101
|
Negalur NV, Ekbote GG, Raval DN, Tanna DV, Kazi WS, Bindroo MA, Yadavalli DJ, Gupta R. The Association of Myositis Specific Antibodies in Patients with Inflammatory Myositis: Preliminary Data in Indian Patients. Ann Indian Acad Neurol 2021; 24:552-558. [PMID: 34728950 PMCID: PMC8513958 DOI: 10.4103/aian.aian_1151_20] [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: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 11/07/2022] Open
Abstract
CONTEXT Autoantibodies have a role in the diagnosis and prognosis in Autoimmune Inflammatory Myositis (AIM). AIMS The aim of this work was to study the prevalence and clinical correlation of myositis specific and associated antibodies (MSA and MAA) in AIM. SETTING AND DESIGN This was a cross-sectional observational study. METHODS AND MATERIALS Consecutive AIM patents were divided into groups as dermatomyositis (DM), polymyositis (PM), CTD-associated myositis (CTD-M), cancer-associated myositis (CAM) and juvenile myositis (JM). Their data along with serum samples were collected after obtaining informed consent. Sera was analyzed for IgG antibodies against Jo-1, PL-7, PL-12, EJ, SRP, Mi-2, MDA-5, TIF1γ, SAE1, SAE2, NXP2 and SSA/R052kD using the microELISA technique. The institutional ethics committee approved the study. STATISTICAL ANALYSIS SPSS software (version 24.0) was used. P value < 0.05 was considered statistically significant. RESULTS There were 48 patients (DM = 19, PM = 19, CTD-M = 5, CAM = 2, JM = 3) included. MSA were positive in 37.5% patients. Antibodies against Mi-2 were present in 6 (12.5%), Jo-1 in 5 (10.4%), 2 (4.1%) each had PL-7 and SRP antibodies. One patient (2%) each had MDA-5, NXP2 and TIf1g antibodies. Jo-1 antibody was associated with mechanic's hands and ILD. There was a significant association of rash in the Mi-2 group with none of the patients having ILD. Malignancy screening was negative in NXP2 and TIF1g antibody-positive patients. Ro52 was the most common MAA (33.3%) and was associated with mechanic's hand. CONCLUSION MSA was present in almost 40% of the cohort. Anti Jo-1 antibody was associated with mechanic's hands and ILD. None of the Mi-2 patients had ILD, which may point to a protective role of this antibody for ILD. The association of newer antibodies in Indian patients needs to be further studied in larger cohorts.
Collapse
Affiliation(s)
- Natasha Vijay Negalur
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Gayatri G. Ekbote
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Dhiren N. Raval
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Dhaval V. Tanna
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Wasim S. Kazi
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Muzaffar A. Bindroo
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Durgarao J. Yadavalli
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Rajiva Gupta
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| |
Collapse
|
102
|
Chung SW, Yoo IS, Kim J, Kang SW, Kwon M, Joung CI, Choi IA, Chang SH, Kang MI, Hong SJ, Lee YA. Comparison of the 2017 EULAR/ACR Criteria with Clinicoserologic Criteria for the Classification of Idiopathic Inflammatory Myopathies in Korean Patients. Yonsei Med J 2021; 62:424-430. [PMID: 33908213 PMCID: PMC8084694 DOI: 10.3349/ymj.2021.62.5.424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate correlations between myositis-specific autoantibodies (MSA) or myositis-associated antibodies (MAA) and clinical features, thereby demonstrating the utility of clinicoserologic classification in idiopathic inflammatory myopathies (IIM) patients. MATERIALS AND METHODS We conducted a multicenter study of 108 adult patients (age ≥18 years) who were diagnosed with IIM by Peter and Bohan criteria or 2004 European Neuromuscular Centre (ENMC) criteria. Clinical data were obtained by medical record review. Immunoblot assay with Euroline strip (EUROIMMUN, Germany) was performed using the sera of dermatomyositis (DM, n=56), polymyositis (PM, n=45), amyopathic DM (n=5), DM sine dermatitis (n=1), and immune mediated necrotizing myopathy (n=1) patients. Patients were classified based on two classifications: 2017 EULAR/ACR and novel clinicoserologic classification. RESULTS According to 2017 EULAR/ACR criteria, DM and PM were the most and the second most frequent entities. Overlap myositis was the major entity of IIM, and the frequency of PM was significantly lower when applying clinicoserologic classification criteria. Sixty-nine (63.9%) patients had one or more MSA, and 61 (56.5%) patients had one or more MAA. Interstitial lung disease was closely associated with anti-MDA5 and anti-ARS, and DM-specific skin lesions were frequently observed in patients with anti-TIF1γ, anti-SRP, and anti-MDA5. CONCLUSION The clinicoserologic criteria based on MSA/MAA positivity could reflect more precise clinical features of IIM. Establishment of a laboratory system routinely available to screen for MSA/MAA status will be beneficial to provide precise diagnosis and proper management of IIM patients.
Collapse
Affiliation(s)
- Sang Wan Chung
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - In Seol Yoo
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jinhyun Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seong Wook Kang
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Mihye Kwon
- Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea
| | - Chung Il Joung
- Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea
| | - In Ah Choi
- Division of Rheumatology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheong-ju, Korea
| | - Sung Hae Chang
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Mi Il Kang
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Seung Jae Hong
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Yeon Ah Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea.
| |
Collapse
|
103
|
Watanabe E, Kato K, Gono T, Chiba E, Terai C, Kotake S. Serum levels of galectin-3 in idiopathic inflammatory myopathies: a potential biomarker of disease activity. Rheumatology (Oxford) 2021; 60:322-332. [PMID: 32770187 DOI: 10.1093/rheumatology/keaa305] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/04/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Galectin-3 is involved in various biological activities, including immune activations and fibrosis. Idiopathic inflammatory myopathies (IIMs) are autoimmune diseases of unknown aetiology, often complicated by interstitial lung disease (ILD). The aim of this study was to evaluate the expression of galectin-3 in sera and tissues of patients with IIM and assess the associations of galectin-3 with patient characteristics and disease activity. RESULTS Serum galectin-3 levels were significantly higher in IIM patients than in healthy controls. The serum galectin-3 levels positively correlated with serum levels of inflammatory markers and proinflammatory cytokines/chemokines and the Myositis Intention-to-Treat Activity Index. Stratification analysis revealed that patients with IIM-associated ILD (IIM-ILD) had significantly higher levels of serum galectin-3 than those without IIM-ILD. In addition, patients with acute/subacute interstitial pneumonia had significantly higher levels of serum galectin-3 than those with chronic interstitial pneumonia. Furthermore, serum galectin-3 levels in IIM-ILD patients correlated with the radiological assessments of parenchymal lung involvement and treatment response. Immunohistochemical analysis revealed that galectin-3 was expressed in inflammatory cells of myositis and dermatitis sections, whereas in ILD sections, galectin-3 was expressed in interstitial fibrosis and inflammatory cells. CONCLUSION Galectin-3 may be involved in the pathogenesis of inflammatory and fibrotic conditions in IIM and can serve as a potential biomarker of disease activity, especially in patients with IIM-ILD.
Collapse
Affiliation(s)
- Eri Watanabe
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama
| | - Kazunori Kato
- Department of Biomedical Engineering, Faculty of Science and Engineering, Toyo University, Saitama
| | - Takahisa Gono
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama.,Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo
| | - Emiko Chiba
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Chihiro Terai
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama
| | - Shigeru Kotake
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama
| |
Collapse
|
104
|
Ryan ME, Cortez D, Dietz KR, Karachunski P, Binstadt BA. Anti-MDA5 juvenile idiopathic inflammatory myopathy with second-degree heart block but no skin or lung involvement: a case report. BMC Rheumatol 2021; 5:8. [PMID: 33795018 PMCID: PMC8017641 DOI: 10.1186/s41927-021-00180-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/31/2021] [Indexed: 12/25/2022] Open
Abstract
Background Patients with idiopathic inflammatory myopathy and autoantibodies directed against melanoma differentiation-associated protein 5 (MDA5) characteristically have interstitial lung disease, severe cutaneous involvement, arthritis, and relatively mild myositis. Cardiac involvement in idiopathic inflammatory myopathy can occur and has been associated with anti-signal recognition particle and anti-polymyositis-scleroderma autoantibodies, but not with anti-MDA5 autoantibodies. Case presentation A 14-year-old male presented with weakness, second-degree heart block, arthritis, and hematologic cytopenias. Imaging and biopsies confirmed the diagnosis of juvenile idiopathic inflammatory myopathy, and he had high titer anti-MDA5 autoantibodies. There were no cutaneous or pulmonary abnormalities. While on prednisone and methotrexate, the patient’s heart block improved from second- to first-degree and the cytopenias resolved. Persistent myositis prompted the addition of intravenous immunoglobulin. Seven months into the disease course, the arthritis and myositis are in remission and the patient is no longer taking corticosteroids. Conclusions We report a novel case of a patient with juvenile idiopathic myositis who lacked the typical cutaneous and pulmonary findings associated with anti-MDA5 positivity, but who had cardiac conduction defects. This report broadens the clinical spectrum of anti-MDA5-associated inflammatory myopathy.
Collapse
Affiliation(s)
- Meghan E Ryan
- Department of Pediatrics, Division of Rheumatology, Allergy & Immunology, University of Minnesota, Minneapolis, USA
| | - Daniel Cortez
- Department of Pediatrics, Division of Cardiology, University of Minnesota, Minneapolis, USA
| | - Kelly R Dietz
- Department of Radiology, University of Minnesota, Minneapolis, USA
| | | | - Bryce A Binstadt
- Department of Pediatrics, Division of Rheumatology, Allergy & Immunology, University of Minnesota, Minneapolis, USA.
| |
Collapse
|
105
|
Phuong TNT, Ngoc LNT, Rönnelid J, Padyukov L, Lundberg IE. Clinical characteristics of Vietnamese patients with idiopathic inflammatory myopathies and autoantibodies to aminoacyl-transfer RNA synthetases. Int J Rheum Dis 2021; 24:663-670. [PMID: 33788398 DOI: 10.1111/1756-185x.14105] [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: 11/03/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess clinical phenotypes of anti-aminoacyl-transfer RNA synthetases (aaRS) autoantibodies in Vietnamese patients of Kinh ethnicity with idiopathic inflammatory myopathies (IIM). METHODS In a cross-sectional study 23 patients with anti-aaRS autoantibodies were compared to 36 patients with other myositis-specific antibodies and to 69 seronegative patients with IIM. Assessments included muscle performance, extra-muscular involvement, and disease activity according to the International Myositis Assessment and Clinical Studies (IMACS). Sera were tested by a line immunoassay (Euroline Myositis Profile 4). RESULTS The frequency of anti-Jo-1 antibodies was 56.5%, anti-EJ antibodies 26.1%, and anti-PL-7 antibodies 17.4%, while anti-PL-12 and anti-OJ antibodies were not present in any case. All patients with anti-aaRS autoantibodies had signs of myositis. At time of investigation 22/23 patients had muscle weakness, 52.2% arthritis, 34.8% Raynaud's phenomenon, 73.9% fever, 14.3% mechanic's hands and 56.5% dysphagia. Interstitial lung disease was present in 52.2%, and pulmonary hypertension in 56.5%. The anti-aaRS autoantibody positive group had higher disease activity in the domains of skin and pulmonary disease compared to the seronegative group and had lower disease activity in skeletal disease compared to the anti-melanoma differentiation-associated protein 5-positive patients. The clinical presentation of antisynthetase syndrome was similar between the aaRS autoantibody specificities with the exception of more frequent pulmonary hypertension in anti-Jo-1 positive patients. CONCLUSIONS Different aaRS autoantibody specificities may vary between different ethnic populations for reasons that still need to be clarified. Furthermore, the high frequency of pulmonary hypertension is noteworthy but otherwise clinical manifestations associated with aaRS autoantibodies did not differ from other ethnic populations.
