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Teh I, Huang V, Oon S, Day J. Real-world implications of IMACS malignancy screening guidelines for idiopathic inflammatory myopathies: An evaluation of compliance and economic impact at a tertiary referral center. Int J Rheum Dis 2024; 27:e15198. [PMID: 38769913 DOI: 10.1111/1756-185x.15198] [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: 11/22/2023] [Revised: 04/19/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
AIM An inaugural set of consensus guidelines for malignancy screening in idiopathic inflammatory myopathy (IIM) were recently published by an international working group. These guidelines propose different investigation strategies based on "high", "intermediate" or "standard" malignancy risk groups. This study compares current malignancy screening practices at an Australian tertiary referral center with the recommendations outlined in these guidelines. METHODS We conducted a retrospective analysis of newly diagnosed IIM patients. Relevant demographic and clinical data regarding malignancy screening were recorded. Existing practice was compared with the guidelines using descriptive statistics; costs were calculated using the Australian Medicare Benefit Schedule. RESULTS Of the 47 patients identified (66% female, median age: 63 years [IQR: 55.5-70], median disease duration: 4 years [IQR: 3-6]), only one had a screening-detected malignancy. Twenty patients (43%) were at high risk, while 20 (43%) were at intermediate risk; the remaining seven (15%) had IBM, for which the proposed guidelines do not recommend screening. Only three (6%) patients underwent screening fully compatible with International Myositis Assessment and Clinical Studies recommendations. The majority (N = 39, 83%) were under-screened; the remaining five (11%) overscreened patients had IBM. The main reason for guideline non-compliance was the lack of repeated annual screening in the 3 years post-diagnosis for high-risk individuals (0% compliance). The mean cost of screening was substantially lower than those projected by following the guidelines ($481.52 [SD 423.53] vs $1341 [SD 935.67] per patient), with the highest disparity observed in high-risk female patients ($2314.29/patient). CONCLUSION Implementation of the proposed guidelines will significantly impact clinical practice and result in a potentially substantial additional economic burden.
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Affiliation(s)
- Ian Teh
- Department of Rheumatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Victoria Huang
- Department of Rheumatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Shereen Oon
- Department of Rheumatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
| | - Jessica Day
- Department of Rheumatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
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2
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Mammen AL. Paraneoplastic myopathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:327-332. [PMID: 38494286 DOI: 10.1016/b978-0-12-823912-4.00022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This chapter reviews the association between cancer and the idiopathic inflammatory myopathies (IIM), which includes dermatomyositis (DM), antisynthetase syndrome (ASyS), immune-mediated necrotizing myopathy (IMNM), and inclusion body myositis (IBM). Accumulating evidence shows that the risk of a coexisting malignancy is high in patients with DM, especially among those with anti-Tif1γ autoantibodies. Patients with IMNM and no defined autoantibodies also have an increased risk of malignancy. Recent evidence demonstrates that many IBM patients have increased numbers of circulating CD57+ CD8+ T cells, consistent with a diagnosis of large granular lymphocytic leukemia. In contrast, IMNM patients with anti-SRP or anti-HMGCR autoantibodies as well as patients with ASyS syndrome do not have a definitively increased risk of cancer. Patients who have a cancer treated with one of the immune checkpoint inhibitors can develop myositis (ICI-myositis), sometimes along with myasthenia gravis and/or myocarditis.
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Affiliation(s)
- Andrew L Mammen
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States; Departments of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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3
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Tang ZL, Chi CC, Tang ZW, Li XW, Man XY. Malignancy in dermatomyositis: a mono-centric retrospective study of 134 patients in China and a potential predictive model. Front Med (Lausanne) 2023; 10:1200804. [PMID: 37359002 PMCID: PMC10285222 DOI: 10.3389/fmed.2023.1200804] [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: 04/05/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Objectives To describe the demographics and phenotypes of malignancies-associated dermatomyositis (MADM) in east China and pinpoint potential factors indicative of malignancies in patients with dermatomyositis and establish a predictive model. Methods We retrospectively analyzed clinical data from 134 patients with adult-onset dermatomyositis hospitalized between January 2019 and May 2022 in one comprehensive hospital. Clinical data including disease course, initial symptoms and signs, and demographic information were retrieved from the Electronic Medical Records System. Other parameters including myositis-specific autoantibodies profiles, ferritin, sedimentation, etc. were all referable. Multivariable multinomial logistic regression was employed to simulate a model to predict cancer risks. Receiver operating characteristic curve was adopted to evaluate the potency of the model. Results 134 patients with adult-onset dermatomyositis were aptly enrolled in this study based on inclusive and exclusive criteria: 12 (8.96%) with malignancies, 57 (42.53%) with aberrant tumor biomarkers but no malignancies, 65 (48.51%) with neither malignancies nor abnormal tumor biomarkers. Senior diagnostic age, higher LDH, higher ferritin, positive anti-TIF1γ and anti-Mi2 rather than anti-NXP2 autoantibodies were positive indicators of malignancies. Additionally, neither initial complaints nor signs were found to be correlated to a tendency towards malignancies. Digestive system, nasopharyngeal, and lung malignancies were mostly documented in east China. One multivariable multinomial logistic regression model was established to predict the phenotypes of dermatomyositis on the basis of potential malignancies and the overall sensitivity and specificity was satisfactory. Conclusion Positivity of anti-TIF1γ and anti-Mi2 autoantibodies are highly indicative of malignancies while the role of anti-NXP2 autoantibody in MADM in the Chinese population remains unclear. The phenotypes of malignancies can be predicted through the model and the predictive power is sufficient. More attention should be paid to malignancies screening in patients with aberrant tumor biomarkers but no malignancies, particularly digestive system, nasopharyngeal, and lung malignancies in patients with dermatomyositis but without malignancies.
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Affiliation(s)
- Zhuang-Li Tang
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chao-cheng Chi
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhen-Wei Tang
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia-Wei Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Yong Man
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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4
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Kim Y, Park D, Choi SY, Chung C. Immune checkpoint inhibitor therapy in a patient with small cell lung cancer and anti-transcriptional intermediary factor 1-γ antibody-positive dermatomyositis: A case report. Thorac Cancer 2022; 13:2808-2811. [PMID: 35982637 PMCID: PMC9527166 DOI: 10.1111/1759-7714.14609] [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: 06/03/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 11/27/2022] Open
Abstract
Autoimmune diseases (ADs) are closely related to cancers; 30% of dermatomyositis (DM) cases are associated with malignancy. In lung cancer patients accompanied by DM, the most frequent cancer type is small cell lung cancer (SCLC). Anti‐transcriptional intermediary factor 1 γ (anti‐TIF1γ) antibody is a promising marker for the assessment of cancer risk in DM patients. The recent use of immune checkpoint inhibitors (ICIs) for extensive‐stage SCLC has improved patient outcomes. However, clinical trials of ICI excluded most patients with ADs because of the increased risk of toxicity. Nevertheless, recent evidences suggest that ICI may be appropriate for AD patients. A 76‐year‐old man diagnosed with extensive‐stage SCLC and anti–TIF1γ Ab‐positive DM developed limb weakness and typical skin manifestations of DM. Positron emission tomography‐computed tomography showed diffuse uptake in all muscles. The results of a nerve conduction study and electromyography were consistent with acute myopathy. Electron microscopy showed tubuloreticular inclusions in endothelial cells. He was treated with corticosteroids for DM and chemotherapy with atezolizumab for SCLC. Despite concerns regarding the use of ICI because of DM, atezolizumab was administered under close observation. After treatment, tumor size decreased and his symptoms improved significantly. We believe that the response of SCLC to chemotherapy including ICI, had a positive effect on the improvement of DM. Clinicians should consider ICIs for SCLC patients with DM and carefully monitor the patient's symptoms during treatment.
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Affiliation(s)
- Yoonjoo Kim
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Dongil Park
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Song-Yi Choi
- Department of pathology, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Chaeuk Chung
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
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5
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Fredi M, Cavazzana I, Ceribelli A, Cavagna L, Barsotti S, Bartoloni E, Benucci M, De Stefano L, Doria A, Emmi G, Fabris M, Fornaro M, Furini F, Giudizi MG, Govoni M, Ghirardello A, Iaccarino L, Iannone F, Infantino M, Isailovic N, Lazzaroni MG, Manfredi M, Mathieu A, Marasco E, Migliorini P, Montecucco C, Palterer B, Parronchi P, Piga M, Pratesi F, Riccieri V, Selmi C, Tampoia M, Tripoli A, Zanframundo G, Radice A, Gerli R, Franceschini F. An Italian Multicenter Study on Anti-NXP2 Antibodies: Clinical and Serological Associations. Clin Rev Allergy Immunol 2022; 63:240-250. [PMID: 35092577 PMCID: PMC9464148 DOI: 10.1007/s12016-021-08920-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 01/13/2023]
Abstract
The identification of anti-NXP2 antibodies is considered a serological marker of dermatomyositis (DM), with calcinosis, severe myositis and, in some reports, with cancer. Historically, these associations with anti-NXP2 antibodies have been detected by immunoprecipitation (IP), but in the last few years commercial immunoblotting assays have been released. The aim of this collaborative project was to analyse the clinical features associated to anti-NXP2 antibodies, both with commercial line blot (LB) and IP. Myositis-specific and myositis-associated autoantibodies were detected in single centres by commercial line blot (LB); available sera were evaluated in a single centre by protein and RNA immunoprecipitation (IP), and IP-Western blot. Sixty patients anti-NXP2+ (NXP2+) positive by LB were compared with 211 patients anti-NXP2 negative with idiopathic inflammatory myositis (IIM). NXP2+ showed a younger age at IIM onset (p = 0.0014), more frequent diagnosis of dermatomyositis (p = 0.026) and inclusion-body myositis (p = 0.009), and lower rate of anti-synthetase syndrome (p < 0.0001). As for clinical features, NXP2+ more frequently develop specific skin manifestations and less frequently features related with overlap myositis and anti-synthetase syndrome. IP confirmed NXP2 positivity in 31 of 52 available sera (62%). Most clinical associations were confirmed comparing NXP2 LB+/IP+ versus NXP2-negative myositis, with the following exceptions: inclusion-body myositis diagnosis was not detected, whilst dysphagia and myositis were found more frequently in NXP2 LB+/IP+ patients. The 21 LB+ /IP-myositis patients did not show differences in clinical features when compared with the NXP2-myositis patients and more frequently displayed multiple positivity at LB. Risk of developing cancer-associated myositis was similar between NXP2-positive and NXP2-negative myositis patients, either when detected by LB or IP. Protein-IP confirmed NXP2 antibodies in nearly 60% of sera positive for the same specificity with commercial assay. Double-positive cases rarely occurred in myositis patients with a clinical diagnosis other than dermatomyositis. Patients only positive by LB (LB+/IP-) did not display clinical features typical of NXP2. NXP2 positivity by LB should be confirmed by other methods in order to correctly diagnose and characterize patients affected by idiopathic inflammatory myositis.
