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Li G, Yan X, Luo C, An Y, Zhang Z, Tang X, Zhao X, Yang X. Clinical and genetic analysis of macrophage activation syndrome complicating juvenile idiopathic inflammatory myopathies. Pediatr Res 2024:10.1038/s41390-024-03515-7. [PMID: 39181985 DOI: 10.1038/s41390-024-03515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Macrophage activation syndrome (MAS) is a serve complication of juvenile idiopathic inflammatory myopathies (JIIMs). This study delineates the clinical manifestations and genetic underpinnings of JIIM-MAS patients. METHODS We retrospectively analysed clinical and UNC13D gene from JIIM patients admitted to our centre between 2011 and 2021 to identify cases of MAS. Additionally, a literature review summarising reported cases of JIIMs and MAS was performed. RESULTS Of 773 JIIM patients, 10 (1.3%) were diagnosed with MAS. All patients presented with persistent fever and hyperferritinaemia. Seventy percent of patients met the HLH-2004 criteria, while 90% met the 2016 sJIA-MAS criteria. Most patients received combined treatment of corticosteroids and immunosuppressants. UNC13D gene analysis was performed in six patients. A homozygous pathogenic mutation (c.2588G>A) was detected in one patient with recurrent MAS, and twenty-eight single-nucleotide polymorphisms (SNPs) were detected. Eighty percent of patients exhibiting a consistent combination of ten SNPs compared to JIIM patients without MAS (35%). CONCLUSION MAS is an early and often overlooked complication of JIIMs. The 2016 sJIA-MAS criteria may facilitate early diagnosis. Combined corticosteroid and immunosuppressant therapy prove effective. An increased prevalence of UNC13D gene polymorphisms was observed in JIIM-MAS patients, highlighting the necessity for further investigations. IMPACT This study aimed to delineate the clinical manifestations and genetic underpinnings of macrophage activation syndrome (MAS) in ten patients with juvenile idiopathic inflammatory myopathies (JIIMs). MAS has been recognised as a complication of JIIMs. However, only a few case reports provide comprehensive descriptions of MAS in JIIM patients, and there are few reports related to UNC13D mutations in these patients. This article offers single-centre clinical insights to enhance the identification and management of MAS in JIIM patients, while also highlighting the potential association between MAS occurrence and UNC13D gene polymorphisms.
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Affiliation(s)
- Guangzhao Li
- Children's Hospital of Chongqing Medical University, Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Xin Yan
- Children's Hospital of Chongqing Medical University, Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Chong Luo
- Children's Hospital of Chongqing Medical University, Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Yunfei An
- Children's Hospital of Chongqing Medical University, Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Zhiyong Zhang
- Children's Hospital of Chongqing Medical University, Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Xuemei Tang
- Children's Hospital of Chongqing Medical University, Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Xiaodong Zhao
- Children's Hospital of Chongqing Medical University, Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Xi Yang
- Children's Hospital of Chongqing Medical University, Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China.
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2
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Raab A, Dressler F. [Boy with aphthae, coeliac disease and polyarthritis]. Laryngorhinootologie 2024. [PMID: 39117314 DOI: 10.1055/a-2341-1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Affiliation(s)
- Anna Raab
- Pädiatrische Rheumatologie, Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - Frank Dressler
- Pädiatrische Rheumatologie, Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
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3
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Ryan MA, Ermarth A. Inflammatory Causes of Dysphagia in Children. Otolaryngol Clin North Am 2024; 57:669-684. [PMID: 38637195 DOI: 10.1016/j.otc.2024.03.002] [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] [Indexed: 04/20/2024]
Abstract
Gastroesophageal reflux (GER) and eosinophilic esophagitis (EoE) are the most common inflammatory causes of pediatric dysphagia, but several other less prevalent conditions should be considered. These conditions can affect one or several aspects of the swallowing process. In some inflammatory conditions dysphagia may be an early symptom. Esophagoscopy and instrumental swallow studies are often needed to determine the underlying diagnosis and best treatment plan. In some inflammatory conditions dysphagia can portend a worse outcome and need for more aggressive treatment of the underlying condition. Consultations with speech language pathology, gastroenterology, dietetics, allergy/immunology and/or rheumatology are often needed to optimize management.
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Affiliation(s)
- Marisa A Ryan
- Pediatric Otolaryngology, Peak ENT Associates, 1055 North 300 West, Suite 401, Provo, UT 84604, USA.
| | - Anna Ermarth
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, 81 Mario Capecchi Drive, Salt Lake City, UT 84113, USA
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Koester ST, Chow A, Pepper-Tunick E, Lee P, Eckert M, Brenchley L, Gardner P, Song HJ, Li N, Schiffenbauer A, Volochayev R, Bayat N, McLean JS, Rider LG, Shenoi S, Stevens AM, Dey N. Familial clustering of dysbiotic oral and fecal microbiomes in juvenile dermatomyositis. Sci Rep 2024; 14:16158. [PMID: 38997299 PMCID: PMC11245510 DOI: 10.1038/s41598-024-60225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/19/2024] [Indexed: 07/14/2024] Open
Abstract
Juvenile dermatomyositis (JDM) is a rare immune-mediated disease of childhood with putative links to microbial exposures. In this multi-center, prospective, observational cohort study, we evaluated whether JDM is associated with discrete oral and gut microbiome signatures. We generated 16S rRNA sequencing data from fecal, saliva, supragingival, and subgingival plaque samples from JDM probands (n = 28). To control for genetic and environmental determinants of microbiome community structure, we also profiled microbiomes of unaffected family members (n = 27 siblings, n = 26 mothers, and n = 17 fathers). Sample type (oral-vs-fecal) and nuclear family unit were the predominant variables explaining variance in microbiome diversity, more so than having a diagnosis of JDM. The oral and gut microbiomes of JDM probands were more similar to their own unaffected siblings than they were to the microbiomes of other JDM probands. In a sibling-paired within-family analysis, several potentially immunomodulatory bacterial taxa were differentially abundant in the microbiomes of JDM probands compared to their unaffected siblings, including Faecalibacterium (gut) and Streptococcus (oral cavity). While microbiome features of JDM are often shared by unaffected family members, the loss or gain of specific fecal and oral bacteria may play a role in disease pathogenesis or be secondary to immune dysfunction in susceptible individuals.
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Affiliation(s)
- Sean T Koester
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- University of Kansas School of Medicine, Kansas City, USA
| | - Albert Chow
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA, USA
- Loma Linda University, Loma Linda, USA
| | - Evan Pepper-Tunick
- Molecular Engineering and Sciences Institute, University of Washington, Seattle, WA, USA
| | - Peggy Lee
- School of Dentistry, University of Washington, Seattle, WA, USA
| | - Mary Eckert
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
- Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, WA, USA
| | - Laurie Brenchley
- Office of the Clinical Director, NIDCR, National Institutes of Health, Bethesda, MD, USA
| | - Pamela Gardner
- Office of the Clinical Director, NIDCR, National Institutes of Health, Bethesda, MD, USA
- Oral Oncology at BC Cancer, Vancouver, BC, Canada
| | - Hyun Jung Song
- School of Dentistry, University of Washington, Seattle, WA, USA
| | - Naisi Li
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Adam Schiffenbauer
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Rita Volochayev
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Nastaran Bayat
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
- Social and Scientific Systems, Inc., A DLH Holdings Corp. Company, Silver Spring, MD, USA
| | - Jeffrey S McLean
- Department of Periodontics, University of Washington, Seattle, WA, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Susan Shenoi
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Anne M Stevens
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
- Janssen, a Wholly Owned Subsidiary of Johnson & Johnson, Raritan, USA
| | - Neelendu Dey
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, WA, USA.
