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Loganathan A, Gupta L, Rudge A, Lu H, Bowler E, McMorrow F, Naveen R, Anuja AK, Agarwal V, McHugh N, Tansley S. Assessing the sensitivity and specificity of myositis-specific and associated autoantibodies: a sub-study from the MyoCite cohort. Rheumatology (Oxford) 2024; 63:2363-2371. [PMID: 38479813 DOI: 10.1093/rheumatology/keae167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/19/2024] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVES Myositis-specific and associated autoantibodies are important biomarkers in routine clinical use. We assessed local testing performance for myositis autoantibodies by comparing line immunoassay (LIA) to protein radio-immunoprecipitation and identifying clinical characteristics associated with each myositis autoantibody in the MyoCite cohort. METHODS Serum samples from patients within the MyoCite cohort, a well-characterized retro-prospective dataset of adult and juvenile idiopathic inflammatory myopathy (IIM) patients in Lucknow, India (2017-2020), underwent LIA at Sanjay Gandhi Postgraduate Institute of Medical Science (SGPGIMS), Lucknow. Immunoprecipitation of 147 IIM patients' serum samples (125 adult-onset, 22 juvenile-onset) was conducted at the University of Bath, with researchers blind to LIA results. LIA performance was assessed against immunoprecipitation as the reference standard, measuring sensitivity, specificity and inter-rater agreement. Univariate and multivariate logistic regression determined clinical associations for specific myositis-specific autoantibodies. RESULTS Immunoprecipitation identified myositis autoantibodies in 56.5% (n = 83) of patient samples, with anti-Jo1 (n = 16; 10.9%) as the most common, followed by anti-MDA5 (n = 14, 9.5%). While LIA showed good agreement for anti-Jo1, anti-PL7 and anti-PL12 (Cohen's κ 0.79, 0.83 and 1, respectively), poor agreement was observed in other subgroups, notably anti-TIF1γ (Cohen's κ 0.21). Strongly positive samples, especially in myositis-specific autoantibodies, correlated more with immunoprecipitation results. Overall, 59 (40.1%) samples exhibited non-congruence on LIA and immunoprecipitation, and κ values for LIAs for anti-TIF1γ, anti-Ku, anti-PmScl, anti-Mi2 and anti-SAE ranged between 0.21 and 0.60. CONCLUSION While LIA reliably detected anti-Jo1, anti-PL7, anti-PL12, anti-MDA5 and anti-NXP-2, it also displayed false positives and negatives. Its effectiveness in detecting other autoantibodies, such as anti-TIF1γ, was poor.
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Affiliation(s)
- Aravinthan Loganathan
- Royal National Hospital of Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department of Life Sciences, University of Bath, Bath, UK
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
- Department of Rheumatology, Royal Wolverhampton Hospital NHS Trust, Wolverhampton, UK
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Alex Rudge
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | - Hui Lu
- Department of Life Sciences, University of Bath, Bath, UK
| | | | | | - R Naveen
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Anamika K Anuja
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Neil McHugh
- Department of Life Sciences, University of Bath, Bath, UK
| | - Sarah Tansley
- Royal National Hospital of Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department of Life Sciences, University of Bath, Bath, UK
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Zhang H, Shi Y, Fan Y, Zhu D, Qiu Z, Chi H, Hu Q, Xie L, Sun Y, Liu H, Cheng X, Ye J, Shi H, Zhou Z, Meng J, Teng J, Yang C, Jin W, Su Y. Anti-signal recognition particle antibodies induce cardiac diastolic dysfunction via oxidative stress injury. Clin Transl Immunology 2024; 13:e1525. [PMID: 39139496 PMCID: PMC11321054 DOI: 10.1002/cti2.1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/24/2024] [Accepted: 07/28/2024] [Indexed: 08/15/2024] Open
Abstract
Objectives Anti-signal recognition particle (SRP) antibodies, markers of immune-mediated necrotising myopathy, are reportedly related to cardiac involvement; however, whether they are pathogenic to the myocardium remains unclear. We aimed, therefore, to explore the pathogenicity of anti-SRP antibodies against the myocardium through in vivo and in vitro studies. Methods Total immunoglobulin G (IgG), purified from patients with positive anti-SRP antibodies, was passively transferred into C57BL/6 mice. Cardiac function was evaluated via echocardiography and the ventricular pressure-volume loop; cardiac histological changes were analysed using haematoxylin-eosin staining, picrosirius red staining, immunofluorescence and immunohistochemistry. Additionally, reactive oxygen species (ROS) formation was evaluated by dihydroethidium (DHE) staining; mitochondrial morphology and function were evaluated using transmission electron microscopy and seahorse mitochondrial respiration assay, respectively. The myositis cohort at our centre was subsequently reviewed in terms of cardiac assessments. Results After the passive transfer of total IgG from patients with positive anti-SRP antibodies, C57BL/6 mice developed significant left ventricular diastolic dysfunction (LVDD). Transcriptomic analysis and corresponding experiments revealed increased oxidative stress and mitochondrial damage in the hearts of the experimental mice. Cardiomyocytes exposed to anti-SRP-specific IgG, however, recovered normal mitochondrial metabolism after treatment with N-acetylcysteine, an ROS scavenger. Moreover, patients positive for anti-SRP antibodies manifested worse diastolic but equivalent systolic function compared to their counterparts after propensity score matching. Conclusion Anti-SRP antibodies may play a pathogenic role in the development of LVDD by promoting ROS production and subsequent myocardial mitochondrial impairment. The inhibition of oxidative stress was effective in reversing anti-SRP antibody-induced LVDD.
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Affiliation(s)
- Hao Zhang
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Rheumatology and ImmunologyThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- The First Clinical Medical CollegeLanzhou UniversityLanzhouGansuChina
| | - Yunjing Shi
- Department of Cardiovascular Medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital, and Ruijin Hospital Lu Wan BranchShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yingze Fan
- Department of Cardiovascular Medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital, and Ruijin Hospital Lu Wan BranchShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Dehao Zhu
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zeping Qiu
- Department of Cardiovascular Medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital, and Ruijin Hospital Lu Wan BranchShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Huihui Chi
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qiongyi Hu
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Liangzhe Xie
- Department of Laboratory Medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yue Sun
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Honglei Liu
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xiaobing Cheng
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Junna Ye
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhuochao Zhou
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jianfen Meng
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jialin Teng
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wei Jin
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital, and Ruijin Hospital Lu Wan BranchShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yutong Su
- Department of Rheumatology and Immunology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Hospital of Civil Aviation Administration of ChinaShanghaiChina
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Schumacher F, Zimmermann M, Kanbach M, Schulze W, Wollsching-Strobel M, Kroppen D, Stanzel SB, Majorski D, Windisch W, Strunk J, Berger M. Clinical relevance of positively determined myositis antibodies in rheumatology: a retrospective monocentric analysis. Arthritis Res Ther 2024; 26:132. [PMID: 39014499 PMCID: PMC11251291 DOI: 10.1186/s13075-024-03368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The increased availability of myositis autoantibodies represents new possibilities and challenges in clinical practice (Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, de Visser M, et al. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis. 2017;76:1955-64. https://doi.org/10.1136/annrheumdis-2017-211468 .). The aim of this study was to perform a retrospective data analysis of patient cases with positive myositis autoantibodies to analyse their significance in routine rheumatology practice. METHODS A monocentric analysis of all the orders used to determine myositis autoantibodies from July 2019 to May 2022 in the Department of Rheumatology, Krankenhaus Porz am Rhein, Cologne, Germany, was carried out. RESULTS In the defined time interval, a total of 71,597 laboratory values for the antibodies mentioned above were obtained. A total of 238 different positive autoantibodies were detected in 209 patients. Idiopathic inflammatory myopathy was diagnosed in 37 patients (18%), and inflammatory rheumatic diseases other than idiopathic inflammatory myopathy were diagnosed in 90 patients (43%). No inflammatory rheumatic disease was diagnosed in 82 patients (39%). General clusters of clinical manifestations were observed. CONCLUSIONS In our cohort, we were able to show that a relevant proportion of patients with positive myositis antibodies did not have idiopathic inflammatory myopathies or inflammatory rheumatic diseases. This finding indicates the importance of myositis autoantibodies in this group of patients. However, further studies on the course of symptoms and examination results in patients without inflammatory rheumatic diseases and with positive myositis antibodies are necessary.
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Affiliation(s)
- Falk Schumacher
- Department of Rheumatology, Krankenhaus Porz am Rhein, Cologne, Germany.
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany.
| | - Maximilian Zimmermann
- Department of Pneumology, Kliniken der Stadt Köln, Cologne, Germany
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Malte Kanbach
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | | | - Maximilian Wollsching-Strobel
- Department of Pneumology, Kliniken der Stadt Köln, Cologne, Germany
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Doreen Kroppen
- Department of Pneumology, Kliniken der Stadt Köln, Cologne, Germany
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Sarah Bettina Stanzel
- Department of Pneumology, Kliniken der Stadt Köln, Cologne, Germany
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Daniel Majorski
- Department of Pneumology, Kliniken der Stadt Köln, Cologne, Germany
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Wolfram Windisch
- Department of Pneumology, Kliniken der Stadt Köln, Cologne, Germany
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Johannes Strunk
- Department of Rheumatology, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Melanie Berger
- Department of Pneumology, Kliniken der Stadt Köln, Cologne, Germany
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
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Maxwell S, Ross L, Oon S, Wicks IP, Day J. Muscle biopsy practices in the evaluation of idiopathic inflammatory myopathies: An international survey of expert clinicians. Semin Arthritis Rheum 2024; 68:152519. [PMID: 39059155 DOI: 10.1016/j.semarthrit.2024.152519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Muscle biopsy is an important test in the evaluation of individuals with suspected myopathy, including those with suspected idiopathic inflammatory myopathy (IIM). Various approaches, including open surgical biopsy, needle biopsy and conchotome forceps, have been reported. However the real-world utilisation of these approaches remains unclear. There are no established guidelines for the use of muscle biopsy, or selection of biopsy technique, in investigating IIM and international practices are not well-documented. This study describes current approaches to muscle biopsy amongst clinicians with expertise in IIM. METHODS A survey regarding muscle biopsy practices was disseminated among members of the International Myositis Assessment and Clinical Studies (IMACS) group. Data were analysed using descriptive statistics. RESULTS One-hundred and sixteen clinicians completed the survey, primarily rheumatologists. Open surgical biopsy was the most commonly employed technique (74.5 %), followed by needle (11.3 %) and conchotome (9.4 %) approaches. Clinical examination was the most common method of muscle selection, with 85.2 % of respondents reporting they 'always or almost always' relied on it. MRI and electromyography were also frequently utilised for muscle selection (51.9 %, 45.4 % respectively). There was variability in the perceived utility of muscle biopsy in certain clinical contexts, such as presence of myositis specific antibodies or cutaneous manifestations of dermatomyositis. While respondents generally reported low complication rates following muscle biopsy, non-diagnostic histopathology was commonly reported, regardless of procedural approach. CONCLUSION Clinicians managing IIM report muscle biopsy to be well tolerated however, non-diagnostic results are common. Substantial heterogeneity regarding perceived indications for biopsy, procedural approaches, and muscle selection strategies were observed within this expert group. Future research is needed to establish best practice and determine the role of muscle biopsy in the context of continued advancements in serological profiling of IIM.
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Affiliation(s)
- Samuel Maxwell
- Department of Rheumatology, Royal Melbourne Hospital, Australia
| | - Laura Ross
- Department of Rheumatology, St Vincent's Hospital Melbourne, Australia; Department of Medicine, The University of Melbourne, Australia
| | - Shereen Oon
- Department of Rheumatology, Royal Melbourne Hospital, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Australia; Department of Medicine, The University of Melbourne, Australia
| | - Ian P Wicks
- Department of Rheumatology, Royal Melbourne Hospital, Australia; Inflammation Division, Walter and Eliza Hall Institute of Medical Research, Australia; Department of Medical Biology, The University of Melbourne, Australia
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Australia; Inflammation Division, Walter and Eliza Hall Institute of Medical Research, Australia; Department of Medical Biology, The University of Melbourne, Australia.
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Kannappan R, Kumar R, Cichelli K, Brent LH. A Review of Myositis-Associated Interstitial Lung Disease. J Clin Med 2024; 13:4055. [PMID: 39064092 PMCID: PMC11278012 DOI: 10.3390/jcm13144055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
There is a well-established relationship between different subsets of idiopathic inflammatory myopathies (IIMs, myositis) and interstitial lung disease (ILD), with lung complications sometimes presenting prior to myopathic manifestations. The subtypes of myositis include those that are strongly associated with ILD, such as polymyositis (PM) and dermatomyositis (DM). Research has shown that in certain patients, these can then be further divided into subtypes using myositis-specific antibodies (MSAs), which are specific for myositis, and myositis-associated antibodies (MAAs), which can be found in myositis in overlap syndromes with other connective tissue diseases (CTDs). Notably, certain MSAs and MAAs are associated with ILD in patients with myositis. The clinical presentations of ILD in patients with myositis can vary widely and can be insidious in onset and difficult to diagnose. As ILD can progress rapidly in some cases, it is essential that clinicians are able to identify and diagnose ILD in patients with myositis. For this reason, the aim of this review is to highlight the clinical features, diagnostic criteria, important histopathologic, laboratory, and radiographic features, and treatment modalities for those patients with myositis-associated ILD.
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Affiliation(s)
- Renuka Kannappan
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Raagni Kumar
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Kimberly Cichelli
- Section of Rheumatology, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Lawrence H. Brent
- Section of Rheumatology, Temple University Hospital, Philadelphia, PA 19140, USA
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Takeshita M, Suzuki K, Nakazawa M, Kamata H, Ishii M, Oyamada Y, Oshima H, Usuda S, Tsunoda K, Takeuchi T. Disease-specific autoantibody production in the lungs and salivary glands of anti-synthetase syndrome. Front Immunol 2024; 15:1265792. [PMID: 38938569 PMCID: PMC11208671 DOI: 10.3389/fimmu.2024.1265792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 05/24/2024] [Indexed: 06/29/2024] Open
Abstract
Interstitial lung disease is a common complication of anti-synthetase syndrome (ASS), and lymphocytic infiltration is often observed in the lesion. We have recently reported that disease-specific autoantibodies are produced by infiltrating lymphocytes in some autoimmune diseases. Here, we investigate the antigen specificity of B cells in the lung lesions of ASS patients. A total of 177 antibodies were produced from antibody-secreting cells in bronchoalveolar fluid (BALF) of three each of serum anti-Jo-1 and serum anti-EJ antibody-positive patients. Twelve to 30% and 50 to 62% of these antibodies were disease-specific autoantibodies, respectively. These autoantibodies recognized conformational epitopes of the whole self-antigen and had affinity maturations, indicating that self-antigens themselves are the target of humoral immunity. In addition, 100 antibodies were produced from two salivary gland tissues, obtained by chance, of ASS patients. Salivary glands are not generally recognized as lesions of ASS, but unexpectedly, ASS-related autoantibody production was also observed similar to that of BALF. Immunostaining confirmed the presence of ASS-related autoantibody-producing cells in salivary glands. Our results suggest that disease-specific autoantibody production at lesion sites is a common pathogenesis of autoimmune diseases, and that tissue-specific production of autoantibodies can provide insights regarding the distribution of organ manifestations in autoimmune diseases.
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Affiliation(s)
- Masaru Takeshita
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Japan
| | - Maho Nakazawa
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Japan
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Japan
- Division of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshitaka Oyamada
- Department of Respiratory Medicine, National Tokyo Medical Center, Meguro, Japan
| | - Hisaji Oshima
- Department of Connective Tissue Diseases, National Tokyo Medical Center, Meguro, Japan
| | - Satoshi Usuda
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Kazuyuki Tsunoda
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Japan
- Saitama Medical University, Saitama, Japan
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Sherman MA, Farhadi PN, Pak K, Trieu EP, Sarkar K, Targoff IN, Neely ML, Mammen AL, Rider LG. Myositis-Associated Autoantibodies in Patients With Juvenile Myositis Are Associated With Refractory Disease and Mortality. Arthritis Rheumatol 2024; 76:963-972. [PMID: 38272842 PMCID: PMC11136598 DOI: 10.1002/art.42813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Myositis-associated autoantibodies (MAAs) have been associated with overlap myositis, certain disease manifestations such as interstitial lung disease (ILD), and worse prognosis in the idiopathic inflammatory myopathies. MAAs overall remain largely uncharacterized in patients with juvenile-onset myositis. Moreover, it is unknown whether the number of MAAs is associated with disease severity. METHODS Patients with juvenile myositis in cross-sectional natural history studies who underwent testing for myositis autoantibodies were included. Demographics, myositis autoantibodies, clinical characteristics, medications received, and outcomes of those with and without MAAs were compared. Multivariable logistic regression was performed to determine whether the number of MAAs detected was associated with severe disease features. RESULTS Among 551 patients, 36% had an MAA and 13% had more than one MAA. Among those who were MAA positive, there was a higher frequency of overlap myositis (18% vs 5.9%, P < 0.001). MAA positivity was associated with certain clinical features, including Raynaud phenomenon (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.41-4.28) and ILD (OR 3.43, 95% CI 1.75-6.96), as well as a chronic disease course (OR 1.72, 95% CI 1.10-2.72) and mortality (OR 3.76, 95% CI 1.72-8.43). The number of MAAs was also associated with mortality (OR 1.83, 95% CI 1.16-2.86). CONCLUSION MAAs were prevalent in a large cohort of patients with juvenile myositis. ILD, refractory disease, and mortality were associated with MAA positivity. Prospective studies are needed to determine whether early detection of MAAs may lead to improved outcomes for patients with juvenile myositis.