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Affiliation(s)
- Micaela Fredi
- grid.7637.50000000417571846Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ilaria Cavazzana
- grid.7637.50000000417571846Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Ceribelli
- grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano (Mi), Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Rozzano (Mi), Italy
| | - Lorenzo Cavagna
- grid.419425.f0000 0004 1760 3027Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Simone Barsotti
- grid.5395.a0000 0004 1757 3729Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Bartoloni
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Maurizio Benucci
- grid.511672.60000 0004 5995 4917Immunology and Allergy Laboratory Unit S. Giovanni Di Dio Hospital, Azienda USL Toscana Centro, Firenze, Italy
| | - Ludovico De Stefano
- grid.419425.f0000 0004 1760 3027Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Andrea Doria
- grid.5608.b0000 0004 1757 3470Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Giacomo Emmi
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Martina Fabris
- grid.411492.bInstitute of Clinical Pathology, Department of Laboratory Medicine, University Hospital of Udine, Udine, Italy
| | - Marco Fornaro
- grid.7644.10000 0001 0120 3326Unit of Rheumatology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Federica Furini
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, Rheumatology Unit, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona (Ferrara), Italy
| | - Maria Grazia Giudizi
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Marcello Govoni
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, Rheumatology Unit, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona (Ferrara), Italy
| | - Anna Ghirardello
- grid.5608.b0000 0004 1757 3470Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Luca Iaccarino
- grid.5608.b0000 0004 1757 3470Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Fiorenzo Iannone
- grid.7644.10000 0001 0120 3326Unit of Rheumatology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Maria Infantino
- grid.511672.60000 0004 5995 4917Immunology and Allergy Laboratory Unit S. Giovanni Di Dio Hospital, Azienda USL Toscana Centro, Firenze, Italy
| | - Natasa Isailovic
- grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano (Mi), Italy
| | - Maria Grazia Lazzaroni
- grid.7637.50000000417571846Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mariangela Manfredi
- grid.511672.60000 0004 5995 4917Immunology and Allergy Laboratory Unit S. Giovanni Di Dio Hospital, Azienda USL Toscana Centro, Firenze, Italy
| | - Alessandro Mathieu
- grid.7763.50000 0004 1755 3242Rheumatology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU University Clinic, Cagliari, Italy
| | - Emiliano Marasco
- grid.419425.f0000 0004 1760 3027Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Paola Migliorini
- grid.5395.a0000 0004 1757 3729Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carlomaurizio Montecucco
- grid.419425.f0000 0004 1760 3027Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Boaz Palterer
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Paola Parronchi
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Matteo Piga
- grid.7763.50000 0004 1755 3242Rheumatology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU University Clinic, Cagliari, Italy
| | - Federico Pratesi
- grid.5395.a0000 0004 1757 3729Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Riccieri
- grid.7841.aDepartment of Rheumatology, Sapienza-University of Rome, Rome, Italy
| | - Carlo Selmi
- grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano (Mi), Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Rozzano (Mi), Italy
| | - Marilina Tampoia
- Clinical Pathology Unit, Department of Biomedical Sciences and Human Oncology, University “Aldo Moro” of Bari, Bari, Italy
| | - Alessandra Tripoli
- grid.5395.a0000 0004 1757 3729Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Zanframundo
- grid.419425.f0000 0004 1760 3027Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Antonella Radice
- grid.416325.7Department of Microbiology and Virology, ASST Santi Paolo E Carlo, San Carlo Hospital, Milan, Italy
| | - Roberto Gerli
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Franco Franceschini
- grid.7637.50000000417571846Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Marzęcka M, Niemczyk A, Rudnicka L. Autoantibody Markers of Increased Risk of Malignancy in Patients with Dermatomyositis. Clin Rev Allergy Immunol 2022; 63:289-296. [PMID: 35147864 PMCID: PMC9464248 DOI: 10.1007/s12016-022-08922-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 01/13/2023]
Abstract
Dermatomyositis is a chronic inflammatory disease involving the skin and muscles. It most commonly occurs in adults with preponderance in females, but pediatric occurrence is also possible. The risk of malignancy in adult patients with dermatomyositis was reported to be 4.66-fold higher compared to that in the general population. A significantly increased risk of malignancy was reported within the first 12 months following the diagnosis of dermatomyositis (standardized incidence ratio equaled 17). One of the characteristic laboratory findings associated with dermatomyositis is the presence of circulating autoantibodies which are classified into two subgroups: myositis-specific and myositis-associated autoantibodies. It was shown that specific types of antibodies might be associated with an increased risk of malignancy. Current literature data indicate that the strongest correlation with malignant diseases was reported in anti-TIF1-γ-positive patients who were at a 9.37-fold higher risk of cancer. A 3.68-fold increase in the risk of cancer was also reported among patients with anti-NXP2 antibodies. Malignant diseases were reported in 14-57% of patients with anti-SAE antibodies. The presence of other autoantibodies may also be associated with an increased risk of malignancy. These data indicate that patients with circulating anti-TIF1-γ, anti-NXP2, and anti-SAE should be very closely monitored for dermatomyositis-associated malignant comorbidities. The aim of this review is to summarize the current data regarding the link between malignancy and the presence of specific antibodies in patients with dermatomyositis.
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Affiliation(s)
- Milena Marzęcka
- grid.13339.3b0000000113287408Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Niemczyk
- grid.13339.3b0000000113287408Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- grid.13339.3b0000000113287408Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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Colapietro F, Lleo A, Generali E. Antimitochondrial Antibodies: from Bench to Bedside. Clin Rev Allergy Immunol 2022; 63:166-177. [PMID: 34586589 PMCID: PMC8480115 DOI: 10.1007/s12016-021-08904-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 01/13/2023]
Abstract
Anti-mitochondrial antibodies (AMA) are directed against the E2 subunits of the 2-oxo acid dehydrogenase complexes (PDC-E2) and are the typical biomarkers of primary biliary cholangitis (PBC), being present in 90-95% of patients, with increasing sensitivity at increasing titers. Albeit being highly specific for PBC diagnosis, AMA can be detected in less than 1% of healthy subjects, and thus the management subjects with no sign or symptom of liver disease is still a challenge and data concerning clinical risk of developing PBC in this subgroup of patients are controversial. Moreover, AMA can also be detected in patients affected by overlap syndrome, as well as hepatic diseases (i.e., NASH and viral hepatitis), while the association with autoimmune diseases, in particular Sjögren's syndrome, systemic sclerosis, and systemic lupus erythematosus, is well established. Furthermore, new associations are being identified with inflammatory myositis and heart disease. AMA are directed towards the pyruvate dehydrogenase multi enzyme complex (PDC-E2) subunit, which represents an epithelial specific autoantigen for PBC. This review focuses on the main characteristics of AMA, their association with autoimmune diseases and liver diseases.
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Affiliation(s)
- Francesca Colapietro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.
| | - Elena Generali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
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8
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Tsamis KI, Boutsoras C, Kaltsonoudis E, Pelechas E, Nikas IP, Simos YV, Voulgari PV, Sarmas I. Clinical features and diagnostic tools in idiopathic inflammatory myopathies. Crit Rev Clin Lab Sci 2021; 59:219-240. [PMID: 34767470 DOI: 10.1080/10408363.2021.2000584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Idiopathic inflammatory myopathies (IIMs) are rare autoimmune disorders affecting primarily muscles, but other organs can be involved. This review describes the clinical features, diagnosis and treatment for IIMs, namely polymyositis (PM), dermatomyositis (DM), sporadic inclusion body myositis (sIBM), immune-mediated necrotizing myopathy (IMNM), and myositis associated with antisynthetase syndrome (ASS). The diagnostic approach has been updated recently based on the discovery of circulating autoantibodies, which has enhanced the management of patients. Currently, validated classification criteria for IIMs allow clinical studies with well-defined sets of patients but diagnostic criteria to guide the care of individual patients in routine clinical practice are still missing. This review analyzes the clinical manifestations and laboratory findings of IIMs, discusses the efficiency of modern and standard methods employed in their workup, and delineates optimal practice for clinical care. Α multidisciplinary diagnostic approach that combines clinical, neurologic and rheumatologic examination, evaluation of electrophysiologic and morphologic muscle characteristics, and assessment of autoantibody immunoassays has been determined to be the preferred approach for effective management of patients with suspected IIMs.
