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Giraudo C, Sudol-Szopinska I, Fichera G, Evangelista L, Zanatta E, Del Grande F, Stramare R, Bazzocchi A, Guglielmi G, Rennie W. Update on Rheumatic Diseases in Clinical Practice: Recent Concepts and Developments. Radiol Clin North Am 2024; 62:725-738. [PMID: 39059968 DOI: 10.1016/j.rcl.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Diagnostic imaging is essential in the diagnostic process of rheumatic diseases. Given the heterogeneity of this group of diseases and the tremendous impact of novel therapeutic options, guidelines and recommendations regarding the optimal choice of the most appropriate technique/s are continuously revised and radiologists should always be up-to-date. Last, because of the continuous technological innovations, we will assist to the progressive application of advanced techniques and tools in rheumatology.
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Affiliation(s)
- Chiara Giraudo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - DCTV, University of Padova, Via Giustiniani 2, Padova, 35122, Italy.
| | - Iwona Sudol-Szopinska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 1- Spartanska Street, Warsaw, Poland
| | - Giulia Fichera
- Pediatric Radiology, Padova Hospital, Via Giustiniani 2, Padova, 35122, Italy
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Elisabetta Zanatta
- Department of Medicine -DIMED, Rheumatology Unit, University of Padova, Via Giustiniani 2, 35122, Padova, Italy
| | - Filippo Del Grande
- Istituto Di Imaging Della Svizzera Italiana (IIMSI), Clinica Di Radiologia Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, Lugano 6900, Switzerland
| | - Roberto Stramare
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - DCTV, University of Padova, Via Giustiniani 2, Padova, 35122, Italy
| | - Alberto Bazzocchi
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Radiology Unit, Foggia University School of Medicine, Via Gramsci 89, 71122, Foggia, Italy; Department of Radiology, Scientific Institute "Casa Sollievo Della Sofferenza" Hospital, Viale Cappuccini, San Giovanni Rotondo, 71013, Italy
| | - Winston Rennie
- Department of Radiology, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, United Kingdom
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Daniel E, Smith IC, Ly V, Bourque PR, Breiner A, Lochmuller H, Maltez N, Thavorn K, Warman-Chardon J. Direct and indirect costs of idiopathic inflammatory myopathies in adults: A systematic review. PLoS One 2024; 19:e0307144. [PMID: 39058702 PMCID: PMC11280229 DOI: 10.1371/journal.pone.0307144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) are rare disorders characterized by inflammation of skeletal muscle, which can result in fatty replacement of muscle, muscle atrophy, and subsequent weakness. Therapeutic advancements have improved clinical outcomes but impose an economic impact on healthcare systems. We aimed to summarize the direct and indirect costs associated with IIMs in a systematic review (PROSPERO Registration #CRD42023443143). Electronic databases (MEDLINE, Embase, CINAHL, and Scopus) were systematically searched for full-length articles (excluding case reports) reporting costs specific to patients diagnosed with an IIM, published between database inception and April 19, 2023. Direct cost categories included inpatient, outpatient, medication, home/long-term care, and durable medical equipment such as mobility and respiratory aids. Indirect costs included lost productivity. Eligibility criteria were met by 21 of the 3,193 unique titles identified. Costs are expressed in 2023 United States of America dollars, with adjustments for differences in purchasing power applied to currency conversions. As no study reported on all cost categories, annualized cost of IIM per patient was estimated by calculating the mean cost per category, and then adding the means of the different cost categories. By this method, IIM was estimated to cost $52,210 per patient per year. Proportional contributions by category were lost productivity (0.278), outpatient care (0.214), medications (0.171), inpatient care (0.161), home/long-term care (0.122), and durable medical equipment (0.053). Newer findings with intravenous immunoglobulin considered first line therapy for IIM demonstrated markedly higher annual medication costs per patient, upwards of $33,900 compared to an average of $3,908 ± $1,042 in older studies. Future cost-effectiveness studies require updated cost-of-illness studies reflecting the evolving sub-classification and treatment options for IIM, and should consider the impact of IIM on patients and their families.
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Affiliation(s)
- Eden Daniel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian C. Smith
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Valentina Ly
- Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierre R. Bourque
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ari Breiner
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hanns Lochmuller
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario and Research Institute, Ottawa, Ontario, Canada
| | - Nancy Maltez
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Rheumatology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario and Research Institute, Ottawa, Ontario, Canada
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Vicino A, Veltsista D, van Alfen N. Muscle ultrasound in myopathies. Curr Opin Neurol 2024:00019052-990000000-00187. [PMID: 39051427 DOI: 10.1097/wco.0000000000001306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE OF REVIEW This review highlights recent developments in the field of muscle ultrasound (MUS) for the diagnosis and follow up of muscle disorders. RECENT FINDINGS The diagnostic screening capacity of quantitative grayscale analysis is still sufficient to assess children suspected of a neuromuscular disorder. A combination of visual and quantitative assessment is advised for optimal interpretation. MUS was more sensitive but less specific than MRI for detecting pathology in limb girdle dystrophies and inflammatory myopathies. New techniques such as shearwave elastography and artificial intelligence algorithms for automated image segmentation show promise but need further development for use in everyday practice.Muscle ultrasound has high correlations with clinical measures of function in skeletal and respiratory muscles and the orofacial region, in most of the myopathies and dystrophies studied. Over time, imaging changes precede changes in clinical status, making them attractive for biomarker use in trials. In Duchenne muscular dystrophy MUS was also responsive to the effects of steroid treatment. SUMMARY Muscle ultrasound is a sensitive technique to diagnose and follow up of skeletal, facial and respiratory muscles in neuromuscular disorders. Its role is both complementary to and partially overlapping with that of MRI.
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Affiliation(s)
- Alex Vicino
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dimitra Veltsista
- Department of Neurology, University Hospital of Patras, Patras, Greece
| | - Nens van Alfen
- Department of Neurology& Clinical Neurophysiology, Clinical Neuromuscular Imaging Group, Donders Center for Neuroscience, Radboudumc, Nijmegen, The Netherlands
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Holzer MT, Uruha A, Roos A, Hentschel A, Schänzer A, Weis J, Claeys KG, Schoser B, Montagnese F, Goebel HH, Huber M, Léonard-Louis S, Kötter I, Streichenberger N, Gallay L, Benveniste O, Schneider U, Preusse C, Krusche M, Stenzel W. Anti-Ku + myositis: an acquired inflammatory protein-aggregate myopathy. Acta Neuropathol 2024; 148:6. [PMID: 39012547 PMCID: PMC11252205 DOI: 10.1007/s00401-024-02765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/07/2024] [Accepted: 07/07/2024] [Indexed: 07/17/2024]
Abstract
Myositis with anti-Ku-autoantibodies is a rare inflammatory myopathy associated with various connective tissue diseases. Histopathological studies have identified inflammatory and necrotizing aspects, but a precise morphological analysis and pathomechanistic disease model are lacking. We therefore aimed to carry out an in-depth morpho-molecular analysis to uncover possible pathomechanisms. Muscle biopsy specimens from 26 patients with anti-Ku-antibodies and unequivocal myositis were analyzed by immunohistochemistry, immunofluorescence, transcriptomics, and proteomics and compared to biopsy specimens of non-disease controls, immune-mediated necrotizing myopathy (IMNM), and inclusion body myositis (IBM). Clinical findings and laboratory parameters were evaluated retrospectively and correlated with morphological and molecular features. Patients were mainly female (92%) with a median age of 56.5 years. Isolated myositis and overlap with systemic sclerosis were reported in 31%, respectively. Isolated myositis presented with higher creatine kinase levels and cardiac involvement (83%), whereas systemic sclerosis-overlap patients often had interstitial lung disease (57%). Histopathology showed a wide spectrum from mild to pronounced myositis with diffuse sarcolemmal MHC-class I (100%) and -II (69%) immunoreactivity, myofiber necrosis (88%), endomysial inflammation (85%), thickened capillaries (84%), and vacuoles (60%). Conspicuous sarcoplasmic protein aggregates were p62, BAG3, myotilin, or immunoproteasomal beta5i-positive. Proteomic and transcriptomic analysis identified prominent up-regulation of autophagy, proteasome, and hnRNP-related cell stress. To conclude, Ku + myositis is morphologically characterized by myofiber necrosis, MHC-class I and II positivity, variable endomysial inflammation, and distinct protein aggregation varying from IBM and IMNM, and it can be placed in the spectrum of scleromyositis and overlap myositis. It features characteristic sarcoplasmic protein aggregation on an acquired basis being functionally associated with altered chaperone, proteasome, and autophagy function indicating that Ku + myositis exhibit aspects of an acquired inflammatory protein-aggregate myopathy.
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Affiliation(s)
- Marie-Therese Holzer
- Division of Rheumatology and Systemic Inflammatory Diseases, III, Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
- Department of Neuropathology, Charité. Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Akinori Uruha
- Department of Neuropathology, Charité. Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Rheumatology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Andreas Roos
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, Centre for Neuromuscular Disorders in Children, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University Dusseldorf, 40225, Dusseldorf, Germany
- Brain and Mind Research Institute, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada
| | - Andreas Hentschel
- Leibniz-Institut für Analytische Wissenschaften -ISAS- E.V., Dortmund, Germany
| | - Anne Schänzer
- Institute of Neuropathology, Justus-Liebig-University, Gießen, Germany
| | - Joachim Weis
- Medical Faculty, Institute of Neuropathology, RWTH Aachen University, Aachen, Germany
| | - Kristl G Claeys
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Laboratory for Muscle Diseases and Neuropathies, KU Leuven, and Leuven Brain Institute (LBI), Leuven, Belgium
| | - Benedikt Schoser
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University, Munich, Germany
| | - Federica Montagnese
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University, Munich, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité. Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Melanie Huber
- Department for Rheumatology, Campus Kerckhoff of Justus-Liebig University Gießen, Bad Nauheim, Germany
| | - Sarah Léonard-Louis
- Reference Center of Neuromuscular Pathology Paris-Est, Pitié-Salpêtrière University Hospital, Paris, France
| | - Ina Kötter
- Division of Rheumatology and Systemic Inflammatory Diseases, III, Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Nathalie Streichenberger
- Neuropathologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Institut NeuroMyogène CNRS UMR 5261- INSERM U1315, Lyon, France
| | - Laure Gallay
- Department of Internal Medicine, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Udo Schneider
- Department of Rheumatology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Corinna Preusse
- Department of Neuropathology, Charité. Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Krusche
- Division of Rheumatology and Systemic Inflammatory Diseases, III, Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité. Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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5
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Maxwell S, Ross L, Oon S, Wicks IP, Day J. Muscle biopsy practices in the evaluation of idiopathic inflammatory myopathies: An international survey of expert clinicians. Semin Arthritis Rheum 2024; 68:152519. [PMID: 39059155 DOI: 10.1016/j.semarthrit.2024.152519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Muscle biopsy is an important test in the evaluation of individuals with suspected myopathy, including those with suspected idiopathic inflammatory myopathy (IIM). Various approaches, including open surgical biopsy, needle biopsy and conchotome forceps, have been reported. However the real-world utilisation of these approaches remains unclear. There are no established guidelines for the use of muscle biopsy, or selection of biopsy technique, in investigating IIM and international practices are not well-documented. This study describes current approaches to muscle biopsy amongst clinicians with expertise in IIM. METHODS A survey regarding muscle biopsy practices was disseminated among members of the International Myositis Assessment and Clinical Studies (IMACS) group. Data were analysed using descriptive statistics. RESULTS One-hundred and sixteen clinicians completed the survey, primarily rheumatologists. Open surgical biopsy was the most commonly employed technique (74.5 %), followed by needle (11.3 %) and conchotome (9.4 %) approaches. Clinical examination was the most common method of muscle selection, with 85.2 % of respondents reporting they 'always or almost always' relied on it. MRI and electromyography were also frequently utilised for muscle selection (51.9 %, 45.4 % respectively). There was variability in the perceived utility of muscle biopsy in certain clinical contexts, such as presence of myositis specific antibodies or cutaneous manifestations of dermatomyositis. While respondents generally reported low complication rates following muscle biopsy, non-diagnostic histopathology was commonly reported, regardless of procedural approach. CONCLUSION Clinicians managing IIM report muscle biopsy to be well tolerated however, non-diagnostic results are common. Substantial heterogeneity regarding perceived indications for biopsy, procedural approaches, and muscle selection strategies were observed within this expert group. Future research is needed to establish best practice and determine the role of muscle biopsy in the context of continued advancements in serological profiling of IIM.
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Affiliation(s)
- Samuel Maxwell
- Department of Rheumatology, Royal Melbourne Hospital, Australia
| | - Laura Ross
- Department of Rheumatology, St Vincent's Hospital Melbourne, Australia; Department of Medicine, The University of Melbourne, Australia
| | - Shereen Oon
- Department of Rheumatology, Royal Melbourne Hospital, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Australia; Department of Medicine, The University of Melbourne, Australia
| | - Ian P Wicks
- Department of Rheumatology, Royal Melbourne Hospital, Australia; Inflammation Division, Walter and Eliza Hall Institute of Medical Research, Australia; Department of Medical Biology, The University of Melbourne, Australia
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Australia; Inflammation Division, Walter and Eliza Hall Institute of Medical Research, Australia; Department of Medical Biology, The University of Melbourne, Australia.
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Baek SH, Choi K, Ju H, Oh J, Kim BJ, Kim BJ. Clinical Manifestations and Prognosis of Anti-Signal-Recognition-Particle Myositis. J Clin Neurol 2024; 20:456-458. [PMID: 38951980 PMCID: PMC11220360 DOI: 10.3988/jcn.2024.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/05/2024] [Accepted: 02/21/2024] [Indexed: 07/03/2024] Open
Affiliation(s)
- Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyomin Choi
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyunjin Ju
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
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Dong J, Meng X, Xu H, Yang H, Yang J, Zhou J, Zhao L. Cluster analysis of clinical phenotypes in idiopathic inflammatory myopathy patients complicated with cardiac involvement. Clin Rheumatol 2024; 43:2237-2244. [PMID: 38761246 DOI: 10.1007/s10067-024-06986-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/14/2024] [Accepted: 04/25/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE This study aimed to classify idiopathic inflammatory myopathy (IIM) patients with cardiac involvement (IIM-CI) into different categories based on their clinical phenotypes via cluster analysis and to explore their differences in outcomes. METHODS IIM-CI patients admitted to Peking Union Medical College Hospital from January 2015 to June 2021 were retrieved. The clinical data, laboratory examinations, and treatment were retrospectively reviewed, and the outcome was traced. A second-order clustering method was employed for categorization. RESULTS A total of 88 IIM-CI patients were enrolled in this study and were classified into two categories through cluster analysis. Category I consisted of patients who exhibited distinct cardiac structural and functional changes, such as enlargement of atriums and/or ventricles, along with the remarkable heart insufficiency biomarkers, whereas patients of category II displayed more widely systemic injuries and intensive skeletal muscle weakness. In comparison, pulmonary hypertension (58.8% vs 16.7%, p < 0.01), arrhythmia (82.4% vs 27.8%, p < 0.01), and positive serum anti-mitochondrial-M2 antibody (52.9% vs 5.6%, p < 0.01) were more prevalent in category I than in category II, and serum N-terminal pro-B-type natriuretic peptide levels (1703.5 pg/L vs 364.0 pg/L, p = 0.02) were significantly elevated in category I, whereas skeletal muscle weakness (50.0% vs 74.1%, p = 0.02), interstitial lung disease (20.6% vs 63.0%, p < 0.01), skin rash (11.8% vs 48.1%, p < 0.01), arthralgia (2.9% vs 27.8%, p < 0.01), fever (2.9% vs 27.8%, p < 0.01), and dysphagia (2.9% vs 22.2%, p < 0.01) were more common in category II patients. Heart failure was the primary cause of death in category I, but severe pneumonia was predominantly responsible for deaths in category II. CONCLUSION Two categories of IIM-CI were identified based on clinical features with distinctive characteristics. Two categories exhibited differences in clinical manifestations, autoantibody profiles, and the primary cause of death.