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Affiliation(s)
- Matthew A. Sherman
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Payam Noroozi Farhadi
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Katherine Pak
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Edward P. Trieu
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Kakali Sarkar
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Ira N. Targoff
- Veterans Affairs Medical Center, University of Oklahoma Health Sciences Center, and Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Megan L. Neely
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Andrew L. Mammen
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa G. Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
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Alhassan E, Yi BY, Rodman J, Weisman MH, Crew A, Wise L. Unique characteristics of anti-MDA-5 associated dermatomyositis in Southern California with a large Hispanic population. Semin Arthritis Rheum 2024; 66:152434. [PMID: 38503149 DOI: 10.1016/j.semarthrit.2024.152434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/08/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES There is little to no data about the presentation and clinical course of anti-melanoma differentiation-associated gene-5 antibody (anti-MDA-5) dermatomyositis in a primarily U.S. Hispanic population. We describe the clinical course of anti-MDA-5 dermatomyositis in our majority Hispanic population. METHODS This is a multicenter, retrospective case series of anti-MDA-5 dermatomyositis. Patients diagnosed with anti-MDA-5 dermatomyositis from June 2015 to March 2023 at four medical centers in Los Angeles, California, were included. Demographics and clinical characteristics were obtained. Descriptive statistics, Pearson's chi-squared, Fisher's exact, Wilcoxon rank sum, and Kruskal-Wallis tests were performed as applicable. RESULTS Thirty anti-MDA-5 dermatomyositis patients were included. Twenty-two (73 %) were Hispanic. Twenty-one patients (70 %) were female, with a median age of 40.5 years. Hispanic patients were diagnosed with anti-MDA-5 dermatomyositis at a younger age than non-Hispanic patients (p = 0.025). Inflammatory arthritis was prominent; more males were affected than females (p = 0.027). Thirteen patients (43 %) were amyopathic. Twenty-five patients (83.3 %) had evidence of interstitial lung disease (ILD), and a higher ferritin level was associated with ILD (p = 0.049). There were six deaths (20 %); five (17 %) were ascribed to rapidly progressive ILD. CONCLUSION ILD was the most common presentation of anti-MDA-5 dermatomyositis in our cohort and was associated with higher ferritin levels. Hispanic patients had a younger age of diagnosis than non-Hispanic patients. Necrotic skin lesions and inflammatory arthritis were frequently seen. This is the first study looking at clinical phenotypes and outcomes of anti-MDA-5 dermatomyositis in a primarily Hispanic U.S. POPULATION Future studies are needed to better understand the clinical manifestations (to promptly recognize and treat) of this population of anti-MDA-5 dermatomyositis.
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Affiliation(s)
- Eaman Alhassan
- Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Belina Y Yi
- Division of Rheumatology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jack Rodman
- Clinical & Translational Science Institute, University of Southern California, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ashley Crew
- Department of Dermatology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Leanna Wise
- Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Rivero-Gallegos D, Mejía M, Rocha-González HI, Huerta-Cruz JC, Falfán-Valencia R, Ramos-Martínez E, Mateos-Toledo HN, Castillo-López MF, Rodríguez-Torres YK, Lira-Boussart V, Rojas-Serrano J. Association between anti-PL7 antibodies and increased fibrotic component in patients with antisynthetase syndrome and interstitial lung disease: a cross-sectional study. Clin Rheumatol 2024; 43:1971-1978. [PMID: 38642252 DOI: 10.1007/s10067-024-06965-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE To evaluate whether anti-PL7 and anti-PL12 autoantibodies are associated with a greater extent of the fibrotic component of ILD in ASSD patients. METHODS Patients with ILD-ASSD who were positive for one of the following autoantibodies: anti-Jo1, anti-PL7, anti-PL12, and anti-EJ were included. Clinical manifestations, CPK levels, pulmonary function tests, and HCRT assessments were prospectively collected according to the Goh index. The fibrotic, inflammatory, and overall extension of the Goh index and DLCO were assessed by multiple linear analyses and compared between ASSD antibody subgroups. RESULTS Sixty-six patients were included; 17 were positive for anti-Jo1 (26%), 17 for anti-PL7 (26%), 20 for anti-PL12 (30%), and 9 (14%) for anti-EJ. Patients with anti-PL7 and anti-PL12 had a more extensive fibrotic component than anti-Jo1. Anti-PL7 patients had a 7.9% increase in the fibrotic extension (cβ = 7.9; 95% CI 1.863, 13.918), and the strength of the association was not modified after controlling for sex, age, and time of disease evolution (aβ = 7.9; 95% CI 0.677, 15.076) and also was associated with an increase in ILD severity after adjusting for the same variables, denoted by a lower DLCO (aβ = - 4.47; 95% CI - 8.919 to - 0.015). CONCLUSIONS Anti-PL7-positive ASSD patients had more extensive fibrosis and severe ILD than the anti-Jo1 subgroup. This information is clinically useful and has significant implications for managing these patients, suggesting the need for early consideration of concurrent immunosuppressive and antifibrotic therapy.
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Affiliation(s)
- Daphne Rivero-Gallegos
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Mayra Mejía
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Héctor I Rocha-González
- Sección de Estudios de Posgrado E Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Juan C Huerta-Cruz
- Laboratory of Clinical Pharmacology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Ramcés Falfán-Valencia
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Espiridion Ramos-Martínez
- Facultad de Medicina, Unidad de Investigación en Medicina Experimental, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Heidegger N Mateos-Toledo
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - María F Castillo-López
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Yeimi K Rodríguez-Torres
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Valeria Lira-Boussart
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Jorge Rojas-Serrano
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
- Program of Masters and Ph.D. in Medical Sciences, School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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10
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Yang L, Guan W, Liu H, Li Y, Gong Y, Lv Q, Zeng Q, Wei Q, Zhang X, Chen W, Chen C, Sun L. Juvenile dermatomyositis with central nervous system involvement: two case reports from a retrospective single-center cohort, with literature review. Front Pediatr 2024; 12:1409950. [PMID: 38873583 PMCID: PMC11169638 DOI: 10.3389/fped.2024.1409950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/20/2024] [Indexed: 06/15/2024] Open
Abstract
Background Juvenile dermatomyositis (JDM) is a systemic autoimmune disease primarily involving the muscles and skin; it can also affect the central nervous system (CNS). The relevant literature provides limited information regarding the characteristics of JDM with CNS involvement. Method We reviewed patients with JDM who were hospitalized at our center between January 2016 and August 2023, with a focus on those with CNS involvement. The aim was to provide detailed case reports on these patients, and to summarize the relevant literature about the characteristics of similar cases. Results Among 193 hospitalized patients with JDM, two (1.03%) had CNS involvement. Two patients, a 5.5-year-old girl and an 11-year-old boy, were admitted with severe proximal muscle weakness and seizures, and presented with active cutaneous vasculitis. Both were ultimately diagnosed with JDM, with CNS involvement. Both patients had confirmed presence of anti-NXP2 antibody through myositis-specific antibody analysis. Additionally, they all exhibited hyperferritinemia and thrombocytopenia. Salvage therapies like intravenous methylprednisolone (IVMP) pulse therapy and/or plasma exchange were administered successfully. At final follow-up, both patients had achieved complete clinical response and full neurological recovery. Our literature review identified nine similar case studies. CNS involvement usually occurred within the first 10 months of the disease course, and most of these patients had fatal outcomes, with a mortality rate of 66.6% (6/9). Including the two patients described herein, the median age for disease onset is 10.5 years (range 4-17 years), and the male: female ratio is 6:5. Seizures are the most common neurological symptom, accompanied by active cutaneous vasculitis. The brain biopsies showed two distinct pathological presentations: one was central nervous system vasculitis, and the other was cerebral macrophage activation syndrome. Conclusions CNS involvement is a rare but life-threatening JDM complication. Herein, our cases and the literature indicate that it typically occurs within the first 10 months of the disease course and manifests as seizures, often accompanied by active cutaneous vasculitis, with fatal outcomes. Timely implementation of salvage therapies, like IVMP pulse therapy and plasma exchange, may significantly impact patient outcomes.
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Affiliation(s)
- Ling Yang
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- Department of Rheumatology, Children’s Hospital of Fudan University at Xiamen (Xiamen Children’s Hospital), Fujian, China
- National Children’s Medical Center, Shanghai, China
| | - Wanzhen Guan
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Haimei Liu
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Yifan Li
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Yinv Gong
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Qianying Lv
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Qiaoqian Zeng
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Qijiao Wei
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Xiaomei Zhang
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Weiming Chen
- National Children’s Medical Center, Shanghai, China
- Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, Shanghai, China
| | - Chao Chen
- National Children’s Medical Center, Shanghai, China
- Department of Otolaryngology, Children’s Hospital of Fudan University, Shanghai, China
| | - Li Sun
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
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11
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Nainia K, Aouzal MA, Ouafik I, Charhbili M, Bouchhab A, Daoudi A, Tizki S, Chakiri R. Juvenile dermatomyositis with Anti-SAE antibodies in a Moroccan child associated with pseudo-angioedema: a case report. Pediatr Rheumatol Online J 2024; 22:57. [PMID: 38773611 PMCID: PMC11107000 DOI: 10.1186/s12969-023-00921-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/02/2023] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Juvenile Dermatomyositis (JDM) is the leading cause of non-infectious inflammatory myopathy in children. It is a heterogeneous group of autoimmune diseases characterized by a variable combination of muscular, dermatological, and visceral involvement. Myositis-specific autoantibodies help define homogeneous subgroups with common clinical characteristics and prognoses. Anti-SAE (small ubiquitin-like modifier 1 (SUMO-1) activating enzyme) antibodies are among the most recently discovered specific autoantibodies. The presence of these antibodies is very rare, making it challenging to define clinical features and prognosis in the juvenile form. We report the first case of an African patient with juvenile dermatomyositis and positive anti-SAE antibodies. CASE REPORT A 5-year-3-month-old Moroccan boy presented to the pediatric emergency department with dysphagia that had been evolving for two days, preceded two months earlier by facial erythema associated with fatigue, lower limb pain, difficulty walking, and progressive inflammatory polyarthralgia. On admission, the child had a heliotrope rash with predominant pseudo-angioedema on the lips, periungual telangiectasia, and Gottron's papules over the bilateral interphalangeal and metatarsophalangeal joints. The patient had a more pronounced proximal muscle weakness in the lower limbs. He had no urticaria, fever, arthritis, calcinosis, cutaneous ulcers, or lipodystrophy. The Joint examination was normal, as was the pleuropulmonary examination. The electroneuromyography showed myogenic changes in all four limbs. Laboratory findings showed elevated levels of creatine phosphokinase and lactate dehydrogenase and a mild inflammatory syndrome. The electrocardiogram was normal. The anti-SAE antibodies were positive. The boy was diagnosed with juvenile dermatomyositis. He received methylprednisolone bolus therapy followed by oral prednisone. The latter was gradually tapered in combination with weekly intramuscular methotrexate. As a result, dysphagia disappeared within 48 h. After two weeks, there was an improvement in the muscular score and a significant regression of facial pseudo-angioedema. CONCLUSION We report the first African patient with anti-SAE autoantibody-positive JDM. He had a typical dermatological manifestation of JDM associated with pseudo-angioedema predominant on the lips; a rarely reported sign in DM and JDM patients. The patient responded well to corticosteroid therapy and methotrexate.
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Affiliation(s)
- Khalila Nainia
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco.
| | - Mohamed Amine Aouzal
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Imane Ouafik
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Mariyam Charhbili
- Pediatrics department, Regional hospital HASSAN II Agadir, Agadir, Morocco
| | - Amal Bouchhab
- Pediatrics department, Regional hospital HASSAN II Agadir, Agadir, Morocco
| | - Abdellatif Daoudi
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Samira Tizki
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Radia Chakiri
- Dermatology department, CHU SOUSS-MASSA, Agadir, Morocco
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12
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Shreyas R, Patteri A, Hayagrivas MB, Singla T, Mohankumar SP, Gupta SK, Jana M, Bagri NK, Ramanan AV. Fatal pulmonary arterial hypertension (PAH): A rare association of anti-MDA-5 positive juvenile dermatomyositis. Int J Rheum Dis 2024; 27:e15180. [PMID: 38720426 DOI: 10.1111/1756-185x.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/13/2024] [Accepted: 04/21/2024] [Indexed: 05/14/2024]
Affiliation(s)
- R Shreyas
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Anagha Patteri
- All India Institute of Medical Sciences, New Delhi, India
| | - M B Hayagrivas
- All India Institute of Medical Sciences, New Delhi, India
| | - Tanya Singla
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Narendra Kumar Bagri
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - A V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
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13
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Tansley SL, McMorrow F, Cotton CV, Adamali H, Barratt SL, Betteridge ZE, Perurena-Prieto J, Gibbons MA, Kular R, Loganathan A, Lamb JA, Lu H, New RP, Pratt D, Rivera-Ortega P, Sayers R, Steward M, Stranks L, Vital E, Spencer LG, McHugh NJ, Cooper RG. Identification of connective tissue disease autoantibodies and a novel autoantibody anti-annexin A11 in patients with "idiopathic" interstitial lung disease. Clin Immunol 2024; 262:110201. [PMID: 38575043 DOI: 10.1016/j.clim.2024.110201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Autoantibodies are a hallmark feature of Connective Tissue Diseases (CTD). Their presence in patients with idiopathic interstitial lung disease (ILD) may suggest covert CTD. We aimed to determine the prevalence of CTD autoantibodies in patients diagnosed with idiopathic ILD. METHODS 499 patient sera were analysed: 251 idiopathic pulmonary fibrosis (IPF), 206 idiopathic non-specific interstitial pneumonia (iNSIP) and 42 cryptogenic organising pneumonia (COP). Autoantibody status was determined by immunoprecipitation. RESULTS 2.4% of IPF sera had a CTD-autoantibody compared to 10.2% of iNSIP and 7.3% of COP. 45% of autoantibodies were anti-synthetases. A novel autoantibody targeting an unknown 56 kDa protein was found in seven IPF patients (2.8%) and two NSIP (1%) patients. This was characterised as anti-annexin A11. CONCLUSION Specific guidance on autoantibody testing and interpretation in patients with ILD could improve diagnostic accuracy. Further work is required to determine the clinical significance of anti-annexin A11.
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Affiliation(s)
- Sarah L Tansley
- Department of Life Sciences, University of Bath, Bath, UK; Royal National Hospital for Rheumatic Diseases, Bath, UK.
| | | | | | - Huzaifa Adamali
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | - Shaney L Barratt
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | | | | | - Michael A Gibbons
- College of Medicine & Health, University of Exeter; Royal Devon University Hospitals Foundation NHS Trust
| | - Raman Kular
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Janine A Lamb
- Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Hui Lu
- Department of Life Sciences, University of Bath, Bath, UK
| | - Robert P New
- Division of Musculoskeletal and dermatological Sciences, University of Manchester, UK
| | - Diane Pratt
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | | | - Ross Sayers
- College of Medicine & Health, University of Exeter
| | | | | | - Edward Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lisa G Spencer
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Neil J McHugh
- Department of Life Sciences, University of Bath, Bath, UK
| | - Robert G Cooper
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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14
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Anderson HT, O'Donnell JL, Tustin P, Steele R. Diagnosis and subtyping of idiopathic inflammatory myopathies: caution required in the use of myositis autoantibodies. Intern Med J 2024; 54:682-686. [PMID: 38444396 DOI: 10.1111/imj.16350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/14/2024] [Indexed: 03/07/2024]
Abstract
Detection of myositis autoantibodies (MAs) has utility in both the diagnosis and subtyping of idiopathic inflammatory myopathies (IIMs). Multiplex assays such as the Euroimmun line immunoassay (LIA) have significant limitations in rare diseases like IIM. A retrospective cohort study was performed on positive MA detected on LIA in 171 patients using the manufacturer's recommended cut-off. Only 16.7% were deemed true positive after clinical correlation. Autoantibody-specific cut-offs were created and applied to the original cohort, along with generically applied higher cut-offs. Positive predictive value (PPV) improved, but there was variable increase in false negatives. False positive MA results are common using LIA, but locally derived cut-offs can improve performance. Clinicians must be aware of the limitations of LIA, which is the commonest method for MA detection in Australasia.