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Affiliation(s)
- Konstantinos I Tsamis
- Department of Neurology, University Hospital of Ioannina, Ioannina, Greece.,School of Medicine, European University Cyprus, Nicosia, Cyprus.,Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | | | | | - Ilias P Nikas
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Yannis V Simos
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Sarmas
- Department of Neurology, University Hospital of Ioannina, Ioannina, Greece
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9
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Myositis autoantibodies in Iranian myositis patients: assessment the frequency and clinical relevancy. Clin Rheumatol 2021; 41:533-539. [PMID: 34514533 DOI: 10.1007/s10067-021-05879-1] [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: 07/09/2021] [Revised: 07/09/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Dermatomyositis (DM) and polymyositis (PM) are known as two major types of idiopathic inflammatory myopathies (IMMs). During the past years, growing data strongly suggest the clinical significance of myositis-associated autoantibodies (MAAs) and myositis-specific autoantibodies (MSAs). The present study aimed to determine the profile of MSAs and MAAs, subsequently to address the clinical significance of these autoantibodies in Iranian myositis patients. METHODOLOGY In this cross-sectional study, 28 DM and 24 PM patients were entered. Demographic and clinical characteristics were collected by direct examination and patients' medical record. The existence of MSAs and MAAs was assessed by indirect immunofluorescence then using immunoblotting (FA 1510-1005-1, DL 1530-1601-4 G; Euroimmun, Germany). Data were analyzed using the SPSS software (v22; SPSS Inc. Chicago, IL, USA). RESULTS The mean age of the patients was 46.18 ± 12.95 years and male/female ratio was 28.8/71.2. Autoantibodies were positive in 63.46% of myositis patients. Interestingly, anti-TIF1γ and anti-PL7 were significantly associated with malignancy (P < 0.001, P = 0.008; respectively). The existence of autoantibody and anti-Jo1 had significant relation with interstitial lung disease (ILD) (P = 0.034, P = 0.006; respectively). Joint involvements including arthritis and arthralgia were significantly associated with anti-Ro52 and anti-Jo1 (P = 0.04, P = 0.02; respectively). CONCLUSION Taken together, it can be concluded that certain myositis autoantibodies present clinical significance which is in line with the literature. The use of these autoantibodies as biomarkers by line blotting along with indirect immunofluorescence facilitates diagnosis of inflammatory myopathies and makes it more accurate as well as better management of myositis patients if used based on a science-based manner. Key Points • Identification of MSAs and MAAs facilitates the diagnosis of inflammatory myopathies and provides better myositis patient's management if used according to a science-based manner. • Anti-rod and ring antibody was detected in a patient with ovarian cancer-induced dermatomyositis. • Malignancy and ILD are integrated parts of myositis which can be associated with MSAs and MAAs.
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10
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Oldroyd AGS, Allard AB, Callen JP, Chinoy H, Chung L, Fiorentino D, George MD, Gordon P, Kolstad K, Kurtzman DJB, Machado PM, McHugh NJ, Postolova A, Selva-O'Callaghan A, Schmidt J, Tansley S, Vleugels RA, Werth VP, Aggarwal R. A systematic review and meta-analysis to inform cancer screening guidelines in idiopathic inflammatory myopathies. Rheumatology (Oxford) 2021; 60:2615-2628. [PMID: 33599244 PMCID: PMC8213426 DOI: 10.1093/rheumatology/keab166] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/26/2021] [Accepted: 02/11/2021] [Indexed: 02/04/2023] Open
Abstract
Objectives To identify clinical factors associated with cancer risk in the idiopathic inflammatory myopathies (IIMs) and to systematically review the existing evidence related to cancer screening. Methods A systematic literature search was carried out on Medline, Embase and Scopus. Cancer risk within the IIM population (i.e. not compared with the general population) was expressed as risk ratios (RR) for binary variables and weighted mean differences (WMD) for continuous variables. Evidence relating to cancer screening practices in the IIMs were synthesized via narrative review. Results Sixty-nine studies were included in the meta-analysis. DM subtype (RR 2.21), older age (WMD 11.19), male sex (RR 1.53), dysphagia (RR 2.09), cutaneous ulceration (RR 2.73) and anti-transcriptional intermediary factor-1 gamma positivity (RR 4.66) were identified as being associated with significantly increased risk of cancer. PM (RR 0.49) and clinically amyopathic DM (RR 0.44) subtypes, Raynaud’s phenomenon (RR 0.61), interstitial lung disease (RR 0.49), very high serum creatine kinase (WMD −1189.96) or lactate dehydrogenase (WMD −336.52) levels, and anti-Jo1 (RR 0.45) or anti-EJ (RR 0.17) positivity were identified as being associated with significantly reduced risk of cancer. Nine studies relating to IIM-specific cancer screening were included. CT scanning of the thorax, abdomen and pelvis appeared to be effective in identifying underlying asymptomatic cancers. Conclusion Cancer risk factors should be evaluated in patients with IIM for risk stratification. Screening evidence is limited but CT scanning could be useful. Prospective studies and consensus guidelines are needed to establish cancer screening strategies in IIM patients.
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Affiliation(s)
- Alexander G S Oldroyd
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Andrew B Allard
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Jeffrey P Callen
- Division of Medicine, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Department of Medicine and Dermatology, Stanford University, Stanford, USA.,Palo Alto Health Care System, Palo Alto, USA
| | - David Fiorentino
- Department of Dermatology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Michael D George
- Division of Rheumatology, Philadelphia, PA, USA.,Division of Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kate Kolstad
- Department of Dermatology, School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Anna Postolova
- Department of Immunology and Rheumatology, Stanford Health Care, Stanford, CA, USA
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Unity, Vall D'Hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jens Schmidt
- Department of Neurology, Neuromuscular Centre, Göttingen, Germany
| | - Sarah Tansley
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Department of Neurology, Neuromuscular Centre, Göttingen, Germany
| | - Ruth Ann Vleugels
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.,Division of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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11
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Negalur NV, Ekbote GG, Raval DN, Tanna DV, Kazi WS, Bindroo MA, Yadavalli DJ, Gupta R. The Association of Myositis Specific Antibodies in Patients with Inflammatory Myositis: Preliminary Data in Indian Patients. Ann Indian Acad Neurol 2021; 24:552-558. [PMID: 34728950 PMCID: PMC8513958 DOI: 10.4103/aian.aian_1151_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 11/07/2022] Open
Abstract
CONTEXT Autoantibodies have a role in the diagnosis and prognosis in Autoimmune Inflammatory Myositis (AIM). AIMS The aim of this work was to study the prevalence and clinical correlation of myositis specific and associated antibodies (MSA and MAA) in AIM. SETTING AND DESIGN This was a cross-sectional observational study. METHODS AND MATERIALS Consecutive AIM patents were divided into groups as dermatomyositis (DM), polymyositis (PM), CTD-associated myositis (CTD-M), cancer-associated myositis (CAM) and juvenile myositis (JM). Their data along with serum samples were collected after obtaining informed consent. Sera was analyzed for IgG antibodies against Jo-1, PL-7, PL-12, EJ, SRP, Mi-2, MDA-5, TIF1γ, SAE1, SAE2, NXP2 and SSA/R052kD using the microELISA technique. The institutional ethics committee approved the study. STATISTICAL ANALYSIS SPSS software (version 24.0) was used. P value < 0.05 was considered statistically significant. RESULTS There were 48 patients (DM = 19, PM = 19, CTD-M = 5, CAM = 2, JM = 3) included. MSA were positive in 37.5% patients. Antibodies against Mi-2 were present in 6 (12.5%), Jo-1 in 5 (10.4%), 2 (4.1%) each had PL-7 and SRP antibodies. One patient (2%) each had MDA-5, NXP2 and TIf1g antibodies. Jo-1 antibody was associated with mechanic's hands and ILD. There was a significant association of rash in the Mi-2 group with none of the patients having ILD. Malignancy screening was negative in NXP2 and TIF1g antibody-positive patients. Ro52 was the most common MAA (33.3%) and was associated with mechanic's hand. CONCLUSION MSA was present in almost 40% of the cohort. Anti Jo-1 antibody was associated with mechanic's hands and ILD. None of the Mi-2 patients had ILD, which may point to a protective role of this antibody for ILD. The association of newer antibodies in Indian patients needs to be further studied in larger cohorts.
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Affiliation(s)
- Natasha Vijay Negalur
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Gayatri G. Ekbote
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Dhiren N. Raval
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Dhaval V. Tanna
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Wasim S. Kazi
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Muzaffar A. Bindroo
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Durgarao J. Yadavalli
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Rajiva Gupta
- Department of Rheumatology and Clinical Immunology, Medanta - The Medicity Hospital, Gurugram, Haryana, India
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12
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Vecellio M, Chen L, Cohen CJ, Cortes A, Li Y, Bonham S, Selmi C, Brown MA, Fischer R, Knight JC, Wordsworth BP. Functional Genomic Analysis of a RUNX3 Polymorphism Associated With Ankylosing Spondylitis. Arthritis Rheumatol 2021; 73:980-990. [PMID: 33369221 PMCID: PMC8251554 DOI: 10.1002/art.41628] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/28/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the functional consequences of the single-nucleotide polymorphism rs4648889 in a putative enhancer upstream of the RUNX3 promoter associated with susceptibility to ankylosing spondylitis (AS). METHODS Using nuclear extracts from Jurkat cells and primary human CD8+ T cells, the effects of rs4648889 on allele-specific transcription factor (TF) binding were investigated by DNA pull-down assay and quantitative mass spectrometry (qMS), with validation by electrophoretic mobility shift assay (EMSA), Western blotting of the pulled-down eluates, and chromatin immunoprecipitation (ChIP)-quantitative polymerase chain reaction (qPCR) analysis. Further functional effects were tested by small interfering RNA knockdown of the gene for interferon regulatory factor 5 (IRF5), followed by reverse transcription-qPCR (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA) to measure the levels of IFNγ messenger RNA (mRNA) and protein, respectively. RESULTS In nuclear extracts from CD8+ T cells, results of qMS showed that relative TF binding to the AS-risk A allele of rs4648889 was increased 3.7-fold (P < 0.03) for Ikaros family zinc-finger protein 3 (IKZF3; Aiolos) and components of the NuRD complex, including chromodomain helicase DNA binding protein 4 (CHD4) (3.6-fold increase; P < 0.05) and retinoblastoma binding protein 4 (RBBP4) (4.1-fold increase; P < 0.03). In contrast, IRF5 bound significantly more to the AS-protective G allele compared to the AS-risk A allele (fold change 8.2; P = 0.003). Validation with Western blotting, EMSA, and ChIP-qPCR confirmed the differential allelic binding of IKZF3, CHD4, RBBP4, and IRF5. Silencing of IRF5 in CD8+ T cells increased the levels of IFNγ mRNA as measured by RT-qPCR (P = 0.03) and IFNγ protein as measured by ELISA (P = 0.02). CONCLUSION These findings suggest that the association of rs4648889 with AS reflects allele-specific binding of this enhancer-like region to certain TFs, including IRF5, IKZF3, and members of the NuRD complex. IRF5 may have crucial influences on the functions of CD8+ lymphocytes, a finding that could reveal new therapeutic targets for the management of AS.