- Microbiome Research Initiative, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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Sangaran LR, Smith JP, Menegotto F, Ramanan AV. Of oranges and lemons: you are what you eat. Arch Dis Child Educ Pract Ed 2024:edpract-2024-327057. [PMID: 38744456 DOI: 10.1136/archdischild-2024-327057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/20/2024] [Indexed: 05/16/2024]
Abstract
A young boy presented with increasing lower limb pain and swelling for a month. At the time of his hospitalisation, he was unable to walk. We report the patient's clinical journey with clinical commentary throughout, highlighting the importance that uncommon diseases may be diagnosed with a high index of suspicion and thorough history taking.
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Affiliation(s)
- La Reina Sangaran
- Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
| | | | - Flavia Menegotto
- Paediatric Radiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Athimalaipet V Ramanan
- Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
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Paharia N, Agrawal S, Agrawal N, Shah J. A rare case report of bilateral Purtscher-like retinopathy in juvenile dermatomyositis. GMS OPHTHALMOLOGY CASES 2024; 14:Doc05. [PMID: 38883974 PMCID: PMC11176935 DOI: 10.3205/oc000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Purpose To report a rare case of bilateral Purtscher-like retinopathy (PLR) in a young adult diagnosed with dermatomyositis. Method A case report with multi-modal imaging. Result A 17-year-old male presented with subacute marked diminution of vision along with arthralgia, weakness of all four limbs and development of multiple rashes around body. Fundus examination revealed bilateral multiple Purtscher flecken, pseudo-cherry red spot, and intra-retinal haemorrhages with cotton wool spots. Systemic and laboratory examinations, magnetic resonance imaging (MRI) and biopsy of tissue confirmed the diagnosis of juvenile dermatomyositis with PLR. Conclusion Dermatomyositis, being a rare cause of PLR, should essentially be considered as one of the differentials as timely intervention can alter the course of disease and prove life-saving for the patient.
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Affiliation(s)
- Nidhi Paharia
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Bhatinda, Punjab, India
| | - Shruti Agrawal
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Nikhil Agrawal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - Jayesh Shah
- Department of Pathology, Christian Medical College, Vellore, India
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Kassani PH, Ehwerhemuepha L, Martin-King C, Kassab R, Gibbs E, Morgan G, Pachman LM. Artificial intelligence for nailfold capillaroscopy analyses - a proof of concept application in juvenile dermatomyositis. Pediatr Res 2024; 95:981-987. [PMID: 37993641 DOI: 10.1038/s41390-023-02894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Biomarkers for idiopathic inflammatory myopathies are difficult to identify and may involve expensive laboratory tests. We assess the potential for artificial intelligence (AI) to differentiate children with juvenile dermatomyositis (JDM) from healthy controls using nailfold capillaroscopy (NFC) images. We also assessed the potential of NFC images to reflect the range of disease activity with JDM. METHODS A total of 1,120 NFC images from 111 children with active JDM, diagnosed between 1990 and 2020, and 321 NFC images from 31 healthy controls were retrieved from the CureJM JDM Registry. We built a lightweight and explainable deep neural network model called NFC-Net. Images were downscaled by interpolation techniques to reduce the computational cost. RESULTS NFC-Net achieved high performance in differentiating patients with JDM from controls, with an area under the ROC curve (AUROC) of 0.93 (0.84, 0.99) and accuracy of 0.91 (0.82, 0.92). With sensitivity (0.85) and specificity (0.90) resulted in model precision of 0.95. The AUROC and accuracy for predicting clinical disease activity from inactivity were 0.75 (0.61, 0.81) and 0.74 (0.65, 0.79). CONCLUSION The good performance of the NFC-Net demonstrates that NFC images are sufficient for detecting often unrecognized JDM disease activity, providing a reliable indicator of disease status. IMPACT Proposed NFC-Net can accurately predict children with JDM from healthy controls using nailfold capillaroscopy (NFC) images. Additionally, it predicts the scores to JDM disease activity versus no activity. Equipped with gradients, NFC-Net is explainable and gives visual information beside the reported accuracies. NFC-Net is computationally efficient since it is applied to substantially downscaled NFC images. Furthermore, the model can be wrapped within an edge-based device like a mobile application that is accessible to both clinicians and patients.
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Affiliation(s)
| | - Louis Ehwerhemuepha
- Research Institute, Children's Hospital of Orange County (CHOC), Orange, CA, USA.
| | - Chloe Martin-King
- Research Institute, Children's Hospital of Orange County (CHOC), Orange, CA, USA
| | - Ryan Kassab
- Research Institute, Children's Hospital of Orange County (CHOC), Orange, CA, USA
| | - Ellie Gibbs
- Department of Biological Sciences, Wellesley College, Wellesley, MA, USA
| | - Gabrielle Morgan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lauren M Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Rosina S, Consolaro A, Pistorio A, Rebollo-Giménez A, Bracaglia C, Dolezalova P, Guilaisne Bernard-Medina A, Herlin T, Trachana M, Vargová V, Wouters C, Carenini L, Ruperto N, Ravelli A. Defining criteria for disease activity states in juvenile dermatomyositis based on the Juvenile Dermatomyositis Activity Index. RMD Open 2024; 10:e003093. [PMID: 38307698 PMCID: PMC10840041 DOI: 10.1136/rmdopen-2023-003093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/22/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To develop and validate the cut-offs in the Juvenile DermatoMyositis Activity Index (JDMAI) to distinguish the states of inactive disease (ID), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) in children with juvenile dermatomyositis (JDM). METHODS For cut-off definition, data from 139 patients included in a randomised clinical trial were used. Among the six versions of the JDMAI, JDMA1 (score range 0-40) and JDMAI2 (score range 0-39) were selected. Optimal cut-offs were determined against external criteria by calculating different percentiles of score distribution and through receiver operating characteristic curve analysis. External criteria included the modified Pediatric Rheumatology International Trials Organization (PRINTO) criteria for clinically ID in JDM (for ID) and PRINTO levels of improvement in the clinical trial (for LDA and HDA). MDA cut-offs were set at the score interval between LDA and HDA cut-offs. Cut-off validation was conducted by assessing construct and discriminative ability in two cohorts including a total of 488 JDM patients. RESULTS The calculated JDMAI1 cut-offs were ≤2.4 for ID, ≤6.6 for LDA, 6.7-11 for MDA and >11 for HDA. The calculated JDMAI2 cut-offs were ≤5.2 for ID, ≤8.5 for LDA, 8.6-11.3 for MDA and >11.3 for HDA. The cut-offs discriminated strongly among disease activity states defined subjectively by caring physicians and parents, parents' satisfaction or non-satisfaction with illness outcome, levels of pain, fatigue, physical functional impairment and physical well-being. CONCLUSIONS Both JDMAI1 and JDMAI2 cut-offs revealed good metrologic properties in validation analyses and are, therefore, suited for application in clinical practice and research.
