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Xing C, Trivedi J, Bitencourt N, Burns DK, Reisch JS, Cai C. Myxovirus resistance protein A (MxA) expression in myositides: Sarcoplasmic expression is common in both dermatomyositis and lupus myositis. Muscle Nerve 2024; 69:548-555. [PMID: 38372203 DOI: 10.1002/mus.28066] [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: 07/20/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION/AIMS Myxovirus resistance protein A (MxA) is a type I interferon (IFN1) pathway activation marker and MxA sarcoplasmic expression is currently recognized as a highly specific marker for dermatomyositis (DM). However, we have frequently observed endothelial tubuloreticular inclusions (TRI), another surrogate IFN1 activation marker, in a variety of overlap myositides. The aim of this study was to examine MxA expression in those myositides. METHODS We retrospectively performed MxA immunostaining on a wide range of myositides. RESULTS MxA sarcoplasmic expression was present in DM (94.4%, 17/18), active lupus myositis (LM, 80%,16/20), inactive LM (36%, 4/11), antisynthetase syndrome (ASyS, 20%, 2/10), systemic sclerosis (13%, 2/15), Sjogren's syndrome (7.7%, 1/13), and human immunodeficiency virus (HIV) myositis (5.6%, 1/18) and was absent in immune-mediated necrotizing myopathy (IMNM, 0/16) and hydroxychloroquine myopathy (0/5). The sensitivity and specificity of MxA sarcoplasmic expression for LM and DM combined compared with all other myositides were 84.6% (95% CI: 69.5-94.1) and 92.1 (95% CI: 83.6-97.0), respectively, and superior to TRIs. MxA capillary expression was nonspecific. Histologically, 35% of LM cases demonstrated a unique panfascicular necrotizing myopathy pattern. The remainder of the LM cases had significant morphological overlap with DM/ASyS (20%), IMNM (20%), or polymyositis (15%). DISCUSSION MxA sarcoplasmic expression is highly prevalent in LM and DM and is a useful marker in differentiating DM and LM from other myositides. LM can manifest in various pathology patterns that need to be differentiated from DM, IMNM, ASyS, and polymyositis.
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Affiliation(s)
- Changhong Xing
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jaya Trivedi
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole Bitencourt
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dennis K Burns
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joan S Reisch
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chunyu Cai
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Huang T, Ding T, Ding L, Xie S, Li X, Meng Q, Wu X, Luo H, Zhao H. A new proposal for phenotypic classification and outcome assessment of dermatomyositis based on clinical manifestations and serological testing. An Bras Dermatol 2024; 99:342-349. [PMID: 38522973 DOI: 10.1016/j.abd.2023.06.005] [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: 03/06/2023] [Revised: 06/17/2023] [Accepted: 06/25/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Dermatomyositis (DM) is an infrequent disease subgroup of idiopathic inflammatory myopathies characterized by distinct skin lesions. However, high heterogeneity makes clinical diagnosis and treatment of DM very challenging. OBJECTIVES Unsupervised classification in DM patients and analysis of key factors related to clinical outcomes. METHODS This retrospective study was conducted between 2017 and 2022 at the Department of Rheumatology, Xiangya Hospital, Central South University. 162 DM patients were enrolled for unsupervised hierarchical cluster analysis. In addition, we divided the clinical outcomes of DM patients into four subgroups: withdrawal, stabilization, aggravation, and death, and compared the clinical profiles amongst the subgroups. RESULTS Out of 162 DM patients, three clusters were defined. Cluster 1 (n = 40) was mainly grouped by patients with prominent muscular involvement and mild Interstitial Lung Disease (ILD). Cluster 2 (n = 72) grouped patients with skin rash, anti-Melanoma Differentiation Associated protein 5 positive (anti-MDA5+), and Rapid Progressive Interstitial Lung Disease (RP-ILD). Cluster 3 (n = 50) grouped patients with the mildest symptoms. The proportion of death increased across the three clusters (cluster 3 < cluster 1 < cluster 2). STUDY LIMITATIONS The number of cases was limited for the subsequent construction and validation of predictive models. We did not review all skin symptoms or pathological changes in detail. CONCLUSIONS We reclassified DM into three clusters with different risks for poor outcome based on diverse clinical profiles. Clinical serological testing and cluster analysis are necessary to help clinicians evaluate patients during follow-up and conduct phenotype-based personalized care in DM.
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Affiliation(s)
- Ting Huang
- Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China; Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Ting Ding
- Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China; Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Liqing Ding
- Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China; Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Shasha Xie
- Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China; Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Xiaojing Li
- Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China; Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Qiming Meng
- Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China; Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Xiaomeng Wu
- Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China; Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Hui Luo
- Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China; Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Hongjun Zhao
- Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China; Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.
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Figueiredo C, Matos AL, Calvao J, Goncalo M. Three cases of Anti-MDA5 positive dermatomyositis with interstitial lung disease and pneumomediastium. Dermatol Online J 2024; 30. [PMID: 38762870 DOI: 10.5070/d330163301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 05/20/2024] Open
Affiliation(s)
- Carolina Figueiredo
- Dermatology Department, Coimbra Hospitalar and University Centre, Praceta Professor Mota Pinto, Coimbra, Portugal
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Soontrapa P, Shahar S, Eauchai L, Ernste FC, Liewluck T. Disease spectrum of myopathies with elevated aldolase and normal creatine kinase. Eur J Neurol 2024; 31:e16117. [PMID: 37922500 DOI: 10.1111/ene.16117] [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: 07/26/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND AND PURPOSE Elevation of serum creatine kinase (CK) or hyperCKemia is considered a biological marker of myopathies. However, selective elevation of serum aldolase with normal CK has been reported in a few myopathies, including dermatomyositis, immune-mediated myopathy with perimysial pathology and fasciitis with associated myopathy. The aim was to investigate the disease spectrum of myopathies with isolated aldolase elevation. METHODS Medical records were reviewed to identify patients >18 years old seen between December 1994 and June 2020 who had pathologically proven myopathies with elevated aldolase and normal CK level. Patients with alternative causes of aldolase elevation were excluded. RESULTS Thirty-four patients with various types of myopathies were identified. Myopathies were treatable in 27 patients. The three most common etiologies were dermatomyositis (n = 8), overlap myositis (n = 4) and nonspecific myopathy (n = 4). Perimysial pathology comprising inflammation, fragmentation, vasculitis, calcified perimysial vessels or extracellular amyloid deposition was found in 17/34 patients (50%). Eight dermatomyositis patients with selective elevated aldolase were compared to 24 sex- and age-matched patients with dermatomyositis and hyperCKemia. Dermatomyositis patients with normal CK significantly (p < 0.05) had less frequent cutaneous involvement (50.0% vs. 100.0%) and fibrillation potentials (50.0% vs. 90.5%) but higher median erythrocyte sedimentation rate (33.5 vs. 13.5 mm/h) and more common perifascicular mitochondrial pathology (37.5% vs. 4.2%). CONCLUSION Isolated aldolase elevation can be found in a greater variety of myopathies than initially thought and most were treatable. Dermatomyositis is the most common myopathy with selective elevation of aldolase in our cohort, which features some unique characteristics compared to dermatomyositis with hyperCKemia.
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Affiliation(s)
- Pannathat Soontrapa
- Department of Neurology, Division of Neuromuscular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine, Division of Neurology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shelly Shahar
- Department of Neurology, Division of Neuromuscular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lattawat Eauchai
- Department of Neurology, Division of Neuromuscular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Anatomy, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Floranne C Ernste
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Teerin Liewluck
- Department of Neurology, Division of Neuromuscular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Yao F, Deng L, Liao Z, Wen Z. Primary pulmonary diffuse large B-cell lymphoma with anti-NXP2-positive dermatomyositis: a case report. Clin Exp Rheumatol 2024; 42:454-455. [PMID: 37650343 DOI: 10.55563/clinexprheumatol/x0389r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/27/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Fangling Yao
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Li Deng
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Zheng Liao
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Zhenhua Wen
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China.
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Caravan S, Lopez CM, Yeh JE. Causes and Clinical Presentation of Drug-Induced Dermatomyositis: A Systematic Review. JAMA Dermatol 2024; 160:210-217. [PMID: 38198130 DOI: 10.1001/jamadermatol.2023.5418] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Importance While several medications are known to induce dermatomyositis (DM), most existing studies are case reports or small case series from a single institution. There is also limited information on DM induced by immune checkpoint inhibitors, which are increasingly used in oncologic therapy. Objective To characterize causes and clinical presentation of drug-induced DM based on the current literature. Evidence Review A systematic review was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, from inception to August 22, 2022. Articles meeting preestablished inclusion criteria (written in English and classified as original articles, case reports, literature reviews, and observation letters) were selected and data abstracted. Articles that met the scope of the review were also added from reference lists. When possible, study results were quantitatively combined. Findings In 134 studies (114 from the literature search and 20 additional studies pulled from reference lists) describing 165 cases, 88 patients (53.3%) were female, and the median (IQR) age was 61 (49-69) years. Among the cases of drug-induced DM, the most common associated medications were hydroxyurea (50 [30.3%]), immune checkpoint inhibitors (27 [16.4%]), statins (22 [13.3%]), penicillamine (10 [6.1%]), and tumor necrosis factor inhibitors (10 [6.1%]). Histopathologic testing, when undertaken, helped establish the diagnosis. There was a median (IQR) of 60 (21-288) days between drug initiation and drug-induced DM onset. History of cancer was reported in 85 cases (51.6%). Conclusions and Relevance In this systematic review, drug-induced DM was associated with multiple types of medications, including chemotherapies and immunotherapies. It is essential that dermatologists promptly recognize and diagnose drug-induced DM so that they can guide management to minimize interruption of therapy when possible.
