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Kannappan R, Kumar R, Cichelli K, Brent LH. A Review of Myositis-Associated Interstitial Lung Disease. J Clin Med 2024; 13:4055. [PMID: 39064092 PMCID: PMC11278012 DOI: 10.3390/jcm13144055] [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: 05/22/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
There is a well-established relationship between different subsets of idiopathic inflammatory myopathies (IIMs, myositis) and interstitial lung disease (ILD), with lung complications sometimes presenting prior to myopathic manifestations. The subtypes of myositis include those that are strongly associated with ILD, such as polymyositis (PM) and dermatomyositis (DM). Research has shown that in certain patients, these can then be further divided into subtypes using myositis-specific antibodies (MSAs), which are specific for myositis, and myositis-associated antibodies (MAAs), which can be found in myositis in overlap syndromes with other connective tissue diseases (CTDs). Notably, certain MSAs and MAAs are associated with ILD in patients with myositis. The clinical presentations of ILD in patients with myositis can vary widely and can be insidious in onset and difficult to diagnose. As ILD can progress rapidly in some cases, it is essential that clinicians are able to identify and diagnose ILD in patients with myositis. For this reason, the aim of this review is to highlight the clinical features, diagnostic criteria, important histopathologic, laboratory, and radiographic features, and treatment modalities for those patients with myositis-associated ILD.
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Affiliation(s)
- Renuka Kannappan
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Raagni Kumar
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Kimberly Cichelli
- Section of Rheumatology, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Lawrence H. Brent
- Section of Rheumatology, Temple University Hospital, Philadelphia, PA 19140, USA
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2
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Nies JF, Krusche M. [Fever in rheumatological diseases]. Z Rheumatol 2024; 83:341-353. [PMID: 38634905 DOI: 10.1007/s00393-024-01505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 04/19/2024]
Abstract
Fever is a frequent and important symptom in patients with rheumatological diseases and can be an expression of activity of the underlying rheumatological disease. There is great variability in the incidence of fever as a symptom of the disease between individual diseases. The growing understanding of the molecular signatures of the diseases can help to explain these discrepancies: A genetic overactivation of potently pyrogenic cytokines is the reason why fever is nearly always present in autoinflammatory syndromes. In contrast, fever is less common in polyarthritis and myositis and mostly limited to severe courses of disease. In the diagnostic work-up of fever, frequent differential diagnoses, such as infections, malignancies, side effects of drugs and hypersensitivity reactions should be considered. This article provides an overview of the physiology of the development of fever, describes the relevance of fever in individual rheumatological diseases and proposes a workflow for the clinical clarification of rheumatological patients who present with fever.
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Affiliation(s)
- Jasper F Nies
- Klinik II für Innere Medizin: Nephrologie, Rheumatologie, Diabetologie und Allgemeine Innere Medizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Martin Krusche
- III. Medizinische Klinik und Poliklinik für Nephrologie, Rheumatologie und Endokrinologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
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Evaluation of Interstitial Lung Disease in Idiopathic Inflammatory Myopathies Through Semiquantitative and Quantitative Analysis of Lung Computed Tomography. J Thorac Imaging 2022; 37:344-351. [PMID: 35576535 DOI: 10.1097/rti.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To perform a semiquantitative and quantitative analysis of interstitial lung disease (ILD), through computed tomography (CT), in different serological subgroups of idiopathic inflammatory myopathies (IIM) patients, to find radiologic and clinical differences of disease related to serology. MATERIALS AND METHODS This was a prospective study, which included 98 IIM patients, divided into serological subgroups: anti-aminoacyl-transfer-RNA-synthetases (anti-ARS) positive and myositis-specific autoantibodies (MSA) negative.For each baseline CT the total semiquantitative score of Warrick (WS) and the automated software (Computer-Aided Lung Informatics for Pathology Evaluation and Rating) quantitative scores interstitial lung disease % (ILD%) and vascular-related structure % (VRS%) were calculated. Pulmonary function tests included total lung capacity % (TLC%), forced vital capacity % (FVC%), and diffusing capacity of the lung for carbon monoxide % (DLCO%). RESULTS Inverse correlations ( P <0.001) between the radiologic scores and the functional scores DLCO% and TLC% were found, the most relevant being between ILD% and DLCO% (ρ=-0.590), VRS% and DLCO% (ρ=-0.549), and WS and DLCO% (ρ=-0.471).Positive correlations between ILD% and VRS% (ρ=0.916; P <0.001), WS and ILD% (ρ=0.663; ρ<0.001), and WS and VRS% (ρ=0.637; P <0.001) were obtained.Statistically significant higher values of WS, ILD%, and VRS% were found in the anti-ARS group (WS=15; ILD%=11; VRS%=3.5) compared with the MSA negative one (WS=2.5; ILD%=0.84; VRS%=2.2).The nonspecific interstitial pneumonia pattern was dominant. No statistically significant differences emerged at pulmonary function tests. CONCLUSIONS In this study, ILD in anti-ARS-positive and MSA-negative groups was defined through semiquantitative and quantitative analysis of lung CT. The inverse correlations between the radiologic scores and TLC% and DLCO% ( P <0.001) confirm the role of lung CT in the evaluation of ILD in IIM.
