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Maher TM. Interstitial Lung Disease: A Review. JAMA 2024; 331:1655-1665. [PMID: 38648021 DOI: 10.1001/jama.2024.3669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Importance Interstitial lung disease (ILD) consists of a group of pulmonary disorders characterized by inflammation and/or fibrosis of the lung parenchyma associated with progressive dyspnea that frequently results in end-stage respiratory failure. In the US, ILD affects approximately 650 000 people and causes approximately 25 000 to 30 000 deaths per year. Observations The most common forms of ILD are idiopathic pulmonary fibrosis (IPF), which accounts for approximately one-third of all cases of ILD, hypersensitivity pneumonitis, accounting for 15% of ILD cases, and connective tissue disease (CTD), accounting for 25% of ILD cases. ILD typically presents with dyspnea on exertion. Approximately 30% of patients with ILD report cough. Thoracic computed tomography is approximately 91% sensitive and 71% specific for diagnosing subtypes of ILDs such as IPF. Physiologic assessment provides important prognostic information. A 5% decline in forced vital capacity (FVC) over 12 months is associated with an approximately 2-fold increase in mortality compared with no change in FVC. Antifibrotic therapy with nintedanib or pirfenidone slows annual FVC decline by approximately 44% to 57% in individuals with IPF, scleroderma associated ILD, and in those with progressive pulmonary fibrosis of any cause. For connective tissue disease-associated ILD, immunomodulatory therapy, such as tocilizumab, rituximab, and mycophenolate mofetil, may slow decline or even improve FVC at 12-month follow-up. Structured exercise therapy reduces symptoms and improves 6-minute walk test distance in individuals with dyspnea. Oxygen reduces symptoms and improves quality of life in individuals with ILD who desaturate below 88% on a 6-minute walk test. Lung transplant may improve symptoms and resolve respiratory failure in patients with end-stage ILD. After lung transplant, patients with ILD have a median survival of 5.2 to 6.7 years compared with a median survival of less than 2 years in patients with advanced ILD who do not undergo lung transplant. Up to 85% of individuals with end-stage fibrotic ILD develop pulmonary hypertension. In these patients, treatment with inhaled treprostinil improves walking distance and respiratory symptoms. Conclusions and Relevance Interstitial lung disease typically presents with dyspnea on exertion and can progress to respiratory failure. First-line therapy includes nintedanib or pirfenidone for IPF and mycophenolate mofetil for ILD due to connective tissue disease. Lung transplant should be considered for patients with advanced ILD. In patients with ILD, exercise training improves 6-minute walk test distance and quality of life.
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Affiliation(s)
- Toby M Maher
- University of Southern California, Los Angeles
- National Heart and Lung Institute, Imperial College, London, UK
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2
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Oreska S, Storkanova H, Pekacova A, Kudlicka J, Tuka V, Mikes O, Krupickova Z, Satny M, Chytilova E, Kvasnicka J, Spiritovic M, Hermankova B, Cesak P, Rybar M, Pavelka K, Senolt L, Mann H, Vencovsky J, Vrablik M, Tomcik M. Cardiovascular risk in myositis patients compared with the general population. Rheumatology (Oxford) 2024; 63:715-724. [PMID: 37279728 PMCID: PMC10907818 DOI: 10.1093/rheumatology/kead271] [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: 01/12/2023] [Revised: 04/15/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVES We aimed to evaluate cardiovascular (CV) risk in patients with idiopathic inflammatory myopathies (IIM) compared with healthy controls (HC) and to assess its association with disease-specific features. METHODS Ninety IIM patients and 180 age-/sex-matched HC were included. Subjects with a history of CV disease (angina pectoris, myocardial infarction and cerebrovascular/peripheral arterial vascular events) were excluded. All participants were prospectively recruited and underwent examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition. The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE) and its modifications. RESULTS Compared with HC, IIM patients had a significantly higher prevalence of traditional CV risk factors, carotid artery disease (CARD), abnormal ABI and PWV. After propensity score matching (using traditional CV risk factors), the prevalence of CARD and pathological PWV remained significantly higher in IIM than HC. No significant difference in SCORE was observed. The most unfavourable CV risk profile was observed in patients with necrotizing myopathy, especially in statin-induced anti-HMGCR+ patients. The calculated CV risk scores by SCORE, SCORE2 and SCORE multiplied by the coefficient 1.5 (mSCORE) were reclassified according to CIMT and the presence of carotid plaques. SCORE was demonstrated to be most inaccurate in predicting CV risk in IIM. Age, disease activity, lipid profile, body composition parameters and blood pressure were the most significant predictors of CV risk in IIM patients. CONCLUSION Significantly higher prevalence of traditional risk factors and subclinical atherosclerosis was observed in IIM patients compared with HC.