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Affiliation(s)
- Sahar Caravan
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Christopher M Lopez
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Jennifer E Yeh
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
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Covert LT, Patel H, Osman A, Duncan L, Dvergsten J, Truskey GA. Effect of type I interferon on engineered pediatric skeletal muscle: a promising model for juvenile dermatomyositis. Rheumatology (Oxford) 2024; 63:209-217. [PMID: 37094222 PMCID: PMC10765138 DOI: 10.1093/rheumatology/kead186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/03/2023] [Revised: 03/24/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE To investigate pathogenic mechanisms underlying JDM, we defined the effect of type I IFN, IFN-α and IFN-β, on pediatric skeletal muscle function and expression of myositis-related proteins using an in vitro engineered human skeletal muscle model (myobundle). METHODS Primary myoblasts were isolated from three healthy pediatric donors and used to create myobundles that mimic functioning skeletal muscle in structural architecture and physiologic function. Myobundles were exposed to 0, 5, 10 or 20 ng/ml IFN-α or IFN-β for 7 days and then functionally tested under electrical stimulation and analyzed immunohistochemically for structural and myositis-related proteins. Additionally, IFN-β-exposed myobundles were treated with Janus kinase inhibitors (JAKis) tofacitinib and baricitinib. These myobundles were also analyzed for contractile force and immunohistochemistry. RESULTS IFN-β, but not IFN-α, was associated with decreased contractile tetanus force and slowed twitch kinetics. These effects were reversed by tofacitinib and baricitinib. Type I IFN paradoxically reduced myobundle fatigue, which did not reverse after JAKi. Additionally, type I IFN correlated with MHC I upregulation, which normalized after JAKi treatment, but expression of myositis-specific autoantigens Mi-2, melanocyte differentiation-associated protein 5 and the endoplasmic reticulum stress marker GRP78 were variable and donor specific after type I IFN exposure. CONCLUSION IFN-α and IFN-β have distinct effects on pediatric skeletal muscle and these effects can partially be reversed by JAKi treatment. This is the first study illustrating effective use of a three-dimensional human skeletal muscle model to investigate JDM pathogenesis and test novel therapeutics.
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Affiliation(s)
- Lauren T Covert
- Department of Pediatrics, Duke University Health System, Durham, NC, USA
| | - Hailee Patel
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Alaa Osman
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Lavonia Duncan
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jeffrey Dvergsten
- Department of Pediatrics, Duke University Health System, Durham, NC, USA
| | - George A Truskey
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
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8
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Walsh M, Bettendorf B, Zahn C. Dermatomyositis presenting with diffuse calcinosis. BMJ Case Rep 2023; 16:e257288. [PMID: 38103899 PMCID: PMC10728952 DOI: 10.1136/bcr-2023-257288] [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] [Indexed: 12/19/2023] Open
Abstract
We present the case of a woman in her early 50s who initially presented to an orthopedist for nodules located near the posterior knee. Imaging revealed diffuse subcutaneous calcifications and she was subsequently referred to rheumatology. Additional testing included myositis panel, electromyography (EMG) and muscle biopsy which indicated the presence of an inflammatory myopathy. It was determined that this patient had an uncommon presentation of dermatomyositis in which her primary complaint was calcinosis cutis. While rash and muscle weakness are often the symptoms most commonly associated with dermatomyositis, it is essential to have a wide differential for patients presenting with calcium deposition in soft tissues. This is particularly important in patients with certain antibodies, including the NXP-2 antibody, which can be associated with malignancy and should prompt an appropriate malignancy workup.
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Affiliation(s)
- Madalyn Walsh
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Brittany Bettendorf
- Division of Immunology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Carleigh Zahn
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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Yazdani M, Mach L, Noseda M. Single cell RNA sequencing sheds light on infiltrating T cells in idiopathic inflammatory myopathies. EMBO Mol Med 2023; 15:e18190. [PMID: 37768011 PMCID: PMC10565633 DOI: 10.15252/emmm.202318190] [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: 08/17/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Idiopathic inflammatory myopathies (IIM), also referred to as "myositis," are a group of heterogeneous autoimmune disorders characterised by muscle weakness, atrophy and progressive reduced mobility (Lundberg et al, 2021). IIM represent a significant health burden in adult populations, affecting individuals at a mean age of 50 with an estimated prevalence of 2.9-34 per 100,000 (Dobloug et al, 2015; Svensson et al, 2017). IIM encompass several subtypes including dermatomyositis, immune-mediated necrotising myopathy, inclusion-body myositis, antisynthetase syndrome and polymyositis, which are characterised by specific clinical features, histopathological findings and autoantibody status (Pinal-Fernandez et al, 2020).
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Affiliation(s)
- Momina Yazdani
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Lukas Mach
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Michela Noseda
- National Heart and Lung InstituteImperial College LondonLondonUK
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Foulke GT, Washington A, Maczuga S, Butt M, Kannappan A, Helm MF. The association of respiratory disease and malignancy on survival rates for patients with dermatomyositis. Int J Dermatol 2023; 62:e511-e512. [PMID: 36912399 DOI: 10.1111/ijd.16633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 01/16/2023] [Accepted: 02/21/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Galen T Foulke
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Steven Maczuga
- Department of Dermatology, Penn State Health, Hershey, PA, USA
| | - Melissa Butt
- Department of Family and Community Medicine, Penn State Health, Hershey, PA, USA
| | - Arun Kannappan
- Department of Pulmonary Sciences and Critical Care, University of Colorado, Aurora, CO, USA
| | - Matthew F Helm
- Department of Dermatology, Penn State Health, Hershey, PA, USA
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Saghir K, Chraa M, Kissani N, Joulal H, Essaadouni L, Louhab N. Anti-MDA5 antibody-positive dermatomyositis with mild encephalopathy with reversible splenial lesion: a possible rare association? Wien Med Wochenschr 2023; 173:263-266. [PMID: 35729459 PMCID: PMC9211780 DOI: 10.1007/s10354-022-00943-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/25/2022] [Indexed: 12/01/2022]
Abstract
Central nervous system (CNS) involvement in dermatomyositis (DM) is seldom observed. However, there are very rare case reports of CNS involvement with juvenile dermatomyositis. Encephalopathy in DM may occur for a number of reasons, such as cerebral vasculitis and hypoperfusion/hypertensive encephalopathy, but mostly as a consequence of immunosuppressant treatment. We report here for the first time the case of a patient with two rare diseases, namely anti-MDA5 antibody-positive dermatomyositis and mild encephalopathy with reversible splenial lesion (MERS).
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Affiliation(s)
- Khadija Saghir
- Neuroscience Research Laboratory, Marrakech Medical School, Cadi Ayyad University, Marrakech, Morocco.
- Department of Neurology, University Teaching Hospital Mohammed VI, Marrakesh, Morocco.
- Faculty of Medicine, Cadi Ayyad. Department of Internal Medicine, University Teaching Hospital Mohammed VI, Marrakesh, Morocco.
| | - Mohammed Chraa
- Neuroscience Research Laboratory, Marrakech Medical School, Cadi Ayyad University, Marrakech, Morocco
- Department of Neurology, University Teaching Hospital Mohammed VI, Marrakesh, Morocco
- Faculty of Medicine, Cadi Ayyad. Department of Internal Medicine, University Teaching Hospital Mohammed VI, Marrakesh, Morocco
| | - Najib Kissani
- Neuroscience Research Laboratory, Marrakech Medical School, Cadi Ayyad University, Marrakech, Morocco
- Department of Neurology, University Teaching Hospital Mohammed VI, Marrakesh, Morocco
- Faculty of Medicine, Cadi Ayyad. Department of Internal Medicine, University Teaching Hospital Mohammed VI, Marrakesh, Morocco
| | - Hajar Joulal
- Neuroscience Research Laboratory, Marrakech Medical School, Cadi Ayyad University, Marrakech, Morocco
- Department of Neurology, University Teaching Hospital Mohammed VI, Marrakesh, Morocco
- Faculty of Medicine, Cadi Ayyad. Department of Internal Medicine, University Teaching Hospital Mohammed VI, Marrakesh, Morocco
| | - Lamiaa Essaadouni
- Neuroscience Research Laboratory, Marrakech Medical School, Cadi Ayyad University, Marrakech, Morocco
- Department of Neurology, University Teaching Hospital Mohammed VI, Marrakesh, Morocco
- Faculty of Medicine, Cadi Ayyad. Department of Internal Medicine, University Teaching Hospital Mohammed VI, Marrakesh, Morocco
| | - Nissrine Louhab
- Neuroscience Research Laboratory, Marrakech Medical School, Cadi Ayyad University, Marrakech, Morocco
- Department of Neurology, University Teaching Hospital Mohammed VI, Marrakesh, Morocco
- Faculty of Medicine, Cadi Ayyad. Department of Internal Medicine, University Teaching Hospital Mohammed VI, Marrakesh, Morocco
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Jiang R, Roy B, Wu Q, Mohanty S, Nowak RJ, Shaw AC, Kleinstein SH, O’Connor KC. The Plasma Cell Infiltrate Populating the Muscle Tissue of Patients with Inclusion Body Myositis Features Distinct B Cell Receptor Repertoire Properties. Immunohorizons 2023; 7:310-322. [PMID: 37171806 PMCID: PMC10579972 DOI: 10.4049/immunohorizons.2200078] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
Inclusion body myositis (IBM) is an autoimmune and degenerative disorder of skeletal muscle. The B cell infiltrates in IBM muscle tissue are predominantly fully differentiated Ab-secreting plasma cells, with scarce naive or memory B cells. The role of this infiltrate in the disease pathology is not well understood. To better define the humoral response in IBM, we used adaptive immune receptor repertoire sequencing, of human-derived specimens, to generate large BCR repertoire libraries from IBM muscle biopsies and compared them to those generated from dermatomyositis, polymyositis, and circulating CD27+ memory B cells, derived from healthy controls and Ab-secreting cells collected following vaccination. The repertoire properties of the IBM infiltrate included the following: clones that equaled or exceeded the highly clonal vaccine-associated Ab-secreting cell repertoire in size; reduced somatic mutation selection pressure in the CDRs and framework regions; and usage of class-switched IgG and IgA isotypes, with a minor population of IgM-expressing cells. The IBM IgM-expressing population revealed unique features, including an elevated somatic mutation frequency and distinct CDR3 physicochemical properties. These findings demonstrate that some of IBM muscle BCR repertoire characteristics are distinct from dermatomyositis and polymyositis and circulating Ag-experienced subsets, suggesting that it may form through selection by disease-specific Ags.
