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Abstract
This chapter reviews the association between cancer and the idiopathic inflammatory myopathies (IIM), which includes dermatomyositis (DM), antisynthetase syndrome (ASyS), immune-mediated necrotizing myopathy (IMNM), and inclusion body myositis (IBM). Accumulating evidence shows that the risk of a coexisting malignancy is high in patients with DM, especially among those with anti-Tif1γ autoantibodies. Patients with IMNM and no defined autoantibodies also have an increased risk of malignancy. Recent evidence demonstrates that many IBM patients have increased numbers of circulating CD57+ CD8+ T cells, consistent with a diagnosis of large granular lymphocytic leukemia. In contrast, IMNM patients with anti-SRP or anti-HMGCR autoantibodies as well as patients with ASyS syndrome do not have a definitively increased risk of cancer. Patients who have a cancer treated with one of the immune checkpoint inhibitors can develop myositis (ICI-myositis), sometimes along with myasthenia gravis and/or myocarditis.
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Affiliation(s)
- Andrew L Mammen
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States; Departments of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Pace M, Cannella R, Di Stefano V, Lupica A, Alonge P, Morici G, Brighina F, Brancato F, Midiri F, Galia M. Usefulness and Clinical Impact of Whole-Body MRI in Detecting Autoimmune Neuromuscular Disorders. Brain Sci 2023; 13:1500. [PMID: 37891867 PMCID: PMC10605918 DOI: 10.3390/brainsci13101500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Autoimmune neuromuscular diseases are a group of heterogenous pathologies secondary to the activation of the immune system that damage the structures of the peripheric nerve, the neuromuscular junction, or the skeleton muscle. The diagnosis of autoimmune neuromuscular disorders comprises a combination of data from clinical, laboratory, electromyography, imaging exam, and biopsy. Particularly, the whole-body MRI examination in the last two decades has been of great use in the assessment of neuromuscular disorders. MRI provides information about the structures involved and the status of activity of the disease. It can also be used as a biomarker, detect the pattern of specific muscle involvement, and is a useful tool for targeting the optimal muscle site for biopsy. In this work, we summarized the most used technical protocol of whole-body MRI and the role of this imaging technique in autoimmune neuromuscular disorders.
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Affiliation(s)
- Mario Pace
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Vincenzo Di Stefano
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Antonino Lupica
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Paolo Alonge
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Giulio Morici
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Filippo Brighina
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Federica Brancato
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy;
| | - Federico Midiri
- IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso 173, 20161 Milano, Italy;
| | - Massimo Galia
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
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Conticini E, d'Alessandro M, Cameli P, Bergantini L, Pordon E, Cassai L, Cantarini L, Bargagli E, Frediani B, Porcelli B. Prevalence of myositis specific and associated antibodies in a cohort of patients affected by idiopathic NSIP and no hint of inflammatory myopathies. Immunol Res 2023; 71:735-742. [PMID: 37133680 PMCID: PMC10517890 DOI: 10.1007/s12026-023-09387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2023] [Indexed: 05/04/2023]
Abstract
The presence of interstitial lung disease (ILD) is a common and fearsome feature of idiopathic inflammatory myopathies (IIM). Such patients show radiological pattern of non-specific interstitial pneumonia (NSIP). The present study aimed to assess the prevalence of myositis-specific and myositis-associated antibodies (MSA and MAA) in a cohort of patients with a previous diagnosis of NSIP and no sign or symptom of IIM. Secondly, it will be assessed whether patients displaying MSA and/or MAA positivity have a worse or a better outcome than idiopathic NSIP. All patients affected by idiopathic NSIP were enrolled. MSA and MAA were detected using EUROLINE Autoimmune Inflammatory Myopathies 20 Ag (Euroimmun Lubeck, Germany), line immunoassay. A total of 16 patients (mean age 72 ± 6.1 years old) were enrolled. Six out of 16 patients (37.5%) had significant MSA and/or MAA positivity: one displayed positivity of anti-PL-7 (+ +), one of anti-Zo (+ +), anti-TIF1γ (+ + +) and anti-Pm-Scl 75 (+ + +), one of anti-Ro52 (+ +), one of anti-Mi2β (+ + +), one of anti-Pm-Scl 75 (+ + +) and the latter of both anti-EJ (+ + +) and anti-Ro52 (+ + +).Two out of 7 seropositive patients showed a significant impairment of FVC (relative risk 4.8, 95% CI 0.78-29.5; p = 0.0350). Accordingly, among the 5 patients that started antifibrotic treatment during the observation time, 4 were seronegative. Our findings highlighted a potential autoimmune or inflammatory in idiopathic NSIP patients and also in those without significant rheumatological symptoms. A more accurate diagnostic assessment may ameliorate diagnostic accuracy as well as may provide new therapeutic strategy (antifibrotic + immunosuppressive). A cautious assessment of NSIP patients with a progressive and non-responsive to glucocorticoids disease course should therefore include an autoimmunity panel comprising MSA and MAA.
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Affiliation(s)
- Edoardo Conticini
- Department of Medicine, Surgery & Neurosciences, Rheumatology Unit, University of Siena, 53100, Siena, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy.
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Laura Bergantini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Elena Pordon
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Lucia Cassai
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Luca Cantarini
- Department of Medicine, Surgery & Neurosciences, Rheumatology Unit, University of Siena, 53100, Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery & Neurosciences, Rheumatology Unit, University of Siena, 53100, Siena, Italy
| | - Brunetta Porcelli
- UOC Laboratorio Patologia Clinica, Policlinico S. Maria Alle Scotte, AOU Senese, Siena, Italy
- Dipartimento Biotecnologie Mediche, Università Degli Studi Di Siena, Siena, Italy
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Shimoda M, Tanaka Y, Taniguchi A, Morimoto K, Yoshimori K, Ohta K. Anti-Mi-2 antibody-positive lung cancer-associated polymyositis. Int Cancer Conf J 2023; 12:173-176. [PMID: 37251005 PMCID: PMC10212843 DOI: 10.1007/s13691-023-00601-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/26/2023] [Indexed: 03/18/2023] Open
Abstract
After a 75-year-old man was diagnosed with lung cancer, proximal weakness and myalgia in the bilateral lower extremities developed, and the creatinine kinase (CK) level was elevated. The anti-Mi-2 antibody test was positive, muscle T2-weighted/fat-suppressed magnetic resonance imaging showed high intensity, and there were no skin lesions. Therefore, he was diagnosed with lung cancer-associated polymyositis (PM). The lung tumour shrank after chemotherapy, accompanied by gradual improvement of his PM-derived symptoms and CK level. Although positive anti-Mi-2 antibody tests rarely indicate PM and cancer, examining myositis-specific autoantibodies, including anti-Mi-2, should be considered if the CK level increases after a cancer diagnosis.
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Affiliation(s)
- Masafumi Shimoda
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Mastuyama, Kiyose, Tokyo 204-8522 Japan
| | - Yoshiaki Tanaka
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Mastuyama, Kiyose, Tokyo 204-8522 Japan
| | - Atsuo Taniguchi
- Department of Rheumatology, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Tokyo Japan
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Mastuyama, Kiyose, Tokyo 204-8522 Japan
| | - Kozo Yoshimori
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Mastuyama, Kiyose, Tokyo 204-8522 Japan
| | - Ken Ohta
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Mastuyama, Kiyose, Tokyo 204-8522 Japan
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Abstract
Although interstitial lung disease (ILD) is a leading cause of morbidity and mortality in patients with inflammatory myopathies, the current definition and diagnostic criteria of autoimmune myositis remain inadequate to capture the large proportion of patients with lung-dominant disease. As a result, these patients present unique diagnostic and treatment challenges for even the most experienced clinicians. This article highlights the emerging role of autoantibodies in the diagnosis, classification, and management of patients with ILD. We propose alternative nomenclature to facilitate research on this unique patient population. Additionally, evidence supporting the various therapies used in the treatment of myositis-associated ILD is reviewed. The classification and treatment of patients with myositis-associated ILD remains challenging. A standardized therapeutic approach to these patients is lacking, and prospective studies in the field are needed to determine optimal treatment regimens.
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Affiliation(s)
- Robert W Hallowell
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Sonye K Danoff
- Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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Moll SA, Platenburg MGJP, Platteel ACM, Vorselaars ADM, Janssen Bonàs M, Kraaijvanger R, Roodenburg-Benschop C, Meek B, van Moorsel CHM, Grutters JC. Prevalence and clinical associations of myositis antibodies in a large cohort of interstitial lung diseases. PLoS One 2022; 17:e0277007. [PMID: 36327336 PMCID: PMC9632801 DOI: 10.1371/journal.pone.0277007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Serologic testing for autoantibodies is recommended in interstitial lung diseases (ILDs), as connective tissue diseases (CTDs) are an important secondary cause. Myositis antibodies are associated with CTD-ILD, but clinical associations with other ILDs are unclear. In this study, associations of myositis antibodies in various ILDs were evaluated. Methods 1463 ILD patients and 116 healthy subjects were screened for myositis antibodies with a line-blot assay on serum available at time of diagnosis. Additionally, bronchoalveolar lavage fluid (BALf) was analysed. Results A total of 394 patients demonstrated reactivity to at least one antibody, including anti-Ro52 (36.0%), anti-Mi-2β (17.3%) and anti-Jo-1 (10.9%). Anti-Jo-1 (OR 6.4; p<0.100) and anti-Ro52 (OR 6.0; p<0.001) were associated with CTD-ILD. Interestingly, anti-Mi-2β was associated with idiopathic pulmonary fibrosis (IPF; OR 5.3; p = 0.001) and hypersensitivity pneumonitis (HP; OR 5.9; p<0.001). Furthermore, anti-Mi-2β was strongly associated with a histological usual interstitial pneumonia (UIP) pattern (OR 6.5; p < 0.001). Moreover, anti-Mi-2β reactivity was identified in BALf and correlated with serum anti-Mi-2β (r = 0.64; p = 0.002). No differences were found in survival rates between ILD patients with and without serum Mi-2β reactivity (hazard ratio 0.835; 95% CI 0.442–1.575; p = 0.577). Conclusion In conclusion, novel associations of antibody Mi-2β with fibrotic ILD were found. Furthermore, serum anti-Mi-2β was associated with a histological UIP pattern and presence of anti-Mi-2β in BALf. Possibly, anti-Mi-2β could be implemented as a future diagnostic biomarker for fibrotic ILD.