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Affiliation(s)
- Hamish T Anderson
- Canterbury Health Laboratories, Christchurch Hospital, Christchurch, New Zealand
- Awanui Laboratories, Wellington Hospital, Wellington, New Zealand
| | - John L O'Donnell
- Canterbury Health Laboratories, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Tustin
- Awanui Laboratories, Wellington Hospital, Wellington, New Zealand
| | - Richard Steele
- Awanui Laboratories, Wellington Hospital, Wellington, New Zealand
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15
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Bennett R, Bradley K, Stevanovic M, McFadden JR, Chaudhari AS, Ramos-Rodriguez AJ, Yan S, Momtahen S, LeBlanc RE, Cloutier JM, Salem I, Grand DG, Hodson EL, Sriharan A. Anti-PL-7, anti-Ro/SSA, anti-Mi-2, and anti-TIF1-γ correlate with specific patterns of histopathologic features in dermatomyositis: An analysis of 39 skin biopsy specimens from 25 patients. J Cutan Pathol 2024; 51:317-326. [PMID: 38158735 DOI: 10.1111/cup.14578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND In dermatomyositis (DM), myositis-specific and myositis-associated antibodies have been correlated with clinical features. It is unknown if histopathologic findings in lesional skin biopsies correlate with serologic subtypes of DM. METHODS A retrospective chart review of patients with DM was performed. Patients with myositis antibodies and DM lesional skin biopsies were included in the study. Skin biopsies were reviewed by blinded dermatopathologists for 20 histopathologic features. RESULTS There was a statistically significant (p < 0.05) association between anti-PL-7 serology and decreased degree of vacuolar degeneration, necrotic keratinocytes, and thickening of the epidermal basement membrane. Anti-aminoacyl tRNA synthetase (anti-ARS) antibodies had the same significant negative association with degree of vacuolar degeneration, necrotic keratinocytes, and thickening of the epidermal basement membrane. A similar pattern was seen with an anti-cytoplasmic serology; where there was a significant association with an increased degree of vacuolar degeneration and necrotic keratinocytes, and a nonsignificant trend of minimally thickened epidermal basement membrane. There was a statistically significant association between anti-Ro/SSA serology and increased degree of vacuolar degeneration. Anti-TIF1-γ serology was significantly associated with the increased presence of necrotic keratinocytes and pigment incontinence, and displayed a pattern of increased neutrophils. There was a significant association between anti-Mi-2 antibodies and pigment incontinence, as well as between myositis-specific antibodies and pigment incontinence. A statistically significant positive association was found between nuclear antibodies and degree of vacuolar degeneration, thickened epidermal basement membrane, pigment incontinence, and epidermal atrophy. CONCLUSION In patients with DM, some specific serotypes, including anti-PL-7, anti-Ro/SSA, anti-Mi-2, and anti-TIF1-γ, may have characteristic histopathologic features.
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Affiliation(s)
- Raven Bennett
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | | | | | - Jason R McFadden
- National Institutes of Health, National Human Genome Research Institute, Undiagnosed Diseases Program, Rockville, Maryland, USA
| | | | - Alvaro J Ramos-Rodriguez
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Shaofeng Yan
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Shabnam Momtahen
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Robert E LeBlanc
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jeffrey M Cloutier
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Iman Salem
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - David G Grand
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Emma L Hodson
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Aravindhan Sriharan
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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16
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Yang B, Liu S, Qian Z, Tong Z. Predicting the death of patients with anti-melanoma differentiation-associated protein-5-positive dermatomyositis-associated interstitial lung disease: A systematic review and meta-analysis. Mod Rheumatol 2024; 34:541-550. [PMID: 37364274 DOI: 10.1093/mr/road042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES To investigate the risk factors for death in anti-melanoma differentiation-associated protein-5-positive dermatomyositis-associated interstitial lung disease (ILD). METHODS Studies were identified by searching PubMed, Embase, Web of Science, and Cochrane Library. We calculated pooled risk ratios (RRs) or standardized mean differences (SMDs) and 95% confidence intervals (CIs) using random-effects models. RESULTS Twenty studies were selected. Factors that may increase death risk included older age (SMD: 0.62, 95% CI: 0.42-0.81), elevated Krebs von den Lungen-6 (SMD: 0.66, 95% CI: 0.47-0.86), lactate dehydrogenase (SMD: 0.87, 95% CI: 0.72-1.02), C-reactive protein (SMD: 0.62, 95% CI: 0.44-0.80), ferritin (SMD: 0.93, 95% CI: 0.71-1.15), creatine kinase (SMD: 0.28, 95% CI: 0.13-0.44), neutrophil (SMD: 0.34, 95% CI: 0.04-0.64), neutrophil-to-lymphocyte ratio (SMD: 0.52, 95% CI: 0.24-0.79), aspartate aminotransferase (SMD: 0.70, 95% CI: 0.45-0.94), shorter disease duration (SMD: -0.44, 95% CI: -0.67 to -0.21), rapidly progressive ILD (RR: 4.08, 95% CI: 3.01-5.54), fever (RR: 1.98, 95% CI: 1.46-2.69), dyspnoea (RR: 1.63, 95% CI: 1.32-2.02), and anti-Ro52 antibody positive (RR: 1.28, 95% CI: 1.11-1.49). Female (RR: 0.86, 95% CI: 0.78-0.94), increased albumin (SMD: -1.20, 95% CI: -1.76 to -0.64), lymphocyte (SMD: -0.49, 95% CI: -0.67 to -0.30), and arthralgia (RR: 0.53, 95% CI: 0.37-0.78) were protective factors. CONCLUSION Older age, shorter disease duration, rapidly progressive ILD, fever, dyspnoea, anti-Ro52 antibody positive, and some inflammatory markers were risk factors for death in patients with anti-melanoma differentiation-associated protein-5-positive dermatomyositis-associated ILD.
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Affiliation(s)
- Baolu Yang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Suying Liu
- Department of Rheumatology and Clinical Immunology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhenbei Qian
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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17
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Cassard L, Seraly N, Riegert M, Patel A, Fernandez AP. Dermatomyositis: Practical Guidance and Unmet Needs. Immunotargets Ther 2024; 13:151-172. [PMID: 38464459 PMCID: PMC10924937 DOI: 10.2147/itt.s381472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Dermatomyositis is a heterogeneous idiopathic inflammatory myopathy associated with various cutaneous manifestations and variable presence of myositis, interstitial lung disease, and other visceral organ involvement. An accurate diagnosis of dermatomyositis requires correlating clinical examination findings with serological and histological findings. Familiarity with pathognomonic and common cutaneous manifestations of dermatomyositis, which are highlighted here, can be especially helpful in making an accurate diagnosis. Additionally, evaluating patients for presence of myositis-specific autoantibodies can further support or refute a dermatomyositis diagnosis. When present, myositis-specific autoantibodies can also help guide workups for various dermatomyositis-associated manifestations, as each is associated with relatively distinct clinical characteristics. Evaluating patients for various systemic manifestations often relies on expert opinion recommendations; however, societal guideline statements concerning the evaluation of some manifestations have recently been described. Although malignancy-associated dermatomyositis is a well-accepted subtype, there is limited evidence to support extensive malignancy screening has a favorable benefit-risk ratio in most dermatomyositis patients. However, recent research has uncovered novel associations between dermatomyositis and malignancy, suggesting the possibility of identifying high-risk subsets of dermatomyositis patients in whom malignancy screening may have a high value. Treatment for dermatomyositis has remained largely unchanged over the past several decades. Although many dermatomyositis patients can be effectively treated with current options, either as monotherapy or with combination regimens, there is a need for more targeted and effective DM therapies, in general, and for MDA5(+) dermatomyositis-associated rapidly progressive interstitial lung disease. Fortunately, significant current and emerging research activities evaluating various novel medications for dermatomyositis provide hope for exciting future advances in patients with this intriguing immune-mediated disease.
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Affiliation(s)
- Lydia Cassard
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Noelle Seraly
- Department of Dermatology, Cleveland Clinic, Cleveland, OH, USA
| | - Maureen Riegert
- Department of Dermatology, Rush University, Chicago, IL, USA
| | - Aditi Patel
- Department of Rheumatology, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, OH, USA
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Berger M, Zimmermann M, Kreuter M, Strunk J, Windisch W, Höppner J, Plath I, Schumacher F. [Pulmonary involvement in idiopathic inflammatory myopathies]. Pneumologie 2024; 78:167-179. [PMID: 37647917 DOI: 10.1055/a-2129-3575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Idiopathic inflammatory myopathies are rare systemic diseases with different types of pulmonary manifestations depending on the underlying aetiology; here, interstitial lung diseases (ILD) are the most frequently found patterns depending on the underlying disorder. There is a lack of sufficient prospective studies on this heterogeneous group of patients, particularly in case of ILD being involved. The diagnosis is based upon guideline recommendations for ILD and requires a multidisciplinary discussion within a team with specific expertise in this field. Myositis specific antibodies and myositis associated antibodies form an essential part of the diagnostic tools and may also be associated with a certain phenotype or disease progression. Anti-t-RNA-synthetase antibodies (Anti-ARS) and anti-melanoma differentiation-associated gene 5 antibodies (MDA5) play an important clinical role for treatment the estimation of response and prognosis. The most common ILD patterns are nonspecific interstitial pneumonia (NSIP) and organising pneumonia (OP) or a mixed pattern of both. Treatment is based on systemic steroids and early initiation of other immunosuppressant drugs. Evidence for this is, however, sparse, since most of the studies having investigated treatment modalities are of retrospective nature, even though some new prospective data may be useful for the establishment of treatment pathways in the future.
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Affiliation(s)
- Melanie Berger
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
- Lehrstuhl für Pneumologie, Universität Witten/Herdecke Fakultät für Gesundheit, Köln, Deutschland
| | - Maximilian Zimmermann
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
- Lehrstuhl für Pneumologie, Universität Witten/Herdecke Fakultät für Gesundheit, Köln, Deutschland
| | - Michael Kreuter
- Lungenzentrum Mainz, Klinik für Pneumologie, ZFT, Universitätsmedizin Mainz, und Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz, Mainz, Deutschland
| | - Johannes Strunk
- Klinik für Rheumatologie, Krankenhaus Porz am Rhein gGmbH, Köln, Deutschland
| | - Wolfram Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
- Lehrstuhl für Pneumologie, Universität Witten/Herdecke Fakultät für Gesundheit, Köln, Deutschland
| | - Jakob Höppner
- Lehrstuhl für Pneumologie, Universität Witten/Herdecke Fakultät für Gesundheit, Köln, Deutschland
| | - Ilka Plath
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - Falk Schumacher
- Lehrstuhl für Pneumologie, Universität Witten/Herdecke Fakultät für Gesundheit, Köln, Deutschland
- Klinik für Rheumatologie, Krankenhaus Porz am Rhein gGmbH, Köln, Deutschland
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19
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Xing X, Gan Y, Mo W, Zhang J, Wang N, Zhang K, Ma K, Zhang L, Ma L, Lu D, Li Y, He J. Clinical and immunological characteristics and prognosis of patients with autoantibody negative dermatomyositis: a case control study. Clin Rheumatol 2024; 43:1145-1154. [PMID: 38326675 DOI: 10.1007/s10067-024-06873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/21/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Myositis-specific antibodies (MSAs) and myositis-associated antibodies (MAAs) are associated with distinctive dermatomyositis (DM) clinical phenotypes. The aim of this study is to explicate the clinical and immunological features of MSAs-negative DM patients. METHODS A total of 515 individuals diagnosed with DM was screened from 2013 to 2022 and 220 DM patients were enrolled in this retrospective cohort. Clinical and laboratory data of these patients were analyzed. RESULTS MSAs-negative DM patients were categorized into two groups: MAAs-negative (MSAs (-)/MAAs (-)) group and MAAs-positive (MSAs (-)/MAAs (+)) group. The percentage of Raynaud's phenomenon (P=0.026) was higher in the MSAs (-)/MAAs (+) DM patients than the MSAs-positive DM patients and MSAs (-)/MAAs (-) DM patients. The proportion of rapidly progressive interstitial lung disease (RP-ILD) in the MSAs-negative DM patients was lower than that in the MSAs-positive group. The MSAs (-)/MAAs (+) group had a higher proportion of organizing pneumonia and usual interstitial pneumonia (P=0.011), and elevated eosinophils in their bronchoalveolar lavage fluid (P=0.008). Counts of lymphocytes (P=0.001) and CD16+CD56+ natural killer (NK) cells (P=0.012) were higher in the MSAs-negative group. Additionally, the percentage of CD4+TNFα+ (P=0.040), CD4+IFNγ+ (P=0.037), and CD4+IL-2+ (P=0.018) cells among total CD4+ T cells were higher in the MSA-negative DM patients compared with the MSAs-positive DM patients. Besides, MSAs-negative patients demonstrated a more favorable prognosis than MSAs-positive patients. Multivariable regression analysis identified advanced onset age, higher level of carcinoembryonic antigen (CEA), and RP-ILD as risk factors for mortality in DM patients. CONCLUSIONS Compared with MSAs-positive group, MSAs-negative DM patients suffered less from organ involvement compared with MSAs-positive group and tend to have better prognosis. Key Points MSAs-negative DM patients exhibited distinct characteristics in comparison with MSAs-positive DM patients: • The MSAs (-)/MAAs (+) DM patients demonstrated a higher prevalence of organizing pneumonia (OP) and usual interstitial pneumonia (UIP), and elevated eosinophil counts in bronchoalveolar lavage fluid. • CEA levels were lower in MSAs-negative patients compared with MSAs-positive patients. • Elevated counts of lymphocytes and CD16+CD56+ NK cells were identified in the MSAs-negative patients. Additionally, proportions of CD4+TNFα+, CD4+IFNγ+, and CD4+IL-2+ cells among total CD4+ T cells were higher in the MSAs-negative DM patients compared with DM MSAs-positive DM patients. • MSAs-negative DM patients had a more favorable prognosis than MSAs-positive DM patients. A multivariable regression analysis revealed the advanced onset age, high CEA levels, and RP-ILD were risk factors for mortality in DM patients.
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Affiliation(s)
- Xiaoyan Xing
- Department of Rheumatology and Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, 100044, China
- Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Yuzhou Gan
- Department of Rheumatology and Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, 100044, China
- Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Wanxing Mo
- Department of Rheumatology and Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, 100044, China
- Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Jian Zhang
- Department of Rheumatology and Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, 100044, China
- Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Naidi Wang
- Department of Rheumatology and Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, 100044, China
- Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Kai Zhang
- Department of Rheumatology and Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, 100044, China
- Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Ke Ma
- Department of Rheumatology and Immunology, Peking University People's Hospital, Qingdao, 266111, Shandong Province, China
| | - Lihua Zhang
- Department of Rheumatology, Hulunbeier People's Hospital, Hulunbuir, 021008, Inner Mongolia, China
| | - Lin Ma
- Department of Rheumatology, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, 050200, Hebei Province, China
| | - Dan Lu
- Institute of Systems Biomedicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Yuhui Li
- Department of Rheumatology and Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, 100044, China.
- Center of Clinical Immunology, Peking University, Beijing, 100044, China.
| | - Jing He
- Department of Rheumatology and Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, 100044, China.
- Center of Clinical Immunology, Peking University, Beijing, 100044, China.