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Affiliation(s)
- Jianling Dong
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
- Department of Rheumatology, Mianyang Central Hospital, Mianyang, 621000, China
| | - Xia Meng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Haojie Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Huaxia Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Jing Yang
- Department of Rheumatology, Mianyang Central Hospital, Mianyang, 621000, China
| | - Jiaxin Zhou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China.
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China.
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China.
| | - Lidan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai-Fu-Yuan, Dongcheng District, Beijing, 100730, China.
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China.
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China.
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Neto Silva I, Kharat A, Marzano F, Marchi E, Duarte JA, Bendjelid K. Unsuccessful Weaning From Mechanical Ventilation in a Patient With An Immune-Mediated Necrotizing Myopathy: A Case Report That Demonstrates the Usefulness of Shear-Wave Elastography. Chest 2024; 165:e177-e185. [PMID: 38852975 PMCID: PMC11177100 DOI: 10.1016/j.chest.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/23/2023] [Accepted: 01/02/2024] [Indexed: 06/11/2024] Open
Affiliation(s)
- Ivo Neto Silva
- Department of Acute Medicine, Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland; Care Directorate, Geneva University Hospitals, Geneva, Switzerland; Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Centre of Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.
| | - Aileen Kharat
- Medicine Department, Division of Respiratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Florian Marzano
- Department of Acute Medicine, Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Elisa Marchi
- Department of Acute Medicine, Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - José Alberto Duarte
- Centre of Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal; TOXRUN-Toxicology Research Unit, University Institute of Health Sciences-CESPU, Gandra, Portugal
| | - Karim Bendjelid
- Department of Acute Medicine, Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland; Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Zierer LK, Naegel S, Schneider I, Kendzierski T, Kleeberg K, Koelsch AK, Scholle L, Schaefer C, Naegel A, Zierz S, Otto M, Stoltenburg-Didinger G, Kraya T, Stoevesandt D, Mensch A. Quantitative whole-body muscle MRI in idiopathic inflammatory myopathies including polymyositis with mitochondrial pathology: indications for a disease spectrum. J Neurol 2024; 271:3186-3202. [PMID: 38438820 PMCID: PMC11136737 DOI: 10.1007/s00415-024-12191-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Inflammatory myopathies (IIM) include dermatomyositis (DM), sporadic inclusion body myositis (sIBM), immune-mediated necrotizing myopathy (IMNM), and overlap myositis (OLM)/antisynthetase syndrome (ASyS). There is also a rare variant termed polymyositis with mitochondrial pathology (PM-Mito), which is considered a sIBM precursor. There is no information regarding muscle MRI for this rare entity. The aim of this study was to compare MRI findings in IIM, including PM-Mito. METHODS This retrospective analysis included 41 patients (7 PM-Mito, 11 sIBM, 11 PM/ASyS/OLM, 12 IMNM) and 20 healthy controls. Pattern of muscle involvement was assessed by semiquantitative evaluation, while Dixon method was used to quantify muscular fat fraction. RESULTS The sIBM typical pattern affecting the lower extremities was not found in the majority of PM-Mito-patients. Intramuscular edema in sIBM and PM-Mito was limited to the lower extremities, whereas IMNM and PM/ASyS/OLM showed additional edema in the trunk. Quantitative assessment showed increased fat content in sIBM, with an intramuscular proximo-distal gradient. Similar changes were also found in a few PM-Mito- and PM/ASyS/OLM patients. In sIBM and PM-Mito, mean fat fraction of several muscles correlated with clinical involvement. INTERPRETATION As MRI findings in patients with PM-Mito relevantly differed from sIBM, the attribution of PM-Mito as sIBM precursor should be critically discussed. Some patients in PM/ASyS/OLM and PM-Mito group showed MR-morphologic features predominantly observed in sIBM, indicative of a spectrum from PM/ASyS/OLM toward sIBM. In some IIM subtypes, MRI may serve as a biomarker of disease severity.
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Affiliation(s)
- Lea-Katharina Zierer
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Radiology, University Medicine Halle, Halle (Saale), Germany
| | - Steffen Naegel
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Neurology, Alfried-Krupp-Krankenhaus Essen, Essen, Germany
| | - Ilka Schneider
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Neurology, St. Georg Hospital Leipzig, Leipzig, Germany
| | - Thomas Kendzierski
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Kathleen Kleeberg
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Anna Katharina Koelsch
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Leila Scholle
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Christoph Schaefer
- Department of Internal Medicine II, Rheumatology, University Medicine Halle, Halle (Saale), Germany
| | - Arne Naegel
- Goethe Center for Scientific Computing (G-CSC), Goethe University, Frankfurt/Main, Germany
| | - Stephan Zierz
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Markus Otto
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Gisela Stoltenburg-Didinger
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Institute of Cell and Neurobiology, Charité University Medicine Berlin, Berlin, Germany
| | - Torsten Kraya
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Neurology, St. Georg Hospital Leipzig, Leipzig, Germany
| | | | - Alexander Mensch
- Department of Neurology, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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10
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Xing C, Trivedi J, Bitencourt N, Burns DK, Reisch JS, Cai C. Myxovirus resistance protein A (MxA) expression in myositides: Sarcoplasmic expression is common in both dermatomyositis and lupus myositis. Muscle Nerve 2024; 69:548-555. [PMID: 38372203 DOI: 10.1002/mus.28066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION/AIMS Myxovirus resistance protein A (MxA) is a type I interferon (IFN1) pathway activation marker and MxA sarcoplasmic expression is currently recognized as a highly specific marker for dermatomyositis (DM). However, we have frequently observed endothelial tubuloreticular inclusions (TRI), another surrogate IFN1 activation marker, in a variety of overlap myositides. The aim of this study was to examine MxA expression in those myositides. METHODS We retrospectively performed MxA immunostaining on a wide range of myositides. RESULTS MxA sarcoplasmic expression was present in DM (94.4%, 17/18), active lupus myositis (LM, 80%,16/20), inactive LM (36%, 4/11), antisynthetase syndrome (ASyS, 20%, 2/10), systemic sclerosis (13%, 2/15), Sjogren's syndrome (7.7%, 1/13), and human immunodeficiency virus (HIV) myositis (5.6%, 1/18) and was absent in immune-mediated necrotizing myopathy (IMNM, 0/16) and hydroxychloroquine myopathy (0/5). The sensitivity and specificity of MxA sarcoplasmic expression for LM and DM combined compared with all other myositides were 84.6% (95% CI: 69.5-94.1) and 92.1 (95% CI: 83.6-97.0), respectively, and superior to TRIs. MxA capillary expression was nonspecific. Histologically, 35% of LM cases demonstrated a unique panfascicular necrotizing myopathy pattern. The remainder of the LM cases had significant morphological overlap with DM/ASyS (20%), IMNM (20%), or polymyositis (15%). DISCUSSION MxA sarcoplasmic expression is highly prevalent in LM and DM and is a useful marker in differentiating DM and LM from other myositides. LM can manifest in various pathology patterns that need to be differentiated from DM, IMNM, ASyS, and polymyositis.
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Affiliation(s)
- Changhong Xing
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jaya Trivedi
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole Bitencourt
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dennis K Burns
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joan S Reisch
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chunyu Cai
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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11
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Trenque T, Hadjoudj J, Trenque A, Tralongo F, Martin S, Azzouz B. Statins and immune-mediated necrotizing myopathy: Variability in the risk. Therapie 2024; 79:365-370. [PMID: 37625939 DOI: 10.1016/j.therap.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/04/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Immune-mediated necrotizing myopathy (IMNM) is a form of statin myopathy characterized by the presence of antibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti HMGCR). OBJECTIVES The aim of this study was to investigate the relationship between the different statins and the risk of IMNM. METHODS A two-time approach was used. First, we performed a descriptive analysis of the French national pharmacovigilance database (FNPV) for the period from 1985 to december2020. To identify relevant cases, we used Medical Dictionary for Regulatory Activities (MedDRA) preferred terms (PTs) related to IMNM. We performed a quantitative and qualitative review of individual case safety reports (ICSRs) recorded in the french vigilance spontaneous reporting system. In a second time, we performed a comparative analysis with the World Health Organization global individual case safety reports database (Vigibase). The association between IMNM and statins exposure was assessed by calculating the reporting odds ratio (ROR) and its 95% confidence interval. RESULTS After analysis, a total of 25 ICSRs were related to IMNM in the FNPV. The suspected statins were atorvastatin (n=21), simvastatin (n=2), pravastatin (n=1) and rosuvastatin (n=1). In Vigibase, 567 notifications were identified. A significant ROR value was found for atorvastatin, pitavastatin, simvastatin, pravastatin and rosuvastatin. CONCLUSION Atorvastatin presents the highest risk of IMNM. Our data suggest that the occurrence of IMNM is a class effect.
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Affiliation(s)
- Thierry Trenque
- Reims University Hospitals, Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 51092 Reims, France; University of Reims Champagne-Ardenne, Faculty of Medicine, EA 3797, 51095 Reims, France.
| | - Jed Hadjoudj
- Reims University Hospitals, Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 51092 Reims, France
| | - Agathe Trenque
- Reims University Hospitals, Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 51092 Reims, France
| | - Federica Tralongo
- Reims University Hospitals, Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 51092 Reims, France
| | - Salomé Martin
- Reims University Hospitals, Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 51092 Reims, France
| | - Brahim Azzouz
- Reims University Hospitals, Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 51092 Reims, France; University of Reims Champagne-Ardenne, Faculty of Medicine, EA 3797, 51095 Reims, France
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12
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Tzilas V, Tzouvelekis A, Sotiropoulou V, Panopoulos S, Bouros E, Avdoula E, Ryu JH, Bouros D. Presenting clinical and imaging features of patients with clinically amyopathic interstitial lung disease associated with myositis-specific autoantibodies. Front Med (Lausanne) 2024; 11:1392659. [PMID: 38711778 PMCID: PMC11070581 DOI: 10.3389/fmed.2024.1392659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/09/2024] [Indexed: 05/08/2024] Open
Abstract
Background Lung involvement in the context of idiopathic inflammatory myopathies has significant impact on outcome; early and accurate diagnosis is important but can be difficult to achieve. In particular, patients without clinically evident muscle involvement pose a significant diagnostic challenge. Methods A computer-assisted search was conducted to identify patients with amyopathic interstitial lung disease associated with the presence of myositis-specific autoantibodies. Medical records and chest imaging studies were reviewed to identify clinical and radiologic features at presentation. Results Of the 35 patients with amyopathic interstitial lung disease associated with myositis-specific autoantibodies, the median age was 65 years (range 43-78) and 20 were women (57%). Of the patients, 34% had previously visited the rheumatology department. Presenting symptoms consisted of dyspnea (94%), cough (43%), and arthritis (23%). Raynaud phenomenon, "mechanic hands," Gottron papules, and inspiratory crackles were present in 23, 31, 9, and 74% of patients, respectively. After a detailed history, none of the patients reported muscle weakness, while four (11%) exhibited increased CK levels; of these four, two had a concomitant increase in aldolase levels. Median FVC was 79% predicted (range: 49-135) and median DLco was 50% predicted (range: 17-103). HRCT pattern was suggestive of an alternative to UIP pattern in 31/33 (94%) patients; the most common imaging patterns were NSIP (49%) and NSIP/OP (39%). Conclusion In patients with NSIP and NSIP/OP pattern, the presence of amyopathic interstitial lung disease associated with myositis-specific autoantibodies should be considered even in the absence of clinical evident myositis.
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Affiliation(s)
- Vasilios Tzilas
- 5th Respiratory Department, Chest Diseases Hospital “Sotiria”, Athens, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, Medical School, University of Patras, Patras, Greece
| | - Vasilina Sotiropoulou
- Department of Respiratory Medicine, Medical School, University of Patras, Patras, Greece
| | - Stylianos Panopoulos
- 1st Department of Propaedeutic and Internal Medicine, and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | | | - Jay H. Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Demosthenes Bouros
- 1st Department of Respiratory Medicine, Medical School, National Kapodistrian University of Athens, and Athens Medical Center, Athens, Greece
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13
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赖 展, 李 嘉, 贠 泽, 张 永, 张 昊, 邢 晓, 邵 苗, 金 月, 王 乃, 李 依, 李 玉, 栗 占. [A unicenter real-world study of the correlation factors for complete clinical response in idiopathic inflammatory myopathies]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2024; 56:284-292. [PMID: 38595246 PMCID: PMC11004955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To investigate the correlation factors of complete clinical response in idiopathic inflammatory myopathies (IIMs) patients receiving conventional treatment. METHODS Patients diagnosed with IIMs hospitalized in Peking University People's Hospital from January 2000 to June 2023 were included. The correlation factors of complete clinical response to conventional treatment were identified by analyzing the clinical characteristics, laboratory features, peripheral blood lymphocytes, immunological indicators, and therapeutic drugs. RESULTS Among the 635 patients included, 518 patients finished the follow-up, with an average time of 36.8 months. The total complete clinical response rate of IIMs was 50.0% (259/518). The complete clinical response rate of dermatomyositis (DM), anti-synthetase syndrome (ASS) and immune-mediated necrotizing myopathy (IMNM) were 53.5%, 48.9% and 39.0%, respectively. Fever (P=0.002) and rapid progressive interstitial lung disease (RP-ILD) (P=0.014) were observed much more frequently in non-complete clinical response group than in complete clinical response group. The aspartate transaminase (AST), lactate dehydrogenase (LDH), D-dimer, erythrocyte sedimentation rate (ESR), C-reaction protein (CRP) and serum ferritin were significantly higher in non-complete clinical response group as compared with complete clinical response group. As for the treatment, the percentage of glucocorticoid received and intravenous immunoglobin (IVIG) were significantly higher in non-complete clinical response group than in complete clinical response group. Risk factor analysis showed that IMNM subtype (P=0.007), interstitial lung disease (ILD) (P=0.001), eleva-ted AST (P=0.012), elevated serum ferritin (P=0.016) and decreased count of CD4+T cells in peripheral blood (P=0.004) might be the risk factors for IIMs non-complete clinical response. CONCLUSION The total complete clinical response rate of IIMs is low, especially for IMNM subtype. More effective intervention should be administered to patients with ILD, elevated AST, elevated serum ferritin or decreased count of CD4+T cells at disease onset.
