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Tebo AE. Autoantibody evaluation in idiopathic inflammatory myopathies. Adv Clin Chem 2024; 120:45-67. [PMID: 38762242 DOI: 10.1016/bs.acc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
Idiopathic inflammatory myopathies (IIM), generally referred to as myositis is a heterogeneous group of diseases characterized by muscle inflammation and/or skin involvement, diverse extramuscular manifestations with variable risk for malignancy and response to treatment. Contemporary clinico-serologic categorization identifies 5 main clinical groups which can be further stratified based on age, specific clinical manifestations and/or risk for cancer. The serological biomarkers for this classification are generally known as myositis-specific (MSAs) and myositis-associated antibodies. Based on the use of these antibodies, IIM patients are classified into anti-synthetase syndrome, dermatomyositis, immune-mediated necrotizing myopathy, inclusion body myositis, and overlap myositis. The current classification criteria for IIM requires clinical findings, laboratory measurements, and histological findings of the muscles. However, the use MSAs and myositis-associated autoantibodies as an adjunct for disease evaluation is thought to provide a cost-effective personalized approach that may not only guide diagnosis but aid in stratification and/or prognosis of patients. This review provides a comprehensive overview of contemporary autoantibodies that are specific or associated myositis. In addition, it highlights possible pathways for the detection and interpretation of these antibodies with limitations for routine clinical use.
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Affiliation(s)
- Anne E Tebo
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, United States.
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2
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Robert M, Lessard LER, Bouhour F, Petiot P, Fenouil T, Svahn J, Fiscus J, Fabien N, Perard L, Robinson P, Durieu I, Coury F, Streichenberger N, Hot A, Gallay L. Inaugural dropped head syndrome and camptocormia in inflammatory myopathies: a retrospective study. Rheumatology (Oxford) 2024; 63:506-515. [PMID: 37462538 PMCID: PMC10837000 DOI: 10.1093/rheumatology/kead347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/27/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Inaugural axial muscle involvement, defined as dropped head syndrome (DHS) and/or camptocormia (CC), is poorly described in inflammatory myopathies (IM). This study aimed to further characterize IM patients with inaugural DHS/CC, their outcome and care management. METHODS This retrospective study included IM patients diagnosed between 2000 and 2021. The main inclusion criterion was IM revealed by axial muscle deficit (DHS/CC). RESULTS Twenty-seven patients were included; median (IQR) age at first symptoms was 66.0 years (55.5-75.0); 21 were female (77.8%). There were nine IBM, 33.3%, nine overlap myositis (OM, 33.3%), five DM, 18.5%, two immune checkpoint inhibitor-related myositis (7.4%), one focal myositis (3.7%) and one myositis with anti-Hu antibodies (3.7%). Age at first symptoms was ≤70 years in 16 patients (59.3%), including all DM patients and 8/9 OM patients (88.9%). In this group, partial remission of the disease was obtained in 9/16 (56.3%) and complete remission in 1/16 patients (6.3%); regression of DHS/CC was achieved in 3/16 patients (18.8%). Conversely, in the group of 11 patients aged >70 years at first symptoms, there were eight IBM (72.7%). Partial remission was obtained in 5/11 patients (45.5%), the disease was stable in 6/11 patients (54.5%); no complete remission was obtained nor regression of DHS/CC. CONCLUSION The analysis of IM patients with inaugural DHS/CC delineates two groups of patients according to the age at first symptoms in terms of clinical and outcome specificities, and proposes an adapted diagnostic and care management approach to prevent long-term complications.