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Affiliation(s)
- Silvia Rosina
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Alessandro Consolaro
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DiNOGMI), University of Genoa, Genova, Italy
| | - Angela Pistorio
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ana Rebollo-Giménez
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Claudia Bracaglia
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesu, Rome, Italy
| | - Pavla Dolezalova
- 1st Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Ana Guilaisne Bernard-Medina
- Servicio de Reumatología, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Mexico
| | - Troels Herlin
- Pediatric Rheumatology Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Trachana
- Thessaloniki University School of Medicine, First Department of Pediatrics, Pediatric Immunology and Rheumatology Referral Center, Hippokration General Hospital, Thessaloniki, Greece
| | - Veronika Vargová
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Kosice, Slovakia
| | - Carine Wouters
- Pediatric Rheumatology and Immune-inflammatory diseases, and KU Leuven - University of Leuven, Department of Microbiology and Immunology, Laboratory Immunobiology, UZ Leuven - Universitair ziekenhuis, Leuven, Belgium
| | - Laura Carenini
- UOC Servizio Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicolino Ruperto
- UOC Servizio Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DiNOGMI), University of Genoa, Genova, Italy
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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De Jesus AV, De Souza JM. Clinically amyopathic dermatomyositis associated with cutaneous ulcerations: a case-based review. Ann Med Surg (Lond) 2024; 86:1210-1214. [PMID: 38333314 PMCID: PMC10849458 DOI: 10.1097/ms9.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Dermatomyositis (DM) is an autoimmune myopathy primarily affecting both muscles and skin. When muscle weakness is not clinically apparent, but characteristic skin lesions are present, the condition is referred to as clinically amyopathic dermatomyositis (CADM). Case presentation The authors present the case of a 52-year-old female with a typical DM rash, interstitial pneumonia, and multiple skin ulcers. The skin biopsy was consistent with DM, and there were no signs of muscle involvement. Myositis-related and myositis-specific autoantibodies were also negative. Significant improvement was not observed until the patient received successive monthly pulses of methylprednisolone and the introduction of methotrexate. This treatment regimen allowed for the complete tapering of prednisone and resulted in sustained disease control. Clinical discussion In addition to the case presentation, a narrative literature review was conducted using the MEDLINE database, and an evidence-based treatment flowchart is proposed. CADM is a subtype of DM, related to higher incidences of interstitial lung disease, skin vasculopathy and malignancy. When ulcers or interstitial pneumonia are present, treatment should be early and aggressive. Active screening for neoplasms is recommended, particularly within the first 5 years. Conclusion The authors presented a case of seronegative CADM featuring skin vasculopathy, successfully treated with consecutive methylprednisolone pulses. Our literature review emphasized the importance of focused CADM management trials, highlighting the need for further research.
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Affiliation(s)
| | - Jean Marcos De Souza
- Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
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10
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Georgi I, Georgi M, Haas JP. [Advances in the diagnostics and treatment of juvenile dermatomyositis]. Z Rheumatol 2024; 83:41-51. [PMID: 38157051 DOI: 10.1007/s00393-023-01454-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: 10/15/2023] [Indexed: 01/03/2024]
Abstract
Juvenile dermatomyositis (JDM) is by far the most frequent inflammatory myopathy in childhood and adolescence. It is clinically characterized by inflammatory changes of the skin and muscles but as a multisystemic disease can also affect the skeletal system, the gastrointestinal tract, lungs and heart. Intrinsic (multigenetic risk) and extrinsic factors (triggers) are involved in the pathogenesis resulting in endothelial damage, involvement of fascies, activation of the interferon system and autoimmune reactions including formation of myositis-specific autoantibodies (MSA). In contrast to dermatomyositis in adults, in children and adolescents there are no associations with malignant diseases. The variable expression, the rarity of the disease and the risk of long-term damage and complications necessitate pediatric rheumatological experience in the diagnostics and treatment. Recently, new approaches in drug treatment have substantially improved the outcome and prognosis but a multidisciplinary treatment (including physicians, physiotherapists, psychologists, social workers) is mandatory, especially in the first phases of the disease. Particularly important is a professionally correct treatment of the functional sequelae, which are a particular focus of this article.
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Affiliation(s)
- Ingrid Georgi
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Kinderklinik Garmisch-Partenkirchen, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland
| | - Mathias Georgi
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Kinderklinik Garmisch-Partenkirchen, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland
| | - Johannes-Peter Haas
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Kinderklinik Garmisch-Partenkirchen, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland.
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Hu M, Shen C, Zheng F, Zhou Y, Teng L, Zheng R, Hu B, Wang C, Lu M, Xu X. Clinical nomogram assisting in discrimination of juvenile dermatomyositis-associated interstitial lung disease. Respir Res 2023; 24:286. [PMID: 37974162 PMCID: PMC10652466 DOI: 10.1186/s12931-023-02599-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To establish a prediction model using non-invasive clinical features for early discrimination of DM-ILD in clinical practice. METHOD Clinical data of pediatric patients with JDM were retrospectively analyzed using machine learning techniques. The early discrimination model for JDM-ILD was established within a patient cohort diagnosed with JDM at a children's hospital between June 2015 and October 2022. RESULTS A total of 93 children were included in the study, with the cohort divided into a discovery cohort (n = 58) and a validation cohort (n = 35). Univariate and multivariate analyses identified factors associated with JDM-ILD, including higher ESR (OR, 3.58; 95% CI 1.21-11.19, P = 0.023), higher IL-10 levels (OR, 1.19; 95% CI, 1.02-1.41, P = 0.038), positivity for MDA-5 antibodies (OR, 5.47; 95% CI, 1.11-33.43, P = 0.045). A nomogram was developed for risk prediction, demonstrating favorable discrimination in both the discovery cohort (AUC, 0.736; 95% CI, 0.582-0.868) and the validation cohort (AUC, 0.792; 95% CI, 0.585-0.930). Higher nomogram scores were significantly associated with an elevated risk of disease progression in both the discovery cohort (P = 0.045) and the validation cohort (P = 0.017). CONCLUSION The nomogram based on the ESIM predictive model provides valuable guidance for the clinical evaluation and long-term prognosis prediction of JDM-ILD.
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Affiliation(s)
- Minfei Hu
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Chencong Shen
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Fei Zheng
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Yun Zhou
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Liping Teng
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Rongjun Zheng
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Bin Hu
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Chaoying Wang
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Meiping Lu
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Xuefeng Xu
- Department of Rheumatology Immunology & Allergy Medicine, The Children's Hospital, Zhejiang Univesity School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China.
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12
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Rosina S, Rebollo-Giménez AI, Consolaro A, Ravelli A. Treat-to-Target in Pediatric Rheumatic Diseases. Curr Rheumatol Rep 2023; 25:226-235. [PMID: 37584859 DOI: 10.1007/s11926-023-01112-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW To summarize the current evidence on the adoption of the treat-to-target (T2T) strategy in pediatric rheumatic diseases (PRD). RECENT FINDINGS The recent advances in the management of PRD have markedly increased the ability to achieve disease remission. Complete disease quiescence is regarded as the ideal therapeutic goal because its attainment leads to lesser long-term damage and physical disability, and to optimization of quality of life. Studies in adult rheumatic diseases have shown that patient outcomes are improved if complete suppression of the inflammatory process is aimed for by frequent adjustments of therapy according to quantitative indices. This approach, which underlies the T2T concept, has been applied in strategic trials in rheumatoid arthritis (RA). Furthermore, recommendations for the T2T have been issued for RA and other adult rheumatic diseases. There is currently a growing interest for the introduction of T2T in PRD, and recommendations for treating juvenile idiopathic arthritis (JIA) to target were promulgated. A similar initiative has been undertaken for childhood-onset systemic lupus erythematosus. Preliminary therapeutic studies have explored the T2T design in JIA. The T2T strategy is a modern therapeutic approach that holds the promise of improving the outcomes in patients with PRD.