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Bao Y, Zhang W, Shi D, Bai W, He D, Wang D. Correlation Between Serum Tumor Marker Levels and Connective Tissue Disease-Related Interstitial Lung Disease. Int J Gen Med 2021; 14:2553-2560. [PMID: 34163223 PMCID: PMC8214529 DOI: 10.2147/ijgm.s310917] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/03/2021] [Indexed: 01/10/2023] Open
Abstract
Objective The main aims of this study were to explore the relationships between serum tumor markers and connective tissue disease-related interstitial lung disease (CTD-ILD) and to evaluate the clinical value of tumor markers for investigating interstitial lung disease (ILD) in patients with connective tissue disease (CTD). Methods The study included 235 patients with CTD (90 CTD without ILDs, 145 CTD-ILD). Clinical information and the levels of inflammatory and tumor markers, including carbohydrate antigen (CA) 19-9, CA125, carcinoembryonic antigen (CEA), CA153, and cytokeratin 19 fragments (CYFRA21-1), were obtained in all the patients. Results A significant difference between CTD with or without ILD and higher levels of tumor markers was observed in the CTD-ILD group, including CA19-9 (p<0.001), CEA (p<0.001), CA153 (p<0.001), and CYFRA21-1 (p<0.001). There was no significant difference in serum tumor marker levels in the various types of CTD (rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, inflammatory myositis, systemic sclerosis, and mixed connective tissue disease). The levels of CA153 [odds ratio (OR)=1.159] and CYFRA21-1 (OR=2.269) were clearly related to the risk of CTD-ILD. The diagnostic value of CA153 [area under receiver operating characteristic curve (AUC)=0.736] and CYFRA21-1 (AUC=0.718) was confirmed for ILDs in CTD patients, at cut-off values of 9.45 U/mL and 2.13 ng/mL, respectively. Conclusion There is a positive correlation between serum tumor marker levels and CTD-ILD. Higher levels of CA153 and CYFRA21-1 suggest an increased risk of developing ILD and may therefore be useful as biomarkers for detecting CTD-ILD in the clinical setting.
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Affiliation(s)
- Yunqi Bao
- Department of Rheumatology, Xi'an Fifth Hospital, Xian, 710000, Shaanxi, People's Republic of China
| | - Wei Zhang
- Department of Rheumatology, Xi'an Fifth Hospital, Xian, 710000, Shaanxi, People's Republic of China
| | - Dandan Shi
- Department of Radiology, Xi'an Fifth Hospital, Xian, 710000, Shaanxi, People's Republic of China
| | - Weili Bai
- Department of Rheumatology, Xi'an Fifth Hospital, Xian, 710000, Shaanxi, People's Republic of China
| | - Dongdong He
- Department of Rheumatology, Xi'an Fifth Hospital, Xian, 710000, Shaanxi, People's Republic of China
| | - Dan Wang
- Department of Rheumatology, Xi'an Fifth Hospital, Xian, 710000, Shaanxi, People's Republic of China
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Diffuse Alveolar Hemorrhage in a Patient with Antisynthetase Syndrome. Case Rep Rheumatol 2019; 2019:5453717. [PMID: 31467762 PMCID: PMC6701415 DOI: 10.1155/2019/5453717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/14/2019] [Accepted: 07/21/2019] [Indexed: 11/22/2022] Open
Abstract
An alveolar hemorrhage case is reported as the initial manifestation of antisynthetase syndrome in a 40-year-old man, who is admitted to the Emergency Department for diagnostic approach of chronic cough and progressive dyspnea. The diagnosis of the alveolar hemorrhage was based on the presence of acute respiratory failure, decrease in hemoglobin levels, and observation of macrophages filled with hemosiderin. The antisynthetase syndrome was classified through a tomographic image compatible with a nonspecific interstitial pneumonia, along with antibodies associated to myositis (PL-12 and Ro-52). The study protocol was completed with the result of a myopathic pattern showed in electromyography. This patient presented a good response to steroids and disease-modifying antirheumatic drug (DMARD).
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Oda K, Kotani T, Takeuchi T, Ishida T, Shoda T, Isoda K, Yoshida S, Nishimura Y, Makino S. Chemokine profiles of interstitial pneumonia in patients with dermatomyositis: a case control study. Sci Rep 2017; 7:1635. [PMID: 28487565 PMCID: PMC5431618 DOI: 10.1038/s41598-017-01685-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/30/2017] [Indexed: 11/22/2022] Open
Abstract
Chemokines play an important role in the pathophysiology of dermatomyositis (DM) with interstitial pneumonia (IP). However, the relation between chemokines and the disease activity or prognosis of DM-IP has not been elucidated. We evaluated the serum C-C motif chemokine ligand (CCL) 2, Th1 chemokines (C-X-C motif chemokine ligand [CXCL] 9, CXCL10, CXCL11), and Th2 chemokine (CCL17) profiles of 30 patients, and examined the relation between these chemokines and the disease activity or prognosis of DM-IP. Initial serum CCL2 level was higher in the death group (P = 0.007). To determine the cut-off points effective as poor prognostic factors of DM-IP, ROC curve analysis was carried out on initial serum CCL2 level. The value that maximized the area under the ROC curve was 894 pg/mL (sensitivity: 100%, specificity: 70.8%). Serum CCL2, CXCL9, CXCL10, and CXCL11 levels were lower at 2 weeks after treatment initiation than before treatment. Serum CCL2, CXCL10, and CXCL11 levels at 2 weeks after treatment initiation were higher in the death group. Serum levels of chemokines such as CCL2, CXCL10, and CXCL11 may be possible biomarkers of disease activity and prognosis in DM-IP, and serum CCL2 level may be useful when deciding initial treatment.