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Affiliation(s)
- 展鸿 赖
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 嘉辰 李
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 泽霖 贠
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 永刚 张
- 保定市第一中心医院风湿免疫科,河北保定 071000Department of Rheumatology and Immunology, Baoding First Hospital, Baoding 071000, Hebei, China
| | - 昊 张
- 大连市中心医院风湿免疫科,辽宁大连 116089Department of Rheumatology and Immunology, Dalian Municipal Central Hospital, Dalian 116089, Liaoning, China
| | - 晓燕 邢
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 苗 邵
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 月波 金
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 乃迪 王
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 依敏 李
- 浙江大学医学院附属第一医院风湿免疫科,杭州 310003Department of Rheumatology and Immunology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - 玉慧 李
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 占国 栗
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
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14
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Tebo AE. Autoantibody evaluation in idiopathic inflammatory myopathies. Adv Clin Chem 2024; 120:45-67. [PMID: 38762242 DOI: 10.1016/bs.acc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
Idiopathic inflammatory myopathies (IIM), generally referred to as myositis is a heterogeneous group of diseases characterized by muscle inflammation and/or skin involvement, diverse extramuscular manifestations with variable risk for malignancy and response to treatment. Contemporary clinico-serologic categorization identifies 5 main clinical groups which can be further stratified based on age, specific clinical manifestations and/or risk for cancer. The serological biomarkers for this classification are generally known as myositis-specific (MSAs) and myositis-associated antibodies. Based on the use of these antibodies, IIM patients are classified into anti-synthetase syndrome, dermatomyositis, immune-mediated necrotizing myopathy, inclusion body myositis, and overlap myositis. The current classification criteria for IIM requires clinical findings, laboratory measurements, and histological findings of the muscles. However, the use MSAs and myositis-associated autoantibodies as an adjunct for disease evaluation is thought to provide a cost-effective personalized approach that may not only guide diagnosis but aid in stratification and/or prognosis of patients. This review provides a comprehensive overview of contemporary autoantibodies that are specific or associated myositis. In addition, it highlights possible pathways for the detection and interpretation of these antibodies with limitations for routine clinical use.
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Affiliation(s)
- Anne E Tebo
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, United States.
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15
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Yamamoto S, Yoshida A, Okazaki Y, Gono T, Kuwana M. Clinical phenotyping in patients with anti-synthetase antibodies using cluster analysis. Rheumatol Adv Pract 2024; 8:rkae049. [PMID: 38708024 PMCID: PMC11069276 DOI: 10.1093/rap/rkae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/26/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives To characterize clinically distinct subgroups among unselected patients with anti-synthetase antibodies using cluster analysis. Methods This study evaluated patients with anti-synthetase antibodies registered to two independent cohorts; 106 consecutive patients from a prospective, single-centre cohort of the Scleroderma/Myositis Centre of Excellence (SMCE) were used as a derivation cohort and 125 patients from the Multicentre Retrospective Cohort of Japanese Patients with Myositis-Associated Interstitial Lung Disease (JAMI) were used as a validation cohort. Anti-synthetase antibodies were identified by RNA immunoprecipitation. A multiple correspondence analysis followed by hierarchical clustering was performed to aggregate the patients into homogeneous subgroups. Subsequently, a simple-to-use classification tree was generated using classification and regression tree analysis. Results Three clusters were identified in the SMCE cohort: cluster 1 (n = 48), the interstitial pneumonia with autoimmune features/amyopathic dermatomyositis cluster, associated with older age at diagnosis and a higher frequency of malignancy; cluster 2 (n = 46), the DM cluster, corresponded to a younger age at diagnosis with a higher prevalence of myositis, arthritis, DM pathognomonic rashes, mechanic's hands and fever; and cluster 3 (n = 12), the SSc cluster, characterized by chronic interstitial lung disease. There was no significant difference in overall survival or progression-free survival between the clusters. A simple classification tree using myositis and RP was created in the SMCE cohort. Clusters 1 and 2 were successfully reproduced and the classification tree demonstrated favourable performance in the JAMI cohort. Conclusion Patients with anti-synthetase antibodies were classified into three distinct phenotypes, indicating substantial heterogeneity within this patient group.
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Affiliation(s)
- Shintaro Yamamoto
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Akira Yoshida
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Yuka Okazaki
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Takahisa Gono
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
- Scleroderma/Myositis Centre of Excellence, Nippon Medical School Hospital, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
- Scleroderma/Myositis Centre of Excellence, Nippon Medical School Hospital, Tokyo, Japan
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16
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Anderson HT, O'Donnell JL, Tustin P, Steele R. Diagnosis and subtyping of idiopathic inflammatory myopathies: caution required in the use of myositis autoantibodies. Intern Med J 2024; 54:682-686. [PMID: 38444396 DOI: 10.1111/imj.16350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/14/2024] [Indexed: 03/07/2024]
Abstract
Detection of myositis autoantibodies (MAs) has utility in both the diagnosis and subtyping of idiopathic inflammatory myopathies (IIMs). Multiplex assays such as the Euroimmun line immunoassay (LIA) have significant limitations in rare diseases like IIM. A retrospective cohort study was performed on positive MA detected on LIA in 171 patients using the manufacturer's recommended cut-off. Only 16.7% were deemed true positive after clinical correlation. Autoantibody-specific cut-offs were created and applied to the original cohort, along with generically applied higher cut-offs. Positive predictive value (PPV) improved, but there was variable increase in false negatives. False positive MA results are common using LIA, but locally derived cut-offs can improve performance. Clinicians must be aware of the limitations of LIA, which is the commonest method for MA detection in Australasia.
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Affiliation(s)
- Hamish T Anderson
- Canterbury Health Laboratories, Christchurch Hospital, Christchurch, New Zealand
- Awanui Laboratories, Wellington Hospital, Wellington, New Zealand
| | - John L O'Donnell
- Canterbury Health Laboratories, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Tustin
- Awanui Laboratories, Wellington Hospital, Wellington, New Zealand
| | - Richard Steele
- Awanui Laboratories, Wellington Hospital, Wellington, New Zealand
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17
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Cassard L, Seraly N, Riegert M, Patel A, Fernandez AP. Dermatomyositis: Practical Guidance and Unmet Needs. Immunotargets Ther 2024; 13:151-172. [PMID: 38464459 PMCID: PMC10924937 DOI: 10.2147/itt.s381472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Dermatomyositis is a heterogeneous idiopathic inflammatory myopathy associated with various cutaneous manifestations and variable presence of myositis, interstitial lung disease, and other visceral organ involvement. An accurate diagnosis of dermatomyositis requires correlating clinical examination findings with serological and histological findings. Familiarity with pathognomonic and common cutaneous manifestations of dermatomyositis, which are highlighted here, can be especially helpful in making an accurate diagnosis. Additionally, evaluating patients for presence of myositis-specific autoantibodies can further support or refute a dermatomyositis diagnosis. When present, myositis-specific autoantibodies can also help guide workups for various dermatomyositis-associated manifestations, as each is associated with relatively distinct clinical characteristics. Evaluating patients for various systemic manifestations often relies on expert opinion recommendations; however, societal guideline statements concerning the evaluation of some manifestations have recently been described. Although malignancy-associated dermatomyositis is a well-accepted subtype, there is limited evidence to support extensive malignancy screening has a favorable benefit-risk ratio in most dermatomyositis patients. However, recent research has uncovered novel associations between dermatomyositis and malignancy, suggesting the possibility of identifying high-risk subsets of dermatomyositis patients in whom malignancy screening may have a high value. Treatment for dermatomyositis has remained largely unchanged over the past several decades. Although many dermatomyositis patients can be effectively treated with current options, either as monotherapy or with combination regimens, there is a need for more targeted and effective DM therapies, in general, and for MDA5(+) dermatomyositis-associated rapidly progressive interstitial lung disease. Fortunately, significant current and emerging research activities evaluating various novel medications for dermatomyositis provide hope for exciting future advances in patients with this intriguing immune-mediated disease.
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Affiliation(s)
- Lydia Cassard
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Noelle Seraly
- Department of Dermatology, Cleveland Clinic, Cleveland, OH, USA
| | - Maureen Riegert
- Department of Dermatology, Rush University, Chicago, IL, USA
| | - Aditi Patel
- Department of Rheumatology, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, OH, USA
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18
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Marwah V, Basnet A, Choudhary R, Koshy V, Shrinath V, Tentu AK, Tripathi S. Rare presentation of rare disease: Idiopathic inflammatory myositis presenting initially as acute respiratory distress syndrome. Lung India 2024; 41:139-142. [PMID: 38700409 PMCID: PMC10959316 DOI: 10.4103/lungindia.lungindia_557_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/05/2023] [Accepted: 02/19/2023] [Indexed: 05/05/2024] Open
Affiliation(s)
- Vikas Marwah
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India E-mail:
| | - Ashok Basnet
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India E-mail:
| | - Robin Choudhary
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India E-mail:
| | - Varghese Koshy
- Department of Rhemutalogy, Command Hospital, Pune, Maharashtra, India.
| | - V Shrinath
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India E-mail:
| | - Ajai K. Tentu
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India E-mail:
| | - Sristhi Tripathi
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India E-mail:
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19
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Julien S, Challier I, Malleter M, Jouen F, Drouot L, Boyer O. Immune-Mediated Necrotizing Myopathy (IMNM): A Story of Antibodies. Antibodies (Basel) 2024; 13:12. [PMID: 38390873 PMCID: PMC10885118 DOI: 10.3390/antib13010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/10/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Immune-mediated necrotizing myopathy (IMNM) is a rare and severe disease that corresponds to a specific entity of idiopathic inflammatory myopathy. Patients with IMNM suffer from proximal muscle weakness, and present high levels of creatine kinase and necrotic myofibers. Anti-Signal Recognition Particle (SRP) and anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase autoantibodies (HMGCR) have recently been identified in two thirds of patients with IMNM and are used as a hallmark of the disease. In this review, we provide a detailed description of these antibodies and the tests used to detect them in the serum of patients. Based on in vitro studies and mouse models of IMNM, we discuss the role of autoantibodies in the pathogenesis of the disease. Finally, in the light of the latest knowledge, we conclude with a review of recent therapeutic approaches in IMNM.
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Affiliation(s)
- Sarah Julien
- INSERM U1234, PAn'THER FOCIS Center of Excellence, Université de Rouen, F-76000 Rouen, France
| | - Inès Challier
- Department of Pharmacy, CHU Rouen, F-76000 Rouen, France
| | - Marine Malleter
- INSERM U1234, PAn'THER FOCIS Center of Excellence, Université de Rouen, F-76000 Rouen, France
| | - Fabienne Jouen
- INSERM U1234, PAn'THER FOCIS Center of Excellence, Université de Rouen, F-76000 Rouen, France
- Department of Immunology and Biotherapy, CHU Rouen, F-76000 Rouen, France
| | - Laurent Drouot
- INSERM U1234, PAn'THER FOCIS Center of Excellence, Université de Rouen, F-76000 Rouen, France
| | - Olivier Boyer
- INSERM U1234, PAn'THER FOCIS Center of Excellence, Université de Rouen, F-76000 Rouen, France
- Department of Immunology and Biotherapy, CHU Rouen, F-76000 Rouen, France
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20
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Connolly CM, Gupta L, Fujimoto M, Machado PM, Paik JJ. Idiopathic inflammatory myopathies: current insights and future frontiers. THE LANCET. RHEUMATOLOGY 2024; 6:e115-e127. [PMID: 38267098 DOI: 10.1016/s2665-9913(23)00322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024]
Abstract
Idiopathic inflammatory myopathies are a group of autoimmune diseases with a broad spectrum of clinical presentations, primarily characterised by immune-mediated muscle injury. Until recently, there was little insight into the pathogenesis of idiopathic inflammatory myopathies, which challenged the recognition of the breadth of heterogeneity of this group of diseases as well as the development of new therapeutics. However, the landscape of idiopathic inflammatory myopathies is evolving. In the past decade, advances in diagnostic tools have facilitated an enhanced understanding of the underlying disease mechanisms in idiopathic inflammatory myopathies, enabling the expansion of therapeutic trials. The fields of transcriptomics, prot§eomics, and machine learning offer the potential to gain greater insights into the underlying pathophysiology of idiopathic inflammatory myopathies. Harnessing insights gained from these sophisticated tools could contribute to the identification of differences at a molecular level among patients, accelerating the development of targeted, tailored therapies. Bolstered by the validation and standardisation of robust outcome measures, many promising therapies are in clinical trial development. Although challenges remain, there is great optimism in the field due to the progress in innovative diagnostics, outcome measures, and therapeutic approaches. In this Review, we discuss the expanding landscape of idiopathic inflammatory myopathies as the frontier of precision medicine becomes imminent.
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Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Pedro M Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK; Centre for Rheumatology, University College London, London, UK; National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK; Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Hospach T, Kallinich T, Rietschel C, Hufnagel M, Freudenhammer J, Rücklová K, Oommen PT. [Society for Pediatric and Adolescent Rheumatology (GKJR) diagnosis and treatment optimization board-New ways to the diagnosis and treatment of complex diseases : An analysis after 2 years testing in practice]. Z Rheumatol 2024; 83:28-33. [PMID: 37945990 DOI: 10.1007/s00393-023-01444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
With the diagnosis and treatment optimization board, the Society for Pediatric and Adolescent Rheumatology (GKJR) has developed a new format for expert-based discussion of rare and complex diseases. So far, 32 cases, predominantly from the areas of hyperinflammation, systemic lupus erythematosus, myositis and nonbacterial osteomyelitis, could be discussed in 8 conferences. The digital format enabled a high number of participants and the involvement of national and international experts. Rare diseases increasingly present modern medicine with challenges, which the GKJR meets with the new format.
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Affiliation(s)
- Toni Hospach
- Zentrum für pädiatrische Rheumatologie am Klinikum Stuttgart (ZEPRAS), Olgahospital, Kriegsbergstr 62, 70176, Stuttgart, Deutschland.
| | - Tilmann Kallinich
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité Universitätsmedizin und Deutsches Rheuma-Forschungszentrum (DRFZ), ein Leibniz Institut, Berlin, Deutschland
| | - Christoph Rietschel
- Kinder- und Jugendrheumatologie, Clementine Kinderhospital, Frankfurt/Main, Deutschland
| | - Markus Hufnagel
- Sektion Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - Johanna Freudenhammer
- Sektion Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - Kristina Rücklová
- Zentrum für pädiatrische Rheumatologie am Klinikum Stuttgart (ZEPRAS), Olgahospital, Kriegsbergstr 62, 70176, Stuttgart, Deutschland
| | - Prasad T Oommen
- Klinik für Kinder-Onkologie, - Hämatologie und Klin. Immunologie, Bereich Päd. Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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22
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Robert M, Lessard LER, Bouhour F, Petiot P, Fenouil T, Svahn J, Fiscus J, Fabien N, Perard L, Robinson P, Durieu I, Coury F, Streichenberger N, Hot A, Gallay L. Inaugural dropped head syndrome and camptocormia in inflammatory myopathies: a retrospective study. Rheumatology (Oxford) 2024; 63:506-515. [PMID: 37462538 PMCID: PMC10837000 DOI: 10.1093/rheumatology/kead347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/27/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Inaugural axial muscle involvement, defined as dropped head syndrome (DHS) and/or camptocormia (CC), is poorly described in inflammatory myopathies (IM). This study aimed to further characterize IM patients with inaugural DHS/CC, their outcome and care management. METHODS This retrospective study included IM patients diagnosed between 2000 and 2021. The main inclusion criterion was IM revealed by axial muscle deficit (DHS/CC). RESULTS Twenty-seven patients were included; median (IQR) age at first symptoms was 66.0 years (55.5-75.0); 21 were female (77.8%). There were nine IBM, 33.3%, nine overlap myositis (OM, 33.3%), five DM, 18.5%, two immune checkpoint inhibitor-related myositis (7.4%), one focal myositis (3.7%) and one myositis with anti-Hu antibodies (3.7%). Age at first symptoms was ≤70 years in 16 patients (59.3%), including all DM patients and 8/9 OM patients (88.9%). In this group, partial remission of the disease was obtained in 9/16 (56.3%) and complete remission in 1/16 patients (6.3%); regression of DHS/CC was achieved in 3/16 patients (18.8%). Conversely, in the group of 11 patients aged >70 years at first symptoms, there were eight IBM (72.7%). Partial remission was obtained in 5/11 patients (45.5%), the disease was stable in 6/11 patients (54.5%); no complete remission was obtained nor regression of DHS/CC. CONCLUSION The analysis of IM patients with inaugural DHS/CC delineates two groups of patients according to the age at first symptoms in terms of clinical and outcome specificities, and proposes an adapted diagnostic and care management approach to prevent long-term complications.