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Affiliation(s)
- Roy Jiang
- Department of Immunobiology, Yale School of Medicine, New Haven, CT
| | - Bhaskar Roy
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Qian Wu
- Department of Pathology, University of Connecticut School of Medicine, Farmington, CT
| | - Subhasis Mohanty
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | | | - Albert C. Shaw
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Steven H. Kleinstein
- Department of Immunobiology, Yale School of Medicine, New Haven, CT
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Kevin C. O’Connor
- Department of Immunobiology, Yale School of Medicine, New Haven, CT
- Department of Neurology, Yale School of Medicine, New Haven, CT
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Kokuzawa A, Nakamura J, Kamata Y, Sato K. Potential role of type I interferon/IP-10 axis in the pathogenesis of anti-MDA5 antibody-positive dermatomyositis. Clin Exp Rheumatol 2023; 41:275-284. [PMID: 36622131 DOI: 10.55563/clinexprheumatol/em67zx] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/16/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Dermatomyositis (DM) patients with anti-melanoma differentiation-associated protein 5 (MDA5) antibodies are known for poor prognosis. This study was designed to identify humoral factors that are readily detectable in the disease and may reflect its activity and pathophysiology. METHODS We first quantified the serum level expression of 28 cytokines in the serum of patients with collagen vascular diseases using bead-based multiplex immunoassays. We completed these evaluations at hospital admission and followed up with three DM patients with anti-MDA5 antibodies during hospitalisation. We also performed an immunohistochemical analysis of skin samples obtained from two patients. RESULTS The serum level of interferon gamma-induced protein 10 (IP-10) was significantly higher in DM patients with anti-MDA5 antibodies than in those without the antibody, decreasing drastically upon treatment. Interestingly, this time course paralleled not that of interferon (IFN)-γ, which was originally reported to be the inducer of IP-10, but that of IFN-α2. Immunohistochemical analysis revealed that most of the IP-10-positive cells were macrophages. Furthermore, monocytes stimulated with type I IFN in vitro produced IP-10 in a dose-dependent manner. CONCLUSIONS IP-10 is a potentially useful disease activity marker of DM with anti-MDA5 antibodies, correlating more with IFN-α2 then IFN-γ. IP-10 released from macrophages might prompt the infiltration of macrophages themselves. Thus, the type I IFN/IP-10 axis may play a pivotal role in the pathogenesis of this intractable disease.
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Affiliation(s)
- Ayako Kokuzawa
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Jun Nakamura
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yasuyuki Kamata
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kojiro Sato
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
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14
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Zhang L, Xia Q, Li W, Liu Q, Zhang L, Tian X, Ye L, Wang G, Peng Q. Immunoproteasome subunit β5i promotes perifascicular muscle atrophy in dermatomyositis by upregulating RIG-I. RMD Open 2023; 9:rmdopen-2022-002818. [PMID: 36854567 PMCID: PMC9980316 DOI: 10.1136/rmdopen-2022-002818] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/04/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Perifascicular atrophy is a unique pathological hallmark in dermatomyositis (DM)-affected muscles; however, the mechanism underlying this process remains unclear. In this study, we aimed to investigate the potential role of the immunoproteasome subunit β5i and retinoic acid-inducible gene-I (RIG-I) in DM-associated muscle atrophy. METHODS The expression of β5i and RIG-I in the muscles of 16 patients with DM was examined by PCR, western blotting and immunohistochemistry. The associations between β5i and RIG-I expression levels and muscle disease severity were evaluated. Lentivirus transduction was used to overexpress β5i in human skeletal muscle myoblasts (HSMMs) and consequent cell functional changes were studied in vitro. RESULTS β5i and RIG-I expression in the muscle of patients with DM was significantly increased and closely associated with muscle disease severity. Immunohistochemistry and immunofluorescence analyses showed the marked colocalised expression of β5i and RIG-I in perifascicular myofibres. β5i overexpression in HSMMs significantly upregulated RIG-I, the muscle atrophy marker MuRF1, type I IFN-related proteins (MxA and IFNβ) and NF-κB pathway-related proteins (pIκBα, pIRF3 and pNF-κBp65). In addition, the viability of HSMMs decreased significantly after β5i overexpression and was partly recovered by treatment with a β5i inhibitor (PR957). Moreover, activation of RIG-I by pppRNA upregulated IFNβ and MuRF1 and reduced the cell viability of HSMMs. CONCLUSION The immunoproteasome subunit β5i promotes perifascicular muscle atrophy in DM via RIG-I upregulation; our findings suggest a pathomechanistic role of β5i and RIG-I in DM-associated muscle damage, highlighting these components as potential therapeutic targets for the treatment of DM.
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Affiliation(s)
- Lu Zhang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Qisheng Xia
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Wenli Li
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Qingyan Liu
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Lining Zhang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Xiaolan Tian
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Lifang Ye
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Guochun Wang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Qinglin Peng
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
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15
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Weng C, Liu Z. Pathogenesis of anti-melanoma differentiation-associated gene-5 (MDA5) dermatomyositis. Chin Med J (Engl) 2022; 135:2188-2190. [PMID: 35245925 PMCID: PMC9771161 DOI: 10.1097/cm9.0000000000002049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 01/26/2023] Open
Affiliation(s)
- Chenghua Weng
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Zhichun Liu
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
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16
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Linhares Leite L, Marchiori Bakos R. The prognosis of cutaneous malignant melanoma associated with paraneoplastic dermatomyositis. Int J Dermatol 2022; 61:1148-1151. [PMID: 35224727 DOI: 10.1111/ijd.16151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 01/23/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
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17
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Wong LS, Lee CH, Yen YT. Increased Epidermal Nerve Growth Factor without Small-Fiber Neuropathy in Dermatomyositis. Int J Mol Sci 2022; 23:ijms23169030. [PMID: 36012289 PMCID: PMC9408946 DOI: 10.3390/ijms23169030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Small-fiber neuropathy (SFN) is suggested to be involved in the pathogenesis of some types of autoimmune connective tissue diseases. SFN with a reduction in epidermal nerve fibers might affect sensory fibers and cause neuropathic symptoms, such as pruritus and pain, which are common in both dermatomyositis (DM) and cutaneous lupus erythematosus (CLE). Nerve growth factor (NGF) has been recognized as important in nociception by regulating epidermal nerve fiber density and sensitizing the peripheral nervous system. The present study aimed to investigate whether SFN was associated with the cutaneous manifestations of DM and CLE. We also investigated the relationship between SFN and axon guidance molecules, such as NGF, amphiregulin (AREG), and semaphorin (Sema3A) in DM and CLE. To explore the molecular signaling, interleukin (IL)-18 and IL-31, which have been implicated in the cutaneous manifestation and neuropathic symptoms in DM, were examined in keratinocytes. Our results revealed that intraepidermal nerve fiber density (IENFD) was unchanged in patients with DM, but significantly reduced in IENFD in patients with CLE compared with healthy control. Increased epidermal expression of NGF and decreased expression of Sema3A were demonstrated in patients with DM. Furthermore, IL-18 and IL-31 both induced the production of NGF from keratinocytes. Taken together, IL-18 and IL-31 mediated epidermal NGF expression might contribute to the cutaneous neuropathic symptoms in DM, while SFN might be important for CLE.
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Affiliation(s)
- Lai-San Wong
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yu-Ta Yen
- Department of Dermatology, Fooyin University Hospital, Pingtung 928, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Correspondence: ; Tel.: +886-8-8323146; Fax: +886-7-7337612
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18
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Sugie K. [Treatment of Dermatomyositis and Immune-Mediated Necrotizing Myopathy with Poor Muscle Recovery with Steroids and IVIg: Intractable Dermatomyositis and Immune-Mediated Necrotizing Myopathy]. Brain Nerve 2022; 74:537-544. [PMID: 35589644 DOI: 10.11477/mf.1416202077] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Among idiopathic inflammatory myopathies, dermatomyositis and immune-mediated necrotizing myopathy are distinguished by their different clinicopathological features. Corticosteroids are administered as the first-line treatment for both, and immunosuppressive agents and intravenous immunoglobulin important second-line treatments. Since some patients show resistance to these therapies, it is necessary to considering additional treatment based on muscle pathology, muscle imaging, and systemic complications such as malignancy and interstitial lung disease, in addition to the careful evaluation of muscle strength. However, more effective therapeutic strategies are not yet well-established for refractory cases because the available therapeutic agents are limited. Therefore, the development of novel therapies is required in the future.