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Affiliation(s)
- Katsuhiro Oda
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takuya Kotani
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Osaka, Japan.
| | - Tohru Takeuchi
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takaaki Ishida
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takeshi Shoda
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kentaro Isoda
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shuzo Yoshida
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Osaka, Japan
| | | | - Shigeki Makino
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Osaka, Japan
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Sunderkötter C, Nast A, Worm M, Dengler R, Dörner T, Ganter H, Hohlfeld R, Melms A, Melzer N, Rösler K, Schmidt J, Sinnreich M, Walter MC, Wanschitz J, Wiendl H. Guidelines on dermatomyositis--excerpt from the interdisciplinary S2k guidelines on myositis syndromes by the German Society of Neurology. J Dtsch Dermatol Ges 2016; 14:321-38. [PMID: 26972210 DOI: 10.1111/ddg.12909] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The present guidelines on dermatomyositis (DM) represent an excerpt from the interdisciplinary S2k guidelines on myositis syndromes of the German Society of Neurology (available at www.awmf.org). The cardinal symptom of myositis in DM is symmetrical proximal muscle weakness. Elevated creatine kinase, CRP or ESR as well as electromyography and muscle biopsy also provide important diagnostic clues. Pharyngeal, respiratory, cardiac, and neck muscles may also be affected. Given that approximately 30% of patients also develop interstitial lung disease, pulmonary function tests should be part of the diagnostic workup. Although the cutaneous manifestations in DM are variable, taken together, they represent a characteristic and crucial diagnostic criterion for DM. Approximately 5-20% of individuals exhibit typical skin lesions without any clinically manifest muscle involvement (amyopathic DM). About 30% of adult DM cases are associated with a malignancy. This fact, however, should not delay the treatment of severe myositis. Corticosteroids are the therapy of choice in myositis (1-2 mg/kg). Additional immunosuppressive therapy is frequently required (azathioprine, for children methotrexate). In case of insufficient therapeutic response, the use of intravenous immunoglobulins is justified. The benefit of rituximab has not been conclusively ascertained yet. Acute therapeutic management is usually followed by low-dose maintenance therapy for one to three years. Skin lesions do not always respond sufficiently to myositis therapy. Effective treatment for such cases consists of topical corticosteroids and sometimes also calcineurin inhibitors. Systemic therapies shown to be effective include antimalarial agents (also in combination), methotrexate, and corticosteroids. Intravenous immunoglobulins or rituximab may also be helpful. UV protection is an important prophylactic measure.
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Affiliation(s)
- Cord Sunderkötter
- Department of Dermatology, University Hospital Münster, and Department of Translational Dermatoinfectiology, Medical Faculty of the University of Münster and University Hospital, Münster, Germany
| | - Alexander Nast
- Division of Evidence-based Medicine (dEBM), Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center Berlin, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology, and Allergology, Charité, Berlin, Germany
| | - Reinhard Dengler
- Department of Neurology, Medical University Hanover, Hanover, Germany
| | - Thomas Dörner
- Department of Medicine, Division of Rheumatology and Clinical Immunology, Charité - University Medical Center Berlin, German Rheumatism Research Center, Berlin, Germany
| | - Horst Ganter
- German Association for Muscular Dystrophy (Executive Director)
| | - Reinhard Hohlfeld
- Institute for Clinical Neuroimmunology, Ludwig Maximilians University, Munich, Germany
| | - Arthur Melms
- Medical Park Bad Rodach and Department of Neurology, University of Erlangen, Erlangen, Germany
| | - Nico Melzer
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Kai Rösler
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Jens Schmidt
- Department of Neurology, University Hospital Göttingen, Göttingen, Germany
| | - Michael Sinnreich
- Neuromuscular Center, Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Maggi C Walter
- Friedrich-Baur Institute, Ludwig Maximilians University, Munich, Germany
| | - Julia Wanschitz
- Department of Neurology, University Hospital Innsbruck, Innsbruck, Austria
| | - Heinz Wiendl
- Department of Neurology, University Hospital, Münster, Germany
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8
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Sharp C, McCabe M, Dodds N, Edey A, Mayers L, Adamali H, Millar AB, Gunawardena H. Rituximab in autoimmune connective tissue disease–associated interstitial lung disease. Rheumatology (Oxford) 2016; 55:1318-24. [DOI: 10.1093/rheumatology/kew195] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Indexed: 11/12/2022] Open
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9
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Sunderkötter C, Nast A, Worm M, Dengler R, Dörner T, Ganter H, Hohlfeld R, Melms A, Melzer N, Rösler K, Schmidt J, Sinnreich M, Walter MC, Wanschitz J, Wiendl H. Leitlinie Dermatomyositis - Auszug aus der interdisziplinären S2k-Leitlinie zu Myositissyndromen der deutschen Gesellschaft für Neurologie. J Dtsch Dermatol Ges 2016. [DOI: 10.1111/ddg.12909_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Cord Sunderkötter
- Klinik für Hautkrankheiten, Universitätsklinikum Münster und Abteilung für Translationale Dermatoinfektiologie; Medizinische Fakultät der Universität Münster und Universitätsklinikum; Münster
| | - Alexander Nast
- Division of Evidence based Medicine (dEBM), Klinik für Dermatologie; Venerologie und Allergologie, Charité - Universitätsmedizin Berlin; Berlin
| | - Margitta Worm
- Klinik für Dermatologie; Venerologie und Allergologie, Charité; Berlin
| | | | - Thomas Dörner
- Med. Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie; Charité - Universitätsmedizin Berlin, Deutsches Rheumaforschungszentrum; Berlin
| | - Horst Ganter
- Deutsche Gesellschaft für Muskelkranke e.V. (Bundesgeschäftsführer)
| | - Reinhard Hohlfeld
- Institut für Klinische Neuroimmunologie, Ludwig-Maximilians-Universität; München
| | - Arthur Melms
- Medical Park Bad Rodach und Neurologische Klinik; Universität Erlangen
| | - Nico Melzer
- Klinik für Neurologie; Universitätsklinikum; Münster
| | - Kai Rösler
- Klinik für Neurologie; Universitätsspital; Bern
| | - Jens Schmidt
- Klinik für Neurologie; Universitätsmedizin; Göttingen
| | - Michael Sinnreich
- Neuromuskuläres Zentrum; Neurologische Klinik, Universitätsspital; Basel
| | - Maggi C. Walter
- Friedrich-Baur-Institut, Ludwig-Maximilians-Universität; München
| | | | - Heinz Wiendl
- Klinik für Neurologie, Universitätsklinikum; Münster
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Korsten P, Konig MF, Müller GA, Barrantes-Freer A, Sweiss NJ, Vasko R. Respiratory Distress and Nephropathy in a Young Male With Small-Joint Polyarthritis. Arthritis Care Res (Hoboken) 2015; 68:1173-9. [PMID: 26555558 DOI: 10.1002/acr.22781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/20/2015] [Accepted: 10/27/2015] [Indexed: 11/08/2022]
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Sharp C, Dodds N, Mayers L, Millar AB, Gunawardena H, Adamali H. The role of biologics in treatment of connective tissue disease-associated interstitial lung disease. QJM 2015; 108:683-8. [PMID: 25614613 DOI: 10.1093/qjmed/hcv007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
With an increased understanding of the molecular pathways of inflammation and autoimmunity, the development of targeted biological agents has revolutionized the management of connective tissue diseases (CTDs). There has been an explosion in the development of these drugs in the last decade, targeting diseases in diverse fields including: allergic disorders, oncology, neuroinflammatory disorders, inflammatory bowel disease, macular degeneration and CTDs. In this last field, commonly applied biologics fall into two categories: cytokine inhibitors and lymphocyte-targeted therapies. The former group includes the antitumour necrosis factor alpha (TNF-α), anti-interleukin (IL)-6 receptor monoclonal antibodies and IL-1 receptor antagonists, whilst the latter encompasses the anti-CD20, B-cell depleting, monoclonal antibody (mAb), Rituximab and the anti-T-cell activation agent, Abatacept. This review will examine our developing experience in the use of these agents in the treatment of CTD-related interstitial lung diseases, with a particular focus on B-cell depletion.
