quantitative (immunodot) and quantitative (ELISA) assays. A specific cytoplasmic pattern was found solely with the sera of anti-MDA5 DM patients. The sensitivity and specificity of IIF on MDA5-transfected cells were 96% and 100%, respectively, compared with ELISA. The anti-MDA5 Abs titers that were determined by this approach were consistent with the quantitative results obtained by ELISA. Baseline concentrations of anti-MDA5 Abs, either by ELISA or IIF, were not significantly different between surviving and deceased patients; further, they did not differ significantly according to clinical phenotypes. Overall, an IIF cell-based assay constitutes a simple, fast, and low-cost approach to identify and quantify anti-MDA5 Abs; moreover, it is as efficient as ELISA.
Collapse
|
15
|
Assessment of Thigh MRI Radiomics and Clinical Characteristics for Assisting in Discrimination of Juvenile Dermatomyositis. J Clin Med 2022; 11:jcm11226712. [PMID: 36431189 PMCID: PMC9693341 DOI: 10.3390/jcm11226712] [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: 08/25/2022] [Revised: 09/30/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) is an important non-invasive examination in the early diagnosis of juvenile dermatomyositis (JDM). We aimed to evaluate the feasibility of radiomics to establish a quantitative analysis of MRI images. Radiomics and machine learning were used to retrospectively analyze MRI T2 fat suppression sequences and relevant clinical data. The model associated with radiomics features was established using a cohort of patients who underwent thigh MRI at the children's hospital from June 2014 to September 2021. In total, 75 patients with JDM and 75 control children were included in the training cohort (n = 102) and validation cohort (n = 48). The independent factors including lower muscle strength (OR, 0.75; 95% CI, 0.59-0.90), higher creatine kinase (CK) level (OR, 1.65; 95% CI, 1.20-2.38), and higher radiomics score (OR, 2.30; 95% CI, 1.63-3.62) were associated with a clinical diagnosis of JDM. The combined model achieved good discrimination performance compared the radiomics score model under linear discriminant analyses in the training cohort (AUC, 0.949; 95% CI, 0.912-0.986 vs. AUC, 0.912; 95% CI, 0.858-0.967; p = 0.02) and in the validation cohort (AUC, 0.945; 95% CI, 0.878-1 vs. AUC, 0.905; 95% CI, 0.812-0.998; p = 0.03). The combined model showed the diagnostic value was not weaker than the biopsy (AUC, 0.950; 95% CI, 0.919-0.981, n = 150 vs. AUC, 0.952; 95% CI, 0.889-1, n = 72; p = 0.95) and electromyogram (EMG) (AUC, 0.950; 95% CI, 0.919-0.981 vs. AUC, 0.900; 95% CI, 0.852-0.948; p = 0.10) among all the patients. The combination of radiomics features extracted from the MRI and non-invasive clinical characteristics obtained a pronounced discriminative performance to assist in discriminating JDM.
Collapse
|
16
|
Clinical Features of Dermatomyositis/Polymyositis with Anti-MDA5 Antibody Positivity. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7102480. [PMID: 35992549 PMCID: PMC9356863 DOI: 10.1155/2022/7102480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022]
Abstract
This paper aims to investigate the clinical and laboratory test characteristics of patients with anti-MDA5 antibody-positive PM/DM by analyzing the clinical characteristics, laboratory test results, and 1-year survival rate of patients with anti-MDA5 antibody-positive PM/DM in polymyositis (PM) and dermatomyositis (DM). To further investigate the impact of positive anti-MDA5 antibodies on the prognosis of PM/DM patients. According to the anti-MDA5 antibody test results, 18 cases with positive anti-MDA5 antibodies were in the positive group and 46 cases with negative anti-MDA5 antibodies were in the negative group. The clinical manifestations, laboratory tests, treatment protocols, and prognostic risk factors were collected for both groups. The chi-square test, Mann–Whitney method, Fisher test, t-test, Kaplan–Meier method, and Log-rank test were used for statistical analysis. Anti-MDA5 antibody positivity was more common in patients with DM/CADM. With no statistically significant differences in age and sex ratio between the two groups, The differences in erythrocyte sedimentation rate (ESR), ferritin (Fer), and creatine kinase (CK) levels in the positive group were statistically significant compared with the negative group. Clinically, the positive group was more prone to arthralgia, skin rash, and interstitial pneumonia.
Collapse
|
17
|
Karasawa R, Yudoh K, Sato T, Tanaka M, Tamaki M, Sabbagh SE, O’Hanlon TP, Noroozi-Farhadi P, Targoff IN, Flegel WA, Mammen AL, Miller FW, Hicar MD, Rider LG, Jarvis JN. Association of anti-HSC70 autoantibodies with cutaneous ulceration and severe disease in juvenile dermatomyositis. Rheumatology (Oxford) 2022; 61:2969-2977. [PMID: 34791087 PMCID: PMC9258543 DOI: 10.1093/rheumatology/keab846] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/06/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES JDM is an inflammatory myopathy characterized by prominent vasculopathy. AECAs are frequently detected in inflammatory and autoimmune diseases. We sought to determine whether AECAs correlate with clinical features of JDM, and thus serve as biomarkers to guide therapy or predict outcome. METHODS Plasma samples from 63 patients with JDM, 49 patients with polyarticular JIA and 40 juvenile healthy controls were used to detect anti-heat shock cognate 71 kDa protein (HSC70) autoantibodies, a newly identified AECA, in ELISA assays. Clinical features were compared between JDM patients with and without anti-HSC70 autoantibodies. RESULTS Anti-HSC70 autoantibodies were detected in 35% of patients with JDM, in 0% of patients with JIA (P < 0.0001) and in 0% of healthy donors (P < 0.0001). Both the presence of cutaneous ulcers (59% vs 17%, P < 0.002) and the use of wheelchairs and/or assistive devices (64% vs 27%, P < 0.007) were strongly associated with anti-HSC70 autoantibodies in JDM. High scores on the severity of myositis damage measures at the time of measurement of anti-HSC70 autoantibodies and an increased number of hospitalizations were also associated with anti-HSC70 autoantibodies. Intravenous immunoglobulin therapy was used more often in anti-HSC70 autoantibody-positive patients. CONCLUSION Anti-HCS70 autoantibodies are detected frequently in children with JDM and are novel myositis-associated autoantibodies correlating with disease severity.
Collapse
Affiliation(s)
- Rie Karasawa
- Department of Frontier Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuo Yudoh
- Department of Frontier Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshiko Sato
- Department of Frontier Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Megumi Tanaka
- Department of Frontier Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mayumi Tamaki
- Department of Frontier Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - 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 (NIH), Bethesda, MD
- Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Terrance P O’Hanlon
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Bethesda, MD
| | - Payam Noroozi-Farhadi
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Bethesda, MD
| | - Ira N Targoff
- Oklahoma City VA Health Care System, University of Oklahoma Health Sciences Center, and Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health (NIH), Bethesda, MD
| | - 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 (NIH), Bethesda, MD
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Bethesda, MD
| | - Mark D Hicar
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Bethesda, MD
| | - James N Jarvis
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences
- Genetics, Genomics, & Bioinformatics Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
18
|
Ganatra K, Aggarwal R, Gupta L. Mechanic's Hand Heralding Relapse in an Indian Adolescent with Anti-MDA5 Positive Juvenile Dermatomyositis. Mediterr J Rheumatol 2022; 33:268-270. [PMID: 36128210 PMCID: PMC9450195 DOI: 10.31138/mjr.33.2.268] [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: 03/24/2021] [Revised: 06/12/2021] [Accepted: 06/25/2021] [Indexed: 11/04/2022] Open
Abstract
Anti-MDA5 antibodies characterise a distinct phenotype of dermatomyositis in adults as well as children, with ethnic disparity in clinical presentation and severity. They often present as a diagnostic conundrum with rash, ulceration, and polyarthritis, but minimal muscle disease. Mechanic's hands are typically associated with anti-synthetase syndrome, but their presence in anti-MDA5 antibody positive patients, although reported, is not well known. We present the case of a boy in whom mechanic's hand heralded a relapse of juvenile dermatomyositis which was suspected based on remotely assessed patient-reported outcome measures on teleconsultation. This report suggests that mechanic's hands should also prompt testing for myositis antibodies including anti-MDA5 in Indian children with JDM. Diligent awareness of the condition, and timely use of patient reported outcome measures of muscle power and skin assessment may guide management while delivering remote care in challenging situations such as a global pandemic.
Collapse
Affiliation(s)
- Keya Ganatra
- Seth Gordhandas Sunderdas Medical College & King Edward Memorial Hospital, Mumbai, India
| | - Rohit Aggarwal
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
19
|
Wang YT, Zhang Y, Tang T, Luo C, Liu MY, Xu L, Wang L, Tang XM. Anti-nuclear matrix protein 2+ juvenile dermatomyositis with severe skin ulcer and infection: A case report and literature review. World J Clin Cases 2022; 10:3579-3586. [PMID: 35611208 PMCID: PMC9048553 DOI: 10.12998/wjcc.v10.i11.3579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is an idiopathic inflammatory myopathy that occurs in childhood. It is characterized by muscle weakness and a characteristic rash. Previous literature reports have rarely described JDM with severe skin ulcers and infections.
CASE SUMMARY Herein, we describe a case of a 2-year-old female patient who suffered from JDM, whose myositis-specific autoantibodies were positive for anti-nuclear matrix protein 2 antibody, with progressively worsening skin ulcers and severe infections. The patient was treated with glucocorticoids and various immunosuppressants. Nevertheless, further progression of the disease and the combination of primary disease and severe infection in the later period were fatal.