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Affiliation(s)
- Marie Robert
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Lola E R Lessard
- Service d'Electroneuromyographie et Pathologies Neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Laboratoire Physiopathologie et Génétique du Neurone et du Muscle (PGNM), CNRS UMR5261-INSERM U1315, Institut NeuroMyoGène-Université Claude Bernard Lyon 1, Lyon, France
| | - Françoise Bouhour
- Service d'Electroneuromyographie et Pathologies Neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Philippe Petiot
- Service d'Electroneuromyographie et Pathologies Neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Tanguy Fenouil
- Service de Cytologie et d'Anatomie Pathologique, Département de Neuropathologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
- Equipe Ribosome Traduction et Cancer, UMR Inserm 1052 CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Juliette Svahn
- Service d'Electroneuromyographie et Pathologies Neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Julie Fiscus
- Service d'Immunologie, UF Autoimmunité, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Nicole Fabien
- Service d'Immunologie, UF Autoimmunité, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Perard
- Service de Médecine Interne, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Philip Robinson
- Direction de la Recherche en Santé, Hospices Civils de Lyon, Lyon, France
| | - Isabelle Durieu
- Service de Médecine interne, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Fabienne Coury
- Département de Rhumatologie, Hôpital Lyon Sud, Hospices civils de Lyon, Pierre-Bénite, France
- Inserm UMR1033, Université Claude Bernard Lyon 1, Lyon, France
| | - Nathalie Streichenberger
- Laboratoire Physiopathologie et Génétique du Neurone et du Muscle (PGNM), CNRS UMR5261-INSERM U1315, Institut NeuroMyoGène-Université Claude Bernard Lyon 1, Lyon, France
- Service de Cytologie et d'Anatomie Pathologique, Département de Neuropathologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Laure Gallay
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Laboratoire Cell Therapy & Musculoskeletal Disorders, Université de Genève, Genève, Switzerland
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Selva-O’Callaghan A, Guillen-Del-Castillo A, Gil-Vila A, Trallero-Araguás E, Matas-García A, Milisenda JC, Pinal-Fernández I, Simeón-Aznar C. Systemic sclerosis associated myopathy: how to treat. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2023; 9:151-167. [PMID: 38737329 PMCID: PMC11086655 DOI: 10.1007/s40674-023-00206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/14/2024]
Abstract
Purpose of review Systemic sclerosis (SSc) and myositis are two different entities that may coexist as an overlap syndrome. Immunological biomarkers such as anti-PM/Scl or anti-Ku reinforce the syndrome. This review is focused on the treatment of different and characteristic manifestations of this syndrome. Recent findings Among the different phenotypes of muscle involvement in patients with SSc, the fibrotic pattern and the sporadic inclusion body myositis must be identified early to avoid a futile immunosuppressive treatment. Other forms such as dermatomyositis, non-specific myositis and immune-mediated necrotizing myopathy need to receive conventional immunosuppressive therapy considering that high dose of glucocorticoids may induce a scleroderma renal crisis in patients with SSc. Physicians must be aware of the existence of a "double trouble" association of hereditary myopathy with an autoimmune phenomenon. Several autoantibodies, mainly anti-PM/Scl and anti-Ku may help to define specific phenotypes with characteristic clinical manifestations that need a more specific therapy. Vasculopathy is one of the underlying mechanisms that link SSc and myositis. Recent advances in this topic are reviewed. Summary Current treatment of SSc associated myopathy must be tailored to specific organs involved. Identifying the specific clinical, pathological, and immunological phenotypes may help to take the correct therapeutic decisions.