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Affiliation(s)
- C Sharp
- Bristol Interstitial Lung Disease Unit, North Bristol NHS Trust, Brunel Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - N Dodds
- Bristol Interstitial Lung Disease Unit, North Bristol NHS Trust, Brunel Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - L Mayers
- Bristol Interstitial Lung Disease Unit, North Bristol NHS Trust, Brunel Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - A B Millar
- Bristol Interstitial Lung Disease Unit, North Bristol NHS Trust, Brunel Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - H Gunawardena
- Bristol Interstitial Lung Disease Unit, North Bristol NHS Trust, Brunel Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - H Adamali
- Bristol Interstitial Lung Disease Unit, North Bristol NHS Trust, Brunel Building, Southmead Hospital, Bristol BS10 5NB, UK
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De Paepe B, Zschüntzsch J. Scanning for Therapeutic Targets within the Cytokine Network of Idiopathic Inflammatory Myopathies. Int J Mol Sci 2015; 16:18683-713. [PMID: 26270565 PMCID: PMC4581266 DOI: 10.3390/ijms160818683] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 12/17/2022] Open
Abstract
The idiopathic inflammatory myopathies (IIM) constitute a heterogeneous group of chronic disorders that include dermatomyositis (DM), polymyositis (PM), sporadic inclusion body myositis (IBM) and necrotizing autoimmune myopathy (NAM). They represent distinct pathological entities that, most often, share predominant inflammation in muscle tissue. Many of the immunopathogenic processes behind the IIM remain poorly understood, but the crucial role of cytokines as essential regulators of the intramuscular build-up of inflammation is undisputed. This review describes the extensive cytokine network within IIM muscle, characterized by strong expression of Tumor Necrosis Factors (TNFα, LTβ, BAFF), Interferons (IFNα/β/γ), Interleukins (IL-1/6/12/15/18/23) and Chemokines (CXCL9/10/11/13, CCL2/3/4/8/19/21). Current therapeutic strategies and the exploration of potential disease modifying agents based on manipulation of the cytokine network are provided. Reported responses to anti-TNFα treatment in IIM are conflicting and new onset DM/PM has been described after administration of anti-TNFα agents to treat other diseases, pointing to the complex effects of TNFα neutralization. Treatment with anti-IFNα has been shown to suppress the IFN type 1 gene signature in DM/PM patients and improve muscle strength. Beneficial effects of anti-IL-1 and anti-IL-6 therapy have also been reported. Cytokine profiling in IIM aids the development of therapeutic strategies and provides approaches to subtype patients for treatment outcome prediction.
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Affiliation(s)
- Boel De Paepe
- Neuromuscular Reference Center, Laboratory for Neuropathology, 10K12E, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Jana Zschüntzsch
- Department of Neurology, University Medical Centre, Göttingen University, 37075 Göttingen, Germany.
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13
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Fischer A, Brown KK. Interstitial lung disease in undifferentiated forms of connective tissue disease. Arthritis Care Res (Hoboken) 2015; 67:4-11. [PMID: 25048539 DOI: 10.1002/acr.22394] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 07/01/2014] [Indexed: 12/14/2022]
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15
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Azuma K, Yamada H, Ohkubo M, Yamasaki Y, Yamasaki M, Mizushima M, Ozaki S. Incidence and predictive factors for malignancies in 136 Japanese patients with dermatomyositis, polymyositis and clinically amyopathic dermatomyositis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0362-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Olson AL, Brown KK, Fischer A. Connective Tissue Disease–Associated Lung Disease. Immunol Allergy Clin North Am 2012; 32:513-36. [DOI: 10.1016/j.iac.2012.09.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Kalluri M, Oddis CV. Pulmonary manifestations of the idiopathic inflammatory myopathies. Clin Chest Med 2011; 31:501-12. [PMID: 20692542 DOI: 10.1016/j.ccm.2010.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Pulmonary involvement in myositis includes interstitial lung disease (ILD), respiratory muscle weakness, aspiration, infections, and drug-induced disease. ILD may precede myositis, and results in increased morbidity and mortality rates. Initial evaluation should include pulmonary function tests and high-resolution computed tomography. Nonspecific interstitial pneumonia (NSIP) is the most common histologic pattern on lung biopsy. Treatment usually consists of a combination of steroids and other immunosuppressive agents, and the response depends on the clinical presentation and underlying histology.
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Affiliation(s)
- Meena Kalluri
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada.