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Affiliation(s)
- Matteo Vecellio
- NIHR Oxford Musculoskeletal Biomedical Research Unit, Botnar Research Centre, Nuffield Orthopaedic Centre, NIHR Oxford Comprehensive Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Liye Chen
- NIHR Oxford Musculoskeletal Biomedical Research Unit, Botnar Research Centre, Nuffield Orthopaedic Centre, NIHR Oxford Comprehensive Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Carla J Cohen
- NIHR Oxford Musculoskeletal Biomedical Research Unit, Botnar Research Centre, Nuffield Orthopaedic Centre, NIHR Oxford Comprehensive Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Adrian Cortes
- John Radcliffe Hospital, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Yan Li
- The First Affiliated Hospital of Xiamen University and Xiamen University School of Medicine, Xiamen, China
| | - Sarah Bonham
- Target Discovery Institute, University of Oxford, Oxford, UK
| | - Carlo Selmi
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matthew A Brown
- NIHR Guy's and St. Thomas' Biomedical Research Centre, London, UK, and University of Queensland, Brisbane, Queensland, Australia
| | - Roman Fischer
- Target Discovery Institute, University of Oxford, Oxford, UK
| | - Julian C Knight
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - B Paul Wordsworth
- NIHR Oxford Musculoskeletal Biomedical Research Unit, Botnar Research Centre, Nuffield Orthopaedic Centre, NIHR Oxford Comprehensive Biomedical Research Centre, University of Oxford, Oxford, UK
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13
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Aguilar-Vazquez A, Chavarria-Avila E, Pizano-Martinez O, Ramos-Hernandez A, Andrade-Ortega L, Rubio-Arellano ED, Vazquez-Del Mercado M. Geographical Latitude Remains as an Important Factor for the Prevalence of Some Myositis Autoantibodies: A Systematic Review. Front Immunol 2021; 12:672008. [PMID: 33968081 PMCID: PMC8100663 DOI: 10.3389/fimmu.2021.672008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
The idiopathic inflammatory myopathies (IIM) are characterized by muscular weakness, cutaneous manifestations, muscle damage revealed by increase of muscular enzymes, muscle biopsy, electromyography and changes on magnetic resonance imaging. However, the hallmark of these IIM, is the development of myositis specific antibodies (MSA) or myositis associated antibodies (MAA). The theories about their presence in the serum of IIM is not known. Some studies have suggested that some of these MSA, such as anti-Mi-2 increases according to the intensity of UV radiation. There is scarce information about the environmental factors that might contribute in order to be considered as triggering factors as UV radiation might be. In this review, we analyzed the reported prevalence of MSAs and MAAs regarding to their geographical location and the possible relation with UV radiation. We collected the prevalence data of fifteen MSA and thirteen MAA from 22 countries around the world and we were able to observe a difference in prevalence between countries and continents. We found differences in anti-PL7, anti-Ro52, anti-La and anti-Ku prevalence according to UV radiation level. Otherwise, we observed that anti-Mi-2 prevalence increases near to the Equator meanwhile anti-MJ/NXP2 and anti-ARS prevalence had an opposite behavior increasing their prevalence in the geographical locations farther to the Equator. Our results highlighted the importance to include the UV radiation and other environmental factors in IIM studies, in order to clarify its association with MSA and MAA prevalence as well as its possible role in the immunopathogenesis of these diseases.
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Affiliation(s)
- Andrea Aguilar-Vazquez
- Centro Universitario de Ciencias de la Salud, Doctorado en Ciencias Biomédicas, Universidad de Guadalajara, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Reumatología y del Sistema Músculo-Esquelético (IIRSME), Universidad de Guadalajara, Guadalajara, Mexico
| | - Efrain Chavarria-Avila
- Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Reumatología y del Sistema Músculo-Esquelético (IIRSME), Universidad de Guadalajara, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud, Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Universidad de Guadalajara, Guadalajara, Mexico.,Hospital Civil Dr. Juan I. Menchaca, División de Medicina Interna, Servicio de Reumatología 004086, PNPC CONACyT, Guadalajara, Mexico
| | - Oscar Pizano-Martinez
- Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Reumatología y del Sistema Músculo-Esquelético (IIRSME), Universidad de Guadalajara, Guadalajara, Mexico.,Hospital Civil Dr. Juan I. Menchaca, División de Medicina Interna, Servicio de Reumatología 004086, PNPC CONACyT, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud, UDG-CA 703 Inmunología y Reumatología, Universidad de Guadalajara, Guadalajara, Mexico
| | - Alejandra Ramos-Hernandez
- Hospital Civil Dr. Juan I. Menchaca, División de Medicina Interna, Servicio de Reumatología 004086, PNPC CONACyT, Guadalajara, Mexico
| | - Lilia Andrade-Ortega
- Departamento de Reumatología Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Ciudad de México, Mexico
| | - Edy-David Rubio-Arellano
- Centro Universitario de Ciencias de la Salud, Departamento de Fisiología, Universidad de Guadalajara, Guadalajara, Mexico
| | - Monica Vazquez-Del Mercado
- Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Reumatología y del Sistema Músculo-Esquelético (IIRSME), Universidad de Guadalajara, Guadalajara, Mexico.,Hospital Civil Dr. Juan I. Menchaca, División de Medicina Interna, Servicio de Reumatología 004086, PNPC CONACyT, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud, UDG-CA 703 Inmunología y Reumatología, Universidad de Guadalajara, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud, Departamento de Biología Molecular y Genómica, Universidad de Guadalajara, Guadalajara, Mexico
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14
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Irekeola AA, Shueb RH, E. A. R. ENS, Wada Y, Abdul Rahman Z, Ahmad S, Mohamud R, Mat Lazim N, Yean CY. Prevalence of Nasopharyngeal Carcinoma in Patients with Dermatomyositis: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13081886. [PMID: 33919987 PMCID: PMC8071042 DOI: 10.3390/cancers13081886] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/25/2021] [Accepted: 04/03/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary This first systematic review and meta-analysis on the prevalence of nasopharyngeal carcinoma in patients suffering dermatomyositis was necessitated by the absence of a true and reliable prevalence estimate necessary to adequately inform medical preparedness and decisions. Following a careful review of literature and data analyses, a prevalence of 3.3% was found. It is hoped that a clear knowledge of the actual prevalence of nasopharyngeal carcinoma in dermatomyositis patients would not only help sensitize clinicians and patients about the frequency of these disease conditions but would also enhance the adoption of precautions essential to mitigate their co-occurrence in patients. Abstract For more than 50 years, nasopharyngeal carcinoma (NPC) has been associated with dermatomyositis (DM), a rare idiopathic inflammatory disorder that mainly affects the skin and muscles. Although the association between these rare diseases is well-documented, the actual prevalence of NPC in DM patients remains unknown. Here, a systematic review and meta-analysis of published data was conducted in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Electronic databases including PubMed, Scopus, ScienceDirect, and Google Scholar were searched without year or language restrictions for studies reporting the occurrence of NPC in DM patients. The study protocol was lodged with PROSPERO (CRD42021225335). A total of 95 studies covering 303 cases of NPC among 16,010 DM patients was included. Summary estimates were calculated using the random-effects model. The pooled prevalence of NPC in DM was 3.3% (95% CI, 2.5–4.3). When stratified according to study location, higher prevalence estimates were obtained for Hong Kong (36.5%), Malaysia (27.7%), and Singapore (11.9%). There was a predominance of cases among male DM patients compared with females, and most patients were aged 40 and above. Many of the NPC cases were found to be diagnosed after the diagnosis of DM. It is therefore pertinent to screen for NPC in DM patients, especially among older DM patients in the Asian region.
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Affiliation(s)
- Ahmad Adebayo Irekeola
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
- Microbiology Unit, Department of Biological Sciences, College of Natural and Applied Sciences, Summit University Offa, Offa PMB 4412, Nigeria
| | - Rafidah Hanim Shueb
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence:
| | - Engku Nur Syafirah E. A. R.
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
| | - Yusuf Wada
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
- Department of Zoology, Faculty of Life Sciences, Ahmadu Bello University, Zaria 810211, Nigeria
| | - Zaidah Abdul Rahman
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
- Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Suhana Ahmad
- Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (S.A.); (R.M.)
| | - Rohimah Mohamud
- Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (S.A.); (R.M.)
| | - Norhafiza Mat Lazim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Chan Yean Yean
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
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15
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Okiyama N, Ichimura Y, Shobo M, Tanaka R, Kubota N, Saito A, Ishitsuka Y, Watanabe R, Fujisawa Y, Nakamura Y, Murakami A, Kayama H, Takeda K, Fujimoto M. Immune response to dermatomyositis-specific autoantigen, transcriptional intermediary factor 1γ can result in experimental myositis. Ann Rheum Dis 2021; 80:1201-1208. [PMID: 33811031 DOI: 10.1136/annrheumdis-2020-218661] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/09/2021] [Accepted: 03/21/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate whether autoimmunity to transcriptional intermediary factor 1 (TIF1)γ, a ubiquitous nuclear autoantigen for myositis-specific autoantibodies detected in patients with dermatomyositis (DM) is pathogenetic for inflammatory myopathy. METHODS Wild-type, β2-microglobulin-null, perforin-null, Igμ-null and interferon α/β receptor (IFNAR)-null mice were immunised with recombinant human TIF1γ whole protein. A thymidine incorporation assay was performed using lymph node T cells from TIF1γ-immunised mice. Plasma was analysed using immunoprecipitation followed by western blot analysis and enzyme-linked immunosorbent assays. Femoral muscles were histologically and immunohistochemically evaluated. CD8+ or CD4+ T cells isolated from lymph node T cells or IgG purified from plasma were adoptively transferred to naïve mice. TIF1γ-immunised mice were treated with anti-CD8 depleting antibody and a Janus kinase inhibitor, tofacitinib. RESULTS Immunisation with TIF1γ-induced experimental myositis presenting with necrosis/atrophy of muscle fibres accompanied by CD8+ T cell infiltration successfully in wild-type mice, in which TIF1γ-specific T cells and antihuman and murine TIF1γ IgG antibodies were detected. The incidence and severity of myositis were significantly lower in β₂-microglobulin-null, perforin-null, CD8-depleted or IFNAR-null mice, while Igμ-null mice developed myositis normally. Adoptive transfer of CD8+ T cells induced myositis in recipients, while transfer of CD4+ T cells or IgG did not. Treatment with tofacitinib inhibited TIF1γ-induced myositis. CONCLUSIONS Here we show that TIF1γ is immunogenic enough to cause experimental myositis, in which CD8+ T cells and type I interferons, but not CD4+ T cells, B cells or antibodies, are required. This murine model would be a tool for understanding the pathologies of DM.