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Affiliation(s)
- Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine
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19
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Silva AMS, Campos ED, Zanoteli E. Inflammatory myopathies: an update for neurologists. Arq Neuropsiquiatr 2022; 80:238-248. [PMID: 35976321 PMCID: PMC9491410 DOI: 10.1590/0004-282x-anp-2022-s131] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Idiopathic inflammatory myopathies (IIM) are a heterogenous group of treatable myopathies. Patients present mainly to the rheumatologist and neurologists, complaining of acute or subacute onset of proximal weakness. Extramuscular manifestations may occur, including involvement of the lungs, skin, and joints. Classically, the diagnosis used to be made based on the creatine kinase level increase, abnormalities in electroneuromyography and presence of inflammatory infiltrates in the muscle biopsy. Recently, the importance of autoantibodies has increased, and now they may be identified in more than half of IIM patients. The continuous clinicoseropathological improvement in IIM knowledge has changed the way we see these patients and how we classify them. In the past, only polymyositis, dermatomyositis and inclusion body myopathy were described. Currently, immune-mediated necrotizing myopathy, overlap myositis and antisynthetase syndrome have been considered the most common forms of IIM in clinical practice, increasing the spectrum of classification. Patients previously considered to have polymyositis, in fact have these other forms of seropositive IIM. In this article, we reviewed the new concepts of classification, a practical way to make the diagnosis and how to plan the treatment of patients suffering from IIM.
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Affiliation(s)
| | - Eliene Dutra Campos
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Edmar Zanoteli
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
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20
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Abstract
The pandemic of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has caused a large number of deaths, and there is still no effective treatment. COVID-19 can induce a systemic inflammatory response, and its clinical manifestations are diverse. Recently, it has been reported that COVID-19 patients may develop myositis and interstitial pulmonary disease similar to dermatomyositis (DM). This condition is similar to the rapidly progressive interstitial lung disease associated with MDA5+ DM that has a poor prognosis and high mortality, and this poses a challenge for an early identification. Suppression of the immune system can protect COVID-19 patients by preventing the production of inflammatory cytokines. This article attempts to explore the possibility of a relationship between COVID-19 and DM in terms of the potential pathogenesis and clinical features and to analyze the therapeutic effect of the immunosuppressive drugs that are commonly used for the treatment of both DM and COVID-19.
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Affiliation(s)
- Jie Qian
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China
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21
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Loarce-Martos J, Lilleker JB, Parker M, McHugh N, Chinoy H. Polymyositis: is there anything left? A retrospective diagnostic review from a tertiary myositis centre. Rheumatology (Oxford) 2021; 60:3398-3403. [PMID: 33367878 DOI: 10.1093/rheumatology/keaa801] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 08/16/2020] [Revised: 11/03/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The current classification criteria for idiopathic inflammatory myopathy (IIM) retain PM as a major disease subgroup. However, evolution in the understanding of IIM has suggested that many of these patients could be better described as having an alternative diagnosis. In the present study, we apply the latest understanding of IIM subtyping to retrospectively review PM diagnoses in a large cohort of IIM patients. METHODS Within a previously reported cohort of 255 patients from a UK tertiary myositis clinic, 37 patients classified as PM according to both the EULAR/ACR IIM criteria and expert opinion were identified. Clinical data and complementary tests were reviewed, and consensus decisions regarding final classification were reached in each case. RESULTS Nine (9/37, 24.3%) patients remained classified as PM, 3.5% (9/255) of the original cohort; these PM patients were seronegative for myositis antibodies, responsive to immunosuppression, and in 4/7 (57.1%) patients where muscle biopsy was performed had HLA-1 upregulation and endomysial inflammatory infiltrates. Immune-mediated necrotizing myopathy (5/37, 13.5%) and connective tissue disease overlap myositis (7/37, 19%) were the main alternative diagnoses. The remaining patients were diagnosed as: unspecified myopathy (6/37, 16%), dermatomyositis (2/37, 5%), cancer-associated myopathy (3/37, 8.1%), and non-inflammatory myopathy (1/37, 3%, myofibrillar myopathy). Four patients (4/37, 10%) had insufficient data available to confidently reclassify. CONCLUSION Our study confirms that PM can now be considered a rare IIM subgroup. A thorough examination, complete myositis autoantibody panel, and careful interpretation of the biopsy results is recommended to confirm the correct IIM sub-type.
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Affiliation(s)
- Jesus Loarce-Martos
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - James B Lilleker
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neuroscience, Salford Royal NHS Foundation Trust, Salford, UK
| | - Matthew Parker
- Department of Rheumatology, RPA Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Neil McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
- Royal National Hospital for Rheumatic Disease, Bath, UK
| | - Hector Chinoy
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
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22
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Kus KJB, LaChance AH, Vleugels RA. Recognition and Management of Cutaneous Connective Tissue Diseases. Med Clin North Am 2021; 105:757-782. [PMID: 34059249 DOI: 10.1016/j.mcna.2021.04.011] [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] [Indexed: 10/21/2022]
Abstract
Connective tissue diseases (CTDs) encompass a broad spectrum of clinical presentations that involve multidisciplinary management. Cutaneous findings are common in CTD and careful examination of these features aids in appropriate diagnosis and subsequent evaluation. Thorough work-up of CTD is crucial to properly identify disease subtypes and systemic involvement. Management plans can be developed based on diagnosis and systemic manifestations of disease. Disease management often requires treatment with pharmacotherapies with potential for toxicities, further underscoring the importance of diagnostic accuracy in this patient population. Evolving research strives to better elucidate the pathogenic mechanisms of CTDs allowing for more targeted treatment modalities.
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MESH Headings
- Adult
- Comorbidity
- Connective Tissue Diseases/complications
- Connective Tissue Diseases/diagnosis
- Connective Tissue Diseases/drug therapy
- Connective Tissue Diseases/pathology
- Dermatomyositis/diagnosis
- Dermatomyositis/etiology
- Dermatomyositis/pathology
- Diagnosis, Differential
- Drug Therapy/methods
- Drug Therapy/statistics & numerical data
- Drug-Related Side Effects and Adverse Reactions
- Early Diagnosis
- Female
- Humans
- Interdisciplinary Communication
- Lupus Erythematosus, Cutaneous/diagnosis
- Lupus Erythematosus, Cutaneous/etiology
- Lupus Erythematosus, Cutaneous/pathology
- Lupus Erythematosus, Discoid/diagnosis
- Lupus Erythematosus, Discoid/etiology
- Lupus Erythematosus, Discoid/pathology
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/etiology
- Lupus Erythematosus, Systemic/pathology
- Male
- Patient Care Management/methods
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/etiology
- Scleroderma, Systemic/pathology
- Vasculitis/diagnosis
- Vasculitis/etiology
- Vasculitis/pathology
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Affiliation(s)
- Kylee J B Kus
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309-4482, USA
| | - Avery H LaChance
- Connective Tissue Disease Clinic, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, 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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23
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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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Carrington AE, Tartar DM, Sivamani RK. Anti-MDA-5 negative, anti-Ku positive clinically amyopathic dermatomyositis. Dermatol Online J 2021; 27:13030/qt1qg7x8gf. [PMID: 33999578] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023] Open
Abstract
We present a patient with anti-MDA5 negative, anti-Ku positive clinically amyopathic dermatomyositis (CADM). A 61-year-old woman presented with a chief complaint of a 20-year history of a pruritic rash that was active on her face, chest, hands, legs, and back. A mildly scaly, erythematous, photo-distributed eruption along with slightly violaceous, scaly papules accentuated on the wrist, metacarpophalangeal joints, proximal interphalangeal and distal interphalangeal joints. Antibody profile was significant for positive ANA and anti-dsDNA, elevated anti-TIF-1gamma (RDL)/p155, and weakly positive anti Ku. Biopsy was consistent with dermatomyositis. Melanoma differentiation-associated gene 5 antibody (anti-MDA-5) has been identified as the most commonly associated autoantibody found in CADM and is associated with poor prognosis and a biomarker for the diagnosis of rapidly progressive interstitial lung disease. To our knowledge, our patient is the first case of negative anti-MDA-5 and anti-Ku positive CADM.
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Affiliation(s)
| | | | - Raja K Sivamani
- Department of Dermatology, University of California Davis, Sacramento, CA Zen Dermatology, Sacramento, CA.
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25
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De Lorenzis E, Natalello G, Gigante L, Verardi L, Bosello SL, Gremese E. What can we learn from rapidly progressive interstitial lung disease related to anti-MDA5 dermatomyositis in the management of COVID-19? Autoimmun Rev 2020; 19:102666. [PMID: 32942036 PMCID: PMC7489246 DOI: 10.1016/j.autrev.2020.102666] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Enrico De Lorenzis
- Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy; Biomolecular Medicine Ph.D. Programme - cycle XXXV, University of Verona, Italy
| | - Gerlando Natalello
- Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Laura Gigante
- Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Lucrezia Verardi
- Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Laura Bosello
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisa Gremese
- Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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26
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Messer A, Drozd B, Glitza IC, Lu H, Patel AB. Dermatomyositis associated with nivolumab therapy for melanoma: a case report and review of the literature. Dermatol Online J 2020; 26:13030/qt4c21b068. [PMID: 32941716] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023] Open
Abstract
We present a rare case of dermatomyositis associated with nivolumab therapy for melanoma. Nivolumab is an immune checkpoint inhibitor that blocks the programmed death-1 (PD1) receptor and has a number of associated immunotherapy related adverse events. Although most are T-cell mediated, some are antibody mediated mimics of classical autoimmune diseases. We review the characteristics of other cases of anti-PD1 associated dermatomyositis and the recent literature to better understand how to classify and treat this challenging immunotherapy related adverse event.
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Affiliation(s)
- Alison Messer
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX Department of Dermatology, McGovern Medical School, Houston, TX.