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Affiliation(s)
- Silvia Rosina
- UOC Reumatologia E Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | | | - Alessandro Consolaro
- UOC Reumatologia E Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento Di Neuroscienze, Scienze Materno-Infantili, Università Degli Studi Di Genova, RiabilitazioneGenoa, Oftalmologia, Geneticae , Italy
| | - Angelo Ravelli
- Dipartimento Di Neuroscienze, Scienze Materno-Infantili, Università Degli Studi Di Genova, RiabilitazioneGenoa, Oftalmologia, Geneticae , Italy
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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13
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Conti F, Moratti M, Leonardi L, Catelli A, Bortolamedi E, Filice E, Fetta A, Fabi M, Facchini E, Cantarini ME, Miniaci A, Cordelli DM, Lanari M, Pession A, Zama D. Anti-Inflammatory and Immunomodulatory Effect of High-Dose Immunoglobulins in Children: From Approved Indications to Off-Label Use. Cells 2023; 12:2417. [PMID: 37830631 PMCID: PMC10572613 DOI: 10.3390/cells12192417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/23/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The large-scale utilization of immunoglobulins in patients with inborn errors of immunity (IEIs) since 1952 prompted the discovery of their key role at high doses as immunomodulatory and anti-inflammatory therapy, in the treatment of IEI-related immune dysregulation disorders, according to labelled and off-label indications. Recent years have been dominated by a progressive imbalance between the gradual but constant increase in the use of immunoglobulins and their availability, exacerbated by the SARS-CoV-2 pandemic. OBJECTIVES To provide pragmatic indications for a need-based application of high-dose immunoglobulins in the pediatric context. SOURCES A literature search was performed using PubMed, from inception until 1st August 2023, including the following keywords: anti-inflammatory; children; high dose gammaglobulin; high dose immunoglobulin; immune dysregulation; immunomodulation; immunomodulatory; inflammation; intravenous gammaglobulin; intravenous immunoglobulin; off-label; pediatric; subcutaneous gammaglobulin; subcutaneous immunoglobulin. All article types were considered. IMPLICATIONS In the light of the current imbalance between gammaglobulins' demand and availability, this review advocates the urgency of a more conscious utilization of this medical product, giving indications about benefits, risks, cost-effectiveness, and administration routes of high-dose immunoglobulins in children with hematologic, neurologic, and inflammatory immune dysregulation disorders, prompting further research towards a responsible employment of gammaglobulins and improving the therapeutical decisional process.
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Affiliation(s)
- Francesca Conti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
| | - Mattia Moratti
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Lucia Leonardi
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Arianna Catelli
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Elisa Bortolamedi
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Emanuele Filice
- Department of Pediatrics, Maggiore Hospital, 40133 Bologna, Italy;
| | - Anna Fetta
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy
| | - Marianna Fabi
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Elena Facchini
- Pediatric Oncology and Hematology Unit “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.F.); (M.E.C.)
| | - Maria Elena Cantarini
- Pediatric Oncology and Hematology Unit “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.F.); (M.E.C.)
| | - Angela Miniaci
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
| | - Duccio Maria Cordelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
| | - Daniele Zama
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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14
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Abu-Rumeileh S, Marrani E, Maniscalco V, Maccora I, Pagnini I, Mastrolia MV, Rouster-Stevens K, Simonini G. Lung involvement in juvenile idiopathic inflammatory myopathy: A systematic review. Autoimmun Rev 2023; 22:103416. [PMID: 37611886 DOI: 10.1016/j.autrev.2023.103416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/20/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Juvenile idiopathic inflammatory myopathies (JIIM) are a group of connective tissue disorders characterized by muscle inflammation and variable systemic involvement, including interstitial lung disease (ILD). Available data on JIIM-associated ILD are very limited. We performed a systematic review of the available clinical, laboratory, and radiological features of JIIM-associated ILD. METHODS A systematic literature review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS A total of 90 patients were identified, of whom 77.8% had JDM, 10% amyopathic JDM, 7.8% anti-synthetase syndrome, 3.3% overlap syndrome, and 1.1% juvenile polymyositis. Anti-melanoma differentiation-associated gene 5 (MDA-5/CADM-140) was the most frequently reported myositis-specific antibody (32.2%). At diagnosis of ILD, 55.5% of patients had respiratory symptoms. Ground glass opacity was the most reported radiological feature (52.9%). Thirty-three % of patients developed rapidly progressive (RP) lung disease; 26.7% were admitted to the intensive care unit (ICU); 28.9% died; all deaths were due to ILD, with a median interval of 2 months (IQR 1.5-4.7) between the onset of respiratory symptoms and death. Patients admitted to the ICU and who died of ILD were more likely to be male, to have a rapidly progressive pattern, progression of radiological features, and a higher level of KL-6. CONCLUSIONS MDA-5/CADM-14 is associated with RP-ILD. ILD is a rare but severe manifestation among the spectrum of systemic involvement associated with JIIM, with a high rate of ICU admission and mortality. Early recognition and aggressive treatment are needed to prevent a severe outcome.
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Affiliation(s)
- Sarah Abu-Rumeileh
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy
| | - Edoardo Marrani
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy.
| | - Valerio Maniscalco
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy
| | - Ilaria Maccora
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy; NEUROFARBA Department, University of Florence, Firenze, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy
| | | | | | - Gabriele Simonini
- Rheumatology Unit, ERN-ReCONNET center, Meyer Children Hospital IRCCS, Florence, Italy; NEUROFARBA Department, University of Florence, Firenze, Italy
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15
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Duvvuri B, Pachman LM, Hermanson P, Wang T, Moore R, Ding-Hwa Wang D, Long A, Morgan GA, Doty S, Tian R, Sancak Y, Lood C. Role of mitochondria in the myopathy of juvenile dermatomyositis and implications for skeletal muscle calcinosis. J Autoimmun 2023; 138:103061. [PMID: 37244073 PMCID: PMC10330803 DOI: 10.1016/j.jaut.2023.103061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/21/2023] [Accepted: 05/08/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To elucidate mechanisms contributing to skeletal muscle calcinosis in patients with juvenile dermatomyositis. METHODS A well-characterized cohorts of JDM (n = 68), disease controls (polymyositis, n = 7; juvenile SLE, n = 10, and RNP + overlap syndrome, n = 12), and age-matched health controls (n = 17) were analyzed for circulating levels of mitochondrial (mt) markers including mtDNA, mt-nd6, and anti-mitochondrial antibodies (AMAs) using standard qPCR, ELISA, and novel-in-house assays, respectively. Mitochondrial calcification of affected tissue biopsies was confirmed using electron microscopy and energy dispersive X-ray analysis. A human skeletal muscle cell line, RH30, was used to generate an in vitro calcification model. Intracellular calcification is measured by flow cytometry and microscopy. Mitochondria were assessed for mtROS production and membrane potential by flow cytometry and real-time oxygen consumption rate by Seahorse bioanalyzer. Inflammation (interferon-stimulated genes) was measured by qPCR. RESULTS In the current study, patients with JDM exhibited elevated levels of mitochondrial markers associated with muscle damage and calcinosis. Of particular interest are AMAs predictive of calcinosis. Human skeletal muscle cells undergo time- and dose-dependent accumulation of calcium phosphate salts with preferential localization to mitochondria. Calcification renders skeletal muscle cells mitochondria stressed, dysfunctional, destabilized, and interferogenic. Further, we report that inflammation induced by interferon-alpha amplifies mitochondrial calcification of human skeletal muscle cells via the generation of mitochondrial reactive oxygen species (mtROS). CONCLUSIONS Overall, our study demonstrates the mitochondrial involvement in the skeletal muscle pathology and calcinosis of JDM and mtROS as a central player in the calcification of human skeletal muscle cells. Therapeutic targeting of mtROS and/or upstream inducers, such as inflammation, may alleviate mitochondrial dysfunction, leading to calcinosis. AMAs can potentially identify patients with JDM at risk for developing calcinosis.
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Affiliation(s)
- Bhargavi Duvvuri
- Division of Rheumatology, University of Washington, Seattle, WA, USA.
| | - Lauren M Pachman
- Division of Pediatric Rheumatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; CureJM Center of Excellence, Ann & Robert H. Lurie Children's Hospital of Chicago and the Stanley Manne Simpson-Quarrey Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Payton Hermanson
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Ting Wang
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Richard Moore
- Cedars Sinai Med Ctr, Division of Rheumatology, Los Angeles, CA, USA
| | | | - Aaron Long
- Department of Pharmacology, University of Washington, Seattle, WA, USA
| | - Gabrielle A Morgan
- Division of Pediatric Rheumatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; CureJM Center of Excellence, Ann & Robert H. Lurie Children's Hospital of Chicago and the Stanley Manne Simpson-Quarrey Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Rong Tian
- Mitochondria and Metabolism Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Yasemin Sancak
- Department of Pharmacology, University of Washington, Seattle, WA, USA
| | - Christian Lood
- Division of Rheumatology, University of Washington, Seattle, WA, USA.