CONCLUSION In children, anti-nuclear matrix protein 2+ JDM combined with skin ulcers often indicates severe disease. In such cases, personalized treatment for the primary disease and infection prevention and control are essential.
Collapse
Affiliation(s)
- Ya-Ting Wang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Yu Zhang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Tao Tang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Chong Luo
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Ming-Yue Liu
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Li Xu
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Li Wang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Xue-Mei Tang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| |
Collapse
|
20
|
Environmental factors associated with juvenile idiopathic inflammatory myopathy clinical and serologic phenotypes. Pediatr Rheumatol Online J 2022; 20:28. [PMID: 35414090 PMCID: PMC9004071 DOI: 10.1186/s12969-022-00684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Environmental exposures have been associated with the juvenile idiopathic inflammatory myopathies (JIIM). We undertook a questionnaire-based study to evaluate patient-reported exposures as possible risk factors for JIIM. FINDINGS One-hundred-seven patients with JIIM were enrolled in a myositis natural history protocol and completed environmental questionnaires. Frequencies of exposures in clinical and myositis-specific autoantibody (MSA) groups were examined. Patients with juvenile dermatomyositis (JDM) and juvenile connective tissue myositis (JCTM) more frequently received an immunization within 1 year of diagnosis compared to juvenile polymyositis (57.5 and 71.4% vs 0.0%, p ≤ 0.017). JCTM patients were more often underweight at diagnosis relative to JDM patients (42.9% vs 7.0%, p = 0.002). MSA-negative patients more frequently had gastroenteritis within a year of diagnosis compared to patients with anti-MDA5 autoantibodies (28.6% vs 0.0%, p = 0.032). Heavy exercise was more frequent in MSA-negative and anti-MDA5 groups compared to the anti-TIF-1 autoantibody group (42.9 and 35.3% vs. 9.0%, p ≤ 0.047). Medications received within 1 year of diagnosis were more frequent in MSA-negative patients relative to those with anti-MDA5 autoantibodies (92.9% vs. 52.8% p = 0.045). Being breastfed > 6 months was more frequent in MSA-negative patients (88.9%) compared to anti-TIF-1 and anti-MDA5 autoantibody groups (41.2 and 28.6%, p ≤ 0.036). CONCLUSIONS Certain environmental exposures prior to diagnosis differed among clinical and serologic subgroups of JIIM, suggesting additional exposures to be explored as possible risk factors for JIIM phenotypes.
Collapse
|
21
|
El-Banna G, Fiorentino D. Update on Cutaneous Signs to Assist in the Diagnosis of Dermatomyositis. Curr Rheumatol Rep 2022; 24:156-165. [PMID: 35404005 DOI: 10.1007/s11926-022-01070-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Dermatomyositis (DM) is a heterogeneous idiopathic inflammatory myopathy that can be challenging to diagnose. Learning about the cutaneous manifestations in DM can assist with prompt diagnosis as well as subgroup classification. This review highlights recent data regarding cutaneous signs in DM and their associations with myositis-specific antibodies (MSAs). RECENT FINDINGS Several novel DM skin signs have recently been reported. Novel and confirmatory data have helped to define more clearly the associations between various cutaneous manifestations and MSAs. Awareness of the diverse cutaneous phenotypes can help with the timely diagnosis of DM. As some MSAs are associated with atypical skin features and/or characteristic patterns of clinical findings, knowledge of these associations can help clinicians to recognize DM patients. Understanding how the prevalence and presentation of various cutaneous signs differ among ethnically diverse patients is a high priority for further study.
Collapse
Affiliation(s)
- Ghida El-Banna
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway, Pavilion C #C-234, Redwood City, CA, 94063, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway, Pavilion C #C-234, Redwood City, CA, 94063, USA.
| |
Collapse
|
22
|
Kobayashi I, Shimomura M, Ueki M, Takezaki S, Okura Y, Nawate M, Yamada M, Takahashi Y, Ariga T. Development of Graves' disease during drug-free remission of juvenile dermatomyositis. Mod Rheumatol Case Rep 2022; 6:55-58. [PMID: 34515780 DOI: 10.1093/mrcr/rxab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022]
Abstract
We report a Japanese boy with Graves' disease (GD) which developed during drug-free remission of juvenile dermatomyositis (JDM). He had been diagnosed with JDM at the age of 6 years by typical skin rashes, muscle weakness, elevated serum transaminase levels, and typical findings of both magnetic resonance imaging and muscle biopsy. Although anti-melanoma differentiation antigen 5 autoantibody was positive, there was no complication of interstitial lung disease. He showed good response to methylprednisolone pulse therapy followed by oral prednisolone in combination with weekly methotrexate (MTX) and achieved drug-free remission after 3.5 years of treatment. Nevertheless, serum levels of soluble interleukin-2 receptor (sIL-2R) gradually elevated to 3185 U/ml despite no signs of relapse or malignancy. Hyperactivity and attention deficit was also noted. One year and 3 months after the cessation of MTX, he presented with abdominal pain, tachycardia, and apparent goitre. Laboratory tests showed elevated free triiodothyronine, undetectable thyroid stimulating hormone (TSH), and positive anti-TSH receptor antibodies. 99mTc scintigraphy showed high levels of thyroid uptake. He was diagnosed with GD and treated with 15 mg/day of thiamazole. Although transient drug eruption was observed, his thyroid functions are currently well-controlled on 5 mg/day of thiamazole. In conclusion, to our knowledge, this is the first report in English literature describing complication of GD with JDM. Unexpected elevation of sIL-2R could be a clue to the diagnosis of GD during the follow-up of JDM.
Collapse
Affiliation(s)
- Ichiro Kobayashi
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaidô, Japan
| | - Masaki Shimomura
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Masahiro Ueki
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaidô, Japan
| | - Shunichiro Takezaki
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaidô, Japan
| | - Yuka Okura
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Mitsuru Nawate
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Masafumi Yamada
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaidô, Japan
| | - Yutaka Takahashi
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Tadashi Ariga
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaidô, Japan
| |
Collapse
|
23
|
Quddusi FI, Youssef MJ, Davis DMR. Dermatologic Manifestations of Systemic Diseases in Childhood. Pediatr Rev 2021; 42:655-671. [PMID: 34850179 DOI: 10.1542/pir.2020-000679] [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: 11/24/2022]
Affiliation(s)
| | - Molly J Youssef
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Dawn Marie R Davis
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
| |
Collapse
|
24
|
Mrosak J, Banasiak K, Edelheit B, Lapin C, Tory H, Collins MS. Polymyxin-B Hemoperfusion as a Novel Treatment for Rapidly Progressive Interstitial Lung Disease in a Pediatric Patient Diagnosed With Anti-MDA5 Juvenile Dermatomyositis. J Clin Rheumatol 2021; 27:S480-S484. [PMID: 31743264 DOI: 10.1097/rhu.0000000000001191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
The Significance of Autoantibodies in Juvenile Dermatomyositis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5513544. [PMID: 34840975 PMCID: PMC8626176 DOI: 10.1155/2021/5513544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/01/2021] [Indexed: 12/22/2022]
Abstract
Juvenile dermatomyositis is a chronic and rare autoimmune disorder classified into the spectrum of idiopathic inflammatory myopathies. Although this entity is mainly characterized by the presence of pathognomonic cutaneous lesions and proximal muscle weakness, the clinical manifestation can be highly heterogeneous; thus, diagnosis might be challenging. Current treatment recommendations for juvenile dermatomyositis, based mainly upon case series, include the use of corticosteroids, immunomodulatory, and immunosuppressive agents. Recently, several specific autoantibodies have been shown to be associated with distinct clinical phenotypes of classic dermatomyositis. There is a need to further evaluate their relevance in the formation of various clinical features. Furthermore, while providing more personalized treatment strategies, one should consider diversity of autoantibody-related subgroups of juvenile dermatomyositis.
Collapse
|
26
|
Abstract
Childhood interstitial lung disease (ChILD) is an umbrella term encompassing a diverse group of diffuse lung diseases affecting infants and children. Although the timely and accurate diagnosis of ChILD is often challenging, it is optimally achieved through the multidisciplinary integration of imaging findings with clinical data, genetics, and potentially lung biopsy. This article reviews the definition and classification of ChILD; the role of imaging, pathology, and genetics in ChILD diagnosis; treatment options; and future goals. In addition, a practical approach to ChILD imaging based on the latest available research and the characteristic imaging appearance of ChILD entities are presented.
Collapse
|
27
|
Nombel A, Fabien N, Coutant F. Dermatomyositis With Anti-MDA5 Antibodies: Bioclinical Features, Pathogenesis and Emerging Therapies. Front Immunol 2021; 12:773352. [PMID: 34745149 PMCID: PMC8564476 DOI: 10.3389/fimmu.2021.773352] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/07/2021] [Indexed: 12/24/2022] Open
Abstract
Anti-MDA5 dermatomyositis is a rare systemic autoimmune disease, historically described in Japanese patients with clinically amyopathic dermatomyositis and life-threatening rapidly progressive interstitial lung disease. Subsequently, the complete clinical spectrum of the disease was enriched by skin, articular and vascular manifestations. Depending on the predominance of these symptoms, three distinct clinical phenotypes with different prognosis are now defined. To date, the only known molecular component shared by the three entities are specific antibodies targeting MDA5, a cytosolic protein essential for antiviral host immune responses. Several biological tools have emerged to detect these antibodies, with drawbacks and limitations for each of them. However, the identification of this highly specific serological marker of the disease raises the question of its role in the pathogenesis. Although current knowledge on the pathogenic mechanisms that take place in the disease are still in their enfancy, several lines of evidence support a central role of interferon-mediated vasculopathy in the development of skin and lung lesions, as well as a possible pathogenic involvement of anti-MDA5 antibodies. Here, we review the clinical and biological evidences in favor of these hypothesis, and we discuss the contribution of emerging therapies that shed some light on the pathogenesis of the disease.