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Affiliation(s)
- Sofia A. Moll
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Centre for Interstitial Lung Diseases, Nieuwegein, The Netherlands
- * E-mail:
| | - Mark G. J. P. Platenburg
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Centre for Interstitial Lung Diseases, Nieuwegein, The Netherlands
| | - Anouk C. M. Platteel
- Department of Medical Microbiology and Immunology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Adriane D. M. Vorselaars
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Centre for Interstitial Lung Diseases, Nieuwegein, The Netherlands
| | - Montse Janssen Bonàs
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Centre for Interstitial Lung Diseases, Nieuwegein, The Netherlands
| | - Raisa Kraaijvanger
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Centre for Interstitial Lung Diseases, Nieuwegein, The Netherlands
| | - Claudia Roodenburg-Benschop
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Centre for Interstitial Lung Diseases, Nieuwegein, The Netherlands
| | - Bob Meek
- Department of Medical Microbiology and Immunology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Coline H. M. van Moorsel
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Centre for Interstitial Lung Diseases, Nieuwegein, The Netherlands
| | - Jan C. Grutters
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Centre for Interstitial Lung Diseases, Nieuwegein, The Netherlands
- Division Heart & Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
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Casal-Dominguez M, Pinal-Fernández I, Mammen AL. Utility of Myositis-Specific Autoantibodies for Treatment Selection in Myositis. Curr Treat Options in Rheum 2022. [DOI: 10.1007/s40674-022-00198-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jia M, Zou X, Yin S, Tian W, Zhao Y, Wang H, Xu G, Cai W, Shao Q. CHD4 orchestrates the symphony of T and B lymphocytes development and a good mediator in preventing from autoimmune disease. Immun Inflamm Dis 2022; 10:e644. [PMID: 35759243 PMCID: PMC9168550 DOI: 10.1002/iid3.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 12/02/2022] Open
Abstract
Chromodomain helicase DNA binding protein 4 (CHD4) is an ATPase subunit of the nucleosome remodeling and deacetylation complex. It has been implicated in gene transcription, DNA damage repair, maintenance of genome stability, and chromatin assembly. Meanwhile, it is highly related to cell cycle progression and the proceeding of malignancy. Most of the previous studies were focused on the function of CHD4 with tumor cells, cancer stem cells, and cancer cells multidrug resistance. Recently, some researchers have explored the CHD4 functions on the development and differentiation of adaptive immune cells, such as T and B lymphocytes. In this review, we will discuss details of CHD4 in lymphocyte differentiation and development, as well as the critical role of CHD4 in the pathogenesis of the autoimmune disease.
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Affiliation(s)
- Miaomiao Jia
- Reproductive Sciences Institute Jiangsu University Zhenjiang Jiangsu P.R. China
- Department of Immunology, School of Medicine Jiangsu University Zhenjiang Jiangsu P.R. China
| | - Xueqin Zou
- Reproductive Sciences Institute Jiangsu University Zhenjiang Jiangsu P.R. China
- Department of Immunology, School of Medicine Jiangsu University Zhenjiang Jiangsu P.R. China
| | - Shuying Yin
- Reproductive Sciences Institute Jiangsu University Zhenjiang Jiangsu P.R. China
- Department of Immunology, School of Medicine Jiangsu University Zhenjiang Jiangsu P.R. China
| | - Weihong Tian
- Reproductive Sciences Institute Jiangsu University Zhenjiang Jiangsu P.R. China
- Department of Immunology, School of Medicine Jiangsu University Zhenjiang Jiangsu P.R. China
| | - Yangjing Zhao
- Reproductive Sciences Institute Jiangsu University Zhenjiang Jiangsu P.R. China
- Department of Immunology, School of Medicine Jiangsu University Zhenjiang Jiangsu P.R. China
| | - Hui Wang
- Reproductive Sciences Institute Jiangsu University Zhenjiang Jiangsu P.R. China
- Department of Immunology, School of Medicine Jiangsu University Zhenjiang Jiangsu P.R. China
| | - Guoying Xu
- School of Medical Science and Laboratory Medicine, Institute of Medical Genetics and Reproductive Immunity Jiangsu College of Nursing Huai'an Jiangsu P.R. China
| | - Weili Cai
- School of Medical Science and Laboratory Medicine, Institute of Medical Genetics and Reproductive Immunity Jiangsu College of Nursing Huai'an Jiangsu P.R. China
| | - Qixiang Shao
- Reproductive Sciences Institute Jiangsu University Zhenjiang Jiangsu P.R. China
- Department of Immunology, School of Medicine Jiangsu University Zhenjiang Jiangsu P.R. China
- School of Medical Science and Laboratory Medicine, Institute of Medical Genetics and Reproductive Immunity Jiangsu College of Nursing Huai'an Jiangsu P.R. China
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Halilu F, Christopher-Stine L. Myositis-specific Antibodies: Overview and Clinical Utilization. Rheumatol Immunol Res 2022; 3:1-10. [PMID: 36467022 PMCID: PMC9524809 DOI: 10.2478/rir-2022-0001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/28/2022] [Indexed: 05/25/2023]
Abstract
Purpose of review-To review autoantibodies associated with different subtypes of idiopathic inflammatory myopathy (IIM) and their clinical applications. IIM are a heterogenous group of autoimmune disorders characterized by muscle weakness, cutaneous features, and internal organ involvement. The diagnosis and classification, which is often challenging, is made using a combination of clinical features, muscle enzyme levels, imaging, and biopsy. The landmark discoveries of novel autoantibodies specific to IIM subtypes have been one of the greatest advancements in the field of myositis. The specificity of these autoantibodies has simplified the diagnostic algorithm of IIM with their heterogenous presentation and outdated the earlier diagnostic criteria. Myositis-specific antibodies (MSAs) have improved diagnostics, clinical phenotyping, and prognostic stratification of the subtypes of IIMs. Furthermore, the levels of certain MSAs correlate with disease activity and muscle enzyme levels such that titers may be able to be used to predict disease course and treatment response.
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Affiliation(s)
- Fatima Halilu
- Department of Medicine, Greater Baltimore Medical Center, Towson, MD, USA
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Pacheco M, Ferreira H, Silva C, Silva J, Matias E, Antunes T, Almeida JS. Antinuclear Antibody (ANA) and Anti-Mi-2-Alpha Positive Dermatomyositis Hinting a Cancer Diagnosis. Cureus 2022; 14:e21844. [PMID: 35291538 PMCID: PMC8896541 DOI: 10.7759/cureus.21844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Dermatomyositis (DM) is a relatively uncommon inflammatory myopathy that has been linked to cancer. We report the case of an 81-year-old woman with cecum adenocarcinoma presenting with antinuclear antibody (ANA) and anti-Mi-2-alpha antibody-positive DM. The patient complained of anorexia, symmetric proximal muscle weakness and skin rash and presented with elevated muscle enzymes. A skin and muscle biopsy supported the diagnosis of DM as did the limbs magnetic resonance imaging (MRI) and electromyography. A diagnosis of localized adenocarcinoma of the cecum was made through colonoscopy and the patient was successfully surgically managed, with decreasing muscle enzymes at discharge and gradual recovery of muscle strength. The presence of both ANA and anti-Mi-2 autoantibodies has classically been described as comprising a better prognosis with a lower risk of underlying malignancy. This case highlights the importance of pursuing a cancer diagnosis in elderly patients presenting with DM even in presence of less predisposing immunological profiles.
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11
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Opinc AH, Makowska JS. Update on Malignancy in Myositis—Well-Established Association with Unmet Needs. Biomolecules 2022; 12:111. [PMID: 35053259 PMCID: PMC8773676 DOI: 10.3390/biom12010111] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 12/31/2022] Open
Abstract
Idiopathic inflammatory myopathies are a group of rare connective tissue diseases with a well-documented association with malignancy. The mechanisms underlying the increased risk of neoplasms in the course of myositis are not fully understood. The Pubmed database has been thoroughly screened for articles concerning cancer-associated myositis (CAM). The article summarizes the current state of knowledge on the epidemiology and pathogenesis of CAM. Furthermore, it analyses potential risk and protective factors for developing CAM, with particular emphasis on the association with distinct serological profiles. The review summarizes recommendations proposed so far for the management of CAM and presents a novel scheme for cancer screening proposed by the authors. Moreover, promising areas requiring further research were indicated.
