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Cheng I, Wong CSM. A systematic review and meta-analysis on the prevalence and clinical characteristics of dysphagia in patients with dermatomyositis. Neurogastroenterol Motil 2023; 35:e14572. [PMID: 37010885 DOI: 10.1111/nmo.14572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Dermatomyositis (DM) is a rare autoimmune disease characterized by distinctive skin rash, muscle inflammation with symmetrical and progressive muscle weakness, and elevated serum levels of muscle-associated enzymes. DM may affect skeletal muscles involved in swallowing, leading to dysphagia, which can negatively impact individual's physical and psychosocial well-being. Despite this, dysphagia in patients with DM remains poorly understood. This systematic review and meta-analysis aimed to evaluate the prevalence and clinical features of dysphagia in patients with DM and juvenile DM (JDM). METHODS Four electronic databases were systematically searched until September 2022. Studies with patients with DM or JDM and dysphagia were included. The pooled prevalence of all included studies was calculated, and the clinical characteristics of dysphagia were qualitatively analyzed. KEY RESULTS Thirty-nine studies with 3335 patients were included. The overall pooled prevalence of dysphagia was 32.3% (95% CI: 0.270, 0.373) in patients with DM and 37.7% (95% CI: -0.031, 0.785) in patients with JDM. Subgroup analyses revealed that Sweden had the highest prevalence (66.7% [95% CI: 0.289, 1.044]), whereas Tunisia had the lowest prevalence (14.3% [95% CI: -0.040, 0.326]). Moreover, South America had the highest prevalence (47.0% [95% CI: 0.401, 0.538]), whereas Africa had the lowest prevalence (14.3% [95% CI: -0.040, 0.326]). Dysphagia in patients with DM and JDM was characterized by both oropharyngeal and esophageal dysfunctions, with predominant difficulties in motility. CONCLUSIONS & INFERENCES Our findings showed that dysphagia affects one in three patients with DM or JDM. However, the documentation on the diagnosis and management of dysphagia in the literature is inadequate. Our results highlighted the need to use both clinical and instrumental assessments to evaluate swallowing function in this population.
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Affiliation(s)
- Ivy Cheng
- Department of Medicine, School of Clinical Medicine, Lee Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Christina Sze-Man Wong
- Department of Medicine, School of Clinical Medicine, Lee Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Division of Dermatology, Department of Medicine, Queen Mary Hospital, Hong Kong, China
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Ge Y, Yang H, Jiang W, Tian X, Lu X, Wang G. Clinical characteristics of myositis patients with isolated anti-U1 ribonucleoprotein antibody resemble immune-mediated necrotizing myopathy. Ther Adv Musculoskelet Dis 2023; 15:1759720X231181336. [PMID: 37465567 PMCID: PMC10350785 DOI: 10.1177/1759720x231181336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/24/2023] [Indexed: 07/20/2023] Open
Abstract
Background Anti-U1 ribonucleoprotein (U1RNP) antibodies were associated with connective tissue diseases (CTDs), but the clinical characteristics of this antibody in Chinese myositis patients have not been studied. Objective We aim to analyze the clinical features of myositis patients who test positive for anti-U1RNP antibodies and delineate a subgroup of myositis. Design This is a retrospective cohort study. Methods We reviewed the clinical data of myositis patients with anti-U1RNP antibodies and compared them to those with anti-signal recognition particle (SRP) and hydroxy-3-methylglutaryl-CoA reductase (HMGCR) antibody-associated immune-mediated necrotizing myopathy (IMNM). Results A total of 30 adult cases were identified; median age was 47.5 years and 24 (80%) were females, and 12 patients did not coexist with myositis-specific antibodies (MSAs) (isolated anti-U1RNP). The serum creatine kinase (CK) was significantly higher in patients with isolated anti-U1RNP (2182.5 U/L versus 289 U/L, p = 0.01), and the number of patients with CK > 2000 U/L was higher compared to that in anti-U1RNP antibody patients coexisting with MSAs (66.7% versus 16.7%, p = 0.009). The prevalence of IMNM in patients' muscle pathology with isolated anti-U1RNP was significantly higher (75%, p = 0.003). Skin rashes were less common in isolated anti-U1RNP group (p < 0.05). Of the 25 individuals with available pulmonary high-resolution CT (HRCT), 14 (56%) were diagnosed with interstitial lung disease (ILD). The incidence of muscular weakness, dysphagia, or levels of CK was not different between the isolated anti-U1RNP antibody individuals and the anti-HMGCR or SRP-IMNM groups (p > 0.05). But the frequency of Raynaud's phenomenon, arthritis, and membrane attack complex (MAC) deposits in myositis patients with isolated anti-U1RNP antibodies were higher than in anti-HMGCR and SRP-IMNM (all p < 0.005). There was no difference between anti-U1RNP patients with and without Ro-52 (p > 0.05). Isolated anti-U1RNP individuals showed marked improvements in muscle strength, and the remission rate in 1 and 2 years was significantly higher than that in anti-HMGCR and SRP-IMNM (p < 0.05). Conclusions The clinical and pathological features of myositis patients with isolated anti-U1RNP antibodies were similar to IMNM. Arthritis and ILD are the most common extramuscular clinical features. Most respond well to treatment and have a good prognosis.