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Affiliation(s)
- Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuki Ichimura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Miwako Shobo
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ryota Tanaka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Noriko Kubota
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akimasa Saito
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yosuke Ishitsuka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Integrative Medicine for Allergic and Immunological Disease, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Rei Watanabe
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Integrative Medicine for Allergic and Immunological Disease, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akihiro Murakami
- Medical and Biological Laboratories Co Ltd, Nagoya, Aichi, Japan
| | - Hisako Kayama
- Institute for Advanced Co-Creation Studies, Osaka University, Suita, Osaka, Japan
| | - Kiyoshi Takeda
- Department of Microbiology and Immunology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Dermatology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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16
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Caractéristiques cliniques des myosites associées aux anticorps anti-NXP2 chez l’adulte : étude de 6 cas. Ann Dermatol Venereol 2020; 147:891-897. [DOI: 10.1016/j.annder.2020.09.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 11/17/2022]
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17
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Sung YK, Jung SY, Kim H, Choi S, Im SG, Cha EJ, Jang EJ, Yoo DH, Cho SK. Temporal relationship between idiopathic inflammatory myopathies and malignancies and its mortality: a nationwide population-based study. Clin Rheumatol 2020; 39:3409-3416. [DOI: 10.1007/s10067-019-04782-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/24/2019] [Accepted: 09/11/2019] [Indexed: 10/24/2022]
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18
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Chang L, Zhang L, Jia H, Nie Z, Zhang L. Malignancy in dermatomyositis: A retrospective paired case-control study of 202 patients from Central China. Medicine (Baltimore) 2020; 99:e21733. [PMID: 32846794 PMCID: PMC7447459 DOI: 10.1097/md.0000000000021733] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Dermatomyositis (DM) is an idiopathic inflammatory myopathy that is closely related to malignant diseases. Our study aims to investigate the incidence and predictive factors for occurrence of malignancy among DM patients from Central China.We performed a retrospective, paired, case-control study of 736 DM patients admitted to the First Affiliated Hospital of Zhengzhou University between 2010 and 2017. We paired the 65 patients with malignancy with age-matched and sex-matched patients without malignancy in a ratio of 1:2. Two hundred two patients were finally enrolled and their clinical and laboratory data were collected.The incidence of malignancy in DM patients was 8.83% (65/736). Most malignancies were detected in the most recent 1 year before (9/65, 13.85%) or within 3 years after (40/65, 61.54%) the onset of DM. Males (35/65, 53.85%) and patients aged between 50 and 69 years (43/65, 66.15%) were prone to develop malignancies. Lung cancer (n = 11, 31.43%) was the most common malignancy in male patients, while for females, thyroid, breast and cervical cancer (n = 4 each, 13.33%) were more prevalent. Adenocarcinoma and squamous cell carcinoma (both 18/65, 27.69%) were the top two most common pathological types. Univariate analysis demonstrated that Gottron's sign (P = .02), dysphagia (P = .04), albumin (ALB) reduction (P = .003), aspartate aminotransferase (AST, P = .03), creatine kinase-MB (P = .02), absence of fever (P = .02), arthralgia (P = .04) and interstitial lung disease (ILD, P = .05) were closely related to the occurrence of malignancy. Multivariate analysis revealed the independent risk factors of ALB reduction (odds ratio = 1.546, P = .04) and the protective factor of ILD (odds ratio = 0.349, P = .003). There was no significant difference in the follow-up period between patients with and without ILD (P = .38).ALB reduction and the absence of ILD were the risk factors for malignancy in DM patients. The protective mechanism of ILD for DM patients needs further study.
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Affiliation(s)
- Lili Chang
- Department of Oncology, the Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang Cancer Hospital, Anyang, Henan
- Department of Rheumatology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lina Zhang
- Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin
| | - Haiquan Jia
- Department of General Surgery, the Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang Cancer Hospital, Anyang
| | - Zhiyong Nie
- Department of Oncology, the Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang Cancer Hospital, Anyang, Henan
| | - Lei Zhang
- Department of Rheumatology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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19
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Moghadam-Kia S, Oddis CV, Ascherman DP, Aggarwal R. Risk Factors and Cancer Screening in Myositis. Rheum Dis Clin North Am 2020; 46:565-576. [DOI: 10.1016/j.rdc.2020.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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20
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Li L, Liu C, Cheng L, Yan S, Chen H, Li Y. Assessment of diagnostic utility, clinical phenotypic associations, and prognostic significance of anti-NXP2 autoantibody in patients with idiopathic inflammatory myopathies: a systematic review and meta-analysis. Clin Rheumatol 2020; 40:819-832. [PMID: 32681367 DOI: 10.1007/s10067-020-05291-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022]
Abstract
The objectives of this study are to analyze the association between anti-nuclear matrix protein 2 (NXP2) autoantibody and idiopathic inflammatory myopathies (IIMs) and to assess the diagnostic and prognostic relevance of anti-NXP2 autoantibody in patients with IIMs. A systematic search was performed in PubMed, Web of Science, EMBASE, the Cochrane Library, and Scopus to identify studies published as of February 29, 2020. Data was analyzed using Stata 12.0 and Meta-DiSc 1.4. Twenty-eight studies (4764 patients with IIMs and 1981 controls) were included in the meta-analysis. Anti-NXP2 autoantibody showed a significant association with IIMs (odds ratio (OR) = 26.36, 95% confidence interval (CI): 12.05-57.67, P < 0.001), especially juvenile IIMs (OR = 62.48, 95% CI: 16.97-229.98, P < 0.001). The pooled sensitivity, specificity, and area under the curve were 0.19 (95% CI = 0.16-0.21), 1.00 (95% CI = 1.00-1.00), and 0.95 for patients with juvenile IIMs versus controls. Anti-NXP2 autoantibody was associated with an increased risk of developing five characteristics (edema, muscle weakness, myalgia/myodynia, dysphagia, and calcinosis) and reduced risk of interstitial lung disease (ILD) (P < 0.001). Anti-NXP2 autoantibody showed no association with increased risk of death in IIMs (P = 0.463). These findings suggest that anti-NXP2 autoantibody is specially related to IIMs and is related to edema, muscle weakness, myalgia/myodynia, dysphagia, calcinosis, and ILD in patients with IIMs. However, there is no evidence to suggest that the presence of anti-NXP2 autoantibody confers a poor prognosis with respect to overall survival. Key Points • This study summarized the diagnostic and prognostic accuracies of anti-NXP2 autoantibody for patients with IIMs. Anti-NXP2 autoantibody is related to edema, muscle weakness, myalgia/myodynia, dysphagia, calcinosis, and ILD in patients with IIMs.
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Affiliation(s)
- Liubing Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Chenxi Liu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Linlin Cheng
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Songxin Yan
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Haizhen Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
- Department of Medical Laboratory, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - Yongzhe Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
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21
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Marco JL, Collins BF. Clinical manifestations and treatment of antisynthetase syndrome. Best Pract Res Clin Rheumatol 2020; 34:101503. [PMID: 32284267 DOI: 10.1016/j.berh.2020.101503] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Antisynthetase syndrome (ASyS) is an autoimmune disease clinically manifested most often by interstitial lung disease, myositis, and arthritis. Raynaud's syndrome, fever, and rashes are also commonly seen. This syndrome is characterized by the highly specific presence of antibodies against various aminoacyl transfer RNA synthetases, including Jo-1 and others. In this chapter, we provide an overview of ASyS, including pathogenesis, common clinical manifestations, and treatment strategies. We discuss the spectrum of disease seen with specific antisynthetase antibodies and examine the differences in phenotype between patients with different antisynthetase antibodies. We outline common treatment strategies, which should generally target the most severe and life- or organ-threatening disease manifestations. Finally, we discuss short- and long-term prognosis in ASyS.
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Affiliation(s)
- Joanna L Marco
- University of Washington, Department of Medicine, Division of Rheumatology, 1959 NE Pacific Street, Box 356428, Seattle, WA, 98195-6522, USA.
| | - Bridget F Collins
- University of Washington Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 1959 NE Pacific Street, Box 356166, Seattle, WA, 98195, USA.