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20
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Fujisaki M, Kasamatsu H, Nishimura K, Yoshida Y, Muneishi Y, Yamaguchi T, Nishino I, Konishi R, Ichimura Y, Okiyama N, Oyama N, Hasegawa M. A case of anti-SAE1/2 antibody-positive dermatomyositis with extensive panniculitis: A possible cutaneous manifestation of treatment resistance. J Dermatol 2024; 51:301-306. [PMID: 37830399 DOI: 10.1111/1346-8138.17000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
Dermatomyositis constitutes a heterogeneous group of autoimmune inflammatory conditions with a wide variety of clinical outcomes. The symptomatic heterogeneity carries skin, muscle, and joint manifestations; pulmonary and cardiac involvements; and concomitant malignancy. Any of these symptoms often appear at different combinations and time courses, thus posing difficulty in early diagnosis and appropriate treatment choice. Recent progress in laboratory investigations explored the identification of several myositis-specific autoantibodies (MSAs) and myositis-associated autoantibodies, allowing precise characterization for a clinical perspective of the disease. MSAs can be detectable in approximately 80% of patients with whole dermatomyositis, some of which closely reflect unique clinical features in the particular disease subset(s), including the distribution and severity of organ involvement, treatment response, and prognosis. However, only limited evidence has been available in dermatomyositis-associated panniculitis, mostly that in anti- melanoma differentiation-associated protein 5 antibody-positive disease. We present a rare case of a patients with dermatomyositis with extensive panniculitis on the trunk whose serum IgG autoantibodies reacted with both subunits of small ubiquitin-like modifier activating enzymes (SAEs), SAE1 and SAE2. The onset of panniculitis coincided with increased disease activity, including disease-related skin manifestations, fever, dysphagia, and muscle weakness in the extremities. These symptoms responded well to a high dose of systemic steroid, but even upon receiving a high-dose intravenous immunoglobulin, the panniculitic lesions and pruritic erythema flared with tapering of steroid dose, further requiring tacrolimus and mycophenolate mofetil to achieve disease remission. To our knowledge, this is the third reported case of anti-SAE autoantibody-positive dermatomyositis with panniculitis. We aim to extend the understanding of the current limitation and further perspective in the clinical management of the extremely rare skin manifestation associated with dermatomyositis.
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Affiliation(s)
- Misako Fujisaki
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroshi Kasamatsu
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kentarou Nishimura
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yasuyuki Yoshida
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoriko Muneishi
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tomohisa Yamaguchi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Risa Konishi
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Ichimura
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoko Okiyama
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noritaka Oyama
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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21
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Zhen C, Zhao B, He J, Wei L, Yan C, Dai T, Hou Y. Myofascial edema of gastrocnemius: A prominent MRI characteristic in dermatomyositis patients with anti-transcriptional intermediate factor 1-γ antibody. CNS Neurosci Ther 2024; 30:e14647. [PMID: 38385674 PMCID: PMC10883095 DOI: 10.1111/cns.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/28/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
AIMS This study was designed to evaluate the magnetic resonance imaging (MRI) patterns of the lower limb muscles in dermatomyositis (DM) with anti-transcriptional intermediate factor 1-γ (anti-TIF1-γ) antibody. METHODS This retrospective, observational, cross-sectional study enrolled 12 adult DM patients with anti-TIF1-γ antibody. Muscles were assessed for fascial edema, subcutaneous-tissue edema, muscle edema, and fatty replacement. These features were analyzed in relation to clinical characteristics. RESULTS All 12 patients underwent hip and thigh MRI, and 8 completed calf MRI. All patients showed myofascial edema, muscle edema, and fatty replacement, and 8 out of 12 further exhibited subcutaneous-tissue edema. Specifically, myofascial edema of the gastrocnemius was observed in all patients (8/8). The vastus intermedialis and vastus lateralis muscles showed the most severe muscle edema, whereas the caput breve of the biceps femoris, semitendinosus, and soleus muscles exhibited the most severe fatty replacement. Although only 1 patient exhibited asymmetric muscle weakness, 9 showed asymmetric muscle edema, and 10 showed asymmetric fatty replacement. Changes in muscle edema positively correlated with creatine kinase (CK) levels. CONCLUSIONS Myofascial edema of gastrocnemius was a prominent characteristic of anti-TIF1-γ-positive DM. Early detection of muscle edema, as well as CK levels, may be helpful for monitoring disease activity.
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Affiliation(s)
- Chao Zhen
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
- Department of Neurology, Qingdao HospitalUniversity of Health and Rehabilitation Sciences (Qingdao Municipal Hospital)QingdaoChina
| | - Bing Zhao
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
| | - Jingzhen He
- Department of RadiologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Li Wei
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
| | - Chuanzhu Yan
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
- Department of Central Laboratory and Mitochondrial Medicine Laboratory, Qilu Hospital (Qingdao), Cheeloo College of MedicineShandong UniversityQingdaoChina
- Brain Science Research Institute, Shandong UniversityJinanChina
| | - Tingjun Dai
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
| | - Ying Hou
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
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22
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Sun T, Hu ZH, He JS, Chen YC, Gao YX. A Case of Dermatomyositis with Coexistence of Positive Anti-MDA5 Antibodies and Anti-SSA/RO52 Antibodies, Combined with Necrotic Skin Ulcers. Int Med Case Rep J 2024; 17:9-15. [PMID: 38205150 PMCID: PMC10778195 DOI: 10.2147/imcrj.s441691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
Background Dermatomyositis (DM) is an idiopathic inflammatory myopathy that is clinically challenging to diagnose and has a poor prognosis. It is characterized by symmetric proximal muscle weakness, muscle tenderness, dysphagia, characteristic skin rash (heliotrope rash, Gottron's sign), elevated muscle enzyme levels, abnormal electromyography, and muscle biopsy findings. DM with positive anti-MDA5 antibodies is mainly characterized by Gottron's sign, skin ulcers, facial erythema, mechanic's hands, and V-sign. In this case, the patient presented with the rare manifestation of severe necrotic skin ulcers in association with Gottron's sign, prompting us to report this case. Case Presentation A 45-year-old female was admitted to the hospital with systemic joint pain, fatigue, multiple ulcers, and purulent discharge on both hands. Her myositis-specific antibody profile revealed positive anti-MDA5 and anti-SSA/RO52 antibodies. Treatment included a combination of glucocorticoids, immunosuppressants, gastric and liver protection, infection control, and wound care. After two weeks of treatment, the patient showed improvement in symptoms. However, on the 24th day of hospitalization, the wound at the right elbow joint ruptured and became infected, requiring debridement and skin grafting in the appropriate department. Conclusion There has been limited research and reported cases of dermatomyositis with coexistence of positive anti-MDA5 and anti-SSA/RO52 antibodies combined with severe skin ulcers. Therefore, we present this rare case and emphasize the need for close follow-up on pulmonary involvement and skin ulcer progression, as well as timely implementation of new treatment strategies to actively improve the prognosis.
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Affiliation(s)
- Tian Sun
- Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Zhong Hao Hu
- Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Jin Shi He
- Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Yu Chi Chen
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People’s Republic of China
| | - Yong Xiang Gao
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People’s Republic of China
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23
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Diaz-Menindez M, Sullivan MM, Wang B, Majithia V, Abril A, Butendieck RR, Ball CT, Berianu F. Dermatomyositis in Association With SARS-CoV-2 Infection or COVID-19 Vaccine. Arthritis Care Res (Hoboken) 2024; 76:98-104. [PMID: 37728071 DOI: 10.1002/acr.25236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE New-onset and relapsed dermatomyositis (DM) has been reported following SARS-CoV-2 infection or COVID-19 vaccination. This study aims to show the characteristics of a DM cohort after COVID-19 infection and vaccination. METHODS A retrospective review was performed on patients treated for DM between March 1, 2020, and October 31, 2022. Charts were evaluated for the presence of new-onset DM or relapse of preexisting DM following either SARS-CoV-2 infection or COVID-19 vaccination. Data on symptom onset, timing of vaccination, type of vaccination, and disease characteristics were collected. RESULTS Ninety-eight patients treated for DM at our institution in the Division of Rheumatology were included. In total, 12 of 98 patients (12.2%) experienced DM symptoms (either incident or relapse) following either infection or vaccination. Of the 12 patients who developed incident disease or relapse, 7 (58.3%) developed postinfection symptoms, and 8 (66.7%) developed symptoms after vaccination (3 patients had symptoms following both infection and vaccination). The mean onset of symptoms following COVID-19 infection was 3.2 days (median 0.5 days), and mean onset following COVID-19 vaccination was 5.75 days (median 3.5 days). Nine of 12 patients (75%) had a positive myositis-specific antibody, and the remaining 3 (25%) had myositis-associated antibodies. There was no predominant vaccine associated with the development of postvaccination DM symptoms. CONCLUSION This retrospective review revealed a strong temporal relationship between DM symptoms and COVID-19 infection or vaccination in 12.2% of all patients with DM evaluated in our clinic during the pandemic. Additional studies are required to understand the possible pathophysiology behind this association.
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Aouintia I, Daly W, Lakhoua G, Kaabi W, Charfi O, Debbeche S, Kastalli S, Zaiem A, El Aidli S. Development of Dermatomyositis after Pfizer BioNTeh COVID-19 Vaccine: A Case Report. Curr Drug Saf 2024; 19:306-308. [PMID: 37317919 DOI: 10.2174/1574886318666230614164607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/08/2023] [Accepted: 05/01/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The Coronavirus Disease 2019 (COVID-19) pandemic led to the fast development of vaccines, which is considered a medical advance in healthcare. With the extensive vaccination campaign performed worldwide, many adverse events following immunization (AEFI) were reported. Most of them were flu-like symptoms, mild and self-limiting. However, serious adverse events, such as dermatomyositis (DM), an idiopathic autoimmune connective tissue disease, have also been reported. CASE PRESENTATION In this report, we describe a case of skin erythema, edema, and diffuse myalgia attributed at first to Pfizer BioNTeh, COVID-19 vaccination, given the temporal relationship and the absence of significant medical history. The causality assessment score was I1B2. However, after completing the etiological assessment, an invasive breast carcinoma was identified, and we retained the diagnosis of paraneoplastic DM. CONCLUSION This study underlines the importance of completing the etiological assessment before attributing any adverse reaction to vaccination to maintain optimal patient care.
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Affiliation(s)
- Imen Aouintia
- Department of Service D'analyse et de Recueil des Données, Centre National de Pharmacovigilance, Tunis, Tunisie
- Unité de Recherche: Faculté de Médecine, Université Tunis El Manar, UR17ES12, Tunis, Tunisie
| | - Wiem Daly
- Department of Service D'analyse et de Recueil des Données, Centre National de Pharmacovigilance, Tunis, Tunisie
| | - Ghozlane Lakhoua
- Department of Service D'analyse et de Recueil des Données, Centre National de Pharmacovigilance, Tunis, Tunisie
- Unité de Recherche: Faculté de Médecine, Université Tunis El Manar, UR17ES12, Tunis, Tunisie
| | - Widd Kaabi
- Department of Service D'analyse et de Recueil des Données, Centre National de Pharmacovigilance, Tunis, Tunisie
- Unité de Recherche: Faculté de Médecine, Université Tunis El Manar, UR17ES12, Tunis, Tunisie
| | - Ons Charfi
- Department of Service D'analyse et de Recueil des Données, Centre National de Pharmacovigilance, Tunis, Tunisie
- Unité de Recherche: Faculté de Médecine, Université Tunis El Manar, UR17ES12, Tunis, Tunisie
| | - Sana Debbeche
- Department of Service D'analyse et de Recueil des Données, Centre National de Pharmacovigilance, Tunis, Tunisie
| | - Sarrah Kastalli
- Department of Service D'analyse et de Recueil des Données, Centre National de Pharmacovigilance, Tunis, Tunisie
- Unité de Recherche: Faculté de Médecine, Université Tunis El Manar, UR17ES12, Tunis, Tunisie
| | - Ahmed Zaiem
- Department of Service D'analyse et de Recueil des Données, Centre National de Pharmacovigilance, Tunis, Tunisie
- Unité de Recherche: Faculté de Médecine, Université Tunis El Manar, UR17ES12, Tunis, Tunisie
| | - Sihem El Aidli
- Department of Service D'analyse et de Recueil des Données, Centre National de Pharmacovigilance, Tunis, Tunisie
- Unité de Recherche: Faculté de Médecine, Université Tunis El Manar, UR17ES12, Tunis, Tunisie
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Oddenino GA, Canepa P, Cozzani E, Gasparini G, Garlaschi A, Roccatagliata L, Schiavetti I, Parodi A. Prevalence of cutaneous manifestations and myositis-specific antibodies in COVID-19 patients and Anti-PL7 antibodies association with pulmonary radiological severity: A retrospective study. Int J Immunopathol Pharmacol 2024; 38:3946320241260295. [PMID: 39052920 PMCID: PMC11282529 DOI: 10.1177/03946320241260295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/22/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Dermatomyositis (DM) is an idiopathic immune-mediated myopathy, and may involve many organs, including muscles, skin and lungs. Myositis-specific autoantibodies (MSAs) are a useful aid in diagnosis DM and identifying its clinical subtype. During the COVID-19 pandemic, several studies found clinical similarities regarding lung involvement in both COVID-19 and DM. Such similarities have prompted speculation of a common pathogenetic mechanism. Indeed, viral infections are well-known triggers of autoimmune diseases. This prompted us to investigate whether circulating MSAs could be markers of the severity of lung involvement and of clinical outcome in COVID-19 patients. Moreover, we investigated the presence of cutaneous signs of DM in COVID-19 patients. METHODS We conducted a retrospective cohort study on 178 hospitalized patients affected by COVID-19. The diagnosis was confirmed by naso-pharyngeal swab positivity for SARS-CoV-2. The severity of lung involvement was assessed by assigning to each patient a radiological score ranging from 1 to 4, based on chest imaging (chest X-rays or CT scans). Serum samples were tested for MSAs. RESULTS Anti-PL-7 antibodies were detected in 10.1% of patients and were found to be associated with an increased risk of severe pulmonary involvement (p = 0.019) and a worse prognosis in COVID-19 patients. Cutaneous lesions were observed in 26.4% of patients. However, none were cutaneous manifestations of DM. CONCLUSIONS The detection of anti-PL7 antibodies might predict severe pulmonary involvement and a worse prognosis in COVID-19 patients.
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Affiliation(s)
- Giorgio Alberto Oddenino
- Section of Dermatology, Dipartimento di Scienze della Salute (DiSSal), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Dermatology Unit, Genoa, Italy
| | - Paola Canepa
- IRCCS Ospedale Policlinico San Martino, Dermatology Unit, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Dipartimento di Scienze della Salute (DiSSal), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Dermatology Unit, Genoa, Italy
| | - Giulia Gasparini
- Section of Dermatology, Dipartimento di Scienze della Salute (DiSSal), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Dermatology Unit, Genoa, Italy
| | - Alessandro Garlaschi
- IRCCS Ospedale Policlinico San Martino, Dermatology Unit, Genoa, Italy
- Section of Radiology, Dipartimento di Scienze della Salute (DiSSal), University of Genoa, Genoa, Italy
| | - Luca Roccatagliata
- IRCCS Ospedale Policlinico San Martino, Dermatology Unit, Genoa, Italy
- Section of Radiology, Dipartimento di Scienze della Salute (DiSSal), University of Genoa, Genoa, Italy
| | - Irene Schiavetti
- Section of Medical Statistics, Dipartimento di Scienze della Salute (DiSSal), University of Genoa, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Dipartimento di Scienze della Salute (DiSSal), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Dermatology Unit, Genoa, Italy
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Mammen AL. Paraneoplastic myopathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:327-332. [PMID: 38494286 DOI: 10.1016/b978-0-12-823912-4.00022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This chapter reviews the association between cancer and the idiopathic inflammatory myopathies (IIM), which includes dermatomyositis (DM), antisynthetase syndrome (ASyS), immune-mediated necrotizing myopathy (IMNM), and inclusion body myositis (IBM). Accumulating evidence shows that the risk of a coexisting malignancy is high in patients with DM, especially among those with anti-Tif1γ autoantibodies. Patients with IMNM and no defined autoantibodies also have an increased risk of malignancy. Recent evidence demonstrates that many IBM patients have increased numbers of circulating CD57+ CD8+ T cells, consistent with a diagnosis of large granular lymphocytic leukemia. In contrast, IMNM patients with anti-SRP or anti-HMGCR autoantibodies as well as patients with ASyS syndrome do not have a definitively increased risk of cancer. Patients who have a cancer treated with one of the immune checkpoint inhibitors can develop myositis (ICI-myositis), sometimes along with myasthenia gravis and/or myocarditis.