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19
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Woodrow JP, Nathan SD, Shlobin OA. Idiopathic non-specific interstitial pneumonitis responsive to transplant-associated immunosuppression. J Heart Lung Transplant 2010; 30:358-9. [PMID: 21185203 DOI: 10.1016/j.healun.2010.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 10/07/2010] [Accepted: 10/21/2010] [Indexed: 12/01/2022] Open
Affiliation(s)
- James P Woodrow
- Pulmonary and Critical Care Medicine, Madigan Army Medical Center, Tacoma, Washington
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Azuma K, Yamada H, Ohkubo M, Yamasaki Y, Yamasaki M, Mizushima M, Ozaki S. Incidence and predictive factors for malignancies in 136 Japanese patients with dermatomyositis, polymyositis and clinically amyopathic dermatomyositis. Mod Rheumatol 2010; 21:178-83. [PMID: 20922453 DOI: 10.1007/s10165-010-0362-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
Abstract
The aim of this study was to define the standardized incidence ratio (SIR) of malignancy and the potential risk factors of concomitant malignancies in patients with inflammatory myopathies, including clinically amyopathic dermatomyositis (CADM). A total of 145 patients diagnosed with either dermatomyositis/polymyositis (DM/PM) or CADM at our institute between 1984 and 2002 were enrolled in the study. The demographic, clinical and laboratory features of the patients at the time of DM/PM or CADM diagnosis were compared between patients with and without malignancies, respectively. Multivariate analysis by logistic regression was used to determine the independent risk factors for the development of malignancies in DM/PM patients. Malignancy was found in 17 of 70 patients with DM (24%), three of 15 patients with CADM (20%), and three of 51 patients with PM (6%). Gastric cancer (8/23) was the most common malignancy. Compared with general population, the SIR of malignancies was 13.8 (range 9.0-21.1). The patients who developed malignancies were older (61.5 vs. 51.1 years; P < 0.005), presented more often with dysphagia (61 vs. 15%; P < 0.0001) and were less likely to have the complication of interstitial lung disease (30 vs. 60%; P < 0.05). These features were independent predictive factors for developing malignancies in multiple logistic regression analysis. The results of our study confirm that CADM in addition to DM was associated with high rates of malignancy among our patient cohort.
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Affiliation(s)
- Kohei Azuma
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
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21
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Peña Ayala A, Escobar Cedillo RE, Espinosa Morales R, Pineda Villaseñor C. [Imaging techniques and electromyography in inflammatory myopathies]. REUMATOLOGIA CLINICA 2009; 5 Suppl 3:23-27. [PMID: 21794665 DOI: 10.1016/j.reuma.2009.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 09/15/2009] [Accepted: 09/15/2009] [Indexed: 05/31/2023]
Abstract
Different imaging techniques are used for the diagnosis, evaluation and follow-up of inflammatory myopathies; of these techniques, the ones that provide the largest amount of information are ultrasonography and magnetic resonance imaging. Electrodiagnosis in inflammatory myopathies is based mainly on electromyography (EMG), which shows different patterns according to the different disease presentations. In the acute phase, polyphasic potentials with diminished amplitude and duration are seen, whereas in its chronic phases, mixed neuropathic and myopathic patterns are found. After corticosteroid treatment, EMG tends to return to normal.
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Affiliation(s)
- Angélica Peña Ayala
- Departamento de Reumatología, Instituto Nacional de Rehabilitación, México D. F., México
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22
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Autoimmune T cell responses to antigenic peptides presented by bronchoalveolar lavage cell HLA-DR molecules in sarcoidosis. Clin Immunol 2009; 133:353-63. [PMID: 19786367 DOI: 10.1016/j.clim.2009.08.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 07/28/2009] [Accepted: 08/12/2009] [Indexed: 11/22/2022]
Abstract
The etiology of sarcoidosis remains unknown. Recently, by mass spectrometric sequencing of peptides eluted from HLA-DR molecules of bronchoalveolar lavage (BAL) cells from DRB10301(pos) patients, we identified potential self-antigens in sarcoidosis. The aim of the present study was to investigate the capacity of selected peptides to stimulate lung and blood T cells of sarcoidosis patients using an interferon-gamma ELISPOT assay. In peripheral blood, there were strong T cell responses to a peptide derived from the cytoskeletal protein vimentin in 6 out of 11 DRB10301(pos) patients with active disease but not in patients with other HLA types. BAL T cell responses against peptides derived from ATP synthase or from lysyl-tRNA synthetase were detected in DRB10301(pos) as well as DRB10301(neg) patients. By using antigenic peptides presented in vivo in the lungs of sarcoidosis patients, we have identified blood and lung T cell autoimmune responses that may help sustain the inflammation in this disease.
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23
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Constantin T, Ponyi A, Orbán I, Molnár K, Dérfalvi B, Dicso F, Kálovics T, Müller J, Garami M, Sallai A, Balogh Z, Szalai Z, Fekete G, Dankó K. National registry of patients with juvenile idiopathic inflammatory myopathies in Hungary—Clinical characteristics and disease course of 44 patients with juvenile dermatomyositis. Autoimmunity 2009; 39:223-32. [PMID: 16769656 DOI: 10.1080/08916930600622819] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Idiopathic inflammatory myopathies (IIMs) are systemic autoimmune diseases characterized by chronic muscle inflammation resulting in progressive weakness and frequent involvement of internal organs, mainly the pulmonary, gastrointestinal and cardiac systems which considerably contribute to the morbidity and mortality of the IIMs. Aim of this study was to present clinical characteristics, disease course, frequency of relapses and survival in patients with juvenile dermatomyositis (DM). A national registry of patients with juvenile IIMs was elaborated by the authors in Hungary. We have summarized data of the register according to signs and symptoms, disease course, frequency of relapses and survival of patients with juvenile IIM. Analysis was performed using data of 44 patients with juvenile DM diagnosed between 1976 and 2004 according to Bohan and Peter's criteria. Survival probability was calculated by Kaplan-Meier method. Data of patients with juvenile DM were compared with data of 66 patients with adult DM. The most frequent cutaneous features were facial erythema and heliotrope rash. Extramuscular and extraskeletal manifestations of the disease were more frequent in adult patients. The most common extramuscular feature was arthralgia in both groups of patients with juvenile or adult DM. Cardiac manifestation of the disease was not observed in juvenile patients. Respiratory muscle involvement and interstitial lung disease (ILD) were more frequent among adult DM patients than cardiac manifestation of the myositis. In view of the disease course, the authors found that frequency of polycyclic and monophasic subtypes of the disease were mainly similar. The hazard of relapse was found higher during the first year after the remission. None of the juvenile patients died. Among adult patients four disease-specific deaths occurred. There was no correlation between relapse free survival and initial therapeutic regimen. Many of our patients had polycyclic or chronic disease. As relapses can occur after a prolonged disease-free interval, patients should be followed up for at least 2 years. Although we found favourable survival probability, further investigations are needed to assess functional outcome.