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12
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Basuita M, Fidler LM. Myositis Antibodies and Interstitial Lung Disease. J Appl Lab Med 2022; 7:240-258. [PMID: 34996093 DOI: 10.1093/jalm/jfab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/16/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Interstitial lung disease (ILD) comprises a heterogeneous group of inflammatory and fibrotic conditions, often resulting in progressive lung function decline and increased mortality. Connective tissue disease (CTD) should be considered in all patients with ILD, as distinguishing between CTD-ILD and other forms of fibrotic lung disease has important therapeutic and prognostic implications. The idiopathic inflammatory myopathies (IIM) represent a CTD subtype of growing interest to ILD experts. The expansion and availability of myositis-specific and myositis-associated antibody testing has allowed for improved disease detection and characterization. CONTENT In this review, we highlight the relationship between myositis antibodies and ILD. Select forms of IIM, such as the antisynthetase syndrome and clinically amyopathic dermatomyositis can present with rapidly progressive ILD, warranting timely disease diagnosis and management. Disease phenotypes, prevalence, laboratory testing, prognosis, and management strategies are described according to select myositis antibodies. SUMMARY Myositis antibodies provide valuable information for clinicians managing patients with ILD. This review aims to increase awareness of their role in disease detection, pathophysiology, and possibly therapeutics.
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Affiliation(s)
- Manpreet Basuita
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lee M Fidler
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada
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Marzęcka M, Niemczyk A, Rudnicka L. Autoantibody Markers of Increased Risk of Malignancy in Patients with Dermatomyositis. Clin Rev Allergy Immunol 2022; 63:289-296. [PMID: 35147864 PMCID: PMC9464248 DOI: 10.1007/s12016-022-08922-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 01/13/2023]
Abstract
Dermatomyositis is a chronic inflammatory disease involving the skin and muscles. It most commonly occurs in adults with preponderance in females, but pediatric occurrence is also possible. The risk of malignancy in adult patients with dermatomyositis was reported to be 4.66-fold higher compared to that in the general population. A significantly increased risk of malignancy was reported within the first 12 months following the diagnosis of dermatomyositis (standardized incidence ratio equaled 17). One of the characteristic laboratory findings associated with dermatomyositis is the presence of circulating autoantibodies which are classified into two subgroups: myositis-specific and myositis-associated autoantibodies. It was shown that specific types of antibodies might be associated with an increased risk of malignancy. Current literature data indicate that the strongest correlation with malignant diseases was reported in anti-TIF1-γ-positive patients who were at a 9.37-fold higher risk of cancer. A 3.68-fold increase in the risk of cancer was also reported among patients with anti-NXP2 antibodies. Malignant diseases were reported in 14-57% of patients with anti-SAE antibodies. The presence of other autoantibodies may also be associated with an increased risk of malignancy. These data indicate that patients with circulating anti-TIF1-γ, anti-NXP2, and anti-SAE should be very closely monitored for dermatomyositis-associated malignant comorbidities. The aim of this review is to summarize the current data regarding the link between malignancy and the presence of specific antibodies in patients with dermatomyositis.
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Affiliation(s)
- Milena Marzęcka
- grid.13339.3b0000000113287408Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Niemczyk
- grid.13339.3b0000000113287408Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- grid.13339.3b0000000113287408Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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14
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Fornaro M, Girolamo F, Cavagna L, Franceschini F, Giannini M, Amati A, Lia A, Tampoia M, D'Abbicco D, Maggi L, Fredi M, Zanframundo G, Moschetti L, Coladonato L, Iannone F. Severe muscle damage with myofiber necrosis and macrophage infiltrates characterize anti-Mi2 positive dermatomyositis. Rheumatology (Oxford) 2021; 60:2916-2926. [PMID: 33249503 DOI: 10.1093/rheumatology/keaa739] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/25/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of our study was to investigate clinical and histopathological findings in adult DM patients positive for anti-Mi2 (anti-Mi2+) antibodies compared with DM patients negative for anti-Mi2 (anti-Mi2-). METHODS Clinical data of adult DM patients, who fulfilled EULAR/ACR 2017 classification criteria, were gathered from electronic medical records of three tertiary Rheumatology Units. Histopathological study was carried out on 12 anti-Mi2+ and 14 anti-Mi2- muscle biopsies performed for diagnostic purpose. Nine biopsies from immune mediated necrotizing myopathy (IMNM) patients were used as control group. RESULTS Twenty-two anti-Mi2+ DM [90.9% female, mean age 56.5 (15.7) years] were compared with 69 anti-Mi2- DM patients [71% female, mean age 52.4 (17) years]. Anti-Mi2+ patients presented higher levels of serum muscle enzymes than anti-Mi2- patients [median (IQR) creatine-kinase fold increment: 16 (7-37)vs 3.5 (1-9.9), P <0.001] before treatment initiation. Moreover, a trend towards less pulmonary involvement was detected in anti-Mi2+ DM (9.1% vs 30.4%, P =0.05), without any case of rapidly progressive interstitial lung disease. At muscle histology, anti-Mi2+ patients showed more necrotic/degenerative fibres than anti-Mi2- patients [mean 5.3% (5) vs 0.8% (1), P <0.01], but similar to IMNM [5.9% (6), P >0.05]. In addition, the endomysial macrophage score was similar between anti-Mi2+ and IMNM patients [mean 1.2 (0.9) vs 1.3 (0.5), P >0.05], whereas lower macrophage infiltration was found in anti-Mi2- DM [mean 0.4 (0.5), <0.01]. CONCLUSIONS Anti-Mi2+ patients represent a specific DM subset with high muscle damage. Histological hallmarks were a higher prevalence of myofiber necrosis, endomysial involvement and macrophage infiltrates at muscle biopsy.
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Affiliation(s)
- Marco Fornaro
- Unit of Rheumatology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Francesco Girolamo
- Unit of Human Anatomy and Histology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Bari, Italy
| | - Lorenzo Cavagna
- Rheumatology Division, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Margherita Giannini
- Unit of Rheumatology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Service de Physiologie, Unité d'Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Angela Amati
- Unit of Neurophysiopathology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Anna Lia
- Unit of Neurophysiopathology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Marilina Tampoia
- Clinical Pathology Unit, Department of Biomedical Sciences and Human Oncology, University 'Aldo Moro' of Bari, Bari, Italy
| | - Dario D'Abbicco
- Institute of General Surgery 'G Marinaccio', Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Lorenzo Maggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Giovanni Zanframundo
- Rheumatology Division, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Liala Moschetti
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Laura Coladonato
- Unit of Rheumatology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Unit of Rheumatology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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15
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Pauling JD, Christopher-Stine L. The aetiopathogenic significance, clinical relevance and therapeutic implications of vasculopathy in idiopathic inflammatory myopathy. Rheumatology (Oxford) 2021; 60:1593-1607. [PMID: 33458769 DOI: 10.1093/rheumatology/keaa816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/16/2020] [Accepted: 10/15/2020] [Indexed: 12/31/2022] Open
Abstract
It is 120 years since 'angiomyositis' was included alongside 'polymyositis' and 'dermatomyositis' in an attempt to propose a taxonomy that reflected the major clinical characteristics of idiopathic inflammatory myopathy (IIM). Endothelial injury, perivascular inflammation and capillary loss are important histological findings in affected tissues in IIM. Overt vascular clinical features including RP and abnormal nailfold capillaroscopy (NC) are also common in IIM. Despite the presence of endothelial injury, perivascular inflammation and capillary loss in affected tissues in IIM, and the presence of clinical features such as RP and NC abnormalities, the pathogenic and therapeutic implications of vasculopathy in IIM have been somewhat overlooked. RP and NC abnormalities are not always present, providing a valuable opportunity to explore aetiopathogenic factors driving vasculopathy within autoimmune rheumatic disease. The present review examines the aetiopathogenic, prognostic and therapeutic significance of vasculopathy in IIM. We describe the prevalence and clinical relevance of vasculopathy in IIM, and consider how vasculopathy may be better utilized to support improved IIM diagnosis and disease classification. Areas of unmet research need are highlighted where relevant.