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Affiliation(s)
- Marie Robert
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Lola E R Lessard
- Service d'Electroneuromyographie et Pathologies Neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Laboratoire Physiopathologie et Génétique du Neurone et du Muscle (PGNM), CNRS UMR5261-INSERM U1315, Institut NeuroMyoGène-Université Claude Bernard Lyon 1, Lyon, France
| | - Françoise Bouhour
- Service d'Electroneuromyographie et Pathologies Neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Philippe Petiot
- Service d'Electroneuromyographie et Pathologies Neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Tanguy Fenouil
- Service de Cytologie et d'Anatomie Pathologique, Département de Neuropathologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
- Equipe Ribosome Traduction et Cancer, UMR Inserm 1052 CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Juliette Svahn
- Service d'Electroneuromyographie et Pathologies Neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Julie Fiscus
- Service d'Immunologie, UF Autoimmunité, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Nicole Fabien
- Service d'Immunologie, UF Autoimmunité, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Perard
- Service de Médecine Interne, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Philip Robinson
- Direction de la Recherche en Santé, Hospices Civils de Lyon, Lyon, France
| | - Isabelle Durieu
- Service de Médecine interne, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Fabienne Coury
- Département de Rhumatologie, Hôpital Lyon Sud, Hospices civils de Lyon, Pierre-Bénite, France
- Inserm UMR1033, Université Claude Bernard Lyon 1, Lyon, France
| | - Nathalie Streichenberger
- Laboratoire Physiopathologie et Génétique du Neurone et du Muscle (PGNM), CNRS UMR5261-INSERM U1315, Institut NeuroMyoGène-Université Claude Bernard Lyon 1, Lyon, France
- Service de Cytologie et d'Anatomie Pathologique, Département de Neuropathologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Laure Gallay
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Laboratoire Cell Therapy & Musculoskeletal Disorders, Université de Genève, Genève, Switzerland
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23
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Anang DC, Walter HAW, Lim J, Niewold ITG, van der Weele L, Aronica E, Eftimov F, Raaphorst J, van Schaik BDC, van Kampen AHC, van der Kooi AJ, de Vries N. TCRβ clones in muscle tissue share structural features in patients with idiopathic inflammatory myopathy and are associated with disease activity. Front Immunol 2024; 14:1279055. [PMID: 38268914 PMCID: PMC10806010 DOI: 10.3389/fimmu.2023.1279055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024] Open
Abstract
Objectives To characterize the T cell receptor (TCRβ) repertoire in peripheral blood and muscle tissues of treatment naïve patients with newly diagnosed idiopathic inflammatory myopathies (IIMs). Methods High throughput RNA sequencing of the TCRβ chain was performed in peripheral blood and muscle tissue in twenty newly-diagnosed treatment-naïve IIM patients (9 DM, 5 NM/OM, 5 IMNM and 1 ASyS) and healthy controls. Results thereof were correlated with markers of disease activity. Results Muscle tissue of IIM patients shows more expansion of TCRβ clones and decreased diversity when compared to peripheral blood of IIM as well as healthy controls (both p=0.0001). Several expanded TCRβ clones in muscle are tissue restricted and cannot be retrieved in peripheral blood. These clones have significantly longer CDR3 regions when compared to clones (also) found in circulation (p=0.0002), while their CDR3 region is more hydrophobic (p<0.01). Network analysis shows that clonal TCRβ signatures are shared between patients. Increased clonal expansion in muscle tissue is significantly correlated with increased CK levels (p=0.03), while it tends to correlate with decreased muscle strength (p=0.08). Conclusion Network analysis of clones in muscle of IIM patients shows shared clusters of sequences across patients. Muscle-restricted CDR3 TCRβ clones show specific structural features in their T cell receptor. Our results indicate that clonal TCRβ expansion in muscle tissue might be associated with disease activity. Collectively, these findings support a role for specific clonal T cell responses in muscle tissue in the pathogenesis of the IIM subtypes studied.
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Affiliation(s)
- Dornatien C. Anang
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Genome Analysis, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hannah A. W. Walter
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Johan Lim
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Ilse T. G. Niewold
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Genome Analysis, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Linda van der Weele
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Joost Raaphorst
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Barbera D. C. van Schaik
- Bioinformatics Laboratory, Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Antoine H. C. van Kampen
- Bioinformatics Laboratory, Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Anneke J. van der Kooi
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Niek de Vries
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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24
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de Boysson H, Cuchet M, Cassius C, Cuchet P, Agard C, Audemard-Verger A, Marchand-Adam S, Cohen-Sors R, Gallay L, Graveleau J, Lesort C, Ly K, Meyer A, Monseau G, Néel A, Bonnotte B, Pérard L, Schleinitz N, Mariotte D, Le Mauff B, Bourdenet G, Masmoudi W, Deshayes S, Dumont A, Dompmartin A, Kottler D, Aouba A. Disease patterns and specific trajectories of anti-MDA5-related disease: a multicentre retrospective study of 70 adult patients. Front Immunol 2024; 14:1319957. [PMID: 38259447 PMCID: PMC10800864 DOI: 10.3389/fimmu.2023.1319957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction This study aimed to provide an updated analysis of the different prognostic trajectories of patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibodies. Methods Among a cohort of 70 patients, baseline characteristics and phenotypes, treatments and outcomes were analyzed. A Cox proportional hazards model was used to identify factors associated with poor outcomes, i.e., death or progressive disease at the last follow-up. Results Among the 70 patients, 45 were women, and 54 were Caucasian. A dermatologic involvement was observed in 58 (83%) patients, including 40 with MDA5 vasculopathy-related skin lesions. Muscular involvement was observed in 39 (56%) patients. Interstitial lung disease (ILD) was observed at baseline in 52 (74%) patients, including 23 (44%) who developed rapidly progressive (RP) ILD. Seven (10%) patients showed thromboembolic complications within the first weeks of diagnosis, and eight (11%) other patients developed a malignancy (4 before the diagnosis of anti-MDA5 disease). Poor outcomes were observed in 28 (40%) patients, including 13 (19%) deaths. Among the 23 patients with RP-ILD, 19 (79%) showed poor outcomes, including 12 (63%) who died. In multivariate analyses, RP-ILD (hazard ratio (HR), 95% CI: 8.24 [3.21-22], p<0.0001), the occurrence of thromboembolic events (HR: 5.22 [1.61-14.77], p=0.008) and the presence of any malignancy (HR: 19.73 [6.67-60], p<0.0001) were the three factors independently associated with poor outcomes. Discussion This new independent cohort confirms the presence of different clinical phenotypes of anti-MDA5 diseases at baseline and the poor prognosis associated with RP-ILD. Thromboembolic events and malignancies were also identified as prognostic factors.
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Affiliation(s)
- Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Marie Cuchet
- Department of Dermatology, Caen University Hospital, Caen, France
| | - Charles Cassius
- Department of Dermatology, France Saint Louis Hospital, (AP-HP), Paris, France
| | - Pierre Cuchet
- Department of Pneumology, Caen University Hospital, Caen, France
| | - Christian Agard
- Nantes Université, Centre Hospitalier et Universitaire (CHU) Nantes, Service de Médecine Interne, Nantes, France
| | | | | | | | - Laure Gallay
- Service de Médecine Interne et Immunologie Clinique, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Julie Graveleau
- Department of Internal Medicine, Saint-Nazaire Hospital, Saint-Nazaire, France
| | - Cécile Lesort
- Department of Dermatology, Edouard Herriot Hospital, Hospices civiles de Lyon (HCL), Lyon, France
| | - Kim Ly
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | - Alain Meyer
- Department of Rheumatology, Strasbourg University Hospital, Strasbourg, France
| | - Grégoire Monseau
- Department of Intensive Medicine, Poitiers University Hospital Center, Poitiers, France
| | - Antoine Néel
- Nantes Université, Centre Hospitalier et Universitaire (CHU) Nantes, Service de Médecine Interne, Nantes, France
| | - Bernard Bonnotte
- Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Laurent Pérard
- Department of Internal Medicine, Saint Joseph Saint Luc Hospital, Lyon, France
| | - Nicolas Schleinitz
- Department of Internal Medicine, La Timone University Hospital, Assistance Publique - Hopitaux de Marseille (AP-HM), Marseille, France
| | | | | | - Gwladys Bourdenet
- Department of Immunology, Amiens University Hospital, Amiens, France
- HEMATIM – EA4666, Jules Verne University of Picardie, Amiens, France
| | - Wafa Masmoudi
- Department of Dermatology, Rouen University Hospital, Rouen, France
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Anaël Dumont
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Anne Dompmartin
- Department of Dermatology, Caen University Hospital, Caen, France
| | - Diane Kottler
- Department of Dermatology, Caen University Hospital, Caen, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France
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Park JW, Kim BJ. Advances in Idiopathic Inflammatory Myopathies Classification: Paving the Way for Personalized Management. J Clin Neurol 2024; 20:1-2. [PMID: 38179627 PMCID: PMC10782090 DOI: 10.3988/jcn.2023.0453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/05/2023] [Accepted: 11/05/2023] [Indexed: 01/06/2024] Open
Affiliation(s)
- Jin-Woo Park
- Department of Neurology, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
- BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, Korea.
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26
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Honda M, Shimizu F, Sato R, Nakamori M. Contribution of Complement, Microangiopathy and Inflammation in Idiopathic Inflammatory Myopathies. J Neuromuscul Dis 2024; 11:5-16. [PMID: 38143369 PMCID: PMC10789353 DOI: 10.3233/jnd-230168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE OF REVIEW Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group characterized by muscle weakness and skin symptoms and are categorized into six subtypes: dermatomyositis (DM), polymyositis (PM), anti-synthetase syndrome (ASS), immune-mediated myopathy (IMNM), inclusion body myopathy (IBM), and overlap myositis. Myositis-specific autoantibodies were detected for the diagnosis and classification of IIM. This review highlights the pathogenic contributions of the complement system, microangiopathy, and inflammation in IIM. RECENT FINDINGS Deposition of complement around capillaries and/or the sarcolemma was observed in muscle biopsy specimens from patients with DM, ASS, and IMNM, suggesting the pathomechanism of complement-dependent muscle and endothelial cell injury. A recent study using human muscle microvascular endothelial cells showed that Jo-1 antibodies from ASS induce complement-dependent cellular cytotoxicity in vitro. Based on both clinical and pathological observations, antibody- and complement-mediated microangiopathy may contribute to the development of DM and anti-Jo-1 ASS. Juvenile DM is characterized by the loss of capillaries, perivascular inflammation, and small-vessel angiopathies, which may be related to microinfarction and perifascicular atrophy. Several serum biomarkers that reflect the IFN1 signature and microangiopathy are elevated in patients with DM. The pathological observation of myxovirus resistance protein A (MxA), which suggests a type 1 interferon (IFN1) signature in DM, supports the diagnosis and further understanding of the pathomechanism of IIM. A recent report showed that an increase in triggering receptor expressed on myeloid cells (TREM-1) around perimysial blood vessels and muscles in patients with IIM plays a role in triggering inflammation and promoting the migration of inflammatory cells by secreting proinflammatory cytokines, such as tumor necrosis factor α. SUMMARY The deposition of complement in muscles and capillaries is a characteristic feature of DM, ASS, and IMNM. Microangiopathy plays a pathogenic role in DM, possibly resulting in perifascicular atrophy. Further understanding of the detailed pathomechanism regarding complement, microangiopathy, and inflammation may lead to novel therapeutic approaches for IIM.
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Affiliation(s)
- Masaya Honda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Fumitaka Shimizu
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Ryota Sato
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Masayuki Nakamori
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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27
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Li Y, Wu Y, Huang J, Cao X, An Q, Peng Y, Zhao Y, Luo Y. A variety of death modes of neutrophils and their role in the etiology of autoimmune diseases. Immunol Rev 2024; 321:280-299. [PMID: 37850797 DOI: 10.1111/imr.13284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Neutrophils are important in the context of innate immunity and actively contribute to the progression of diverse autoimmune disorders. Distinct death mechanisms of neutrophils may exhibit specific and pivotal roles in autoimmune diseases and disease pathogenesis through the orchestration of immune homeostasis, the facilitation of autoantibody production, the induction of tissue and organ damage, and the incitement of pathological alterations. In recent years, more studies have provided in-depth examination of various neutrophil death modes, revealing nuances that challenge conventional understanding and underscoring their potential clinical utility in diagnosis and treatment. This review explores the multifaceted processes and characteristics of neutrophil death, with a focus on tailored investigations within various autoimmune diseases. It also highlights the potential interplay between neutrophil death and the landscape of autoimmune disorders. The review encapsulates the pertinent pathways implicated in various neutrophil death mechanisms across diverse autoimmune diseases while also charts possible avenues for future research.
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Affiliation(s)
- Yanhong Li
- Department of Rheumatology & Immunology, Laboratory of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yinlan Wu
- Department of Rheumatology & Immunology, Laboratory of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingang Huang
- Medical Research Center, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xue Cao
- Department of Rheumatology and Immunology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, Henan, China
| | - Qiyuan An
- School of Inspection and Biotechnology, Southern Medical University, Guangzhou, China
| | - Yun Peng
- Department of Rheumatology and Clinical Immunology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian, China
| | - Yi Zhao
- Department of Rheumatology & Immunology, Laboratory of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yubin Luo
- Department of Rheumatology & Immunology, Laboratory of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Campar A, Alves I, da Silva AM, Farinha F, Vasconcelos C. Idiopathic inflammatory myopathies - The burden of disease: Cohort analysis focusing on damage and comorbidities. Autoimmun Rev 2023; 22:103455. [PMID: 37778406 DOI: 10.1016/j.autrev.2023.103455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION/BACKGROUND Idiopathic Inflammatory Myopathies (IIM) continue to be a major clinical challenge worldwide. The exact aetiopathogenesis of this chronic and disabling disease remains elusive, preventing the development of novel and effective therapeutic strategies and leading to a high incidence of damage. The complexity of treating these diseases is even greater due to the numerous comorbidities that affect these patients. METHODS Retrospective review of the cohort of patients diagnosed with IIM and followed in a dedicated unit of a tertiary hospital between 1971 and December 2022, with particular attention to damage and comorbidities. Damage was assessed using the Myositis Damage Index. Comorbidities were recorded and analysed as a whole and also assessed using the Charlson Comorbidity Index. Health Assessment Questionnaire (HAQ) Disability Index (DI) was performed by phone call in December 2022, to all patients actively followed-up in the Unit. RESULTS Analysis of 149 patients with a mean follow-up of 9 years (range 0-51) revealed >90% with damage and comorbidities. Most comorbidities were a consequence of the damage and were particularly related to prolonged steroid therapy. Cardiovascular damage, which occurred either as cardiovascular risk factors or as end-organ sequelae (cardiovascular disease and chronic kidney disease), was the main cause and a major contributor to death. Depression was also high on the list of associated comorbidities. Median HAQ was 2.09 representing high negative impact in quality of life. CONCLUSIONS Although survival rates have increased in recent decades, patients with IIM carry a high burden of disease with poor quality of life, mainly caused by damage and comorbidities. While comorbidities accumulation is the major factor for poor quality of life, damage severity is the main predictor for mortality. Improved therapeutic strategies are needed to reduce the need for steroids and to introduce routine screening and management of comorbidities as an essential partner of immunosuppressive therapy, leading to comprehensive care of myositis patients and effective improvement of their quality of life.