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Affiliation(s)
- A Selva-O’Callaghan
- Systemic Autoimmune Diseases Unit. Internal Medicine Departament. Universitat Autónoma de Barcelona. Vall d’Hebron Hospital. Barcelona. Spain
| | - A Guillen-Del-Castillo
- Systemic Autoimmune Diseases Unit. Internal Medicine Departament. Universitat Autónoma de Barcelona. Vall d’Hebron Hospital. Barcelona. Spain
| | - A Gil-Vila
- Systemic Autoimmune Diseases Unit. Internal Medicine Departament. Universitat Autónoma de Barcelona. Vall d’Hebron Hospital. Barcelona. Spain
| | | | - A Matas-García
- Muscle Research Unit, Internal Medicine Service, Hospital Clinic de Barcelona (HCB), Universidad de Barcelona and Center for Biomedical Research on Rare Diseases (CIBERER). Barcelona. Spain
| | - JC Milisenda
- Muscle Research Unit, Internal Medicine Service, Hospital Clinic de Barcelona (HCB), Universidad de Barcelona and Center for Biomedical Research on Rare Diseases (CIBERER). Barcelona. Spain
| | - I Pinal-Fernández
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Simeón-Aznar
- Systemic Autoimmune Diseases Unit. Internal Medicine Departament. Universitat Autónoma de Barcelona. Vall d’Hebron Hospital. Barcelona. Spain
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Kono M, Komai T, Yuki H, Hanata N, Kakumoto T, Kubota A, Maeda MH, Toda T, Shoda H, Fujio K. Anti-Ku Antibody-Positive Myositis Presenting as a Wide Range of Axial Myopathies and Myocarditis: A Case Report and Review of the Literature. Mod Rheumatol Case Rep 2021; 6:64-68. [PMID: 34516654 DOI: 10.1093/mrcr/rxab024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/29/2021] [Accepted: 08/08/2021] [Indexed: 11/14/2022]
Abstract
Idiopathic inflammatory myopathies (IIMs) are autoimmune diseases predominantly affecting proximal muscles; paraspinal muscle involvement is relatively rare. Because paraspinal myopathies do not always cause clinically-evident symptoms, the diagnosis of IIMs with axial myopathies can be challenging. Anti-Ku autoantibodies, initially reported in polymyositis/systemic sclerosis overlap syndrome, are myositis-associated antibodies (MAAs) observed in patients with a wide variety of connective tissue diseases (CTDs). Few reports have been published demonstrating predominant axial myopathy in IIM patients with anti-Ku antibodies. Herein, we investigated a previously healthy Japanese woman in her early 70s who presented with Raynaud's phenomenon, back pain, and exertional dyspnea. The creatine kinase (CK) was elevated and antinuclear antibody staining was positive, but myositis-specific antibodies (MSAs) were negative. Magnetic resonance imaging (MRI) revealed myocarditis and a wide range of axial muscle inflammation, including bilateral thoracolumbar paraspinal, infraspinatus, and trapezius muscles. The muscle biopsy was consistent with IIM. In addition, anti-Ku antibody was positive. Administration of prednisolone and tacrolimus quickly alleviated the symptoms and the CK level returned to normal. The diagnosis of IIM was arduous in this case because she did not present with camptocormia, muscle weakness involving the proximal limbs was not apparent, and MSAs were negative. Whether axial myopathy and myocarditis are more prevalent in IIM patients with than without anti-Ku antibodies is uncertain. Clinicians should suspect axial myopathy and MAAs, such as anti-Ku antibodies, especially in patients in whom muscle weakness of the proximal limbs is not noticeable.
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Affiliation(s)
- Masanori Kono
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshihiko Komai
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Yuki
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norio Hanata
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiyuki Kakumoto
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Meiko Hashimoto Maeda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Shoda
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Araujo CSR, Miossi R, De Souza FHC, Costa MD, Da Silva AMS, Campos ED, Zanoteli E, Shinjo SK. Brachio-cervical inflammatory myopathy associated with systemic sclerosis. Case series and review of literature. Reumatismo 2021; 73:122-130. [PMID: 34342214 DOI: 10.4081/reumatismo.2021.1397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 11/23/2022] Open
Abstract
This study was aimed at describing a case series of brachio-cervical inflammatory myopathy (BCIM) associated with systemic sclerosis (SSc), due to its rarity and limited coverage in published data. Another aim was to provide a literature review. We reported four cases of BCIM-SSc from our tertiary center. In addition, we researched the literature and found six articles featuring 17 patients who fit this phenotype. We pooled all cases and reported their features. Most patients were female and had limited SSc, and the median time of BCIM presentation was three years after SSc diagnosis. Asymmetric muscle involvement, scapular winging, dropped head, axial weakness, camptocormia, dysphagia, and dermatomyositis stigmas were common features. All patients had esophageal involvement. Most had positive antinuclear antibody results, a scleroderma pattern in their capillaroscopy images, elevated serum creatine phosphokinase, myopathic electrophysiology, and muscle involvement in magnetic resonance imaging. Muscle histopathological findings varied widely, but in general all showed the presence of lymphoid infiltrates, muscle atrophy, increased MHC-I expression, MAC deposits, vasculopathy, and muscle fiber necrosis. The response to immunosuppressive therapy was highly irregular. BCIM-SSc is a rare disorder that shares many similar phenotypes among the described cases, but has a highly heterogeneous response to treatment. At present, more data on the physiopathology, clinical features, and treatment is still needed.