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27
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Campanilho-Marques R, Deakin CT, Simou S, Papadopoulou C, Wedderburn LR, Pilkington CA. Retrospective analysis of infliximab and adalimumab treatment in a large cohort of juvenile dermatomyositis patients. Arthritis Res Ther 2020; 22:79. [PMID: 32293539 PMCID: PMC7161150 DOI: 10.1186/s13075-020-02164-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 08/16/2019] [Accepted: 03/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anti-TNF treatment may be useful for the treatment of patients with refractory juvenile dermatomyositis (JDM). The aim of this study was to describe the use of infliximab and adalimumab therapy in juvenile dermatomyositis as an adjunctive treatment. METHODS Sixty children recruited to the UK JDM Cohort and Biomarker Study that had received at least 3 months of anti-TNF treatment (infliximab or adalimumab) were studied. Childhood Myositis Assessment Scale (CMAS), Manual Muscle Testing (MMT8) and physician's global assessment (PGA) were recorded. Skin disease was assessed using the modified skin disease activity score (DAS). Data were analysed using Friedman's test for repeated measures analysis of variance. RESULTS Compared to baseline, there were improvements at 6 and 12 months in skin disease (χ2(2) = 15.52, p = 0.00043), global disease (χ2(2) = 8.14, p = 0.017) and muscle disease (CMAS χ2(2) = 17.02, p = 0.0002 and MMT χ2(2) = 10.56, p = 0.005) in infliximab patients. For patients who switched from infliximab to adalimumab, there was improvement in global disease activity (χ2(2) = 6.73, p = 0.03), and trends towards improvement in CMAS, MMT8 and modified DAS. The median initial prednisolone dose was 6 [0-10] mg, and final was 2.5 [0-7.5] mg (p < 0.0001). Fifty-four per cent of patients had a reduction in the number and/or size of calcinosis lesions. Twenty-five per cent switched their anti-TNF treatment from infliximab to adalimumab. 66.7%of the switches were to improve disease control, 26.7% due to adverse events and 6.6% due to patient preference. A total of 13.9 adverse reactions occurred in 100 patient-years, of which 5.7 were considered serious. CONCLUSION Reductions in muscle and skin disease, including calcinosis, were seen following treatment with infliximab and adalimumab.
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Affiliation(s)
- Raquel Campanilho-Marques
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN-Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa-Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Claire T Deakin
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London, UK
| | - Stefania Simou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
| | - Charalampia Papadopoulou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Lucy R Wedderburn
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London, UK
| | - Clarissa A Pilkington
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK.
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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Ohira J, Kawamoto M, Sugino Y, Kohara N. A case report of fulminant cytokine release syndrome complicated by dermatomyositis after the combination therapy with immune checkpoint inhibitors. Medicine (Baltimore) 2020; 99:e19741. [PMID: 32282733 PMCID: PMC7220092 DOI: 10.1097/md.0000000000019741] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Immune-related adverse events (ir-AEs) are increasingly becoming a concern, as immune checkpoint inhibitors (ICIs) are used more frequently. Herein, we present a case of fulminant cytokine release syndrome (CRS) complicated by dermatomyositis after the combination therapy with ICIs. PATIENT CONCERNS A 70-year-old male developed dermatomyositis during the course of treatment with two ICIs, nivolumab and ipilimumab. He was treated by steroid pulse therapy, but the effect was limited. Afterwards, he had acute-onset high fever, hypotension, respiratory failure, impaired consciousness, renal failure, and coagulation abnormality at the same time. C reactive protein (CRP), creatinine kinase (CK), D-dimer, and ferritin levels were considerably elevated: CRP, 24 mg/dL; CK, 40,500 U/L; D-dimer, 290 μg/mL; ferritin, 329,000 ng/mL. DIAGNOSIS CRS induced by ICI combination therapy. INTERVENTIONS Given that high fever and elevated CRP level indicated potential sepsis, an antibiotic was used until the confirmation of negative blood cultures. All the simultaneous acute symptoms were supposed to be CRS. He was admitted to the intensive care unit (ICU), and temporary intubation and hemodialysis were needed. Immunosuppressive therapy was reinforced by mycophenolate mofetil together with steroid, and plasma exchange was performed for the elimination of abnormal proteins. OUTCOMES The patient's clinical symptoms and laboratory parameters gradually improved and he was discharged from the ICU in a month. CONCLUSION Fulminant CRS can be induced by ICI combination therapy. As the initial symptoms of CRS resemble sepsis, it is important to consider CRS as a differential diagnosis and to initiate immunosuppressive therapy early when needed. In steroid-resistant cases, early introduction of other immunosuppressive therapy and plasma exchange can be effective.
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Affiliation(s)
- Junichiro Ohira
- Department of Neurology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo
- Department of Neurology, Kyoto University Hospital, 606-8507, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto
| | - Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo
| | - Yoshio Sugino
- Department of Urology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo
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Didona D, Fania L, Didona B, Eming R, Hertl M, Di Zenzo G. Paraneoplastic Dermatoses: A Brief General Review and an Extensive Analysis of Paraneoplastic Pemphigus and Paraneoplastic Dermatomyositis. Int J Mol Sci 2020; 21:ijms21062178. [PMID: 32245283 PMCID: PMC7139382 DOI: 10.3390/ijms21062178] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 02/06/2023] Open
Abstract
Skin manifestations of systemic disease and malignancy are extremely polymorphous. Clinicians should be familiarized with paraneoplastic dermatoses in order to perform an early diagnosis of the underlying neoplasm. Lack of familiarity with cutaneous clues of internal malignancy may delay diagnosis and treatment of cancer. In this review, we described several paraneoplastic dermatoses and discussed extensively two paradigmatic ones, namely paraneoplastic pemphigus and paraneoplastic dermatomyositis.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University, 35043 Marburg, Germany; (R.E.); (M.H.)
- Correspondence: ; Tel.: +49-(6421)-58-64882; Fax: +49-(6421)-58-62902
| | - Luca Fania
- First Dermatology Division, IDI-IRCCS, 00167 Rome, Italy;
| | | | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps University, 35043 Marburg, Germany; (R.E.); (M.H.)
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University, 35043 Marburg, Germany; (R.E.); (M.H.)
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, IDI-IRCCS, 00167 Rome, Italy;
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Cartron AM, Osler M, Chung C, Trinidad JC. Nuclear matrix protein 2 antibody-positive adult dermatomyositis: a case report and review of the literature. Dermatol Online J 2020; 26:13030/qt9n50x88m. [PMID: 32609448] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023] Open
Abstract
Dermatomyositis is a clinically heterogenous inflammatory myopathy with unique cutaneous features. Myositis-specific antibodies can aid in diagnosis and anticipation of patient prognosis. Herein, we report a 22-year-old man who presented with multifocal erythematous plaques with violaceous papules on his bilateral elbows, neck, and face. He was diagnosed with biopsy-proven dermatomyositis and determined to be seropositive for nuclear matrix protein 2 antibody (NXP-2). He was treated with systemic corticosteroids, then intravenous methylprednisolone and azathioprine, and ultimately achieved greatest treatment response with intravenous immune globulin therapy.
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Affiliation(s)
- Alexander M Cartron
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD.
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Nguyen M, Hai J, Bovenberg MSS, Wilken R, Kiuru M, Brassard A, Tartar D. A patient with anti-NXP2-positive dermatomyositis and syphilis. Dermatol Online J 2020; 26:13030/qt0783v3nx. [PMID: 32239891] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023] Open
Abstract
Dermatomyositis is an auto-immune inflammatory myopathy that primarily affects the skin and muscle and can be triggered by exposure to various environmental factors. We present a patient with active syphilis infection who developed dermatomyositis and discuss the significance of anti-NXP2 autoantibody positivity.
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Affiliation(s)
| | | | | | | | | | | | - Danielle Tartar
- Department of Dermatology, University of California Davis, Sacramento, CA.
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Affiliation(s)
- Yu Bai
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
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Chai KX, Chen YQ, Kong LS, Fan PL, Yuan X, Yang J. A Study Based on the Correlation Between Slit2/Robo1 Signaling Pathway Proteins and Polymyositis/Dermatomyositis. Curr Mol Med 2020; 20:717-722. [PMID: 32213157 DOI: 10.2174/1566524020666200326102837] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 02/08/2023]
Abstract
AIMS To investigate the role of Slit2 and Robo1 during the vascular disease of Polymyositis (PM) / dermatomyositis (DM). BACKGROUND PM and DM are nonsuppurative inflammatory myopathies that mainly invade the skeletal muscles. OBJECTIVE This study attempted to explore the specific mechanism of Slit2/Robo1 signaling pathway proteins during the vascular disease of PM/DM. METHODS The mRNA expressions of Slit2 and Robo1 in the muscle tissue were detected by RT-qPCR between newly-diagnosed PM/DM patients and healthy controls. The number of Slit2 and Robo1 positive cells in the serial sections of muscle paraffin tissues was measured by immunohistochemistry in 10 patients with PM, 10 patients with DM and 20 healthy controls. RESULTS The study results revealed that the mRNA expressions of Slit2 and Robo1 in muscle tissue in the PM and DM groups were higher than that in the control group (P<0.05). The positive expression rates of Slit2 and Robo1 in muscle tissue in the PM and DM groups were 80.0%, 80.0%, 70.0% and 70.0%, respectively. The difference was statistically significant (P<0.001), when compared to the control group (the positive expression rates were 0% and 10%, respectively). CONCLUSION The activation of the Slit2/Robo1 signaling pathway is an important mechanism leading to the development of PM/DM.