Collapse
Affiliation(s)
- Thuy Nguyen Thi Phuong
- Rheumatology Department, Bach Mai Hospital, Hanoi, Vietnam.,Internal Medicine Department, Hanoi Medical University, Hanoi, Vietnam
| | | | - Johan Rönnelid
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Rheumatology clinic, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
106
|
Albayda J, Mecoli C, Casciola-Rosen L, Danoff SK, Lin CT, Hines D, Gutierrez-Alamillo L, Paik JJ, Tiniakou E, Mammen AL, Christopher-Stine L. A North American Cohort of Anti-SAE Dermatomyositis: Clinical Phenotype, Testing, and Review of Cases. ACR Open Rheumatol 2021; 3:287-294. [PMID: 33774928 PMCID: PMC8126760 DOI: 10.1002/acr2.11247] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/19/2021] [Indexed: 01/18/2023] Open
Abstract
Objective Antibodies against the small ubiquitin‐like modifier (SUMO) activating enzyme (SAE) are one of the rarer specificities associated with dermatomyositis (DM). The purpose of this study is to describe the clinical characteristics of patients with anti‐SAE autoantibodies in a North American cohort and to ascertain cancer prevalence. We also describe the performance characteristics of the line blotting (Euroimmun) method for antibody detection compared with an immunoprecipitation‐based assay. Methods Sera from 2127 patients suspected of having myositis were assayed for myositis‐specific autoantibodies using the Euroimmun platform. Those positive for SAE autoantibodies were assayed by a second method (immunoprecipitation) for confirmation. Only those cases positive by both methods were taken as definite cases of anti‐SAE–positive DM. Chart reviews of these patients were completed to obtain information on clinical characteristics, cancer history, and treatment. Results Forty‐three of 2127 sera were anti‐SAE autoantibody positive by Euroimmun (≥15 units, +); of these, only 19 were confirmed positive by immunoprecipitation. All 19 cases had skin involvement and varying presentations of muscle, lung, and joint disease. Cancer occurred coincident with DM in two patients, and cancers were detected more than 5 years from symptom onset in three patients. In a population of suspected inflammatory myositis, a higher cutoff on line blot testing (≥36 units, ++) yielded better agreement with immunoprecipitation methods. Conclusion SAE autoantibodies associate with a clinical phenotype of DM, which most commonly presents with a rash first, followed by muscle involvement and varying extramuscular involvement. As coincident cancer was seen in anti‐SAE–positive DM, judicious malignancy screening may be warranted.
Collapse
Affiliation(s)
| | | | | | | | | | - David Hines
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Andrew L Mammen
- Johns Hopkins University, Baltimore, Maryland, and National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | | |
Collapse
|
107
|
Van Horebeek N, Vulsteke JB, Bossuyt X, Claeys KG, Dillaerts D, Poesen K, Lenaerts J, Van Damme P, Blockmans D, De Haes P, De Langhe E. Detection of multiple myositis-specific autoantibodies in unique patients with idiopathic inflammatory myopathy: A single centre-experience and literature review: Systematic review. Semin Arthritis Rheum 2021; 51:486-494. [PMID: 33831755 DOI: 10.1016/j.semarthrit.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/23/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Myositis-specific autoantibodies (MSAs) are thought to be mutually exclusive in patients with idiopathic inflammatory myopathies (IIM) based on studies with immunoprecipitation-based (IP) detection methods. Recently, detection of multiple MSAs in unique patients is increasingly reported, but the extent of this phenomenon remains unclear. METHODS At our centre, we reviewed results from two line immunoassays and one dot immunoassay in 145 IIM patients and 240 controls for the presence of multiple MSAs. Pubmed and Embase were systematically searched for articles mentioning detection of multiple MSAs in IIM patients, published until February 2019. We assessed the frequency, detection method, the precise combinations and clinical phenotypes of participants with multiple MSAs. RESULTS At our centre, detection of multiple MSAs occurred in 3.4-8.3% of patients with IIM, depending on the assay. However, no cases with full concordance across all three assays were identified. Forty-four articles reported detection of multiple MSAs, representing a total of 133 cases, including four patients with a connective tissue disease other than IIM and two healthy controls. In 101 cases all MSAs were detected using only one detection method: 40 cases with IP-based methods (most frequently used technique) and 61 cases with other assay types. In most cases the phenotype of patients with multiple MSAs matched the predicted presentation associated with one MSA and in few cases the phenotype matched with both MSAs. CONCLUSION Detection of multiple MSAs in unique IIM patients is less rare than commonly accepted. Specificity issues of the commercially available multiplex immunoassays may, at least partly, explain the higher frequency compared to IP-based methods. 'True multiple MSA-positive' patients may exist, though they are most likely rare.
Collapse
Affiliation(s)
- Nele Van Horebeek
- General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Jean-Baptiste Vulsteke
- Rheumatology, University Hospitals Leuven, Leuven, Belgium; KU Leuven Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Laboratory of Tissue Homeostasis and Disease
| | - Xavier Bossuyt
- Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium; Clinical and Diagnostic Immunology, KU Leuven, Leuven, Belgium
| | - Kristl G Claeys
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium; KU Leuven, Laboratory for Muscle Diseases and Neuropathies, Leuven, Belgium
| | | | - Koen Poesen
- Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium; KU Leuven, Laboratory for Molecular Neurobiomarker Research, Leuven, Belgium
| | - Jan Lenaerts
- Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Philip Van Damme
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium; KU Leuven, Department of Neurosciences, Experimental Neurology, VIB Centre for Brain and Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Daniel Blockmans
- General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Petra De Haes
- Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Ellen De Langhe
- Rheumatology, University Hospitals Leuven, Leuven, Belgium; KU Leuven Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Laboratory of Tissue Homeostasis and Disease.
| |
Collapse
|
108
|
Wu W, Xu W, Sun W, Zhang D, Zhao J, Luo Q, Wang X, Zhu F, Zheng Y, Xue Y, Wan W, Wu H, Han Q, Ye S. Forced vital capacity predicts the survival of interstitial lung disease in anti-MDA5 positive dermatomyositis: a multi-centre cohort study. Rheumatology (Oxford) 2021; 61:230-239. [PMID: 33764398 DOI: 10.1093/rheumatology/keab305] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Anti-melanoma differentiation-associated gene 5 (MDA5) positive dermatomyositis (DM) is a life-threatening disease often complicated with rapidly progressive interstitial lung disease (ILD). This study aimed to establish and validate a clinical prediction model for 6-month all-cause mortality in Chinese patients with anti-MDA5 positive DM-ILD. METHODS We conducted a retrospective observational study using a single-centre derivation cohort and a multi-centre validation cohort. Hospitalized DM patients with positive anti-MDA5 antibody and ILD course ≤3 months on admission were included. Patients' baseline characteristics were described and compared between the deceased and survivors by univariable Cox regression. Optimal cut-off values were defined by the 'survminer' R package for significant continuous variables. Independent prognostic factors were determined by the final multivariable Cox regression model chosen by backward stepwise algorithm, which could be reproduced in both cohorts. The Kaplan-Meier survival analyses based on the derived predictor were conducted. RESULTS A total of 184 and 81 eligible patients were included with a cumulative 40.8% and 40.7% six-month mortality in the derivation and validation cohorts, respectively. Based on multivariable Cox regression, the prognostic factor at baseline was identified and validated as three-category forced vital capacity (FVC)%: FVC% ≥ 50%, FVC% <50%, unable to perform. This significantly distinguishes three risk stages with mortalities of 15.3%, 46.8%, 97.4% in the derivation cohort, and 14.9%, 58.3%, 86.4% in the validation cohort, respectively (all p < 0.05). CONCLUSION The validated FVC%-based categorical predictor in anti-MDA5 positive DM-ILD is helpful for risk stratification in clinical practice and might facilitate cohort enrichment for future trials.
Collapse
Affiliation(s)
- Wanlong Wu
- Department of Rheumatology, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenwen Xu
- Department of Rheumatology, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjia Sun
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Danting Zhang
- Department of Rheumatology, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiangfeng Zhao
- Department of Rheumatology, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qun Luo
- State Key Laboratory of Respiratory Disease, National Clinical Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaodong Wang
- Department of Rheumatology, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Zhu
- Department of Pulmonology, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zheng
- Department of Pulmonology, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xue
- Division of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weiguo Wan
- Division of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Huaxiang Wu
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Qian Han
- State Key Laboratory of Respiratory Disease, National Clinical Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shuang Ye
- Department of Rheumatology, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
109
|
Chen M, Zhao Q, Diao L, Xue K, Ruan Y, Xue F, Li J, Shi R, Pan M, Zheng J, Cao H. Distribution of anti-melanoma differentiation associated gene 5 (MDA5) IgG subclasses in MDA5+ dermatomyositis. Rheumatology (Oxford) 2021; 61:430-439. [PMID: 33742662 DOI: 10.1093/rheumatology/keab268] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The anti-melanoma differentiation-associated gene 5 (MDA5) antibody is the main predictor of interstitial lung disease (ILD) in dermatomyositis (DM) and clinically amyopathic dermatomyositis (CADM). Nevertheless, a subset of MDA5+ patients have a favorable prognosis. We aimed to determine the possibility of using anti-MDA5 antibody isotypes and IgG subclasses for evaluating ILD risk. METHODS The isotypes (IgG, IgA and IgM) of anti-MDA5 were detected in serum samples of 36 anti-MDA5+ patients with DM/CADM using enzyme-linked immunosorbent assay (ELISA). IgG subclasses of anti-MDA5 antibodies were further investigated. Laboratory findings and cumulative survival were analyzed based on the isotypes of anti-MDA5 and subclasses of anti-MDA5 IgG. RESULTS Among the MDA5+ patients with DM/CADM, the positive rates of anti-MDA5 IgG, IgA, IgM were 100%, 97%, and 6%, respectively. The positive rates of anti-MDA5 IgG1, IgG2, IgG3, and IgG4 were 72%, 25%, 0%, and 28%, respectively. The incidence of acute interstitial pneumonia, mortality rate, and serum ferritin were significantly higher in anti-MDA5 IgG1+ patients than those in anti-MDA5 IgG1- patients with DM/CADM (P = 0.0027, 0.015, 0.0011, respectively). The sensitivity and specificity of anti-MDA5 IgG1 for predicting mortality were 100% and 41.7%, respectively. A combination of anti-MDA5 IgG1 and IgG4 for predicting mortality, yielded better specificity (87.5%). CONCLUSION IgA and IgG are the primary anti-MDA5 antibody isotypes. Anti-MDA5 IgG1 is the primary component of MDA5 IgG subclasses and anti-MDA5 IgG1 and IgG4 might serve as useful biomarkers for predicting mortality in DM-ILD.
Collapse
Affiliation(s)
- Mengya Chen
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China
| | - Qian Zhao
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China
| | - Licheng Diao
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China
| | - Ke Xue
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China
| | - Yeping Ruan
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China
| | - Feng Xue
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China
| | - Jian Li
- Department of Clinical Research Center, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China
| | - Ruofei Shi
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China
| | - Meng Pan
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China
| | - Jie Zheng
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China
| | - Hua Cao
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China
| |
Collapse
|
110
|
Anti-SAE autoantibody-positive Japanese patient with juvenile dermatomyositis complicated with interstitial lung disease - a case report. Pediatr Rheumatol Online J 2021; 19:34. [PMID: 33740993 PMCID: PMC7980636 DOI: 10.1186/s12969-021-00532-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical phenotypes and outcomes in juvenile dermatomyositis (JDM) have been defined by various myositis-specific autoantibodies (MSAs). One of the recently described MSAs associated with DM is targeted against the small ubiquitin-like modifier 1 activating enzyme (SAE). We report an anti-SAE autoantibody-positive JDM patient complicated with interstitial lung disease (ILD). CASE PRESENTATION An 8-year-8-month-old Japanese girl presented with bilateral eyelid edema and facial erythema. At 8 years 4 months, she had dry cough and papules with erythema on the dorsal side of the interphalangeal joints of both hands. Her facial erythema gradually worsened and did not improve with topical steroids. At the first visit to our department at 8 years 8 months of age, she had a typical heliotrope rash and Gottron's papules, with no fever or weight loss, and a chest computed tomography scan showed ground-glass opacity under visceral pleura. There was no clinical evidence of myositis, muscle weakness, myalgia, or muscle magnetic resonance imaging (MRI) findings. She had mild dry cough, without any signs of respiratory distress. Laboratory tests showed no elevated inflammatory markers. She had a normal serum creatine kinase level with a slightly elevated aldolase level, and serum anti-SAE autoantibody was detected by immunoprecipitation-western blotting. She was diagnosed with juvenile amyopathic DM complicated by ILD and received two courses of methylprednisolone pulse therapy followed by oral corticosteroid and cyclosporin A. We gradually reduced the corticosteroid dose as her skin rash improved after treatment initiation. There was no progression of muscle symptoms, dysphagia, or disease flare during a 24-month follow-up period. CONCLUSIONS We report a patient with anti-SAE autoantibody-positive JDM complicated by interstitial pneumonia. This patient had no progression of muscle symptoms and dysphagia during a 24-month follow-up period, which differs from previous reports in adult patients with MSAs. There have been no previous reports of pediatric patients with SAE presenting with ILD. However, ILD seen in this case was not rapidly progressive and did not require cytotoxic agents. To prevent overtreatment, appropriate treatment choices are required considering the type of ILD.