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Affiliation(s)
- C S R Araujo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP.
| | - R Miossi
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP.
| | - F H C De Souza
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP.
| | | | - A M S Da Silva
- Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP.
| | - E D Campos
- Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP.
| | - E Zanoteli
- Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP.
| | - S K Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP.
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Dropped head in systemic sclerosis: a case based review. Rheumatol Int 2021; 42:1483-1489. [PMID: 34223951 DOI: 10.1007/s00296-021-04942-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
Dropped head syndrome is a rare disease entity characterized by severe weakness of the cervical para-spinal muscles, resulting in a chin-on-chest deformity. Systemic sclerosis is one of the causes of dropped head syndrome, but its characteristics and prognosis remain unclear due to the extreme rarity of this condition. We present a case of dropped head which occurred in systemic sclerosis. He presented with severe dropped head and relatively mild weakness of the proximal limb muscles. Serum level of creatine kinase was elevated, myopathic change was observed in electromyography, and gadolinium enhancement was found in magnetic resonance imaging of his posterior neck muscles. Anti-topoisomerase I antibody was positive, while other autoantibodies such as anti-PM/Scl and anti-Ku antibodies were negative. Since his dropped head acutely progressed, high dose of glucocorticoid therapy was initiated, which successfully improved dropped head, serum level of creatine kinase, and gadolinium enhancement in magnetic resonance imaging. Our present case and literature review suggest that dropped head occurring in systemic sclerosis can be treatable with immunosuppressive therapy. It is important to recognize this rare but treatable involvement of systemic sclerosis because early diagnosis and treatment initiation are crucial to prevent the irreversible organ damage and the significant decrease of daily activities.
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7
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Tomaras S, Kekow J, Feist E. Idiopathische inflammatorische Myopathien: Aktuelles zu Diagnose und Klassifikation. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1383-5737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungAuf dem Sektor der Kollagenosen ist der wissenschaftliche Fortschritt bei der Myositis in den letzten 15–20 Jahren bemerkenswert. Durch kontinuierliche Forschung und intensive Vernetzung der Myositis-Experten ist es gelungen, neue Untergruppen zu identifizieren und somit für die Prognose wichtige Organmanifestationen rechtzeitig zu erkennen. Vor dem Hintergrund dieser Neuerungen verfolgt diese Übersichtsarbeit sowohl das Ziel, möglichst alle Facetten der Erkrankung zu präsentieren, als auch die moderne Einteilung der idiopathischen inflammatorischen Myopathien zu erläutern. Außerdem werden die neuen Klassifikationskriterien vorgestellt, die die Kriterien von Bohan und Peter aus dem Jahr 1975 abgelöst haben. Im Artikel werden ihre Stärken und Schwächen sowie ihr Optimierungspotenzial diskutiert.
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Affiliation(s)
- Stylianos Tomaras
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
| | - Jörn Kekow
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
| | - Eugen Feist
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
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Akiyama M, Kaneko Y, Saito S, Matsumoto K, Kondo Y, Hanaoka H, Otomo K, Oyama M, Matsubara S, Takeuchi T. A case of dropped head syndrome due to focal myositis that worsened with cellulitis and improved only by treatment of cellulitis. Mod Rheumatol Case Rep 2021; 5:431-436. [PMID: 33686913 DOI: 10.1080/24725625.2021.1899381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Dropped head syndrome due to focal myositis is extremely rare. Due to the rarity of the disease, its clinical characteristics and prognosis remain unknown. We present a unique case of dropped head syndrome due to focal myositis that exacerbated following cellulitis and was dramatically improved along with the improvement of her cellulitis only treated with antibiotics. We should consider the possibility of preceding trigger event such as infection when we face with the exacerbation of focal myositis before making a decision of strengthening immunosuppressive therapy to avoid unnecessary increase of glucocorticoid.