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22
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Li L, Liu C, Wang Q, Wu C, Zhang Y, Cheng L, Wen X, Zeng X, Zhang F, Li Y. Analysis of myositis autoantibodies in Chinese patients with cancer-associated myositis. J Clin Lab Anal 2020; 34:e23307. [PMID: 32222002 PMCID: PMC7439325 DOI: 10.1002/jcla.23307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022] Open
Abstract
Background Cancer‐associated myositis (CAM) has poor prognosis and causes higher mortality. In general, myositis‐specific autoantibodies (MSAs) and myositis‐associated autoantibodies (MAAs) have been shown to be useful biomarkers for its diagnosis. Methods In the present study, focus was given in assessing the presence, prevalence, and diagnostic values of myositis autoantibodies in Chinese patients diagnosed with CAM. The sera collected from 49 CAM patients, 108 dermatomyositis/polymyositis (DM/PM) patients without cancer, 105 disease controls, and 60 healthy controls were detected for the presence of 16 autoantigens (Jo‐1, OJ, EJ, PL‐7, PL‐12, MDA5, TIF1γ, Mi‐2α, Mi‐2β, SAE1, NXP2, SRP, Ku, PM‐Scl75, PM‐Scl100, and Ro‐52) using a commercial Euroline assay. Results The frequency of anti‐TIF1γ was significantly higher in CAM patients than in DM/PM patients without cancer (46.9% vs 14.8%, P < .001). Importantly, the sensitivity and specificity for this MSA were 46.9% and 85.2%, respectively. These helped to differentiate CAM patients from DM/PM patients without cancer. However, there was no difference in other MSAs and MAAs between CAM and DM/PM patients without cancer. Conclusion The present study indicates that anti‐TIF1γ levels can serve as important biomarkers for CAM diagnosis and help in distinguishing between CAM and DM/PM patients without cancer.
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Affiliation(s)
- Liubing Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chenxi Liu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chanyuan Wu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanfang Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Department of Medical Laboratory, the First Hospital of Jilin University, Changchun, China
| | - Linlin Cheng
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoting Wen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongzhe Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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23
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French S, Lang U, Margaretten M. A 21-Year-Old Woman with Joint Pain and Skin Ulceration. Arthritis Care Res (Hoboken) 2020; 73:1553-1560. [PMID: 31961480 DOI: 10.1002/acr.24141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/07/2020] [Indexed: 11/05/2022]
Abstract
The illness started with pain and stiffness in her bilateral hands and wrists four months prior, with progression to bilateral elbows, knees, and ankles. The pain and stiffness were worse in the morning and limited her ability to use her hands or walk comfortably. She also noted swelling of her hands, knees, and ankles. The pain and swelling improved slightly with ibuprofen. She also noted increased fatigue, alopecia, decreased appetite, and nausea. She went to urgent care one month earlier and a physician prescribed ibuprofen and obtained initial serologies.
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Affiliation(s)
- Sarah French
- Division of Rheumatology, Department of Medicine, University of California San Francisco
| | - Ursula Lang
- Departments of Pathology and Dermatology, University of California San Francisco
| | - Mary Margaretten
- Division of Rheumatology, Department of Medicine, University of California San Francisco
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24
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The role of cancer-associated autoantibodies as biomarkers in paraneoplastic myositis syndrome. Curr Opin Rheumatol 2019; 31:643-649. [DOI: 10.1097/bor.0000000000000641] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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25
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De Andrea M, De Santis M, Caneparo V, Generali E, Sirotti S, Isailovic N, Guidelli GM, Ceribelli A, Fabbroni M, Simpatico A, Cantarini L, Gisondi P, Idolazzi L, Gariglio M, Selmi C. Serum IFI16 and anti-IFI16 antibodies in psoriatic arthritis. Clin Exp Immunol 2019; 199:88-96. [PMID: 31571199 DOI: 10.1111/cei.13376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 12/19/2022] Open
Abstract
Nuclear interferon-inducible protein 16 (IFI16) and anti-IFI16 antibodies have been detected in subjects with several rheumatic diseases, often correlating with disease severity, and in this study we investigated their prevalence and clinical associations in psoriatic arthritis (PsA) compared to psoriasis (Pso). We tested sera and synovial fluids of patients with PsA for IFI16 protein levels by capture enzyme-linked immunosorbent assay (ELISA) and for anti-IFI16 immunoglobulin (Ig)G and IgA by ELISA, protein radio-immunoprecipitation and immunoprecipitation-Western blot of IgG. Sera from patients with Pso and healthy subjects were used as controls, and in a subgroup of patients with PsA we also studied sera after treatment with etanercept. IFI16 was detectable in the sera of 66% of patients with Pso, 46% with PsA and 19% of controls. Among PsA cases, 51% of IFI16-positive cases had elevated levels of C-reactive protein (CRP) compared to 31% of patients with undetectable IFI16. Anti-IFI16 of both IgG and IgA isoforms were detected with significantly higher frequency in PsA and Pso compared to healthy controls, with higher IgG titres in patients with elevated C-reactive protein (CRP) (P = 0·015). Immunoprecipitation confirmed the presence of anti-IFI16 IgG antibodies and these preferentially recognized epitopes outside the N-terminus of the protein. Lastly, IFI16 was detected in one of seven and anti-IFI16 in three of seven synovial fluids from patients with PsA. Therefore, IFI16 and anti-IFI16 are detectable in serum and synovial fluid of PsA patients, especially in cases of elevated CRP.
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Affiliation(s)
- M De Andrea
- Department of Public Health and Paediatric Sciences, Turin Medical School, Turin, Italy.,Department of Translational Medicine, Novara Medical School, Novara, Italy.,Intrinsic Immunity Unit, CAAD, Center for Translational Research on Autoimmune and Allergic Diseases, University of Piemonte Orientale, Novara, Italy
| | - M De Santis
- Rheumatology and Clinical Immunology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - V Caneparo
- Department of Public Health and Paediatric Sciences, Turin Medical School, Turin, Italy.,Department of Translational Medicine, Novara Medical School, Novara, Italy.,Intrinsic Immunity Unit, CAAD, Center for Translational Research on Autoimmune and Allergic Diseases, University of Piemonte Orientale, Novara, Italy
| | - E Generali
- Rheumatology and Clinical Immunology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - S Sirotti
- Rheumatology and Clinical Immunology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - N Isailovic
- Rheumatology and Clinical Immunology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - G M Guidelli
- Rheumatology and Clinical Immunology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - A Ceribelli
- Rheumatology and Clinical Immunology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - M Fabbroni
- Department of Rheumatology, University of Siena, Siena, Italy
| | - A Simpatico
- Department of Rheumatology, University of Siena, Siena, Italy
| | - L Cantarini
- Department of Rheumatology, University of Siena, Siena, Italy
| | - P Gisondi
- Department of Dermatology, University of Verona, Verona, Italy
| | - L Idolazzi
- Department of Rheumatology, University of Verona, Verona, Italy
| | - M Gariglio
- Department of Translational Medicine, Novara Medical School, Novara, Italy.,Intrinsic Immunity Unit, CAAD, Center for Translational Research on Autoimmune and Allergic Diseases, University of Piemonte Orientale, Novara, Italy
| | - C Selmi
- Rheumatology and Clinical Immunology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy.,Humanitas University, Rozzano, Milan, Italy
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26
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de Souza FHC, de Araújo DB, Vilela VS, Simões RS, Bernardo WM, Frank TA, da Cunha BM, Shinjo SK. The Brazilian Society of Rheumatology recommendations on investigation and diagnosis of systemic autoimmune myopathies. Adv Rheumatol 2019; 59:42. [PMID: 31601261 DOI: 10.1186/s42358-019-0085-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This research is recommended by the Myopathy Committee of the Brazilian Society of Rheumatology for the investigation and diagnosis of systemic autoimmune myopathies. BODY: A systematic literature review was performed in the Embase, Medline (PubMed) and Cochrane databases, including studies published until October 2018. PRISMA was used for the review, and the articles were evaluated, based on the Oxford levels of evidence. Ten recommendations were developed addressing different aspects of systemic autoimmune myopathy investigation and diagnosis. CONCLUSIONS The European League Against Rheumatism/ American College of Rheumatology (EULAR/ACR) classification stands out for the diagnosis of systemic autoimmune myopathies. Muscular biopsy is essential, aided by muscular magnetic resonance images and electroneuromyography in complementary research. Analysis of the factors related to prognosis with the evaluation of extramuscular manifestations, and comorbidities and intense investigation regarding differential diagnoses are mandatory.
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Affiliation(s)
| | | | | | - Ricardo Santos Simões
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | | | - Thais Amanda Frank
- Programa Diretrizes da Associação Médica Brasileira (AMB), Brasília, Brazil
| | | | - Samuel Katsuyuki Shinjo
- Disciplina de Reumatologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3150, Sao Paulo, Cerqueira César, CEP: 01246-903, Brazil.
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27
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Abstract
The discovery of novel autoantigen systems related to idiopathic inflammatory myopathies (collectively referred to as myositis) in adults and children has had major implications for the diagnosis and management of this group of diseases across a wide range of medical specialties. Traditionally, autoantibodies found in patients with myositis are described as being myositis-specific autoantibodies (MSAs) or myositis-associated autoantibodies (MAAs), depending on their prevalence in other, related conditions. However, certain MSAs are more closely associated with extramuscular manifestations, such as skin and lung disease, than with myositis itself. It is very rare for more than one MSA to coexist in the same individual, underpinning the potential to use MSAs to precisely define genetic and disease endotypes. Each MSA is associated with a distinctive pattern of disease or phenotype, which has implications for diagnosis and a more personalized approach to therapy. Knowledge of the function and localization of the autoantigenic targets for MSAs has provided key insights into the potential immunopathogenic mechanisms of myositis. In particular, evidence suggests that the alteration of expression of a myositis-related autoantigen by certain environmental influences or oncogenesis could be a pivotal event linking autoantibody generation to the development of disease.
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28
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Acute myositis: an unusual and severe side effect of docetaxel: a case report and literature review. Anticancer Drugs 2019; 29:477-481. [PMID: 29561309 DOI: 10.1097/cad.0000000000000620] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Docetaxel is an antimicrotubules cytotoxic agent prescribed widely by medical oncologists in multiple tumor types (breast, lung, prostate, stomach, head, and neck). However, the side effects of docetaxel are numerous (cytopenia, peripheral edema, myalgia, arthralgia, alopecia, and sensitive neuropathy) and recent concerns have been raised about neutropenic enterocolitis in France. Here, we report the case of a 57-year-old patient with metastatic prostatic cancer, who developed a severe myositis and fasciitis grade IV 1 week after his second docetaxel infusion. We reviewed the five cases of docetaxel-related myositis described in the literature, and found that most of them occurred in patients with diabetes (n=5/5) or hypertension (n=4/5). A vascular toxicity may explain this severe complication, and patients with diabetes or hypertension should be monitored closely in the context of a docetaxel chemotherapy.