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Affiliation(s)
- Ke-Xia Chai
- Department of Rheumatism and Immunology, Affiliated Hospital of Qinghai University, Xining 810001, China
| | - Yu-Qi Chen
- Department of Rheumatism and Immunology, The People's Hospital of SND, Suzhou 215219, China
| | - Ling-Shuang Kong
- Department of Rheumatism and Immunology, The Second Hospital of Hebei University, Shijiazhuang 050000, China
| | - Pei-Lin Fan
- Department of Medical Imaging Technology, West China School of Medicine and West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xia Yuan
- Department of Rheumatism and Immunology, Affiliated Hospital of Qinghai University, Xining 810001, China
| | - Jie Yang
- Department of Rheumatism and Immunology, Affiliated Hospital of Qinghai University, Xining 810001, China
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Abstract
PURPOSE OF REVIEW Juvenile dermatomyositis is a heterogeneous disease with variable clinical outcomes. Here, we describe the recognised subtypes of idiopathic inflammatory myositis which occur in children, with particular reference to disease-associated autoantibodies. RECENT FINDINGS Large cohort studies have demonstrated that myositis autoantibodies are common in juvenile dermatomyositis and can be found in the majority of patients. They identify homogenous clinical subgroups and inform prognosis, particularly the risks of developing interstitial lung disease. Descriptions of immune-mediated necrotising myositis in juvenile patients have highlighted a rare but important clinical subset typically associated with severe muscle disease and treatment resistance. It is increasingly apparent that autoantibodies can provide detailed information on prognosis and the likely disease associations in those with juvenile dermatomyositis. Further work is needed to establish how this knowledge should influence our approach to treatment.
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Affiliation(s)
- Danyang Li
- University of Bath, Claverton Down, Bath, BA2 7AY, UK
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35
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Cuadros-Torres M, Ganoza-Calero AM, Plácido Z, Prado B J. [Dermatomyositis associated with hepatitis B virus-related hepatocellular carcinoma: a case report in Peru]. Rev Gastroenterol Peru 2019; 39:374-377. [PMID: 32097401] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Dermatomyositis is an idiopathic inflammatory myopathie characterized by proximal skeletal muscle weakness, typical skin manifestations and muscle inflammation. This disease has been associated with malignancies as a paraneoplastic syndrome. We present a patient of thirty-three years diagnosed with hepatitis B, chronic inactive HBV who presents papular, pruritic and desquamative lesions on the face, hands, inguinal area and feet. At the physical examination is evidentiated Gottron's papules, heliotrope sign and proximal symmetric muscular weakness. Findings compatible with DM were found in a skin biopsy. An abdominal ultrasound revealed a liver tumor whereby a biopsy was performed and the result was a moderately differentiated hepatocellular carcinoma. Subsequently, a segmentectomy has been made and consequently the DM symptoms decreased. This case is of great interest and rare reason why we decided to reported it.
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Affiliation(s)
- Milagros Cuadros-Torres
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas. Lima, Perú; Sociedad Científica de Estudiantes de Medicina, Universidad Peruana de Ciencias Aplicadas (SOCIEMUPC). Lima, Perú
| | - Antonelhla M Ganoza-Calero
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas. Lima, Perú; Sociedad Científica de Estudiantes de Medicina, Universidad Peruana de Ciencias Aplicadas (SOCIEMUPC). Lima, Perú
| | - Zuly Plácido
- Departamento de Gastroenterología, Hospital Nacional Edgardo Rebagliati Martins. Lima, Perú
| | - José Prado B
- Departamento de Gastroenterología, Hospital Nacional Edgardo Rebagliati Martins. Lima, Perú
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Ramtohul P, Denis D. Paraneoplastic Dermatomyositis Presenting as Atopic Blepharitis. Ophthalmology 2019; 126:1423. [PMID: 31543112 DOI: 10.1016/j.ophtha.2019.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Prithvi Ramtohul
- Centre Hospitalier Universitaire de l'Hôpital Nord, Chemin des Bourrely, Marseille, France
| | - Danièle Denis
- Centre Hospitalier Universitaire de l'Hôpital Nord, Chemin des Bourrely, Marseille, France
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37
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Ahmed S, Okon L, Keller M. Anti-MDA-5 Dermatomyositis Presenting with Rapidly Progressive Interstitial Lung Disease: A Cautionary Tale. Skinmed 2019; 17:211-214. [PMID: 31496481] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 68-year-old Indian man presented with a pruritic eruption on his neck, back, elbows, knees, and the dorsum of his hands. He was initially treated for possible Lyme's disease by his primary care physician, but without improvement. Then he developed daily chills and fevers up to 101 °F, as well as shortness of breath. A chest radiograph showed patchy airspace opacities suggestive of atypical pneumonia, and the patient was treated with levofloxacin and prednisone. Although prednisone diminished the eruption, the patient continued to experience fever, malaise, and generalized weakness, at which point he was hospitalized. Blood cultures and an antinuclear antibodies (ANA) were negative and extensive lab workup was only notable for an elevated erythrocyte sedimentation rate (ESR) (63 mm/hr, Reference Range 0-22), mild transaminitis (AST 77 U/L, Reference Range 10-40), hyponatremia (131 mEq/L, Reference Range 135-145) and elevated ferritin (440, Reference Range 20-500). The patient was discharged on 20 mg of prednisone, with referral to rheumatology and dermatology for possible autoimmune diseases.
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Affiliation(s)
- Sarah Ahmed
- From the Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Lauren Okon
- From the Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Matthew Keller
- From the Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA;
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Uruha A, Allenbach Y, Charuel JL, Musset L, Aussy A, Boyer O, Mariampillai K, Landon-Cardinal O, Rasmussen C, Bolko L, Maisonobe T, Leonard-Louis S, Suzuki S, Nishino I, Stenzel W, Benveniste O. Diagnostic potential of sarcoplasmic myxovirus resistance protein A expression in subsets of dermatomyositis. Neuropathol Appl Neurobiol 2019; 45:513-522. [PMID: 30267437 DOI: 10.1111/nan.12519] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [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: 03/14/2018] [Accepted: 09/17/2018] [Indexed: 12/31/2022]
Abstract
AIMS To elucidate the diagnostic value of sarcoplasmic expression of myxovirus resistance protein A (MxA) for dermatomyositis (DM) specifically analysing different DM subforms, and to test the superiority of MxA to other markers. METHODS Immunohistochemistry for MxA and retinoic acid-inducible gene I (RIG-I) was performed on skeletal muscle samples and compared with the item presence of perifascicular atrophy (PFA) in 57 DM patients with anti-Mi-2 (n = 6), -transcription intermediary factor 1 gamma (n = 10), -nuclear matrix protein 2 (n = 13), -melanoma differentiation-associated gene 5 (MDA5) (n = 10) or -small ubiquitin-like modifier activating enzyme (n = 1) autoantibodies and with no detectable autoantibody (n = 17). Among the patients, nine suffered from cancer and 22 were juvenile-onset type. Disease controls included antisynthetase syndrome (ASS)-associated myositis (n = 30), immune-mediated necrotizing myopathy (n = 9) and inclusion body myositis (n = 5). RESULTS Sarcoplasmic MxA expression featured 77% sensitivity and 100% specificity for overall DM patients, while RIG-I staining and PFA reached respectively 14% and 59% sensitivity and 100% and 86% specificity. In any subset of DM, sarcoplasmic MxA expression showed higher sensitivity than RIG-I and PFA. Some anti-MDA5 antibody-positive DM samples distinctively showed a scattered staining pattern of MxA. No ASS samples had sarcoplasmic MxA expression even though six patients had DM skin rash. CONCLUSIONS Sarcoplasmic MxA expression is more sensitive than PFA and RIG-I expression for a pathological diagnosis of DM, regardless of the autoantibody-related subgroup. In light of its high sensitivity and specificity, it may be considered a pathological hallmark of DM per se. Also, lack of MxA expression in ASS supports the idea that ASS is a distinct entity from DM.