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Affiliation(s)
- Yongpeng Ge
- Department of Rheumatology, The Key Laboratory of Myositis, China-Japan Friendship Hospital, Beijing, China
| | - Hongxia Yang
- Department of Rheumatology, The Key Laboratory of Myositis, China-Japan Friendship Hospital, Beijing, China
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Wei Jiang
- Department of Rheumatology, The Key Laboratory of Myositis, China-Japan Friendship Hospital, Beijing, China
| | - Xiaolan Tian
- Department of Rheumatology, The Key Laboratory of Myositis, China-Japan Friendship Hospital, Beijing, China
| | - Xin Lu
- Department of Rheumatology, The Key Laboratory of Myositis, China-Japan Friendship Hospital, Beijing, China
| | - Guochun Wang
- Department of Rheumatology, The Key Laboratory of Myositis, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing 100029, China
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
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Nephrotic Syndrome as an Extramuscular Manifestation of Anti-EJ Antibody-Positive Dermatomyositis: A Case Report and Review of the Literature. Case Rep Rheumatol 2022; 2022:1233522. [PMID: 36249573 PMCID: PMC9553724 DOI: 10.1155/2022/1233522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022] Open
Abstract
Renal involvement is underestimated as an extramuscular manifestation of dermatomyositis (DM). Here, we describe a 67-year-old woman with anti-glycyl-transfer ribonucleic acid synthetase (anti-EJ) antibody and anti-ribonucleoprotein antibody-positive DM complicated by systemic sclerosis, who developed nephrotic syndrome concurrently with the exacerbation of DM, as indicated by incremental serum creatine kinase levels, high-intensity lesions on muscle magnetic resonance imaging, and active interstitial pneumonitis on chest computed tomography. Renal biopsy revealed the presence of immune-deposition in the glomerulus by immunofluorescence. To our knowledge, this is the first report describing the coexistence of anti-EJ antibody-positive DM and nephrotic syndrome. More reports of similar cases are warranted to substantiate the association.
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Lefebvre F, Giannini M, Ellezam B, Leclair V, Troyanov Y, Hoa S, Bourré-Tessier J, Satoh M, Fritzler MJ, Senécal JL, Hudson M, Meyer A, Landon-Cardinal O. Histopathological features of systemic sclerosis-associated myopathy: A scoping review. Autoimmun Rev 2021; 20:102851. [PMID: 33971337 DOI: 10.1016/j.autrev.2021.102851] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/13/2021] [Accepted: 03/20/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Scleromyositis (SM) is an emerging subset of myositis associated with features of systemic sclerosis (SSc) but it is currently not recognized as a distinct histopathological subset by the European NeuroMuscular Center (ENMC). Our aim was to review studies reporting muscle biopsies from SSc patients with myositis and to identify unique histopathological features of SM. METHODS A scoping review was conducted and included all studies reporting histopathological findings in SSc patients with myositis searching the following databases: PubMed, MEDLINE, EMBASE, CINAHL and EBM-Reviews. Clinical, serological, and histopathological data were extracted using a standardized protocol. RESULTS Out of 371 citations, 77 studies that included 559 muscle biopsies were extracted. Fifty-seven percent (n = 227/400) had inflammatory infiltrates, predominantly T cells, which were endomysial (49%), perimysial (42%) and perivascular (41%). Few studies (18%, n = 8/44) evaluated the presence of B-cells. Myofiber atrophy was present in 48% (n = 104/218) of biopsies, and was predominantly perifascicular in 19% (n = 6/31), with necrosis reported in 56% (n = 162/290) of cases. Sarcolemmal MHC-I upregulation was found in 72% (n = 64/89) of biopsies. Non-specified C5b-9 deposition was described in 39% of muscle biopsies (n = 28/72). Neurogenic features were present in 23% (n = 44/191); endomysial fibrosis was reported in 35% (n = 120/340); and rimmed vacuoles were observed in 32% (n = 11/34) of biopsies. Capillaropathy, such as capillary dropout and/or ultrastructural endothelial abnormalities, was reported in 33% (n = 43/129) of cases. Reported ENMC categories were mainly polymyositis (21%), non-specific myositis (19%), immune-mediated necrotizing myopathy (16%), and dermatomyositis (8%). Histopathological features were analyzed according to serological subtypes in 28 studies, including anti-PM-Scl (n = 48), -Ku (n = 23) and -U1RNP (n = 90). Most of these biopsies demonstrated inflammatory infiltrates (range 49-85%) as well as MHC-I expression (range 63-81%). Necrosis was associated with anti-Ku (85%) and anti-U1RNP (73%), while anti-Ku was also associated with neurogenic features and rimmed vacuoles in 57% and 25% of cases, respectively. CONCLUSION Our review suggests that SM is characterized by heterogeneous pathological features using definitions included in current histopathological criteria. Whether a distinct histopathological signature exists in SM remains to be determined. SSc-specific and SSc-associated autoantibodies may help define more homogeneous histopathological subsets.