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16
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Gebreamlak A, Sawicka KM, Garrett R, Goh YI, Baker KM, Feldman BM. Currently recommended skin scores correlate highly in the assessment of patients with Juvenile Dermatomyositis (JDM). Pediatr Rheumatol Online J 2023; 21:63. [PMID: 37381026 DOI: 10.1186/s12969-023-00844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Juvenile Dermatomyositis (JDM) is a rare, chronic, and life-threatening childhood autoimmune disease. Currently, there are recommended, reliable and validated measurement tools for assessment of skin disease activity in JDM including the Disease Activity Score (skinDAS), Cutaneous Assessment Tool (CAT), and the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI). The Physician's global assessment skin visual analog scale (Skin VAS) is also widely used for skin activity in JDM. For the purpose of comparative international studies, we wanted to compare these tools to the Physician's skin VAS (as a standard) to identify which performs better. OBJECTIVES We sought to compare the correlations of these scoring tools, and separately assess the responsiveness each tool demonstrates following patient treatment, in order to see if one tool may be preferred. This was determined by assessing how well these tools correlate with each other, and the Physician's skin VAS over time, as well as the responsiveness of each tool after patient treatment. METHODS Skin scores were recorded at a baseline (first visit after June 1st, 2018) and all follow-up office visits at the Juvenile Dermatomyositis Clinic. Following baseline visits, patients were followed up as clinically indicated. A subset of newly diagnosed patients (inception cohort) was identified. Correlations were assessed at the baseline visit and over time for the whole cohort. The correlations over time were derived using Generalized Estimating Equations (GEEs). Standardized response means with 95% confidence intervals were calculated to test score responsiveness for the nested inception cohort. RESULTS The skinDAS, CAT and CDASI all correlated highly with each other and with the Physician's skin VAS. The three scoring tools accurately reflected Physician's skin VAS scores over time. In addition, all tools showed moderate to high responsiveness following treatment. CONCLUSION All studied skin score tools performed well in our study and appear to be useful. Since no tool far outperforms the others, arbitrary consensus will be needed to select a single standard measurement tool for the purposes of efficiency and global comparability.
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Affiliation(s)
- Alexander Gebreamlak
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Katherine M Sawicka
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Canada
| | - Rose Garrett
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Y Ingrid Goh
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada
- Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, 555 University Ave, 555 University Ave, Toronto, Canada
| | - Kayla M Baker
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada
- Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, 555 University Ave, 555 University Ave, Toronto, Canada
| | - Brian M Feldman
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, 555 University Ave, 555 University Ave, Toronto, Canada.
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17
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Lin TW, Hu YC, Chiang BL. Characterization of the biomarkers related to the clinical course and outcomes of juvenile dermatomyositis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:416-423. [PMID: 36572597 DOI: 10.1016/j.jmii.2022.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the clinical characteristics of children diagnosed with juvenile dermatomyositis (JDM) in a tertiary medical centre in Taiwan and to identify important biomarkers for predicting the disease course and outcomes of JDM. METHODS We retrospectively reviewed patients with JDM diagnosed at the National Taiwan University Hospital between 1 January 2001 and 31 December 2021. The endpoints for disease assessment included complete clinical response or remission. The JDM courses were divided into monocyclic, polycyclic, and chronic continuous statuses. The significant relationship between the predictors and outcomes was further analysed. RESULTS A total of 47 patients were included in this study. The mean age at disease onset was 7.5 years. The female-to-male ratio was 1.35. The most common initial presentations were Gottron's sign (74%), followed by muscle weakness (66%) and facial rash (66%). Among all included patients, 35 (74.5%) patients achieved complete clinical remission, 15 (31.9%) had a monocyclic course, six (12.7%) had a polycyclic course, and 24 (51.1%) had a chronic continuous course. Negative facial rash and arthralgia were favourable factors for achieving complete clinical remission. Muscle weakness, higher lactate dehydrogenase (LDH), and higher erythrocyte sedimentation rate (ESR) at disease onset were related to the chronic continuous course. The most common long-term complication was calcinosis (29.8%). CONCLUSION Juvenile dermatomyositis is a rare disease, and only a few studies have been conducted in Asia. Our results identified the important predictors of the disease course and outcomes. The chronic continuous course requires more attention and aggressive treatment.
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Affiliation(s)
- Ting-Wei Lin
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Chiao Hu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
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18
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Marstein HS, Witczak BN, Godang K, Olarescu NC, Schwartz T, Flatø B, Molberg Ø, Bollerslev J, Sjaastad I, Sanner H. Adipokine profile in long-term juvenile dermatomyositis, and associations with adipose tissue distribution and cardiac function: a cross-sectional study. RMD Open 2023; 9:rmdopen-2022-002815. [PMID: 36828644 PMCID: PMC9972436 DOI: 10.1136/rmdopen-2022-002815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/02/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVES In long-term juvenile dermatomyositis (JDM), altered adipose tissue distribution and subclinical cardiac dysfunction have been described. Our aims were to compare adipokine levels in patients with JDM after long-term disease with controls, and explore associations between adipokines and (1) adipose tissue distribution and (2) cardiac function. METHODS The study cohort included 59 patients with JDM (60% female, mean age 25.2 years, mean disease duration 16.9 years), and 59 age/sex-matched controls. Updated Pediatric Rheumatology International Trials Organization criteria for clinically inactive JDM were used to stratify patients into active (JDM-active) or inactive (JDM-inactive) disease groups. Lipodystrophy was clinically assessed in all patients. In all study participants, we measured adipose tissue distribution by dual-energy X-ray absorptiometry and cardiac function by echocardiography. Serum adipokines (adiponectin, apelin-12, lipocalin-2, leptin, visfatin and resistin) were analysed using ELISA. RESULTS Patients with JDM had higher leptin levels compared with controls (p≤0.01). In JDM-active, apelin-12 and visfatin were higher compared with JDM-inactive (p≤0.05). In JDM-total and JDM-active, lower adiponectin correlated with lipodystrophy and total fat mass. Also, systolic dysfunction correlated with: lower adiponectin in JDM-total, JDM-inactive and JDM-active, and with lower apelin-12 in JDM-total and JDM-active and resistin in JDM-active (all p≤0.05). Lower adiponectin correlated with diastolic dysfunction in JDM-total and JDM-active. CONCLUSION After long-term disease, leptin levels were unfavourably regulated in patients with JDM compared with controls, and apelin-12 and visfatin in JDM-active versus JDM-inactive. We found associations between adipokines and both adipose tissue distribution and cardiac systolic function in all patients with JDM, which was most prominent in patients with active disease.