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Affiliation(s)
- John D Pauling
- Royal National Hospital for Rheumatic Diseases (Part of the Royal United Hospitals NHS Foundation Trust), Bath, UK.,Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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16
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Tardo DT, Bruce A, Pearlman A, Wang LW, Sturgess A, Pitney M. Chest Pain, Statins, Troponin Elevation, and Myopathy: A Diagnostic and Management Dilemma. Am J Med 2021; 134:e303-e305. [PMID: 33181100 DOI: 10.1016/j.amjmed.2020.09.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel T Tardo
- Department of Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia; School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia.
| | - Alana Bruce
- Department of Rheumatology, St George Hospital, Kogarah, NSW, Australia; Department of Rheumatology, Campbelltown and Camden Hospitals, Campbelltown, NSW, Australia; School of Medicine, Macquarie University, Sydney, NSW, Australia
| | - Alice Pearlman
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Louis W Wang
- Department of Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia; School of Medicine, University of New South Wales, Kensingtown, NSW, Australia
| | - Allan Sturgess
- Department of Rheumatology, St George Hospital, Kogarah, NSW, Australia; School of Medicine, University of New South Wales, Kensingtown, NSW, Australia
| | - Mark Pitney
- School of Medicine, University of New South Wales, Kensingtown, NSW, Australia; Department of Cardiology, Sutherland Hospital, Caringbah, NSW, Australia; Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
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18
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Abstract
The past 15 years has seen significant advances in the characterization of myositis-specific autoantibodies (MSAs) and their associated phenotypes in patients with dermatomyositis (DM). As more careful studies are performed, it is clear that unique combinations of clinical and pathological phenotypes are associated with each MSA, despite the fact that there is considerable heterogeneity within antibody classes as well as overlap across the groups. Because risk for interstitial lung disease (ILD), internal malignancy, adverse disease trajectory, and, potentially response to therapy differ by DM MSA group, a deeper understanding of MSAs and validation and standardization of assays used for detection are critical for optimizing diagnosis and treatment. Like any test, the diagnostic sensitivity and specificity of assays for various MSAs is not perfect. Currently tests for MSAs are helpful at minimum for a clinician to assess relative risk or contribute to diagnosis and perhaps counsel the appropriate patient about what to expect. With international standardization and larger studies it is likely that more antibody tests will make their way into formal schemata for diagnosis and actionable risk assessment in DM. In this review, we summarize key considerations for interpreting the clinical and pathologic associations with MSA in DM and identify critical gaps in knowledge and practice that will maximize their clinical utility and utility for understanding disease pathogenesis.
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Affiliation(s)
| | - Tiffany Tingshuen Wu
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
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19
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Espinosa‐Ortega F, Holmqvist M, Dastmalchi M, Lundberg IE, Alexanderson H. Factors associated with treatment response in patients with idiopathic inflammatory myopathies. A registry-based study. Arthritis Care Res (Hoboken) 2020; 74:468-477. [PMID: 33105033 PMCID: PMC9304210 DOI: 10.1002/acr.24498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 10/09/2020] [Accepted: 10/22/2020] [Indexed: 11/29/2022]
Abstract
Objective To identify predictors of response to immunosuppressive therapy after 1 year, with a focus on autoantibodies, in patients newly diagnosed with idiopathic inflammatory myopathies (IIM) followed longitudinally in an electronic registry. Methods We assessed the association between autoantibody‐defined groups and improvement according to American College of Rheumatology/European Alliance of Associations for Rheumatology 2016 response criteria. Results We identified 156 patients; of those, 111 (71%) were positive for any autoantibody tested, 90% received glucocorticoid treatment at baseline, and 78% received immunosuppressive drugs at some follow‐up point. After 1 year from the index date, the overall median improvement score was 27.5 (interquartile range 10–51). No differences were observed in the total improvement score between the autoantibody‐defined groups. Overall, 62% of patients (n = 96) showed a minimal response, 38% (n = 60) achieved a moderate response, and 19% (n = 30) achieved a major response. Regarding the different levels of response, dermatomyositis‐specific autoantibodies were associated with a moderate response versus the seronegative group (reference), odds ratio 4.12 (95% confidence interval 1.2–16.5). In addition, dysphagia, time from symptom onset to diagnosis, and initial glucocorticoid dose were significant predictors of response after 1 year of follow‐up. Conclusion Patients with DM‐specific autoantibodies achieved better levels of response compared to other autoantibody‐defined groups. Dysphagia, a shorter time span from symptom onset to diagnosis, and intensive initial immunosuppressive treatment were associated with a higher response rate after 1 year of pharmacologic treatment from the index date, regardless of autoantibody status.
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Affiliation(s)
| | - Marie Holmqvist
- Solna, Karolinska Institutet, and Karolinska University HospitalStockholmSweden
| | - Maryam Dastmalchi
- Solna, Karolinska Institutet, and Karolinska University HospitalStockholmSweden
| | - Ingrid E. Lundberg
- Solna, Karolinska Institutet, and Karolinska University HospitalStockholmSweden
| | - Helene Alexanderson
- Solna, Karolinska Institutet, and Karolinska University HospitalStockholmSweden
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20
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Ahn GY, Suh CH, Kim YG, Park YB, Shim SC, Lee SH, Lee SS, Bae SC, Yoo DH. Efficacy and Safety of Rituximab in Korean Patients with Refractory Inflammatory Myopathies. J Korean Med Sci 2020; 35:e335. [PMID: 32989931 PMCID: PMC7521958 DOI: 10.3346/jkms.2020.35.e335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/29/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Rituximab (RTX), a monoclonal antibody that selectively binds to CD20+ B cells, showed favorable outcomes in patients with idiopathic inflammatory myopathies (IIM) in small case series, but the evidence is still not enough. Our goal was to determine the efficacy and safety of RTX for Korean patients with refractory IIM. METHODS We retrospectively analyzed the medical records of 16 patients with refractory IIM treated with RTX in seven tertiary rheumatology clinics in the Korea. The efficacy of RTX was evaluated with the improvement of serum creatine phosphokinase (CPK) level and physician's global assessment (PGA), and daily corticosteroid dose reduction. A > 25% decrease in CPK level, corticosteroid dose, or PGA was considered significant. A complete response (CR) was designated by meeting three efficacy criteria and a partial response (PR) by only two criteria. RESULTS Sixteen patients with IIM were evaluated (13 female; median age, 51.8 years). All patients had received at least one conventional immunosuppressive agent (median, 3.6 [2.0-5.0]) and concomitant corticosteroids. The median CPK level and median dose of prednisolone was 421.0 units/L and 20.0 mg/day respectively. Eleven patients were treated with intravenous immunoglobulin. Seven patients received 2,000 mg of RTX and the others received lower dose. Twenty-four weeks after RTX treatment, 11 patients achieved a > 25% reduction in corticosteroid dose and CPK levels, and nine showed improved PGA. The overall response rate was 68.8% (11 patients). At the end of follow-up (median 24 weeks), 12 (75.0%) patients responded overall: four (25.0%) and eight (50.0%) patients achieved CR and PR, respectively. Baseline muscle enzyme levels were higher in responders than non-responders, but disease duration, RTX dose, ESR and serum CRP were not significantly different between the two groups. The rate of adverse event was 25.4/1,000 person-years. CONCLUSION RTX could be an effective and relatively safe therapeutic option in patients with refractory IIM.
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Affiliation(s)
- Ga Young Ahn
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Chang Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Yong Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Cheol Shim
- Division of Rheumatology, Regional Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, Korea
| | - Sang Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Shin Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Dae Hyun Yoo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
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21
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Moll SA, Platenburg MGJP, Platteel ACM, Vorselaars ADM, Janssen Bonàs M, Roodenburg-Benschop C, Meek B, van Moorsel CHM, Grutters JC. Prevalence of Novel Myositis Autoantibodies in a Large Cohort of Patients with Interstitial Lung Disease. J Clin Med 2020; 9:jcm9092944. [PMID: 32933078 PMCID: PMC7563342 DOI: 10.3390/jcm9092944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/28/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022] Open
Abstract
Connective tissue diseases (CTDs) are an important secondary cause of interstitial lung disease (ILD). If a CTD is suspected, clinicians are recommended to perform autoantibody testing, including for myositis autoantibodies. In this study, the prevalence and clinical associations of novel myositis autoantibodies in ILD are presented. A total of 1194 patients with ILD and 116 healthy subjects were tested for antibodies specific for Ks, Ha, Zoα, and cN1A with a line-blot assay on serum available at the time of diagnosis. Autoantibodies were demonstrated in 63 (5.3%) patients and one (0.9%) healthy control (p = 0.035). Autoantibodies were found more frequently in females (p = 0.042) and patients without a histological and/or radiological usual interstitial pneumonia (UIP; p = 0.010) and a trend towards CTD-ILDs (8.4%) was seen compared with other ILDs (4.9%; p = 0.090). The prevalence of antibodies specific for Ks, Ha, Zoα, and cN1A was, respectively, 1.3%, 2.0%, 1.4%, and 0.9% in ILD. Anti-Ha and Anti-Ks were observed in males with unclassifiable idiopathic interstitial pneumonia (unclassifiable IIP), hypersensitivity pneumonitis (HP), and various CTD-ILDs, whereas anti-cN1A was seen in females with antisynthetase syndrome (ASS), HP, and idiopathic pulmonary fibrosis (IPF). Anti-Zoα was associated with CTD-ILD (OR 2.5; 95%CI 1.11-5.61; p = 0.027). In conclusion, a relatively high prevalence of previously unknown myositis autoantibodies was found in a large cohort of various ILDs. Our results contribute to the awareness that circulating autoantibodies can be found in ILDs with or without established CTD. Whether these antibodies have to be added to the standard set of autoantibodies analysed in conventional myositis blot assays for diagnostic purposes in clinical ILD care requires further study.
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Affiliation(s)
- Sofia A. Moll
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Post box 2500, 3435 CM Nieuwegein, The Netherlands; (M.G.J.P.P.); (A.D.M.V.); (M.J.B.); (C.R.-B.); (C.H.M.v.M.); (J.C.G.)