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Affiliation(s)
- Mitsuhiro Akiyama
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuntaro Saito
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kotaro Matsumoto
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Kondo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hironari Hanaoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kotaro Otomo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Munenori Oyama
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Shiro Matsubara
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Leclair V, D'Aoust J, Gyger G, Landon-Cardinal O, Meyer A, O'Ferrall E, Karamchandani J, Massie R, Ellezam B, Satoh M, Troyanov Y, Fritzler MJ, Hudson M. Autoantibody profiles delineate distinct subsets of scleromyositis. Rheumatology (Oxford) 2021; 61:1148-1157. [PMID: 34146090 DOI: 10.1093/rheumatology/keab492] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Scleromyositis remains incompletely characterized owing in part to its heterogeneity. The purpose of this study was to explore the role of autoantibody profiles to define subsets of scleromyositis. METHODS Subjects with scleromyositis from a prospective cohort were divided into 3 groups based on autoantibody profiles: subjects with SSc-specific autoantibodies (anti-centromere, -topoisomerase 1, -RNA polymerase III, -Th/To, -fibrillarin), subjects with SSc-overlap autoantibodies (anti-PM/Scl, -U1RNP, -Ku), and subjects without SSc-related autoantibodies. Clinical features, laboratory tests, and histopathological findings were retrieved and compared between groups. RESULTS Of 42 scleromyositis subjects (79% female, mean age at diagnosis 55 years, mean disease duration 3.5 years), 8 (19%) subjects had SSc-specific autoantibodies, 14 (33%) SSc-overlap autoantibodies and 20 (48%) had no SSc-related autoantibodies. One-third had no skin involvement, a finding more frequent in the SSc-overlap subjects and those without SSc-related autoantibodies. Proximal and distal weakness was common and head drop/bent spine was found in 50% of the SSc-specific and 35% of the subjects without SSc-related autoantibodies. Of note, the group without SSc-related autoantibodies had the only cases of severe cardiac systolic dysfunction (n = 1) and scleroderma renal crisis (n = 1), as well as 3 out of the 4 cancers and 3 out of the 4 deaths. CONCLUSION In this carefully phenotyped series of scleromyositis subjects, absence of SSc-related autoantibodies was common and associated with distinct features and poor prognosis. Future studies are needed to validate these results and possibly identify novel autoantibodies or other biomarkers associated with scleromyositis.
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Affiliation(s)
- Valérie Leclair
- Department of Medicine, McGill University, Montreal, Canada.,Division of Rheumatology, Jewish General Hospital, Montreal, Canada
| | - Julie D'Aoust
- Department of Medicine, McGill University, Montreal, Canada
| | - Geneviève Gyger
- Department of Medicine, McGill University, Montreal, Canada.,Division of Rheumatology, Jewish General Hospital, Montreal, Canada
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); CHUM Research Center; Department of Medicine, Université de Montréal, Montréal, Canada
| | - Alain Meyer
- Centre de Reference des Maladies Autoimmunes Rares service de rhumatologie, Exploration fonctionnelle musculaires service de physiologie Hôpitaux Universitaires de Strasbourg, EA3072 Université de Strasbourg, Strasbourg, France
| | - Erin O'Ferrall
- Department of Neurology and Neurosurgery, McGill University, Montreal Neurological Institute, Montreal, Canada.,Department of Pathology, McGill University, Montreal Neurological Institute, Montreal, Canada
| | - Jason Karamchandani
- Department of Pathology, McGill University, Montreal Neurological Institute, Montreal, Canada
| | - Rami Massie
- Department of Neurology and Neurosurgery, McGill University, Montreal Neurological Institute, Montreal, Canada
| | - Benjamin Ellezam
- Centre hospitalier universitaire Sainte-Justine, Montreal, Canada
| | - Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yves Troyanov
- Division of Rheumatology, Department of Medicine, Hôpital du Sacre-Coeur de Montreal, Montreal, QC, Canada
| | | | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Canada.,Division of Rheumatology, Jewish General Hospital, Montreal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
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Lefebvre F, Giannini M, Ellezam B, Leclair V, Troyanov Y, Hoa S, Bourré-Tessier J, Satoh M, Fritzler MJ, Senécal JL, Hudson M, Meyer A, Landon-Cardinal O. Histopathological features of systemic sclerosis-associated myopathy: A scoping review. Autoimmun Rev 2021; 20:102851. [PMID: 33971337 DOI: 10.1016/j.autrev.2021.102851] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/13/2021] [Accepted: 03/20/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Scleromyositis (SM) is an emerging subset of myositis associated with features of systemic sclerosis (SSc) but it is currently not recognized as a distinct histopathological subset by the European NeuroMuscular Center (ENMC). Our aim was to review studies reporting muscle biopsies from SSc patients with myositis and to identify unique histopathological features of SM. METHODS A scoping review was conducted and included all studies reporting histopathological findings in SSc patients with myositis searching the following databases: PubMed, MEDLINE, EMBASE, CINAHL and EBM-Reviews. Clinical, serological, and histopathological data were extracted using a standardized protocol. RESULTS Out of 371 citations, 77 studies that included 559 muscle biopsies were extracted. Fifty-seven percent (n = 227/400) had inflammatory infiltrates, predominantly T cells, which were endomysial (49%), perimysial (42%) and perivascular (41%). Few studies (18%, n = 8/44) evaluated the presence of B-cells. Myofiber atrophy was present in 48% (n = 104/218) of biopsies, and was predominantly perifascicular in 19% (n = 6/31), with necrosis reported in 56% (n = 162/290) of cases. Sarcolemmal MHC-I upregulation was found in 72% (n = 64/89) of biopsies. Non-specified C5b-9 deposition was described in 39% of muscle biopsies (n = 28/72). Neurogenic features were present in 23% (n = 44/191); endomysial fibrosis was reported in 35% (n = 120/340); and rimmed vacuoles were observed in 32% (n = 11/34) of biopsies. Capillaropathy, such as capillary dropout and/or ultrastructural endothelial abnormalities, was reported in 33% (n = 43/129) of cases. Reported ENMC categories were mainly polymyositis (21%), non-specific myositis (19%), immune-mediated necrotizing myopathy (16%), and dermatomyositis (8%). Histopathological features were analyzed according to serological subtypes in 28 studies, including anti-PM-Scl (n = 48), -Ku (n = 23) and -U1RNP (n = 90). Most of these biopsies demonstrated inflammatory infiltrates (range 49-85%) as well as MHC-I expression (range 63-81%). Necrosis was associated with anti-Ku (85%) and anti-U1RNP (73%), while anti-Ku was also associated with neurogenic features and rimmed vacuoles in 57% and 25% of cases, respectively. CONCLUSION Our review suggests that SM is characterized by heterogeneous pathological features using definitions included in current histopathological criteria. Whether a distinct histopathological signature exists in SM remains to be determined. SSc-specific and SSc-associated autoantibodies may help define more homogeneous histopathological subsets.
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Affiliation(s)
- Frédéric Lefebvre
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Margherita Giannini
- Service de Physiologie-Explorations Fonctionnelles Musculaire, Service de Rhumatologie et Centre de Référence des Maladies Autoimmunes Rares, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Ellezam
- Division of Pathology, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Valérie Leclair
- Division of Rheumatology, Jewish General Hospital, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Yves Troyanov
- Division of Rheumatology, Hôpital du Sacré-Coeur, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Sabrina Hoa
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Josiane Bourré-Tessier
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Marvin J Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Luc Senécal
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Alain Meyer
- Service de Physiologie-Explorations Fonctionnelles Musculaire, Service de Rhumatologie et Centre de Référence des Maladies Autoimmunes Rares, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada.