Collapse
|
111
|
Association of anti-NXP2 antibody with clinical characteristics and outcomes in adult dermatomyositis: results from clinical applications based on a myositis-specific antibody. Clin Rheumatol 2021; 40:3695-3702. [PMID: 33712891 DOI: 10.1007/s10067-021-05667-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/02/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim was to study and compare the clinical manifestations, auxiliary examinations, and therapeutic responses in patients with different myositis-specific antibody (MSA) types. METHOD We retrospectively investigated the medical records of 143 hospitalized dermatomyositis patients, all of whom were tested for MSAs, and performed follow-up. Patients were divided into groups with and without anti-nuclear matrix protein 2 (NXP2) antibodies (17 vs 126 patients). Demographic, clinical manifestation (occurring at any time during the disease course), imaging, laboratory, treatment response, and survival data were collected for statistical analyses. RESULTS Adult dermatomyositis patients with anti-NXP2 antibodies were more prone to dysphagia (P<0.001), had higher levels of muscle injury markers (CK peak, P=0.007; CK peak>1000 IU/L, P<0.001; CK-MB, P=0.002), were younger at onset (P=0.008), and were less likely to present with interstitial lung disease (P=0.016) than the anti-NXP2 antibody-negative subgroup. Multivariable logistic regression analysis showed that onset age (OR=0.96 CI 95%: 0.924-0.999, P=0.043) and dysphagia (OR=7.088, CI 95%: 1.824-27.536, P=0.005) were independent risk factors for anti-NXP2 antibody positivity. Kaplan-Meier survival analysis did not reveal that dermatomyositis patients with anti-NXP2 antibodies have a relatively worse prognosis. However, the disease course was more frequently polycyclic, and 68.75% of patients had a relapsing-remitting disease course. More than half (52.94%) of those who showed no response to treatment used at least 3 disease-modifying antirheumatic drugs. CONCLUSIONS We show the important clinical features of and risk factors for this unique antibody-mediated form of dermatomyositis. Although these patients had a relatively low mortality rate, they were prone to recurrence, and treatment was challenging. Key points • The clinical features and risk factors for adult dermatomyositis patients with anti-NXP2 antibodies. • The impact of anti-NXP2 antibody on survival outcomes.
Collapse
|
112
|
Cao X, Zhang M, Lu Z, Li C, Zeng Y, Fan J, Yu K. Multiple neurological manifestations in a patient with systemic lupus erythematosus and anti-NXP2-positive myositis: A case report. Medicine (Baltimore) 2021; 100:e25063. [PMID: 33725895 PMCID: PMC7969320 DOI: 10.1097/md.0000000000025063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Systemic lupus erythematosus (SLE) is a complex autoimmune inflammatory disease that frequently affects various organs. Neuropsychiatric manifestations in SLE patients, known as neuropsychiatric SLE, are clinically common. However, the principal manifestation of cranial neuropathy in patients with SLE and comorbidities is relatively rare. PATIENT CONCERNS In this report, we describe a 51-year-old Chinese woman who was admitted with a chief complaint of chronic-onset facial paresthesia, dysphagia, and choking cough when drinking water, accompanied by slurred speech, salivation, and limb weakness. The blood autoantibody test results showed that many SLE-associated antibodies were positive. Meanwhile, anti-nuclear matrix protein 2 (NXP2) antibody was strongly positive in the idiopathic inflammatory myopathy (IIM) spectrum test from the serum. Muscle biopsy indicated inflammatory infiltration of the muscle fiber stroma. DIAGNOSES Taking into account the clinical manifestations and laboratory tests of the present case, the diagnosis of SLE and probable IIM was established. INTERVENTIONS Corticosteroids and additional gamma globulin were administered and the clinical symptoms were relieved during the treatment process. OUTCOMES Unfortunately, the patient experienced sudden cardiac and respiratory arrest. Multiple system dysfunctions exacerbated disease progression, but in the present case, we speculated that myocardial damage resulting from SLE could explain why she suddenly died. LESSONS To our knowledge, multiple neurological manifestations in patients with SLE and anti-NXP2-positive myositis are rare. Note that SLE is still a life-threatening disease that causes multiple system dysfunctions, which requires increasing attention.
Collapse
|
113
|
Hodgkinson LM, Wu TT, Fiorentino DF. Dermatomyositis autoantibodies: how can we maximize utility? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:433. [PMID: 33842654 PMCID: PMC8033377 DOI: 10.21037/atm-20-5175] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The past 15 years has seen significant advances in the characterization of myositis-specific autoantibodies (MSAs) and their associated phenotypes in patients with dermatomyositis (DM). As more careful studies are performed, it is clear that unique combinations of clinical and pathological phenotypes are associated with each MSA, despite the fact that there is considerable heterogeneity within antibody classes as well as overlap across the groups. Because risk for interstitial lung disease (ILD), internal malignancy, adverse disease trajectory, and, potentially response to therapy differ by DM MSA group, a deeper understanding of MSAs and validation and standardization of assays used for detection are critical for optimizing diagnosis and treatment. Like any test, the diagnostic sensitivity and specificity of assays for various MSAs is not perfect. Currently tests for MSAs are helpful at minimum for a clinician to assess relative risk or contribute to diagnosis and perhaps counsel the appropriate patient about what to expect. With international standardization and larger studies it is likely that more antibody tests will make their way into formal schemata for diagnosis and actionable risk assessment in DM. In this review, we summarize key considerations for interpreting the clinical and pathologic associations with MSA in DM and identify critical gaps in knowledge and practice that will maximize their clinical utility and utility for understanding disease pathogenesis.
Collapse
Affiliation(s)
| | - Tiffany Tingshuen Wu
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | | |
Collapse
|
114
|
Yoo J, Ahn SS, Jung SM, Song JJ, Park YB, Lee SW. Reclassification of Korean patients with polymyositis and dermatomyositis based on the Bohan and Peter criteria by the 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies. Korean J Intern Med 2021; 36:441-446. [PMID: 31875667 PMCID: PMC7969061 DOI: 10.3904/kjim.2019.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/01/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/AIMS We investigated the concordance rate of the classification of polymyositis (PM) and dermatomyositis (DM) between the Bohan and Peter criteria and the 2017 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for idiopathic inflammatory myopathies (IIMs) (the 2017 EULAR/ACR criteria) in Korean patients. METHODS We retrospectively reviewed the medical records of 137 patients with PM and DM. We finally included 72 PM patients and 49 DM patients who fulfilled the Bohan and Peter criteria for PM and DM and reclassified them by the 2017 EULAR/ ACR criteria. RESULTS Three patients (4.2%) with probable PM were newly reclassified as non-IIM due to a total score of 5.3 or smaller. Meanwhile, one patient with possible PM was newly reclassified as probable PM due to the presence of dysphagia. In addition, eight patients (16.3%) with possible DM with DM-specific typical skin rash were newly reclassified as amyopathic DM (ADM) due to the absence of proximal muscle weakness. The concordance rate of the classification between the Bohan and Peter criteria and the 2017 EULAR/ACR criteria was 95.8% for PM patients and 83.7% for DM patients. CONCLUSION The Bohan and Peter criteria were comparable to the 2017 EULAR/ ACR criteria for classifying PM and DM in Korean patients. Considering the convenience of the Bohan and Peter criteria in the real clinical settings, we suggest that the old criteria should be preferentially applied and then performing muscle biopsy should be considered in a patient suspected of PM without antihistidyl tRNA synthetase (anti-Jo-1). Moreover, we suggest that ADM could also clinically be classified by the old criteria.
Collapse
Affiliation(s)
- Juyoung Yoo
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Ahn
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jason Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Sang-Won Lee, M.D. Division of Rheumatology, Department of Internal Medicine, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1987 Fax: +82-2-393-6884 E-mail:
| |
Collapse
|
115
|
Real world utilization of the myositis autoantibody panel. Clin Rheumatol 2021; 40:3195-3205. [PMID: 33629202 DOI: 10.1007/s10067-021-05658-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/31/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Myositis autoantibody panel results can offer diagnostic and prognostic information in patients with concern for idiopathic inflammatory myopathy (IIM). However, there has been widespread utilization of myositis autoantibody testing clinically, often in situations where concern for an IIM is unclear. We sought to determine ordering practices and factors predicting positive results on ordered myositis antibody panels. METHODS We included all patients in the Duke University Health System who had a "myositis antibody panel" ordered from October 2014 through December 2016. Retrospective chart review was performed evaluating antibody positivity, provider specialty, ordering location, demographics, medical history, review of systems (ROS), physical examination (PE), and laboratory values. Fisher's exact and t test tests and backward multivariable regression analysis were performed for statistical analysis. RESULTS There were 642 unique tests obtained with 114 positive autoantibodies (17.7%) over the 26-month period. Myositis-specific autoantibodies (MSAs) were the most common and anti-Mi-2 was the most frequent (40% of MSAs). Pulmonology providers ordered the majority of tests (383; 59.6%). Adult Rheumatology had the highest antibody positivity rate (34.3%, p=0.0001) among specialties with at least 10 panels ordered. In backward multivariable regression analysis, factors independently associated with a positive myositis antibody panel were chronic corticosteroid use (OR: 2.10, 95% CI: 1.30-3.38) and sclerodermoid skin changes (OR: 6.89; 95% CI: 2.02-23.47). CONCLUSION The positivity rate of myositis antibody panel testing in this real-world clinical setting was 18%. Anti-Mi-2 antibody was the most frequent autoantibody present. Specific factors associated with positive results can be utilized to identify patients at higher risk for IIM. KEY POINTS • Only eighteen percent of all myositis antibody panel tests ordered returned positive. • Anti-Mi-2 antibody was the most frequent autoantibody in our cohort. • Specific factors associated with positive results can help identify patients at higher risk for IIM, particularly for non-rheumatologists.
Collapse
|
116
|
McElhanon KE, Young N, Hampton J, Paleo BJ, Kwiatkowski TA, Beck EX, Capati A, Jablonski K, Gurney T, Perez MAL, Aggarwal R, Oddis CV, Jarjour WN, Weisleder N. Autoantibodies targeting TRIM72 compromise membrane repair and contribute to inflammatory myopathy. J Clin Invest 2021; 130:4440-4455. [PMID: 32687067 DOI: 10.1172/jci131721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 05/14/2020] [Indexed: 12/27/2022] Open
Abstract
Idiopathic inflammatory myopathies (IIM) involve chronic inflammation of skeletal muscle and subsequent muscle degeneration due to an uncontrolled autoimmune response; however, the mechanisms leading to pathogenesis are not well understood. A compromised sarcolemmal repair process could promote an aberrant exposure of intramuscular antigens with the subsequent initiation of an inflammatory response that contributes to IIM. Using an adoptive transfer mouse model of IIM, we show that sarcolemmal repair is significantly compromised in distal skeletal muscle in the absence of inflammation. We identified autoantibodies against TRIM72 (also known as MG53), a muscle-enriched membrane repair protein, in IIM patient sera and in our mouse model of IIM by ELISA. We found that patient sera with elevated levels of TRIM72 autoantibodies suppress sarcolemmal resealing in healthy skeletal muscle, and depletion of TRIM72 antibodies from these same serum samples rescues sarcolemmal repair capacity. Autoantibodies targeting TRIM72 lead to skeletal muscle fibers with compromised membrane barrier function, providing a continuous source of autoantigens to promote autoimmunity and further amplifying humoral responses. These findings reveal a potential pathogenic mechanism that acts as a feedback loop contributing to the progression of IIM.