- Correspondence:
| | - Mark G. J. P. Platenburg
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Post box 2500, 3435 CM Nieuwegein, The Netherlands; (M.G.J.P.P.); (A.D.M.V.); (M.J.B.); (C.R.-B.); (C.H.M.v.M.); (J.C.G.)
| | - Anouk C. M. Platteel
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (A.C.M.P.); (B.M.)
| | - Adriane D. M. Vorselaars
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Post box 2500, 3435 CM Nieuwegein, The Netherlands; (M.G.J.P.P.); (A.D.M.V.); (M.J.B.); (C.R.-B.); (C.H.M.v.M.); (J.C.G.)
| | - Montse Janssen Bonàs
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Post box 2500, 3435 CM Nieuwegein, The Netherlands; (M.G.J.P.P.); (A.D.M.V.); (M.J.B.); (C.R.-B.); (C.H.M.v.M.); (J.C.G.)
| | - Claudia Roodenburg-Benschop
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Post box 2500, 3435 CM Nieuwegein, The Netherlands; (M.G.J.P.P.); (A.D.M.V.); (M.J.B.); (C.R.-B.); (C.H.M.v.M.); (J.C.G.)
| | - Bob Meek
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (A.C.M.P.); (B.M.)
| | - Coline H. M. van Moorsel
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Post box 2500, 3435 CM Nieuwegein, The Netherlands; (M.G.J.P.P.); (A.D.M.V.); (M.J.B.); (C.R.-B.); (C.H.M.v.M.); (J.C.G.)
| | - Jan C. Grutters
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Post box 2500, 3435 CM Nieuwegein, The Netherlands; (M.G.J.P.P.); (A.D.M.V.); (M.J.B.); (C.R.-B.); (C.H.M.v.M.); (J.C.G.)
- Division Heart & Lungs, University Medical Centre Utrecht, 3435 CM Utrecht, The Netherlands
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22
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Lim J, Raaphorst J, van der Kooi AJ. Comment on "Systematic retrospective study on 64 patients anti-Mi2 dermatomyositis: A classic skin rash with a necrotizing myositis and high risk of malignancy". J Am Acad Dermatol 2020; 83:e459-e460. [PMID: 32758632 DOI: 10.1016/j.jaad.2020.06.1032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/16/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Johan Lim
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, The Netherlands.
| | - Joost Raaphorst
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, The Netherlands
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23
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Abstract
Dermatomyositis is a rare inflammatory disease with characteristic cutaneous findings and varying amounts of systemic involvement. Patients may present with skin disease alone, have concomitant muscle disease, or have extracutaneous manifestations such as pulmonary disease or an associated malignancy. Given such diverse presentations, dermatomyositis is both a diagnostic and therapeutic challenge. However, a prompt diagnosis is of utmost importance to institute adequate therapy and screen patients for an associated malignancy. Dermatologists should play a crucial role in the diagnosis and management of patients with dermatomyositis as cutaneous disease tends to be chronic, negatively impact quality of life, and be more recalcitrant to therapy. In this review, we discuss diagnosis, with a focus on myositis-specific antibodies and their associated phenotypes. We also review therapies available for this often refractory skin disease.
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Affiliation(s)
- Gabriela A Cobos
- Autoimmune Skin Disease Program, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Alisa Femia
- Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Ruth Ann Vleugels
- Autoimmune Skin Disease Program, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.
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24
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Shinjo SK, de Souza FHC. Treatment options from bench to bedside for adult dermatomyositis. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1742695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
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25
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Hervier B, Uzunhan Y. Inflammatory Myopathy-Related Interstitial Lung Disease: From Pathophysiology to Treatment. Front Med (Lausanne) 2020; 6:326. [PMID: 32010700 PMCID: PMC6978912 DOI: 10.3389/fmed.2019.00326] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022] Open
Abstract
Inflammatory myopathies (IM) are auto-immune connective tissue diseases characterized by muscle involvement and by extramuscular manifestations. As such, pulmonary manifestations, which mainly include interstitial lung disease (ILD), often darken two out of four distinct IM, namely dermatomyositis and overlapping myositis. Being the initiation site of the disease and being the leading cause of morbidity and mortality, ILD is of major importance in this context. ILD has a heterogeneous expression among the patients, with various onset mode, various radiological pattern, various severity and finally with different prognoses, which are particularly difficult to predict at the time of IM diagnosis. Therefore, ILD is a challenging issue. Treatments are based on steroids and immunosuppressive or targeted therapies. Their respective place is yet poorly codified however and remains often based on clinician expertise. Dedicated clinical trials are lacking to date and are also difficult to build, due to difficulty of constituting large and homogeneous patient groups and to rigorously evaluate disease outcomes. Indeed, pulmonary function tests alone are being regularly defeated in IM, in which respiratory muscles are often involved. Composite scores, bringing together several lung parameters, should thus be developed and validated in the future, to better assess the disease response to treatment. This review aims to describe the current knowledge of IM immuno-pathogenesis, the clinical features associated with IM related-ILD, focusing of both severity and prognosis, and the actual therapeutic approaches.
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Affiliation(s)
- Baptiste Hervier
- Internal Medicine and Clinical Immunology Department, French Referral Centre for Rare Neuromuscular Disorders, Hôpital Pitié-Salpêtrière, APHP, Paris, France.,INSERM UMR-S 1135, CIMI-Paris, UPMC & Sorbonne Université, Paris, France
| | - Yurdagül Uzunhan
- Pneumology Department, Reference Center for Rare Pulmonary Diseases, Hôpital Avicenne, APHP, Bobigny, France.,INSERM UMR1272, Université Paris 13, Bobigny, France
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26
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Abstract
Dermatomyositis are rare chronic auto-immune diseases characterized by cutaneous involvement. Diagnosis could be made in childhood or in aldult. There are some different clinical and histological presentation associated with different myositis specific antibody. There are five dermatomyositis specific autoantibodies, anti-Mi2, anti-Tif1-γ, anti-NXP2, anti-MDA5, and anti-SAE. Anti-Mi2 are associated with "classical form" of DM with cutaneous and muscular involvement. Anti-Tif1γ and anti-NXP2 are found in juvenile and adult dermatomyositis, and are associated with recurrent diseases with cutaneous involvement at the forefront. In adults, they are associated with cancer. Anti-MDA5 antibodies are associated with a systemic involvement and an interstitial lung disease. Finally, anti-SAE have been found only in adults, with a classic form.
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Affiliation(s)
- Loïs Bolko
- Service de Rhumatologie Maison Blanche, CHU de Reims, Reims, France
| | - Cyril Gitiaux
- Centre de référence des pathologies neuromusculaires Paris Nord Est, service de neurophysiologie clinique, Hôpital universitaire Necker Enfants Malades, APHP.5, Université de Paris, France
| | - Yves Allenbach
- Service de médecine interne et immunologie clinique, APHP Pitié-Salpêtrière, Paris, France
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Pinal-Fernandez I, Mecoli CA, Casal-Dominguez M, Pak K, Hosono Y, Huapaya J, Huang W, Albayda J, Tiniakou E, Paik JJ, Johnson C, Danoff SK, Corse AM, Christopher-Stine L, Mammen AL. More prominent muscle involvement in patients with dermatomyositis with anti-Mi2 autoantibodies. Neurology 2019; 93:e1768-e1777. [PMID: 31594859 DOI: 10.1212/wnl.0000000000008443] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/29/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To define the clinical phenotype of dermatomyositis (DM) with anti-Mi2 autoantibodies. METHODS In this longitudinal cohort study, the prevalence and severity of clinical features at disease onset and during follow-up in patients with anti-Mi2-positive DM were compared to patients with anti-Mi2-negative DM, antisynthetase syndrome (AS), and immune-mediated necrotizing myopathy (IMNM). Longitudinal anti-Mi2 autoantibody titers were assessed. RESULTS A total of 58 patients with anti-Mi2-positive DM, 143 patients with anti-Mi2-negative DM, 162 patients with AS, and 170 patients with IMNM were included. Among patients with anti-Mi2-positive DM, muscle weakness was present in 60% at disease onset and occurred in 98% during longitudinal follow-up; fewer patients with anti-Mi2-negative DM developed weakness (85%; p = 0.008). Patients with anti-Mi2-positive DM were weaker and had higher creatine kinase (CK) levels than patients with anti-Mi2-negative DM or patients with AS. Muscle biopsies from patients with anti-Mi2-positive DM had prominent necrosis. Anti-Mi2 autoantibody levels correlated with CK levels and strength (p < 0.001). With treatment, most patients with anti-Mi2-positive DM had improved strength and CK levels; among 10 with multiple serum samples collected over 4 or more years, anti-Mi2 autoantibody titers declined in all and normalized in 3, 2 of whom stopped immunosuppressant treatment and never relapsed. Patients with anti-Mi2-positive DM had less calcinosis (9% vs 28%; p = 0.003), interstitial lung disease (5% vs 16%; p = 0.04), and fever (7% vs 21%; p = 0.02) than did patients with anti-Mi2-negative DM. CONCLUSIONS Patients with anti-Mi2-positive DM have more severe muscle disease than patients with anti-Mi2-negative DM or patients with AS. Anti-Mi2 autoantibody levels correlate with disease severity and may normalize in patients who enter remission.