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Affiliation(s)
- T Constantin
- Faculty of Medicine, Semmelweis University, 2nd Department of Pediatrics, Budapest, Hungary.
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24
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Burd CJ, Kinyamu HK, Miller FW, Archer TK. UV radiation regulates Mi-2 through protein translation and stability. J Biol Chem 2008; 283:34976-82. [PMID: 18922793 DOI: 10.1074/jbc.m805383200] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Dermatomyositis (DM) is an autoimmune disease, which is often accompanied by the development of disease-specific autoantibodies directed against the SNF2-superfamily helicase, Mi-2. Recent evidence suggests that ultraviolet radiation exposure may be an important risk factor for the development of not only the disease but also specific autoimmunity against Mi-2. Consequently, we investigated the effects of ultraviolet radiation on Mi-2 protein expression. We observed an increase in protein levels upon ultraviolet radiation exposure in cell culture systems. These changes in expression occur quite rapidly, are maximized just 1 h following exposure, and are unique to Mi-2 when compared with other members of the NuRD complex. Changes in protein levels are not mediated through transcriptional mechanisms. Treatment results in a more efficiently translated message through regulatory elements in the 5'-UTR region of the transcript. Investigation into protein half-life further demonstrated increased stability of Mi-2 following UV exposure. Taken together, we describe a system by which Mi-2 protein expression can be quickly increased following UV exposure and then maintained up to 16 h later. These data provide a novel regulation of an important transcriptional regulator and provide insight into the possible mechanisms of the development of DM and associated autoantibodies.
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Affiliation(s)
- Craig J Burd
- Laboratory of Molecular Carcinogenesis, NIEHS, National Intitutes of Health, Research Triangle Park, NC 27709, USA
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25
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Abstract
Idiopathic inflammatory myopathies (notably polymyositis and dermatomyositis) are relatively uncommon diseases with a heterogeneous clinical presentation. Only a few randomized, double-blind, placebo-controlled trials have been performed, measures to assess outcome and response to treatment have to be validated. Initial treatment options of first choice are corticosteroids, although rarely tested in randomized, controlled trials. Unfortunately, not all patients respond to them and many develop undesirable side effects. Thus, second line agents or immunosuppressants given in combination with corticosteroids are used. For dermatomyositis/polymyositis, combination with azathioprine is most common. In case this combination is not sufficient or applicable, intravenous immunoglobulins are justified. Alternative or stronger immunosuppressants, such as cyclosporine A, cyclophosphamide, methotrexate, or mycophenolate are also used. There are no defined guidelines or best treatment protocols agreed on internationally; therefore, the medical approach must be individualized based on the severity of clinical presentation, disease duration, presence of extramuscular features, and prior therapy and contraindications to particular agents. Approximately 25% of patients are nonresponders and continue to experience clinical relapses. Those are candidates for alternative treatment options and experimental therapies. New immunoselective therapies directed toward cytokine modulation, immune cell migration, or modification of certain immune subsets (B- and T-cells) are a promising avenue of research and clinical application. Possible future therapeutic options are presented and discussed.
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Affiliation(s)
- Heinz Wiendl
- Department of Neurology, University of Wuerzburg, Wuerzburg, Germany.
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26
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Wahlström J, Dengjel J, Persson B, Duyar H, Rammensee HG, Stevanović S, Eklund A, Weissert R, Grunewald J. Identification of HLA-DR-bound peptides presented by human bronchoalveolar lavage cells in sarcoidosis. J Clin Invest 2008; 117:3576-82. [PMID: 17975675 DOI: 10.1172/jci32401] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 08/15/2007] [Indexed: 11/17/2022] Open
Abstract
Sarcoidosis is an inflammatory disease of unknown etiology, most commonly affecting the lungs. Activated CD4+ T cells accumulate in the lungs of individuals with sarcoidosis and are considered to be of central importance for inflammation. We have previously shown that Scandinavian sarcoidosis patients expressing the HLA-DR allele DRB1*0301 are characterized by large accumulations in the lungs of CD4+ T cells expressing the TCR AV2S3 gene segment. This association afforded us a unique opportunity to identify a sarcoidosis-specific antigen recognized by AV2S3+ T cells. To identify candidates for the postulated sarcoidosis-specific antigen, lung cells from 16 HLA-DRB1*0301pos patients were obtained by bronchoalveolar lavage. HLA-DR molecules were affinity purified and bound peptides acid eluted. Subsequently, peptides were separated by reversed-phase HPLC and analyzed by liquid chromatography-mass spectrometry. We identified 78 amino acid sequences from self proteins presented in the lungs of sarcoidosis patients, some of which were well-known autoantigens such as vimentin and ATP synthase. For the first time, to our knowledge, we have identified HLA-bound peptides presented in vivo during an inflammatory condition. This approach can be extended to characterize HLA-bound peptides in various autoimmune settings.