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Affiliation(s)
- Sabina Oreska
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Storkanova
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Aneta Pekacova
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslav Kudlicka
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vladimir Tuka
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ondrej Mikes
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zdislava Krupickova
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Satny
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eva Chytilova
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Kvasnicka
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maja Spiritovic
- Institute of Rheumatology, Prague, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Barbora Hermankova
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Petr Cesak
- Department of Human Movement Laboratory, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Marian Rybar
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Senolt
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Herman Mann
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Vencovsky
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Vrablik
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomcik
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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3
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Deepak V, Buragamadagu B, Rida Ul Jannat F, Salyer R, Landis T, Kaur S, Balakrishnan B. Clinical Features and Outcomes of Patients with Idiopathic Inflammatory Myositis-Associated Interstitial Lung Disease in Rural Appalachia: A Cross-Sectional Study. J Clin Med 2024; 13:1294. [PMID: 38592101 PMCID: PMC10931674 DOI: 10.3390/jcm13051294] [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: 12/30/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Idiopathic inflammatory myopathies (IIMs) are a group of autoimmune disorders often complicated by interstitial lung disease (ILD). The clinical characteristics and outcomes of IIM-associated ILD have been reported variably, but the literature on rural populations is scarce. METHODS A retrospective cross-sectional study was conducted at a rural tertiary academic medical center. Twenty-nine patients met the final inclusion criteria. The primary outcome was to assess the disease state and immunological and radiographic features of IIM-associated ILD. Secondary outcomes included disease progression, ILD exacerbation, mortality rate, and factors associated with poor outcome. RESULTS Dermatomyositis (n = 15, 51.72%) followed by polymyositis (n = 8, 27.58%) were predominant myopathies. The most common autoantibodies were anti-Jo1 antibodies (n = 11, 37.93%). Indeterminate usual interstitial pneumonitis (41.30%, n = 12) was the most common radiographic pattern followed by non-specific interstitial pneumonia (n = 5, 17.24%). ILD exacerbation (n = 14, 66.66%) and mortality rate (n = 6, 20.69%) were high. Albumin levels were significantly lower in patients who died. CONCLUSIONS The clinical characteristics of patients with IIM-associated ILD in rural Appalachia exhibit notable distinctions, and outcomes are worse compared to other populations. Larger studies are needed to investigate other prognostics factors and longitudinal trends of clinical characteristics and outcomes of IIM-associated ILD in rural populations.
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Affiliation(s)
- Vishal Deepak
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, NY 10017, USA
| | - Bhanusowmya Buragamadagu
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Fnu Rida Ul Jannat
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Rachel Salyer
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Ty Landis
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Sayanika Kaur
- Division of Rheumatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Wang H, Wang Y, Sun D, Yu S, Du X, Ye Q. Progressive pulmonary fibrosis in myositis-specific antibody-positive interstitial pneumonia: a retrospective cohort study. Front Med (Lausanne) 2024; 10:1325082. [PMID: 38274458 PMCID: PMC10808296 DOI: 10.3389/fmed.2023.1325082] [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: 10/20/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
Objectives Idiopathic inflammatory myopathy (IIM) frequently coexists with interstitial pneumonia (IP) and is commonly the initial or sole manifestation accompanied by positive myositis-specific autoantibodies (MSAs), even in the absence of meeting diagnostic criteria. This study aims to evaluate the proportion of progressive pulmonary fibrosis (PPF) and identify potential predictors influencing the progression of pulmonary fibrosis in patients with MSA-IP. Methods This descriptive study employed a retrospective cohort design, enrolling patients diagnosed with interstitial pneumonia and positive MSAs at Beijing Chao-Yang Hospital in a sequential manner. Clinical data were systematically collected from the patients' medical records during regular follow-up visits conducted every 3 to 6 months. Cox regression analysis was utilized to identify independent predictors of PPF in patients with positive MSAs and interstitial pneumonia. Results A total of 307 patients were included in the study, with 30.6% of them developing PPF during a median follow-up period of 22 months. Kaplan-Meier survival curves demonstrated a significantly lower survival in the PPF patients compared to the non-PPF patients (median 11.6 months vs. 31 months, p = 0.000). An acute/subacute onset of interstitial pneumonia (HR 3.231, 95%CI 1.936-5.392, p = 0.000), lower diffusing capacity of the lungs for carbon monoxide (DLCO) % predicted (HR 6.435, 95%CI 4.072-10.017, p = 0.001), and the presence of diffuse alveolar damage (DAD) on high-resolution computed tomography (HRCT) (HR 8.679, 95%CI 1.974-38.157, p = 0.004) emerged as independent predictors of PPF. Notably, the implementation of triple therapy comprising glucocorticoids, immunosuppressants, and antifibrotic drugs was associated with a reduced risk of developing PPF (HR 0.322, 95%CI 0.115-0.899, p = 0.031). Conclusion Approximately 30.6% of patients with MSA-IP may develop PPF within the follow-up period. Patients presenting with an acute/subacute onset of interstitial pneumonia, lower predicted DLCO SB% and evidence of DAD on HRCT are more susceptible to developing PPF. Conversely, the administration of triple therapy appears to serve as a protective factor against the development of PPF in patients with MSA-IP.