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29
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Zhong L, Yu Z, Song H. Association of anti-nuclear matrix protein 2 antibody with complications in patients with idiopathic inflammatory myopathies: A meta-analysis of 20 cohorts. Clin Immunol 2019; 198:11-18. [DOI: 10.1016/j.clim.2018.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/10/2018] [Accepted: 11/11/2018] [Indexed: 12/31/2022]
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30
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Hoesly PM, Sluzevich JC, Jambusaria-Pahlajani A, Lesser ER, Heckman MG, Abril A. Association of antinuclear antibody status with clinical features and malignancy risk in adult-onset dermatomyositis. J Am Acad Dermatol 2018; 80:1364-1370. [PMID: 30458207 DOI: 10.1016/j.jaad.2018.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/04/2018] [Accepted: 11/10/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND The clinical significance of antinuclear antibody (ANA) status in adults with dermatomyositis (DM) has yet to be fully defined. OBJECTIVE We compared the incidence of amyopathic disease, risk of malignancy, and clinical findings in ANA+ and ANA- patients with adult-onset DM. METHODS This was a retrospective cohort study of patients with ANA+ or ANA- adult-onset DM determined by enzyme-linked immunosorbent assay. RESULTS Of 231 patients, 140 (61%) were ANA+ and 91 (39%) were ANA-. Compared with the ANA- patients, the ANA+ patients had a lower frequency of dysphagia (15% vs 26% [P = .033]) and heliotrope rash (38% vs 53% [P = .026]). In all, 54 patients (23%) developed malignancy within 3 years of diagnosis of their DM; 11% of the ANA+ patients developed malignancy versus 43% of the ANA- patients (P < .001). There was a strong association between ANA positivity and lower likelihood of malignancy in multivariable analysis (odds ratio, 0.16; P < .001). Conversely, ANA positivity was not associated with amyopathic disease (odds ratio, 0.94; P = .87). LIMITATIONS The retrospective nature of the study was a limitation. CONCLUSION In patients with adult-onset DM, ANA negativity is associated with increased likelihood of development of malignancy within 3 years of diagnosis of their DM. Particularly close follow-up and frequent malignancy screening may be warranted in ANA- individuals with DM.
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Affiliation(s)
- Paul M Hoesly
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida.
| | | | - Anokhi Jambusaria-Pahlajani
- Department of Internal Medicine, Division of Dermatology, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Elizabeth R Lesser
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Andy Abril
- Department of Rheumatology, Mayo Clinic, Jacksonville, Florida
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Abstract
To date, increasing numbers of myositis-specific autoantibodies (MSAs) have been reported and their clinical significance has been elucidated. Anti-aminoacyl-tRNA synthetase (ARS) and anti-melanoma-differentiation associated gene 5 (MDA5) are strongly associated with interstitial lung disease (ILD); however, the clinical course of ILD is different depending on which autoantibody is present. Anti-ARS is associated with chronic and repetitive ILD and anti-MDA5 is associated with rapidly progressive ILD. Anti-MDA5, anti-transcriptional intermediary factor (TIF) 1-γ, anti-nuclear matrix protein (NXP) 2 and anti-Mi-2 antibodies are dermatomyositis specific. Anti-TIF1-γ and anti-NXP-2 antibodies are associated with malignancy, and anti-signal recognition particle (SRP) and anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies are associated with immune-mediated necrotizing myopathy (IMNM). Prognosis is also different among MSA-positive patient groups. Thus, MSAs are of great use for predicting disease course, prognosis, and determining therapeutic strategy as well as the diagnosis of idiopathic inflammatory myopathy (IIM) patients. Investigation of the pathogenic role of MSAs and their corresponding autoantigens will help us to understand the pathophysiology of IIM and identify new therapeutic targets.
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Affiliation(s)
- Ran Nakashima
- a Department of Rheumatology and Clinical Immunology , Graduate School of Medicine, Kyoto University , Kyoto , Japan
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Liu Y, Xu L, Wu H, Zhao N, Tang Y, Li X, Liang Y. Characteristics and predictors of malignancy in dermatomyositis: Analysis of 239 patients from northern China. Oncol Lett 2018; 16:5960-5968. [PMID: 30344746 PMCID: PMC6176340 DOI: 10.3892/ol.2018.9409] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/10/2018] [Indexed: 01/08/2023] Open
Abstract
The present study aimed to determine the characteristics of patients with dermatomyositis (DM) in order to identify predictors of cancer in these patients. Data of 239 patients with DM, treated at Yuhuangding Hospital between 1997 and 2016, was retrospectively assessed. The patients' demographic, clinical, survival and laboratory data were analyzed. Of the 239 patients, 43 developed malignancies. In 30 (69.77%) patients, the malignancy was detected within 1 year before or after DM diagnosis. There were 15 (34.88%) fatalities. Lung cancer was the most common type of malignancy identified (n=6, 13.95%), and adenocarcinoma was the most common pathological type (n=6, 13.95%). Older age, absence of interstitial lung disease, and absence of arthralgia were demonstrated to be independent risk factors for malignancy. Myositis-specific autoantibody expression, specifically anti-TIF1γ positivity and/or anti-MDA5 negativity, was associated with cancer in patients with DM. The survival rate was significantly lower in patients with malignancy than in patients without malignancy. Patients with DM had a high incidence of malignancy and a poor prognosis. Lung cancer and adenocarcinoma are common among patients with DM in northern China. Cancer screening should be conducted in all DM patients, particularly within 1 year of DM diagnosis. Older age is a risk factor for malignancy in DM patients, while interstitial lung disease and arthralgia are protective factors. Myositis-specific autoantibody detection may be useful for cancer screening in patients with DM.
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Affiliation(s)
- Ying Liu
- Department of Rheumatology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Lulu Xu
- Department of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Hongliang Wu
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Na Zhao
- Department of Rheumatology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Yanchun Tang
- Department of Rheumatology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Xiaoping Li
- Department of Pneumology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Ying Liang
- Department of Rheumatology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
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34
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Calcinosis and malignancy are rare in Chinese adult patients with myositis and nuclear matrix protein 2 antibodies identified by an unlabeled immunoprecipitation assay. Clin Rheumatol 2018; 37:2731-2739. [PMID: 30039266 DOI: 10.1007/s10067-018-4216-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/06/2018] [Accepted: 07/12/2018] [Indexed: 01/29/2023]
Abstract
Autoantibodies in patients with myositis may associate with specific clinical manifestations. This study aimed to identify a subset of patients with myositis carrying antinuclear matrix protein 2 (anti-NXP-2) antibodies using an unlabeled immunoprecipitation (IP) assay, and clarify the features of these patients in a Chinese cohort. We developed novel methods for unlabeled protein IP and immunoblotting of Myc-tagged truncated NXP-2 fragments for anti-NXP-2 detection. The sera of 120 Chinese adult patients with myositis were screened for anti-NXP-2 by IP and immunoblot. Anti-NXP-2 antibodies were detected in 10 of the 120 patients (8.3%) using the established unlabeled protein IP and immunoblotting, with 70% (7/10) exhibiting either heliotrope rash or Gottron's papules. All 10 anti-NXP-2-positive patients exhibited myopathy and 60% complained of dysphagia. Severe diffuse calcinosis (10%) and nasopharyngeal carcinoma (10%) were each only present in single anti-NXP-2-positive patients with myositis. Antibodies against Ro-52 were found in four living but not in three deceased anti-NXP-2-positive patients. A comprehensive review of 13 anti-NXP-2 studies demonstrated markedly lower anti-NXP-2 prevalence among adult patients with myositis and lower association of anti-NXP-2 with calcinosis in Japan, China, and Hungary than in the USA and Italy. Anti-NXP-2 antibody association with internal malignancy in adult patients varied from 0 to 50% across different studies. A novel IP assay was developed to detect patients with myositis expressing anti-NXP-2. Calcinosis and malignancy are rare in Chinese adult patients with myositis positive for anti-NXP-2. Literature review indicated highest anti-NXP-2 prevalence and association of anti-NXP-2 with calcinosis in US and Italian myositis cohorts.
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Chen H, Peng Q, Yang H, Yin L, Shi J, Zhang Y, Wang G. Increased Levels of Soluble Programmed Death Ligand 1 Associate with Malignancy in Patients with Dermatomyositis. J Rheumatol 2018; 45:835-840. [DOI: 10.3899/jrheum.170544] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 01/01/2023]
Abstract
Objective.To investigate the levels of soluble programmed death ligand 1 (sPD-L1) and evaluate its association with malignancy in patients with dermatomyositis (DM).Methods.Levels of sPD-L1 were measured in serum from 88 DM patients without malignancies (sDM), 40 with cancer-related DM (CRDM), and 30 healthy controls (HC) using ELISA. The CRDM subjects were divided into new-onset cancers (nCRDM) and stable cancers (sCRDM). Receiver-operating characteristic (ROC) curve analysis was performed to determine the cutoff sPD-L1 value that distinguished patients with nCRDM from those who were sDM. Serum antitranscriptional intermediary factor 1-γ (TIF1-γ) antibodies were detected using immunoblot, and the diagnostic values for malignancy were compared with sPD-L1 levels in patients with DM.Results.Serum sPD-L1 levels were significantly higher in sDM [median 12.3 ng/ml, interquartile range (IQR) 8.4–16.2] than in HC (median 1.3 ng/ml, IQR 0.4–2.2, p = 0.0001). Extremely high sPD-L1 levels were seen in nCRDM (median 18.5 ng/ml, IQR 13.8–22.4), much higher than those in sCRDM (median 8.5 ng/ml, IQR 6.8–11.8, p = 0.0001). The sPD-L1 levels in 4 patients with nCRDM decreased after curative cancer treatment (p = 0.013). ROC curve analysis revealed that the sPD-L1 value distinguishing nCRDM from sDM was 16.1 ng/ml, with an area under the curve value of 0.72 ± 0.04 (p = 0.0001). The combination of sPD-L1 and anti-TIF1-γ antibodies yielded greater specificity and positive predictive value in diagnosing cancer, reaching values of 95% and 70%, respectively.Conclusion.Serum sPD-L1 levels increased significantly in sDM, and markedly high sPD-L1 levels could be a diagnostic indicator for malignancies in patients with DM, especially in those with anti-TIF1-γ antibodies.
