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Cavagna L, Meloni F, Meyer A, Sambataro G, Belliato M, De Langhe E, Cavazzana I, Pipitone N, Triantafyllias K, Mosca M, Barsotti S, Zampogna G, Biglia A, Emmi G, De Visser M, Van Der Kooi A, Parronchi P, Hirschi S, da Silva JAP, Scirè CA, Furini F, Giannini M, Martinez Gonzalez O, Damian L, Piette Y, Smith V, Mera-Valera A, Bachiller-Corral J, Cabezas Rodriguez I, Brandy-Garcia AM, Maurier F, Perrin J, Gonzalez-Moreno J, Drott U, Delbruck C, Schwarting A, Arrigoni E, Sebastiani GD, Iuliano A, Nannini C, Quartuccio L, Rodriguez Cambron AB, Blázquez Cañamero MÁ, Villa Blanco I, Cagnotto G, Pesci A, Luppi F, Dei G, Romero Bueno FI, Franceschini F, Chiapparoli I, Zanframundo G, Lettieri S, De Stefano L, Cutolo M, Mathieu A, Piga M, Prieto-González S, Moraes-Fontes MF, Fonseca JE, Jovani V, Riccieri V, Santaniello A, Montfort S, Bilocca D, Erre GL, Bartoloni E, Gerli R, Monti MC, Lorenz HM, Sambataro D, Bellando Randone S, Schneider U, Valenzuela C, Lopez-Mejias R, Cifrian J, Mejia M, Gonzalez Perez MI, Wendel S, Fornaro M, De Luca G, Orsolini G, Rossini M, Dieude P, Knitza J, Castañeda S, Voll RE, Rojas-Serrano J, Valentini A, Vancheri C, Matucci-Cerinic M, Feist E, Codullo V, Iannone F, Distler JH, Montecucco C, Gonzalez-Gay MA. Clinical spectrum time course in non-Asian patients positive for anti-MDA5 antibodies. Clin Exp Rheumatol 2022; 40:274-283. [PMID: 35200123 DOI: 10.55563/clinexprheumatol/di1083] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To define the clinical spectrum time-course and prognosis of non-Asian patients positive for anti-MDA5 antibodies. METHODS We conducted a multicentre, international, retrospective cohort study. RESULTS 149 anti-MDA5 positive patients (median onset age 53 years, median disease duration 18 months), mainly females (100, 67%), were included. Dermatomyositis (64, 43%) and amyopathic dermatomyositis (47, 31%), were the main diagnosis; 15 patients (10%) were classified as interstitial pneumonia with autoimmune features (IPAF) and 7 (5%) as rheumatoid arthritis. The main clinical findings observed were myositis (84, 56%), interstitial lung disease (ILD) (108, 78%), skin lesions (111, 74%), and arthritis (76, 51%). The onset of these manifestations was not concomitant in 74 cases (50%). Of note, 32 (21.5%) patients were admitted to the intensive care unit for rapidly progressive-ILD, which occurred in median 2 months from lung involvement detection, in the majority of cases (28, 19%) despite previous immunosuppressive treatment. One-third of patients (47, 32% each) was ANA and anti-ENA antibodies negative and a similar percentage was anti-Ro52 kDa antibodies positive. Non-specific interstitial pneumonia (65, 60%), organising pneumonia (23, 21%), and usual interstitial pneumonia-like pattern (14, 13%) were the main ILD patterns observed. Twenty-six patients died (17%), 19 (13%) had a rapidly progressive-ILD. CONCLUSIONS The clinical spectrum of the anti-MDA5 antibodies-related disease is heterogeneous. Rapidly-progressive ILD deeply impacts the prognosis also in non-Asian patients, occurring early during the disease course. Anti-MDA5 antibody positivity should be considered even when baseline autoimmune screening is negative, anti-Ro52 kDa antibodies are positive, and radiology findings show a NSIP pattern.