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Affiliation(s)
- Frédéric Lefebvre
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Margherita Giannini
- Service de Physiologie-Explorations Fonctionnelles Musculaire, Service de Rhumatologie et Centre de Référence des Maladies Autoimmunes Rares, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Ellezam
- Division of Pathology, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Valérie Leclair
- Division of Rheumatology, Jewish General Hospital, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Yves Troyanov
- Division of Rheumatology, Hôpital du Sacré-Coeur, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Sabrina Hoa
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Josiane Bourré-Tessier
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Marvin J Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Luc Senécal
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Alain Meyer
- Service de Physiologie-Explorations Fonctionnelles Musculaire, Service de Rhumatologie et Centre de Référence des Maladies Autoimmunes Rares, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal, Montréal, Québec, Canada.
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Akagi M, Umeda M, Hashisako M, Hara K, Tsuji S, Endo Y, Takatani A, Shimizu T, Fukui S, Koga T, Kawashiri SY, Iwamoto N, Igawa T, Ichinose K, Tamai M, Nakamura H, Origuchi T, Niino D, Kawakami A. Drop Head Syndrome as a Rare Complication in Mixed Connective Tissue Disease. Intern Med 2020; 59:729-732. [PMID: 31735790 PMCID: PMC7086316 DOI: 10.2169/internalmedicine.3626-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 54-year-old woman developed drop head syndrome (DHS), Raynaud's phenomenon and creatine kinase (CK) elevation. She did not meet the international classification criteria of dermatomyositis/polymyositis, as we observed no muscle weakness, grasping pain or electromyography abnormality in her limbs, and anti-aminoacyl tRNA synthetase (ARS) antibody was negative. Cervical magnetic resonance imaging and a muscle biopsy of the trapezius muscle revealed myositis findings as the only clinical observations in muscle. These findings, along with her anti-U1-ribonucleoprotein (RNP) antibody positivity and leukopenia, resulted in a diagnosis of mixed connective tissue disease (MCTD). Prednisolone treatment significantly improved her myositis. To our knowledge, this is the first report of DHS as the only muscle complication of MCTD.
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Affiliation(s)
- Midori Akagi
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Masataka Umeda
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Medical Education Development Center, Nagasaki University Hospital, Japan
| | - Mikiko Hashisako
- Department of Anatomic Pathology, Graduate School of Medicine Sciences, Kyushu University, Japan
| | - Kazusato Hara
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Sousuke Tsuji
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yushiro Endo
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Ayuko Takatani
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Shoichi Fukui
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Shin-Ya Kawashiri
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takashi Igawa
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Mami Tamai
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tomoki Origuchi
- Department of Physical Therapy Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Daisuke Niino
- Nagasaki Educational and Diagnostic Center of Pathology, Nagasaki University Hospital, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Wesner N, Uruha A, Suzuki S, Mariampillai K, Granger B, Champtiaux N, Rigolet A, Schoindre Y, Lejeune S, Guillaume-Jugnot P, Vautier M, Hervier B, Simon A, Granier F, Gallay L, Nishino I, Benveniste O, Allenbach Y. Anti-RNP antibodies delineate a subgroup of myositis: A systematic retrospective study on 46 patients. Autoimmun Rev 2020; 19:102465. [PMID: 31918028 DOI: 10.1016/j.autrev.2020.102465] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Nadège Wesner
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Akinori Uruha
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France; Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, 183-0042 Tokyo, Japan
| | - Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582 Tokyo, Japan
| | - Kubéraka Mariampillai
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Benjamin Granger
- Department of Public Health, Pitié Salpétrière Hospital, 84 Boulevard de l'Hôpital, 75013 Paris, France
| | - Nicolas Champtiaux
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Aude Rigolet
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yoland Schoindre
- Internal Medicine Department, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
| | - Sylvain Lejeune
- Internal Medicine Department, Avicennes Hospital, 125, rue de Stalingrad, 93000 Bobigny, France
| | - Perrine Guillaume-Jugnot
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Matthieu Vautier
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Baptiste Hervier
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anne Simon
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Françoise Granier
- Internal Medicine Department, Centre Hospitalier François Quesnay, 62 rue Saint Vincent, 78201 Mantes la Jolie, France
| | - Laure Gallay
- Internal Medicine Department, Hospices Civils de Lyon, Neuro-Myo-Gène Institut, INSERM U1217, 68008 Lyon, France
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience and Department of Genome Medicine Development, Medical Genome Center National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8551 Tokyo, Japan
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France.
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Yoo IS, Kim J. The Role of Autoantibodies in Idiopathic Inflammatory Myopathies. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.3.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- In Seol Yoo
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jinhyun Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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Abstract
INTRODUCTION The idiopathic inflammatory myopathies (IIM) dermatomyositis (DM) and polymyositis (PM) are chronic diseases affecting the striated muscles with variable involvement of other organs. Glucocorticoids are considered the cornerstone of treatment, but some patients require adjunctive immunosuppressive agents because of insufficient response to glucocorticoids, flares upon glucocorticoid tapering, or glucocorticoid-related adverse events. Areas covered: The aim of this article was to review (PubMed search until February 2018) the evidence on established and new therapies derived from randomized controlled trials (RCTs) on adult DM and PM. In addition, key data from open-label trials, case reports, and abstracts were included where data from RCT were lacking. Expert commentary: Numerous synthetic and biological immunosuppressive agents are currently available to treat the IIM, sometimes in combination. The choice of the specific medication in the individual patient depends upon the disease phenotype and patient's characteristics. Exercise improves muscle performance without causing disease flares and should be an integral part of the treatment of the IIM. Prompt diagnosis and treatment can lead to better outcome.