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Affiliation(s)
- Andrew L Mammen
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States; Departments of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Tebo AE, Peterson LK, Snyder MR, Lebiedz-Odrobina D. Clinical Significance of Anti-U1 Ribonucleoprotein Antibody Is Analyte Dependent: Implications for Laboratory Reporting, Interpretation, and Interassay Correlations. Arch Pathol Lab Med 2023; 147:1461-1465. [PMID: 36897998 DOI: 10.5858/arpa.2022-0316-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 03/12/2023]
Abstract
CONTEXT.— Antibodies to U1 ribonucleoprotein (U1RNP) were first described more than 50 years ago, and although clinically relevant for antinuclear antibody-associated connective tissue disease (ANA-CTD), test results are challenging to interpret. OBJECTIVE.— To evaluate the impact of anti-U1RNP analyte diversity in the assessment of patients at risk for ANA-CTD. DESIGN.— Two multiplex assays for U1RNP (Smith [Sm]/RNP and RNP68/A) were used to test serum specimens from consecutive patients (n = 498) under evaluation for CTD in a single academic center. Discrepant specimens were further tested for Sm/RNP antibody by enzyme-linked immunosorbent assay and the BioPlex multiplex assay. Data were evaluated for antibody positivity per analyte and their method of detection, correlations between analytes, and impact on clinical diagnoses through retrospective chart review. RESULTS.— Of the 498 patients tested, 47 (9.4%) were positive in the RNP68/A (BioPlex) and 15 (3.0%) were positive in the Sm/RNP (Theradiag) immunoassays. U1RNP-CTD, other ANA-CTD, and no ANA-CTD were diagnosed in 34% (16 of 47), 12.8% (6 of 47), and 53.2% (25 of 47) of the cases, respectively. The prevalence of antibody by method in patients with U1RNP-CTD was 100.0% (16 of 16), 85.7% (12 of 14), 81.5% (13 of 16), and 87.5% (14 of 16) for RNP68/A, Sm/RNP BioPlex, Sm/RNP Theradiag, and Sm/RNP Inova, respectively. For other ANA-CTD and no ANA-CTD, the highest prevalence was observed with RNP68/A; all others had comparable performance. CONCLUSIONS.— In this study, the overall performance characteristics of Sm/RNP antibody assays were comparable; however, the RNP68/A immunoassay was very sensitive but less specific. In the absence of harmonization, reporting the type of U1RNP analyte in clinical testing may be useful in guiding interpretation and interassay correlations.
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Affiliation(s)
- Anne E Tebo
- From the Department of Pathology, University of Utah School of Medicine ARUP Institute for Clinical and Experimental Pathology, Salt Lake City (Tebo, Peterson)
| | - Lisa K Peterson
- From the Department of Pathology, University of Utah School of Medicine ARUP Institute for Clinical and Experimental Pathology, Salt Lake City (Tebo, Peterson)
| | - Melissa R Snyder
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Snyder)
| | - Dorota Lebiedz-Odrobina
- The Department of Internal Medicine, University of Utah Health, Salt Lake City (Lebiedz-Odrobina)
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Demortier J, Vautier M, Chosidow O, Gallay L, Bessis D, Berezne A, Cordel N, Schmidt J, Smail A, Duffau P, Jachiet M, Begon E, Gottlieb J, Chasset F, Graveleau J, Marque M, Cesbron E, Forestier A, Josse S, Kluger N, Beauchêne C, Le Corre Y, Pagis V, Rigolet A, Guillaume-Jugnot P, Authier FJ, Guilain N, Streichenberger N, Leonard-Louis S, Boussouar S, Landon-Cardinal O, Benveniste O, Allenbach Y. Anti-SAE autoantibody in dermatomyositis: original comparative study and review of the literature. Rheumatology (Oxford) 2023; 62:3932-3939. [PMID: 37010495 DOI: 10.1093/rheumatology/kead154] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/26/2023] [Accepted: 03/10/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Among specific autoantibodies in DM, the anti-small ubiquitin-like modifier activating enzyme (SAE) antibody is rare. We aim to describe the clinical characteristics, cancer prevalence, and muscle pathology of anti-SAE-positive DM. METHODS Patients with a diagnosis of DM and sera positive for the anti-SAE antibody were recruited from 19 centres in this retrospective observational study. The available muscular biopsies were reviewed. We conducted a comparison with anti-SAE-negative DM and a review of the literature. RESULTS Of the patients in the study (n = 49), 84% were women. Skin involvement was typical in 96% of patients, with 10% having calcinosis, 18% ulceration and 12% necrosis; 35% presented with a widespread skin rash. Muscular disease affected 84% of patients, with mild weakness [Medical Research Council (MRC) scale 4 (3, 5)], although 39% of patients had dysphagia. Muscular biopsies showed typical DM lesions. Interstitial lung disease was found in 21% of patients, mainly with organizing pneumonia pattern, and 26% of patients showed dyspnoea. Cancer-associated myositis was diagnosed in 16% of patients and was responsible for the majority of deaths, its prevalence being five times that of the general population. IVIG therapy was administered to 51% of the patients during the course of the disease. Comparison with anti-SAE-negative DM (n = 85) showed less and milder muscle weakness (P = 0.02 and P = 0.006, respectively), lower creatinine kinase levels (P < 0.0001) and less dyspnoea (P = 0.003). CONCLUSION Anti-SAE positive DM is a rare subgroup associated with typical skin features but a potentially diffuse rash, a mild myopathy. Interstitial lung disease defines an organizing pneumonia pattern. Cancer associated DM prevalence is five times that of the general population. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT04637672.
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Affiliation(s)
- Juliette Demortier
- Department of Dermatology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - Mathieu Vautier
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Olivier Chosidow
- Department of Dermatology, Henri Mondor University Hospital, Université Paris-Est Créteil, AP-HP, Créteil, France
| | - Laure Gallay
- Department of Internal Medicine and Clinical Immunology, Edouard Herriot University Hospital, Claude Bernard University Lyon1, Lyon, France
| | - Didier Bessis
- Department of Dermatology, University Hospital Center of Montpellier, Montpellier, France
| | - Alice Berezne
- Department of Internal Medicine, CHR Annecy-Genevois, Annecy, France
| | - Nadège Cordel
- Department of Dermatology and Clinical Immunology, Guadeloupe University Hospital, Pointe-à-Pitre, Guadeloupe and Normandie University, UNIROUEN, IRIB, Inserm, U1234, Rouen, France
| | - Jean Schmidt
- Department of Internal Medicine and Clinical Immunology, Amiens-Picardie Nord University Hospital, Amiens, France
| | - Amar Smail
- Department of Internal Medicine and Clinical Immunology, Amiens-Picardie Nord University Hospital, Amiens, France
| | - Pierre Duffau
- Department of Internal Medicine, Saint André, Bordeaux University Hospital, Bordeaux, France
| | - Marie Jachiet
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris, France
| | - Edouard Begon
- Department of Dermatology, René Dubos Hospital, Pontoise, France
| | - Jeremy Gottlieb
- Department of Internal Medicine and Clinical Immunology, Bicêtre Hospital, Université Paris-Sud, AP-HP, Le Kremlin-Bicêtre Cedex, France
| | - François Chasset
- Department of Dermatology, Tenon Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Julie Graveleau
- Department of Internal Medicine, CH de St Nazaire, St Nazaire, France
| | - Myriam Marque
- Department of Dermatology, Caremeau Hospital, Nîmes University Hospital, Nîmes, France
| | - Elise Cesbron
- Department of Dermatology, Le Mans Hospital Center, Le Mans, France
| | - Amandine Forestier
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Séverine Josse
- Department of Internal Medicine and Clinical Immunology, Dieppe Hospital, Dieppe, France
| | - Nicolas Kluger
- Department of Dermatology, Helsinki University Hospital, Helsinki, Finland
| | | | - Yannick Le Corre
- Department of Dermatology, Angers University Hospital, Angers, France
| | - Valentine Pagis
- Department of Internal Medicine and Clinical Immunology, Beaujon Hospital, AP-HP, Paris, France
| | - Aude Rigolet
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Perrine Guillaume-Jugnot
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - François-Jérôme Authier
- Department of Pathology, Henri-Mondor University Hospital, Institut Mondor de Recherche Biomédicale, INSERM, Centre de Reference pour les Maladies Neuromusculaires of Nord-Est-Île de France, Université Paris-Est Créteil, AP-HP, Créteil, France
| | - Nelly Guilain
- Department of Pathology, Amiens Picardie University Hospital, Amiens, France
| | | | - Sarah Leonard-Louis
- Neuropathology Department, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Samia Boussouar
- ICT Cardiothoracic Imaging Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre Hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
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Waisayarat J, Wongsuwan P, Tuntiseranee K, Waisayarat P, Dejthevaporn C, Khongkhatithum C, Soponkanaporn S. Sarcoplasmic Myxovirus Resistance Protein A: A Study of Expression in Idiopathic Inflammatory Myopathy. J Inflamm Res 2023; 16:5417-5426. [PMID: 38026261 PMCID: PMC10676103 DOI: 10.2147/jir.s433239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases affecting primarily proximal muscles. Major subtypes include dermatomyositis, polymyositis, inclusion body myositis, immune-mediated necrotizing myopathy and antisynthetase syndrome. Overexpression of sarcoplasmic myxovirus-resistance protein A (MxA) has been observed in muscle biopsy specimens of dermatomyositis but is rarely seen in other subtypes of IIM and other myopathies. Objective We evaluate the expression of sarcoplasmic MxA and its diagnostic value in IIM and other myopathies. Methods One hundred and thirty-eight muscle biopsy specimens with the diagnosis of IIM and other myopathies from 2011 to 2020 were reviewed and stained for MxA by immunohistochemistry. The difference of the expression of MxA between IIM and other myopathies was analyzed by Fisher's exact test, and the sensitivity and specificity of MxA immunohistochemistry in the diagnosis of IIM were assessed. Results MxA protein was positive in 16/138 (11.6%) specimens. All 12 dermatomyositis specimens positive for MxA protein were positive in perifascicular area pattern. Only dermatomyositis specimens had a significantly higher percentage of positive sarcoplasmic MxA expression than specimens of other subtypes of IIM (p<0.001). Sarcoplasmic MxA expression for dermatomyositis diagnosis had a sensitivity of 46.15% (95% CI 26.59-66.63%) and a specificity of 94.44% (95% CI 81.34-99.32%) with the positive and negative likelihood ratio of 8.31 (95% CI 2.03-34.01) and 0.57 (95% CI 0.40-0.82), respectively. Conclusion The MxA immunohistochemistry is highly specific for dermatomyositis and should be added to a routine inflammatory panel of muscle biopsy. MxA expression should be cautiously interpreted to avoid pitfalls.
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Affiliation(s)
- Jariya Waisayarat
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phumin Wongsuwan
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Phu Waisayarat
- Faculty of Medicine, King Mongkut’s Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Charungthai Dejthevaporn
- Division of Neurology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiyos Khongkhatithum
- Division of Neurology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirisucha Soponkanaporn
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Liu Y, Feng S, Liu X, Tang Y, Li X, Luo C, Tao J. IFN-beta and EIF2AK2 are potential biomarkers for interstitial lung disease in anti-MDA5 positive dermatomyositis. Rheumatology (Oxford) 2023; 62:3724-3731. [PMID: 36912714 DOI: 10.1093/rheumatology/kead117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/03/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE DM with positive anti-melanoma differentiation-related gene 5 (MDA5) antibody is an autoimmune disease with multiple complications. Interstitial lung diseases (ILDs) are significantly associated with DM and are particularly related to MDA5+ DM. This article aims to explore potential molecular mechanisms and develop new diagnostic biomarkers for MDA5+ DM-ILD. METHODS The series matrix files of DM and non-specific interstitial pneumonia (NSIP) were downloaded from the Gene Expression Omnibus (GEO) database to identify the differentially expressed genes (DEGs). Gene set enrichment analysis (GSEA) was used to screen the common enriched pathways related to DM and NSIP. Next, the co-expressed differential expressed genes (co-DEGs) between MDA5+, MDA5- and NSIP groups were identified by Venn plots, and then selected for different enrichment analyses and protein-protein interaction (PPI) network construction. The mRNA expression levels of IFN-beta and EIF2AK2 were measured by RT-qPCR. The protein expression levels of IFN-beta were measured by ELISA. RESULTS Using GSEA, the enriched pathway 'herpes simplex virus 1 infection' was both up-regulated in DM and NSIP. Enrichment analysis in MDA5+ DM, MDA5- DM and NSIP reported that the IFN-beta signalling pathway was an important influencing factor in the MDA5+ DM-ILD. We also identified that eukaryotic translation initiation factor 2 alpha kinase 2 (EIF2AK2) was an important gene signature in the MDA5+ DM-ILD by PPI analysis. The expression levels of IFN-beta and EIF2AK2 were significantly increased in MDA5+ DM-ILD patients. CONCLUSIONS IFN-beta and EIF2AK2 contributed to the pathogenesis of MDA5+ DM-ILD, which could be used as potential therapeutic targets.
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Affiliation(s)
- Yiming Liu
- Division of Life Sciences and Medicine, Department of Rheumatology and Immunology, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Hefei, PR China
| | - Shuo Feng
- Division of Life Sciences and Medicine, Stroke Center and Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Hefei, PR China
| | - Xingyue Liu
- Division of Life Sciences and Medicine, Department of Rheumatology and Immunology, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Hefei, PR China
| | - Yujie Tang
- Division of Life Sciences and Medicine, Department of Rheumatology and Immunology, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Hefei, PR China
| | - Xiaoling Li
- Division of Life Sciences and Medicine, Department of Rheumatology and Immunology, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Hefei, PR China
| | - Chengyu Luo
- Division of Life Sciences and Medicine, Department of Rheumatology and Immunology, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Hefei, PR China
| | - Jinhui Tao
- Division of Life Sciences and Medicine, Department of Rheumatology and Immunology, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Hefei, PR China
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Khoo T, Lilleker JB, Thong BYH, Leclair V, Lamb JA, Chinoy H. Epidemiology of the idiopathic inflammatory myopathies. Nat Rev Rheumatol 2023; 19:695-712. [PMID: 37803078 DOI: 10.1038/s41584-023-01033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/08/2023]
Abstract
The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of systemic autoimmune diseases that affect the skeletal muscles and can also involve the skin, joints, lungs and heart. The epidemiology of IIM is obscured by changing classification criteria and the inherent shortcomings of case identification using healthcare record diagnostic coding. The incidence of IIM is estimated to range from 0.2 to 2 per 100,000 person-years, with prevalence from 2 to 25 per 100,000 people. Although the effects of age and gender on incidence are known, there is only sparse understanding of ethnic differences, particularly in indigenous populations. The incidence of IIM has reportedly increased in the twenty-first century, but whether this is a genuine increase is not yet known. Understanding of the genetic risk factors for different IIM subtypes has advanced considerably. Infections, medications, malignancy and geography are also commonly identified risk factors. Potentially, the COVID-19 pandemic has altered IIM incidence, although evidence of this occurrence is limited to case reports and small case series. Consideration of the current understanding of the epidemiology of IIM can highlight important areas of interest for future research into these rare diseases.
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Affiliation(s)
- Thomas Khoo
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neuroscience, Manchester Academic Health Science Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Valérie Leclair
- Department of Medicine, Division of Rheumatology, McGill University, Montreal, Canada
| | - Janine A Lamb
- Epidemiology and Public Health Group, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
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Beam MJ, Montgomery A, Anastasiou C, Schmajuk G. Association between self-reported race and ethnicity and myositis-specific autoantibodies in a diverse cohort of patients with inflammatory myopathy. Clin Rheumatol 2023; 42:3043-3047. [PMID: 37542130 PMCID: PMC10587270 DOI: 10.1007/s10067-023-06719-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
Myositis-specific autoantibodies (MSAs) are highly specific biomarkers for idiopathic inflammatory myopathies (IIMs). We investigated whether self-reported race and ethnicity were associated with the presence of specific MSAs. Charts of patients with IIM seen at 3 large healthcare systems in the same US city were reviewed. Demographic data and MSA test results were abstracted. Associations between race and ethnicity and presence of MSAs were analyzed using bivariate analysis and further characterized using separate unadjusted and adjusted logistic regression models. One hundred twenty-one subjects were included (19% Asian, 10% Black or African American, 27% Latinx or Hispanic, 36% non-Hispanic White, and 7% Other). In a bivariate analysis, anti-Jo-1 and anti-MDA5 autoantibodies were associated with race and ethnicity (p = 0.03 and 0.02, respectively). Black or African American subjects had increased odds of a positive anti-Jo-1 result compared to non-Hispanic White subjects on unadjusted logistic regression analysis (OR 8.61, 95% CI 1.61-46.07), although after adjustment for age and gender this finding was not significant. Subjects categorized as Other had increased odds of a positive anti-MDA5 result compared to non-Hispanic White subjects on both unadjusted (OR 55.0, 95% CI 2.02-1493) and adjusted analyses (OR 44.8, 95% CI 1.55-1298). Anti-Jo-1 and anti-MDA5 autoantibodies were significantly associated with race and ethnicity on bivariate analysis. Black or African American subjects had increased odds of positive anti-Jo-1 autoantibody on unadjusted, but not adjusted, logistic regression analysis. Subjects characterized as Other had increased odds of positive anti-MDA5 autoantibody, although confidence intervals were wide. Key Points • Association found between MSAs and race and ethnicity in diverse US cohort • Anti-Jo-1 and anti-MDA5 associated with race and ethnicity in bivariate analyses.