Collapse
Affiliation(s)
- Anaïs Nombel
- Immunology Department, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Nicole Fabien
- Immunology Department, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Frédéric Coutant
- Immunology Department, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France.,Immunogenomics and Inflammation Research Team, University of Lyon, Edouard Herriot Hospital, Lyon, France
| |
Collapse
|
28
|
Stenzel W, Goebel HH, Bader-Meunier B, Gitiaux C. Inflammatory myopathies in childhood. Neuromuscul Disord 2021; 31:1051-1061. [PMID: 34736626 DOI: 10.1016/j.nmd.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022]
Abstract
Myositis in childhood can occur under different conditions and with various aetiologies, juvenile dermatomyositis (jDM) being by far the most frequent entity. The exact diagnostic workup and precise assessment of muscular as well as extramuscular involvement of organs in these systemic autoimmune diseases are relevant for specific and adjunct treatment of complications. Many new insights have become available with respect to the pathophysiological concepts as well as modern diagnostic measures and therapeutic approaches. Autoantibody detection in the serum of children with myositis is one of the major novelties that has become widely used and that is indeed helpful for diagnostic and prognostic measures. The pathophysiological relevance of type I interferons in jDM has been studied intensively in the past years. jDM is now seen as an acquired interferonopathy and first therapeutic consequences have been drawn from this pathogenic finding with the use of Janus-kinase inhibitors for severe and not otherwise treatable children.
Collapse
Affiliation(s)
- Werner Stenzel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany.
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Brigitte Bader-Meunier
- Department of Pediatric Immunolgy, Hematology, Rheumatology and Reference Center for Rare Autoimmune Systemic Diseases (RAISE), Necker Enfants Malades Hospital, AP-HP Centre, Paris, France
| | - Cyril Gitiaux
- Department of Pediatric Clinical Neurophysiology and reference Centre for Neuromuscular Diseases "Nord-Est-Ile de France", Necker Enfants Malades Hospital, AP-HP Centre, Paris University, Paris, France
| |
Collapse
|
29
|
Kim H, Huber AM, Kim S. Updates on Juvenile Dermatomyositis from the Last Decade: Classification to Outcomes. Rheum Dis Clin North Am 2021; 47:669-690. [PMID: 34635298 DOI: 10.1016/j.rdc.2021.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Juvenile dermatomyositis (JDM) is a heterogeneous disease with new classification criteria and updates in myositis-specific autoantibody and myositis-associated antibody groups. There are many validated assessment tools for assessing disease activity in JDM. Future studies will optimize these tools and improve feasibility in clinical and research contexts. Genetic and environmental risk factors, mechanisms of muscle pathology, role of interferon, vascular markers, and changes in immune cells provide insights to JDM pathogenesis. Outcomes have improved, but chronic disease, damage, and mortality highlight the need for better outcome predictors and treatments. Increased collaboration of stakeholders may help overcome research barriers and improve JDM treatment.
Collapse
Affiliation(s)
- Hanna Kim
- Juvenile Myositis Pathogenesis and Therapeutics Unit, National Institute of Arthritis Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Drive, Building 10, 12N-240, Bethesda, MD 20892, USA.
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Division of Pediatric Rheumatology, 5850 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
| | - Susan Kim
- University of California, San Francisco, 550 16th Street, San Francisco, CA 94158, USA
| |
Collapse
|
30
|
Gupta P, Kharbanda R, Lawrence A, Gupta L. Systemic flare and cutaneous ulceration following cytomegalovirus infection in a patient with anti-melanoma differentiation-associated protein 5 (MDA5) associated myositis: Diagnostic challenge during the time of coronavirus disease (COVID-19) pandemic. THE EGYPTIAN RHEUMATOLOGIST 2021; 43:271-274. [DOI: 10.1016/j.ejr.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
|
31
|
Ll Wilkinson MG, Deakin CT, Papadopoulou C, Eleftheriou D, Wedderburn LR. JAK inhibitors: a potential treatment for JDM in the context of the role of interferon-driven pathology. Pediatr Rheumatol Online J 2021; 19:146. [PMID: 34563217 PMCID: PMC8466894 DOI: 10.1186/s12969-021-00637-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/28/2021] [Indexed: 12/29/2022] Open
Abstract
Juvenile Idiopathic Inflammatory Myopathies (IIM) are a group of rare diseases that are heterogeneous in terms of pathology that can include proximal muscle weakness, associated skin changes and systemic involvement. Despite options for treatment, many patients continue to suffer resistant disease and lasting side-effects. Advances in the understanding of the immunopathology and genetics underlying IIM may specify new therapeutic targets, particularly where conventional treatment has not achieved a clinical response. An upregulated type I interferon signature is strongly associated with disease and could be a prime target for developing more specific therapeutics. There are multiple components of the IFN pathway that could be targeted for blockade therapy.Downstream of the cytokine receptor complexes are the Janus kinase-signal transducers and activators of transcription (JAK-STAT) pathway, which consists of JAK1-3, TYK2, and STAT1-6. Therapeutic inhibitors have been developed to target components of this pathway. Promising results have been observed in case studies reporting the use of the JAK inhibitors, Baricitinib, Tofacitinib and Ruxolitinib in the treatment of refractory Juvenile Dermatomyositis (JDM). There is still the question of safety and efficacy for the use of JAK inhibitors in JDM that need to be addressed by clinical trials. Here we review the future for the use of JAK inhibitors as a treatment for JDM.
Collapse
Affiliation(s)
- Meredyth G Ll Wilkinson
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, University College London, London, UK.
- NIHR Biomedical Research Centre at GOSH, London, UK.
| | - Claire T Deakin
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, University College London, London, UK
- NIHR Biomedical Research Centre at GOSH, London, UK
| | - Charalampia Papadopoulou
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Rheumatology, Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Despina Eleftheriou
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Rheumatology, Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Lucy R Wedderburn
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, University College London, London, UK
- NIHR Biomedical Research Centre at GOSH, London, UK
- Rheumatology, Great Ormond Street Hospital, Great Ormond Street, London, UK
| |
Collapse
|
32
|
Deakin CT, Papadopoulou C, McCann LJ, Martin N, Al-Obaidi M, Compeyrot-Lacassagne S, Pilkington CA, Tansley SL, McHugh NJ, Wedderburn LR, De Stavola BL. Identification and prediction of novel classes of long-term disease trajectories for patients with juvenile dermatomyositis using growth mixture models. Rheumatology (Oxford) 2021; 60:1891-1901. [PMID: 33146389 PMCID: PMC8023987 DOI: 10.1093/rheumatology/keaa497] [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: 02/17/2020] [Revised: 07/11/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives Uncertainty around clinical heterogeneity and outcomes for patients with JDM represents a major burden of disease and a challenge for clinical management. We sought to identify novel classes of patients having similar temporal patterns in disease activity and relate them to baseline clinical features. Methods Data were obtained for n = 519 patients, including baseline demographic and clinical features, baseline and follow-up records of physician’s global assessment of disease (PGA), and skin disease activity (modified DAS). Growth mixture models (GMMs) were fitted to identify classes of patients with similar trajectories of these variables. Baseline predictors of class membership were identified using Lasso regression. Results GMM analysis of PGA identified two classes of patients. Patients in class 1 (89%) tended to improve, while patients in class 2 (11%) had more persistent disease. Lasso regression identified abnormal respiration, lipodystrophy and time since diagnosis as baseline predictors of class 2 membership, with estimated odds ratios, controlling for the other two variables, of 1.91 for presence of abnormal respiration, 1.92 for lipodystrophy and 1.32 for time since diagnosis. GMM analysis of modified DAS identified three classes of patients. Patients in classes 1 (16%) and 2 (12%) had higher levels of modified DAS at diagnosis that improved or remained high, respectively. Patients in class 3 (72%) began with lower DAS levels that improved more quickly. Higher proportions of patients in PGA class 2 were in DAS class 2 (19%, compared with 16 and 10%). Conclusion GMM analysis identified novel JDM phenotypes based on longitudinal PGA and modified DAS.