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Affiliation(s)
- Henriette Schermacher Marstein
- Institute of Experimental Medical Research, Oslo University Hospital Ullevaal, Oslo, Norway .,Department of Health Sciences, Oslo New University College, Oslo, Norway.,KG Jebsen Center for Cardiac Research, Oslo University Hospital, Oslo, Norway
| | - Birgit Nomeland Witczak
- Institute of Experimental Medical Research, Oslo University Hospital Ullevaal, Oslo, Norway,KG Jebsen Center for Cardiac Research, Oslo University Hospital, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Medical Clinic, Oslo University Hospital, Oslo, Norway
| | - Nicoleta Christina Olarescu
- Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Medical Clinic, Oslo University Hospital, Oslo, Norway,Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Thomas Schwartz
- Institute of Experimental Medical Research, Oslo University Hospital Ullevaal, Oslo, Norway,KG Jebsen Center for Cardiac Research, Oslo University Hospital, Oslo, Norway
| | - Berit Flatø
- Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway,Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Medical Clinic, Oslo University Hospital, Oslo, Norway,Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Ivar Sjaastad
- Institute of Experimental Medical Research, Oslo University Hospital Ullevaal, Oslo, Norway,KG Jebsen Center for Cardiac Research, Oslo University Hospital, Oslo, Norway,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Helga Sanner
- Department of Health Sciences, Oslo New University College, Oslo, Norway,Department of Rheumatology, Oslo University Hospital, Oslo, Norway
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19
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Varnier GC, Consolaro A, Cheng IL, Silva Riveiro A, Pilkington C, Ravelli A. Experience with the use of mycophenolate mofetil in juvenile idiopathic inflammatory myopathies. Rheumatology (Oxford) 2023; 62:SI163-SI169. [PMID: 35929784 DOI: 10.1093/rheumatology/keac404] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy and safety of MMF in juvenile idiopathic inflammatory myopathies (JIIMs). METHODS Patients diagnosed with JIIM and treated with MMF enrolled in the Juvenile Dermatomyositis Research Group (JDRG) in the UK or followed at the Giannina Gaslini Institute in Genoa, Italy, were included. The following information was collected retrospectively at MMF initiation, at 3, 6 and 12 months after treatment start, and at last follow-up visit: clinical manifestations, laboratory data, physicians' subjective assessment of disease activity, standardized outcome measures of muscle strength/endurance, cutaneous disease activity, physical function, global disease activity, cumulative damage, and ongoing treatment. RESULTS Of the 29 patients included, 23 had juvenile DM and 6 had overlap myositis. During administration of MMF, improvement in measures of muscle strength, skin disease activity, and overall disease activity was seen, with an increase in the frequency of normal scores for Manual Muscle Test-8 from 50.0% to 83.3%, Childhood Myositis Activity Score from 53.5% to 88.9%, muscle component of DAS from 55.2% to 84.2%, skin component of DAS from 31.0% to 42.1%, visual analogue scale for skin disease activity from 25.0% to 47.4%, and visual analogue scale for overall disease activity from 7.1% to 42.1%. The number of patients with inactive disease increased from 10.3% at baseline to 68.5% at last follow-up. CS dose was significantly reduced, from 0.3 to 0.1 mg/kg/day. No relevant side effects were reported. CONCLUSION Our experience suggests that MMF is a valuable therapeutic option for the management of JIIM.
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Affiliation(s)
- Giulia Camilla Varnier
- Università degli Studi di Genova, Genoa, Italy.,Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Alessandro Consolaro
- Università degli Studi di Genova, Genoa, Italy.,Clinica Pediatrica e Reumatologica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Iek Leng Cheng
- Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | | | | | - Angelo Ravelli
- Università degli Studi di Genova, Genoa, Italy.,Clinica Pediatrica e Reumatologica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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20
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Sener S, Basaran O, Batu ED, Sag E, Oz S, Talim B, Bilginer Y, Haliloglu G, Ozen S. Early-onset juvenile dermatomyositis: A tertiary referral center experience and review of the literature. Semin Arthritis Rheum 2023; 58:152133. [PMID: 36434896 DOI: 10.1016/j.semarthrit.2022.152133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/24/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of our study is twofold: To evaluate the presentation, diagnosis, clinical course, and management of juvenile dermatomyositis (JDM) in children under three years of age, and to compare with older-onset patients. METHODS Nine patients with early-onset, and 63 patients with older-onset JDM followed between December 2010 and April 2022 are included. We also reviewed the literature on early-onset JDM from the inceptions of the PubMed/MEDLINE and Scopus databases up to April 1st, 2022. RESULTS Early-onset JDM patients were characterized by longer median diagnostic delay (p = 0.005), calcinosis (p = 0.006), anti-NXP2 antibody (p = 0.049). Diagnostic pathway included muscle biopsy (77.7% versus 50.8%). Muscle biopsy findings were more severe in the early-onset group (p<0.001). Although there was no difference in the partial and complete remission rates, the relapse rate was significantly higher in the early-onset group (p = 0.001), reflected to requirement of intravenous immunoglobulin (p = 0.001), cyclophosphamide (p = 0.011), and biological agents (p = 0.016). Literature search revealed 32 articles reporting 75 patients. The median diagnostic delay was 5 (1-30) months. Calcinosis was present in 29.5%. Twenty-three of the 44 patients (52.3%) had a muscle biopsy. Forty-one patients (64.1%) received second and third-line treatments. Complete remission was achieved in almost half of these patients (48.9%), but relapse was observed in 75%. The mortality rate was 10.2%. CONCLUSION Diagnosis can be challenging and delayed in early-onset JDM patients. Compared to older-onset JDM patients, this group had higher relapse rate, more severe muscle biopsy findings, and received intensive immunosuppressive treatment.
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Affiliation(s)
- Seher Sener
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozge Basaran
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey; Currently at Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Sibel Oz
- Division of Pediatric Neurology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Beril Talim
- Division of Pediatric Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Goknur Haliloglu
- Division of Pediatric Neurology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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21
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Zhou D, King EH, Rothwell S, Krystufkova O, Notarnicola A, Coss S, Abdul-Aziz R, Miller KE, Dang A, Yu GR, Drew J, Lundström E, Pachman LM, Mamyrova G, Curiel RV, De Paepe B, De Bleecker JL, Payton A, Ollier W, O'Hanlon TP, Targoff IN, Flegel WA, Sivaraman V, Oberle E, Akoghlanian S, Driest K, Spencer CH, Wu YL, Nagaraja HN, Ardoin SP, Chinoy H, Rider LG, Miller FW, Lundberg IE, Padyukov L, Vencovský J, Lamb JA, Yu CY. Low copy numbers of complement C4 and C4A deficiency are risk factors for myositis, its subgroups and autoantibodies. Ann Rheum Dis 2023; 82:235-245. [PMID: 36171069 PMCID: PMC9887400 DOI: 10.1136/ard-2022-222935] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/02/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases characterised by myositis-related autoantibodies plus infiltration of leucocytes into muscles and/or the skin, leading to the destruction of blood vessels and muscle fibres, chronic weakness and fatigue. While complement-mediated destruction of capillary endothelia is implicated in paediatric and adult dermatomyositis, the complex diversity of complement C4 in IIM pathology was unknown. METHODS We elucidated the gene copy number (GCN) variations of total C4, C4A and C4B, long and short genes in 1644 Caucasian patients with IIM, plus 3526 matched healthy controls using real-time PCR or Southern blot analyses. Plasma complement levels were determined by single radial immunodiffusion. RESULTS The large study populations helped establish the distribution patterns of various C4 GCN groups. Low GCNs of C4T (C4T=2+3) and C4A deficiency (C4A=0+1) were strongly correlated with increased risk of IIM with OR equalled to 2.58 (2.28-2.91), p=5.0×10-53 for C4T, and 2.82 (2.48-3.21), p=7.0×10-57 for C4A deficiency. Contingency and regression analyses showed that among patients with C4A deficiency, the presence of HLA-DR3 became insignificant as a risk factor in IIM except for inclusion body myositis (IBM), by which 98.2% had HLA-DR3 with an OR of 11.02 (1.44-84.4). Intragroup analyses of patients with IIM for C4 protein levels and IIM-related autoantibodies showed that those with anti-Jo-1 or with anti-PM/Scl had significantly lower C4 plasma concentrations than those without these autoantibodies. CONCLUSIONS C4A deficiency is relevant in dermatomyositis, HLA-DRB1*03 is important in IBM and both C4A deficiency and HLA-DRB1*03 contribute interactively to risk of polymyositis.