Collapse
Affiliation(s)
- Kevin E McElhanon
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, and
| | - Nicholas Young
- Division of Rheumatology and Immunology, Department of Internal Medicine, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffrey Hampton
- Division of Rheumatology and Immunology, Department of Internal Medicine, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian J Paleo
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, and
| | - Thomas A Kwiatkowski
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, and
| | - Eric X Beck
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, and
| | - Ana Capati
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, and
| | - Kyle Jablonski
- Division of Rheumatology and Immunology, Department of Internal Medicine, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Travis Gurney
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, and
| | - Miguel A Lopez Perez
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, and
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Wael N Jarjour
- Division of Rheumatology and Immunology, Department of Internal Medicine, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Noah Weisleder
- Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, and
| |
Collapse
|
117
|
Zuo Y, Ye L, Liu M, Li S, Liu W, Chen F, Lu X, Gordon P, Wang G, Shu X. Clinical significance of radiological patterns of HRCT and their association with macrophage activation in dermatomyositis. Rheumatology (Oxford) 2021; 59:2829-2837. [PMID: 32065646 DOI: 10.1093/rheumatology/keaa034] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/30/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To evaluate the distribution of radiological characteristics stratified by different myositis-specific autoantibodies, identify prognostic value of high-resolution CT (HRCT) patterns in DM-associated interstitial lung disease (DM-ILD), and explore the possible mechanism associated with macrophage activation. METHODS We enrolled 165 patients with PM/DM-ILD. The distribution of HRCT radiological types with different myositis-specific autoantibodies and the relationship between radiological features and ILD course and prognosis were analysed. Additionally, the potential role of macrophage activation in rapidly progressive ILD (RP-ILD) with DM was studied. RESULTS The organizing pneumonia pattern was dominant in HRCT findings of patients with DM-ILD, especially those with anti-SAE (6/6, 100%) and anti-MDA5 (46/62, 74.2%) antibodies. The ratios of organizing pneumonia and nonspecific interstitial pneumonia patterns were almost equal in patients with aminoacyl tRNA synthetase antibodies, and nonspecific interstitial pneumonia pattern was associated with a mild clinical course. Lower lung zone consolidation in HRCT was related to RP-ILD in both anti-MDA5 and anti-aminoacyl tRNA synthetase antibody-positive groups. Ferritin levels of >1000 ng/ml (odds ratio (OR), 12.3; P=0.009), elevated carcinoembryonic antigen (OR, 5.8; P=0.046) and carbohydrate antigen 19-9 (OR, 7.8; P=0.018) were independent predictors of a lower lung zone consolidation pattern in anti-MDA5 antibody-positive DM. The infiltration of CD163-positive macrophages into alveolar spaces was significantly higher in the DM-RP-ILD group than in the chronic DM-ILD group. CONCLUSION HRCT patterns are different among variable myositis-specific autoantibodies positive patients with ILD and lower zone consolidation in HRCT correlated with RP-ILD in DM. Activated macrophages may contribute to the pathogenesis of RP-ILD in DM.
Collapse
Affiliation(s)
- Yu Zuo
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital
| | - Lifang Ye
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital.,Peking University China-Japan Friendship School of Clinical Medicine
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Shanshan Li
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital
| | - Weifang Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Fang Chen
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital
| | - Xin Lu
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital, NHS Foundation Trust, London, UK
| | - Guochun Wang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital.,Peking University China-Japan Friendship School of Clinical Medicine
| | - Xiaoming Shu
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital
| |
Collapse
|
118
|
Santler B, Ehrchen J. [Antinuclear antibodies : Practical diagnostic recommendations for dermatologists]. Hautarzt 2021; 72:71-80. [PMID: 33346859 DOI: 10.1007/s00105-020-04740-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antinuclear antibodies (ANA) are a common diagnostic finding in patients with systemic autoimmune diseases. In patients with typical clinical symptoms, the determination of ANA is of both diagnostic and prognostic importance. However, if ANA were determined due to unspecific symptoms, the interpretation of ANA findings can be problematic. In these cases, misjudgements with severe consequences for the patients are possible. Many systemic autoimmune diseases have prominent early skin involvement and the dermatologist can be the first physician that such a patient sees. Therefore, knowledge of ANA diagnostics is important for dermatologists. Basic principles of autoantibody diagnostics, guidance for the interpretation of laboratory results and new developments are discussed in this overview.
Collapse
Affiliation(s)
- Bettina Santler
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie -, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - Jan Ehrchen
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie -, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
| |
Collapse
|
119
|
Wang X, Ding Y, Zhou Z, Hou J, Xu Y, Li J. Clinical characteristics and poor predictors of anti-NXP2 antibody-associated Chinese JDM children. Pediatr Rheumatol Online J 2021; 19:6. [PMID: 33407621 PMCID: PMC7788734 DOI: 10.1186/s12969-020-00492-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is a rare and sometimes fatal disease in children. The anti-NXP2 antibody is one of the most common antibodies and muscle ischaemia associated with NXP2 autoantibodies was a severe subtype of JDM. Further information is needed regarding clinical characteristics and factors associated with poor prognosis. But there are no reports about clinical characteristics and high risk factor of poor prognosis. For the first time, we introduced the clinical characteristics and poor predictors of anti-NXP2 antibody-associated juvenile dermatomyositis in Chinese children. METHODS Twenty-six patients with anti-NXP2 antibody-related JDM from 85 JDM Chinese patients were diagnosed from January 2016 to November 2019. Logistic regression was used to analyze the risk factors for refractory cases and mortality. RESULTS The ratio of male to female was 1:1.9. The median age of onset was 4.5 (1-13) years. Twenty-four cases (92.3%) had rash and muscle weakness. Treatments included glucocorticoids, immunosuppressive agents, biological agents (7 cases), plasma exchange, Janus kinase inhibitor (7 cases) and autologous stem cell transplant (1 case). Refractory JDM patients (11/26, 42.3%) were associated with edema, skin ulcer, muscle strength<=grade 3, CD4/CD8 ratio < 1.4 and ferritin > 200μg/ml. Among 6 cases (6/26, 23.1%) with severe gastrointestinal involvement, 5 cases died and 1 case survived after autologous stem cell transplant (ASCT). The risk factors for gastrointestinal involvement and mortality were edema, skin ulcer, severe muscle weakness (dysphagia/ hoarseness/ soft voice), BMI < 15 and ANA positive. CONCLUSIONS Edema, skin ulcer and severe muscle weakness predicted refractory disease, GI involvement, and mortality in anti-NXP2 antibody-positive JDM of Chinese children. Decreased CD4/CD8 ratio and high ferritin related with refractory cases, and very low BMI and ANA (+) are probably, associated with gastrointestinal involvement and mortality. TRIAL REGISTRATION http://www.chictr.org.cn/showproj.aspx?proj=49846 .
Collapse
Affiliation(s)
- Xinning Wang
- grid.418633.b0000 0004 1771 7032Department of Rheumatology and Immunology, The Affiliated Children’s Hospital, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing, 100020 China
| | - Yuchuan Ding
- grid.418633.b0000 0004 1771 7032Department of Rheumatology and Immunology, The Affiliated Children’s Hospital, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing, 100020 China
| | - Zhixuan Zhou
- Department of Rheumatology and Immunology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing, 100020, China.
| | - Jun Hou
- grid.418633.b0000 0004 1771 7032Department of Rheumatology and Immunology, The Affiliated Children’s Hospital, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing, 100020 China
| | - Yingjie Xu
- grid.418633.b0000 0004 1771 7032Department of Rheumatology and Immunology, The Affiliated Children’s Hospital, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing, 100020 China
| | - Jianguo Li
- Department of Rheumatology and Immunology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing, 100020, China.
| |
Collapse
|
120
|
Idiopathic Inflammatory Myositis. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
121
|
Parks CG, Wilkerson J, Rose KM, Faiq A, Noroozi Farhadi P, Long CS, Bayat N, Brunner HI, Goldberg B, McGrath JA, Miller FW, Rider LG. Association of Ultraviolet Radiation Exposure With Dermatomyositis in a National Myositis Patient Registry. Arthritis Care Res (Hoboken) 2020; 72:1636-1644. [PMID: 31478597 DOI: 10.1002/acr.24059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/27/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Dermatomyositis (DM) has been associated with geospatial differences in ultraviolet (UV) radiation, but the role of individual determinants of UV exposure prior to diagnosis is unknown. The objective was to examine the role of those individual determinants. METHODS We analyzed questionnaire data from 1,350 adults in a US national myositis registry (638 with DM, 422 with polymyositis [PM], and 290 with inclusion body myositis [IBM] diagnosed at ages 18-65 years), examining the likelihood of DM compared with PM and IBM diagnosis, in relation to self-reported sunburn history and job- and hobby-related sun exposures in the year prior to diagnosis. We estimated odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression adjusted for age, skin tone, and sex, to determine the association of individual UV exposures with DM diagnosis. We also evaluated the proportion of DM by maximum daily ambient UV exposure, based on UVB erythemal irradiances for participant residence in the year prior to diagnosis. RESULTS DM was associated with sunburn in the year before diagnosis (2 or more sunburns OR 1.77 [95% CI 1.28-2.43] versus PM/IBM; 1 sunburn OR 1.44 [95% CI 1.06-1.95]) and with having elevated job- or hobby-related sun exposure (high exposure OR 1.64 [95% CI 1.08-2.49] or moderate exposure OR 1.35 [95% CI 1.02-1.78] versus low or no exposure). Ambient UV intensity was associated with DM in females (β = 3.97, P = 0.046), but not overall. CONCLUSION Our findings suggest that high or moderate personal exposure to intense sunlight is associated with developing DM compared with other types of myositis. Prospective research on UV exposure as a modifiable risk factor for DM is warranted.
Collapse
Affiliation(s)
- Christine G Parks
- National Institute of Environmental Health Sciences/NIH, Durham, North Carolina
| | | | | | - Abdullah Faiq
- National Institute of Environmental Health Sciences/NIH,, Bethesda, Maryland
| | | | - Craig S Long
- National Oceanic and Atmospheric Administration/National Weather Service, National Centers for Environmental Prediction Climate Prediction Center, College Park, Maryland
| | - Nastaran Bayat
- National Institute of Environmental Health Sciences/NIH,, Bethesda, Maryland
| | | | | | | | - Frederick W Miller
- National Institute of Environmental Health Sciences/NIH,, Bethesda, Maryland
| | - Lisa G Rider
- National Institute of Environmental Health Sciences/NIH,, Bethesda, Maryland
| |
Collapse
|
122
|
Rituximab in Antimelanoma Differentiation-Associated Protein-5 Dermatomyositis with Interstitial Lung Disease. Case Rep Rheumatol 2020; 2020:8145790. [PMID: 33204565 PMCID: PMC7654211 DOI: 10.1155/2020/8145790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/08/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022] Open
Abstract
In this paper, we report a challenging case of a middle-age woman who developed antimelanoma differentiation-associated protein-5 dermatomyositis (anti-MDA5 DM) with interstitial lung disease (ILD) and was successfully treated with rituximab (RTX), after failure of a first-line therapy.
Collapse
|
123
|
Rajasinghe LD, Li QZ, Zhu C, Yan M, Chauhan PS, Wierenga KA, Bates MA, Harkema JR, Benninghoff AD, Pestka JJ. Omega-3 fatty acid intake suppresses induction of diverse autoantibody repertoire by crystalline silica in lupus-prone mice. Autoimmunity 2020; 53:415-433. [PMID: 32903098 PMCID: PMC8020726 DOI: 10.1080/08916934.2020.1801651] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/22/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
Inhalation of crystalline silica (cSiO2) in the workplace is etiologically linked to lupus and other autoimmune diseases. Exposing lupus-prone NZBWF1 mice to respirable cSiO2 unleashes a vicious cycle of inflammation and cell death in the lung that triggers interferon-regulated gene expression, ectopic lymphoid structure (ELS) development, elevation of local and systemic autoantibodies (AAbs), and glomerulonephritis. However, cSiO2-induced inflammation and onset of autoimmunity can be prevented by inclusion of the ω-3 polyunsaturated fatty acid docosahexaenoic acid (DHA) into the diet of these mice. Since cSiO2 both causes cell death and interferes with efferocytosis, secondary necrosis of residual cell corpses might provide a rich and varied autoantigen (AAg) source in the lung. While it is known that the particle induces anti-nuclear and anti-dsDNA AAbs in NZBWF1 mice, the full extent of the cSiO2-induced AAb response relative to specificity and isotype is not yet understood. The purpose of this study was to test the hypotheses that cSiO2 exposure induces a wide spectrum of AAbs in the pulmonary and systemic compartments, and that dietary DHA intervention prevents these changes. Archived tissue fluid samples were obtained from a prior study in which NZBWF1 mice were fed purified isocaloric diets containing no DHA (control) or DHA corresponding calorically to human doses of 2 and 5 g/day. Mice were intranasally instilled with 1 mg cSiO2 or saline vehicle weekly for 4 weeks, then groups euthanized 1, 5, 9, or 13 weeks post-instillation (PI) of the last cSiO2 dose. Bronchoalveolar lavage fluid (BALF) and plasma from each time point were subjected to AAb profiling using a microarray containing 122 AAgs. cSiO2 triggered robust IgG and IgM AAb responses against lupus-associated AAgs, including DNA, histones, ribonucleoprotein, Smith antigen, Ro/SSA, La/SSB, and complement as early as 1 week PI in BALF and 5 weeks PI in plasma, peaking at 9 and 13 weeks PI, respectively. Importantly, cSiO2 also induced AAbs to AAgs associated with rheumatoid arthritis (collagen II, fibrinogen IV, fibrinogen S, fibronectin, and vimentin), Sjögren's syndrome (α-fodrin), systemic sclerosis (topoisomerase I), vasculitis (MPO and PR3), myositis (Mi-2, TIF1-γ, MDA5), autoimmune hepatitis (LC-1), and celiac disease (TTG). cSiO2 elicited comparable but more modest IgA AAb responses in BALF and plasma. cSiO2-induced AAb production was strongly associated with time dependent inflammatory/autoimmune gene expression, ELS development, and glomerulonephritis. AAb responses were dose-dependently suppressed by DHA supplementation and negatively correlated with the ω-3 index, an erythrocyte biomarker of ω-3 content in tissue phospholipids. Taken together, these findings suggest that cSiO2 exposure elicits a diverse multi-isotype repertoire of AAbs, many of which have been reported in individuals with lupus and other autoimmune diseases. Furthermore, induction of this broad AAb spectrum could be impeded by increasing ω-3 tissue content via dietary DHA supplementation.