Collapse
Affiliation(s)
- Claire T Deakin
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospitals and Great Ormond Street Hospital, London, UK.,NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - Charalampia Papadopoulou
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Rheumatology Unit, Great Ormond Street Hospital, London, UK
| | - Liza J McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Neil Martin
- Rheumatology Department, Royal Hospital for Sick Children, Glasgow
| | | | | | | | - Sarah L Tansley
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Lucy R Wedderburn
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospitals and Great Ormond Street Hospital, London, UK.,NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK.,Rheumatology Unit, Great Ormond Street Hospital, London, UK
| | - Bianca L De Stavola
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | |
Collapse
|
33
|
Yeung TW, Cheong KN, Lau YL, Tse KCN. Adolescent-onset anti-MDA5 antibody-positive juvenile dermatomyositis with rapidly progressive interstitial lung disease and spontaneous pneumomediastinum: a case report and literature review. Pediatr Rheumatol Online J 2021; 19:103. [PMID: 34193210 PMCID: PMC8247223 DOI: 10.1186/s12969-021-00595-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dermatomyositis with positive anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody has a distinct phenotype associated with small hand joint arthritis, mucocutaneous ulceration, palmar papules and less muscle involvement. It is also associated with increased risk of rapidly progressive interstitial lung disease (RP-ILD) and has a high mortality rate in adults. There is evidence that cases complicated with spontaneous pneumomediastinum (PNM) have an increase in mortality. While most of the evidence for this rare disease is derived from the adult literature, we report a case diagnosed in an adolescent complicated with both RP-ILD and PNM with a good outcome after aggressive immunosuppressive therapy. Our case also illustrates the potential challenges in diagnosis of this condition in the setting of non-specific clinical manifestations, the need for a high index of suspicion, and the importance of testing for myositis-specific antibodies (MSA) early to aid in diagnosis given the risk of rapid progression in these patients. CASE PRESENTATION A 16-year-old Chinese female presented with fever and cough for 1 day, and finger swelling for 3 weeks. Physical examination revealed arthritis of fingers and wrists, ulcers and palmar papules over fingers, hyperpigmentation of interphalangeal joints, and rash over the neck. The diagnosis of dermatomyositis was made 1 month later with the onset of malar rash, Gottron's papules, calcinosis and myalgia. The diagnosis was supported by the presence of anti-MDA5 antibody and evidence of inflammatory myopathy on magnetic resonance imaging. In retrospect, she already had interstitial lung disease at first presentation manifested as cough and opacity on chest radiograph, which was later confirmed with chest computed tomography. She was treated according to adult guidelines with steroid and calcineurin inhibitor. Her disease was resistant to initial therapy and was complicated by RP-ILD and spontaneous PNM. Intensive immunosuppressive therapy including cyclophosphamide and rituximab were required to induce remission. CONCLUSIONS Recognition of distinct clinical features of anti-MDA5 antibody-positive dermatomyositis and testing for MSA is crucial in patients with skin ulceration and abnormal pulmonary findings of unknown etiology, as prompt diagnosis with early aggressive treatment and anticipation of complications could make a difference in the outcome of this disease with high mortality.
Collapse
Affiliation(s)
- Tsz-Wing Yeung
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR. .,Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong SAR.
| | - Kai-Ning Cheong
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Kowloon Bay, Hong Kong SAR ,grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Kowloon Bay, Hong Kong SAR ,grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR ,grid.415550.00000 0004 1764 4144Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR
| | - Kei-Chiu Niko Tse
- grid.417336.40000 0004 1771 3971Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR
| |
Collapse
|
34
|
Mamyrova G, Kishi T, Shi M, Targoff IN, Huber AM, Curiel RV, Miller FW, Rider LG. Anti-MDA5 autoantibodies associated with juvenile dermatomyositis constitute a distinct phenotype in North America. Rheumatology (Oxford) 2021; 60:1839-1849. [PMID: 33140079 DOI: 10.1093/rheumatology/keaa429] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/03/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Myositis-specific autoantibodies have defined distinct phenotypes of patients with juvenile myositis (JIIM). We assessed the frequency and clinical significance of anti-melanoma differentiation-associated gene 5 (MDA5) autoantibody-associated JIIM in a North American registry. METHODS Retrospective examination of the characteristics of 35 JIIM patients with anti-MDA5 autoantibodies was performed, and differences from other myositis-specific autoantibody groups were evaluated. RESULTS Anti-MDA5 autoantibodies were present in 35/453 (7.7%) of JIIM patients and associated with older age at diagnosis, and lower serum creatine kinase and aldolase levels. Patients with anti-MDA5 autoantibodies had more frequent weight loss, adenopathy, arthritis, interstitial lung disease (ILD), and less frequent falling compared with anti-transcriptional intermediary factor 1 (TIF1), anti-nuclear matrix protein 2 (NXP2) and myositis-specific autoantibody/myositis-associated autoantibody-negative patients. They had a different season of diagnosis and less frequent mechanic's hands and ILD compared with those with anti-synthetase autoantibodies. Anti-MDA5 patients received fewer medications compared with anti-TIF1, and corticosteroid treatment was shorter compared with anti-TIF1 and anti-nuclear matrix protein 2 autoantibody groups. The frequency of remission was higher in anti-MDA5 than anti-synthetase autoantibody-positive JIIM. In multivariable analyses, weight loss, arthritis and arthralgia were most strongly associated with anti-MDA5 autoantibody-positive JIIM. CONCLUSION Anti-MDA5 JIIM is a distinct subset, with frequent arthritis, weight loss, adenopathy and less severe myositis, and is also associated with ILD. Anti-MDA5 is distinguished from anti-synthetase autoantibody-positive JIIM by less frequent ILD, lower creatine kinase levels and differing seasons of diagnosis. Anti-MDA5 has comparable outcomes, but with the ability to discontinue steroids more rapidly and less frequent flares compared with anti-TIF1 autoantibodies, and more frequent remission compared with anti-synthetase JIIM patients.
Collapse
Affiliation(s)
- Gulnara Mamyrova
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Takayuki Kishi
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Min Shi
- Biostatistics & Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Ira N Targoff
- Veteran's Affairs Medical Center, University of Oklahoma Health Sciences Center, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, NS, Canada
| | - Rodolfo V Curiel
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | | |
Collapse
|
35
|
Perron MM, Vasquez-Canizares N, Tarshish G, Wahezi DM. Myositis autoantibodies in a racially diverse population of children with idiopathic inflammatory myopathies. Pediatr Rheumatol Online J 2021; 19:92. [PMID: 34118936 PMCID: PMC8199392 DOI: 10.1186/s12969-021-00574-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/20/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Juvenile idiopathic inflammatory myopathies (JIIMs) is a group of autoimmune disorders, including juvenile dermatomyositis (JDM), juvenile polymyositis (JPM) and overlap myositis, that are characterized by proximal muscle weakness, elevated levels of serum muscle enzymes, and pathognomonic skin findings. While the exact etiology of JIIMs is unclear, the presence of myositis specific autoantibodies (MSAs) have been associated with certain clinical phenotypes, organ involvement and disease prognosis. To date, there have been few studies of the associations between MSA presence and patient ethnicity. It is important to understand the extent to which ethnicity impacts disease manifestations, organ involvement and clinical outcomes. The goal of our study is to determine MSA and myositis associated autoantibody (MAA) presence, clinical phenotype, and disease course in a racially diverse population of pediatric patients with JIIMs. METHODS Patients age 2-21 years with a prior diagnosis of JDM, JPM or overlap myositis, who had been tested for MSA/MAA, were eligible for study inclusion. Clinical and laboratory data were collected retrospectively via manual chart review in this single-center study. Descriptive statistics were performed to summarize each variable. Given the small sample size, non-parametric testing was performed using Fischer's exact test, Wilcoxon rank sum test and Kruskal-Wallis test. RESULTS Thirty one patients were included in the analysis. Race and ethnicity were self-reported as Hispanic (48.4%), white (25.8%), and Black (25.8%). The most prevalent MSAs were anti-MDA5 (25.8%), anti-p155/140 (22.6%) and anti-MJ (19.4%). Presence of autoantibodies (p = 0.04) and pulmonary disease (p = 0.03) were significantly higher in patients of Black or Hispanic descent compared with white descent. Anti-MDA5 antibodies, cutaneous ulceration, cardiopulmonary involvement, hospitalizations and one death were only reported in patients with Black or Hispanic descent. Patients with anti-MDA5 antibodies were more likely to be male (p = 0.04) and to have cutaneous ulceration (p = 0.02). CONCLUSIONS This study describes the prevalence of MSA/MAA in a racially diverse group of patients with JIIM and further delineates clinical phenotype and disease complications in these groups. We found a relatively high proportion of children with anti-MDA5 antibodies and described potentially worse clinical courses in children of Black or Hispanic descent. Further investigation is warranted to examine these findings.
Collapse
Affiliation(s)
- Megan Mariko Perron
- Children's Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY, 10467, USA. .,Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Natalia Vasquez-Canizares
- grid.414114.50000 0004 0566 7955Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Gabriel Tarshish
- grid.414114.50000 0004 0566 7955Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Dawn M. Wahezi
- grid.414114.50000 0004 0566 7955Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| |
Collapse
|
36
|
Disease characteristics and clinical outcomes of adults and children with anti-MDA-5 antibody-associated myositis: a prospective observational bicentric study. Rheumatol Int 2021; 42:1155-1165. [PMID: 34050793 DOI: 10.1007/s00296-021-04897-1] [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: 04/03/2021] [Accepted: 05/15/2021] [Indexed: 12/14/2022]
Abstract
To study the demographic, clinical and serologic characteristics of anti-MDA5-positive DM from two geographically and ethnically disparate inception cohorts in India. To identify the clinical and serological parameters at inception that could predict mortality among these individuals. Individuals with anti-MDA5 antibody-positive DM diagnosed between 2017 and 2020 from two centres in India were prospectively followed up. The clinical and serological characteristics at baseline and the treatment outcome at follow-up were assessed for this study. Anti-MDA5 antibody was positive in 25 (7.5%) out of the 330 individuals with myositis. These 25 (21 adults, 4 juvenile) patients were followed up for a median duration of 14 months. Among adults, a majority had cutaneous manifestations 21 (84%) followed by, arthritis 17 (80%), and interstitial lung disease 12 (ILD, 57.1%). Four (19%) had rapidly progressive ILD (RP-ILD). Eight (38%) presented as clinically amyopathic DM. Among cutaneous manifestations, majority (62%) had classic features (gottron's papules/sign, heliotrope rash) while 8 (38%) had cutaneous ulceration and 2 each had periorbital edema and tendon rupture. Eight (38%) were positive for anti-Ro-52 antibody. Out of 21 adults, 8 (38%) succumbed to the diseases. RP-ILD (n = 4; 19%), ulcerative gottron's (n = 5) and anti-Ro-52 (n = 8) were significantly associated with mortality (p < 0.05). Upon binary logistic regression, positive anti-Ro-52 antibody predicted mortality [HR 17.3 (95%CI 1.4-210, p = 0.025)]. All juvenile anti-MDA5-positive DMs had classic cutaneous features with 2 of them having ulcerative gottron's. None of the juvenile patients had ILD and everyone survived till the last follow-up. Indian adults with anti-MDA5 DM have high mortality. Rarer atypical features like tendon rupture or periorbital edema could assist in diagnosis. Ulcerative gottron's, positive anti-Ro 52 antibodies, and RP-ILD are valuable clinical-serological markers that portend poor prognosis.