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Affiliation(s)
- Danlei Zhou
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA,Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Emily H King
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA,Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Simon Rothwell
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK,Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Olga Krystufkova
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Antonella Notarnicola
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, University Hospital Karolinska, Stockholm, Sweden
| | - Samantha Coss
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA,Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Rabheh Abdul-Aziz
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA,Division of Allergy/Immunology and Rheumatology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Katherine E Miller
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA,Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Amanda Dang
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - G Richard Yu
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joanne Drew
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Emeli Lundström
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, University Hospital Karolinska, Stockholm, Sweden
| | - Lauren M Pachman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gulnara Mamyrova
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rodolfo V Curiel
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Boel De Paepe
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | | | - Antony Payton
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - William Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Terrance P O'Hanlon
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health, Bethesda, MD, USA
| | - Ira N Targoff
- Veteran’s Affairs Medical Center, University of Oklahoma Health Sciences Center, and Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Vidya Sivaraman
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Edward Oberle
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Shoghik Akoghlanian
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Kyla Driest
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | | | - Yee Ling Wu
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA,Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL, USA
| | - Haikady N Nagaraja
- Division of Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Stacy P Ardoin
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK,Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health, Bethesda, MD, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health, Bethesda, MD, USA
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, University Hospital Karolinska, Stockholm, Sweden
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, University Hospital Karolinska, Stockholm, Sweden
| | - Jiří Vencovský
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Janine A Lamb
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chack-Yung Yu
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA,Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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22
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Muacevic A, Adler JR, Chaudhari J, Panchal V, Shah A. An Unusual Presentation of Juvenile Polymyositis in an Adolescent Girl. Cureus 2023; 15:e33249. [PMID: 36741666 PMCID: PMC9890880 DOI: 10.7759/cureus.33249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/03/2023] Open
Abstract
Juvenile idiopathic inflammatory myopathies (JIIMs) are a group of diverse, systemic autoimmune diseases that manifest in childhood and are characterized by weakness and chronic inflammation of skeletal muscles. One of the relatively rare variants of JIIMs is juvenile polymyositis (JPM). JPM patients present with proximal and distal muscle weakness, gait instability with falls, muscle pain and tenderness, and high levels of creatine kinase (CK) during adolescence. There are currently few people being diagnosed with JPM, which raises the question of whether or not it is a distinct disease. We discuss the case of a 13-year-old girl who presented to the hospital with generalized body swelling and difficulty swallowing solid food. She also had drooling of saliva during the presentation and a history of difficulty climbing up and down the stairs for three months. Her extensive laboratory workup showed a positive antinuclear antibody (ANA) test and increased muscle enzyme. A muscle biopsy was ordered, and she was diagnosed with JPM. Such a unique presentation has rarely been reported in the pediatric literature. This case report outlines an unusual JPM presentation that could help clinicians identify the condition and start treatment as soon as possible to minimize complications.
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23
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Cancarini P, Nozawa T, Whitney K, Bell-Peter A, Marcuz JA, Taddio A, Guo J, Dover S, Feldman BM. The clinical features of juvenile dermatomyositis: A single-centre inception cohort. Semin Arthritis Rheum 2022; 57:152104. [PMID: 36183479 DOI: 10.1016/j.semarthrit.2022.152104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Juvenile Dermatomyositis (JDM), a severe and rare autoimmune disease, is the most common idiopathic inflammatory myopathy in children. We describe the clinical features of a large single-centre cohort. METHODS We studied an inception cohort (0-18 years old) referred for diagnosis to the JDM clinic at The Hospital for Sick Children (SickKids), between January 1989 and September 2017. Probable or definite diagnosis of JDM was done according to the 2017 ACR/EULAR Criteria. We excluded children who had treatment started at another hospital. The data were collected retrospectively from clinical charts and the SickKids JDM database. RESULTS 172/230 (74.8%) patients were included. They were most often female (female:male = 1.8:1); the age at diagnosis was 8.5±4.3 years. There was a positive family history for autoimmune disease in 52%, mainly rheumatoid arthritis. No patient died. The most common signs at inception were muscle weakness (85.5%), nailfold capillary abnormalities (83.4%), Gottron papules (78.5%), heliotrope rash (66.3%), abnormal gait (55.8%), and malar/facial rash (54.7%). The prevalence of Gottron papules, heliotrope rash, facial/malar rash, nailfold capillary abnormalities, Raynaud phenomenon, dysphonia/dysphagia (a frequent cause of hospitalization), mouth ulcers, calcinosis, eye problems, joint involvement, acanthosis nigricans and lipodystrophy increased during follow-up. Muscle enzymes, namely CK, ALT, AST, were often normal or only slightly raised despite active muscle disease; conversely LD was often high. Anti-Nuclear Autoantibodies were positive in 49.7% of patients at diagnosis. The course of the disease was: 29.1% monocyclic, 5.3% polycyclic, 33.1% chronic. The course of 56 patients (32.5%) was not classifiable due to length of follow-up. Corticosteroids were used as treatment in almost all our patients and 30% required intravenous therapy due to the severity of the presentation; methotrexate was added in 64%, more often in recent years. Unresponsive patients were treated mostly with intravenous immunoglobulins (IVIG). CONCLUSIONS The information obtained from this relatively large number of patients adds to the growing knowledge base of this rare disease. TRIAL REGISTRATION SickKids Research Ethics Board approved the study.
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Affiliation(s)
- Paola Cancarini
- Operative Unit of Pediatrics, ASST del Garda, Desenzano del Garda (BS), Italy
| | - Tomo Nozawa
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan; Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Kristi Whitney
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Canada
| | - Audrey Bell-Peter
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Jo-Anne Marcuz
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Canada
| | - Andrea Taddio
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" and University of Trieste, Trieste, Italy
| | - Jessica Guo
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Saunya Dover
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Brian M Feldman
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada; Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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24
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An Unusual Cause of Necrotising Fasciitis in a Young Male with Juvenile Dermatomyositis. Case Rep Rheumatol 2022; 2022:8758263. [PMID: 35982709 PMCID: PMC9381251 DOI: 10.1155/2022/8758263] [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: 12/26/2021] [Revised: 03/28/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Juvenile dermatomyositis (JDM) is a rare condition worldwide, affecting children younger than 16 years. It is characterized by weakness in the proximal skeletal muscles and a pathognomonic skin rash. Patients with JDM develop complications that are usually a consequence of vasculopathy affecting multiple organ systems. Occult gastrointestinal (GI) perforation is an uncommon complication and is associated with an increased risk of mortality due to a delay in diagnosis. We report on a 14-year-old male with JDM with an aggressive course over two years and severe clinical manifestations. The patient developed necrotizing fasciitis, an unusual rapidly progressing lethal infection of the fascia resulting from bowel contents seeping from multiple intestinal perforations. This case, less commonly seen in males, highlights the occurrence of multiple phenomena—JDM complicated by skin and gastrointestinal vasculopathy with resultant development of multiple GI perforations and consequently life-threatening necrotizing fasciitis of the leg. Physicians need a high index of suspecting GI perforation in JDM patients as the delayed recognition of this complication can result in significant morbidity and/or mortality since the typical symptoms of perforation may be absent.
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25
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Mondal S, Barman P, Vignesh P. Cardiovascular Abnormalities in Juvenile Dermatomyositis: A Scoping Review for the Clinical Rheumatologists. Front Med (Lausanne) 2022; 9:827539. [PMID: 35814777 PMCID: PMC9263083 DOI: 10.3389/fmed.2022.827539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Juvenile dermatomyositis (JDM) is a common form of inflammatory myositis in children. Vasculopathy and endothelial dysfunction play significant roles in the pathogenesis of JDM. Cardiac involvement in JDM is often underestimated, and it may be a potential indicator of poor prognosis. Cardiac dysfunction in JDM can occur both in the acute and chronic stages of the disease. Amongst the acute complications, acute congestive heart failure (CHF), myocarditis, arrhythmia, and complete heart block are common. However, these remain unrecognized due to a lack of overt clinical manifestations. Increased rates of cardiovascular abnormalities have been noted with anti-SRP and anti-Jo 1 auto-antibody positivity. Long-term follow-up studies in JDM have shown an increased prevalence of hypertension, atherosclerosis, coronary artery disease, and metabolic syndrome in adolescence and adulthood. Monitoring of body-mass index, blood pressure, and laboratory evaluation of fasting glucose and lipid profile may help in identifying metabolic syndrome in children with JDM. Steroid-sparing agents, daily exercise, and a healthy diet may reduce such long-term cardiac morbidities. Current use of multimodality imaging such as stress-echocardiography, contrast-enhanced echocardiography, cardiac magnetic resonance imaging, and positron emission tomography has increased the diagnostic yield of subclinical heart disease during acute and chronic stages of JDM. This review elaborates on different aspects of cardiac dysfunction in JDM. It also emphasizes the importance of cardiac screening in long-term follow-up of children with JDM.