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Affiliation(s)
- Iago Pinal-Fernandez
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia.
| | - Christopher A Mecoli
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Maria Casal-Dominguez
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Katherine Pak
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Yuji Hosono
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Julio Huapaya
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Wilson Huang
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Jemima Albayda
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Eleni Tiniakou
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Julie J Paik
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Cheilonda Johnson
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Sonye K Danoff
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Andrea M Corse
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Lisa Christopher-Stine
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia
| | - Andrew L Mammen
- From the Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation (I.P.-F., M.C.-D., K.P., Y.H., W.H., A.L.M.), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Departments of Neurology (I.P.-F., M.C.-D., A.M.C., L.C.-S., A.L.M.) and Medicine (C.A.M., J.A., E.T., J.J.P., S.K.D., L.C.-S., A.L.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Faculty of Health Sciences (I.P.-F.), Universitat Oberta de Catalunya, Barcelona, Spain; Department of Medicine (J.H.), Medstar Georgetown University Hospital, Washington, DC; and Department of Medicine (C.J.), Hospital of the University of Pennsylvania, Philadelphia.
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Abstract
The discovery of novel autoantigen systems related to idiopathic inflammatory myopathies (collectively referred to as myositis) in adults and children has had major implications for the diagnosis and management of this group of diseases across a wide range of medical specialties. Traditionally, autoantibodies found in patients with myositis are described as being myositis-specific autoantibodies (MSAs) or myositis-associated autoantibodies (MAAs), depending on their prevalence in other, related conditions. However, certain MSAs are more closely associated with extramuscular manifestations, such as skin and lung disease, than with myositis itself. It is very rare for more than one MSA to coexist in the same individual, underpinning the potential to use MSAs to precisely define genetic and disease endotypes. Each MSA is associated with a distinctive pattern of disease or phenotype, which has implications for diagnosis and a more personalized approach to therapy. Knowledge of the function and localization of the autoantigenic targets for MSAs has provided key insights into the potential immunopathogenic mechanisms of myositis. In particular, evidence suggests that the alteration of expression of a myositis-related autoantigen by certain environmental influences or oncogenesis could be a pivotal event linking autoantibody generation to the development of disease.
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Betteridge Z, Tansley S, Shaddick G, Chinoy H, Cooper RG, New RP, Lilleker JB, Vencovsky J, Chazarain L, Danko K, Nagy-Vincze M, Bodoki L, Dastmalchi M, Ekholm L, Lundberg IE, McHugh N. Frequency, mutual exclusivity and clinical associations of myositis autoantibodies in a combined European cohort of idiopathic inflammatory myopathy patients. J Autoimmun 2019; 101:48-55. [PMID: 30992170 PMCID: PMC6580360 DOI: 10.1016/j.jaut.2019.04.001] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 01/30/2023]
Abstract
Objectives To determine prevalence and co-existence of myositis specific autoantibodies (MSAs) and myositis associated autoantibodies (MAAs) and associated clinical characteristics in a large cohort of idiopathic inflammatory myopathy (IIM) patients. Methods Adult patients with confirmed IIM recruited to the EuroMyositis registry (n = 1637) from four centres were investigated for the presence of MSAs/MAAs by radiolabelled-immunoprecipitation, with confirmation of anti-MDA5 and anti-NXP2 by ELISA. Clinical associations for each autoantibody were calculated for 1483 patients with a single or no known autoantibody by global linear regression modelling. Results MSAs/MAAs were found in 61.5% of patients, with 84.7% of autoantibody positive patients having a sole specificity, and only three cases (0.2%) having more than one MSA. The most frequently detected autoantibody was anti-Jo-1 (18.7%), with a further 21 specificities each found in 0.2–7.9% of patients. Autoantibodies to Mi-2, SAE, TIF1, NXP2, MDA5, PMScl and the non-Jo-1 tRNA-synthetases were strongly associated (p < 0.001) with cutaneous involvement. Anti-TIF1 and anti-Mi-2 positive patients had an increased risk of malignancy (OR 4.67 and 2.50 respectively), and anti-SRP patients had a greater likelihood of cardiac involvement (OR 4.15). Interstitial lung disease was strongly associated with the anti-tRNA synthetases, anti-MDA5, and anti-U1RNP/Sm. Overlap disease was strongly associated with anti-PMScl, anti-Ku, anti-U1RNP/Sm and anti-Ro60. Absence of MSA/MAA was negatively associated with extra-muscular manifestations. Conclusions Myositis autoantibodies are present in the majority of patients with IIM and identify distinct clinical subsets. Furthermore, MSAs are nearly always mutually exclusive endorsing their credentials as valuable disease biomarkers. Myositis specific autoantibodies very rarely coexist in the one individual allowing endotypes to be more precisely defined. The association of anti-TIF1 and cancer-associated myositis is confirmed with a cut-off age of over 58 years. In a large combined European myositis cohort associations of anti-SRP with carditis and anti-Mi-2 with cancer have emerged. Myositis associated autoantibodies are strongly associated with having myositis in association with another connective tissue disease.
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Affiliation(s)
- Z Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - S Tansley
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - G Shaddick
- Department of Mathematics, University of Exeter, Exeter, UK
| | - H Chinoy
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute of Health Research Manchester Biomedical Research Centre, Manchester University Foundation Trust.UK; Salford Royal NHS Foundation Trust, Manchester, UK
| | - R G Cooper
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - R P New
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - J B Lilleker
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Salford Royal NHS Foundation Trust, Manchester, UK
| | - J Vencovsky
- Institute of Rheumatology and Department of Rheumatology, 1stMedical Faculty, Charles University, Prague, Czech Republic
| | - L Chazarain
- Institute of Rheumatology and Department of Rheumatology, 1stMedical Faculty, Charles University, Prague, Czech Republic
| | - K Danko
- Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - M Nagy-Vincze
- Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - L Bodoki
- Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - M Dastmalchi
- Division of Rheumatology, Department of Medicine, Solna Karolinska Institutet, And Karolinska University Hospital, Stockholm, Sweden
| | - L Ekholm
- Division of Rheumatology, Department of Medicine, Solna Karolinska Institutet, And Karolinska University Hospital, Stockholm, Sweden
| | - I E Lundberg
- Division of Rheumatology, Department of Medicine, Solna Karolinska Institutet, And Karolinska University Hospital, Stockholm, Sweden
| | - N McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
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Damoiseaux J, Vulsteke JB, Tseng CW, Platteel AC, Piette Y, Shovman O, Bonroy C, Hamann D, De Langhe E, Musset L, Chen YH, Shoenfeld Y, Allenbach Y, Bossuyt X. Autoantibodies in idiopathic inflammatory myopathies: Clinical associations and laboratory evaluation by mono- and multispecific immunoassays. Autoimmun Rev 2019; 18:293-305. [DOI: 10.1016/j.autrev.2018.10.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
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Espinosa-Ortega F, Holmqvist M, Alexanderson H, Storfors H, Mimori T, Lundberg IE, Rönnelid J. Comparison of autoantibody specificities tested by a line blot assay and immunoprecipitation-based algorithm in patients with idiopathic inflammatory myopathies. Ann Rheum Dis 2019; 78:858-860. [PMID: 30760469 DOI: 10.1136/annrheumdis-2018-214690] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/31/2019] [Indexed: 02/04/2023]
Affiliation(s)
| | - Marie Holmqvist
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helene Alexanderson
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Helena Storfors
- Department of Clinical Immunology and Transfusion Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate school of Medicine, Kyoto, Japan
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Rönnelid
- Department Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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32
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Affiliation(s)
- In Seol Yoo
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jinhyun Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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Kohsaka H, Mimori T, Kanda T, Shimizu J, Sunada Y, Fujimoto M, Kawaguchi Y, Jinnin M, Muro Y, Ishihara S, Tomimitsu H, Ohta A, Sumida T. Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists, neurologists and dermatologists. Mod Rheumatol 2018; 29:1-19. [DOI: 10.1080/14397595.2018.1521185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Jun Shimizu
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihide Sunada
- Department of Neurology, Kawasaki Medical School, Okayama, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yasushi Kawaguchi
- Department of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan
| | - Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichiro Ishihara
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroyuki Tomimitsu
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akiko Ohta
- Division of Public Health, Department of Social Medicine, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Kohsaka H, Mimori T, Kanda T, Shimizu J, Sunada Y, Fujimoto M, Kawaguchi Y, Jinnin M, Muro Y, Ishihara S, Tomimitsu H, Ohta A, Sumida T. Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists, neurologists and dermatologists. J Dermatol 2018; 46:e1-e18. [PMID: 30562845 DOI: 10.1111/1346-8138.14604] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 12/27/2022]
Abstract
Although rheumatologists, neurologists and dermatologists see patients with polymyositis (PM) and dermatomyositis (DM), their management appears to vary depending on the physician's specialty. The aim of the present study was to establish the treatment consensus among specialists of the three fields to standardize the patient care. We formed a research team supported by a grant from the Ministry of Health, Labor and Welfare, Japan. Clinical questions (CQ) on the management of PM and DM were raised. A published work search on CQ was performed primarily using PubMed. Using the nominal group technique, qualified studies and results in the published work were evaluated and discussed to reach consensus recommendations. They were sent out to the Japan College of Rheumatology, Japanese Society of Neurology and Japanese Dermatological Association for their approval. We reached a consensus in 23 CQ and made recommendations and a decision tree for management was proposed. They were officially approved by the three scientific societies. In conclusion, a multidisciplinary treatment consensus for the management of PM and DM was established for the first time.