Collapse
|
37
|
Sabbagh SE, Neely J, Chow A, DeGuzman M, Lai J, Lvovich S, McGrath T, Pereira M, Pinal-Fernandez I, Roberts J, Rouster-Stevens K, Schmeling H, Sura A, Tarshish G, Tucker L, Rider LG, Kim S. Risk factors associated with Pneumocystis jirovecii pneumonia in juvenile myositis in North America. Rheumatology (Oxford) 2021; 60:829-836. [PMID: 32889531 DOI: 10.1093/rheumatology/keaa436] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/24/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Pneumocystis jirovecii pneumonia (PJP) is associated with significant morbidity and mortality in adult myositis patients; however, there are few studies examining PJP in juvenile myositis [juvenile idiopathic inflammatory myopathy (JIIM)]. The purpose of this study was to determine the risk factors and clinical phenotypes associated with PJP in JIIM. METHODS An research electronic data capture (REDCap) questionnaire regarding myositis features, disease course, medications and PJP infection characteristics was completed by treating physicians for 13 JIIM patients who developed PJP (PJP+) from the USA and Canada. Myositis features and medications were compared with 147 JIIM patients without PJP (PJP-) from similar geographic regions who enrolled in National Institutes of Health natural history studies. RESULTS PJP+ patients were more often of Asian ancestry than PJP- patients [odds ratio (OR) 8.7; 95% CI 1.3, 57.9]. Anti- melanoma differentiation associated protein 5 (MDA5) autoantibodies (OR 12.5; 95% CI 3.0, 52.4), digital infarcts (OR 43.8; 95% CI 4.2, 460.2), skin ulcerations (OR 12.0; 95% CI 3.5, 41.2) and interstitial lung disease (OR 10.6; 95% CI 2.1, 53.9) were more frequent in PJP+ patients. Before PJP diagnosis, patients more frequently received pulse steroids, rituximab and more immunosuppressive therapy compared with PJP- patients. Seven PJP+ patients were admitted to the intensive care unit and four patients died due to PJP or its complications. CONCLUSIONS PJP is a severe infection in JIIM that can be associated with mortality. Having PJP was associated with more immunosuppressive therapy, anti-MDA5 autoantibodies, Asian race and certain clinical features, including digital infarcts, cutaneous ulcerations and interstitial lung disease. Prophylaxis for PJP should be considered in juvenile myositis patients with these features.
Collapse
Affiliation(s)
- Sara E Sabbagh
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA.,Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jessica Neely
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Albert Chow
- Division of Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA.,Division of Pediatric Rheumatology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Marietta DeGuzman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Rheumatology, Texas Children's Hospital, Houston, TX, USA
| | - Jamie Lai
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Rheumatology, Texas Children's Hospital, Houston, TX, USA.,University of Colorado School of Medicine, Division of Pediatric Rheumatology, Children's Hospital Colorado, Aurora, CO, USA
| | - Svetlana Lvovich
- Section of Rheumatology, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Tara McGrath
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, USA.,BC Children's Hospital, Vancouver, BC, Canada
| | - Maria Pereira
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Rheumatology, Texas Children's Hospital, Houston, TX, USA
| | - Iago Pinal-Fernandez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), 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
| | - Jordan Roberts
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Heinrike Schmeling
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Anjali Sura
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.,Department of Pediatrics, Upstate University Hospital, Syracuse, NY, USA
| | - Gabriel Tarshish
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Lori Tucker
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, USA.,BC Children's Hospital, Vancouver, BC, Canada
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Susan Kim
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | | |
Collapse
|
38
|
Anjani G, Govindarajan S, Sudhakar M, Chaudhary H, Rawat A, Kumar Jindal A. Catch the thief by its marks: inverse Gottron papules, interstitial lung disease, anti MDA-5 antibody positivity in juvenile dermatomyositis. Rheumatology (Oxford) 2021; 60:e56-e58. [PMID: 32888028 DOI: 10.1093/rheumatology/keaa433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/21/2020] [Accepted: 06/21/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gummadi Anjani
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Srinivasavardan Govindarajan
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Murugan Sudhakar
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Himanshi Chaudhary
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
39
|
Okiyama N. Clinical Features and Cutaneous Manifestations of Juvenile and Adult Patients of Dermatomyositis Associated with Myositis-Specific Autoantibodies. J Clin Med 2021; 10:jcm10081725. [PMID: 33923564 PMCID: PMC8073628 DOI: 10.3390/jcm10081725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Dermatomyositis is one of the idiopathic inflammatory myopathies, which is characterized with specific skin manifestations, and considered as an autoimmune disease. Dermatomyositis is a heterogeneous disorder with various presences, severities and characteristics of myositis, dermatitis, and interstitial lung disease. Our and others' data showed that myositis-specific autoantibodies have been associated with distinct clinical features. This article reviewed the epidemiology and characteristic clinical features of the different types of antibody-associated dermatomyositis in adult and juvenile patients, which include the severity of myopathy, the potential complication of interstitial lung disease, potential association with malignancies, and characteristic cutaneous manifestations.
Collapse
Affiliation(s)
- Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| |
Collapse
|
40
|
Ryan ME, Cortez D, Dietz KR, Karachunski P, Binstadt BA. Anti-MDA5 juvenile idiopathic inflammatory myopathy with second-degree heart block but no skin or lung involvement: a case report. BMC Rheumatol 2021; 5:8. [PMID: 33795018 PMCID: PMC8017641 DOI: 10.1186/s41927-021-00180-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/31/2021] [Indexed: 12/25/2022] Open
Abstract
Background Patients with idiopathic inflammatory myopathy and autoantibodies directed against melanoma differentiation-associated protein 5 (MDA5) characteristically have interstitial lung disease, severe cutaneous involvement, arthritis, and relatively mild myositis. Cardiac involvement in idiopathic inflammatory myopathy can occur and has been associated with anti-signal recognition particle and anti-polymyositis-scleroderma autoantibodies, but not with anti-MDA5 autoantibodies. Case presentation A 14-year-old male presented with weakness, second-degree heart block, arthritis, and hematologic cytopenias. Imaging and biopsies confirmed the diagnosis of juvenile idiopathic inflammatory myopathy, and he had high titer anti-MDA5 autoantibodies. There were no cutaneous or pulmonary abnormalities. While on prednisone and methotrexate, the patient’s heart block improved from second- to first-degree and the cytopenias resolved. Persistent myositis prompted the addition of intravenous immunoglobulin. Seven months into the disease course, the arthritis and myositis are in remission and the patient is no longer taking corticosteroids. Conclusions We report a novel case of a patient with juvenile idiopathic myositis who lacked the typical cutaneous and pulmonary findings associated with anti-MDA5 positivity, but who had cardiac conduction defects. This report broadens the clinical spectrum of anti-MDA5-associated inflammatory myopathy.
Collapse
Affiliation(s)
- Meghan E Ryan
- Department of Pediatrics, Division of Rheumatology, Allergy & Immunology, University of Minnesota, Minneapolis, USA
| | - Daniel Cortez
- Department of Pediatrics, Division of Cardiology, University of Minnesota, Minneapolis, USA
| | - Kelly R Dietz
- Department of Radiology, University of Minnesota, Minneapolis, USA
| | | | - Bryce A Binstadt
- Department of Pediatrics, Division of Rheumatology, Allergy & Immunology, University of Minnesota, Minneapolis, USA.
| |
Collapse
|
41
|
Mehta P, Machado PM, Gupta L. Understanding and managing anti-MDA 5 dermatomyositis, including potential COVID-19 mimicry. Rheumatol Int 2021; 41:1021-1036. [PMID: 33774723 PMCID: PMC8000693 DOI: 10.1007/s00296-021-04819-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/18/2021] [Indexed: 12/19/2022]
Abstract
Anti-Melanoma Differentiation-Associated gene 5 (MDA-5) Dermatomyositis (MDA5, DM) is a recently identified subtype of myositis characteristically associated with Rapidly Progressive Interstitial Lung Disease (RP-ILD) and unique cutaneous features. We reviewed PubMed, SCOPUS and Web of Science databases and selected 87 relevant articles after screening 1485 search results, aiming to gain a better understanding of the pathophysiology, clinical features, diagnosis, and treatment approaches of anti-MDA-5 DM described in the literature. The etiopathogenesis is speculatively linked to an unidentified viral trigger on the background of genetic predisposition culminating in an acquired type I interferonopathy. The clinical phenotype is highly varied in different ethnicities, with new clinical features having been recently described, expanding the spectrum of cases that should raise the suspicion of anti-MDA-5 DM. Unfortunately, the diagnosis is frequently missed despite excessive mortality, calling for wider awareness of suspect symptoms. RP ILD is the major determinant of survival, treatment being largely based on observational studies with recent insights into aggressive combined immunosuppression at the outset.