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Affiliation(s)
- A Uruha
- Mixed Research Unit (UMR) 974, Center of Research in Myology, Institute of Myology, Pitié-Salpêtrière University Hospital, National Institute of Health and Medical Research (INSERM), Paris-Sorbonne University, Paris, France
| | - Y Allenbach
- UMR974, Department of Internal Medicine and Clinical Immunology, Public Assistance-Hospitals of Paris (APHP), Pitié-Salpêtrière University Hospital, National Institute of Health and Medical Research (INSERM), Paris-Sorbonne University, Paris, France
- Inflammation-Immunopathology-Biotherapy Department (DHU I2B), and Reference Center for Neuromuscular Pathologies, Institute of Myology, Paris, France
| | - J-L Charuel
- Immunochemistry & Autoimmunity Laboratory, Department of Immunology, APHP, Pitié-Salpêtrière University Hospital, Paris, France
| | - L Musset
- Immunochemistry & Autoimmunity Laboratory, Department of Immunology, APHP, Pitié-Salpêtrière University Hospital, Paris, France
| | - A Aussy
- Department of Immunology, Rouen University Hospital, INSERM, Rouen Normandie University, Rouen, France
| | - O Boyer
- Department of Immunology, Rouen University Hospital, INSERM, Rouen Normandie University, Rouen, France
| | - K Mariampillai
- UMR974, Department of Internal Medicine and Clinical Immunology, Public Assistance-Hospitals of Paris (APHP), Pitié-Salpêtrière University Hospital, National Institute of Health and Medical Research (INSERM), Paris-Sorbonne University, Paris, France
- Inflammation-Immunopathology-Biotherapy Department (DHU I2B), and Reference Center for Neuromuscular Pathologies, Institute of Myology, Paris, France
| | - O Landon-Cardinal
- UMR974, Department of Internal Medicine and Clinical Immunology, Public Assistance-Hospitals of Paris (APHP), Pitié-Salpêtrière University Hospital, National Institute of Health and Medical Research (INSERM), Paris-Sorbonne University, Paris, France
- Inflammation-Immunopathology-Biotherapy Department (DHU I2B), and Reference Center for Neuromuscular Pathologies, Institute of Myology, Paris, France
| | - C Rasmussen
- UMR974, Department of Internal Medicine and Clinical Immunology, Public Assistance-Hospitals of Paris (APHP), Pitié-Salpêtrière University Hospital, National Institute of Health and Medical Research (INSERM), Paris-Sorbonne University, Paris, France
- Inflammation-Immunopathology-Biotherapy Department (DHU I2B), and Reference Center for Neuromuscular Pathologies, Institute of Myology, Paris, France
| | - L Bolko
- UMR974, Department of Internal Medicine and Clinical Immunology, Public Assistance-Hospitals of Paris (APHP), Pitié-Salpêtrière University Hospital, National Institute of Health and Medical Research (INSERM), Paris-Sorbonne University, Paris, France
- Inflammation-Immunopathology-Biotherapy Department (DHU I2B), and Reference Center for Neuromuscular Pathologies, Institute of Myology, Paris, France
| | - T Maisonobe
- Reference Center for Neuromuscular Pathologies, Institute of Myology, APHP, Pitié-Salpêtrière University Hospital, Paris, France
| | - S Leonard-Louis
- Reference Center for Neuromuscular Pathologies, Institute of Myology, APHP, Pitié-Salpêtrière University Hospital, Paris, France
| | - S Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - I 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
| | - W Stenzel
- Department of Neuropathology, Charité-Universitätsmedizin, Berlin, Germany
| | - O Benveniste
- UMR974, Department of Internal Medicine and Clinical Immunology, Public Assistance-Hospitals of Paris (APHP), Pitié-Salpêtrière University Hospital, National Institute of Health and Medical Research (INSERM), Paris-Sorbonne University, Paris, France
- Inflammation-Immunopathology-Biotherapy Department (DHU I2B), and Reference Center for Neuromuscular Pathologies, Institute of Myology, Paris, France
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Milisenda JC, Collado MV, Pinal-Fernandez I, Hormaza Jaramillo A, Faruch Bilfeld M, Cano MD, García AI, Tomás X, Grau JM. Correlation between quantitative and semiquantitative magnetic resonance imaging and histopathology findings in dermatomyositis. Clin Exp Rheumatol 2019; 37:633-640. [PMID: 30620292] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/18/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of this study was to compare muscle biopsy findings, as well as clinical and analytical features, with those of magnetic resonance imaging (MRI) studies of muscle in patients with dermatomyositis. METHODS All patients from the Longitudinal Myopathy Cohort of the Hospital Clínic de Barcelona were prospectively included in the study from 2009 to 2016. MRI images of muscle and fascial oedema were compared with muscle pathology results using both quantitative and semi-quantitative scores. RESULTS We found a statistically significant association between the inflammatory infiltrate and both muscle (r2=0.54, p=0.001) and fascial oedema (r2=0.54, p<0.001). In addition, muscle oedema was significantly associated with punched-out vacuoles (p=0.04) and muscle enzymes in serum (r2=0.34, p=<0.01 for CK and r2=0.22, p<0.05 for aldolase). The number of treatment drugs received at the time of MRI was inversely associated with the number of muscle inflammatory cells in the biopsy and with both muscle and fascial oedema (all p<0.05). CONCLUSIONS Key MRI findings correlate with the main features of dermatomyositis muscle biopsy results, suggesting that MRI findings could be used as a surrogate marker of disease activity.
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Affiliation(s)
- José César Milisenda
- Muscle Research Unit, Internal Medicine Service, Hospital Clínic de Barcelona, Universidad de Barcelona IDIBAPS and CIBERER, Barcelona, Spain.
| | - María Victoria Collado
- Rheumatology Service, Instituto de Investigaciones Médicas Alfredo Lanari (UBA), Buenos Aires, Argentina
| | - Iago Pinal-Fernandez
- Muscle Diseases Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | - Ana Isabel García
- Muscle Research Unit, Radiology Department, Hospital Clínic de Barcelona, Universidad de Barcelona, Spain
| | - Xavier Tomás
- Muscle Research Unit, Radiology Department. Hospital Clínic de Barcelona, Universidad de Barcelona, Spain
| | - Josep María Grau
- Muscle Research Unit, Internal Medicine Service, Hospital Clínic de Barcelona, Universidad de Barcelona IDIBAPS and CIBERER, Barcelona, Spain
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Martis N, Viau P, Zenone T, Andry F, Grados A, Ebbo M, Castela E, Brihaye B, Denis E, Liguori S, Audemard A, Schoindre Y, Morin AS, Terrier B, Marcq L, Mounier N, Lidove O, Chaborel JP, Quinsat D. Clinical value of a [18F]-FDG PET-CT muscle-to-muscle SUV ratio for the diagnosis of active dermatomyositis. Eur Radiol 2019; 29:6708-6716. [PMID: 31250167 DOI: 10.1007/s00330-019-06302-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/11/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study a muscle-to-muscle standardised uptake value (SUV) ratio with FDG-PET/CT (FDG-PET) as a marker for the detection of disease activity in dermatomyositis (DM). METHODS Patients with DM (n = 24) who met the European Neuro-Muscular Centre diagnostic criteria were retrospectively identified over a 3-year period through a national survey. Muscle biopsy was performed in all patients. Maximum SUV was measured in proximal muscles (SUVPROX) that had the highest radiotracer uptake on visual grading as well as in the musculus longissimus thoracis (SUVMLT), whereas mean SUV was measured for the liver (SUVLIV). Muscle-to-liver SUV ratios for either muscle group were compared and a SUVPROX/SUVMLT ratio was calculated. SUVPROX/SUVMLT of DM patients were compared with age- and sex-matched control subjects (n = 24) with melanoma who had received FDG-PET scans. RESULTS DM patients presented with proximal and symmetrical muscle uptake. Differences in SUVPROX/SUVLIV and SUVMLT/SUVLIV ratios in DM subjects were significant (p < 0.001). SUVPROX/SUVMLT ratios in DM and their controls also differed significantly (p = 0.0012). The SUVPROX/SUVMLT ratio threshold between DM subjects and controls was 1.73 with a sensitivity of 50% (CI95%, 29.1 to 70.9%) and specificity at 83.3% (CI95%, 62.6 to 95.3%). When amyopathic DM patients were removed from the analysis, specificity was increased to 95% (CI95%, 75.1 to 99.9%) with a likelihood ratio of 10 and an AUC of 83.4% (CI95%, 71.4 to 95.4%). CONCLUSION A muscle-to-muscle SUVPROX/SUVMLT ratio with a cut-off value of 1.73 in FDG-PET imaging might serve as a non-invasive marker to determine disease activity in dermatomyositis. KEY POINTS • [18F]-FDG PET-scanner standardised uptake value (SUV) could reflect disease activity in dermatomyositis (DM). • A ratio of SUV in proximal muscles (SUVPROX) to SUV in musculus longissimus thoracis (SUVMLT) could be used to determine active DM. • Active disease is suspected for SUV PROX /SUV MLT ratios greater than 1.73.
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Affiliation(s)
- Nihal Martis
- Service de Médecine Interne, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France.
| | - Philippe Viau
- Service de Médecine Nucléaire, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France
| | - Thierry Zenone
- Service de Médecine Interne, CH de Valence, Valence, France
| | - Fanny Andry
- Service de Médecine Interne, CHU Michallon, Grenoble, France
| | - Aurélie Grados
- Service de Médecine Interne, Hôpital La Timone, AP-HM, Marseille, France
| | - Mikael Ebbo
- Service de Médecine Interne, Hôpital La Timone, AP-HM, Marseille, France
| | - Emeline Castela
- Service de Médecine Interne, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France
| | - Benoit Brihaye
- Service de Médecine Interne, CH Saint-Quentin, Saint-Quentin, France
| | - Eric Denis
- Service de Médecine Interne, CH d'Antibes-Juan-les-Pins, Antibes, France
| | - Stéphane Liguori
- Service de Biologie Médicale, CH d'Antibes-Juan-les-Pins, Antibes, France
| | | | - Yoland Schoindre
- Service de Médecine Interne, Hôpital de la Pitié Salpêtrière, AP-HP, Paris, France
| | - Anne-Sophie Morin
- Service de Médecine Interne, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, AP-HP, Paris, France
| | - Laurent Marcq
- Service de Médecine Interne, CH d'Antibes-Juan-les-Pins, Antibes, France
| | - Nicolas Mounier
- Service d'Onco-Hématologie, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France
| | - Olivier Lidove
- Service de Médecine Interne, CH Croix St-Simon, Paris, France
| | | | - Denis Quinsat
- Service de Médecine Interne, CH d'Antibes-Juan-les-Pins, Antibes, France
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Park SJ, Choi IH, Kim HS. Rapid changes in capillary morphology and architecture in a patient with dermatomyositis. Korean J Intern Med 2019; 34:680-682. [PMID: 29294600 PMCID: PMC6506739 DOI: 10.3904/kjim.2017.338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 12/01/2022] Open
Affiliation(s)
- Sung-Jo Park
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - In-Ho Choi
- Department of Pathology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyun-Sook Kim
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
- Correspondence to Hyun-Sook Kim, M.D. Tel: +82-2-710-3214 Fax: +82-2-709-9554 E-mail :
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43
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Zhou H, Wang Y, Bi K, Qi H, Song S, Zhou M, Chen L, Wang G, Duan T. Serum-soluble TRAIL: a potential biomarker for disease activity in myositis patients. Clin Rheumatol 2019; 38:1425-1431. [PMID: 30645753 DOI: 10.1007/s10067-018-04418-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/13/2018] [Revised: 12/17/2018] [Accepted: 12/26/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a member of the TNF super-family, which is involved in the regulation of immune response and pathogenesis of autoimmune diseases, including polymyositis (PM) and dermatomyositis (DM). In this study, we examined the level and origin of serum-soluble TRAIL (sTRAIL) in patients with PM and DM and analyzed its association with disease activity and clinical features. METHOD 11 PM patients, 33 DM patients, and 20 healthy controls were enrolled in this study. Clinical features were recorded when admitted, and disease activity was evaluated by myositis disease activity assessment visual analogue scale (MYOACT). TRAIL expression in muscle tissues was detected by immunohistochemistry. Serum sTRAIL levels were measured by enzyme-linked immunosorbent assay. The expression of membrane TRAIL (mTRAIL) and its receptors, including DR4 and DR5, on circulating T cells was analyzed by flow cytometry. RESULTS TRAIL was expressed in infiltrated inflammatory cells in muscle tissues from patients. The serum sTRAIL level was markedly increased in patients and was positively correlated with the disease activity. Serum sTRAIL was decreased after therapy in patients and was specifically higher in patients with dysphagia, but lower in patients with autoantibody Jo-1 positive. The frequency of mTRAIL and its receptors on circulating T cells from patients were significantly elevated than that from healthy controls. CONCLUSIONS The serum sTRAIL could be a biomarker for evaluating the disease activity of PM and DM, and targeting the generation of TRAIL in T cells might be a potential approach in the treatment of PM and DM.