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Affiliation(s)
- Nicolò Pipitone
- a SC di Reumatologia, Dipartimento Medicina Interna e Specialità Mediche, Azienda Unità Sanitaria Locale di Reggio Emilia - Istituto di Ricerca e Cura a Carattere Scientifico , Reggio , Emilia-Romagna , Italy
| | - Carlo Salvarani
- a SC di Reumatologia, Dipartimento Medicina Interna e Specialità Mediche, Azienda Unità Sanitaria Locale di Reggio Emilia - Istituto di Ricerca e Cura a Carattere Scientifico , Reggio , Emilia-Romagna , Italy.,b Rheumatology Department , University of Modena and Reggio Emilia , Italy
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Palterer B, Vitiello G, Carraresi A, Giudizi MG, Cammelli D, Parronchi P. Bench to bedside review of myositis autoantibodies. Clin Mol Allergy 2018. [PMID: 29540998 PMCID: PMC5840827 DOI: 10.1186/s12948-018-0084-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Idiopathic inflammatory myopathies represent a heterogeneous group of autoimmune diseases with systemic involvement. Even though numerous specific autoantibodies have been recognized, they have not been included, with the only exception of anti-Jo-1, into the 2017 Classification Criteria, thus perpetuating a clinical-serologic gap. The lack of homogeneous grouping based on the antibody profile deeply impacts the diagnostic approach, therapeutic choices and prognostic stratification of these patients. This review is intended to highlight the comprehensive scenario regarding myositis-related autoantibodies, from the molecular characterization and biological significance to target antigens, from the detection tools, with a special focus on immunofluorescence patterns on HEp-2 cells, to their relative prevalence and ethnic diversity, from the clinical presentation to prognosis. If, on the one hand, a notable body of literature is present, on the other data are fragmented, retrospectively based and collected from small case series, so that they do not sufficiently support the decision-making process (i.e. therapeutic approach) into the clinics.
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Affiliation(s)
- Boaz Palterer
- Experimental and Clinical Medicine Department, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Gianfranco Vitiello
- Experimental and Clinical Medicine Department, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Alessia Carraresi
- Experimental and Clinical Medicine Department, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Maria Grazia Giudizi
- Experimental and Clinical Medicine Department, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Daniele Cammelli
- Experimental and Clinical Medicine Department, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Paola Parronchi
- Experimental and Clinical Medicine Department, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Gunnarsson R, Hetlevik SO, Lilleby V, Molberg Ø. Mixed connective tissue disease. Best Pract Res Clin Rheumatol 2016; 30:95-111. [DOI: 10.1016/j.berh.2016.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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11
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Zong M, Dorph C, Dastmalchi M, Alexanderson H, Pieper J, Amoudruz P, Barbasso Helmers S, Nennesmo I, Malmström V, Lundberg IE. Anakinra treatment in patients with refractory inflammatory myopathies and possible predictive response biomarkers: a mechanistic study with 12 months follow-up. Ann Rheum Dis 2013; 73:913-20. [DOI: 10.1136/annrheumdis-2012-202857] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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12
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Sugiura T, Kawaguchi Y, Soejima M, Katsumata Y, Gono T, Baba S, Kawamoto M, Murakawa Y, Yamanaka H, Hara M. Increased HGF and c-Met in muscle tissues of polymyositis and dermatomyositis patients: Beneficial roles of HGF in muscle regeneration. Clin Immunol 2010; 136:387-99. [DOI: 10.1016/j.clim.2010.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 04/19/2010] [Accepted: 04/20/2010] [Indexed: 11/29/2022]
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13
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Sibilia J, Chatelus E, Meyer A, Gottenberg JE, Sordet C, Goetz J. [How can we diagnose and better understand inflammatory myopathies? The usefulness of auto-antibodies]. Presse Med 2010; 39:1010-25. [PMID: 20655695 DOI: 10.1016/j.lpm.2010.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 05/26/2010] [Accepted: 06/02/2010] [Indexed: 01/30/2023] Open
Abstract
The inflammatory myopathies are a group of quite proteiform, systemic auto-immune diseases which include polymyositis, dermatomyositis and inclusion body myopathies. To facilitate the diagnosis, classification criteria (Bohan and Peter, 1975) have been proposed, based essentially on clinical criteria. In addition, over the past fifteen years, auto-antibodies characterizing certain forms of inflammatory myopathy have been identified. One distinguishes schematically: auto-antibodies specific for myositis and auto-antibodies sometimes associated with myositis. Concerning the myositis specific auto-antibodies (MSA), schematically there are a dozen specificities which are classed according to the cellular distribution of the auto-antigen. The most characteristic are certainly the auto-antibodies directed against cytoplasmic antigens: the anti-tRNA synthetases (anti-Jo-1 (PL-1), anti-PL-7, PL-12, EJ, OJ, JS, KS, ZO, YRS), anti-SRP (signal recognition particle), anti-Mas and anti-KJ, anti-Fer (eEF1), anti-Wa and anti-CADM p140. Other auto-antibodies are directed against nuclear auto-antigens: the anti-Mi-2, anti-PMS (PMS1, PMS2) and related antibodies (MLH1, DNA PKcs…), anti-56 kDa, anti-MJ (NXP-2), anti-SAE and anti-p155/p140 (TIF-1γ). Concerning the auto-antibodies sometimes associated with myositis (myositis associated auto-antibodies or MAA), they can also be observed in other auto-immune diseases. These auto-antibodies are directed against nuclear or nucleolar auto-antigens: the anti-PM-Scl, anti-Ku, anti-RNP (U1 RNP and U2 RNP, U4/U6 RNP and U5 RNP), anti-Ro 52 kDa and more rarely, anti-Ro 60 kDa and anti-La. The auto-antibodies related to myositis are biological tools which are of interest in two main ways. They have allowed us to sort out the nosology of these inflammatory myopathies, in particular by defining anti-tRNA synthetase syndrome. It now remains to determine how they might be employed to complement the classical clinico-biological diagnostic criteria. In this perspective, it will be indispensable first of all to diffuse and standardize the methods of detection. The latter are at the moment very heterogeneous as they use techniques and above all antigenic preparations which are extremely diverse. These antibodies are also very interesting "physiopathological" tools to try to better understand myositis. The example of anti-tRNA synthetases is a particularly original model of auto-immunization, which allows one to establish a link between an initial, probably poorly specific muscular lesion and the appearance of auto-antibodies which maintain and aggravate the muscular disease.