Collapse
Affiliation(s)
- Pankti Mehta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Rae Bareilly road, Lucknow, 226014, Uttar Pradesh, India
| | - Pedro M Machado
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.,Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Rae Bareilly road, Lucknow, 226014, Uttar Pradesh, India.
| |
Collapse
|
42
|
Jiang Y, Liu Y, Zhao Y, Zheng Y, Yu M, Deng J, Hao H, Zhang W, Wang Z, Yuan Y. Mitochondrial morphology and MAVS-IFN1 signaling pathway in muscles of anti-MDA5 dermatomyositis. Ann Clin Transl Neurol 2021; 8:677-686. [PMID: 33576578 PMCID: PMC7951095 DOI: 10.1002/acn3.51311] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 01/20/2023] Open
Abstract
Objective This study aimed to investigate mitochondrial changes and the mitochondrial antiviral‐signaling protein (MAVS)‐type I interferon (IFN1) signaling pathway in the muscles of anti‐melanoma differentiation gene 5(MDA5) dermatomyositis (DM) patients. Methods Eleven anti‐MDA5 DM and ten antibody‐negative DM patients were included. Muscle biopsies were performed in all patients. Muscle pathology and mitochondrial morphology in particular were compared between two groups. The expression of MDA5, MAVS, interferon (IFN) regulatory factor 7, and IFN‐stimulated gene 15, which are components of the MAVS‐IFN1 signaling pathway, was measured in muscle specimen. The correlation between MAVS expression in muscles and disease phenotypes and muscle pathology were analyzed. Results Anti‐MDA5 DM showed a significantly lower incidence of the characteristic DM pathology (P < 0.05) than antibody‐negative DM, including perifascicular fiber atrophy, inflammation, and vasculopathy. Mitochondrial abnormalities in anti‐MDA5 patients revealed a high incidence of (8/11,72.7%) and different pattern from that in antibody‐negative DM. MDA5, MAVS, IFN regulatory factor 7, and IFN stimulated gene 15 expression levels in the muscles of anti‐MDA5 DM patients were higher than those of the controls (P < 0.05) but lower than those of antibody‐negative DM patients (P < 0.05). The MAVS levels negatively correlated with manual muscle test 8 scores (r = 0.701, P = 0.016). Conclusions Compared to antibody‐negative DM, we presented a different distribution of the mitochondrial pathology and less severe morphology in anti‐MDA5 DM. We also revealed the enhanced but less intensive MAVS‐IFN1 signaling pathway activity in muscles of anti‐MDA5 DM. Such disparity suggested the potentially different mechanism of muscle injury in two DM groups.
Collapse
Affiliation(s)
- Yanyan Jiang
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
| | - Yilin Liu
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
| | - Yawen Zhao
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
| | - Yiming Zheng
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
| | - Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
| | - Jianwen Deng
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
| | - Hongjun Hao
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
| |
Collapse
|
43
|
Kul Cinar O, Papadopoulou C, Pilkington CA. Treatment of Calcinosis in Juvenile Dermatomyositis. Curr Rheumatol Rep 2021; 23:13. [PMID: 33555459 DOI: 10.1007/s11926-020-00974-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Juvenile dermatomyositis (JDM) is a rare autoimmune disease characterised by muscle and skin involvement. Calcinosis is a debilitating complication of JDM which is difficult to treat and may cause long-term morbidity. The purpose of this review is to provide an update for the treatment of JDM-associated calcinosis based on previously published studies. RECENT FINDINGS Evidence-based studies are lacking for the management of calcinosis, and current treatment modalities have been largely based on case reports, case series, cohort studies, limited controlled studies and anecdotal clinical experience. The use of early aggressive therapy for resistant cases is strongly suggested to halt persistent disease activity which may help in reducing steroid use and their associated complications. Recent insights into disease pathogenesis, myositis-specific antibodies and genetic associations have led to identification of novel therapeutic targets such as Janus kinase (JAK) 1/2. Different treatment regimens with variable outcomes are in use for the treatment of refractory calcinosis; nevertheless, the level of evidence is not sufficient to propose specific guidelines. Recently, JAK 1/2 inhibitors have shown to be effective as an emerging therapeutic option highlighting that translational and clinical research is crucial to develop targeted treatment for JDM-associated calcinosis.
Collapse
Affiliation(s)
- Ovgu Kul Cinar
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. .,Division of Infection and Immunity, University College London, London, WC1E 6BT, UK.
| | - Charalampia Papadopoulou
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Clarissa A Pilkington
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,NIHR Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
44
|
Yamasaki Y, Kobayashi N, Akioka S, Yamazaki K, Takezaki S, Nakaseko H, Ohara A, Nishimura K, Nishida Y, Sato S, Kishi T, Hashimoto M, Mori M, Okazaki Y, Kuwana M, Ohta A. Clinical impact of myositis-specific autoantibodies on long-term prognosis of juvenile idiopathic inflammatory myopathies: multicenter study. Rheumatology (Oxford) 2021; 60:4821-4831. [PMID: 33576399 DOI: 10.1093/rheumatology/keab108] [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: 12/16/2020] [Revised: 01/17/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the clinical characteristics, treatment, and prognosis of juvenile idiopathic inflammatory myopathies (JIIM) in Japan for each myositis-specific autoantibody (MSA) profile. METHODS A multicenter, retrospective study was conducted using data of patients with JIIM at nine pediatric rheumatology centers in Japan. Patients with MSA profiles, determined by immunoprecipitation using stored serum from the active stage, were included. RESULTS MSA were detected in 85 of 96 cases eligible for the analyses. Over 90% of the patients in this study had one of the following three MSA types: anti-MDA5 (n = 31), anti-TIF1γ (n = 25), and anti-NXP2 (n = 25) antibodies. Gottron papules and periungual capillary abnormalities were the most common signs of every MSA group in the initial phase. The presence of interstitial lung disease (ILD) was the highest risk factor for patients with anti-MDA5 antibodies. Most patients were administered multiple drug therapies: glucocorticoids and methotrexate were administered to patients with anti-TIF1γ or anti-NXP2 antibodies. Half of the patients with anti-MDA5 antibodies received more than three medications including intravenous cyclophosphamide, especially patients with ILD. Patients with anti-MDA5 antibodies were more likely to achieve drug-free remission (29% vs 21%) and less likely to relapse (26% vs 44%) than others. CONCLUSION Anti-MDA5 antibodies are the most common MSA type in Japan, and patients with this antibody are characterized by ILD at onset, multiple medications including intravenous cyclophosphamide, drug-free remission, and a lower frequency of relapse. New therapeutic strategies are required for other MSA types.
Collapse
Affiliation(s)
- Yuichi Yamasaki
- Department of Pediatrics, Kagoshima University Hospital, Kagoshima, Japan
| | - Norimoto Kobayashi
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shinji Akioka
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuko Yamazaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Haruna Nakaseko
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Asami Ohara
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Kenichi Nishimura
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yutaka Nishida
- Department of Pediatrics, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Satoshi Sato
- Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Takayuki Kishi
- Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Motomu Hashimoto
- Department of Pediatrics, Kagoshima University Hospital, Kagoshima, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuka Okazaki
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Akiko Ohta
- Division of Public Health, Department of Social Medicine, Saitama Medical University Faculty of Medicine, Moroyama, Saitama, Japan
| |
Collapse
|
45
|
Tansley SL, Li D, Betteridge ZE, McHugh NJ. The reliability of immunoassays to detect autoantibodies in patients with myositis is dependent on autoantibody specificity. Rheumatology (Oxford) 2021; 59:2109-2114. [PMID: 32030410 PMCID: PMC7382594 DOI: 10.1093/rheumatology/keaa021] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/30/2019] [Indexed: 12/18/2022] Open
Abstract
Objectives In order to address the reliability of commercial assays to identify myositis-specific and -associated autoantibodies, we aimed to compare the results of two commercial immunoassays with the results obtained by protein immunoprecipitation. Methods Autoantibody status was determined using radio-labelled protein immunoprecipitation for patients referred to our laboratory for myositis autoantibody characterization. For each autoantibody of interest, the sera from 25 different patients were analysed by line blot (Euroline Myositis Antigen Profile 4, EuroImmun, Lübeck, Germany) and dot blot (D-Tek BlueDiver, Diagnostic Technology, Belrose, NSW, Australia). Sera from 134 adult healthy controls were analysed. Results Overall commercial assays performed reasonably well, with high agreement (Cohen’s κ >0.8). Notable exceptions were the detection of rarer anti-synthetases with κ < 0.2 and detection of anti-TIF1γ, where κ was 0.70 for the line blot and 0.31 for dot blot. Further analysis suggested that the proportion of patients with anti-TIF1γ may recognize a conformational epitope, limiting the ability of blotting-based assays that utilize denatured antigen to detect this clinically important autoantibody. A false-positive result occurred in 13.7% of samples analysed by line blot and 12.1% analysed by dot blot. Conclusion The assays analysed do not perform well for all myositis-specific and -associated autoantibodies and overall false positives are relatively common. It is crucial that clinicians are aware of the limitations of the methods used by their local laboratory. Results must be interpreted within the clinical context and immunoprecipitation should still be considered in selected cases, such as apparently autoantibody-negative patients where anti-synthetase syndrome is suspected.