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Qiao L, Ban R, Shi Q. Axial muscle weakness and the rimmed vacuoles in muscle histology in inflammatory myopathy with anti-ku antibody: a case report. Scand J Rheumatol 2021; 51:83-85. [PMID: 33949908 DOI: 10.1080/03009742.2021.1894825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- L Qiao
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - R Ban
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Q Shi
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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12
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Biliciler S, Kwan J. Inflammatory Myopathies: Utility of Antibody Testing. Neurol Clin 2020; 38:661-678. [PMID: 32703475 DOI: 10.1016/j.ncl.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inflammatory myopathies are a group of immune-mediated muscle disorders comprising dermatomyositis; polymyositis; overlap myositis, including antisynthetase syndromes and nonspecific myositis, immune-mediated necrotizing myopathies, and sporadic inclusion body myositis. They are now much more eloquently classified both pathologically and clinically because of the discovery of several myositis-specific and myositis-associated antibodies. These antibodies also aid in choosing the best treatment options in each case. Based on the initial classifications of inflammatory myopathies, inclusion body myositis, overlap myositis, and necrotizing myositis were all included in the polymyositis group. This article discusses cases, diagnostic tools, associated antibodies, and pathology.
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Affiliation(s)
- Suur Biliciler
- Department of Neurology, UT Health Science Center in Houston, McGovern Medical School, 6341 Fannin Street, MSC #466, Houston, TX 77030, USA.
| | - Justin Kwan
- Department of Neurology, Temple University, Lewis Katz School of Medicine, 3401 North Broad Street Street, Suite C525, Philadelphia, PA 19410, USA
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13
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Chatterjee S, Prayson RA. Concurrent anti-PM-Scl antibody-associated systemic sclerosis and inclusion body myositis – report of two cases and review of the literature. Semin Arthritis Rheum 2020; 50:498-502. [DOI: 10.1016/j.semarthrit.2019.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/08/2019] [Accepted: 11/08/2019] [Indexed: 12/31/2022]
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Alhammad RM, Naddaf E. Myopathies presenting with head drop: Clinical spectrum and treatment outcomes. Neuromuscul Disord 2019; 30:128-136. [PMID: 32005492 DOI: 10.1016/j.nmd.2019.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/23/2019] [Accepted: 12/09/2019] [Indexed: 11/25/2022]
Abstract
Dropped head syndrome can be the presenting feature of a wide spectrum of neurological conditions. In this study, we aimed to define the clinical characteristics and treatment outcomes of 107 patients, where head drop was the presenting or predominant clinical feature of a myopathy. Median age at presentation was 68 years (range 42-88). A specific diagnosis was reached in 53% of patients: Inflammatory myopathy (n = 16), myopathy with rimmed vacuoles (n = 10), radiation-induced myopathy (n = 8), sporadic late-onset nemaline myopathy (n = 7), myofibrillar myopathy (n = 4), facioscapulohumeral dystrophy (n = 3), inclusion body myositis (n = 2), mitochondrial myopathy (n = 2), scleroderma-associated myopathy (n = 2), and single cases of necrotizing autoimmune myopathy, drug-induced myopathy, and B-cell chronic lymphocytic leukemia-myopathy. Splenius capitis had the highest diagnostic yield for a muscle biopsy (67%). When tested, 31/35 (89%) of patients had abnormal pulmonary function tests, 15/30 (50%) abnormal swallow evaluation, 24/65 (37%) abnormal electrocardiogram and 5/38 (13%) abnormal transthoracic echocardiogram. 23/43 (53%) treated patients responded to treatment. Patient-reported limb weakness and neck flexion weakness on physical examination were associated with good response to treatment. A wide spectrum of acquired and hereditary myopathies can present with head drop, some of which are potentially treatable. Establishing a diagnosis is crucial for timely treatment administration, screening for swallowing and cardiorespiratory involvement, and counseling regarding prognosis.
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Affiliation(s)
| | - Elie Naddaf
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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