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Affiliation(s)
- Jean Sibilia
- CHU de Strasbourg, hôpital Hautepierre, service de rhumatologie, laboratoire d'immunologie, 67098 Strasbourg cedex, France.
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Kattah NH, Kattah MG, Utz PJ. The U1-snRNP complex: structural properties relating to autoimmune pathogenesis in rheumatic diseases. Immunol Rev 2010; 233:126-45. [PMID: 20192997 PMCID: PMC3074261 DOI: 10.1111/j.0105-2896.2009.00863.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The U1 small nuclear ribonucleoprotein particle (snRNP) is a target of autoreactive B cells and T cells in several rheumatic diseases including systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD). We propose that inherent structural properties of this autoantigen complex, including common RNA-binding motifs, B and T-cell epitopes, and a unique stimulatory RNA molecule, underlie its susceptibility as a target of the autoimmune response. Immune mechanisms that may contribute to overall U1-snRNP immunogenicity include epitope spreading through B and T-cell interactions, apoptosis-induced modifications, and toll-like receptor (TLR) activation through stimulation by U1-snRNA. We conclude that understanding the interactions between U1-snRNP and the immune system will provide insights into why certain patients develop anti-U1-snRNP autoimmunity, and more importantly how to effectively target therapies against this autoimmune response.
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Affiliation(s)
- Nicole H Kattah
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA 94305, USA.
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[Laboratory abnormalities and autoantibodies]. ACTA ACUST UNITED AC 2009; 5 Suppl 3:16-9. [PMID: 21794663 DOI: 10.1016/j.reuma.2009.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/11/2009] [Accepted: 09/15/2009] [Indexed: 11/24/2022]
Abstract
Laboratory tests in inflammatory myopathies (IIM) are of great help in the diagnosis of these diseases. Two main groups can be defined, one of them quantifies the muscle enzymes that reflect muscle inflammation and the other one detects the presence of autoantibodies which reflect the autoimmune process in these diseases. The most important muscle enzyme is creatine kinase and other enzymes to take into consideration are aspartate and alanine aminotransferase, aldolase and lactic dehydrogenase. In the autoantibodies group, antinuclear antibodies are the most important, since they occur in approximately 50-80% of patients with IIM and help define the distinct disease sub-groups. They are divided into myositis specific antibodies (MSA) and myositis associated antibodies (MAA). The most important MSA are anti-Jo-1 antibody which occur in patients with Polymyositis and anti-Mi-2 antibody that occur in patients with Dermatomyositis.
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Na SJ, Kim SM, Sunwoo IN, Choi YC. Clinical characteristics and outcomes of juvenile and adult dermatomyositis. J Korean Med Sci 2009; 24:715-21. [PMID: 19654958 PMCID: PMC2719214 DOI: 10.3346/jkms.2009.24.4.715] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 09/26/2008] [Indexed: 12/18/2022] Open
Abstract
Dermatomyositis (DM) is an idiopathic inflammatory myopathy with bimodal onset age distribution. The age of onset is between 5-18 yr in juvenile DM and 45-64 yr in adult DM. DM has a distinct clinical manifestation characterized by proximal muscle weakness, skin rash, extramuscular manifestations (joint contracture, dysphagia, cardiac disturbances, pulmonary symptoms, subcutaneous calcifications), and associated disorders (connective tissue disease, systemic autoimmune diseases, malignancy). The pathogenesis of juvenile and adult DM is presumably similar but there are important differences in some of the clinical manifestations, associated disorders, and outcomes. In this study, we investigated the clinical characteristics and outcomes of 16 patients with juvenile DM and 48 with adult DM. This study recognizes distinctive characteristics of juvenile DM such as higher frequency of neck muscle involvement, subcutaneous calcifications, and better outcomes.