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Affiliation(s)
- Ana Campar
- Clinical Immunology Unit - Centro Hospitalar Universitário de Santo António, Núcleo de Estudos em Doenças Autoimunes (NEDAI) - Portuguese Society of Internal Medicine (SPMI), Portugal.
| | - Inês Alves
- Immunology, Cancer and Glycomedicine group - Instituto de Patologia e Imunologia Molecular and Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
| | - Ana Martins da Silva
- Neuroimmunology group, Neurology department - Centro Hospitalar Universitário de Santo António, Portugal
| | - Fátima Farinha
- Clinical Immunology Unit - Centro Hospitalar Universitário de Santo António, Portugal
| | - Carlos Vasconcelos
- Institute for Biomedical Sciences Abel Salazar - University of Porto, Portugal
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Oldroyd AGS, Callen JP, Chinoy H, Chung L, Fiorentino D, Gordon P, Machado PM, McHugh N, Selva-O'Callaghan A, Schmidt J, Tansley SL, Vleugels RA, Werth VP, Aggarwal R. International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening: an International Myositis Assessment and Clinical Studies Group (IMACS) initiative. Nat Rev Rheumatol 2023; 19:805-817. [PMID: 37945774 PMCID: PMC10834225 DOI: 10.1038/s41584-023-01045-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
Adult-onset idiopathic inflammatory myopathy (IIM) is associated with an increased cancer risk within the 3 years preceding and following IIM onset. Evidence- and consensus-based recommendations for IIM-associated cancer screening can potentially improve outcomes. This International Guideline for IIM-Associated Cancer Screening provides recommendations addressing IIM-associated cancer risk stratification, cancer screening modalities and screening frequency. The international Expert Group formed a total of 18 recommendations via a modified Delphi approach using a series of online surveys. First, the recommendations enable an individual patient's IIM-associated cancer risk to be stratified into standard, moderate or high risk according to the IIM subtype, autoantibody status and clinical features. Second, the recommendations outline a 'basic' screening panel (including chest radiography and preliminary laboratory tests) and an 'enhanced' screening panel (including CT and tumour markers). Third, the recommendations advise on the timing and frequency of screening via basic and enhanced panels, according to risk status. The recommendations also advise consideration of upper or lower gastrointestinal endoscopy, nasoendoscopy and 18F-FDG PET-CT scanning in specific patient populations. These recommendations are aimed at facilitating earlier IIM-associated cancer detection, especially in those who are at a high risk, thus potentially improving outcomes, including survival.
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Affiliation(s)
- Alexander G S Oldroyd
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Jeffrey P Callen
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Department of Medicine and Dermatology, Stanford University, Stanford, CA, USA
- Palo Alto Health Care System, Palo Alto, CA, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Pedro M Machado
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
- Department of Neuromuscular Diseases, Division of Medicine, University College London, London, UK
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Neil McHugh
- Department of Life Sciences, University of Bath, Bath, UK
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Vall D'Hebron General Hospital, Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jens Schmidt
- Department of Neurology, Neuromuscular Centre, University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah L Tansley
- Department of Life Sciences, University of Bath, Bath, UK
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust Bath, Bath, UK
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Division of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Rohit Aggarwal
- Myositis Center and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Janardana R, KN S, Bhat V, Balakrishnan D, Raj JM, Pinto B, K C, Nadig R, Mahadevan A, Shobha V. Long Term Outcomes in Idiopathic Inflammatory Myositis: An Observational Epidemiologic Study over 15 Years. Mediterr J Rheumatol 2023; 34:513-524. [PMID: 38282927 PMCID: PMC10815524 DOI: 10.31138/mjr.280823.lto] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 01/30/2024] Open
Abstract
Background We report a longitudinal observational cohort of idiopathic inflammatory myositis (IIM) focusing on the long-term clinical outcome and associated parameters. Methods IIM patients were classified as per Bohan and Peter criteria. In those with ≥ 24 months of follow-up; the treatment response, functional outcomes, and damage at last follow-up were recorded. Complete clinical response and clinical remission as defined by Oddis et al., was used to define outcomes at last follow-up. Results The cohort consists of 175 patients, mean age 40.9 (+12.6) years, M:F 1:3.3; and the major subsets were dermatomyositis (44.6%), overlap myositis (25.7%), antisynthetase syndrome (6.3%), polymyositis (14.3%), and juvenile DM/OM (8.6%). Ninety-four patients have followed up for 24 months or more, with the median (IQR) of 65(35,100.7) months. Of them, 74.1% and 11.8% had complete and partial clinical responses respectively at the last follow-up. In our cohort 40.2% were off-steroids and 13.8% were in clinical remission at the last follow-up. Complete clinical response was associated with better functional outcomes and lesser damage as determined by HAQ-DI of 0[OR10.9; 95%CI (3.3,160)], MRS [OR 3.2; 95%CI (1.4,7.3)] and lesser MDI [OR 1.7; 95% CI (1.1,2.7)] respectively as compared to partial response (unadjusted analysis). Baseline parameters and IIM subsets did not significantly influence the functional outcome and damage. The mortality rate in our cohort is 24/175 (13.7%), the disease-specific mortality rate being 9.1%. Large majority of deaths were early, associated with active disease. Conclusion We report good long-term outcomes in all major myositis subsets. Partial clinical response to treatment is associated with worse functional outcomes and damage accrual. Death occurs early in association with active disease.
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Affiliation(s)
- Ramya Janardana
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Sangeetha KN
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Vasudha Bhat
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Divya Balakrishnan
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - John Michael Raj
- Department of Biostatistics, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Benzeeta Pinto
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Chanakya K
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Raghunandan Nadig
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Anita Mahadevan
- Department of Pathology, NIMHANS, Bengaluru, Karnataka, India
| | - Vineeta Shobha
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
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Demortier J, Vautier M, Chosidow O, Gallay L, Bessis D, Berezne A, Cordel N, Schmidt J, Smail A, Duffau P, Jachiet M, Begon E, Gottlieb J, Chasset F, Graveleau J, Marque M, Cesbron E, Forestier A, Josse S, Kluger N, Beauchêne C, Le Corre Y, Pagis V, Rigolet A, Guillaume-Jugnot P, Authier FJ, Guilain N, Streichenberger N, Leonard-Louis S, Boussouar S, Landon-Cardinal O, Benveniste O, Allenbach Y. Anti-SAE autoantibody in dermatomyositis: original comparative study and review of the literature. Rheumatology (Oxford) 2023; 62:3932-3939. [PMID: 37010495 DOI: 10.1093/rheumatology/kead154] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/26/2023] [Accepted: 03/10/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Among specific autoantibodies in DM, the anti-small ubiquitin-like modifier activating enzyme (SAE) antibody is rare. We aim to describe the clinical characteristics, cancer prevalence, and muscle pathology of anti-SAE-positive DM. METHODS Patients with a diagnosis of DM and sera positive for the anti-SAE antibody were recruited from 19 centres in this retrospective observational study. The available muscular biopsies were reviewed. We conducted a comparison with anti-SAE-negative DM and a review of the literature. RESULTS Of the patients in the study (n = 49), 84% were women. Skin involvement was typical in 96% of patients, with 10% having calcinosis, 18% ulceration and 12% necrosis; 35% presented with a widespread skin rash. Muscular disease affected 84% of patients, with mild weakness [Medical Research Council (MRC) scale 4 (3, 5)], although 39% of patients had dysphagia. Muscular biopsies showed typical DM lesions. Interstitial lung disease was found in 21% of patients, mainly with organizing pneumonia pattern, and 26% of patients showed dyspnoea. Cancer-associated myositis was diagnosed in 16% of patients and was responsible for the majority of deaths, its prevalence being five times that of the general population. IVIG therapy was administered to 51% of the patients during the course of the disease. Comparison with anti-SAE-negative DM (n = 85) showed less and milder muscle weakness (P = 0.02 and P = 0.006, respectively), lower creatinine kinase levels (P < 0.0001) and less dyspnoea (P = 0.003). CONCLUSION Anti-SAE positive DM is a rare subgroup associated with typical skin features but a potentially diffuse rash, a mild myopathy. Interstitial lung disease defines an organizing pneumonia pattern. Cancer associated DM prevalence is five times that of the general population. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT04637672.
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Affiliation(s)
- Juliette Demortier
- Department of Dermatology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - Mathieu Vautier
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Olivier Chosidow
- Department of Dermatology, Henri Mondor University Hospital, Université Paris-Est Créteil, AP-HP, Créteil, France
| | - Laure Gallay
- Department of Internal Medicine and Clinical Immunology, Edouard Herriot University Hospital, Claude Bernard University Lyon1, Lyon, France
| | - Didier Bessis
- Department of Dermatology, University Hospital Center of Montpellier, Montpellier, France
| | - Alice Berezne
- Department of Internal Medicine, CHR Annecy-Genevois, Annecy, France
| | - Nadège Cordel
- Department of Dermatology and Clinical Immunology, Guadeloupe University Hospital, Pointe-à-Pitre, Guadeloupe and Normandie University, UNIROUEN, IRIB, Inserm, U1234, Rouen, France
| | - Jean Schmidt
- Department of Internal Medicine and Clinical Immunology, Amiens-Picardie Nord University Hospital, Amiens, France
| | - Amar Smail
- Department of Internal Medicine and Clinical Immunology, Amiens-Picardie Nord University Hospital, Amiens, France
| | - Pierre Duffau
- Department of Internal Medicine, Saint André, Bordeaux University Hospital, Bordeaux, France
| | - Marie Jachiet
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris, France
| | - Edouard Begon
- Department of Dermatology, René Dubos Hospital, Pontoise, France
| | - Jeremy Gottlieb
- Department of Internal Medicine and Clinical Immunology, Bicêtre Hospital, Université Paris-Sud, AP-HP, Le Kremlin-Bicêtre Cedex, France
| | - François Chasset
- Department of Dermatology, Tenon Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Julie Graveleau
- Department of Internal Medicine, CH de St Nazaire, St Nazaire, France
| | - Myriam Marque
- Department of Dermatology, Caremeau Hospital, Nîmes University Hospital, Nîmes, France
| | - Elise Cesbron
- Department of Dermatology, Le Mans Hospital Center, Le Mans, France
| | - Amandine Forestier
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Séverine Josse
- Department of Internal Medicine and Clinical Immunology, Dieppe Hospital, Dieppe, France
| | - Nicolas Kluger
- Department of Dermatology, Helsinki University Hospital, Helsinki, Finland
| | | | - Yannick Le Corre
- Department of Dermatology, Angers University Hospital, Angers, France
| | - Valentine Pagis
- Department of Internal Medicine and Clinical Immunology, Beaujon Hospital, AP-HP, Paris, France
| | - Aude Rigolet
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Perrine Guillaume-Jugnot
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - François-Jérôme Authier
- Department of Pathology, Henri-Mondor University Hospital, Institut Mondor de Recherche Biomédicale, INSERM, Centre de Reference pour les Maladies Neuromusculaires of Nord-Est-Île de France, Université Paris-Est Créteil, AP-HP, Créteil, France
| | - Nelly Guilain
- Department of Pathology, Amiens Picardie University Hospital, Amiens, France
| | | | - Sarah Leonard-Louis
- Neuropathology Department, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Samia Boussouar
- ICT Cardiothoracic Imaging Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre Hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, Paris, France
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McLeish E, Slater N, Mastaglia FL, Needham M, Coudert JD. From data to diagnosis: how machine learning is revolutionizing biomarker discovery in idiopathic inflammatory myopathies. Brief Bioinform 2023; 25:bbad514. [PMID: 38243695 PMCID: PMC10796252 DOI: 10.1093/bib/bbad514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/29/2023] [Accepted: 12/17/2023] [Indexed: 01/21/2024] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of muscle disorders including adult and juvenile dermatomyositis, polymyositis, immune-mediated necrotising myopathy and sporadic inclusion body myositis, all of which present with variable symptoms and disease progression. The identification of effective biomarkers for IIMs has been challenging due to the heterogeneity between IIMs and within IIM subgroups, but recent advances in machine learning (ML) techniques have shown promises in identifying novel biomarkers. This paper reviews recent studies on potential biomarkers for IIM and evaluates their clinical utility. We also explore how data analytic tools and ML algorithms have been used to identify biomarkers, highlighting their potential to advance our understanding and diagnosis of IIM and improve patient outcomes. Overall, ML techniques have great potential to revolutionize biomarker discovery in IIMs and lead to more effective diagnosis and treatment.
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Affiliation(s)
- Emily McLeish
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, Western Australia (WA), Australia
| | - Nataliya Slater
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, Western Australia (WA), Australia
| | - Frank L Mastaglia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Merrilee Needham
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, Western Australia (WA), Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- University of Notre Dame Australia, School of Medicine, Fremantle, WA, Australia
- Fiona Stanley Hospital, Department of Neurology, Murdoch, WA, Australia
| | - Jerome D Coudert
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, Western Australia, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- University of Notre Dame Australia, School of Medicine, Fremantle, WA, Australia
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Waisayarat J, Wongsuwan P, Tuntiseranee K, Waisayarat P, Dejthevaporn C, Khongkhatithum C, Soponkanaporn S. Sarcoplasmic Myxovirus Resistance Protein A: A Study of Expression in Idiopathic Inflammatory Myopathy. J Inflamm Res 2023; 16:5417-5426. [PMID: 38026261 PMCID: PMC10676103 DOI: 10.2147/jir.s433239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases affecting primarily proximal muscles. Major subtypes include dermatomyositis, polymyositis, inclusion body myositis, immune-mediated necrotizing myopathy and antisynthetase syndrome. Overexpression of sarcoplasmic myxovirus-resistance protein A (MxA) has been observed in muscle biopsy specimens of dermatomyositis but is rarely seen in other subtypes of IIM and other myopathies. Objective We evaluate the expression of sarcoplasmic MxA and its diagnostic value in IIM and other myopathies. Methods One hundred and thirty-eight muscle biopsy specimens with the diagnosis of IIM and other myopathies from 2011 to 2020 were reviewed and stained for MxA by immunohistochemistry. The difference of the expression of MxA between IIM and other myopathies was analyzed by Fisher's exact test, and the sensitivity and specificity of MxA immunohistochemistry in the diagnosis of IIM were assessed. Results MxA protein was positive in 16/138 (11.6%) specimens. All 12 dermatomyositis specimens positive for MxA protein were positive in perifascicular area pattern. Only dermatomyositis specimens had a significantly higher percentage of positive sarcoplasmic MxA expression than specimens of other subtypes of IIM (p<0.001). Sarcoplasmic MxA expression for dermatomyositis diagnosis had a sensitivity of 46.15% (95% CI 26.59-66.63%) and a specificity of 94.44% (95% CI 81.34-99.32%) with the positive and negative likelihood ratio of 8.31 (95% CI 2.03-34.01) and 0.57 (95% CI 0.40-0.82), respectively. Conclusion The MxA immunohistochemistry is highly specific for dermatomyositis and should be added to a routine inflammatory panel of muscle biopsy. MxA expression should be cautiously interpreted to avoid pitfalls.