Collapse
Affiliation(s)
- Lichchavi D. Rajasinghe
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, U.S
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, U.S
| | - Quan-Zhen Li
- Department of Immunology and Internal Medicine, IIMT Microarray Core Facility, University of Texas Southwestern Medical Center, Dallas, TX 75390, U.S
| | - Chengsong Zhu
- Department of Immunology and Internal Medicine, IIMT Microarray Core Facility, University of Texas Southwestern Medical Center, Dallas, TX 75390, U.S
| | - Mei Yan
- Department of Immunology and Internal Medicine, IIMT Microarray Core Facility, University of Texas Southwestern Medical Center, Dallas, TX 75390, U.S
| | - Preeti S. Chauhan
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, U.S
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, U.S
| | - Kathryn A. Wierenga
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, U.S
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI 48824, U.S
| | - Melissa A. Bates
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, U.S
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, U.S
| | - Jack R. Harkema
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, U.S
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI 48824, U.S
| | - Abby D. Benninghoff
- Department of Animal, Dairy and Veterinary Sciences and the School of Veterinary Medicine, Utah State University, Logan UT 84322, U.S
| | - James J. Pestka
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, U.S
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, U.S
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, U.S
| |
Collapse
|
124
|
Yanagihara T, Suzuki K, Egashira A, Ogo N, Asoh T, Nara T, Takatsuki K, Yoshizawa S, Chong SG, Hamada N, Maeyama T. Nintedanib and intensive immunosuppressive therapy to treat rapidly progressive interstitial lung disease presenting anti-ARS antibodies. Respir Med Case Rep 2020; 31:101272. [PMID: 33163354 PMCID: PMC7606860 DOI: 10.1016/j.rmcr.2020.101272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022] Open
Abstract
We describe a case of fulminant onset, rapidly progressive-interstitial lung disease (RP-ILD) with anti-ARS antibodies (anti-PL-7). The patient was successfully treated with nintedanib in addition to intensive immunosuppressive therapies, including intravenous cyclophosphamide. Nintedanib has just been approved for treatment of progressive fibrosing ILD, but to date, no reports of RP-ILD treated with nintedanib have been published. This case report may advance discussions regarding the use and timing of nintedanib in treating RP-ILD.
Collapse
Affiliation(s)
- Toyoshi Yanagihara
- Department of Respiratory Medicine, And Department of Rheumatology, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
- Research Institute for Diseases of the Chest, Kyushu University, Fukuoka, 812-8582, Japan
| | - Kunihiro Suzuki
- Research Institute for Diseases of the Chest, Kyushu University, Fukuoka, 812-8582, Japan
| | - Ayaka Egashira
- Department of Respiratory Medicine, And Department of Rheumatology, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Naruhiko Ogo
- Department of Respiratory Medicine, And Department of Rheumatology, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Tatsuma Asoh
- Department of Respiratory Medicine, And Department of Rheumatology, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Tsukasa Nara
- Department of Respiratory Medicine, And Department of Rheumatology, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Kensaku Takatsuki
- Department of Rheumatology, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Seiji Yoshizawa
- Department of Rheumatology, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Sy Giin Chong
- Firestone Institute for Respiratory Health, Research Institute at St Joseph's Healthcare, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Naoki Hamada
- Research Institute for Diseases of the Chest, Kyushu University, Fukuoka, 812-8582, Japan
| | - Takashige Maeyama
- Department of Respiratory Medicine, And Department of Rheumatology, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| |
Collapse
|
125
|
Chen H, Yang H, Cheng QX, Ge YP, Peng QL, Zhang YM, Cheng GH, Wang GC, Lu X. A novel autoantibody targeting calreticulin is associated with cancer in patients with idiopathic inflammatory myopathies. Clin Transl Immunology 2020; 9:e1195. [PMID: 33082955 PMCID: PMC7558046 DOI: 10.1002/cti2.1195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/15/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022] Open
Abstract
Objectives To investigate the prevalence and clinical significance of anti‐calreticulin autoantibodies (anti‐CRT Ab) in a large cohort of idiopathic inflammatory myopathy (IIM) patients. Methods Sera from 469 patients with IIM, 196 patients with other connective tissue diseases, 28 patients with solid tumors and 81 healthy controls were screened for anti‐CRT Ab by enzyme‐linked immunosorbent assay using human recombinant CRT protein. Sera from 35 IIM patients were tested using an immunoprecipitation assay to confirm the presence of anti‐CRT Ab. Subsequently, IIM–cancer patients were identified and divided into new‐onset, remission and recurrent groups based on their cancer status. The relationships between anti‐CRT Ab levels and IIM disease activity were also investigated. Results Serum anti‐CRT Ab was detected positive in 81 of the 469 (17.3%) IIM patients. Immunoprecipitated bands were observed at a molecular weight of 60 kDa corresponding to the CRT protein. The IIM patients with anti‐CRT Ab more frequently had cancers compared to the patients without anti‐CRT Ab. Moreover, the prevalence of anti‐CRT Ab differed according to the cancer status. The IIM patients with recurrent cancers had a much higher prevalence of anti‐CRT Ab than those with cancers in remission. Also, serum anti‐CRT Ab levels positively correlated with disease activity at baseline and at follow‐up visits. Conclusion We report the existence of serum anti‐CRT Ab in IIM patients and demonstrate the possible association of anti‐CRT Ab with malignancy in IIM patients. Serum anti‐CRT Ab could serve as a novel candidate marker of cancer in IIM patients.
Collapse
Affiliation(s)
- He Chen
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| | - Heng Yang
- Center for Systems Medicine Institute of Basic Medical Sciences Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100005 China.,Suzhou Institute of Systems Medicine Suzhou Jiangsu 215123 China
| | - Qiu-Xiang Cheng
- Center for Systems Medicine Institute of Basic Medical Sciences Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100005 China.,Suzhou Institute of Systems Medicine Suzhou Jiangsu 215123 China
| | - Yong-Peng Ge
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| | - Qing-Lin Peng
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| | - Ya-Mei Zhang
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| | - Gen-Hong Cheng
- Department of Microbiology, Immunology and Molecular Genetics University of California Los Angeles CA 90095 USA
| | - Guo-Chun Wang
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| | - Xin Lu
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| |
Collapse
|
126
|
Ultra-efficient sequencing of T Cell receptor repertoires reveals shared responses in muscle from patients with Myositis. EBioMedicine 2020; 59:102972. [PMID: 32891935 PMCID: PMC7484536 DOI: 10.1016/j.ebiom.2020.102972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Myositis, or idiopathic inflammatory myopathy (IIM), is a group disorders of unknown etiology characterized by the inflammation of skeletal muscle. The role of T cells and their antigenic targets in IIM initiation and progression is poorly understood. T cell receptor (TCR) repertoire sequencing is a powerful approach for characterizing complex T cell responses. However, current TCR sequencing methodologies are complex, expensive, or both, greatly limiting the scale of feasible studies. METHODS Here we present Framework Region 3 AmplifiKation sequencing ("FR3AK-seq"), a simplified multiplex PCR-based approach for the ultra-efficient and quantitative analysis of TCR complementarity determining region 3 (CDR3) repertoires. By using minimal primer sets targeting a conserved region immediately upstream of CDR3, undistorted amplicons are analyzed via short read, single-end sequencing. We also introduce the novel algorithm Inferring Sequences via Efficiency Projection and Primer Incorporation ("ISEPPI") for linking CDR3s to their associated variable genes. FINDINGS We find that FR3AK-seq is sensitive and quantitative, performing comparably to two different industry standards. FR3AK-seq and ISEPPI were used to efficiently and inexpensively characterize the T cell infiltrates of surgical muscle biopsies obtained from 145 patients with IIM and controls. A cluster of closely related TCRs was identified in samples from patients with sporadic inclusion body myositis (IBM). INTERPRETATION The ease and minimal cost of FR3AK-seq removes critical barriers to routine, large-scale TCR CDR3 repertoire analyses, thereby democratizing the quantitative assessment of human TCR repertoires in disease-relevant target tissues. Importantly, discovery of closely related TCRs in muscle from patients with IBM provides evidence for a shared antigen-driven T cell response in this disease of unknown pathogenesis. FUNDING This work was supported by NIH grant U24AI118633 and a Prostate Cancer Foundation Young Investigator Award.
Collapse
|
127
|
Pinal-Fernandez I, Casal-Dominguez M, Derfoul A, Pak K, Miller FW, Milisenda JC, Grau-Junyent JM, Selva-O'Callaghan A, Carrion-Ribas C, Paik JJ, Albayda J, Christopher-Stine L, Lloyd TE, Corse AM, Mammen AL. Machine learning algorithms reveal unique gene expression profiles in muscle biopsies from patients with different types of myositis. Ann Rheum Dis 2020; 79:1234-1242. [PMID: 32546599 PMCID: PMC10461844 DOI: 10.1136/annrheumdis-2019-216599] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Myositis is a heterogeneous family of diseases that includes dermatomyositis (DM), antisynthetase syndrome (AS), immune-mediated necrotising myopathy (IMNM), inclusion body myositis (IBM), polymyositis and overlap myositis. Additional subtypes of myositis can be defined by the presence of myositis-specific autoantibodies (MSAs). The purpose of this study was to define unique gene expression profiles in muscle biopsies from patients with MSA-positive DM, AS and IMNM as well as IBM. METHODS RNA-seq was performed on muscle biopsies from 119 myositis patients with IBM or defined MSAs and 20 controls. Machine learning algorithms were trained on transcriptomic data and recursive feature elimination was used to determine which genes were most useful for classifying muscle biopsies into each type and MSA-defined subtype of myositis. RESULTS The support vector machine learning algorithm classified the muscle biopsies with >90% accuracy. Recursive feature elimination identified genes that are most useful to the machine learning algorithm and that are only overexpressed in one type of myositis. For example, CAMK1G (calcium/calmodulin-dependent protein kinase IG), EGR4 (early growth response protein 4) and CXCL8 (interleukin 8) are highly expressed in AS but not in DM or other types of myositis. Using the same computational approach, we also identified genes that are uniquely overexpressed in different MSA-defined subtypes. These included apolipoprotein A4 (APOA4), which is only expressed in anti-3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) myopathy, and MADCAM1 (mucosal vascular addressin cell adhesion molecule 1), which is only expressed in anti-Mi2-positive DM. CONCLUSIONS Unique gene expression profiles in muscle biopsies from patients with MSA-defined subtypes of myositis and IBM suggest that different pathological mechanisms underly muscle damage in each of these diseases.