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Affiliation(s)
- Sang-Jun Na
- Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
- Department of Neurology, Brain Korea 21 Project for Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Kim
- Department of Neurology, Brain Korea 21 Project for Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Il Nam Sunwoo
- Department of Neurology, Brain Korea 21 Project for Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Chul Choi
- Department of Neurology, Brain Korea 21 Project for Medicine, Yonsei University College of Medicine, Seoul, Korea
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Sordet C, Goetz J, Sibilia J. Contribution of autoantibodies to the diagnosis and nosology of inflammatory muscle disease. Joint Bone Spine 2006; 73:646-54. [PMID: 17110150 DOI: 10.1016/j.jbspin.2006.04.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Accepted: 04/07/2006] [Indexed: 01/26/2023]
Abstract
The myositides are systemic autoimmune conditions of which the most important are polymyositis, dermatomyositis, and inclusion body myositis. In addition to the classic clinical diagnostic criteria, myositis-specific autoantibodies were identified about 15 years ago. Among the dozen or so myositis-specific autoantibodies reported to date, the most characteristic are directed against cytoplasmic antigens, such as tRNA synthetase (Jo-1 or PL-1, PL-7, PL-12, EJ, OJ, JS, and KS), signal-recognition particle (SRP), Mas, KJ, Fer (eEF1), and Wa. Antibodies to nuclear antigens include anti-Mi-2, anti-PMS (PMS1, and PMS2), and related antibodies (MLH1, DNA protein kinase catalytic subunit (DNA PKCS)...), and anti-56 kDa. Myositis-associated antibodies are not specific but may be found in patients with myositis. They are directed to nuclear or nucleolar antigens such as PM-Scl, Ku, RNP (U1-RNP and U2-RNP, U4/U6-RNP, and U5-RNP), Ro 52 kDa and, more rarely, Ro 60 kDa and La. Myositis-specific antibodies have proved useful on two fronts. They have improved the diagnosis of myositis by leading to the identification of characteristic clinical patterns, such as anti-synthetase syndrome. The place of autoantibodies alongside classic clinical and laboratory criteria remains to be determined, however. First, standardized assays will have to be developed to replace current detection methods, which use widely variable techniques and antigen preparations. Myositis-specific antibodies have also shed light on the pathogenesis of myositis. For instance, the development of antibodies to tRNA synthetases constitutes an original autoimmunity model that shows how muscle damage, probably of a nonspecific nature, can lead to the production of autoantibodies that perpetuate and aggravate the muscle lesions.
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Affiliation(s)
- Christelle Sordet
- Rheumatology Department and Immunology Laboratory, Strasbourg Teaching Hospital, Louis Pasteur University, EA 3432 Strasbourg, France
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Abstract
Symmetric proximal muscle weakness has many potential etiologies. An onset over weeks to months and elevated serum levels of muscle enzymes point to the diagnosis of an idiopathic inflammatory myopathy, including dermatomyositis, polymyositis, and inclusion body myositis. However, there is a broad differential diagnosis, including certain muscular dystrophies, metabolic myopathies, drug- or toxin-induced myotoxicity, neuropathies, and infectious myositides. The differentiation is critical for defining appropriate treatment. In addition, an alternative diagnosis may explain the lack of response to immunosuppressive treatment for some patients with polymyositis. Careful clinical evaluation and choice of available diagnostic tests are required to establish the correct diagnosis.
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Affiliation(s)
- Alan N Baer
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215, USA.
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Abstract
The prognosis for patients who have mixed connective tissue disease (MCTD) varies from a benign course to severe progressive disease. In approximately one third of patients the clinical symptoms go into long-term remission and the anti-U1 small nuclear ribonucleoprotein antibodies disappear. One third of patients have a severe, progressive disease course. Persistent morbidity often is attributable to arthritis, easy fatiguability, and dyspnea on exertion. The most severe clinical manifestation is pulmonary hypertension which contributes to premature death in patients who have MCTD. Pulmonary hypertension is associated with proliferative vascular abnormalities that involve small pulmonary vessels, rather than interstitial lung disease.
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Affiliation(s)
- Ingrid E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
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Abstract
Muscle disease has been recognized as a common feature of mixed connective tissue disease (MCTD) since its first description in 1972. In the absence of clinical trials that are directed specifically at the myositis of MCTD, patients should be treated in the manner that is recommended for other forms of myositis. Myositis of MCTD may have a better prognosis than other forms of myositis.
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Affiliation(s)
- Stephen Hall
- Department of Medicine, Monash University, Box Hill Hospital, Melbourne, Australia.