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Affiliation(s)
- Jariya Waisayarat
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phumin Wongsuwan
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Phu Waisayarat
- Faculty of Medicine, King Mongkut’s Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Charungthai Dejthevaporn
- Division of Neurology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiyos Khongkhatithum
- Division of Neurology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirisucha Soponkanaporn
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Wang Y, Zhao Y, Yu M, Wei L, Zhang W, Wang Z, Yuan Y. Clinicopathological and circulating cell-free DNA profile in myositis associated with anti-mitochondrial antibody. Ann Clin Transl Neurol 2023; 10:2127-2138. [PMID: 37723899 PMCID: PMC10647000 DOI: 10.1002/acn3.51901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE Anti-mitochondrial antibodies (AMAs) are associated with idiopathic inflammatory myopathies (IIMs). We aimed to summarize the clinicopathological characteristics, assess circulating cell-free mitochondrial DNA (ccf-mtDNA), and circulating cell-free nuclear DNA (ccf-nDNA) in AMA-associated IIMs. METHODS Medical records of 37 IIMs patients with AMAs were reviewed. Circulating cell-free mtDNA and ccf-nDNA levels in sera from IIMs patients with AMAs (n = 21), disease controls (n = 66) and healthy controls (HCs) (n = 23) were measured and compared. Twenty-eight immune-mediated necrotizing myopathy (IMNM) patients, 23 dermatomyositis (DM) patients, and 15 anti-synthetase syndrome (ASS) patients were enrolled as disease controls. Correlations between variables were analyzed. RESULTS Limb weakness was observed in 75.7% and neck weakness in 56.8% of patients. Cardiac involvement occurred in 51.4% of patients. Muscle pathology revealed 81.1% of IMNM, 5.4% polymyositis, and 13.5% nonspecific myositis. Microinfarction was observed in 8.1% of patients. Serum ccf-mtDNA levels in AMA-associated IIMs were significantly higher than those in HCs (p < 0.001), but no significant differences between AMA-associated IIMs and IMNM, DM, or ASS. Serum ccf-nDNA levels in AMA-associated IIMs were significantly higher than those in HCs (p = 0.02), and significantly lower than those in DM (p = 0.02). Serum ccf-nDNA levels correlated negatively with MMT8 total scores (rs = -0.458, p = 0.037) and positively with mRS scores (rs = 0.486, p = 0.025). Serum ccf-nDNA levels were significantly higher in the non-remission group (p < 0.01). INTERPRETATION AMA-associated IIMs exhibit distinct clinicopathological features. Serum ccf-nDNA may serve as a potential marker for disease severity and prognosis in AMA-associated IIMs.
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Affiliation(s)
- Yikang Wang
- Department of NeurologyPeking University First HospitalBeijing100034China
| | - Yawen Zhao
- Department of NeurologyPeking University First HospitalBeijing100034China
| | - Meng Yu
- Department of NeurologyPeking University First HospitalBeijing100034China
| | - Luhua Wei
- Department of NeurologyPeking University First HospitalBeijing100034China
| | - Wei Zhang
- Department of NeurologyPeking University First HospitalBeijing100034China
- Beijing Key Laboratory of Neurovascular Disease DiscoveryBeijing100034China
| | - Zhaoxia Wang
- Department of NeurologyPeking University First HospitalBeijing100034China
- Beijing Key Laboratory of Neurovascular Disease DiscoveryBeijing100034China
- Key Laboratory for Neuroscience, National Health Commission of the People's Republic of ChinaPeking UniversityBeijing100083China
| | - Yun Yuan
- Department of NeurologyPeking University First HospitalBeijing100034China
- Beijing Key Laboratory of Neurovascular Disease DiscoveryBeijing100034China
- Key Laboratory for Neuroscience, National Health Commission of the People's Republic of ChinaPeking UniversityBeijing100083China
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Mensi S, Lescoat A. [Intraveinous immunoglobulins in dermatomyositis: Is this article of the New England Journal of Medicine a game changer?]. Rev Med Interne 2023; 44:533-535. [PMID: 37777431 DOI: 10.1016/j.revmed.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 10/02/2023]
Affiliation(s)
- S Mensi
- Médecine interne et immunologie clinique, CHU de Rennes, université de Rennes 1, Rennes, France.
| | - A Lescoat
- Médecine interne et immunologie clinique, CHU de Rennes, université de Rennes 1, Rennes, France
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de Visser M, Carlier P, Vencovský J, Kubínová K, Preusse C. 255th ENMC workshop: Muscle imaging in idiopathic inflammatory myopathies. 15th January, 16th January and 22nd January 2021 - virtual meeting and hybrid meeting on 9th and 19th September 2022 in Hoofddorp, The Netherlands. Neuromuscul Disord 2023; 33:800-816. [PMID: 37770338 DOI: 10.1016/j.nmd.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023]
Abstract
The 255th ENMC workshop on Muscle Imaging in Idiopathic Inflammatory myopathies (IIM) aimed at defining recommendations concerning the applicability of muscle imaging in IIM. The workshop comprised of clinicians, researchers and people living with myositis. We aimed to achieve consensus on the following topics: a standardized protocol for the evaluation of muscle images in various types of IIMs; the exact parameters, anatomical localizations and magnetic resonance imaging (MRI) techniques; ultrasound as assessment tool in IIM; assessment methods; the pattern of muscle involvement in IIM subtypes; the application of MRI as biomarker in follow-up studies and clinical trials, and the place of MRI in the evaluation of swallowing difficulty and cardiac manifestations. The following recommendations were formulated: In patients with suspected IIM, muscle imaging is highly recommended to be part of the initial diagnostic workup and baseline assessment. MRI is the preferred imaging modality due to its sensitivity to both oedema and fat accumulation. Ultrasound may be used for suspected IBM. Repeat imaging should be considered if patients do not respond to treatment, if there is ongoing diagnostic uncertainty or there is clinical or laboratory evidence of disease relapse. Quantitative MRI is established as a sensitive biomarker in IBM and could be included as a primary or secondary outcome measure in early phase clinical trials, or as a secondary outcome measure in late phase clinical trials. Finally, a research agenda was drawn up.
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Affiliation(s)
- Marianne de Visser
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centre, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Jiří Vencovský
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Kateřina Kubínová
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Corinna Preusse
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Department of Neuropathology, Berlin, Germany
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Ghirardello A, Gatto M, Franco C, Zanatta E, Padoan R, Ienna L, Gallo N, Zen M, Lundberg IE, Mahler M, Doria A, Iaccarino L. Detection of Myositis Autoantibodies by Multi-Analytic Immunoassays in a Large Multicenter Cohort of Patients with Definite Idiopathic Inflammatory Myopathies. Diagnostics (Basel) 2023; 13:3080. [PMID: 37835823 PMCID: PMC10572214 DOI: 10.3390/diagnostics13193080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The usefulness of myositis-specific autoantibodies (MSAs) and myositis-associated autoantibodies (MAAs) for the assessment of idiopathic inflammatory myopathies (IIMs) is acknowledged, but laboratory standardization remains a challenge. We detected MSAs/MAAs by multi-analytic line immunoassay (LIA) and particle-based multi-analyte technology (PMAT) in a multicenter cohort of patients with IIMs. METHODS We tested the sera from 411 patients affected with definite IIM, including 142 polymyositis (PM), 147 dermatomyositis (DM), 19 cancer-associated myositis, and 103 overlap myositis syndrome (OM), and from 269 controls. MSAs/MAAs were determined by 16Ags LIA in all sera, and anti-HMGCR by ELISA in 157/411 IIM sera and 91/269 control sera. The analytical specificity of LIA/HMGCR ELISA was compared with that of PMAT in 89 MSA+ IIM sera. RESULTS MSAs/MAAs were positive in 307/411 (75%) IIM patients and 65/269 (24%) controls by LIA (Odds Ratio 9.26, 95% CI 6.43-13.13, p < 0.0001). The sensitivity/specificity of individual MSAs/MAAs were: 20%/100% (Jo-1), 3%/99.3% (PL-7), 4%/98.8% (PL-12), 1%/100% (EJ), 0.7%/100% (OJ), 9%/98% (SRP), 5.6%/99.6% (TIF1γ), 4.6%/99.6% (MDA5), 8%/96% (Mi-2), 1.5%/98% (NXP2), 1.7%/100% (SAE1), 4%/92% (Ku), 8.5%/99% (PM/Scl-100), 8%/96% (PM/Scl-75), and 25.5%/79% (Ro52). Anti-HMGCR was found in 8/157 (5%) IIM patients and 0/176 (0%) controls by ELISA (p = 0.007). Concordance between LIA/HMGCR ELISA and PMAT was found in 78/89 (88%) samples. Individual MSAs detected by LIA were associated with IIM subsets: Jo-1 with PM and OM, PL-12 with OM, Mi-2, TIF1γ, and MDA5 with DM, SRP with PM, and PM/Scl-75/100 with OM (p < 0.001 for all). CONCLUSIONS Since MSAs are mostly mutually exclusive, multi-specific antibody profiling seems effective for a targeted clinical-serologic approach to the diagnosis of IIMs.
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Affiliation(s)
- Anna Ghirardello
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital of Padova, 35128 Padova, Italy; (A.G.); (M.G.); (C.F.); (E.Z.); (R.P.); (L.I.); (M.Z.); (L.I.)
| | - Mariele Gatto
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital of Padova, 35128 Padova, Italy; (A.G.); (M.G.); (C.F.); (E.Z.); (R.P.); (L.I.); (M.Z.); (L.I.)
- Rheumatology Unit, Department of Clinical and Biological Sciences, Mauriziano Hospital, University of Turin, 10124 Turin, Italy
| | - Chiara Franco
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital of Padova, 35128 Padova, Italy; (A.G.); (M.G.); (C.F.); (E.Z.); (R.P.); (L.I.); (M.Z.); (L.I.)
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital of Padova, 35128 Padova, Italy; (A.G.); (M.G.); (C.F.); (E.Z.); (R.P.); (L.I.); (M.Z.); (L.I.)
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital of Padova, 35128 Padova, Italy; (A.G.); (M.G.); (C.F.); (E.Z.); (R.P.); (L.I.); (M.Z.); (L.I.)
| | - Luana Ienna
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital of Padova, 35128 Padova, Italy; (A.G.); (M.G.); (C.F.); (E.Z.); (R.P.); (L.I.); (M.Z.); (L.I.)
| | - Nicoletta Gallo
- Unit of Laboratory Medicine, Department of Medicine-DIMED, University Hospital of Padova, 35128 Padova, Italy;
| | - Margherita Zen
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital of Padova, 35128 Padova, Italy; (A.G.); (M.G.); (C.F.); (E.Z.); (R.P.); (L.I.); (M.Z.); (L.I.)
| | - Ingrid E. Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | | | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital of Padova, 35128 Padova, Italy; (A.G.); (M.G.); (C.F.); (E.Z.); (R.P.); (L.I.); (M.Z.); (L.I.)
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital of Padova, 35128 Padova, Italy; (A.G.); (M.G.); (C.F.); (E.Z.); (R.P.); (L.I.); (M.Z.); (L.I.)
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Nomiya H, Hamano T, Takaku N, Sasaki H, Usui K, Sanada S, Yamaguchi T, Kitazaki Y, Endo Y, Kamisawa T, Enomoto S, Shirafuji N, Matsunaga A, Ueno A, Ikawa M, Yamamura O, Hasegawa M, Kimura H, Nishino I, Nakamoto Y. Magnetic resonance imaging findings of the lower limb muscles in anti-mitochondrial M2 antibody-positive myositis. Neuromuscul Disord 2023; 33:74-80. [PMID: 37652755 DOI: 10.1016/j.nmd.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/19/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
Anti-mitochondrial M2 antibody (AMA-M2)-positive myositis is an idiopathic inflammatory myopathy (IIM). Of all patients with myositis, 2.5-19.5% have AMA-M2 antibodies. However, the detailed distribution of muscles affected in AMA-positive myositis is unknown. Therefore, we examined lower muscle magnetic resonance imaging (MRI) findings of patients with AMA-positive myositis. Among the 63 patients with IIM at our institute, 5 (7.9%) were positive for AMA-M2 antibodies. However, one was also positive for anti-Jo1 antibodies; therefore, four patients were finally participated in this study. All patients had high-intensity MRI signals in the proximal muscles, including the gluteus maximus and iliopsoas muscles, and in the thigh muscles, including the vastus lateralis, vastus medialis, adductor magnus, and semimembranosus muscles. Lower leg muscles were relatively spared. Fascial edema was observed in all patients and was also present in the lower leg muscles. Subcutaneous edema was observed, particularly in the proximal portion of the lower limbs. In AMA-positive myositis, proximal muscles, including the gluteus maximus, vastus lateralis, adductor magnus, and the semimembranosus, were markedly affected, while the lower leg muscles were relatively preserved. Additionally, fascial edema was evident even in lower leg muscles. Therefore, muscle MRI can be a useful diagnostic aid for AMA-positive myositis.