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Affiliation(s)
- Huijuan Wang
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuanying Wang
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Di Sun
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shiwen Yu
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Occupational Medicine and Toxicology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xuqin Du
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Occupational Medicine and Toxicology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qiao Ye
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Occupational Medicine and Toxicology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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5
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Yeo J, Yoon SH, Kim JY, Lee JS, Lee EY, Goo JM, Pourzand L, Goldin JG, Kim GJ, Ha Y. Quantitative interstitial lung disease scores in idiopathic inflammatory myopathies: longitudinal changes and clinical implications. Rheumatology (Oxford) 2023; 62:3690-3699. [PMID: 36929924 PMCID: PMC10629794 DOI: 10.1093/rheumatology/kead122] [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: 07/22/2022] [Revised: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES To investigate computer-aided quantitative scores from high-resolution CT (HRCT) images and determine their longitudinal changes and clinical significance in patients with idiopathic inflammatory myopathies (IIMs)-related interstitial lung disease (IIMs-ILD). METHODS The clinical data and HRCT images of 80 patients with IIMs who underwent serial HRCT scans at least twice were retrospectively analysed. Quantitative ILD (QILD) scores (%) were calculated as the sum of the extent of lung fibrosis, ground-glass opacity, and honeycombing. The individual time-estimated ΔQILD between two consecutive scans was derived using a linear approximation of yearly changes. RESULTS The baseline median QILD (interquartile range) scores in the whole lung were 28.1% (19.1-43.8). The QILD was significantly correlated with forced vital capacity (r = -0.349, P = 0.002) and diffusing capacity for carbon monoxide (r = -0.381, P = 0.001). For ΔQILD between the first two scans, according to the visual ILD subtype, QILD aggravation was more frequent in patients with usual interstitial pneumonia (UIP) than non-UIP (80.0% vs 44.4%, P = 0.013). Multivariable logistic regression analyses identified UIP was significantly related to radiographic ILD progression (ΔQILD >2%, P = 0.015). Patients with higher baseline QILD scores (>28.1%) had a higher risk of lung transplantation or death (P = 0.015). In the analysis of three serial HRCT scans (n = 41), dynamic ΔQILD with four distinct patterns (improving, worsening, convex and concave) was observed. CONCLUSION QILD changes in IIMs-ILD were dynamic, and baseline UIP patterns seemed to be related to a longitudinal progression in QILD. These may be potential imaging biomarkers for lung function, changes in ILD severity and prognosis in IIMs-ILD.