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Affiliation(s)
- Jan Wahlström
- Lung Research Laboratory, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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27
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Fujimoto H, D'Alessandro-Gabazza CN, Palanki MSS, Erdman PE, Takagi T, Gabazza EC, Bruno NE, Yano Y, Hayashi T, Tamaki S, Sumida Y, Adachi Y, Suzuki K, Taguchi O. Inhibition of Nuclear Factor-κB in T Cells Suppresses Lung Fibrosis. Am J Respir Crit Care Med 2007; 176:1251-60. [PMID: 17901412 DOI: 10.1164/rccm.200609-1288oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Cytokines secreted by T cells play a pivotal role in the pathogenesis of lung injury and fibrosis, and the transcription factors nuclear factor (NF)-kappaB and activator protein (AP)-1 are involved in the expression of cytokines from T cells during lung injury. OBJECTIVES We assessed the potential therapeutic effect of SP100030, a specific inhibitor of T-cell NF-kappaB and AP-1 in lung fibrosis. METHODS The effect of SP100030 was evaluated using a mouse model of chronic lung fibrosis. MEASUREMENTS AND MAIN RESULTS Mice treated with SP100030, as compared with untreated mice, had significantly less cachexia and less lung injury and had decreased levels of inflammatory cytokines and growth factors, decreased activation of coagulation activation, and decreased collagen deposition in the lung. The inhibitory activity of SP100030 was dose dependent and was effective in acute and chronic phases of lung fibrosis. SP100030 inhibited the activation of the protein kinase C-isoform in T-cell lines and suppressed NF-kappaB-driven cytokine expression in CD4(+) and CD8(+) T cells. CONCLUSIONS These results suggest that the specific inhibition of NF-kappaB could be useful for the treatment of lung fibrosis.
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Affiliation(s)
- Hajime Fujimoto
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie, Japan
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28
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Constantin T, Ponyi A, Kálovics T, Orbán I, Molnár K, Dérfalvy B, Dicso F, Sallai A, Garami M, Balogh Z, Szalai Z, Fekete G, Dankó K. [Disease course, frequency of relapses and survival of patients with juvenile or adult dermatomyositis]. Orv Hetil 2007; 148:1989-97. [PMID: 17932005 DOI: 10.1556/oh.2007.27907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The idiopathic inflammatory myopathies are systemic autoimmune diseases characterized by chronic muscle inflammation resulting progressive weakness and frequent involvement of internal organs, mainly the pulmonary, gastrointestinal and cardiac systems. OBJECTIVE To present clinical characteristics, disease course, frequency of relapses and survival of 79 patients with juvenile or adult dermatomyositis. METHODS A national registry of patients with juvenile dermatomyositis was elaborated by the authors in Hungary. The authors summarize data of the register such as signs and symptoms, disease course, frequency of relapses and survival of patients with juvenile dermatomyositis. Analysis was performed using data of 44 patients diagnosed between 1976 and 2004 according to Bohan and Peter's criteria. Survival probability was calculated by Kaplan-Meier method. Data of patients with juvenile dermatomyositis were compared with data of 35 patients with adult dermatomyositis. RESULTS In view of the disease course, the authors found that more than the half of patients have monophasic disease, while one third of them suffered from polycyclic disease. The risk of the relapse was found to be higher during the first year after the remission. None of the juvenile patients died. Among adult patients, 4 disease-specific deaths occurred. DISCUSSION There was no correlation between relapse free survival and initial therapeutic regimen. Many of the patients had polycyclic or chronic disease. As relapses can occur after a prolonged disease-free interval, patients should be followed up for at least 2 years. Despite favourable survival probability, further investigations are needed to assess functional outcome.
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Affiliation(s)
- Tamás Constantin
- Semmelweis Egyetem, Altalános Orvostudományi Kar, II. Gyermekgyógyászati Klinika, Budapest, Tuzoltó u. 7-9., 1094.
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29
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Won Huh J, Soon Kim D, Keun Lee C, Yoo B, Bum Seo J, Kitaichi M, Colby TV. Two distinct clinical types of interstitial lung disease associated with polymyositis-dermatomyositis. Respir Med 2007; 101:1761-9. [PMID: 17428649 DOI: 10.1016/j.rmed.2007.02.017] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 02/13/2007] [Accepted: 02/22/2007] [Indexed: 11/26/2022]
Abstract
Most patients with interstitial lung disease (ILD) associated with collagen vascular diseases (CVD) have a chronic indolent course with a relatively favorable prognosis; however, acute progression has been reported in some polymyositis-dermatomyositis patients. This study evaluated the prevalence, clinical features, and outcome relative to the presentation type of ILD in polymyositis-dermatomyositis (PM-DM). Ninety-nine patients with newly diagnosed polymyositis-dermatomyositis seen at the Asan Medical Center in Korea between January 1990 and December 2004 were enrolled. The clinical, radiological, and pathological findings were retrospectively reviewed. ILD were divided into acute (dyspnea within 1 month before diagnosis) or chronic types. ILD was found on chest radiographs in 33 patients (33.3%), and 11 (33.3%) of these were considered acute. The acute group presented with more severe respiratory symptoms, hypoxemia, and poorer lung function. Patients with an acute presentation had ground glass opacity and consolidation on high-resolution computed tomography (HRCT), in contrast to reticulation and honeycombing in the chronic type. Surgical lung biopsy of one acute-type patient revealed diffuse alveolar damage, whereas biopsies in the chronic type showed usual interstitial pneumonia (UIP) in four cases and nonspecific interstitial pneumonia (NSIP) in another four. Eight acute-type patients (72.7%) died of respiratory failure within 1-2 months despite steroid therapy. The 3-year mortality rate of the chronic-type patients (21.2%) was not statistically significantly different from that of the patients without ILD (10.2%). In polymyositis-dermatomyositis, the acute, severe form of ILD was not infrequent.