Collapse
Affiliation(s)
- Sarah L Tansley
- Department of Pharmacy and pharmacology, University of Bath, Bath, UK
- Correspondence to: Sarah Tansley, University of Bath, Claverton Down, Bath BA2 7AY, UK. E-mail:
| | - Danyang Li
- Department of Pharmacy and pharmacology, University of Bath, Bath, UK
| | - Zoe E Betteridge
- Department of Pharmacy and pharmacology, University of Bath, Bath, UK
| | - Neil J McHugh
- Department of Pharmacy and pharmacology, University of Bath, Bath, UK
| |
Collapse
|
46
|
Melki I, Devilliers H, Gitiaux C, Bondet V, Duffy D, Charuel JL, Miyara M, Bokov P, Kheniche A, Kwon T, Authier FJ, Allenbach Y, Belot A, Bodemer C, Bourrat E, Dumaine C, Fabien N, Faye A, Frémond ML, Hadchouel A, Kitabayashi N, Lepelley A, Martin-Niclos MJ, Mudumba S, Musset L, Quartier P, Rice GI, Seabra L, Uettwiller F, Uggenti C, Viel S, Rodero MP, Crow YJ, Bader-Meunier B. Anti-MDA5 juvenile idiopathic inflammatory myopathy: a specific subgroup defined by differentially enhanced interferon-α signalling. Rheumatology (Oxford) 2021; 59:1927-1937. [PMID: 31755959 DOI: 10.1093/rheumatology/kez525] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/03/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES JDM and juvenile overlap myositis represent heterogeneous subtypes of juvenile idiopathic inflammatory myopathy (JIIM). Chronic evolution can occur in up to 60% of cases, and morbidity/mortality is substantial. We aimed to describe the clinical, biological, histological and type I IFN status in JIIM associated with anti-melanoma differentiation-associated protein 5 (anti-MDA5) autoantibodies at presentation (group 1) in comparison with other JIIM (group 2). METHODS This was a retrospective and prospective study of patients with JIIM ascertained from three French paediatric rheumatology reference centres between 2013 and 2019. Muscle biopsies were reviewed. Type I interferon pathway activity was assessed by dosage of IFNα serum protein and the expression of IFN-stimulated genes. RESULTS Sixty-four patients were included, 13 in group 1 (54% JDM and 46% juvenile overlap myositis) and 51 in group 2 (76% JDM and 24% juvenile overlap myositis). Group 1 patients demonstrated more arthritis, skin ulcerations, lupus features and interstitial lung disease, and a milder muscular involvement. Serum IFNα levels were higher in group 1 than 2, and decreased after treatment or improvement in both groups. Outcome was similar in both groups. Unconventional treatment (more than two lines) was required in order to achieve remission, especially when skin ulceration was reported. CONCLUSION This study indicates a higher frequency of arthritis, skin ulcerations and interstitial lung disease, but milder muscular involvement, in JIIM with positive anti-MDA5 autoantibodies compared with other JIIM. Our data support an important role of systemic IFNα in disease pathology, particularly in the anti-MDA5 auto-antibody-positive subgroup. In severe and refractory forms of JIIM, IFNα may represent a therapeutic target.
Collapse
Affiliation(s)
- Isabelle Melki
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris.,General Paediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert Debré, AP-HP, Paris.,Paediatric Hematology-Immunology and Rheumatology Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Necker-Enfants Malades, AP-HP, Paris
| | - Hervé Devilliers
- Centre Hospitalier Universitaire de Dijon, Hôpital François-Mitterrand, Service de Médecine Interne 2 et Centre d'Investigation Clinique, Inserm CIC 1432, Dijon
| | - Cyril Gitiaux
- Reference Centre for Neuromuscular Diseases, Necker-Enfants Malades Hospital, AP-HP.5, Paris.,Department of Paediatric Neurophysiology, Necker-Enfants Malades Hospital, AP-HP.5, Paris University, Paris.,INSERM U955-Team 10 'Biology of the Neuromuscular System', Paris Est-Creteil University, Creteil
| | - Vincent Bondet
- Immunobiology of Dendritic Cells, Institut Pasteur, Paris.,INSERM U1223, Paris
| | - Darragh Duffy
- Immunobiology of Dendritic Cells, Institut Pasteur, Paris.,INSERM U1223, Paris
| | - Jean-Luc Charuel
- Department of Immunology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris
| | - Makoto Miyara
- Department of Immunology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris
| | - Plamen Bokov
- Paediatric Physiology Department, Hôpital Robert Debré, AP-HP, Paris.,Université Paris Diderot, Paris
| | - Ahmed Kheniche
- Paediatric Radiology Department, Hôpital Robert Debré, AP-HP, Paris
| | - Theresa Kwon
- Nephrology Department, Hôpital Robert Debré, AP-HP, Paris
| | - François Jérôme Authier
- INSERM U955-Team 10 'Biology of the Neuromuscular System', Paris Est-Creteil University, Creteil.,Reference Centre for Neuromuscular Diseases, Henri Mondor University Hospital, Paris
| | - Yves Allenbach
- Département de médecine Interne et Immunologie Clinique, Centre de Référence Maladies Neuro-Musculaires, DHUi2B, AP-HP, GH Pitié-Salpêtrière, Paris.,Centre de Recherche en Myologie, UMRS 974 UPMC - INSERM, Paris
| | - Alexandre Belot
- Service de néphrologie, rhumatologie et dermatologie pédiatriques, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Filière des maladies autoimmunes et autoinflammatoires rares (FAI2R), Hôpital Femme Mère-Enfant, hospices civils de Lyon, Lyon.,Université de Lyon, Bron cedex, France.,Inserm U1111, Lyon
| | - Christine Bodemer
- National Reference Centre for Genodermatosis and Rare Diseases of the Skin (MAGEC).,Department of Dermatology, Necker-Enfants Malades Hospital, APHP5, Paris.,Imagine Institute, Inserm U 1163, Paris University, Paris
| | - Emmanuelle Bourrat
- General Paediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert Debré, AP-HP, Paris
| | - Cécile Dumaine
- General Paediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert Debré, AP-HP, Paris
| | - Nicole Fabien
- Université de Lyon, Bron cedex, France.,Department of Immunology, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Filière des maladies autoimmunes et autoinflammatoires rares (FAI2R), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon
| | - Albert Faye
- General Paediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert Debré, AP-HP, Paris.,Université Paris Diderot, Paris
| | - Marie-Louise Frémond
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris.,Paediatric Hematology-Immunology and Rheumatology Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Necker-Enfants Malades, AP-HP, Paris
| | - Alice Hadchouel
- Paris University, Paris.,Paediatric Pulmonology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Naoki Kitabayashi
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris
| | - Alice Lepelley
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris
| | | | | | - Lucile Musset
- Department of Immunology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris
| | - Pierre Quartier
- Paediatric Hematology-Immunology and Rheumatology Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Necker-Enfants Malades, AP-HP, Paris.,Imagine Institute, Inserm U 1163, Paris University, Paris
| | - Gillian I Rice
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Luis Seabra
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris
| | - Florence Uettwiller
- Paediatric Hematology-Immunology and Rheumatology Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Necker-Enfants Malades, AP-HP, Paris.,Transversal Unit of Allergology and Rheumatology, CHRU Tours, Tours, France
| | - Carolina Uggenti
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris.,Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Sebastien Viel
- Université de Lyon, Bron cedex, France.,Inserm U1111, Lyon.,Department of Immunology, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Filière des maladies autoimmunes et autoinflammatoires rares (FAI2R), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon
| | - Mathieu P Rodero
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris.,Chimie & Biologie, Modélisation et Immunologie pour la Thérapie (CBMIT), Université Paris Descartes, CNRS, UMR8601, Paris, France
| | - Yanick J Crow
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris.,Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Brigitte Bader-Meunier
- Paediatric Hematology-Immunology and Rheumatology Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Necker-Enfants Malades, AP-HP, Paris.,Imagine Institute, Inserm U 1163, Paris University, Paris
| |
Collapse
|
47
|
Quintana-Ortega C, Remesal A, Ruiz de Valbuena M, de la Serna O, Laplaza-González M, Álvarez-Rojas E, Udaondo C, Alcobendas R, Murias S. Fatal outcome of anti-MDA5 juvenile dermatomyositis in a paediatric COVID-19 patient: a case report. Mod Rheumatol Case Rep 2021; 5:101-107. [PMID: 33019894 PMCID: PMC8344517 DOI: 10.1080/24725625.2020.1832755] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
Anti-melanoma differentiation-associated gene 5 juvenile dermatomyositis (anti-MDA5 JDM) is associated with high risk of developing rapidly progressive interstitial lung disease (RP-ILD). Here we report an 11-year-old girl with anti-MDA5 JDM and RP-ILD which led to a fatal outcome, further aggravated by SARS-CoV-2 infection. She was referred to our hospital after being diagnosed with anti-MDA5 JDM and respiratory failure due to RP-ILD. On admission, fibrobronchoscopy with bronchoalveolar lavage (BAL) revealed Pneumocystis jirovecii infection so treatment with intravenous trimethoprim-sulfamethoxazole was initiated. Due to RP-ILD worsening, immunosuppressive therapy was intensified using methylprednisolone pulses, cyclophosphamide, tofacitinib and intravenous immunoglobulin without response. She developed severe hypoxemic respiratory failure, pneumomediastinum and pneumothorax, further complicated with severe RP-ILD and cervical subcutaneous emphysema. Three real-time RT-PCR for SARS-CoV-2 were made with a negative result. In addition, she was complicated with a secondary hemophagocytic lymphohistiocytosis and a fourth real-time PCR for SARS-CoV-2 performed in BAS sample was positive. Despite aggressive treatment of RP-ILD due to anti-MDA5 JDM, there was no improvement of respiratory failure in the following days and patient developed refractory septic shock and died. Anti-MDA5 JDM patients with RP-ILD have a poor prognosis with a high mortality rate. For this reason, intensive immunosuppressive therapy is essential including the use of promising drugs such as tofacitinib. COVID-19 in children with underlying health conditions like anti-MDA5 JDM may still be at risk for disease and severe complications.