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Affiliation(s)
- Jina Yeo
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju Yeon Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Seok Lee
- Clinic Pappalardo Center, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- GENOME INSIGHT Inc, Daejeon, Republic of Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Lila Pourzand
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jonathan G Goldin
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Grace‐Hyun J Kim
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - You‐Jung Ha
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi‐Do, Republic of Korea
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6
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Abu-Rumeileh S, Marrani E, Maniscalco V, Maccora I, Pagnini I, Mastrolia MV, Rouster-Stevens K, Simonini G. Lung involvement in juvenile idiopathic inflammatory myopathy: A systematic review. Autoimmun Rev 2023; 22:103416. [PMID: 37611886 DOI: 10.1016/j.autrev.2023.103416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/20/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Juvenile idiopathic inflammatory myopathies (JIIM) are a group of connective tissue disorders characterized by muscle inflammation and variable systemic involvement, including interstitial lung disease (ILD). Available data on JIIM-associated ILD are very limited. We performed a systematic review of the available clinical, laboratory, and radiological features of JIIM-associated ILD. METHODS A systematic literature review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS A total of 90 patients were identified, of whom 77.8% had JDM, 10% amyopathic JDM, 7.8% anti-synthetase syndrome, 3.3% overlap syndrome, and 1.1% juvenile polymyositis. Anti-melanoma differentiation-associated gene 5 (MDA-5/CADM-140) was the most frequently reported myositis-specific antibody (32.2%). At diagnosis of ILD, 55.5% of patients had respiratory symptoms. Ground glass opacity was the most reported radiological feature (52.9%). Thirty-three % of patients developed rapidly progressive (RP) lung disease; 26.7% were admitted to the intensive care unit (ICU); 28.9% died; all deaths were due to ILD, with a median interval of 2 months (IQR 1.5-4.7) between the onset of respiratory symptoms and death. Patients admitted to the ICU and who died of ILD were more likely to be male, to have a rapidly progressive pattern, progression of radiological features, and a higher level of KL-6. CONCLUSIONS MDA-5/CADM-14 is associated with RP-ILD. ILD is a rare but severe manifestation among the spectrum of systemic involvement associated with JIIM, with a high rate of ICU admission and mortality. Early recognition and aggressive treatment are needed to prevent a severe outcome.
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Affiliation(s)
- Sarah Abu-Rumeileh
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy
| | - Edoardo Marrani
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy.
| | - Valerio Maniscalco
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy
| | - Ilaria Maccora
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy; NEUROFARBA Department, University of Florence, Firenze, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy
| | | | | | - Gabriele Simonini
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy; NEUROFARBA Department, University of Florence, Firenze, Italy
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7
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Hallowell RW, Danoff SK. Diagnosis and Management of Myositis-Associated Lung Disease. Chest 2023; 163:1476-1491. [PMID: 36764512 DOI: 10.1016/j.chest.2023.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Although interstitial lung disease (ILD) is a leading cause of morbidity and mortality in patients with inflammatory myopathies, the current definition and diagnostic criteria of autoimmune myositis remain inadequate to capture the large proportion of patients with lung-dominant disease. As a result, these patients present unique diagnostic and treatment challenges for even the most experienced clinicians. This article highlights the emerging role of autoantibodies in the diagnosis, classification, and management of patients with ILD. We propose alternative nomenclature to facilitate research on this unique patient population. Additionally, evidence supporting the various therapies used in the treatment of myositis-associated ILD is reviewed. The classification and treatment of patients with myositis-associated ILD remains challenging. A standardized therapeutic approach to these patients is lacking, and prospective studies in the field are needed to determine optimal treatment regimens.
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Affiliation(s)
- Robert W Hallowell
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Sonye K Danoff
- Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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8
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Leveque T, Pavlidi A, Lacoste-Palasset T, Cazes A, Messika J, Montravers P, Lortat-Jacob B, Castier YH, Bunel V, Borie R, Sène D, Allenbach Y, Mégarbane B, Comarmond C. A 24-Year-Old Woman With Cough, Arthralgia, and Skin Ulcerations. Chest 2023; 163:e223-e229. [PMID: 37164587 DOI: 10.1016/j.chest.2022.12.038] [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: 07/26/2022] [Revised: 10/27/2022] [Accepted: 12/07/2022] [Indexed: 05/12/2023] Open
Abstract
CASE PRESENTATION A 24-year-old Senegalese woman without remarkable history except anemia and iron deficiency related to excessive menstrual bleeding and sickle cell trait was admitted to our internal medicine department with 4-month fever, weight loss (-13 kg), dyspnea for limited efforts, intermittent productive cough, and bilateral metacarpophalangeal (MCP) and interphalangeal arthralgia. She was born and lived in France. She traveled previously to Senegal in 2015. She had no history of tobacco, alcohol, or drug use nor proximity with animals. She was taking no medication.