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Targoff IN. Laboratory testing in the diagnosis and management of idiopathic inflammatory myopathies. Rheum Dis Clin North Am 2002; 28:859-90, viii. [PMID: 12506776 DOI: 10.1016/s0889-857x(02)00032-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Laboratory testing commonly used to assess the idiopathic inflammatory myopathies (IIMs) can be divided into three categories: (1) measurement of serum activities or concentrations of muscle-derived factors--such as enzymes, myoglobin, and other molecules--in order to assess muscle injury; (2) immunologic tests that detect markers of the disease process, including serum autoantibodies that have been associated with myositis; and (3) general laboratory tests that are used to assess the patient's general status and medical condition. The laboratory assessment of muscle-derived factors that reflect muscle injury, and the determination of serum autoantibodies, play valuable roles in the diagnosis and management of the IIM. Enzyme elevations do not correlate with disease activity in all patients, however, and they must be interpreted within the clinical context. Autoantibodies can identify disease subsets with distinctive patterns of clinical manifestations, genetics, responses to therapy and prognosis, but disease-specific autoantibodies are present in only half of patients with IIM. Recent studies have defined additional myositis autoantibodies that may improve our capacity to diagnose and manage the IIM.
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Affiliation(s)
- Ira N Targoff
- Department of Medicine, Veterans Affairs Medical Center, Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, 825 NE 13th Street, Oklahoma City, OK 73104, USA.
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Abstract
The idiopathic inflammatory myopathies (IIMs) encompass a group of muscle disorders of unknown origin and pathogenesis characterized by symmetrical, proximal muscle weakness and by inflammatory infiltrates in muscle tissue. The mechanisms behind the loss of muscle function are largely unknown. It is often anticipated that the muscle weakness is caused by the inflammatory cells. However, inflammatory infiltrates are not always present in the muscle tissue and the infiltrates sometimes have a patchy distribution, which makes it difficult to explain the generalized muscle weakness merely by infiltration of inflammatory cells. We investigated patients at different stages of myositis: early myositis without detectable inflammatory infiltrates, active myositis with pronounced inflammatory infiltrates and chronic myositis with persisting muscle weakness but without detectable inflammatory cells in muscle tissues. In these studies, a better correlation was observed between the clinical symptoms and involvement of the capillaries with expression of the cytokine interleukin (IL)-1alpha and by the presence of major histocompatibility complex (MHC) class I expression on muscle fibres. Whether these molecules could affect muscle function is not known. Using phosphorus P-31 magnetic resonance spectroscopy decreased values of adenosine triphosphate (ATP) and phosphocreatine (PCr) levels were observed at rest. These metabolic abnormalities were further accentuated by exercise and increased PCr levels correlated with improved clinical status. The underlying mechanisms responsible for these biochemical abnormalities have not been defined but could be related to a disturbed tissue oxygenation.
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Affiliation(s)
- I E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, and Rheumatology Clinic, Karolinska Hospital, Stockholm, Sweden
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Brouwer R, Hengstman GJ, Vree Egberts W, Ehrfeld H, Bozic B, Ghirardello A, Grøndal G, Hietarinta M, Isenberg D, Kalden JR, Lundberg I, Moutsopoulos H, Roux-Lombard P, Vencovsky J, Wikman A, Seelig HP, van Engelen BG, van Venrooij WJ. Autoantibody profiles in the sera of European patients with myositis. Ann Rheum Dis 2001; 60:116-23. [PMID: 11156543 PMCID: PMC1753477 DOI: 10.1136/ard.60.2.116] [Citation(s) in RCA: 264] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the prevalence of myositis specific autoantibodies (MSAs) and several myositis associated autoantibodies (MAAs) in a large group of patients with myositis. METHODS A total of 417 patients with myositis from 11 European countries (198 patients with polymyositis (PM), 181 with dermatomyositis (DM), and 38 with inclusion body myositis (IBM)) were serologically analysed by immunoblot, enzyme linked immunosorbent assay (ELISA) and/or immunoprecipitation. RESULTS Autoantibodies were found in 232 sera (56%), including 157 samples (38%) which contained MSAs. The most commonly detected MSA was anti-Jo-1 (18%). Other anti-synthetase, anti-Mi-2, and anti-SRP autoantibodies were found in 3%, 14%, and 5% of the sera, respectively. A relatively high number of anti-Mi-2 positive PM sera were found (9% of PM sera). The most commonly detected MAA was anti-Ro52 (25%). Anti-PM/Scl-100, anti-PM/Scl-75, anti-Mas, anti-Ro60, anti-La, and anti-U1 snRNP autoantibodies were present in 6%, 3%, 2%, 4%, 5%, and 6% of the sera, respectively. Remarkable associations were noticed between anti-Ro52 and anti-Jo-1 autoantibodies and, in a few sera, also between anti-Jo-1 and anti-SRP or anti-Mi-2 autoantibodies. CONCLUSIONS The incidence of most of the tested autoantibody activities in this large group of European patients is in agreement with similar studies of Japanese and American patients. The relatively high number of PM sera with anti-Mi-2 reactivity may be explained by the use of multiple recombinant fragments spanning the complete antigen. Furthermore, our data show that some sera may contain more than one type of MSA and confirm the strong association of anti-Ro52 with anti-Jo-1 reactivity.