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Affiliation(s)
- Michael J Beam
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Anna Montgomery
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Christine Anastasiou
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Gabriela Schmajuk
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- University of California San Francisco, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, USA
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Zhang D, Wang H, Zhou X, Yang J, Liu Y, Wang W, Jiang P, Fan B. Clinical characteristics and prognostic analysis of idiopathic inflammatory myopathy with positive anti-aminoacyl-tRNA synthetase antibodies: A single center experience. Immun Inflamm Dis 2023; 11:e1085. [PMID: 38018600 PMCID: PMC10655634 DOI: 10.1002/iid3.1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES To identify the differences of clinical characteristics, laboratory findings, and the long-term outcomes in patients with anti-synthetase syndrome (ASS) of different anti-aminoacyl-transfer RNA synthetase antibodies. METHODS We retrospectively enrolled 119 patients with ASS, and the clinical characteristics and laboratory findings were collected. Additionally, multivariate COX regression analysis was performed to estimate the risk factors of prognosis in patients with ASS. RESULTS The frequency of interstitial lung disease (ILD) reached 93.3% in our cohort, of 28 (23.5%) was classified as rapidly progressive (RP)-ILD. The highest incidence of RP-ILD was 36.4% in the PL12 group of ASS patients. The ILD group was characterized by an older age, a lower prevalence of V sign, and a higher prevalence of pulmonary symptoms when contrasted with the non-ILD group. There were statistical differences of clinical significance in arthritis, myositis, mechanic's hands, triad, shawl sign, V sign, and Raynaud's phenomenon among the four subgroups (all p < .05). Additionally, the prevalence rates of arthritis, myositis, mechanic's hands, triad, and V sign in the anti-Jo1 antibody-positive group were significantly higher than anti-Jo1 antibody-negative patients with ASS (all p < .05). Multivariate Cox regression analysis showed mechanic's hands (odds ratio [OR] = 6.47, p < .001), anti-nuclear antibodies (ANA) (OR = 2.13, p = .026), ILD (OR = 10.50, p < .001), and V sign (OR = 0.30, p = .007) were independent factors affecting the prognosis of patients with ASS. The incidences of RP-ILD, arthritis, myositis, triad, mechanic's hands, and shawl sign were more frequent in the anti-Ro52 antibody-positive group than the anti-Ro52 antibody-negative patients with ASS (all p < .05). CONCLUSIONS Patients with ASS accompanied with ILD are highly prevalent. Mechanic's hands, ANA, and ILD may be a potential biomarker for predicting a poor prognosis in patients with ASS. Additionally, the detection of the anti-Ro52 antibody provides valuable insights for managing and predicting disease progression and long-term outcomes.
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Affiliation(s)
- Di Zhang
- Department of RheumatologyAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanShandongChina
| | - Huijing Wang
- Department of RheumatologyRenji Hospital, School of Medicine, Shanghai Jiaotong UniversityShanghaiChina
| | - Xinpeng Zhou
- Department of RheumatologyAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanShandongChina
| | - Jianguo Yang
- College of Traditional Chinese MedicineShandong University of Traditional Chinese MedicineJinanShandongChina
| | - Yuan Liu
- College of Traditional Chinese MedicineShandong University of Traditional Chinese MedicineJinanShandongChina
| | - Wenjing Wang
- College of Traditional Chinese MedicineShandong University of Traditional Chinese MedicineJinanShandongChina
| | - Ping Jiang
- Department of RheumatologyAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanShandongChina
| | - Bing Fan
- Department of RheumatologyAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanShandongChina
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Pachman LM, Morgan G, Klein-Gitelman MS, Ahsan N, Khojah A. Nailfold capillary density in 140 untreated children with juvenile dermatomyositis: an indicator of disease activity. Pediatr Rheumatol Online J 2023; 21:118. [PMID: 37828536 PMCID: PMC10571265 DOI: 10.1186/s12969-023-00903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND We lack a reliable indicator of disease activity in Juvenile Dermatomyositis (JDM), a rare disease. The goal of this study is to identify the association of nailfold capillary End Row Loop (ERL) loss with disease damage in children with newly diagnosed, untreated JDM. FINDINGS We enrolled 140 untreated JDM and 46 age, race and sex matched healthy controls, ages 2-17. We selected items from the Juvenile Myositis Registry for analysis. Variables include average ERL density of 8 fingers, average capillary pattern, hemorrhages, and clinical and laboratory correlates. Laboratory data includes Myositis Specific Antibodies (MSA), disease activity scores (DAS), Childhood Myositis Assessment Scale (CMAS), and standard clinical serologic data. The reduced mean ERL density is 5.1 ± 1.5/mm for untreated JDM vs 7.9 ± 0.9/mm for healthy controls, p < 0.0001, and is associated with DAS-skin, r = -0.27 p = 0.014, which did not change within the age range tested. Untreated JDM with MSA Tif-1-γ had the lowest ERL density, (p = 0.037); their ERL patterns were primarily "open" and the presence of hemorrhages in the nailfold matrix was associated with dysphagia (p = 0.004). CONCLUSIONS Decreased JDM ERL density is associated with increased clinical symptoms; nailfold hemorrhages are associated with dysphagia. Duration of untreated disease symptoms and MSA, modify NFC shape. We speculate nailfold characteristics are useful indicators of disease activity in children with JDM before start of therapy.
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Affiliation(s)
- Lauren M Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Gabrielle Morgan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
| | - Marisa S Klein-Gitelman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Najah Ahsan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
| | - Amer Khojah
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Hu Q, Huang KC, Goh CH, Tsuchiya Y, Liu Y, Qiu H. Characteristics and risk of interstitial lung disease in dermatomyositis and polymyositis: a retrospective cohort study in Japan. Sci Rep 2023; 13:17172. [PMID: 37821555 PMCID: PMC10567809 DOI: 10.1038/s41598-023-44092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
Dermatomyositis and polymyositis are rare, idiopathic inflammatory myopathies. Interstitial lung disease is one of the most common and potentially severe extra-muscular manifestations of dermatomyositis and polymyositis and is strongly linked to poor prognosis and early mortality. We aimed to characterise the demographic and clinical characteristics, incidence, and treatment of interstitial lung disease in patients with dermatomyositis or polymyositis. We conducted a retrospective cohort study using the Japan Medical Data Center healthcare claims database. Patients in the database with dermatomyositis (International Classification of Disease version 10 M33.0, M33.1, M33.9) or polymyositis (M33.2) from 01-Jan-2011 until 31-Dec-2019 were identified and followed-up for interstitial lung disease (J84.x) until death, dis-enrolment, or study end (31 December 2020). Cumulative risk curves compared interstitial lung disease risk in dermatomyositis versus polymyositis. Risk factors were evaluated by Cox proportional hazard models. There were 886 patients with dermatomyositis and 745 patients with polymyositis included in the cohort analysis. Mean (standard deviation) age at dermatomyositis/polymyositis diagnosis was 46.0 (16.0)/49.7 (13.3) years and 300 (34%)/104 (14%) developed interstitial lung disease during follow-up. The incidence rate of interstitial lung disease per 100 person-years was 18.42 (95% CI 16.42-20.59) for dermatomyositis and 5.39 (95% CI 4.43-6.50) for polymyositis. In the analysis adjusted for sex, age, and comorbidity score, the risk of interstitial lung disease was significantly higher in patients with dermatomyositis than with polymyositis (hazard ratio 2.72, 95% CI 2.18-3.41). The rate diverged markedly between the groups in the first year after diagnosis. Risk factors for interstitial lung disease were older age in dermatomyositis, female sex and rheumatoid arthritis in polymyositis. Glucocorticoids with/without tacrolimus were the most common newly prescribed drugs after the interstitial lung disease diagnosis. In conclusion, the risk of developing interstitial lung disease was significantly higher in patients with dermatomyositis than with polymyositis, and risk factors were different in the 2 patient groups.
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Affiliation(s)
- Qingqing Hu
- Global Epidemiology, Office of the Chief Medical Officer, Johnson & Johnson, Shanghai, China
| | - Kuan-Chih Huang
- Global Epidemiology, Office of the Chief Medical Officer, Johnson & Johnson, Taipei, Taiwan
| | - Choo Hua Goh
- Global Epidemiology, Office of the Chief Medical Officer, Johnson & Johnson, Singapore, Singapore
| | - Yumi Tsuchiya
- Research & Development, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - Yanfang Liu
- Global Epidemiology, Office of the Chief Medical Officer, Johnson & Johnson, Singapore, Singapore
| | - Hong Qiu
- Global Epidemiology, Office of the Chief Medical Officer, Johnson & Johnson, Titusville, USA.
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Leclair V, Galindo-Feria AS, Rothwell S, Kryštůfková O, Zargar SS, Mann H, Diederichsen LP, Andersson H, Klein M, Tansley S, Rönnblom L, Lindblad-Toh K, Syvänen AC, Wahren-Herlenius M, Sandling JK, McHugh N, Lamb JA, Vencovský J, Chinoy H, Holmqvist M, Bianchi M, Padyukov L, Lundberg IE, Diaz-Gallo LM. Distinct HLA associations with autoantibody-defined subgroups in idiopathic inflammatory myopathies. EBioMedicine 2023; 96:104804. [PMID: 37769433 PMCID: PMC10550566 DOI: 10.1016/j.ebiom.2023.104804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND In patients with idiopathic inflammatory myopathies (IIM), autoantibodies are associated with specific clinical phenotypes suggesting a pathogenic role of adaptive immunity. We explored if autoantibody profiles are associated with specific HLA genetic variants and clinical manifestations in IIM. METHODS We included 1348 IIM patients and determined the occurrence of 14 myositis-specific or -associated autoantibodies. We used unsupervised cluster analysis to identify autoantibody-defined subgroups and logistic regression to estimate associations with clinical manifestations, HLA-DRB1, HLA-DQA1, HLA-DQB1 alleles, and amino acids imputed from genetic information of HLA class II and I molecules. FINDINGS We identified eight subgroups with the following dominant autoantibodies: anti-Ro52, -U1RNP, -PM/Scl, -Mi2, -Jo1, -Jo1/Ro52, -TIF1γ or negative for all analysed autoantibodies. Associations with HLA-DRB1∗11, HLA-DRB1∗15, HLA-DQA1∗03, and HLA-DQB1∗03 were present in the anti-U1RNP-dominated subgroup. HLA-DRB1∗03, HLA-DQA1∗05, and HLA-DQB1∗02 alleles were overrepresented in the anti-PM/Scl and anti-Jo1/Ro52-dominated subgroups. HLA-DRB1∗16, HLA-DRB1∗07 alleles were most frequent in anti-Mi2 and HLA-DRB1∗01 and HLA-DRB1∗07 alleles in the anti-TIF1γ subgroup. The HLA-DRB1∗13, HLA-DQA1∗01 and HLA-DQB1∗06 alleles were overrepresented in the negative subgroup. Significant signals from variations in class I molecules were detected in the subgroups dominated by anti-Mi2, anti-Jo1/Ro52, anti-TIF1γ, and the negative subgroup. INTERPRETATION Distinct HLA class II and I associations were observed for almost all autoantibody-defined subgroups. The associations support autoantibody profiles use for classifying IIM which would likely reflect underlying pathogenic mechanisms better than classifications based on clinical symptoms and/or histopathological features. FUNDING See a detailed list of funding bodies in the Acknowledgements section at the end of the manuscript.
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Affiliation(s)
- Valérie Leclair
- Clinical Epidemiology Division, Department Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Division of Rheumatology, Jewish General Hospital Lady Davis Institute, Montreal, Canada.
| | - Angeles S Galindo-Feria
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Simon Rothwell
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Olga Kryštůfková
- Institute of Rheumatology and Department of Rheumatology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Sepehr Sarrafzadeh Zargar
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Herman Mann
- Institute of Rheumatology and Department of Rheumatology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Louise Pyndt Diederichsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Helena Andersson
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Martin Klein
- Institute of Rheumatology and Department of Rheumatology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Sarah Tansley
- Department of Life Sciences, University of Bath, Bath, United Kingdom
| | - Lars Rönnblom
- Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden
| | - Kerstin Lindblad-Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden; Broad Institute of MIT and Harvard, Cambridge, MA, Unite States of America
| | - Ann-Christine Syvänen
- Science for Life Laboratory, Uppsala University, Department of Medical Sciences, Molecular Precision Medicine, Uppsala, Sweden
| | - Marie Wahren-Herlenius
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Norway
| | - Johanna K Sandling
- Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden
| | - Neil McHugh
- Department of Life Sciences, University of Bath, Bath, United Kingdom
| | - Janine A Lamb
- Epidemiology and Public Health Group, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Jiri Vencovský
- Institute of Rheumatology and Department of Rheumatology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Hector Chinoy
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, United Kingdom; Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Marie Holmqvist
- Clinical Epidemiology Division, Department Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Matteo Bianchi
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Lina-Marcela Diaz-Gallo
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
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Norimatsu Y, Matsuda KM, Yamaguchi K, Ono C, Okumura T, Kogo E, Kotani H, Hisamoto T, Kuzumi A, Fukasawa T, Yoshizaki-Ogawa A, Goshima N, Sato S, Yoshizaki A. The Autoantibody Array Assay: A Novel Autoantibody Detection Method. Diagnostics (Basel) 2023; 13:2929. [PMID: 37761295 PMCID: PMC10528021 DOI: 10.3390/diagnostics13182929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Systemic sclerosis (SSc) and dermatomyositis (DM) are autoimmune collagen diseases. Specific autoantibodies are known to be involved in their pathogeneses, each presenting with a different clinical manifestation. Although immunoprecipitation is the gold standard method for detecting autoantibodies, it is difficult to perform in all cases owing to the use of radioisotopes. In this study, we developed a new detection method for SSc and DM autoantibodies (A-cube) using cell-free protein synthesis and examined its validity. Proteins were synthesized using wheat germ cell-free protein synthesis. A total of 100 cases of SSc, 50 cases of DM, and 82 healthy controls were examined. The validity of the method was examined by a comparison with existing test results. Anti-centromere antibody, anti-topoisomerase I antibody, anti-RNA polymerase III antibody, anti-U1RNP anti-body, anti-Jo-1 antibody, anti-TIF1γ antibody, anti-Mi-2 antibody, and anti-ARS antibody were tested for. The results suggested that A-cube is comparable with existing testing methods or has a high sensitivity or specificity. In addition, there was a case in which the diagnosis was reconsidered using the A-cube. The quality of the A-cube was ensured, and its usefulness for a comprehensive analysis was demonstrated. The A-cube can therefore contribute to the clinical assessment and treatment of SSc and DM.
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Affiliation(s)
- Yuta Norimatsu
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (Y.N.); (T.F.); (A.Y.-O.)
- Department of Dermatology, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
| | - Kazuki Mitsuru Matsuda
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (Y.N.); (T.F.); (A.Y.-O.)
| | - Kei Yamaguchi
- Molecular Profiling Research Center for Drug Discovery, National Institute of Advanced Industrial Science and Technology, Tokyo 100-0013, Japan
- ProteoBridge Corporation, Tokyo 135-0064, Japan
| | - Chihiro Ono
- ProteoBridge Corporation, Tokyo 135-0064, Japan
| | | | - Emi Kogo
- ProteoBridge Corporation, Tokyo 135-0064, Japan
| | - Hirohito Kotani
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (Y.N.); (T.F.); (A.Y.-O.)
| | - Teruyoshi Hisamoto
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (Y.N.); (T.F.); (A.Y.-O.)
| | - Ai Kuzumi
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (Y.N.); (T.F.); (A.Y.-O.)
| | - Takemichi Fukasawa
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (Y.N.); (T.F.); (A.Y.-O.)
- Department of Clinical Cannabinoid Research, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan
| | - Asako Yoshizaki-Ogawa
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (Y.N.); (T.F.); (A.Y.-O.)
| | - Naoki Goshima
- Molecular Profiling Research Center for Drug Discovery, National Institute of Advanced Industrial Science and Technology, Tokyo 100-0013, Japan
- ProteoBridge Corporation, Tokyo 135-0064, Japan
| | - Shinichi Sato
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (Y.N.); (T.F.); (A.Y.-O.)
| | - Ayumi Yoshizaki
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (Y.N.); (T.F.); (A.Y.-O.)