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Affiliation(s)
- Hang Zhou
- Department of Rheumatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, China
| | - Yunchao Wang
- Department of Medical and Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kuo Bi
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Haiyu Qi
- Department of Rheumatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, China
| | - Shuju Song
- Department of Rheumatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, China
| | - Mingzhu Zhou
- Department of Rheumatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, China
| | - Letian Chen
- Department of Rheumatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, China
| | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Ting Duan
- Department of Rheumatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, China.
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44
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Goldstein Z, Zussman J, Worswick S. Paraneoplastic dermatomyositis presenting with interesting cutaneous findings. Cutis 2019; 103:E17-E19. [PMID: 30758348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Zachary Goldstein
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jamie Zussman
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Scott Worswick
- Keck School of Medicine of the University of Southern California, Los Angeles, USA
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45
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Saikaly SK, Weinstein D. Disseminated Cutaneous Mycobacterium chelonae Infection in a Patient with Dermatomyositis. Skinmed 2018; 16:343-345. [PMID: 30413232] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 39-year-old Caucasian man with a history of dermatomyositis and diabetes mellitus on a regimen of tacrolimus and methylprednisolone presented to our dermatology outpatient clinic with a painful eruption on his left lower leg. Three months before presentation, he had been admitted to the hospital for cellulitis of the left leg. During admission, a needle aspirate of the left leg cellulitis was performed to obtain fluid for culture to guide therapy. The patient was empirically started on vancomycin 1 g every 12 hours and managed by infectious diseases. The culture yielded no growth, however, and the patient was continued on vancomycin for 2 weeks, with resolution of his cellulitis. Two months later, the patient developed multiple painful nodules on his left leg and returned to the infectious disease physician who had managed him during his inpatient stay. He was initially treated with 2 weeks of clindamycin 300 mg twice daily (bid) without improvement. This was then followed by 2 weeks of erythromycin 500 mg every 6 hours, again without improvement. At this point, he was referred to our clinic.
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Affiliation(s)
- Sami K Saikaly
- Department of Dermatology, University of Florida Gainesville, FL;
| | - David Weinstein
- University of Central Florida College of Medicine, Orlando, FL
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46
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Wong DE, Williams E, Warrier S. Dermatomyositis Developing Post Neoadjuvant Chemotherapy and Lumpectomy. R I Med J (2013) 2018; 101:34-36. [PMID: 30068052] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Dermatomyositis is an idiopathic inflammatory myopathy known to occur as a paraneoplastic syndrome. The course of dermatomyositis is commonly reported to mirror the course of the malignancy. Here, we report a case of dermatomyositis that developed in a patient after lump- ectomy and completed chemotherapeutic treatment.
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Affiliation(s)
- Daniel E Wong
- MD Candidate, Warren Alpert Medical School of Brown University, Providence, RI
| | - Edelva Williams
- Resident Physician, Warren Alpert Medical School of Brown University, Providence, RI
| | - Sarita Warrier
- Assistant Professor of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
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47
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Ahn JW, Yang S, Johnson K, Shwayder T. Gottron papules mimicking dermatomyositis: an unusual manifestation of systemic lupus erythematosus. Cutis 2018; 102:E16-E18. [PMID: 30138508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Ji W Ahn
- University of Michigan, Ann Arbor, USA
| | - Sherry Yang
- Department of Dermatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Tor Shwayder
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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48
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Adler BL, Christopher-Stine L. Triggers of inflammatory myopathy: insights into pathogenesis. Discov Med 2018; 25:75-83. [PMID: 29579414 PMCID: PMC5921929] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The inflammatory myopathies, which include dermatomyositis, polymyositis, and the immune-mediated necrotizing myopathies, are a heterogeneous group of autoimmune diseases that manifest with muscle, skin, or lung damage. Collectively, these autoimmune diseases result from loss of tolerance to a select group of self-antigens, although the precise mechanism through which this occurs is not known. Infection, malignancy, and certain medications including statins and the immune checkpoint inhibitors used in cancer therapy have been identified as potential immunologic triggers of the inflammatory myopathies. Some of these triggers are classically associated with specific myositis-specific autoantibodies (MSAs). The strong association between certain triggers and MSAs provides insights into how an immunologic event can lead to loss of tolerance to specific self-antigens, resulting in autoimmune disease. In this review, we discuss the proposed triggers of the inflammatory myopathies and their associations with MSAs, and provide insights into how these triggers may result in the inflammatory myopathies.
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Affiliation(s)
- Brittany L Adler
- Department of Medicine Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Lisa Christopher-Stine
- Department of Medicine Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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49
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Collado MV, Gargiulo MDLÁ, Gómez R, Gómez G, Pérez N, Suarez L, Taratuto AL, Aruj P. [Dermatomyositis associated with anti-MDA5 autoantibody]. Medicina (B Aires) 2018; 78:360-363. [PMID: 30285929] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Dematomyositis is an idiopathic inflammatory myopathy with a variable clinical spectrum. In recent years, a number of myositis-specific antibodies have been identified including anti-MDA5, which is us eful for diagnosis, prognosis and classification of the diverse clinical forms of the disease. This antibody is associated with cutaneous ulcers, rapidly progressive interstitial lung disease, early mortality and poor prognosis, so the detection of this antibody in a suitable clinical context, raises the need for an aggressive immunosuppressive treatment. We describe a case of dermatomyositis classified as hypomyopathic (i.e. involving mild muscle weakness), presenting specific skin lesions, interstitial lung disease, and presence of anti-MDA5 antibody that had a favorable response to combined treatment with cyclophosphamide, gamma globulin and corticosteroids.
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Affiliation(s)
- María Victoria Collado
- Sección Inmunología, Instituto de Investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina. E-mail:
| | | | - Ramiro Gómez
- Hospital de Clínicas Gral. José de San Martín, Buenos Aires, Argentina
| | - Graciela Gómez
- Sección Inmunología, Instituto de Investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina
| | - Nicolás Pérez
- Sección Inmunología, Instituto de Investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina
| | - Lorena Suarez
- Sección Inmunología, Instituto de Investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina
| | - Ana Lía Taratuto
- Consultoría en Neuropatología y Patología Neuromuscular, Instituto de Investigaciones Neurológicas-FLENI, Hospital Nacional de Pediatría J.P Garrahan, Buenos Aires, Argentina
| | - Patricia Aruj
- Sección Neumonología, Instituto de Investigaciones Médicas Alfredo Lanari, UBA, Buenos Aires, Argentina
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50
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Azevedo PDO, Castellen NR, Salai AF, Barbosa FS, Alves CAXDM, Pinto CAL. Panniculitis associated with amyopathic dermatomyositis. An Bras Dermatol 2018; 93:119-121. [PMID: 29641712 PMCID: PMC5871377 DOI: 10.1590/abd1806-4841.20186597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 07/31/2017] [Indexed: 11/22/2022] Open
Abstract
Panniculitis is a rare clinical finding in dermatomyositis, with less than 30 cases reported and there is only one case associated with the amyopathic subtype described in the literature. The present report describes a 49-year-old female patient that one year after being diagnosed with amyopathic dermatomyositis, presented indurated, painful, erythematous to violaceous nodules located on the upper limbs, thighs and gluteal region. Skin biopsy revealed lobular panniculitis with a lymphocytic infiltrate. The patient was treated with prednisone and methotrexate, but remained unresponsive to treatment.
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Affiliation(s)
| | | | - Ana Flávia Salai
- (Dermatology Service, Faculdade de Medicina de Jundiaí
(FMJ) - Jundiaí (SP), Brasil
| | | | | | - Clóvis Antonio Lopes Pinto
- Department of Pathology, Faculdade de Medicina de Jundiaí
(FMJ) - Jundiaí (SP), Brasil
- Pathology Service, Hospital AC Camargo - São Paulo (SP),
Brasil
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