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Khoo T, Lilleker JB, Thong BYH, Leclair V, Lamb JA, Chinoy H. Epidemiology of the idiopathic inflammatory myopathies. Nat Rev Rheumatol 2023; 19:695-712. [PMID: 37803078 DOI: 10.1038/s41584-023-01033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/08/2023]
Abstract
The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of systemic autoimmune diseases that affect the skeletal muscles and can also involve the skin, joints, lungs and heart. The epidemiology of IIM is obscured by changing classification criteria and the inherent shortcomings of case identification using healthcare record diagnostic coding. The incidence of IIM is estimated to range from 0.2 to 2 per 100,000 person-years, with prevalence from 2 to 25 per 100,000 people. Although the effects of age and gender on incidence are known, there is only sparse understanding of ethnic differences, particularly in indigenous populations. The incidence of IIM has reportedly increased in the twenty-first century, but whether this is a genuine increase is not yet known. Understanding of the genetic risk factors for different IIM subtypes has advanced considerably. Infections, medications, malignancy and geography are also commonly identified risk factors. Potentially, the COVID-19 pandemic has altered IIM incidence, although evidence of this occurrence is limited to case reports and small case series. Consideration of the current understanding of the epidemiology of IIM can highlight important areas of interest for future research into these rare diseases.
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Affiliation(s)
- Thomas Khoo
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neuroscience, Manchester Academic Health Science Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Valérie Leclair
- Department of Medicine, Division of Rheumatology, McGill University, Montreal, Canada
| | - Janine A Lamb
- Epidemiology and Public Health Group, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
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Chhor L, Tu S, Fogarty P, Fong C. Antisynthetase syndrome with rare EJ-1 antibodies with antiphospholipid syndrome. Respirol Case Rep 2022; 10:e0990. [PMID: 35734553 PMCID: PMC9194464 DOI: 10.1002/rcr2.990] [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: 03/24/2022] [Accepted: 05/30/2022] [Indexed: 11/06/2022] Open
Abstract
We describe the first case of antisynthetase syndrome (ASS) with antibodies to anti-glycyl tRNA synthetase (EJ-1) with antiphospholipid syndrome (APLS). A 66-year-old man presented with progressive dyspnoea, fever, dry cough and proximal muscle weakness over several months on a background of cryptogenic organizing pneumonia. Examination revealed bibasal fine chest crackles, proximal muscle weakness of the upper and lower limbs, digital skin thickening and facial telangiectasias. Creatine kinase was elevated and autoimmune screening was positive for anti-EJ-1, anti-beta-2-glycoprotein, anti-Ro and anti-La antibodies. Computed tomography of the chest revealed a usual interstitial pneumonia pattern and a ventilation-perfusion scan demonstrated scintigraphic evidence of bilateral pulmonary emboli. A diagnosis of ASS and APLS was made. Immunosuppressive therapy including pulsed methylprednisolone, rituximab and mycophenolate was commenced with improvement in symptoms. This case highlights the importance of evaluation for ASS in idiopathic interstitial pneumonia, and APLS in ASS patients.
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Affiliation(s)
- Louis Chhor
- Department of RheumatologyEastern HealthBox HillVictoriaAustralia
| | - Steven Tu
- Department of RheumatologyEastern HealthBox HillVictoriaAustralia
| | - Paul Fogarty
- Department of Respiratory and Sleep MedicineEastern HealthBox HillVictoriaAustralia
| | - Christopher Fong
- Department of RheumatologyEastern HealthBox HillVictoriaAustralia
- Eastern Health Clinical School, Monash UniversityClaytonVictoriaAustralia
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Sambataro G, Ferrara CA, Spadaro C, Torrisi SE, Vignigni G, Vancheri A, Muscato G, Del Papa N, Colaci M, Malatino L, Palmucci S, Cavagna L, Zanframundo G, Ferro F, Baldini C, Sambataro D, Vancheri C. A New Method for the Assessment of Myalgia in Interstitial Lung Disease: Association with Positivity for Myositis-Specific and Myositis-Associated Antibodies. Diagnostics (Basel) 2022; 12:1139. [PMID: 35626295 PMCID: PMC9140063 DOI: 10.3390/diagnostics12051139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023] Open
Abstract
In this study, it was found that myositis-specific and myositis-associated antibodies (MSAs and MAAs) improved the recognition of idiopathic inflammatory myopathies (IIMs) in interstitial lung disease (ILD) patients. The objective of this study is to propose a clinical method to evaluate myalgia in respiratory settings as a possible tool for the recognition of MSA/MAA positivity in ILD patients. We prospectively enrolled 167 ILD patients with suspected myositis, of which 63 had myalgia evoked at specific points (M+ILD+). We also enrolled in a 174 patients with only myalgia (M+ILD-) in a rheumatological setting. The patients were assessed jointly by rheumatologists and pulmonologists and were tested for autoantibodies. M+ILD+ patients were positive for at least one MAA/MSA in 68.3% of cases, as were M-ILD+ patients in 48.1% of cases and M+ILD- patients in 17.2% of cases (p = 0.01 and <0.0001, respectively). A diagnosis of IIM was made in 39.7% of M+ILD+ patients and in 23.1% of the M-ILD+ group (p = 0.02). Myalgia was significantly associated with positivity for MSA/MAAs in ILD patients (p = 0.01, X2: 6.47). In conclusion, myalgia in ILD patients with suspected myositis is associated with MSA/MAA positivity, and could support a diagnosis of IIM. A significant proportion of M+ILD- patients also had MSA/MAA positivity, a phenomenon warranting further study to evaluate its clinical meaning.
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Affiliation(s)
- Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
- Outpatient Clinic of Rheumatology, Artroreuma S.R.L., Corso S. Vito 53, 95030 Mascalucia (CT), Italy;
| | - Chiara Alfia Ferrara
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Carla Spadaro
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Sebastiano Emanuele Torrisi
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Giovanna Vignigni
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Ada Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Giuseppe Muscato
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Nicoletta Del Papa
- Day Hospital of Rheumatology, Department of Rheumatology, ASST G.Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy;
| | - Michele Colaci
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Via Messina 829, 95100 Catania, Italy; (M.C.); (L.M.)
| | - Lorenzo Malatino
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Via Messina 829, 95100 Catania, Italy; (M.C.); (L.M.)
| | - Stefano Palmucci
- Department of Medical, Surgical Sciences and Advanced Technologies, “G.F. Ingrassia”, University of Catania, Via S. Sofia 68 Catania, 95123 Catania, Italy;
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Piazzale C. Golgi 19, 27100 Pavia, Italy; (L.C.); (G.Z.)
| | - Giovanni Zanframundo
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Piazzale C. Golgi 19, 27100 Pavia, Italy; (L.C.); (G.Z.)
| | - Francesco Ferro
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Via Roma 24, 56126 Pisa, Italy; (F.F.); (C.B.)
| | - Chiara Baldini
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Via Roma 24, 56126 Pisa, Italy; (F.F.); (C.B.)
| | - Domenico Sambataro
- Outpatient Clinic of Rheumatology, Artroreuma S.R.L., Corso S. Vito 53, 95030 Mascalucia (CT), Italy;
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
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