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Affiliation(s)
- R Brouwer
- Department of Biochemistry, University of Nijmegen, Nijmegen, The Netherlands
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Scola RH, Werneck LC, Prevedello DM, Toderke EL, Iwamoto FM. Diagnosis of dermatomyositis and polymyositis: a study of 102 cases. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:789-99. [PMID: 11018813 DOI: 10.1590/s0004-282x2000000500001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
UNLABELLED Patients with dermatomyositis (DM) or polymyositis (PM) were studied retrospectively. The patients were divided into four groups: definite PM 24, probable PM 19, definite DM 34 and mild-early DM 25 cases. PM patients complained more often proximal muscle weakness [p <0.01]. DM patients complained more arthralgia [p <0.05], dysphagia [p <0.03] and weight loss [p <0.04]. Five patients had a malignant neoplasm and 9 had other connective-tissue disease. DM presented higher ESR than PM [p <0.002]. PM presented more significant increase in creatine kinase (CK) [p <0.02] and in alanine aminotransferase (ALT) [p <0.001] levels. Electromyography showed myopathic pattern in 76%. Muscle biopsy was the definitive test. Perifascicular atrophy was more frequent in definite DM than in mild-early DM group [p <0.03]. CONCLUSION A small association with connective-tissue diseases and neoplasms was found. DM and PM are clinically different. DM presents systemic involvement affecting the skin, developing more severe arthralgia, dysphagia and weight loss and presenting higher values of ESR. PM presents a restricted and more significant involvement of muscles generating more weakness complaints and higher levels of serum muscle enzymes.
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Affiliation(s)
- R H Scola
- Disorders Service, Neurology Division and Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.
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Lundberg I, Chung Y. Treatment and investigation of idiopathic inflammatory myopathies. Rheumatology (Oxford) 2000; 39:7-17. [PMID: 10662868 DOI: 10.1093/rheumatology/39.1.7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I Lundberg
- Department of Rheumatology, Karolinska Hospital, S-171 76, Sweden
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Abstract
Through register research 21 new cases (10 male, 11 female) of polymyositis/dermatomyositis during the period 1984-1993 in the county of Gävleborg, Sweden, were identified. The case records were studied retrospectively. Inclusion body myositis was found in three cases and overlap syndrome in seven cases. Three patients had associated malignant disease. The annual incidence was estimated to 7.6 cases/million people. The clinical features are described. 19 patients were given steroid treatment, and azathioprin was the most used additive immunosuppressive drug. All patients could be followed for at least two years, and during this period three patients died (all of cancer disease). Remission and withdrawal of medication were achieved in five cases. The results of the study corresponds to previous investigations with similar design.
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Affiliation(s)
- T Weitoft
- Department of Internal Medicine, Länssjukhuset Gävle, Sweden
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Uthman I, Vázquez-Abad D, Senécal JL. Distinctive features of idiopathic inflammatory myopathies in French Canadians. Semin Arthritis Rheum 1996; 26:447-58. [PMID: 8870112 DOI: 10.1016/s0049-0172(96)80025-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This is the first report on idiopathic inflammatory myopathies (IIM) in French Canadians. We reviewed retrospectively 30 French Canadian adults (20 women and 10 men) with IIM seen consecutively over 12 years. The median age at diagnosis was 45 years. The IIM were 8 (27%) primary polymyositis (PM), 9 (30%) primary dermatomyositis (DM), 5 (17%) IIM with neoplasia (lymphoma, breast, esophageal, colonic, and skin cancer) and 8 (27%) IIM with a connective tissue disease (4 with systemic sclerosis, 2 with mixed connective tissue disease, and 2 with rheumatoid arthritis). The most common presenting symptom was proximal muscle weakness (n = 10,33%). Of the remaining 20 patients, 6 (20%) had the onset of their weakness within 1 month of the presenting symptom. Only 3 (10%) patients did not have proximal muscle weakness. Twenty-six (87%) patients had weakness in the pelvic girdle, 25 (83%) in the shoulder girdle, and 7 (23%) in the neck muscles. Other common symptoms included dyspnea on exertion and dysphagia, each present in 13 (43%) patients. Gottron's papules and the heliotrope rash were the most common skin lesions documented in 11 (37%) and 10 (33%) patients, respectively. The serum creatine kinase (CK) level was between 171 and 1,000 U/L in 13 (43%) patients and between 1,001 and 6,000 U/L in 13 (43%) patients. Antinuclear antibodies (ANA) on HEp-2 cells were positive in 16 (53%) patients, of which 2 (13%) expressed autoantibodies to nuclear pore complexes. Autoantibody specificities were anti-La (n = 4, 13%), anti-U1RNP (n = 3, 10%), and anti-Ro (n = 2, 7%). None of the patients expressed anti-Jo-1, anti-topoisomerase I, or anticentromere antibodies. Twenty-eight (93%) patients received corticosteroid therapy, and 8 (27%) patients responded to prednisone alone. Thirteen (43%) patients were treated with methotrexate, and 9 (69%) responded. The mean follow-up was 62 months: 23 (77%) had their disease controlled, 3 (10%) patients were lost to follow-up, and 4 (13%) died (no death occurred because of IIM or its treatment). Therapy was discontinued because of remission in 5 (17%) patients. Cumulative survival rates at 2, 5, and 10 years were 89%, 89%, and 85%, respectively. The presence of autoantibodies to nuclear pore complexes and anti-La autoantibodies, the rare occurrence of anti-Jo-1 autoantibodies, the response to conventional therapies, and a high survival rate may distinguish IIM in French Canadians from that of other reported series.
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Affiliation(s)
- I Uthman
- Division of Rheumatology, Hôpital Notre-Dame, Montréal, Québec, Canada
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