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Affiliation(s)
- Hirotaka Nomiya
- Clinical Training Center, University of Fukui Hospital, Fukui, Japan; Department of Cell Biology and Biochemistry, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan; Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Tadanori Hamano
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan; Department of Aging and Dementia, Faculty of Medical Sciences, University of Fukui, Japan; Life Science Innovation Center, University of Fukui, Fukui, Japan.
| | - Naoko Takaku
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Hirohito Sasaki
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Kojiro Usui
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Sayaka Sanada
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Tomohisa Yamaguchi
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Yuki Kitazaki
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Yoshinori Endo
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Tomoko Kamisawa
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Soichi Enomoto
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Norimichi Shirafuji
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Akiko Matsunaga
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Asako Ueno
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masamichi Ikawa
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Osamu Yamamura
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
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Pijnenburg L, Giannini M, Bouchard-Marmen M, Arnaud L, Barsotti S, Bellando-Randone S, Bernardi L, Bini P, Blagojevic J, Codullo V, Couderc M, De Moreuil C, Dernis E, Diamanti L, Dubost JJ, Duval F, Emmi G, Galempoix JM, Geny B, Gottenberg JE, Groza M, Guffroy A, Guichard I, Guilpain P, Hervier B, Hudson M, Iaccarino L, Iannone F, Lebrun D, Marchioni E, Mariampillai K, Maurier F, Mosca M, Nadaj-Pakleza A, Nannini C, Piot JM, Prieto-González S, Poursac N, Rouanet E, Sellam J, Selva-O'Callaghan A, Séverac F, Sibilia J, Sole G, Soulages A, Terrier B, Tournadre A, Troyanov Y, Vernier N, Vesperini V, Viallard JF, Ziane R, Cavagna L, Meyer A. In inflammatory myopathies, dropped head/bent spine syndrome is associated with scleromyositis: an international case-control study. RMD Open 2023; 9:e003081. [PMID: 37666644 PMCID: PMC10481849 DOI: 10.1136/rmdopen-2023-003081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/22/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Some myopathies can lead to dropped head or bent spine syndrome (DH/BS). The significance of this symptom has not been studied in inflammatory myopathies (IM). OBJECTIVES To assess the significance of DH/BS in patients with IM. METHODS Practitioners from five IM networks were invited to report patients with IM suffering from DH/BS (without other known cause than IM). IM patients without DH/BS, randomly selected in each participating centre, were included as controls at a ratio of 2 to 1. RESULTS 49 DH/BS-IM patients (DH: 57.1%, BS: 42.9%) were compared with 98 control-IM patients. DH/BS-IM patients were older (65 years vs 53 years, p<0.0001) and the diagnosis of IM was delayed (6 months vs 3 months, p=0.009). Weakness prevailing in the upper limbs (42.9% vs 15.3%), dysphagia (57.1% vs 25.5%), muscle atrophy (65.3% vs 34.7%), weight loss (61.2% vs 23.5%) and loss of the ability to walk (24.5% vs 5.1%) were hallmarks of DH/BS-IM (p≤0.0005), for which the patients more frequently received intravenous immunoglobulins (65.3% vs 34.7%, p=0.0004). Moreover, DH/BS-IM patients frequently featured signs and/or complications of systemic sclerosis (SSc), fulfilling the American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for this disease in 40.8% of the cases (vs 5.1%, p<0.0001). Distribution of the myopathy, its severity and its association with SSc were independently associated with DH/BS (p<0.05). Mortality was higher in the DH/BS-IM patients and loss of walking ability was independently associated with survival (p<0.05). CONCLUSION In IM patients, DH/BS is a marker of severity and is associated with SSc (scleromyositis).
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Affiliation(s)
- Luc Pijnenburg
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Margherita Giannini
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
- Exploration fonctionnelle musculaire, Service de Physiologie Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | | | - Laurent Arnaud
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Simone Barsotti
- Department of Rheumatology and Clinical Immunology Unit, University of Pisa, Pisa, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Universitaria Careggi, Azienda Ospedaliera, Florence, Italy
| | - Livio Bernardi
- Departement of rheumatology, University of Padova, Padova, Italy
| | - Paola Bini
- Department of neurology, Neurological Institute Mondino, University of Pavia, Pavia, Italy
| | - Jelena Blagojevic
- Department of Experimental and Clinical Medicine, Universitaria Careggi, Azienda Ospedaliera, Florence, Italy
| | - Veronica Codullo
- Rheumatology Division, University and IRCCS Policlinico S. Matteo Foundation Pavia, Pavia, Italy
| | - Marion Couderc
- Service de rhumatologie, Hôpitaux Universitaires de Clermont-Ferrand, Clermont-Ferrand, France
| | - Claire De Moreuil
- Service de médecine interne, Hôpitaux Universitaires de Brest, Brest, France
| | - Emanuelle Dernis
- Service de rhumatologie, Centre hospitalier Le Mans, Le Mans, France
| | - Luca Diamanti
- Department of neurology, Neurological Institute Mondino, University of Pavia, Pavia, Italy
| | - Jean Jacques Dubost
- Service de médecine interne, Hôpitaux Universitaires de Clermont-Ferrand, Clermont-Ferrand, France
| | - Fanny Duval
- Service de neurologie, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, Universitaria Careggi, Azienda Ospedaliera, Florence, Italy
| | - Jean-Marc Galempoix
- Service de Médecine Interne, Centre Hospitalier de Charleville-Mézières, Charleville-Mézières, France
| | - Bernard Geny
- Exploration fonctionnelle musculaire, Service de Physiologie Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Jacques-Eric Gottenberg
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Monica Groza
- Service de médecine interne, Centre hospitalier Colmar, Colmar, France
| | - Aurelien Guffroy
- Service d'immunologie clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Isabelle Guichard
- Service de médecine interne, Hôpitaux Universitaires de Saint Etienne, Saint Etienne, France
| | - Philippe Guilpain
- Service de médecine interne, Hôpitaux Universitaires de Montpellierr, Montpellier, France
| | - Baptiste Hervier
- Service de médecine interne, Assistance publique - Hôpitaux de Paris, Saint Louis, Paris, France
| | - Marie Hudson
- Department of medicine, Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Luca Iaccarino
- Departement of rheumatology, University of Padova, Padova, Italy
| | | | - Delphine Lebrun
- Service de Médecine Interne, Centre Hospitalier de Charleville-Mézières, Charleville-Mézières, France
| | - Enrico Marchioni
- Department of neurology, Neurological Institute Mondino, University of Pavia, Pavia, Italy
| | - Kuberaka Mariampillai
- Service de médecine interne, Assistance publique - Hôpitaux de Paris, Saint Louis, Paris, France
| | - Francois Maurier
- Service de médecine interne, Hôpitaux privés de Metz, Metz, France
| | - Marta Mosca
- Department of Rheumatology and Clinical Immunology Unit, University of Pisa, Pisa, Italy
| | - Aleksandra Nadaj-Pakleza
- Service de neurologie, Centre de référence des maladies neuromusculaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Jean-Maxime Piot
- Service de rhumatologie, Centre hospitalier Le Mans, Le Mans, France
| | | | - Nicolas Poursac
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Eglantine Rouanet
- Service de rhumatologie, Centre hospitalier Le Mans, Le Mans, France
| | - Jérémie Sellam
- Service de rhumatologie, Hôpital Saint Antoine, Assistance publique - Hôpitaux de Paris, Paris, France
| | | | - François Séverac
- Service de Santé Publique, GMRC; ICube, UMR 7357, Hôpitaux universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Jean Sibilia
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Guilhem Sole
- Service de neurologie, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Antoine Soulages
- Service de neurologie, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Benjamin Terrier
- Service de médecine interne, Hôpital Cochin Assistance publique - Hôpitaux de Paris Cochin, Paris, France
| | - Anne Tournadre
- Service de rhumatologie, Hôpitaux Universitaires de Clermont-Ferrand, Clermont-Ferrand, France
| | - Yves Troyanov
- Department of rheumatology, Hôpital Sacre Cœur Montréal, Université de Montréal, Montreal, Québec, Canada
| | - Nathalie Vernier
- Service de médecine interne, Hôpitaux Universitaires de Dijon, Dijon, France
| | | | | | - Rahima Ziane
- Service de médecine interne, Hôpitaux Universitaires de Montpellierr, Montpellier, France
| | - Lorenzo Cavagna
- Rheumatology Division, University and IRCCS Policlinico S. Matteo Foundation Pavia, Pavia, Italy
| | - Alain Meyer
- Exploration fonctionnelle musculaire, Service de Physiologie Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
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Kamoun F, Laroussi S, Mellouli A, Jallouli O, Feki S, Ben Sassi S, Charfi Triki C. Juvenile Dermatomyositis Without Skin Lesions in an Antinuclear Matrix Protein 2 Antibody Seropositive Pediatric Case. J Clin Neuromuscul Dis 2023; 25:46-50. [PMID: 37611270 DOI: 10.1097/cnd.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
ABSTRACT We report a 5-year-old boy who presented with progressive weakness in 4 limbs and gait disorders over 7 months. No skin rash was observed on admission. A symmetrical proximodistal weakness was found. The creatine kinase level was normal with a slightly elevated lactate dehydrogenase level. Biopsy specimens showed infiltration of mononuclear cells, few necrotic fibers, and perifascicular atrophy. Screening for myositis-specific antibodies was positive for the antinuclear matrix protein 2 antibody, which is mainly associated with dermatomyositis. Symptoms improved on receiving corticosteroids. Our findings suggest that in cases where inflammatory muscle disease is suspected, antinuclear matrix protein 2 antibody analyses should be considered for precise diagnosis, even with the absence of dermatological symptoms. The case suggests consideration of juvenile dermatomyositis in children with no associated skin manifestations or elevated creatine kinase levels and highlights the importance of screening for myositis-specific antibodies in helping with the diagnosis, given the possible heterogeneity of its clinical presentations.
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Affiliation(s)
- Fatma Kamoun
- Child Neurology Department, Hedi Chaker Sfax University Hospital, Sfax, Tunisia
- LR19ES15 University of Sfax, Tunisia
| | - Sirine Laroussi
- Child Neurology Department, Hedi Chaker Sfax University Hospital, Sfax, Tunisia
| | - Azza Mellouli
- Child Neurology Department, Hedi Chaker Sfax University Hospital, Sfax, Tunisia
| | - Olfa Jallouli
- Child Neurology Department, Hedi Chaker Sfax University Hospital, Sfax, Tunisia
- LR19ES15 University of Sfax, Tunisia
| | - Sawsan Feki
- Autoimmunity, Cancer and Immunogenetics Research Laboratory (LR18SP12), Immunology Department, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Samia Ben Sassi
- Neurology Department, National Institute of Neurology, Tunis, Tunisia; and
- Faculty of Medicine of Tunis, Neurosciences Department, University of Tunis El Manar, Tunis, Tunisia
| | - Chahnez Charfi Triki
- Child Neurology Department, Hedi Chaker Sfax University Hospital, Sfax, Tunisia
- LR19ES15 University of Sfax, Tunisia
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Liang X, Li Y, Cheng L, Wu Y, Wu T, Wen J, Huang D, Liao Z, Tan C, Luo Y, Liu Y. Gut microbiota dysbiosis characterized by abnormal elevation of Lactobacillus in patients with immune-mediated necrotizing myopathy. Front Cell Infect Microbiol 2023; 13:1243512. [PMID: 37692165 PMCID: PMC10486907 DOI: 10.3389/fcimb.2023.1243512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Aim The gut microbiota plays an important role in human health. In this study, we aimed to investigate whether and how gut microbiota communities are altered in patients with immune-mediated necrotizing myopathy (IMNM) and provide new ideas to further explore the pathogenesis of IMNM or screen for its clinical therapeutic targets in the future. Methods The gut microbiota collected from 19 IMNM patients and 23 healthy controls (HCs) were examined by using 16S rRNA gene sequencing. Alpha and beta-diversity analyses were applied to examine the bacterial diversity and community structure. Welch's t test was performed to identify the significantly abundant taxa of bacteria between the two groups. Spearman correlation analysis was performed to analyze the correlation between gut microbiota and clinical indicators. A receiver operator characteristic (ROC) curve was used to reflect the sensitivity and specificity of microbial biomarker prediction of IMNM disease. P < 0.05 was considered statistically significant. Results Nineteen IMNM patients and 23 HCs were included in the analysis. Among IMNM patients, 94.74% (18/19) of them used glucocorticoids, while 57.89% (11/19) of them used disease-modifying antirheumatic drugs (DMARDs), and the disease was accessed by MITAX (18.26 ± 8.62) and MYOACT (20.68 ± 8.65) scores. Participants in the groups were matched for gender and age. The diversity of the gut microbiota of IMNM patients differed and decreased compared to that of HCs (Chao1, Shannon, and Simpson indexes: p < 0.05). In IMNM patients, the relative abundances of Bacteroides, Roseburia, and Coprococcus were decreased, while that of Lactobacillus and Streptococcus were relatively increased. Furthermore, in IMNM patients, Lactobacillus was positively correlated with the levels of anti-signal recognition particle (SRP) antibodies, anti-Ro52 antibodies, and erythrocyte sedimentation rate (ESR), while Streptococcus was positively correlated with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies and C-reactive protein (CRP). Roseburia was negatively correlated with myoglobin (MYO), cardiac troponin T (cTnT), ESR, CRP, and the occurrence of interstitial lung disease (ILD). Bacteroides was negatively correlated with ESR and CRP, and Coprococcus was negatively correlated with ESR. Finally, the prediction model was built using the top five differential genera, which was verified using a ROC curve (area under the curve (AUC): 87%, 95% confidence interval: 73%-100%). Conclusion We observed a characteristic compositional change in the gut microbiota with an abnormal elevation of Lactobacillus in IMNM patients, which was accompanied by changes in clinical indicators. This suggests that gut microbiota dysbiosis occurs in IMNM patients and is correlated with systemic autoimmune features.
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Affiliation(s)
- Xiuping Liang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Yanhong Li
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Lu Cheng
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Yinlan Wu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Tong Wu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Ji Wen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Deying Huang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Zehui Liao
- Department of Rheumatolopy and Immunolopy, Meishan People’s Hospital, Meishan, Sichuan, China
| | - Chunyu Tan
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Yubin Luo
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
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Tanboon J, Needham M, Mozaffar T, Stenzel W, Nishino I. Editorial: Inflammatory muscle diseases: an update. Front Neurol 2023; 14:1259275. [PMID: 37614973 PMCID: PMC10442951 DOI: 10.3389/fneur.2023.1259275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Jantima Tanboon
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Merrilee Needham
- University of Notre Dame Australia, Fremantle, WA, Australia
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia
- Department of Neurology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Tahseen Mozaffar
- Department of Neurology, School of Medicine, University of California, Irvine, Irvine, CA, United States
- Pathology and Laboratory Medicine, School of Medicine, University of California, Irvine, Irvine, CA, United States
- School of Medicine, The Institute for Immunology, University of California, Irvine, Irvine, CA, United States
| | - Werner Stenzel
- Department of Neuropathology, Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
- Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
- Department of Clinical Genome Analysis, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
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Lekieffre M, Gallay L, Landon-Cardinal O, Hot A. Joint and muscle inflammatory disease: A scoping review of the published evidence. Semin Arthritis Rheum 2023; 61:152227. [PMID: 37210805 DOI: 10.1016/j.semarthrit.2023.152227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Polyarthritis is commonly reported in idiopathic inflammatory myositis patients, but few studies have focused on the overlap of myositis with rheumatoid arthritis which is a difficult diagnosis in the absence of well-defined diagnostic criteria. The primary objective of this scoping review was to map the field of research to explore the potential diagnoses in patients presenting with both myositis and polyarthritis. METHODS Two electronic databases (MEDLINE/PubMed® and Web of Science®) were systematically searched using the terms (myositis OR 'inflammatory idiopathic myopathies') AND (polyarthritis OR 'rheumatoid arthritis') without any publication date limit. RESULTS Among individual records, 280 reports met inclusion criteria after full-text review. There was heterogeneity in the definition of overlap myositis as well as the characteristics of rheumatoid arthritis. In many studies, key data were lacking; rheumatoid factor status was reported in 56.8% (n=151), anti-citrullinated proteins antibodies status in 18.8% (n=50), and presence or absence of bone erosions in 45.1% (n=120) of the studies. Thirteen different diagnoses were found to associate myositis with polyarthritis: antisynthetase syndrome (29.6%, n=83), overlap myositis with rheumatoid arthritis (16.1%, n=45), drug-induced myositis (20.0%, n=56), rheumatoid myositis (7.5%, n=21), inclusion body myositis (1.8%, n=5), overlap with connective tissue disease (20.0%, n=56), and others (5.0%, n=14). CONCLUSION The spectrum of joint and muscle inflammatory diseases encompasses many diagnoses including primitive and secondary myositis associated with RA or arthritis mimicking RA. This review highlights the need for a consensual definition of OM with RA to better individualise this entity from the numerous differential diagnoses.