Collapse
Affiliation(s)
- Iago Pinal-Fernandez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Insititutes of Health, Bethesda, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
- Faculty of Computer Science, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Maria Casal-Dominguez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Insititutes of Health, Bethesda, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Assia Derfoul
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Insititutes of Health, Bethesda, Maryland, USA
| | - Katherine Pak
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Insititutes of Health, Bethesda, Maryland, USA
| | - Frederick W Miller
- Enivironmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Albert Selva-O'Callaghan
- Internal Medicine, Vall d'Hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carme Carrion-Ribas
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jemima Albayda
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa Christopher-Stine
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas E Lloyd
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea M Corse
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Insititutes of Health, Bethesda, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
128
|
To F, Ventín-Rodríguez C, Elkhalifa S, Lilleker JB, Chinoy H. Line blot immunoassays in idiopathic inflammatory myopathies: retrospective review of diagnostic accuracy and factors predicting true positive results. BMC Rheumatol 2020; 4:28. [PMID: 32699830 PMCID: PMC7370419 DOI: 10.1186/s41927-020-00132-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/05/2020] [Indexed: 01/05/2023] Open
Abstract
Background Line blot immunoassays (LIA) for myositis-specific (MSA) and myositis-associated (MAA) autoantibodies have become commercially available. In the largest study of this kind, we evaluated the clinical performance of a widely used LIA for MSAs and MAAs. Methods Adults tested for MSA/MAA by LIA at a tertiary myositis centre (January 2016–July 2018) were identified. According to expert-defined diagnoses, true and false positive rates were calculated for strongly and weakly positive autoantibody results within three cohorts: idiopathic inflammatory myopathy (IIM), connective tissue disease (CTD) without myositis, and non-CTD/IIM. Factors associated with true positivity were determined. Results We analysed 342 cases. 67 (19.6%) had IIM, in whom 71 autoantibodies were detected (50 strong positives [70.4%], 21 weak positives [29.6%]). Of the strong positives, 48/50 (96.0%; 19 MSAs, 29 MAAs) were deemed true positives. Of the weak positives, 15/21 (71.4%; 3 MSAs, 12 MAAs) were deemed true positives. In CTD without myositis cases (n = 120), 31/61 (51.0%; 5 MSAs, 26 MAAs) autoantibodies were strongly positive, with 24/31 (77.4%; 0 MSAs, 24 MAAs) true positives. 30/61 (49.2%; 13 MSAs, 17 MAAs) were weakly positive, with 16/30 (53.3%; 0 MSAs, 16 MAAs) true positives. In non-CTD/IIM cases (n = 155), all 24 MSAs and 22 MAAs were false positives; these results included 17 (37.0%; 7 MSAs, 10 MAAs) strong positives. Individual autoantibody specificities were > 98.2 and > 97.5% for weakly and strongly positive results, respectively. True positivity was associated with high pre-test for IIM (odds ratio 50.8, 95% CI 13.7–189.2, p < 0.001) and strong positive (versus weak positive) results (4.4, 2.3–8.3, p < 0.001). Conclusions We demonstrated the high specificity of a myositis LIA in a clinical setting. However, a significant burden of false positive results was evident in those with a low pre-test likelihood of IIM and for weakly positive autoantibodies.
Collapse
Affiliation(s)
- Fergus To
- Division of Rheumatology, University of British Columbia Division of Rheumatology, University of British Columbia, 802 - 1200 Burrard Street, Vancouver, BC V6Z 2C7 Canada
| | - Clara Ventín-Rodríguez
- Complejo Hospitalario Universitario de A Coruña, Xubias de Arriba, 84, 15006 A Coruña, Spain
| | - Shuayb Elkhalifa
- Department of Immunology, Salford Royal NHS Foundation Trust, 2nd floor, Turnberg Building, Stott Lane, Salford, M68HD UK
| | - James B Lilleker
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Stopford Building, 99 Oxford Rd, Manchester, M13 9PG UK.,Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M68HD UK
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Stott Lane, Salford, M68HD UK.,Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| |
Collapse
|
129
|
Li L, Liu C, Cheng L, Yan S, Chen H, Li Y. Assessment of diagnostic utility, clinical phenotypic associations, and prognostic significance of anti-NXP2 autoantibody in patients with idiopathic inflammatory myopathies: a systematic review and meta-analysis. Clin Rheumatol 2020; 40:819-832. [PMID: 32681367 DOI: 10.1007/s10067-020-05291-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022]
Abstract
The objectives of this study are to analyze the association between anti-nuclear matrix protein 2 (NXP2) autoantibody and idiopathic inflammatory myopathies (IIMs) and to assess the diagnostic and prognostic relevance of anti-NXP2 autoantibody in patients with IIMs. A systematic search was performed in PubMed, Web of Science, EMBASE, the Cochrane Library, and Scopus to identify studies published as of February 29, 2020. Data was analyzed using Stata 12.0 and Meta-DiSc 1.4. Twenty-eight studies (4764 patients with IIMs and 1981 controls) were included in the meta-analysis. Anti-NXP2 autoantibody showed a significant association with IIMs (odds ratio (OR) = 26.36, 95% confidence interval (CI): 12.05-57.67, P < 0.001), especially juvenile IIMs (OR = 62.48, 95% CI: 16.97-229.98, P < 0.001). The pooled sensitivity, specificity, and area under the curve were 0.19 (95% CI = 0.16-0.21), 1.00 (95% CI = 1.00-1.00), and 0.95 for patients with juvenile IIMs versus controls. Anti-NXP2 autoantibody was associated with an increased risk of developing five characteristics (edema, muscle weakness, myalgia/myodynia, dysphagia, and calcinosis) and reduced risk of interstitial lung disease (ILD) (P < 0.001). Anti-NXP2 autoantibody showed no association with increased risk of death in IIMs (P = 0.463). These findings suggest that anti-NXP2 autoantibody is specially related to IIMs and is related to edema, muscle weakness, myalgia/myodynia, dysphagia, calcinosis, and ILD in patients with IIMs. However, there is no evidence to suggest that the presence of anti-NXP2 autoantibody confers a poor prognosis with respect to overall survival. Key Points • This study summarized the diagnostic and prognostic accuracies of anti-NXP2 autoantibody for patients with IIMs. Anti-NXP2 autoantibody is related to edema, muscle weakness, myalgia/myodynia, dysphagia, calcinosis, and ILD in patients with IIMs.
Collapse
Affiliation(s)
- Liubing Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Chenxi Liu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Linlin Cheng
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Songxin Yan
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Haizhen Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
- Department of Medical Laboratory, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - Yongzhe Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
| |
Collapse
|
130
|
Xu Q, Li QX, Bi FF, Duan HQ, Luo YB, Yang H. The association between myositis-specific autoantibodies and muscle pathologies in idiopathic inflammatory myopathies. Clin Rheumatol 2020; 40:613-624. [PMID: 32671659 DOI: 10.1007/s10067-020-05274-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate specific muscle pathologies of different kinds of myositis-specific autoantibodies (MSAs) in idiopathic inflammatory myopathy (IIM) patients. METHODS One hundred eleven Chinese patients from Xiangya Hospital, Central South University diagnosed with IIMs according to European Neuromuscular Centre (ENMC) criteria were included. Clinical manifestation, myositis-specific autoantibodies, and histologic findings were evaluated to explore the pattern of necrosis, regeneration, and perifascicular atrophy, inflammatory cells in IIM patients with different MSAs. RESULTS Anti-SRP group has the lowest muscle strength scores, the highest creatine kinase levels, the most severe degree of necrosis and regeneration (1.90[0.80-3.95], 1.00[0.30-1.71]), and the lowest positive rate of MHC-I staining (35.71%). The anti-MDA5 group demonstrates the mildest pathological changes, with the fewest necrotic and regenerated muscle fibers (0.00[0.00-0.50], 0.00[0.00-0.00]), and the fewest inflammatory cell infiltration, and the highest muscle strength scores. The anti-NXP2 group has the most frequent inflammatory infiltrates, especially CD4+ T cells (31.14[15.00-39.00]). The patients with anti-NXP2 and the anti-TIF1γ antibodies show higher frequency of punched-out fibers (1.50[0.00-3.70], 0.00[0.00-1.00]) and perifascicular atrophy (71.43%, 55.56%). As for anti-synthetase antibodies (ASAs), the anti-Jo-1 group shows the most frequent rate of perifascicular necrosis (60%), while other ASA groups do not show perifascicular necrosis. CONCLUSIONS Of the MSAs, the anti-SRP antibody leads to the most severe muscle involvement, while the anti-MAD5 antibody the mildest. The anti-NXP2 and anti-TIF1γ groups have the most typical "DM" pathology. Key Points • Anti-SRP group shows severe muscle pathology while anti-MDA5 group shows the mildest. • Anti-NXP2 group has the most frequent inflammatory infiltrates. Pouch-out fibers and perifascicular atrophy are more prevalent in anti-NXP2 and anti-TIF1γ groups. • Anti-Jo-1 group is often accompanied by perifascicular necrosis, while other anti-synthetase antibody groups are not.
Collapse
Affiliation(s)
- Qiu Xu
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China
| | - Qiu-Xiang Li
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China
| | - Fang-Fang Bi
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China
| | - Hui-Qian Duan
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China
| | - Yue-Bei Luo
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China.
| | - Huan Yang
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China.
| |
Collapse
|
131
|
Insights into pathogenesis and clinical implications in myositis-associated interstitial lung diseases. Curr Opin Pulm Med 2020; 26:507-517. [PMID: 32657836 DOI: 10.1097/mcp.0000000000000698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Interstitial lung diseases (ILDs) have been reported to be associated with myositis (including polymyositis and dermatomyositis). These myositis-associated ILDs carry significant morbidity and mortality. This review summarizes recent findings on myositis-associated ILD with a focus on pathogenesis and emerging treatment. RECENT FINDINGS Recent advances in genetics have revealed 22 myositis-associated genome-wide loci, which were significantly enriched in regulatory regions in immune cells. An analysis of such disease-associated loci elucidated potential drug targets (e.g., TYK2 targeted by tofacitinib). In another study, an intronic variant in WDFY4 in association with clinically amyopathic dermatomyositis (CADM) had an effect for higher expression of a truncated WDFY4 isoform. Truncated WDFY4 markedly enhanced the MDA5-mediated NF-κB activation and cell apoptosis, indicating the dysregulated WDFY4-MDA5 pathway as a novel pathogenesis of CADM. As a novel strategy, tofacitinib treatment showed a promising improvement in survival and clinical features of CADM-associated ILD. SUMMARY The genetic differences in the myositis-susceptible loci may explain the heterogeneous phenotypes and treatment responses in myositis-associated ILD. The understanding of pathogenesis with the genetic background as well as autoantibodies will enable the practice of personalized treatment in the management of the disease.
Collapse
|
132
|
Kotobuki Y, Tonomura K, Fujimoto M. Transcriptional intermediary factor 1 (TIF1) and anti-TIF1γ antibody-positive dermatomyositis. Immunol Med 2020; 44:23-29. [PMID: 32649853 DOI: 10.1080/25785826.2020.1791402] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Recently, great advancements have been made towards understanding the mechanisms underlying dermatomyositis (DM). Many novel autoantibodies, such as anti-MDA5, anti-TIF1γ, anti-NXP2, and anti-SAE, have been reported to be involved in DM. DM is now classified based on these myositis-specific autoantibodies. Anti-TIF1γ antibodies are closely associated with juvenile DM and adult cancer-associated DM. Anti-TIF1γ antibody-positive DM tends to present severe cutaneous manifestations, mild myositis, and dysphagia. TIF1γ (also known as TRIM33) plays a role in transcriptional elongation, DNA repair, differentiation of cells, embryonic development, and mitosis. Moreover, TIF1γ has been shown to suppress various tumors via the TGF-β/Smad and the Wnt/β-Catenin signaling pathways. In this review, we explore the relationship between TIF1γ, cancer, and DM. We also discuss the pathogenesis of anti-TIF1γ antibody-positive DM.
Collapse
Affiliation(s)
- Yorihisa Kotobuki
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kyoko Tonomura
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| |
Collapse
|
133
|
Watanabe E, Gono T, Kuwana M, Terai C. Predictive factors for sustained remission with stratification by myositis-specific autoantibodies in adult polymyositis/dermatomyositis. Rheumatology (Oxford) 2020; 59:586-593. [PMID: 31410476 DOI: 10.1093/rheumatology/kez328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/02/2019] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE The aim of this study was to clarify predictive factors for sustained remission in adult patients with PM/DM, particularly focusing on stratification by myositis-specific autoantibodies (MSAs). METHODS A total of 162 adult patients with PM/DM who were followed up for >1 year after diagnosis were retrospectively enrolled. MSAs were evaluated comprehensively in 102 patients whose sera were available. Sustained remission was defined as no evidence of disease activity (active skin rash, active myositis or active interstitial lung disease) for longer than a 6-month continuous period while undergoing myositis therapy or no medication. Clinical data were reviewed in patients' medical charts. RESULTS The sustained remission rate for all patients was 58% during the median follow-up period at 4 years. With regard to MSAs, the achievement rate of sustained remission among MSA-negative patients was significantly higher than that for patients with anti-aminoacyl-tRNA synthetase (P = 0.004), anti-melanoma differentiation-associated gene 5 (P = 0.037) or anti-transcriptional intermediary factor 1-γ (P = 0.013) antibodies. MSA-negative status (odds ratio 5.84, P = 0.009) and absence of severe muscle weakness requiring assistance at diagnosis (odds ratio 43.6, P < 0.001) were independent factors associated with sustained remission in multivariate analysis. Cumulative remission rates were significantly higher (P < 0.001) in patients with both the MSA-negative status and absence of severe muscle weakness at diagnosis than the others. CONCLUSION MSA-negative status and the absence of severe muscle weakness requiring assistance at diagnosis are independent predictive factors for sustained remission in adult PM/DM patients.