Collapse
MESH Headings
- Adenosine Monophosphate/analogs & derivatives
- Adenosine Monophosphate/therapeutic use
- Alanine/analogs & derivatives
- Alanine/therapeutic use
- Anti-Bacterial Agents/therapeutic use
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antiviral Agents/therapeutic use
- Autoantibodies/immunology
- Bronchoscopy
- COVID-19/complications
- COVID-19/therapy
- COVID-19 Nucleic Acid Testing
- Child
- Cyclophosphamide/therapeutic use
- Dermatomyositis/complications
- Dermatomyositis/drug therapy
- Dermatomyositis/immunology
- Disease Progression
- Fatal Outcome
- Female
- Humans
- Hydroxychloroquine/therapeutic use
- Immunocompromised Host
- Immunoglobulins, Intravenous/therapeutic use
- Immunologic Factors/therapeutic use
- Immunosuppressive Agents/therapeutic use
- Interferon-Induced Helicase, IFIH1/immunology
- Lung/diagnostic imaging
- Lung Diseases, Interstitial/complications
- Lung Diseases, Interstitial/diagnostic imaging
- Lung Diseases, Interstitial/immunology
- Lung Diseases, Interstitial/therapy
- Lymphohistiocytosis, Hemophagocytic/etiology
- Lymphohistiocytosis, Hemophagocytic/immunology
- Mediastinal Emphysema/etiology
- Methylprednisolone/therapeutic use
- Piperidines/therapeutic use
- Pneumonia, Pneumocystis/complications
- Pneumonia, Pneumocystis/immunology
- Pneumothorax/etiology
- Pyrimidines/therapeutic use
- Respiratory Insufficiency/etiology
- Respiratory Insufficiency/therapy
- Shock, Septic/etiology
- Subcutaneous Emphysema/etiology
- Tomography, X-Ray Computed
- Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
Collapse
Affiliation(s)
- Cristian Quintana-Ortega
- Pediatric Rheumatology Department, La Paz Children´s Hospital, Madrid, Spain
- CONTACT Cristian Quintana-Ortega
Pediatric Rheumatology Department, La Paz Children’s Hospital, Paseo de la Castellana, Madrid 261, 28046, Spain
| | - Agustín Remesal
- Pediatric Rheumatology Department, La Paz Children´s Hospital, Madrid, Spain
| | | | - Olga de la Serna
- Pediatric Pulmonology Department, La Paz Children’s Hospital, Madrid, Spain
| | | | | | - Clara Udaondo
- Pediatric Rheumatology Department, La Paz Children´s Hospital, Madrid, Spain
| | - Rosa Alcobendas
- Pediatric Rheumatology Department, La Paz Children´s Hospital, Madrid, Spain
| | - Sara Murias
- Pediatric Rheumatology Department, La Paz Children´s Hospital, Madrid, Spain
| |
Collapse
|
48
|
Sag E, Demir S, Bilginer Y, Talim B, Haliloglu G, Topaloglu H, Ozen S. Clinical features, muscle biopsy scores, myositis specific antibody profiles and outcome in juvenile dermatomyositis. Semin Arthritis Rheum 2020; 51:95-100. [PMID: 33360233 DOI: 10.1016/j.semarthrit.2020.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Juvenile dermatomyositis (JDM) is the most common inflammatory myopathy of childhood. OBJECTIVE To analyze clinical features, paraclinical examinations, MSAs, treatment response and long-term outcome in a JDM cohort METHODS: 58 patients (35F, 23 M) from a tertiary referral center in the last two decades are included. RESULTS Mean age at onset was 8.1 ± 4.3, with a mean follow-up period of 5.66±3.59 years. Dermatological manifestations (91%) and muscle weakness (76%) were the key diagnostic elements. Elevated serum creatine kinase levels (86%), electromyography (23/25), muscle MRI (12/15), and muscle biopsy (n = 35) were compatible with the diagnosis. Out of 46 patients tested, 34 (76%) had autoantibodies, with NXP2 (21.7%), followed by TIF1g (17.4%), MDA5 (8.7%), and Mi-2 (8.7%). Presence of TIF1g and NXP2 indicated a severe course; and Ku a much severe course compared to previous studies. Corticosteroids (100%) combined with methotrexate (93%) was the initial treatment. Biological disease modifying anti-rheumatic drugs (DMARDs) were used in 22% of the cohort. Calcinosis (36%) was the most common long-term complication, associated with disease onset ≤6 years, higher muscle biopsy scores and MDA5 positivity. Complete remission was achieved in 65.5% of the patients in a median 24 (IQR 11.8-42.5) months with a relapse rate of 26.3%. 43.9% of NXP2 and 33.3% of TIF-1 g positive patients had a relapse. Course was monophasic (31%), polyphasic (17.2%), chronic (51.8%) without mortality. CONCLUSION Integration of clinical features with laboratory and biopsy findings may help to predict prognosis and guide treatment in JDM. In our cohort calcinosis was associated with age, MDA5 autoantibodies, and muscle biopsy scores.
Collapse
Affiliation(s)
- Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara 06100, Turkey
| | - Selcan Demir
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara 06100, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara 06100, Turkey
| | - Beril Talim
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Goknur Haliloglu
- Division of Pediatric Neurology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Haluk Topaloglu
- Division of Pediatric Neurology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara 06100, Turkey.
| |
Collapse
|
49
|
Sag E, Kale G, Haliloglu G, Bilginer Y, Akcoren Z, Orhan D, Gucer S, Topaloglu H, Ozen S, Talim B. Inflammatory milieu of muscle biopsies in juvenile dermatomyositis. Rheumatol Int 2020; 41:77-85. [PMID: 33106894 DOI: 10.1007/s00296-020-04735-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023]
Abstract
Juvenile dermatomyositis (JDM) is an inflammatory myopathy which causes severe morbidity and high mortality if untreated. In this study, we aimed to define the T-helper cell profile in the muscle biopsies of JDM patients. Muscle biopsies of twenty-six patients (50% female) were included in the study. Immunohistochemical expression of CD3, CD20, CD138, CD68, IL-17, Foxp3, IFN-ɣ, IFN-alpha and IL-4 was studied and muscle biopsies were scored using the JDM muscle biopsy scoring tool. Inflammatory cells were in small clusters in perimysium and perivascular area or scattered throughout the endomysium in most biopsies; however in 2 biopsies, lymphoid follicle-like big clusters were observed, and in one, there was a very dense and diffuse inflammatory infiltration nearly destroying all the muscle architecture. Seventy-three per cent of the biopsies had T cells, 88% had B cells, 57% had plasma cells, and all had macrophages. As for T-helper cell subtypes, 80% of the biopsies were Th1 positive, 92% Th17 positive and 30% Treg positive. No IL-4 positive inflammatory cell was detected, and only 2 biopsies showed IFN-alpha positivity. The mean JDM biopsy score was 17.6, meaning moderate to severe muscular involvement. Visual analogue score of the pathologist was strongly correlated with histopathological features. B cells, macrophages, plasma cells and T cells constitute the inflammatory milieu of the JDM muscle biopsies. As for T cells, JDM is a disease mainly related with Th1 and Th17 T-helper cell subtypes and to some extend Treg. Th2 cells are not involved in the pathogenesis.
Collapse
Affiliation(s)
- Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey.
| | - Gulsev Kale
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Goknur Haliloglu
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Zuhal Akcoren
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Diclehan Orhan
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Safak Gucer
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Haluk Topaloglu
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Beril Talim
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| |
Collapse
|
50
|
Sekiguchi A, Endo Y, Yamazaki S, Uchiyama A, Shimizu A, Motegi SI. Plasma homocysteine levels are positively associated with interstitial lung disease in dermatomyositis patients with anti-aminoacyl-tRNA synthetase antibody. J Dermatol 2020; 48:34-41. [PMID: 32892413 DOI: 10.1111/1346-8138.15602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/14/2020] [Indexed: 12/18/2022]
Abstract
Homocysteine is a sulfhydryl-containing amino acid that is derived from dietary methionine, and there has been increasing evidence that elevated plasma homocysteine levels are associated with increased risk of central and peripheral vascular disorders, including carotid, coronary and peripheral arterial diseases, and Raynaud's phenomenon. Recently, associations of plasma homocysteine levels with autoimmune diseases such as systemic lupus erythematodes and systemic sclerosis have been reported. However, no study analyzed the association between plasma homocysteine levels and dermatomyositis (DM). The objective of this study was to examine plasma homocysteine levels and their clinical associations in patients with DM. Plasma homocysteine levels in 28 Japanese patients with DM and 22 healthy controls were examined. We found that the plasma homocysteine levels in DM patients were significantly higher than those in healthy individuals (15.8 ± 1.1 vs 8.5 ± 0.5 µmol/L, P < 0.01). Presence of mechanic's hand, complication of interstitial lung disease (ILD), high serum Krebs von den Lungen-6 (KL-6), surfactant protein-D and creatine kinase levels, and anti-aminoacyl-tRNA synthetase (ARS) antibody (Ab) positivity were significantly more prevalent among DM patients with elevated plasma homocysteine levels. The plasma homocysteine levels in DM patients with mechanic's hand, ILD and anti-ARS Ab were significantly higher than those in DM without those features. Furthermore, the plasma homocysteine levels were positively correlated with serum KL-6 levels. These results suggest that the pathogenesis of elevated plasma homocysteine levels may be associated with ILD in DM patients, especially with anti-ARS Ab, and further examination is required.
Collapse
Affiliation(s)
- Akiko Sekiguchi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yukie Endo
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sahori Yamazaki
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihiko Uchiyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akira Shimizu
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|