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Affiliation(s)
- Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Jun Shimizu
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihide Sunada
- Department of Neurology, Kawasaki Medical School, Okayama, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yasushi Kawaguchi
- Department of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan
| | - Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichiro Ishihara
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroyuki Tomimitsu
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akiko Ohta
- Division of Public Health, Department of Social Medicine, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Abstract
To date, increasing numbers of myositis-specific autoantibodies (MSAs) have been reported and their clinical significance has been elucidated. Anti-aminoacyl-tRNA synthetase (ARS) and anti-melanoma-differentiation associated gene 5 (MDA5) are strongly associated with interstitial lung disease (ILD); however, the clinical course of ILD is different depending on which autoantibody is present. Anti-ARS is associated with chronic and repetitive ILD and anti-MDA5 is associated with rapidly progressive ILD. Anti-MDA5, anti-transcriptional intermediary factor (TIF) 1-γ, anti-nuclear matrix protein (NXP) 2 and anti-Mi-2 antibodies are dermatomyositis specific. Anti-TIF1-γ and anti-NXP-2 antibodies are associated with malignancy, and anti-signal recognition particle (SRP) and anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies are associated with immune-mediated necrotizing myopathy (IMNM). Prognosis is also different among MSA-positive patient groups. Thus, MSAs are of great use for predicting disease course, prognosis, and determining therapeutic strategy as well as the diagnosis of idiopathic inflammatory myopathy (IIM) patients. Investigation of the pathogenic role of MSAs and their corresponding autoantigens will help us to understand the pathophysiology of IIM and identify new therapeutic targets.
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Affiliation(s)
- Ran Nakashima
- a Department of Rheumatology and Clinical Immunology , Graduate School of Medicine, Kyoto University , Kyoto , Japan
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Affiliation(s)
- Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa Italy and Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Ingrid E. Lundberg
- Division of rheumatology, Department of Medicine, Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
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Lepreux S, Hainfellner JA, Vital A. Idiopathic inflammatory myopathies overlapping with systemic diseases. Clin Neuropathol 2018; 37:6-15. [PMID: 29154752 DOI: 10.5414/NP301077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 12/21/2022] Open
Abstract
A muscle biopsy is currently requested to assess the diagnosis of an idiopathic inflammatory myopathy overlapping with a systemic disease. During the past few years, the classification of inflammatory myopathy subtypes has been revisited progressively on the basis of correlations between clinical phenotypes, autoantibodies and histological data. Several syndromic entities are now more clearly defined, and the aim of the present review is to clarify the contribution of muscle biopsy in a setting of idiopathic inflammatory myopathies overlapping with systemic diseases.
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Wang L, Huang L, Yang Y, Chen H, Liu Y, Liu K, Liu M, Xiao Y, Luo H, Zuo X, Li Y, Xiao X, Zhang H. Calcinosis and malignancy are rare in Chinese adult patients with myositis and nuclear matrix protein 2 antibodies identified by an unlabeled immunoprecipitation assay. Clin Rheumatol 2018; 37:2731-9. [PMID: 30039266 DOI: 10.1007/s10067-018-4216-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/06/2018] [Accepted: 07/12/2018] [Indexed: 01/29/2023]
Abstract
Autoantibodies in patients with myositis may associate with specific clinical manifestations. This study aimed to identify a subset of patients with myositis carrying antinuclear matrix protein 2 (anti-NXP-2) antibodies using an unlabeled immunoprecipitation (IP) assay, and clarify the features of these patients in a Chinese cohort. We developed novel methods for unlabeled protein IP and immunoblotting of Myc-tagged truncated NXP-2 fragments for anti-NXP-2 detection. The sera of 120 Chinese adult patients with myositis were screened for anti-NXP-2 by IP and immunoblot. Anti-NXP-2 antibodies were detected in 10 of the 120 patients (8.3%) using the established unlabeled protein IP and immunoblotting, with 70% (7/10) exhibiting either heliotrope rash or Gottron's papules. All 10 anti-NXP-2-positive patients exhibited myopathy and 60% complained of dysphagia. Severe diffuse calcinosis (10%) and nasopharyngeal carcinoma (10%) were each only present in single anti-NXP-2-positive patients with myositis. Antibodies against Ro-52 were found in four living but not in three deceased anti-NXP-2-positive patients. A comprehensive review of 13 anti-NXP-2 studies demonstrated markedly lower anti-NXP-2 prevalence among adult patients with myositis and lower association of anti-NXP-2 with calcinosis in Japan, China, and Hungary than in the USA and Italy. Anti-NXP-2 antibody association with internal malignancy in adult patients varied from 0 to 50% across different studies. A novel IP assay was developed to detect patients with myositis expressing anti-NXP-2. Calcinosis and malignancy are rare in Chinese adult patients with myositis positive for anti-NXP-2. Literature review indicated highest anti-NXP-2 prevalence and association of anti-NXP-2 with calcinosis in US and Italian myositis cohorts.
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Wolstencroft PW, Fiorentino DF. Dermatomyositis Clinical and Pathological Phenotypes Associated with Myositis-Specific Autoantibodies. Curr Rheumatol Rep 2018; 20. [DOI: 10.1007/s11926-018-0733-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Matsuda T, Ueda-Hayakawa I, Kambe N, Son Y, Ozaki Y, Hamaguchi Y, Takehara K, Fujimoto M, Okamoto H. Four cases of anti-Mi-2 antibody-positive dermatomyositis: relationship between anti-Mi-2 antibody titre and disease severity and activity. J Eur Acad Dermatol Venereol 2018; 32:e233-e234. [PMID: 29237096 DOI: 10.1111/jdv.14754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- T Matsuda
- Department of Dermatology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - I Ueda-Hayakawa
- Department of Dermatology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - N Kambe
- Department of Dermatology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Y Son
- Department of Rheumatology and Clinical Immunology, Kansai Medical University, Hirakata, Japan
| | - Y Ozaki
- Department of Rheumatology and Clinical Immunology, Kansai Medical University, Hirakata, Japan
| | - Y Hamaguchi
- Department of Molecular Pathology of Skin Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, 920-8641, Japan
| | - K Takehara
- Department of Molecular Pathology of Skin Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, 920-8641, Japan
| | - M Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan
| | - H Okamoto
- Department of Dermatology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
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Yang H, Peng Q, Yin L, Li S, Shi J, Zhang Y, Lu X, Shu X, Zhang S, Wang G. Identification of multiple cancer-associated myositis-specific autoantibodies in idiopathic inflammatory myopathies: a large longitudinal cohort study. Arthritis Res Ther 2017; 19:259. [PMID: 29178913 PMCID: PMC5702134 DOI: 10.1186/s13075-017-1469-8] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer is a significant complication contributing to increased mortality in idiopathic inflammatory myopathies (IIMs), and the association between IIMs and cancer has been extensively reported. Myositis-specific autoantibodies (MSAs) can help to stratify patients into more homogeneous groups and may be used as a biomarker for cancer-associated myositis. In this study, we aimed to systematically define the cancer-associated MSAs in IIMs. METHODS Serum from 627 patients with IIMs was tested for MSAs. The cancer risk with different MSAs was estimated by standardized incidence ratio (SIR). Paraneoplastic manifestation, such as the close temporal relationship between myositis onset and cancer diagnoses in patients with different MSAs, was also evaluated. RESULTS Compared with the general Chinese population, patients with IIMs and anti-transcriptional intermediary factor (TIF1)-γ antibodies (SIR = 17.28, 95% CI 11.94 to 24.14), anti-nuclear matrix protein (NXP2) antibodies (SIR = 8.14, 95% CI 1.63 to 23.86), or anti-SAE1 antibodies (SIR = 12.92, 95% CI 3.23 to 32.94), or who were MSAs-negative (SIR = 3.99, 95% CI 1.96 to 7.14) faced increased risk of cancer. There was no association between specific MSAs subtypes and certain types of cancer. Paraneoplastic manifestations were observed in the patients carrying anti-TIF1-γ, as well as other MSAs. There were no prognostic differences among the patients with cancer-associated myositis (CAM) from different MSAs subgroups. However, in comparison to those with cancer unrelated to myositis, CAM had a worse prognosis, with an age-adjusted and sex-adjusted Cox hazard ratio (HR) of 10.8 (95% CI 1.38-84.5, p = 0.02) for all-cause mortality. CONCLUSIONS Our study demonstrates in what is, to our knowledge, the largest population examined to date, that anti-SAE1, and previously reported anti-TIF1-γ and anti-NXP2 antibodies, are all associated with an increased risk of cancer in patients with IIMs. Moreover, our data suggest that in some cases, anti-HMGCR, anti-Jo-1 and anti-PL-12 antibody production might also be driven by malignancy. This can aid in the etiologic research of paraneoplastic myositis and clinical management.