- Department of Clinical Cannabinoid Research, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan
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Pijnenburg L, Giannini M, Bouchard-Marmen M, Arnaud L, Barsotti S, Bellando-Randone S, Bernardi L, Bini P, Blagojevic J, Codullo V, Couderc M, De Moreuil C, Dernis E, Diamanti L, Dubost JJ, Duval F, Emmi G, Galempoix JM, Geny B, Gottenberg JE, Groza M, Guffroy A, Guichard I, Guilpain P, Hervier B, Hudson M, Iaccarino L, Iannone F, Lebrun D, Marchioni E, Mariampillai K, Maurier F, Mosca M, Nadaj-Pakleza A, Nannini C, Piot JM, Prieto-González S, Poursac N, Rouanet E, Sellam J, Selva-O'Callaghan A, Séverac F, Sibilia J, Sole G, Soulages A, Terrier B, Tournadre A, Troyanov Y, Vernier N, Vesperini V, Viallard JF, Ziane R, Cavagna L, Meyer A. In inflammatory myopathies, dropped head/bent spine syndrome is associated with scleromyositis: an international case-control study. RMD Open 2023; 9:e003081. [PMID: 37666644 PMCID: PMC10481849 DOI: 10.1136/rmdopen-2023-003081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/22/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Some myopathies can lead to dropped head or bent spine syndrome (DH/BS). The significance of this symptom has not been studied in inflammatory myopathies (IM). OBJECTIVES To assess the significance of DH/BS in patients with IM. METHODS Practitioners from five IM networks were invited to report patients with IM suffering from DH/BS (without other known cause than IM). IM patients without DH/BS, randomly selected in each participating centre, were included as controls at a ratio of 2 to 1. RESULTS 49 DH/BS-IM patients (DH: 57.1%, BS: 42.9%) were compared with 98 control-IM patients. DH/BS-IM patients were older (65 years vs 53 years, p<0.0001) and the diagnosis of IM was delayed (6 months vs 3 months, p=0.009). Weakness prevailing in the upper limbs (42.9% vs 15.3%), dysphagia (57.1% vs 25.5%), muscle atrophy (65.3% vs 34.7%), weight loss (61.2% vs 23.5%) and loss of the ability to walk (24.5% vs 5.1%) were hallmarks of DH/BS-IM (p≤0.0005), for which the patients more frequently received intravenous immunoglobulins (65.3% vs 34.7%, p=0.0004). Moreover, DH/BS-IM patients frequently featured signs and/or complications of systemic sclerosis (SSc), fulfilling the American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for this disease in 40.8% of the cases (vs 5.1%, p<0.0001). Distribution of the myopathy, its severity and its association with SSc were independently associated with DH/BS (p<0.05). Mortality was higher in the DH/BS-IM patients and loss of walking ability was independently associated with survival (p<0.05). CONCLUSION In IM patients, DH/BS is a marker of severity and is associated with SSc (scleromyositis).
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Affiliation(s)
- Luc Pijnenburg
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Margherita Giannini
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
- Exploration fonctionnelle musculaire, Service de Physiologie Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | | | - Laurent Arnaud
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Simone Barsotti
- Department of Rheumatology and Clinical Immunology Unit, University of Pisa, Pisa, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Universitaria Careggi, Azienda Ospedaliera, Florence, Italy
| | - Livio Bernardi
- Departement of rheumatology, University of Padova, Padova, Italy
| | - Paola Bini
- Department of neurology, Neurological Institute Mondino, University of Pavia, Pavia, Italy
| | - Jelena Blagojevic
- Department of Experimental and Clinical Medicine, Universitaria Careggi, Azienda Ospedaliera, Florence, Italy
| | - Veronica Codullo
- Rheumatology Division, University and IRCCS Policlinico S. Matteo Foundation Pavia, Pavia, Italy
| | - Marion Couderc
- Service de rhumatologie, Hôpitaux Universitaires de Clermont-Ferrand, Clermont-Ferrand, France
| | - Claire De Moreuil
- Service de médecine interne, Hôpitaux Universitaires de Brest, Brest, France
| | - Emanuelle Dernis
- Service de rhumatologie, Centre hospitalier Le Mans, Le Mans, France
| | - Luca Diamanti
- Department of neurology, Neurological Institute Mondino, University of Pavia, Pavia, Italy
| | - Jean Jacques Dubost
- Service de médecine interne, Hôpitaux Universitaires de Clermont-Ferrand, Clermont-Ferrand, France
| | - Fanny Duval
- Service de neurologie, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, Universitaria Careggi, Azienda Ospedaliera, Florence, Italy
| | - Jean-Marc Galempoix
- Service de Médecine Interne, Centre Hospitalier de Charleville-Mézières, Charleville-Mézières, France
| | - Bernard Geny
- Exploration fonctionnelle musculaire, Service de Physiologie Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Jacques-Eric Gottenberg
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Monica Groza
- Service de médecine interne, Centre hospitalier Colmar, Colmar, France
| | - Aurelien Guffroy
- Service d'immunologie clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Isabelle Guichard
- Service de médecine interne, Hôpitaux Universitaires de Saint Etienne, Saint Etienne, France
| | - Philippe Guilpain
- Service de médecine interne, Hôpitaux Universitaires de Montpellierr, Montpellier, France
| | - Baptiste Hervier
- Service de médecine interne, Assistance publique - Hôpitaux de Paris, Saint Louis, Paris, France
| | - Marie Hudson
- Department of medicine, Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Luca Iaccarino
- Departement of rheumatology, University of Padova, Padova, Italy
| | | | - Delphine Lebrun
- Service de Médecine Interne, Centre Hospitalier de Charleville-Mézières, Charleville-Mézières, France
| | - Enrico Marchioni
- Department of neurology, Neurological Institute Mondino, University of Pavia, Pavia, Italy
| | - Kuberaka Mariampillai
- Service de médecine interne, Assistance publique - Hôpitaux de Paris, Saint Louis, Paris, France
| | - Francois Maurier
- Service de médecine interne, Hôpitaux privés de Metz, Metz, France
| | - Marta Mosca
- Department of Rheumatology and Clinical Immunology Unit, University of Pisa, Pisa, Italy
| | - Aleksandra Nadaj-Pakleza
- Service de neurologie, Centre de référence des maladies neuromusculaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Jean-Maxime Piot
- Service de rhumatologie, Centre hospitalier Le Mans, Le Mans, France
| | | | - Nicolas Poursac
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Eglantine Rouanet
- Service de rhumatologie, Centre hospitalier Le Mans, Le Mans, France
| | - Jérémie Sellam
- Service de rhumatologie, Hôpital Saint Antoine, Assistance publique - Hôpitaux de Paris, Paris, France
| | | | - François Séverac
- Service de Santé Publique, GMRC; ICube, UMR 7357, Hôpitaux universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Jean Sibilia
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Guilhem Sole
- Service de neurologie, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Antoine Soulages
- Service de neurologie, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Benjamin Terrier
- Service de médecine interne, Hôpital Cochin Assistance publique - Hôpitaux de Paris Cochin, Paris, France
| | - Anne Tournadre
- Service de rhumatologie, Hôpitaux Universitaires de Clermont-Ferrand, Clermont-Ferrand, France
| | - Yves Troyanov
- Department of rheumatology, Hôpital Sacre Cœur Montréal, Université de Montréal, Montreal, Québec, Canada
| | - Nathalie Vernier
- Service de médecine interne, Hôpitaux Universitaires de Dijon, Dijon, France
| | | | | | - Rahima Ziane
- Service de médecine interne, Hôpitaux Universitaires de Montpellierr, Montpellier, France
| | - Lorenzo Cavagna
- Rheumatology Division, University and IRCCS Policlinico S. Matteo Foundation Pavia, Pavia, Italy
| | - Alain Meyer
- Exploration fonctionnelle musculaire, Service de Physiologie Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
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Nagatomo Y, Yoshizawa S, Oya Y, Nishino I. Anti-mitochondrial antibody-mediated myopathy with cardiac involvement: reply. Eur Heart J Case Rep 2023; 7:ytad348. [PMID: 37575533 PMCID: PMC10413312 DOI: 10.1093/ehjcr/ytad348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Affiliation(s)
- Yuji Nagatomo
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Saeko Yoshizawa
- Department of Surgical Pathology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Yasushi Oya
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
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Zhang H, Yue J, Hou X, Lu H, Bikdeli A, Guo H, Li H, Li D. Rapidly progressive interstitial lung disease combined with pneumocystis jiroveci pneumonia in a patient with single anti-TIF-1γ antibody positive dermatomyositis in the context of an underlying tumor. BMC Pulm Med 2023; 23:248. [PMID: 37415133 DOI: 10.1186/s12890-023-02542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) is a frequently observed comorbidity in autoimmune diseases such as dermatomyositis/polymyositis (DM/PM), and it is significantly associated with specific autoantibody types. One unique antibody type is the anti-transcription intermediate factor-1γ antibody (anti-TIF-1γ Ab), which has a positive rate of only 7%. It is often found in combination with malignancy and rarely with ILD, particularly rapidly progressive ILD (RPILD). In some cases, the presence of ILD in individuals with DM may indicate a paraneoplastic syndrome. Pneumocystis jiroveci pneumonia (PJP) typically occurs due to intensive immunosuppressive therapy, human immunodeficiency virus (HIV) infection, or malignancy, and rarely as an isolated condition. CASE PRESENTATION A 52-year-old man with a history of rapid weight loss but non-HIV infected and not immunosuppressed who presented with fever, cough, dyspnea, weakness of the extremities, characteristic rash and mechanic's hand. Pathogenic tests suggested PJP, laboratory tests suggested a single anti-TIF-1γ Ab positive DM, imaging suggested ILD, and pathology revealed no malignancy. RPILD and acute respiratory distress syndrome (ARDS) developed after anti-infection and steroid hormone therapy. After mechanical support therapy such as Extracorporeal Membrane Oxygenation (ECMO), the patient developed late-onset cytomegalovirus pneumonia (CMVP), complicated bacterial infection, and ultimately death. Additionally, we discuss the potential causes of rapid weight loss, the mechanisms by which anti-TIF-1γ Ab may lead to ILD, and the possible connection between anti-TIF-1γ Ab positivity, rapid weight loss, immune abnormalities, and opportunistic infections. CONCLUSIONS This case emphasizes the importance of early recognition of malignant tumors and pulmonary lesions, assessment of the body's immune status, prompt initiation of immunosuppressive treatment, and prevention of opportunistic infections in individuals with single anti-TIF-1γ Ab positive DM presenting with rapid weight loss.
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Affiliation(s)
- Hengzhe Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Department of Intensive Care Medicine, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Jinfeng Yue
- Department of Intensive Care Medicine, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Xiaohui Hou
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Department of Intensive Care Medicine, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Hongjun Lu
- Department of Intensive Care Medicine, Traditional Chinese Medicine of Rizhao Hospital, Rizhao, 276800, Shandong, China
| | - Arezou Bikdeli
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Haipeng Guo
- Department of Intensive Care Medicine, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Hao Li
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Daqing Li
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
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Chaudhry S, Christopher-Stine L. Myositis interstitial lung disease and autoantibodies. Front Med (Lausanne) 2023; 10:1117071. [PMID: 37384043 PMCID: PMC10296774 DOI: 10.3389/fmed.2023.1117071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/15/2023] [Indexed: 06/30/2023] Open
Abstract
The aim of this review is to examine and evaluate published literature associated with idiopathic inflammatory myopathies (IIM) and interstitial lung disease (ILD) based on myositis specific autoantibodies (MSA) and the potential clinical significance of each autoantibody subtype for the practicing clinician. The review is a comprehensive search of literature published in PubMed from the year 2005 and onward coinciding with the surge in the discovery of new MSAs. Additionally, we comment on recommended multidisciplinary longitudinal care practices for patients with IIM-ILD with regard to imaging and other testing. Treatment is not covered in this review.
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Affiliation(s)
- Shire Chaudhry
- Department of Medicine, Luminis Health Anne Arundel Medical Center, Annapolis, MD, United States
| | - Lisa Christopher-Stine
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Camargo-Coronel A, Quiñones-Moya H, Hernández-Zavala MR, Hernández-Vázquez JR, Vázquez-Zaragoza MÁ. Idiopathic inflammatory myopathies linked to vaccination against SARS-CoV-2: a systematic review. Reumatismo 2023; 75. [PMID: 37154256 DOI: 10.4081/reumatismo.2023.1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/27/2023] [Indexed: 05/10/2023] Open
Abstract
The COVID-19 pandemic represents a global health problem, which has been mitigated by the opportune introduction of vaccination programs. Although we already know the benefit that vaccines provide, these are not exempt from adverse events which can be mild to deadly, such as idiopathic inflammatory myopathies, in which a temporal association has not been defined. It is for this reason that we carried out a systematic review of all reported cases of vaccination against COVID-19 and myositis. To identify previously reported cases of idiopathic inflammatory myopathies associated with vaccination against SARS-CoV-2 we registered this protocol on the website of PROSPERO with identification number CRD42022355551. Of the 63 publications identified in MEDLINE and 117 in Scopus, 21 studies were included, reporting 31 cases of patients with vaccination-associated myositis. Most of these cases were women (61.3%); mean age was 52.3 years (range 19-76 years) and mean time of symptom onset post-vaccination was 6.8 days. More than half of the cases were associated with Comirnaty, 11 cases (35.5%) were classified as dermatomyositis, and 9 (29%) as amyopathic dermatomyositis. In 6 (19.3%) patients another probable trigger was identified. Case reports of inflammatory myopathies associated with vaccination have heterogeneous presentations without any specific characteristics: as a consequence, it is not possible to ensure a temporal association between vaccination and the development of inflammatory myopathies. Large epidemiological studies are required to determine the existence of a causal association.
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Affiliation(s)
- A Camargo-Coronel
- Rheumatology Department, Centro Médico Nacional Siglo XXI, Mexico City.
| | - H Quiñones-Moya
- Rheumatology Department, Centro Médico Nacional Siglo XXI, Mexico City.
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Alenzi F, Alotaibi J, Alnasser M, Alokaily F. Clinical and laboratory characteristics of idiopathic inflammatory myositis in Saudi patients: A retrospective study in a single tertiary centre. Saudi Med J 2023; 44:492-497. [PMID: 37182927 PMCID: PMC10187745 DOI: 10.15537/smj.2023.44.5.20220213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/19/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES Idiopathic inflammatory myositis (IIM) in Saudi patients has been poorly studied owing to the lack of available data. This study aimed to identify the clinical and laboratory features of patients at a single tertiary care center. METHODS This retrospective study reviewed the medical records of Prince Sultan Military Medical City, Riyadh, Saudi Arabia to collect clinical and laboratory data between December 2022 and February 2017 as follows: age at disease onset, gender, follow-up duration and disease duration; clinical symptoms; laboratory result; presence and type of myositis-specific autoantibody or myositis-associated autoantibody; and type of immunosuppression, presence of malignancy, disease course, and outcome. RESULTS There were 26 patients with a mean age of 36.16±13.48, and 84.6% were women. The most prevalent form of IIM was dermatomyositis (n=16, 61.5%), and the most affected organ was the skin. weakness was observed in 25 patients (96.2%), and dysphagia was the most common alarm sign (n=10, 38.5%). During follow-up, the creatine kinase level was elevated at the beginning of the disease and then decreased following treatment, with a mean of 277.73 IU/L. Of the total patients, 17 (68%) were positive for anti-nuclear antibody and 5 (19.2%) were positive for anti-Jo-1. CONCLUSION In our patients, dermatomyositis was the most common form of myositis, and skin manifestations were the most prevalent clinical characteristics. None of the patients developed a malignancy or died.