Collapse
Affiliation(s)
- Eri Watanabe
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama, Tokyo, Japan
| | - Takahisa Gono
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama, Tokyo, Japan.,Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Chihiro Terai
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama, Tokyo, Japan
| |
Collapse
|
134
|
Liu D, Zuo X, Luo H, Zhu H. The altered metabolism profile in pathogenesis of idiopathic inflammatory myopathies. Semin Arthritis Rheum 2020; 50:627-635. [PMID: 32502727 DOI: 10.1016/j.semarthrit.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
Idiopathic inflammatory myopathies (IIMs) are a group of heterogeneous autoimmune diseases characterized by muscle weakness, muscle inflammation and extramuscular manifestations. Despite extensive efforts, the mechanisms of IIMs remain largely unknown, and treatment is still a challenge for physicians. Metabolism changes have emerged as a crucial player in autoimmune diseases, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However, little is known about metabolism changes in IIMs. In this review, we focus on the alteration of metabolism profile in IIMs, and the relationships with clinical information. We highlight the potential roles of metabolism in the pathogenesis of IIMs and discuss future perspectives for metabolic checkpoint-based therapeutic interventions.
Collapse
Affiliation(s)
- Di Liu
- Department of Rheumatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, People's Republic of China
| | - Xiaoxia Zuo
- Department of Rheumatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, People's Republic of China
| | - Hui Luo
- Department of Rheumatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, People's Republic of China
| | - Honglin Zhu
- Department of Rheumatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, People's Republic of China.
| |
Collapse
|
135
|
Performance of the new EULAR/ACR classification criteria for idiopathic inflammatory myopathies (IIM) in a large monocentric IIM cohort. Semin Arthritis Rheum 2020; 50:492-497. [DOI: 10.1016/j.semarthrit.2019.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/19/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
|
136
|
Green LJ, O’Neill L, Frise CJ. Antisynthetase syndrome in pregnancy: A case and review of the literature. Obstet Med 2020; 13:96-100. [PMID: 32714443 PMCID: PMC7359659 DOI: 10.1177/1753495x18808646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 09/28/2018] [Indexed: 12/13/2022] Open
Abstract
Antisynthetase syndrome is a rare autoimmune, multisystem, inflammatory condition, characterised by autoantibodies against aminoacyl tRNA synthetases. The predominant features are myositis and interstitial lung disease but other symptoms such as Raynaud's phenomenon may also be present. Described here is a 36-year-old woman with antisynthetase syndrome who planned and underwent a successful pregnancy, during which a multidisciplinary team approach secured a good outcome for both mother and baby.
Collapse
Affiliation(s)
- Lauren J Green
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Lorraine O’Neill
- Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Charlotte J Frise
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
137
|
Chung MP, Richardson C, Kirakossian D, Orandi AB, Saketkoo LA, Rider LG, Schiffenbauer A, von Mühlen CA, Chung L. Calcinosis Biomarkers in Adult and Juvenile Dermatomyositis. Autoimmun Rev 2020; 19:102533. [PMID: 32234404 PMCID: PMC7225028 DOI: 10.1016/j.autrev.2020.102533] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 02/06/2023]
Abstract
Dermatomyositis (DM) is a rare idiopathic inflammatory myopathy characterized by muscle weakness and cutaneous manifestations in adults and children. Calcinosis, a complication of DM, is the abnormal deposition of insoluble calcium salts in tissues, including skin, subcutaneous tissue, tendons, fascia, and muscle. Calcinosis is more commonly seen in juvenile DM (JDM), but also develops in adult DM. Although the mechanism of calcinosis remains unclear, several pathogenic hypotheses have been proposed, including intracellular accumulation of calcium secondary to an alteration of the cellular membrane by trauma and inflammation, local vascular ischemia, dysregulation of mechanisms controlling the deposition and solubility of calcium and phosphate, and mitochondrial damage of muscle cells. Identifying calcinosis biomarkers is important for early disease detection and risk assessment, and may lead to novel therapeutic targets for the prevention and treatment of DM-associated calcinosis. In this review, we summarize myositis autoantibodies associated with calcinosis in DM, histopathology and chemical composition of calcinosis, genetic and inflammatory markers that have been studied in adult DM and JDM-associated calcinosis, as well as potential novel biomarkers.
Collapse
Affiliation(s)
- Melody P Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Carrie Richardson
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - David Kirakossian
- Department of Internal Medicine, Kaiser Permanente Santa Clara, Santa Clara, CA, USA
| | - Amir B Orandi
- Division of Pediatric Rheumatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lesley A Saketkoo
- Louisiana State University School of Medicine, Tulane University School of Medicine, New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Adam Schiffenbauer
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A von Mühlen
- Consultant in Rheumatology and Clinical Pathology, San Diego, USA; Brazilian Society of Autoimmunity, Porto Alegre, Brazil
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA; VA Palo Alto Health Care System, Palo Alto, CA, USA.
| |
Collapse
|
138
|
Qureshi A, Brown D, Brent L. Anti-Signal Recognition Particle Antibody-Associated Severe Interstitial Lung Disease Requiring Lung Transplantation. Cureus 2020; 12:e7962. [PMID: 32523819 PMCID: PMC7273426 DOI: 10.7759/cureus.7962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Anti-signal recognition particle (SRP) antibodies are typically associated with immune-mediated necrotizing myopathy. Some patients with anti-SRP antibodies may have extramuscular manifestations including mild respiratory symptoms secondary to interstitial lung disease. We present a case of a 40-year-old female presenting with acute hypoxic respiratory failure secondary to anti-SRP antibody-associated interstitial lung disease with mildly elevated creatinine kinase but without evidence of necrotizing myopathy on muscle biopsy. After a complicated six-month hospitalization, the patient successfully received double lung transplantation and was eventually discharged on room air. Unexplained worsening interstitial infiltrates leading to persistent hypoxic respiratory failure in the setting of nonspecifically elevated creatinine kinase should warrant consideration of an underlying connective tissue disease, including myositis with anti-SRP antibody-associated interstitial lung disease. In rare cases, interstitial lung disease may be severe requiring lung transplantation.
Collapse
Affiliation(s)
- Anam Qureshi
- Internal Medicine, Reading Hospital - Tower Health, West Reading, USA
| | - Daniel Brown
- Pathology and Laboratory Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Lawrence Brent
- Rheumatology, Temple University Hospital, Philadelphia, USA
| |
Collapse
|
139
|
Jerome R, Sebastien H, Nadine MB. An Unusual Cause of Dysphagia. Gastroenterology 2020; 158:e3-e5. [PMID: 31738914 DOI: 10.1053/j.gastro.2019.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 12/02/2022]
Affiliation(s)
- Razanamahery Jerome
- Department of internal Medicine, Besancon University Hospital, Besancon, France.
| | - Humbert Sebastien
- Department of internal Medicine, Besancon University Hospital, Besancon, France
| | | |
Collapse
|
140
|
Macrophage activation syndrome in adult dermatomyositis: a case-based review. Rheumatol Int 2020; 40:1151-1162. [PMID: 32356114 DOI: 10.1007/s00296-020-04590-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/18/2020] [Indexed: 12/22/2022]
Abstract
Macrophage activation syndrome (MAS) is a severe and life-threatening syndrome associated with autoimmune diseases, characterized by fever, hepatosplenomegaly, and pancytopenia. Dermatomyositis (DM) is one of the causes of MAS; however, its clinical characteristics in DM patients remain unclear. This study aimed to present a case of anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive DM complicated by MAS in a 29-year-old woman and to review the literatures including similar cases. Even though symptoms and cytopenia of our patient were refractory to combination therapy, including glucocorticoids, immunosuppressants, and plasma exchange, the administration of rituximab (RTX) resulted in rapid clinical improvement and glucocorticoid reduction. The literature review revealed 18 adult patients with DM associated MAS. Most patients developed MAS within 3 months from DM onset. A monotherapy of glucocorticoid was insufficient to control the disease, and the mortality of MAS in DM was higher than that of MAS in other rheumatic diseases, despite being treated by various means. RTX may be an effective treatment for patients with DM complicated by MAS who are refractory to conventional therapy. Anti-MDA5 antibody could influence the development of MAS; however, further investigations are needed to elucidate the association between myositis-specific antibody and MAS.
Collapse
|
141
|
Wilkinson MGL, Radziszewska A, Wincup C, Ioannou Y, Isenberg DA, Manson JJ, Jury EC. Using peripheral blood immune signatures to stratify patients with adult and juvenile inflammatory myopathies. Rheumatology (Oxford) 2020; 59:194-204. [PMID: 31292651 DOI: 10.1093/rheumatology/kez252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/20/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The inflammatory idiopathic myopathies (IIM) are a group of rare autoimmune diseases defined by muscle weakness and characterized by pro-inflammatory infiltrates in muscle. Little is known about the immunological profile in peripheral blood of these patients and how this relates to IIM subtypes. This study aimed to stratify adult and juvenile-onset IIM patients according to immune cell profile. METHODS Peripheral blood mononuclear cells from 44 patients with adult myositis (AM), 15 adolescent-onset juvenile dermatomyositis (a-JDM), and 40 age-matched healthy controls were analysed by flow cytometry to quantify 33 immune cell subsets. Adult myositis patients were grouped according to myositis subtype; DM and polymyositis; and also autoantibody specificity. Disease activity was determined by the myositis disease activity assessment tool and clinicians' decision on treatment. RESULTS Unique immune signatures were identified for DM, polymyositis and a-JDM compared with healthy controls. DM patients had a T-cell signature comprising increased CD4+ and TH17 cell frequencies and increased immune cell expression of IL-6. Polymyositis patients had a B-cell signature with reduced memory B cells. A-JDM had decreased naïve B cells and increased CD4+T cells. All patient groups had decreased CD8+central memory T-cell frequencies. The distinct immune signatures were also seen when adult myositis patients were stratified according to auto-antibody expression; patients with anti-synthetase-antibodies had reduced memory B cells and patients with autoimmune rheumatic disease overlap had an elevated Th17 profile. CONCLUSION Unique immune signatures were associated with adult vs juvenile disease. The Th17 signature in DM patients supports the potential use of IL-17 inhibitors in treatment of IIMs.
Collapse
Affiliation(s)
- Meredyth G Ll Wilkinson
- Division of Medicine, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London Hospital and Great Ormond Street Hospital, London, UK.,Infection Inflammation and Rheumatology, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Chris Wincup
- Division of Medicine, University College London, London, UK.,Department of Rheumatology, University College London Hospital, London, UK
| | - Yiannis Ioannou
- Division of Medicine, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London Hospital and Great Ormond Street Hospital, London, UK.,Department of Rheumatology, University College London Hospital, London, UK
| | - David A Isenberg
- Division of Medicine, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London Hospital and Great Ormond Street Hospital, London, UK.,Department of Rheumatology, University College London Hospital, London, UK
| | - Jessica J Manson
- Department of Rheumatology, University College London Hospital, London, UK
| | - Elizabeth C Jury
- Division of Medicine, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London Hospital and Great Ormond Street Hospital, London, UK
| |
Collapse
|
142
|
Nikolic D, Banach M, Chianetta R, Luzzu LM, Pantea Stoian A, Diaconu CC, Citarrella R, Montalto G, Rizzo M. An overview of statin-induced myopathy and perspectives for the future. Expert Opin Drug Saf 2020; 19:601-615. [PMID: 32233708 DOI: 10.1080/14740338.2020.1747431] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Statins remain the most commonly prescribed lipid-lowering drug class for the treatment of atherosclerotic cardiovascular disease. Their well-recognized side effects are known as statin-associated muscle symptom (SAMS). Some advances in this field have been made in recent years, but the understanding of the mechanisms has lagged. Investigating the specific role of the anti-HMGCR autoantibody, pharmacokinetic genetic variants, characterization of the known phenotypes of statin toxicity, in relation to clinical markers of disease, is of high importance.Areas covered: We summarized currently available findings (on PubMed) related to SAMS and discussed the therapeutic approaches, risk factors, drug interactions, potential novel systems, algorithms and biomarkers for SAMS detection. CoQ10 supplementation has been suggested as a complementary approach to manage SAMS, while vitamin D levels may be useful for both the diagnosis and management.Expert Opinion/Commentary: Further studies might help to understand the easiest way to diagnose SAMS, suitable prevention and an effective non-statin therapy. This review sheds new light on the future directions in both research and clinical practice, which will help with rapid risk assessment, identification of the SAMS risk factors in order to decrease the incidence of statins' adverse effects, and the most effective therapy.