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Affiliation(s)
- Hanbo Yang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 2 Yinhua Road, Chaoyang District, Beijing, 100029 China
- Graduate School of Peking Union Medical College, Beijing, 100730 China
| | - Qinglin Peng
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 2 Yinhua Road, Chaoyang District, Beijing, 100029 China
| | - Liguo Yin
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 2 Yinhua Road, Chaoyang District, Beijing, 100029 China
| | - Shanshan Li
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 2 Yinhua Road, Chaoyang District, Beijing, 100029 China
| | - Jingli Shi
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 2 Yinhua Road, Chaoyang District, Beijing, 100029 China
| | - Yamei Zhang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 2 Yinhua Road, Chaoyang District, Beijing, 100029 China
| | - Xin Lu
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 2 Yinhua Road, Chaoyang District, Beijing, 100029 China
| | - Xiaoming Shu
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 2 Yinhua Road, Chaoyang District, Beijing, 100029 China
| | - Sigong Zhang
- Department of Rheumatology, Lanzhou University Second Hospital, Gansu province, 730046 China
| | - Guochun Wang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 2 Yinhua Road, Chaoyang District, Beijing, 100029 China
- Graduate School of Peking Union Medical College, Beijing, 100730 China
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42
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Affiliation(s)
- Akinori Uruha
- Pierre and Marie Curie University - Paris VI; National Institute of Health and Medical Research (INSERM); Mixed Research Unit 974; Center of Research in Myology; Institute of Myology; Pitié-Salpêtrière University Hospital; Paris France
| | - Shigeaki Suzuki
- Department of Neurology; Keio University School of Medicine; Tokyo Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research; National Institute of Neuroscience; Tokyo Japan
- Department of Genome Medicine Development; Medical Genome Center; National Center of Neurology and Psychiatry; Tokyo Japan
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Suzuki S, Uruha A, Suzuki N, Nishino I. Integrated Diagnosis Project for Inflammatory Myopathies: An association between autoantibodies and muscle pathology. Autoimmun Rev 2017; 16:693-700. [DOI: 10.1016/j.autrev.2017.05.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/25/2017] [Indexed: 01/30/2023]
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Affiliation(s)
- M.L. Daly
- King's College Hospital NHS Foundation Trust, Denmark Hill; London SE5 9RS U.K
| | - P.A. Gordon
- King's College Hospital NHS Foundation Trust, Denmark Hill; London SE5 9RS U.K
| | - D. Creamer
- King's College Hospital NHS Foundation Trust, Denmark Hill; London SE5 9RS U.K
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Allenbach Y, Benveniste O, Goebel HH, Stenzel W. Integrated classification of inflammatory myopathies. Neuropathol Appl Neurobiol 2017; 43:62-81. [DOI: 10.1111/nan.12380] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/04/2017] [Accepted: 01/11/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Y. Allenbach
- Department of Internal Medicine and Clinical Immunology; Pitié-Salpêtrière Hospital; DHU I2B; AP-HP; Paris France
- INSERM U974; UPMC Sorbonne Universities; Paris France
| | - O. Benveniste
- Department of Internal Medicine and Clinical Immunology; Pitié-Salpêtrière Hospital; DHU I2B; AP-HP; Paris France
- INSERM U974; UPMC Sorbonne Universities; Paris France
| | - H-H. Goebel
- Department of Neuropathology; Charité - Universitätsmedizin; Berlin Germany
| | - W. Stenzel
- Department of Neuropathology; Charité - Universitätsmedizin; Berlin Germany
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Fujimoto M, Murakami A, Kurei S, Okiyama N, Kawakami A, Mishima M, Sato S, Seishima M, Suda T, Mimori T, Takehara K, Kuwana M. Enzyme-linked immunosorbent assays for detection of anti-transcriptional intermediary factor-1 gamma and anti-Mi-2 autoantibodies in dermatomyositis. J Dermatol Sci 2016; 84:272-281. [DOI: 10.1016/j.jdermsci.2016.09.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/17/2016] [Accepted: 09/23/2016] [Indexed: 10/21/2022]
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Abstract
The idiopathic inflammatory myopathies are characterized by muscle weakness, skin disease and internal organ involvement. Autoimmunity is known to have a role in myositis pathogenesis, and myositis-specific autoantibodies, targeting important intracellular proteins, are regarded as key biomarkers aiding in the diagnosis of patients. In recent years, a number of novel myositis autoantibodies including anti-TIF1, anti-NXP2, anti-MDA5, anti-SAE, anti-HMGCR and anti-cN1A have been identified in both adult and juvenile patients. These autoantibodies correlate with distinct clinical manifestations and importantly are found in inclusion body, statin-induced, clinically amyopathic and juvenile groups of myositis patients, previously believed to be mainly autoantibody negative. In this review, we will describe the main myositis-specific and myositis-associated autoantibodies and their frequencies and clinical associations across different ages and ethnic groups. We will also discuss preliminary studies investigating correlations between specific myositis autoantibody titres and clinical markers of disease course, collectively demonstrating the utility of myositis autoantibodies as both diagnostic and prognostic markers of disease.
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Affiliation(s)
- Z Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - N McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Disease, Bath, UK
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Tampoia M, Notarnicola A, Abbracciavento L, Fontana A, Giannini M, Louis Humbel R, Iannone F. A New Immunodot Assay for Multiplex Detection of Autoantibodies in a Cohort of Italian Patients With Idiopathic Inflammatory Myopathies. J Clin Lab Anal 2016; 30:859-866. [PMID: 27074881 DOI: 10.1002/jcla.21948] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/11/2016] [Accepted: 01/18/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Autoantibody detection has been assessed as tool for the diagnosis and the definition of idiopathic inflammatory myopathies (IIM). The aim of the study was to characterize the autoantibody profiling of a cohort of Italian patients with IIM. METHODS Sera of 53 adult patients with definite IIM, according to Bohan-Peter criteria, were tested for anti-nuclear autoantibodies (ANA), using indirect immunofluorescence (IIF) method, and for myositis-specific autoantibodies (MSAs) and myositis-associated autoantibodies (MAAs), using two new commercial immunodot assays. RESULTS MSAs and/or MAAs were detected in 29 of 53 (54.7%) patients with IIM. Twenty-three patients (43.4%) were positive for at least one MSAs: 13 (24.5%) had anti-histidyl-tRNA synthetase autoantibodies (Jo1), 4 (7.5%) had other anti-aminoacyl-tRNA synthetases autoantibodies (anti-ARS), 1 (1.8%) had anti-transcription intermediary factor 1 gamma autoantibodies (anti-TIF1γ), 2 (3.7%) had anti-nuclear helicase protein Mi-2 autoantibodies (anti-Mi-2), 4 (7.5%) had anti-small ubiquitin like modifier activating enzyme heterodimer autoantibodies (anti-SAE). Moreover, 17 patients (32%) were positive for at least one MAAs. Coexisting MSAs and MAAs were observed in 9 of 53 (16.9%) patients, anti-Jo1/SS-A autoantibodies in most cases. Overall sensitivity of immunodot assays was 54.7%, the specificity was almost absolute. At cut-off value of 1:160, the sensitivity of ANA-IIF was 52.8%, increasing to 66% if cytoplasmatic fluorescence reaction was reported. Notably, two (5.7%) ANA-IIF negative patients had MSAs, detected only by immunodot assays. CONCLUSION It was possible to identify MSAs otherwise undetectable because of the use of new assays. Immunodot can reveal MSAs even when IIF results are inconclusive or, in some cases, ANA negative.
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Affiliation(s)
- Marilina Tampoia
- Laboratory of Clinical Pathology, University Hospital of Bari, Bari, Italy.
| | - Antonella Notarnicola
- Interdisciplinary Department of Medicine, Rheumatology Unit, University Hospital of Bari, Bari, Italy
| | | | - Antonietta Fontana
- Laboratory of Clinical Pathology, University Hospital of Bari, Bari, Italy
| | - Margherita Giannini
- Interdisciplinary Department of Medicine, Rheumatology Unit, University Hospital of Bari, Bari, Italy
| | - Renè Louis Humbel
- Laboratoire Luxembougeois d'Immuno-Pathologie, Esch/Alzette, Luxembourg
| | - Florenzo Iannone
- Interdisciplinary Department of Medicine, Rheumatology Unit, University Hospital of Bari, Bari, Italy
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Kawasumi H, Gono T, Kawaguchi Y, Kuwana M, Kaneko H, Katsumata Y, Kataoka S, Hanaoka M, Yamanaka H. Clinical Manifestations and Myositis-Specific Autoantibodies Associated with Physical Dysfunction after Treatment in Polymyositis and Dermatomyositis: An Observational Study of Physical Dysfunction with Myositis in Japan. Biomed Res Int 2016; 2016:9163201. [PMID: 26925419 DOI: 10.1155/2016/9163201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/31/2015] [Indexed: 01/30/2023]
Abstract
Objective. The physical function of PM/DM patients after remission induction therapy remains unknown adequately. The aim of our study was to evaluate the present status of physical dysfunction and to clarify the clinical manifestations and myositis-specific autoantibodies (MSAs) associated with physical dysfunction after treatment in PM/DM. Methods. We obtained clinical data including the age at disease onset, gender, disease duration, laboratory data prior to initial treatment, and the specific treatment administered. We evaluated disease activity and physical dysfunction after treatment using the core set provided by the International Myositis Assessment and Clinical Studies Group. Results. 57% of the 77 enrolled patients with PM/DM had troubles in daily living after treatment. At the enrolment, disease activity evaluated by physicians was only revealed in 20% of patients. In a multivariate analysis, the age at disease onset, female gender, and CK levels before treatment were significantly associated with the severity of physical dysfunction after treatment. Anti-SRP positivity was associated with more severe physical dysfunction after treatment than anti-ARS or anti-MDA5. Conclusions. Half of the PM/DM patients showed physical dysfunction after treatment. Age at disease onset, gender, CK level before treatment, and anti-SRP were significant predictors associated with physical dysfunction after treatment in PM/DM.
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