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Affiliation(s)
- Thibault Leveque
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Anastasia Pavlidi
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Thomas Lacoste-Palasset
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Aurélie Cazes
- Department of Pathology, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Jonathan Messika
- Pulmonology B and Lung Transplantation Department, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Philippe Montravers
- Department of Anaesthesiology and Critical Care Medicine, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Brice Lortat-Jacob
- Department of Anaesthesiology and Critical Care Medicine, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Yves-Hervé Castier
- Thoracic Surgery Department, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Vincent Bunel
- Pulmonology B and Lung Transplantation Department, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Raphaël Borie
- Pulmonology A Department, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Damien Sène
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, Paris, France.
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9
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Oreska S, Storkanova H, Kudlicka J, Tuka V, Mikes O, Krupickova Z, Satny M, Chytilova E, Kvasnicka J, Spiritovic M, Hermankova B, Cesak P, Rybar M, Pavelka K, Senolt L, Mann H, Vencovsky J, Vrablik M, Tomcik M. Cardiovascular Risk in Myositis Patients Compared to the General Population: Preliminary Data From a Single-Center Cross-Sectional Study. Front Med (Lausanne) 2022; 9:861419. [PMID: 35602501 PMCID: PMC9118331 DOI: 10.3389/fmed.2022.861419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Idiopathic inflammatory myopathies (IIM) are associated with systemic inflammation, limited mobility, and glucocorticoid therapy, all of which can lead to metabolism disturbances, atherogenesis, and increased cardiovascular (CV) risk. The aim of this study was to assess the CV risk in IIM patients and healthy controls (HC), and its association with disease-specific features. Methods Thirty nine patients with IIM (32 females; mean age 56; mean disease duration 4.8 years; dermatomyositis: n = 16, polymyositis: n = 7, immune-mediated necrotizing myopathy: n = 8, anti-synthetase syndrome: n = 8) and 39 age-/sex-matched HC (32 females, mean age 56) without rheumatic diseases were included. In both groups, subjects with a history of CV disease (angina pectoris, myocardial infarction, cerebrovascular, and peripheral arterial vascular events) were excluded. Muscle involvement, disease activity, and tissue damage were evaluated (Manual Muscle Test-8, Myositis Intention to Treat Activity Index, Myositis Damage Index). Comorbidities and current treatment were recorded. All participants underwent examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition (by densitometry and bioelectric impedance). The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE, charts for the European population) and its modifications. Results Compared to HC, there was no significant difference in IIM patients regarding blood pressure, ABI, PWV, CIMT, and the risk of fatal CV events by SCORE or SCORE2, or subclinical atherosclerosis (CIMT, carotid plaques, ABI, and PWV). The calculated CV risk scores by SCORE, SCORE2, and SCORE multiplied by the coefficient 1.5 (mSCORE) were reclassified according to the results of carotid plaque presence and CIMT; however, none of them was demonstrated to be significantly more accurate. Other significant predictors of CV risk in IIM patients included age, disease duration and activity, systemic inflammation, lipid profile, lean body mass, and blood pressure. Conclusions No significant differences in CV risk factors between our IIM patients and HC were observed. However, in IIM, CV risk was associated with age, disease duration, duration of glucocorticoid therapy, lipid profile, and body composition. None of the currently available scoring tools (SCORE, SCORE2, mSCORE) used in this study seems more accurate in estimating CV risk in IIM.
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Affiliation(s)
- Sabina Oreska
- Institute of Rheumatology, Prague, Czechia.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Hana Storkanova
- Institute of Rheumatology, Prague, Czechia.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Jaroslav Kudlicka
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Vladimir Tuka
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Ondrej Mikes
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Zdislava Krupickova
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Martin Satny
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Eva Chytilova
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Jan Kvasnicka
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Maja Spiritovic
- Institute of Rheumatology, Prague, Czechia.,Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Barbora Hermankova
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Petr Cesak
- Department of Human Movement Laboratory, Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Marian Rybar
- Faculty of Mathematics and Physics, Charles University, Prague, Czechia
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czechia.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Ladislav Senolt
- Institute of Rheumatology, Prague, Czechia.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Herman Mann
- Institute of Rheumatology, Prague, Czechia.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Jiri Vencovsky
- Institute of Rheumatology, Prague, Czechia.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Michal Vrablik
- 3rd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Michal Tomcik
- Institute of Rheumatology, Prague, Czechia.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czechia
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