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Affiliation(s)
- Fahidah Alenzi
- From the Department of Clinical Science (Alenzi), College of Medicine, Princess Nourah bint Abdulrahman University; and from the Division of Rheumatology, Department of Medicine (Alotaibi, Alnasser, Alokaily), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Jawaher Alotaibi
- From the Department of Clinical Science (Alenzi), College of Medicine, Princess Nourah bint Abdulrahman University; and from the Division of Rheumatology, Department of Medicine (Alotaibi, Alnasser, Alokaily), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Manal Alnasser
- From the Department of Clinical Science (Alenzi), College of Medicine, Princess Nourah bint Abdulrahman University; and from the Division of Rheumatology, Department of Medicine (Alotaibi, Alnasser, Alokaily), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Fahdah Alokaily
- From the Department of Clinical Science (Alenzi), College of Medicine, Princess Nourah bint Abdulrahman University; and from the Division of Rheumatology, Department of Medicine (Alotaibi, Alnasser, Alokaily), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
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Ceribelli A, Tonutti A, Isailovic N, De Santis M, Selmi C. Interstitial lung disease associated with inflammatory myositis: Autoantibodies, clinical phenotypes, and progressive fibrosis. Front Med (Lausanne) 2023; 10:1068402. [PMID: 37007784 PMCID: PMC10061022 DOI: 10.3389/fmed.2023.1068402] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
Progressive pulmonary fibrosis is generally diagnosed when interstitial lung disease progression occurs in the absence of any other cause, and a subset of patients with myositis and associated interstitial lung disease may develop progressive pulmonary fibrosis. Numerous autoantibodies (e.g., against tRNA-synthetase, MDA5, Ro52) increase the risk of this clinical feature in myositis and we speculate that serum biomarkers, sought using the most sensitive laboratory techniques available (i.e., immunoprecipitation) may predict pulmonary involvement and allow the early identification of progressive pulmonary fibrosis. We herein provide a narrative review of the literature and also present original data on pulmonary fibrosis in a cohort of patients with myositis and serum anti-Ro52 with interstitial lung disease. Our results fit into the previous evidence and support the association between anti-Ro52 and signs of pulmonary fibrosis in patients with inflammatory myositis. We believe that the combination of available and real-life data has significant clinical relevance as a paradigm of serum autoantibodies that prove useful in determining precision medicine in rare connective tissue diseases.
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Affiliation(s)
- Angela Ceribelli
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Antonio Tonutti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Natasa Isailovic
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maria De Santis
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Carlo Selmi
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- *Correspondence: Carlo Selmi,
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Bandeira M, Dourado E, Melo AT, Martins P, Fraga V, Ferraro JL, Saraiva A, Sousa M, Parente H, Soares C, Correia AM, Almeida DE, Dinis SP, Pinto AS, Oliveira Pinheiro F, Rato MS, Beirão T, Samões B, Santos B, Mazeda C, Chícharo AT, Faria M, Neto A, Lourenço MH, Brites L, Rodrigues M, Silva-Dinis J, Dias JM, Araújo FC, Martins N, Couto M, Valido A, Santos MJ, Barreira SC, Fonseca JE, Campanilho-Marques R. Predictors of cardiac involvement in idiopathic inflammatory myopathies. Front Immunol 2023; 14:1146817. [PMID: 36969246 PMCID: PMC10030705 DOI: 10.3389/fimmu.2023.1146817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivesIdiopathic inflammatory myopathies (IIM) are a group of rare disorders that can affect the heart. This work aimed to find predictors of cardiac involvement in IIM.MethodsMulticenter, open cohort study, including patients registered in the IIM module of the Rheumatic Diseases Portuguese Register (Reuma.pt/Myositis) until January 2022. Patients without cardiac involvement information were excluded. Myo(peri)carditis, dilated cardiomyopathy, conduction abnormalities, and/or premature coronary artery disease were considered.Results230 patients were included, 163 (70.9%) of whom were females. Thirteen patients (5.7%) had cardiac involvement. Compared with IIM patients without cardiac involvement, these patients had a lower bilateral manual muscle testing score (MMT) at the peak of muscle weakness [108.0 ± 55.0 vs 147.5 ± 22.0, p=0.008] and more frequently had oesophageal [6/12 (50.0%) vs 33/207 (15.9%), p=0.009] and lung [10/13 (76.9%) vs 68/216 (31.5%), p=0.001] involvements. Anti-SRP antibodies were more commonly identified in patients with cardiac involvement [3/11 (27.3%) vs 9/174 (5.2%), p=0.026]. In the multivariate analysis, positivity for anti-SRP antibodies (OR 104.3, 95% CI: 2.5-4277.8, p=0.014) was a predictor of cardiac involvement, regardless of sex, ethnicity, age at diagnosis, and lung involvement. Sensitivity analysis confirmed these results.ConclusionAnti-SRP antibodies were predictors of cardiac involvement in our cohort of IIM patients, irrespective of demographical characteristics and lung involvement. We suggest considering frequent screening for heart involvement in anti-SRP-positive IIM patients.
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Affiliation(s)
- Matilde Bandeira
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
- *Correspondence: Matilde Bandeira,
| | - Eduardo Dourado
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Ana Teresa Melo
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Patrícia Martins
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Vanessa Fraga
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal
| | | | - André Saraiva
- Serviço de Reumatologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Marlene Sousa
- Serviço de Reumatologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Hugo Parente
- Serviço de Reumatologia, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Catarina Soares
- Serviço de Reumatologia, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | | | | | - Sara Paiva Dinis
- Serviço de Reumatologia, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Ana Sofia Pinto
- Serviço de Reumatologia, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | | | - Maria Seabra Rato
- Serviço de Reumatologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Tiago Beirão
- Serviço de Reumatologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Beatriz Samões
- Serviço de Reumatologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Bernardo Santos
- Serviço de Reumatologia, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Carolina Mazeda
- Serviço de Reumatologia, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | | | - Margarida Faria
- Serviço de Reumatologia, Hospital Nélio Mendonça, Serviços de Saúde da Região Autónoma da Madeira, Funchal, Portugal
| | - Agna Neto
- Serviço de Reumatologia, Hospital Nélio Mendonça, Serviços de Saúde da Região Autónoma da Madeira, Funchal, Portugal
| | | | - Luísa Brites
- Serviço de Reumatologia, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Marília Rodrigues
- Serviço de Reumatologia, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Joana Silva-Dinis
- Serviço de Reumatologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - João Madruga Dias
- Serviço de Reumatologia, Centro Hospitalar de Médio Tejo, Tomar, Portugal
| | - Filipe C. Araújo
- Serviço de Reumatologia, Hospital CUF Cascais, Cascais, Portugal
| | - Nádia Martins
- Serviço de Reumatologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Maura Couto
- Serviço de Reumatologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Ana Valido
- Serviço de Reumatologia, Unidade Local de Saúde do Litoral Alentejano, Santiago do Cacém, Portugal
| | - Maria José Santos
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal
| | - Sofia Carvalho Barreira
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - João Eurico Fonseca
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Raquel Campanilho-Marques
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
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Tanboon J, Inoue M, Hirakawa S, Tachimori H, Hayashi S, Noguchi S, Okiyama N, Fujimoto M, Suzuki S, Nishino I. Muscle pathology of antisynthetase syndrome according to antibody subtypes. Brain Pathol 2023:e13155. [PMID: 36882048 DOI: 10.1111/bpa.13155] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/15/2023] [Indexed: 03/09/2023] Open
Abstract
Identification of antisynthetase syndrome (ASS) could be challenging due to inaccessibility and technical difficulty of the serology test for the less common non-Jo-1 antibodies. This study aimed to describe ASS antibody-specific myopathology and evaluate the diagnostic utility of myofiber HLA-DR expression. We reviewed 212 ASS muscle biopsies and compared myopathologic features among subtypes. Additionally, we compared their HLA-DR staining pattern with 602 non-ASS myositis and 140 genetically confirmed myopathies known to have an inflammatory component. We used t-test and Fisher's exact for comparisons and used sensitivity, specificity, positive and negative predictive values to assess the utility of HLA-DR expression for ASS diagnosis. RNAseq performed from a subset of myositis cases and histologically normal muscle biopsies was used to evaluate interferon (IFN)-signaling pathway-related genes. Anti-OJ ASS showed prominent myopathology with higher scores in muscle fiber (4.6 ± 2.0 vs. 2.8 ± 1.8, p = 0.001) and inflammatory domains (6.8 ± 3.2 vs. 4.5 ± 2.9, p = 0.006) than non-OJ ASS. HLA-DR expression and IFN-γ-related genes upregulation were prominent in ASS and inclusion body myositis (IBM). When dermatomyositis and IBM were excluded, HLA-DR expression was 95.4% specific and 61.2% sensitive for ASS with a positive predictive value of 85.9% and a negative predictive value of 84.2%; perifascicular HLA-DR pattern is common in anti-Jo-1 ASS than non-Jo-1 ASS (63.1% vs. 5.1%, p < 0.0001). In the appropriate clinicopathological context, myofiber HLA-DR expression help support ASS diagnosis. The presence of HLA-DR expression suggests involvement of IFN-γ in the pathogenesis of ASS, though the detailed mechanisms have yet to be elucidated.
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Affiliation(s)
- Jantima Tanboon
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan.,Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan
| | - Michio Inoue
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan.,Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan
| | - Shinya Hirakawa
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan
| | - Hisateru Tachimori
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan
| | - Shinichiro Hayashi
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan.,Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan
| | - Satoru Noguchi
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan.,Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan
| | - Naoko Okiyama
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Dermatology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan.,Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan.,Department of Clinical Genome Analysis, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan
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47
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Advanced Autoantibody Testing in Systemic Sclerosis. Diagnostics (Basel) 2023; 13:diagnostics13050851. [PMID: 36899995 PMCID: PMC10001109 DOI: 10.3390/diagnostics13050851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Systemic sclerosis is a systemic autoimmune rheumatic disease characterized by immune abnormalities, leading to vasculopathy and fibrosis. Autoantibody testing has become an increasingly important part of diagnosis and prognostication. Clinicians have been limited to antinuclear antibody (ANA), antitopoisomerase I (also known as anti-Scl-70) antibody, and anticentromere antibody testing. Many clinicians now have improved access to an expanded profile of autoantibody testing. In this narrative review article, we review the epidemiology, clinical associations, and prognostic value of advanced autoantibody testing in people with systemic sclerosis.
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48
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Sambataro G, Orlandi M, Fagone E, Fruciano M, Gili E, Libra A, Palmucci S, Vancheri C, Malatino L, Colaci M, Sambataro D. Myositis-Specific and Myositis-Associated Antibodies in Fibromyalgia Patients: A Prospective Study. Biomedicines 2023; 11:biomedicines11030658. [PMID: 36979638 PMCID: PMC10045737 DOI: 10.3390/biomedicines11030658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Fibromyalgia (FM) is a common rheumatologic disorder characterised by widespread muscular pain. Myalgia is also a common clinical feature in Connective Tissue Disease (CTD), and FM should be studied for the concomitant presence of a CTD. The aim of this study is to evaluate the prevalence of Myositis-Specific and Myositis-Associated Antibodies (MSA/MAA) in a cohort of FM patients. We enrolled 233 consecutive FM patients (defined according to the 2016 criteria) that did not report clinical signs of autoimmune disorders and followed them for at least one year. The patients were tested for MSA/MAA with immunoblotting. FM patients were seropositive for Antinuclear Antibodies (ANA) in 24% of cases, for MSA in 9%, and for MAA in 6%. A specific diagnosis of CTD was made in 12 patients (5.2%), namely, 5 cases of primary Sjögren’s Syndrome and 7 of Idiopathic Inflammatory Myopathy. Seropositive patients showed clinical features similar to those who were seronegative at baseline. A CTD diagnosis was associated with ANA positivity (p = 0.03, X2 4.9), the presence of a speckled pattern (p = 0.02, X2 5.3), positivity for MAA (p = 0.004, X2 8.1), and MSA (p = 0.003, X2 9.2). In conclusion, a non-negligible proportion of FM patients may be seropositive for MSA/MAA, and that seropositivity might suggest a diagnosis of CTD.
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Affiliation(s)
- Gianluca Sambataro
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia, CT, Italy
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
- Correspondence:
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC Careggi, University of Florence, 50134 Florence, Italy
| | - Evelina Fagone
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Mary Fruciano
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Elisa Gili
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Alessandro Libra
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Lorenzo Malatino
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy
| | - Michele Colaci
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy
| | - Domenico Sambataro
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia, CT, Italy
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49
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Loarce-Martos J, Calvo Sanz L, Garrote-Corral S, Ballester González R, Pariente Rodríguez R, Rita CG, García-Soidan A, Bachiller-Corral J, Roy Ariño G. Myositis autoantibodies detected by line blot immunoassay: clinical associations and correlation with antibody signal intensity. Rheumatol Int 2023; 43:1101-1109. [PMID: 36763166 DOI: 10.1007/s00296-023-05279-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/15/2023] [Indexed: 02/11/2023]
Abstract
The aim of this study is to assess the relationship between myositis specific (MSA) and myositis associated (MAA) antibodies and diagnosis (including idiopathic inflammatory myopathies [IIM] and other systemic autoimmune diseases [SAID]), and to explore the impact of antibody signal intensity in diagnostic accuracy. We retrospectively reviewed all the serum samples obtained from patients tested for MSA/MAA by line immunoassay (LIA) between 01/01/2018 and 31/12/2020 in Ramón y Cajal University Hospital (Spain). Clinical true positive (CTP) MSAs and MAAs were defined as those patients with IIM or SAID with phenotypes expected of that MSA/MAA. Patients who did not have a phenotype compatible with that antibody were classified as clinical false positive (CFP). One hundred and thirty positive samples were analysed. Forty-six patients (33.38%) were classified as IIM, forty-two (32.3%) as SAID and forty-two (32.3%) as non-IIM/SAID. Among these 130 patients, 164 MSA/MAA were detected. Eighty-five (51.8%) positive MSA/MAA were classified as CTP, and seventy-nine (48.2%) as CFP. Strongly positive antibodies were more frequently CTP (35/47, 74.5%) than weak positives (54/68, 36.8%), (p ˂ 0.001). Antibodies classified as CTP had a higher signal intensity than CFP (36.77 AU vs 20.00 AU, CI95% 7.79-22.09, p ˂ 0.001). The probability of a CFP was associated to negative ANA, low ANA titer, and multiple positive MSA/MAA (p ˂ 0.001). In this study, we confirmed that CFP results using LIA are frequent, and are associated with low signal intensity MSA/MAA, negative ANA, lower titer ANA, and with multiple positive samples.
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Affiliation(s)
- Jesús Loarce-Martos
- Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Laura Calvo Sanz
- Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | | | - Ana García-Soidan
- Department of Immunology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Garbiñe Roy Ariño
- Department of Immunology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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50
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Vignesh P, Barman P, Basu S, Mondal S, Ishran B, Kumrah R, Dod A, Garg R, Rawat A, Singh S. Juvenile dermatomyositis associated with autoantibodies to small ubiquitin-like modifier activating enzyme: a report of 4 cases from North India and a review of literature. Immunol Res 2023; 71:112-120. [PMID: 36278969 DOI: 10.1007/s12026-022-09334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/17/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is the commonest inflammatory myositis in children. The clinical phenotype is often characterized by the presence of myositis-specific antibodies (MSA). Antibodies to small ubiquitin-like modifier activating enzyme (SAE) are amongst the rarest MSA reported in children. MATERIALS AND METHODS A review of medical records of all patients diagnosed to have JDM during the period January 1992-April 2022 in our institute was done. Case records of children with JDM who had significant positivity for anti-SAE antibody by myositis immunoblot were analysed in detail. RESULTS Of the 140 children with JDM, MSA immunoblot was carried out in 53 patients-4 (7.5%) amongst these had significant positivity for anti-SAE antibodies. Median age of onset of symptoms was 5.5 years (range: 5-11 years). Clinical features at presentation included fever, photosensitivity, heliotrope rash, and Gottron papules. Clinically significant proximal muscle weakness was noted in 3/4 patients; 1 had no discernible weakness but had radiological evidence of myositis. None of the 4 patients had evidence of interstitial lung disease or calcinosis. All patients were treated with intravenous pulse methylprednisolone: subcutaneous weekly methotrexate and hydroxychloroquine. One patient received mycophenolate mofetil because of a relapse of muscle disease, while none received cyclophosphamide or biologics. Median follow-up duration was 21.5 months (range: 6-39 months). CONCLUSION Anti-SAE antibodies were found in 4/53 (7.5%) of North Indian children with JDM. All 4 patients had predominant cutaneous manifestations followed by muscle disease. Response to treatment was brisk and sustained. None had developed calcinosis in the follow-up. KEY MESSAGES 1. We report high prevalence of anti-SAE antibody positivity (7.5%) in North Indian cohort of JDM. 2. Cutaneous disease precedes muscle weakness in children with anti-SAE positive JDM. 3. No evidence of interstitial lung disease/calcinosis was seen in these children.
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Affiliation(s)
- Pandiarajan Vignesh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Prabal Barman
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Suprit Basu
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sanjib Mondal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Bhoomika Ishran
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rajni Kumrah
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aditya Dod
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ravinder Garg
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Amit Rawat
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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