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Best M, Jachiet M, Molinari N, Manna F, Girard C, Pallure V, Cosnes A, Lipsker D, Hubiche T, Schmutz JL, Le Corre Y, Cordel N, Dandurand M, Dereure O, Guillot B, Du-Thanh A, Bulai Livideanu C, Chasset F, Bouaziz JD, Francès C, Bengoufa D, Vincent T, Bessis D. Distinctive cutaneous and systemic features associated with specific antimyositis antibodies in adults with dermatomyositis: a prospective multicentric study of 117 patients. J Eur Acad Dermatol Venereol 2018; 32:1164-1172. [PMID: 29237090 DOI: 10.1111/jdv.14759] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/29/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Identification of myositis-specific autoantibodies (MSAs) for dermatomyositis (DM) could allow the characterization of an antibody-associated clinical phenotype. OBJECTIVE We sought to define the clinical phenotype of DM and the risk of cancer, interstitial lung disease (ILD) and calcinosis based on MSA. METHODS A 3.5-year multicentre prospective study of adult DM patients was conducted to determine the clinical phenotype associated with MSAs and the presence of cancer, ILD and calcinosis. RESULTS MSAs were detected in 47.1% of 117 included patients. Patients with antimelanoma differentiation-associated protein-5 antibodies (13.7%) had significantly more palmar violaceous macules/papules [odds ratio (OR) 9.9], mechanic's hands (OR 8), cutaneous necrosis (OR 3.2), articular involvement (OR 15.2) and a higher risk of ILD (OR 25.3). Patients with antitranscriptional intermediary factor-1 antibodies (11.1%), antinuclear matrix protein-2 antibodies (6.8%) and antiaminoacyl-transfer RNA synthetase (5.1%) had, respectively, significantly more poikiloderma (OR 5.9), calcinosis (OR 9.8) and articular involvement (OR 15.2). Cutaneous necrosis was the only clinical manifestation significantly associated with cancer (OR 3.1). CONCLUSION Recognition of the adult DM phenotype associated with MSAs would allow more accurate appraisal of the risk of cancer, ILD and calcinosis.
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Affiliation(s)
- M Best
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France
| | - M Jachiet
- Department of Dermatology, AP-HP, University of Paris VII Sorbonne Paris City and Saint-Louis Hospital, Paris, France
| | - N Molinari
- Department of Statistics, Montpellier University Hospital, Montpellier, France.,IMAG, CNRS, University of Montpellier, Montpellier, France
| | - F Manna
- Department of Statistics, Montpellier University Hospital, Montpellier, France
| | - C Girard
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France
| | - V Pallure
- Department of Internal Medicine and Dermatology, Perpignan Hospital, Perpignan, France
| | - A Cosnes
- Department of Dermatology, Henri-Mondor Hospital, Créteil, France
| | - D Lipsker
- Faculty of Medicine, University of Strasbourg and Dermatologic Clinic, Strasbourg University Hospital, Strasbourg, France
| | - T Hubiche
- Department of Dermatology and Infectious Diseases, Fréjus Hospital, Fréjus, France
| | - J-L Schmutz
- Department of Dermatology, Brabois Hospital, Nancy University Hospital, Nancy, France
| | - Y Le Corre
- Department of Dermatology, Angers University Hospital, Angers, France
| | - N Cordel
- Unit of Dermatology and Internal Medicine, Guadeloupe University Hospital, Pointe-à-Pitre, Guadeloupe, France
| | - M Dandurand
- Department of Dermatology, Caremeau Hospital, Nîmes, France
| | - O Dereure
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1058, Montpellier, France
| | - B Guillot
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1058, Montpellier, France
| | - A Du-Thanh
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1058, Montpellier, France
| | - C Bulai Livideanu
- Department of Dermatology, Toulouse University Hospital, Toulouse, France
| | - F Chasset
- AP-HP, Department of Dermatology and Allergology, Faculty of Medicine, Tenon Hospital, Sorbonne University, Paris, France
| | - J-D Bouaziz
- Department of Dermatology, AP-HP, University of Paris VII Sorbonne Paris City and Saint-Louis Hospital, Paris, France
| | - C Francès
- AP-HP, Department of Dermatology and Allergology, Faculty of Medicine, Tenon Hospital, Sorbonne University, Paris, France
| | - D Bengoufa
- Department of Immunology, Saint-Louis Hospital, Paris, France
| | - T Vincent
- Department of Immunology, Saint Eloi Hospital, and Montpellier University, Montpellier, France
| | - D Bessis
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1058, Montpellier, France
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Ceribelli A, Isailovic N, De Santis M, Generali E, Satoh M, Selmi C. Detection of anti-mitochondrial antibodies by immunoprecipitation in patients with systemic sclerosis. J Immunol Methods 2017; 452:1-5. [PMID: 28986201 DOI: 10.1016/j.jim.2017.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe a new immunoprecipitation pattern identified in Italian patients affected by systemic sclerosis (SSc), corresponding to the pyruvate dehydrogenase antigen complex recognized by anti-mitochondrial antibodies (AMA) in primary biliary cholangitis (PBC). METHODS Autoantibodies in sera from 85 patients with SSc were tested by protein- and RNA-immunoprecipitation. Immunoprecipitation-Western blot was used to determine the identified proteins, and medical records re-evaluated for liver function tests and PBC. RESULTS In 13/85 (15%) SSc sera, a unique set of 75-50-40-34kD proteins that had not been previously reported, was noted. The four proteins were identified as the proteins X/E3BP, E1α, E1β, and E2/E3 of the pyruvate dehydrogenase antigen complex by immunoprecipitation-Western blot. From clinical record evaluation, 9/13 (69%) SSc patients with this new pattern were positive for AMA by routine indirect immunofluorescence, and 7/13 (54%) had a diagnosis of PBC, while 4/13 (31%) manifested no biochemical signs of cholestasis. Twelve of 13 patients with SSc and AMA by immunoprecipitation have a limited cutaneous form of SSc and anti-centromere antibodies. CONCLUSIONS We describe a pattern of 4 proteins in 15% of SSc patients, identified for the first time by protein-immunoprecipitation. This pattern corresponds to serum AMA against the pyruvate dehydrogenase antigen complex and it must be considered in the interpretation of protein-immunoprecipitation results.
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Affiliation(s)
- Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Laboratory of Autoimmunity and Metabolism, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Natasa Isailovic
- Division of Rheumatology and Clinical Immunology, Laboratory of Autoimmunity and Metabolism, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Laboratory of Autoimmunity and Metabolism, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elena Generali
- Division of Rheumatology and Clinical Immunology, Laboratory of Autoimmunity and Metabolism, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Laboratory of Autoimmunity and Metabolism, Humanitas Research Hospital, Rozzano, Milan, Italy; BIOMETRA Department, University of Milan, Italy.
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Sirotti S, Generali E, Ceribelli A, Isailovic N, De Santis M, Selmi C. Personalized medicine in rheumatology: the paradigm of serum autoantibodies. AUTOIMMUNITY HIGHLIGHTS 2017; 8:10. [PMID: 28702930 PMCID: PMC5507804 DOI: 10.1007/s13317-017-0098-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/04/2017] [Indexed: 02/08/2023]
Abstract
The sequencing of the human genome is now well recognized as the starting point of personalized medicine. Nonetheless, everyone is unique and can develop different phenotypes of the same disease, despite identical genotypes, as well illustrated by discordant monozygotic twins. To recognize these differences, one of the easiest and most familiar examples of biomarkers capable of identifying and predicting the outcome of patients is represented by serum autoantibodies. In this review, we will describe the concept of personalized medicine and discuss the predictive, prognostic and preventive role of antinuclear antibodies (ANA), anti-citrullinated peptide antibodies (ACPA), rare autoantibodies and anti-drug antibodies (ADA), to evaluate how these can help to identify different disease immune phenotypes and to choose the best option for treating and monitoring rheumatic patients in everyday practice. The importance of ANA resides in the prediction of clinical manifestations in systemic sclerosis and systemic lupus erythematosus and their association with malignancies. ACPA have a predictive role in rheumatoid arthritis, they are associated with the development of a more aggressive disease, extra-articular manifestations and premature mortality in RA patients; moreover, they are capable of predicting therapeutic response. Rare autoantibodies are associated with different disease manifestations and also with a greater incidence of cancer. The determination of ADA levels may be useful in patients where the clinical efficacy of TNF-α inhibitor has dropped, for the assessment of a right management. The resulting scenario supports serum autoantibodies as the cornerstone of personalized medicine in autoimmune diseases.
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Affiliation(s)
- Silvia Sirotti
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Elena Generali
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Natasa Isailovic
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy. .,BIOMETRA Department, University of Milan, Milan, Italy.
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Abstract
The terms 'lichenoid' and 'interface' dermatitis are often used interchangeably to describe an inflammatory pattern characterized histologically by damage to the basal keratinocytes in the epidermis. The mechanism of cell damage of such cells is now best understood as apoptosis, or programmed cell death. This inflammatory pattern of dermatoses, is also accompanied frequently by a band of lymphocytes and histiocytes in the superficial dermis, that often obscures the dermal-epidermal junction, hence the term 'lichenoid'. A discussion of the more common lichenoid/interface dermatitides encountered in the routine clinical practice encompasses the following entities: lichen planus, lupus erythematosus, dermatomyositis, erythema multiforme, graft versus host disease, fixed drug reactions, and multiple others.
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Affiliation(s)
- Alejandro A Gru
- Department of Pathology & Dermatology, University of Virginia, Charlottesville, VA, Unitee States.
| | - Andrea L Salavaggione
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, United States
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