Collapse
Affiliation(s)
- Dragana Nikolic
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,BELSS, Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Roberta Chianetta
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,BELSS, Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Luca Marco Luzzu
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania.,Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Roberto Citarrella
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Giuseppe Montalto
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| |
Collapse
|
143
|
Abstract
The idiopathic inflammatory myopathies (IIMs), including polymyositis (PM) and dermatomyositis (DM), are autoimmune connective tissue diseases with variable degrees of muscle inflammation and systemic involvement. Interstitial lung disease (ILD) is a common complication of the IIMs and is associated with increased mortality. Many patients with PM/DM have myositis-specific and myositis-associated antibodies (MSA/MAAs) that result in distinct clinical phenotypes. Among these MSAs, anti-aminoacyl-tRNA antibodies and anti-melanoma differentiation factor 5 antibodies have high rates of ILD. Corticosteroids are the mainstay of treatment, although the addition of other immunosuppressive therapy is typically necessary to achieve disease control.
Collapse
|
144
|
Abstract
Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of inflammatory myopathies whose common feature is immune-mediated muscle injury. There are distinct subgroups including dermatomyositis (DM), polymyositis (PM), inclusion body myositis, and immune-mediated necrotizing myopathy. Antisynthetase syndrome is also emerging as a distinct subgroup with its unique muscle histopathological characteristic of perifascicular necrosis. While the newly updated EULAR/ACR Classification Criteria for IIM have brought advancements in diagnosis and the exclusion of mimickers, the use of only one autoantibody in the derivation of the schema limits its use. Similarly, while the advent of multiple novel therapeutics in the treatment of myositis has been exciting, it has also highlighted the scarcity of validated outcome measures. The purpose of our review is to highlight the updated classification criteria of myositis, newly reported clinical phenotypes associated with myositis autoantibodies, the measurement of outcomes, and emerging treatments in the field.
Collapse
Affiliation(s)
- Sara Baig
- Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Suite 1B.1, Baltimore, MD 21224 USA
| | - Julie J Paik
- Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower Suite 4500, Baltimore, MD 21224 USA.
| |
Collapse
|
145
|
Kobayashi I, Akioka S, Kobayashi N, Iwata N, Takezaki S, Nakaseko H, Sato S, Nishida Y, Nozawa T, Yamasaki Y, Yamazaki K, Arai S, Nishino I, Mori M. Clinical practice guidance for juvenile dermatomyositis (JDM) 2018-Update. Mod Rheumatol 2020; 30:411-423. [PMID: 31955618 DOI: 10.1080/14397595.2020.1718866] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Juvenile dermatomyositis is the most common type of juvenile idiopathic inflammatory myopathy mainly affecting the skin and proximal muscles. We have published the Japanese version of 'Clinical practice guidance for juvenile dermatomyositis (JDM) 2018 'consisting of a review of articles in the field and evidence-informed consensus-based experts' opinion on the treatment strategy in collaboration with The Pediatric Rheumatology Association of Japan and The Japan College of Rheumatology under the financial support by 'Research on rare and intractable diseases, Health and Labor Sciences Research Grants'. This article is a digest version of the Japanese guidance.
Collapse
Affiliation(s)
- Ichiro Kobayashi
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Shinji Akioka
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Norimoto Kobayashi
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | | | - Haruna Nakaseko
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Satoshi Sato
- Division of Infectious Disease and Immunology, Saitama Children's Medical Center, Omiya, Japan
| | - Yutaka Nishida
- Department of Pediatrics, School of Medicine, Gunma University, Maebashi, Japan
| | - Tomo Nozawa
- Department of Pediatrics, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yuichi Yamasaki
- Department of Pediatrics, Kagoshima University Hospital, Kagoshima, Japan
| | - Kazuko Yamazaki
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital, Tokyo, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaaki Mori
- Lifetime Clinical Immunology, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
146
|
Fujimoto S, Saito K, Kuwano K. A case of simultaneous onset of anti‐melanoma differentiation‐associated gene 5 antibody‐positive dermatomyositis accompanied by interstitial pneumonia and pulmonary tuberculosis. Int J Rheum Dis 2020; 23:273-275. [DOI: 10.1111/1756-185x.13788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/20/2019] [Accepted: 12/16/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Shota Fujimoto
- Division of Respiratory Medicine Department of Internal Medicine The Jikei University Daisan Hospital Tokyo Japan
| | - Keisuke Saito
- Division of Respiratory Medicine Department of Internal Medicine The Jikei University Daisan Hospital Tokyo Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Medicine Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| |
Collapse
|
147
|
Dermatomyositis: Clinical features and pathogenesis. J Am Acad Dermatol 2020; 82:267-281. [DOI: 10.1016/j.jaad.2019.06.1309] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/22/2019] [Accepted: 06/06/2019] [Indexed: 12/11/2022]
|
148
|
Oldroyd A, Sergeant JC, New P, McHugh NJ, Betteridge Z, Lamb JA, Ollier WE, Cooper RG, Chinoy H. The temporal relationship between cancer and adult onset anti-transcriptional intermediary factor 1 antibody-positive dermatomyositis. Rheumatology (Oxford) 2020; 58:650-655. [PMID: 30535395 PMCID: PMC6434375 DOI: 10.1093/rheumatology/key357] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/16/2018] [Indexed: 01/30/2023] Open
Abstract
Objectives To characterize the 10 year relationship between anti-transcriptional intermediary factor 1 antibody (anti-TIF1-Ab) positivity and cancer onset in a large UK-based adult DM cohort. Methods Data from anti-TIF1-Ab-positive/-negative adults with verified diagnoses of DM from the UK Myositis Network register were analysed. Each patient was followed up until they developed cancer. Kaplan–Meier methods and Cox proportional hazard modelling were employed to estimate the cumulative cancer incidence. Results Data from 263 DM cases were analysed, with a total of 3252 person-years and a median 11 years of follow-up; 55 (21%) DM cases were anti-TIF1-Ab positive. After 10 years of follow-up, a higher proportion of anti-TIF1-Ab-positive cases developed cancer compared with anti-TIF1-Ab-negative cases: 38% vs 15% [hazard ratio 3.4 (95% CI 2.2, 5.4)]. All the detected malignancy cases in the anti-TIF1-Ab-positive cohort occurred between 3 years prior to and 2.5 years after DM onset. No cancer cases were detected within the following 7.5 years in this group, whereas cancers were detected during this period in the anti-TIF1-Ab-negative cases. Ovarian cancer was more common in the anti-TIF1-Ab-positive vs -negative cohort: 19% vs 2%, respectively (P < 0.05). No anti-TIF1-Ab-positive case <39 years of age developed cancer, compared with 21 (53%) of those ≥39 years of age. Conclusion Anti-TIF1-Ab-positive-associated malignancy occurs exclusively within the 3 year period on either side of DM onset, the risk being highest in those ≥39 years of age. Cancer types differ according to anti-TIF1-Ab status, and this may warrant specific cancer screening approaches.
Collapse
Affiliation(s)
- Alexander Oldroyd
- Centre for Musculoskeletal Research, University of Manchester, Manchester.,NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Jamie C Sergeant
- Centre for Biostatistics, University of Manchester, Manchester.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester
| | - Paul New
- MRC/ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath.,Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath Foundation Trust, Bath
| | - Zoe Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Bath
| | - Janine A Lamb
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester
| | - William E Ollier
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester
| | - Robert G Cooper
- MRC/ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool.,Department of Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Hector Chinoy
- Centre for Musculoskeletal Research, University of Manchester, Manchester.,NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | | |
Collapse
|
149
|
Parker MJS, Oldroyd A, Roberts ME, Lilleker JB, Betteridge ZE, McHugh NJ, Herrick AL, Cooper RG, Chinoy H. The performance of the European League Against Rheumatism/American College of Rheumatology idiopathic inflammatory myopathies classification criteria in an expert-defined 10 year incident cohort. Rheumatology (Oxford) 2020; 58:468-475. [PMID: 30496561 PMCID: PMC6381759 DOI: 10.1093/rheumatology/key343] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/17/2018] [Indexed: 01/31/2023] Open
Abstract
Objectives To assess the performance of the EULAR/ACR idiopathic inflammatory myopathies (IIMs) classification criteria in a cohort of incident IIM cases and examine how criteria-assigned IIM subtype correlates with expert opinion. Methods Adults with newly diagnosed IIM attending Salford Royal NHS Foundation Trust were identified over a 10 year period. A retrospective review of all putative cases was performed and those fulfilling a consensus expert opinion diagnosis of IIM were included. Clinical, serological and histological data were collected and each case was assigned a single IIM subtype. The EULAR/ACR classification criteria were then applied and sensitivity, specificity and positive and negative predictive values were calculated, presented with 95% CIs. Results A total of 1637 cases were screened, with 255 consensus expert opinion IIM cases ultimately identified. Applying the EULAR/ACR classification criteria, the sensitivity to diagnose an IIM was 99.6% (95% CI 97.2, 100) and 80.9% (95% CI 76.0, 85.8) for the criteria cut-points of probable and definite diagnoses, respectively. In 94/255 cases the IIM subtype differed between consensus expert opinion and classification criteria, most strikingly in the group subtyped as PM by the EULAR/ACR criteria, where there was discrepancy in the majority (i.e. in 87/161). Conclusion The EULAR/ACR criteria performed with high sensitivity in identifying IIM in this external cohort of incident IIM. However, substantial disagreements arose between consensus expert opinion and the criteria regarding IIM subtype assignments, resulting in a large proportion of criteria-assigned cases of PM having heterogeneous features. These results may have important implications for future use of these criteria in subsequent research.
Collapse
Affiliation(s)
- Matthew J S Parker
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.,Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Rheumatology Department, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alexander Oldroyd
- Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Mark E Roberts
- Manchester Academic Health Science Centre, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - James B Lilleker
- Manchester Academic Health Science Centre, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Zoe E Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Disease, Bath, UK
| | - Ariane L Herrick
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.,Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Robert G Cooper
- MRC-ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, UK.,Centre for Integrated Genomic Medical Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Hector Chinoy
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.,Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
150
|
Saki J, Mowla K, Arjmand R, Kazemi F, Fallahizadeh S. Prevalence of Toxoplasma gondii and Toxocara canis Among Myositis Patients in the Southwest of Iran. Infect Disord Drug Targets 2020; 21:43-48. [PMID: 31889500 DOI: 10.2174/1871526520666191231123159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Parasitic myositis is caused by some parasites, such as Toxoplasma gondii) T. gondii (and Toxocara canis (T. canis). So, the aim of the study was to evaluate the prevalence T. gondii and T. canis in patients with myositis and healthy individuals. METHODS A total of 108 samples were randomly selected as the control (54 healthy individuals) and test (54 myositis patients) groups. IgG and IgM antibodies (Ab) against T. gondii and IgG Ab against T. canis were measured by the enzyme-linked immunosorbent assay (ELISA). The detection of chronic and acute toxoplasmosis was performed by the ELISA IgG avidity. The presence of T. gondii in the blood was evaluated using the nested polymerase chain reaction (nested-PCR). RESULTS Of 108, 33 (30.6%) cases were positive for IgG against T. gondii that 19 (35.2%) and 14 (25.9%) were observed in myositis patients and healthy individuals, respectively (P=0.296). Of 19 positive cases, 12 (63.2%) and 7 (36.8%) cases were detected as chronic and acute toxoplasmosis, respectively, while, all positive cases in the control group had chronic toxoplasmosis (P=0.013). One (1.9%) sample was positive for anti- T. gondii IgM and two (3.7%) samples were positive for IgG against T. canis by the ELISA that these positive cases were observed only in myositis patients (P=1.000 P=0.495, respectively). B1 T. gondii gene was amplified in 12 (63.2%) and 1 (7.1%) in myositis patients and healthy subjects (P=0.001). CONCLUSION Our findings showed that there was a relatively high prevalence of acute toxoplasmosis in myositis patients in comparison with the control subjects in the Southwest of Iran.
Collapse
Affiliation(s)
- Jasem Saki
- Department of Medical Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Karim Mowla
- Department of Rheumatology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Arjmand
- Department of Medical Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Forough Kazemi
- Department of Medical Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Somayeh Fallahizadeh
- Department of Medical Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|