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Affiliation(s)
- Lorenzo Cavagna
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
| | - Federica Meloni
- Transplant Centre Unit, IRCCS San Matteo Foundation and University of Pavia, Italy
| | - Alain Meyer
- Rheumatology, Centre de Référence des Maladies Auto-Immunes Rares, Service de Physiologie et Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, France
| | | | - Mirko Belliato
- UOC Anestesia e Rianimazione 2 Cardiopolmonare, Foundation IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | | | | | - Marta Mosca
- Rheumatology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Simone Barsotti
- Rheumatology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Alessandro Biglia
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Giacomo Emmi
- Internal Interdisciplinary Unit, Lupus Clinic, Careggi University Hospital and Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | | | | | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Sandrine Hirschi
- Pneumology, NHC, Strasbourg University Hospital, Strasbourg University, France
| | | | | | - Federica Furini
- Rheumatology, Azienda Ospedaliero Universitaria S. Anna, Ferrara, Italy
| | - Margherita Giannini
- Rheumatology, Centre de Référence des Maladies Auto-Immunes Rares, Service de Physiologie et Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, France
| | | | - Laura Damian
- Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital; Department of Internal Medicine, Ghent University; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital; Department of Internal Medicine, Ghent University; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Antonio Mera-Valera
- Rheumatology, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | | | | | | | | | - Julie Perrin
- Pneumology HPMetz, Hopital Belle-Ile, Metz, France
| | - Juan Gonzalez-Moreno
- Rheumatology, Internal Medicine Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | - Ulrich Drott
- Rheumatology, Johann Wolfgang Goethe-Universität, Frankfurt, Germany
| | | | | | | | | | | | | | - Luca Quartuccio
- Rheumatology Unit, Department of Medicine (DAME), University of Udine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy
| | | | | | | | | | - Alberto Pesci
- Pneumology, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | - Fabrizio Luppi
- Pneumology, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | - Giulia Dei
- Pneumology, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | | | | | | | - Giovanni Zanframundo
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Sara Lettieri
- Pneumology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Ludovico De Stefano
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Maurizio Cutolo
- Rheumatology, University of Genova, DIMI, IRCCS San Martino, Genova, Italy
| | - Alessandro Mathieu
- Rheumatology, University Clinic and Azienda Ospedaliera Universitaria of Cagliari, Italy
| | - Matteo Piga
- Rheumatology, University Clinic and Azienda Ospedaliera Universitaria of Cagliari, Italy
| | | | | | - Joao Eurico Fonseca
- Serviço Reumatologia, Centro Hospitalar Lisboa Norte and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal
| | - Vega Jovani
- Rheumatology, University Hospital, Alicante, Spain
| | - Valeria Riccieri
- Rheumatology, University La Sapienza and Policlinico Umberto I, Rome, Italy
| | - Alessandro Santaniello
- Scleroderma Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Gian Luca Erre
- Rheumatology, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | | | | | - M Cristina Monti
- Biostatistics Unit, Department of Public Health, University of Pavia, Italy
| | | | - Domenico Sambataro
- Artroreuma srl, Outpatient of Rheumatology accredited with the Italian National Health System, Mascalucia, Catania, Italy
| | | | - Udo Schneider
- Rheumatology, Charité - Universitätsmedizin Berlin, Germany
| | - Claudia Valenzuela
- Pneumology, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-Roche (EPID Future), Universidad Autonoma, Madrid, Spain
| | - Raquel Lopez-Mejias
- Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Jose Cifrian
- Pneumology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Mayra Mejia
- Pneumology, Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, Mexico
| | - Monserrat-Ixchel Gonzalez Perez
- Pneumology, Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, Mexico
| | - Sarah Wendel
- Rheumatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | | | - Giacomo De Luca
- Rheumatology, Università Vita-Salute, San Raffaele, Milano, Italy
| | | | | | - Philippe Dieude
- Rheumatology, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France
| | | | - Santos Castañeda
- Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-Roche (EPID Future), Universidad Autonoma, Madrid, Spain
| | - Reinhard E Voll
- Rheumatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Jorge Rojas-Serrano
- Rheumatology, Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, México
| | - Adele Valentini
- Radiology, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Carlo Vancheri
- Pulmonology, Azienda Ospedaliera Universitaria Catania, Italy
| | | | - Eugen Feist
- Rheumatology, Charité - Universitätsmedizin Berlin, Germany
| | - Veronica Codullo
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | | | | | | | - Miguel A Gonzalez-Gay
- Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
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