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Affiliation(s)
- Maud Lekieffre
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, Lyon 69003, France.
| | - Laure Gallay
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, Lyon 69003, France
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Arnaud Hot
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, Lyon 69003, France
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Arcani R, Rey L, Mazziotto A, Bertin D, Kaplanski G, Jarrot PA, Lafforgue P, Venton G, Heim X, Villani P, Mège JL, Brodovitch A, Bardin N. Anti-Jo-1 autoantibodies: biomarkers of severity and evolution of the disease in antisynthetase syndrome. Arthritis Res Ther 2023; 25:125. [PMID: 37481643 PMCID: PMC10362709 DOI: 10.1186/s13075-023-03116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Anti-Jo-1 autoantibodies represent essential markers in the diagnosis of antisynthetase syndrome (ASS). In this retrospective study, we aimed to investigate whether their concentrations and fluctuations could both respectively reflect the severity and evolution of ASS. METHODS Between 2015 and 2020, clinical and biological features of ASS patients with at least one positive measure of anti-Jo-1 autoantibody were collected. At each serum sampling, we assessed myositis activity by using the Myositis Intention to Treat Activities Index (MITAX) and compared anti-Jo-1 concentrations with ASS severity, anti-Jo-1 concentrations between patients with and without active disease, and changes in anti-Jo-1 concentrations with disease activity. RESULTS Forty-eight patients with ASS had at least one positive determination of anti-Jo-1 concentration. Among them, twenty-nine patients had at least two determinations of anti-Jo-1 autoantibody in their follow-up. We showed that these autoantibody concentrations were significantly correlated with MITAX (r = 0.4, p = 0.03) and creatine kinase concentration (r = 0.34, p = 0.002) and that they were significantly higher in patients with active disease than in those with inactive disease (91.7 IU/L vs 44.4 IU/L, p = 0.016). During follow-up, we found a significant correlation between fluctuations of anti-Jo-1 autoantibody concentrations and MITAX score (r = 0.7, p < 0.0001). CONCLUSION Our results suggest that anti-Jo-1 autoantibody concentration could be a predictive marker of the severity and evolution of ASS and show that their quantification could represent a precious tool for disease monitoring and for improving the therapeutic management of ASS patients.
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Affiliation(s)
- Robin Arcani
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 264 Rue Saint-Pierre, 13005, Marseille, France.
- Center for Cardiovascular and Nutrition Research (C2VN), INRA, 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France.
| | - Louise Rey
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Alice Mazziotto
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 264 Rue Saint-Pierre, 13005, Marseille, France
| | - Daniel Bertin
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Gilles Kaplanski
- Center for Cardiovascular and Nutrition Research (C2VN), INRA, 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Pierre-André Jarrot
- Center for Cardiovascular and Nutrition Research (C2VN), INRA, 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Pierre Lafforgue
- Department of Rheumatology, CHU Sainte-Marguerite, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Geoffroy Venton
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Xavier Heim
- Center for Cardiovascular and Nutrition Research (C2VN), INRA, 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Patrick Villani
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 264 Rue Saint-Pierre, 13005, Marseille, France
| | - Jean-Louis Mège
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Alexandre Brodovitch
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Nathalie Bardin
- Center for Cardiovascular and Nutrition Research (C2VN), INRA, 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
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Yildiz H, Lepere C, Zorzi G, Gheysens O, Roodhans F, Pothen L. [ 18F]FDG-PET/CT in Idiopathic Inflammatory Myopathies: Retrospective Data from a Belgian Cohort. Diagnostics (Basel) 2023; 13:2316. [PMID: 37510060 PMCID: PMC10377909 DOI: 10.3390/diagnostics13142316] [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: 06/08/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
[18F]FDG-PET/CT is a useful tool for diagnosis and cancer detection in idiopathic inflammatory myopathies (IIMs), especially polymyositis (PM) and dermatomyositis (DM). Data deriving from Europe are lacking. We describe [18F]FDG-PET/CT results in a Belgian cohort with IIMs, focusing on patients with PM and DM. All of the cases of IIMs admitted between December 2010 and January 2023 to the Cliniques Universitaires Saint-Luc (Belgium) were retrospectively reviewed. In total, 44 patients were identified with suspected IIMs; among them, 29 were retained for final analysis. The mean age of the retained patients was 48.7 years; 19 patients were female (65.5%). Twenty-two patients had DM and seven had PM. The mean serum creatinine kinase (CK) and the mean CRP levels were 3125 UI/L and 30.3 mg/L, respectively. [18F]FDG-PET/CT imaging was performed for 27 patients, detecting interstitial lung diseases (ILDs) in 7 patients (25.9%), cancer in 3 patients (11.1%), and abnormal muscle FDG uptake compatible with myositis in 13 patients (48.1%). All of the patients who were detected to have ILDs via PET/CT imaging were confirmed using a low-dose lung CT scan. Among the patients who were detected to have abnormal muscle FDG uptake via PET/CT scans (13/28), the EMG was positive in 12 patients (p = 0.004), while the MRI was positive in 8 patients (p = 0.02). We further observed that there was a significantly higher level of CK in the group with abnormal muscle FDG uptake (p = 0.008). Our study showed that PET/CT is useful for detecting cancer and ILDs. We showed that the detection of abnormal muscle uptake via PET/CT was in accordance with EMG and MRI results, as well as with the mean CK value, and that the presence of dyspnea was significantly associated with the presence of ILDs detected via PET/CT imaging (p = 0.002).
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Affiliation(s)
- Halil Yildiz
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Charlotte Lepere
- Department of Internal Medicine, Hôpital d'Arlon (Vivalia), 6700 Arlon, Belgium
| | - Giulia Zorzi
- Department of Laboratory, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Fabien Roodhans
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Lucie Pothen
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, B-1200 Brussels, Belgium
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Kamiya M, Kimura N, Umezawa N, Hasegawa H, Yasuda S. Muscle fiber necroptosis in pathophysiology of idiopathic inflammatory myopathies and its potential as target of novel treatment strategy. Front Immunol 2023; 14:1191815. [PMID: 37483632 PMCID: PMC10361824 DOI: 10.3389/fimmu.2023.1191815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Idiopathic inflammatory myopathies (IIMs), which are a group of chronic and diverse inflammatory diseases, are primarily characterized by weakness in the proximal muscles that progressively leads to persistent disability. Current treatments of IIMs depend on nonspecific immunosuppressive agents (including glucocorticoids and immunosuppressants). However, these therapies sometimes fail to regulate muscle inflammation, and some patients suffer from infectious diseases and other adverse effects related to the treatment. Furthermore, even after inflammation has subsided, muscle weakness persists in a significant proportion of the patients. Therefore, the elucidation of pathophysiology of IIMs and development of a better therapeutic strategy that not only alleviates muscle inflammation but also improves muscle weakness without increment of opportunistic infection is awaited. Muscle fiber death, which has been formerly postulated as "necrosis", is a key histological feature of all subtypes of IIMs, however, its detailed mechanisms and contribution to the pathophysiology remained to be elucidated. Recent studies have revealed that muscle fibers of IIMs undergo necroptosis, a newly recognized form of regulated cell death, and promote muscle inflammation and dysfunction through releasing inflammatory mediators such as damage-associated molecular patterns (DAMPs). The research on murine model of polymyositis, a subtype of IIM, revealed that the inhibition of necroptosis or HMGB1, one of major DAMPs released from muscle fibers undergoing necroptosis, ameliorated muscle inflammation and recovered muscle weakness. Furthermore, not only the necroptosis-associated molecules but also PGAM5, a mitochondrial protein, and reactive oxygen species have been shown to be involved in muscle fiber necroptosis, indicating the multiple target candidates for the treatment of IIMs acting through necroptosis regulation. This article overviews the research on muscle injury mechanisms in IIMs focusing on the contribution of necroptosis in their pathophysiology and discusses the potential treatment strategy targeting muscle fiber necroptosis.
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Anang DC, Walter HAW, Lim J, Niewold I, van der Weele L, Aronica E, Eftimov F, Raaphorst J, van Schaik BDC, van Kampen AHC, van der Kooi AJ, de Vries N. B-cell receptor profiling before and after IVIG monotherapy in newly diagnosed idiopathic inflammatory myopathies. Rheumatology (Oxford) 2023; 62:2585-2593. [PMID: 36321862 PMCID: PMC10321087 DOI: 10.1093/rheumatology/keac602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/06/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To unravel B-cell receptor (BcR) characteristics in muscle tissues and peripheral blood and gain more insight into BcR repertoire changes in peripheral blood in idiopathic inflammatory myopathies (IIMs), and study how this correlates to the clinical response to IVIG. METHODS Nineteen treatment-naive patients with newly diagnosed IIM were prospectively treated with IVIG monotherapy. RNA-based BcR repertoire sequencing was performed in muscle biopsies collected before, and in peripheral blood (PB) collected before and nine weeks after IVIG treatment. Results were correlated to patients' clinical improvement based on the total improvement score (TIS). RESULTS Prior to IVIG treatment, BcR clones found in muscle tissue could be retrieved in peripheral blood. Nine weeks after IVIG treatment, new patient-specific dominant BcR clones appeared in peripheral blood while pre-treatment dominant BcR clones disappeared. The cumulative frequency of all dominant BcR clones before treatment was significantly higher in individuals who responded to IVIG compared with those who did not respond to IVIG, and correlated with a higher CK. During follow-up, a decrease in the cumulative frequency of all dominant clones correlated with a higher TIS. CONCLUSION In treatment-naive patients with newly diagnosed IIM, muscle tissue and peripheral blood share expanded BcR clones. In our study a higher cumulative frequency of dominant BcR clones in blood before treatment was associated with a higher CK and better treatment response, suggesting that response to IVIG may depend on the composition of the pre-treatment BcR repertoire.
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Affiliation(s)
| | | | - Johan Lim
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Ilse Niewold
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Genome analysis, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Linda van der Weele
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Barbera D C van Schaik
- Bioinformatics Laboratory, Department of Epidemiology and Data science, Amsterdam Public Health Institute, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Antoine H C van Kampen
- Bioinformatics Laboratory, Department of Epidemiology and Data science, Amsterdam Public Health Institute, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Niek de Vries
- Correspondence to: Niek de Vries, Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, PO. Box 22600, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands. E-mail:
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Armadans-Tremolosa I, Selva-O'Callaghan A. Inflammatory myopathy in adults, health-related quality of life, and wellbeing: a round trip between immune disease and wellness. Expert Rev Clin Immunol 2023; 19:1239-1246. [PMID: 37452824 DOI: 10.1080/1744666x.2023.2238128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Health-related quality of life (HRQoL) and wellbeing are poorer in patients with chronic conditions than in the general population, and this is the case of individuals with myositis. Research has shown a negative relationship between this disease and wellbeing, but there is little data on the effect that enhanced wellbeing has on the disease course. AREAS COVERED HRQoL, wellbeing, and other related concepts are examined here with special emphasis on the benefits of positive status in the physical, environmental, psychological, and social function areas for reducing the severity of the clinical course and organ damage in a chronic condition such as myositis. The factors affecting HRQoL, and wellbeing are analyzed to delineate specific strategies that will lead to improvements in the life of adult patients with myositis. The mechanisms implicated in these changes are also discussed. EXPERT OPINION Myositis refers to a heterogeneous group of chronic systemic autoimmune diseases. HRQoL and wellbeing are poor in these patients, and evidence suggests that improvements in this line can have positive repercussions on the course and outcome of the disease. Strategies to improve HRQoL and wellbeing should be designed for adults with myositis.
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Affiliation(s)
- Immaculada Armadans-Tremolosa
- Department of Social Psychology and Quantitative Psychology, PsicoSAO-Research Group in Social, Environmental, and Organizational Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Department of Medicine, Vall d'Hebron General Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
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Connolly CM, Paik JJ. Clinical pearls and promising therapies in myositis. Expert Rev Clin Immunol 2023; 19:797-811. [PMID: 37158055 PMCID: PMC10330909 DOI: 10.1080/1744666x.2023.2212162] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Idiopathic inflammatory myopathies (IIMs) represent a diverse group of systemic autoimmune disorders with variable clinical manifestations and disease course. Currently, the challenges of IIMs are multifold, including difficulties in timely diagnosis owing to clinical heterogeneity, limited insights into disease pathogenesis, as well as a restricted number of available therapies. However, advances utilizing myositis-specific autoantibodies have facilitated the definition of subgroups as well as the prediction of clinical phenotypes, disease course, and response to treatment. AREAS COVERED Herein we provide an overview of the clinical presentations of dermatomyositis, anti-synthetase syndrome, immune-mediated necrotizing myopathy, and inclusion body myositis. We then provide an updated review of available and promising therapies for each of these disease groups. We synthesize current treatment recommendations in the context of case-based construct to facilitate application to patient care. Finally, we provide high-yield, clinical pearls relevant to each of the subgroups that can be incorporated into clinical reasoning. EXPERT OPINION There are many exciting developments on the horizon for IIM. As insights into pathogenesis evolve, the therapeutic armamentarium is expanding with many novel therapies in development, holding promise for more targeted treatment approaches.
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Affiliation(s)
- Caoilfhionn M. Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie J. Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Shaik MR, Shaik NA, Mikdashi J. Autoimmune Dysphagia Related to Rheumatologic Disorders: A Focused Review on Diagnosis and Treatment. Cureus 2023; 15:e41883. [PMID: 37581141 PMCID: PMC10423619 DOI: 10.7759/cureus.41883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
Autoimmune dysphagia is defined as dysphagia caused by autoimmune processes affecting various components of the swallowing process such as muscle, neuromuscular junction, nerves, roots, brainstem, or cortex. These autoimmune causes can be classified into gastroenterological, dermatological, rheumatologic, and neurologic. Rheumatological disorders, such as scleroderma, Sjogren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, sarcoidosis, Behcet's disease, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, or granulomatosis with polyangiitis, have been associated with dysphagia. Autoimmune dysphagia in the context of rheumatological disorders is particularly significant because it can occur as a sole manifestation or as part of a symptom complex associated with the underlying disorder and often responds to immunosuppressive therapies. However, diagnosing autoimmune dysphagia can be challenging as it requires the exclusion of structural and primary motility disorders through procedures such as endoscopy and manometry. Early diagnosis is important to improve the quality of life and prevent significant mortality and morbidity. Management focuses on treating the underlying disease activity, and a multidisciplinary approach involving various medical specialties may be necessary to achieve success. This article aims to review the autoimmune rheumatological conditions that can lead to dysphagia and discuss the associated pathophysiological mechanisms. We also outline the clinical clues and laboratory testing methods that facilitate early diagnosis, with the goal of improving patient outcomes through timely intervention and appropriate management.
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Affiliation(s)
- Mohammed Rifat Shaik
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Nishat Anjum Shaik
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Jamal Mikdashi
- Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, USA
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