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Affiliation(s)
- Jin Won Huh
- Departments of Pulmonary and Critical Care Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul, Republic of Korea
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30
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Abstract
Interstitial lung disease is a serious complication of polymyositis/dermatomyositis and leads to death from chronic respiratory insufficiency in 30 to 66% of cases. It is a criterion of poor prognosis in these disorders. Its onset occurs at variable points in the course of polymyositis/dermatomyositis, and precedes them in half of all cases. Presentation may also vary: acute (25%), insidious (60%), or infraclinical, discovered fortuitously (15%). The examinations of choice for early screening are high-resolution computed tomography (CT) and pulmonary function tests, which should be performed during the initial work-up and during ongoing surveillance. Moreover, high-resolution CT also makes it possible to determine the type of histologic lesions in the interstitial lung disease. Today, diagnosis of this disease does not generally require histological confirmation; nonspecific interstitial lung disease seems to be the most common histologic form of lung damage in polymyositis/dermatomyositis (40 to 80%). Anti-Jo1 antibodies are a sensitive marker of interstitial lung disease during polymyositis/dermatomyositis, and close surveillance of lung function is recommended in patients with these autoantibodies. Systematic testing for them is also justified in patients with apparently idiopathic interstitial lung disease, to rule out underlying polymyositis/dermatomyositis. No clear treatment protocols have been established for interstitial lung disease during polymyositis/dermatomyositis. Corticosteroid treatment is the first choice. Its combination with cyclophosphamide may be most effective in corticosteroid-resistant forms of polymyositis/dermatomyositis, especially when begun early; it may also be appropriate to begin corticosteroids as soon as factors predicting poor prognosis are detected.
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MESH Headings
- Acetylcysteine/administration & dosage
- Acetylcysteine/therapeutic use
- Adult
- Biomarkers
- Biopsy
- Bronchoalveolar Lavage
- Cyclophosphamide/therapeutic use
- Dermatomyositis/complications
- Dermatomyositis/physiopathology
- Hematopoietic Stem Cell Transplantation
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Immunosuppressive Agents/therapeutic use
- Lung/pathology
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/diagnostic imaging
- Lung Diseases, Interstitial/drug therapy
- Lung Diseases, Interstitial/epidemiology
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/immunology
- Lung Diseases, Interstitial/pathology
- Lung Diseases, Interstitial/surgery
- Lung Transplantation
- Middle Aged
- Multicenter Studies as Topic
- Polymyositis/complications
- Polymyositis/physiopathology
- Prevalence
- Prognosis
- Radiography, Thoracic
- Randomized Controlled Trials as Topic
- Respiratory Function Tests
- Tomography, X-Ray Computed
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Affiliation(s)
- Isabelle Marie
- Département de médecine interne et Unité Inserm 644, Centre hospitalier universitaire de Rouen.
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31
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Englund P, Wahlström J, Fathi M, Rasmussen E, Grunewald J, Tornling G, Lundberg IE. Restricted T cell receptor BV gene usage in the lungs and muscles of patients with idiopathic inflammatory myopathies. ACTA ACUST UNITED AC 2006; 56:372-83. [PMID: 17195241 DOI: 10.1002/art.22293] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate T cell receptor (TCR) expression in 3 different compartments that could be involved in patients with myositis: muscle, lung, and peripheral blood. METHODS Nine patients with polymyositis (PM), dermatomyositis, or inclusion body myositis underwent bronchoscopy and bronchoalveolar lavage (BAL) as well as muscle biopsy and blood sampling. A panel of 19 monoclonal antibodies specific for TCR V(beta) (BV) and V(alpha) (AV) were used to characterize the TCR profile in CD4(+) and CD8(+) T cell populations in BAL fluid and peripheral blood by flow cytometry. Muscle biopsy tissues were analyzed by immunohistochemistry. Patients were also typed for HLA-DRB1 and DRB3 alleles. RESULTS A total of 17 T cell expansions were detected in BAL fluid, 6 in the CD4(+) T cell population and 11 in the CD8(+) T cell population. Four T cell expansions were detected in peripheral blood. A selective TCR V usage was found in muscle. Two PM patients, both of whom had BAL fluid BV3(+) T cell expansions in the CD4 population and in whom BV3 was also a prominent TCR V segment in muscle tissue, shared the HLA-DRB1*03 allele. These 2 patients were the only ones who were positive for anti-Jo-1 antibody. CONCLUSION We found a restricted accumulation of T lymphocytes expressing selected TCR V-gene segments in the target organ compartments (i.e., lung and muscle). The occurrence of shared TCR gene segment usage in muscle and lungs could suggest common target antigens in these organs.
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Affiliation(s)
- Pernilla Englund
- Karolinska University Hospital at Solna, and Karolinska Institutet, Stockholm, Sweden
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32
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Plastiras SC, Soliotis FC, Vlachoyiannopoulos P, Tzelepis GE. Interstitial lung disease in a patient with antisynthetase syndrome and no myositis. Clin Rheumatol 2005; 26:108-11. [PMID: 16328094 DOI: 10.1007/s10067-005-0111-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 10/18/2005] [Accepted: 10/18/2005] [Indexed: 11/25/2022]
Abstract
Interstitial lung disease in patients with antisynthetase syndrome and no evidence of myositis is rare and may precede other disease manifestations. We report a patient who initially presented with symptoms primarily related to lung involvement. The diagnosis of the antisynthetase syndrome without myositis was made many months later when he developed a characteristic hand rash (mechanic's hands), which was confirmed by positive antibodies to Jo-1. With treatment, both the hand rash and the interstitial lung disease improved. Antisynthetase syndrome should be considered in patients presenting with interstitial lung disease with no evidence of myositis. Appropriate laboratory testing with measurement of specific autoantibodies may help in the early diagnosis and treatment of the syndrome.
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Affiliation(s)
- Sotiris C Plastiras
- Department of Pathophysiology, University of Athens Medical School, Athens, Greece.
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