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26
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Wang YT, Zhang Y, Tang T, Luo C, Liu MY, Xu L, Wang L, Tang XM. Anti-nuclear matrix protein 2+ juvenile dermatomyositis with severe skin ulcer and infection: A case report and literature review. World J Clin Cases 2022; 10:3579-3586. [PMID: 35611208 PMCID: PMC9048553 DOI: 10.12998/wjcc.v10.i11.3579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is an idiopathic inflammatory myopathy that occurs in childhood. It is characterized by muscle weakness and a characteristic rash. Previous literature reports have rarely described JDM with severe skin ulcers and infections.
CASE SUMMARY Herein, we describe a case of a 2-year-old female patient who suffered from JDM, whose myositis-specific autoantibodies were positive for anti-nuclear matrix protein 2 antibody, with progressively worsening skin ulcers and severe infections. The patient was treated with glucocorticoids and various immunosuppressants. Nevertheless, further progression of the disease and the combination of primary disease and severe infection in the later period were fatal.
CONCLUSION In children, anti-nuclear matrix protein 2+ JDM combined with skin ulcers often indicates severe disease. In such cases, personalized treatment for the primary disease and infection prevention and control are essential.
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Affiliation(s)
- Ya-Ting Wang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Yu Zhang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Tao Tang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Chong Luo
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Ming-Yue Liu
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Li Xu
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Li Wang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Xue-Mei Tang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
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Environmental factors associated with juvenile idiopathic inflammatory myopathy clinical and serologic phenotypes. Pediatr Rheumatol Online J 2022; 20:28. [PMID: 35414090 PMCID: PMC9004071 DOI: 10.1186/s12969-022-00684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Environmental exposures have been associated with the juvenile idiopathic inflammatory myopathies (JIIM). We undertook a questionnaire-based study to evaluate patient-reported exposures as possible risk factors for JIIM. FINDINGS One-hundred-seven patients with JIIM were enrolled in a myositis natural history protocol and completed environmental questionnaires. Frequencies of exposures in clinical and myositis-specific autoantibody (MSA) groups were examined. Patients with juvenile dermatomyositis (JDM) and juvenile connective tissue myositis (JCTM) more frequently received an immunization within 1 year of diagnosis compared to juvenile polymyositis (57.5 and 71.4% vs 0.0%, p ≤ 0.017). JCTM patients were more often underweight at diagnosis relative to JDM patients (42.9% vs 7.0%, p = 0.002). MSA-negative patients more frequently had gastroenteritis within a year of diagnosis compared to patients with anti-MDA5 autoantibodies (28.6% vs 0.0%, p = 0.032). Heavy exercise was more frequent in MSA-negative and anti-MDA5 groups compared to the anti-TIF-1 autoantibody group (42.9 and 35.3% vs. 9.0%, p ≤ 0.047). Medications received within 1 year of diagnosis were more frequent in MSA-negative patients relative to those with anti-MDA5 autoantibodies (92.9% vs. 52.8% p = 0.045). Being breastfed > 6 months was more frequent in MSA-negative patients (88.9%) compared to anti-TIF-1 and anti-MDA5 autoantibody groups (41.2 and 28.6%, p ≤ 0.036). CONCLUSIONS Certain environmental exposures prior to diagnosis differed among clinical and serologic subgroups of JIIM, suggesting additional exposures to be explored as possible risk factors for JIIM phenotypes.
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Piette Y, Reynaert V, Vanhaecke A, Bonroy C, Gutermuth J, Sulli A, Cutolo M, Smith V. Standardised interpretation of capillaroscopy in autoimmune idiopathic inflammatory myopathies: A structured review on behalf of the EULAR study group on microcirculation in Rheumatic Diseases. Clin Exp Rheumatol 2022; 21:103087. [PMID: 35421608 DOI: 10.1016/j.autrev.2022.103087] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We conducted a systematic review, on behalf of the EULAR Study Group on Microcirculation in Rheumatic Diseases (EULAR SG MC/RD), to investigate the value of nailfold videocapillaroscopy (NVC) in idiopathic inflammatory myopathies (IIM). METHODS Three electronic databases were systematically searched to find all relevant manuscripts reporting NVC outcomes in IIM patients. Articles were assessed based on study design, population, NVC methodology and description of NVC results. To allow comparison between the articles, all NVC results were interpreted according to standardised capillaroscopic terminology, as previously consented by the EULAR SG MC/RD and the Scleroderma Clinical Trials Consortium (SCTC) Group on Capillaroscopy. RESULTS Of the 653 identified records; five were retained after critical appraisal on title, abstract and manuscript level. A marked difference in NVC was observed between (juvenile) dermatomyositis [(j)DM] versus polymyositis, healthy controls and systemic sclerosis patients. In addition, reduced capillary density and scleroderma pattern seem to be associated with active disease in (j)DM, while immunosuppressive treatment appears to reduce NVC abnormalities. CONCLUSION This is the first systematic review investigating NVC in IIM, interpreting the results according to an international consented standardised manner, as proposed by the EULAR SG MC/RD and SCTC Group on Capillaroscopy. We can conclude that NVC presents a promising asset in the diagnosis of (j)DM. Moreover, NVC could be a biomarker for organ involvement and follow-up. Large multicentre prospective standardised studies are further needed to definitely describe associations with clinical and laboratory parameters in the different IIM subtypes.
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Affiliation(s)
- Yves Piette
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Valerie Reynaert
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, SKIN research group, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Amber Vanhaecke
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Carolien Bonroy
- Department of Laboratory Medicine, Ghent University Hospital, Department of Diagnostic Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Jan Gutermuth
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, SKIN research group, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium.
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Hinze C, Dressler F, Schara-Schmidt U, Haas JP. Juvenile Dermatomyositis. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1769-4299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDie juvenile Dermatomyositis (JDM) ist die häufigste chronische
entzündliche Myopathie des Kindesalters. In dieser Übersicht
soll der aktuelle Kenntnisstand hinsichtlich der Diagnostik, Behandlung und
Überwachung der JDM dargestellt werden. So liegen häufig
myositis-spezifische Antikörper vor, die mit klinischen
Phänotypen und dem Verlauf der Erkrankung korrelieren. Typ I Interferone
spielen eine wichtige Rolle in der Pathogenese der Erkrankung.
Möglicherweise kann diese Beobachtung in der Zukunft zu gezielten
Therapien führen. Da langfristig schwerwiegende Komplikationen, wie
z. B. Kalzinosen oder Lipodystrophie, drohen, besonders bei auf Dauer
unzureichend kontrollierter Erkrankung, ist eine möglichst rasche und
effektive Behandlung anzustreben. Zu diesem Zweck sollte eine intensive
Remissionsinduktionstherapie, gefolgt von einer zielgerichteten Therapie
angestrebt werden. Verschiedene validierte Messinstrumente stehen zur
Verfügung, um den Verlauf der Erkrankung zu beurteilen. Die
Pro-KIND-Initiative der Gesellschaft für Kinder- und Jugendrheumatologie
hat Praxis- und Konsens-basiert in Deutschland sowohl eine diagnostische als
auch eine Treat-to-Target-Behandlungsstrategie entwickelt. Im Rahmen nationaler
und internationaler Kollaborationen soll sich die Behandlung der JDM in der
Zukunft weiter verbessern.
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Affiliation(s)
- Claas Hinze
- Klinik für Pädiatrische Rheumatologie und Immunologie,
Universitätsklinikum Münster, Münster,
Germany
| | - Frank Dressler
- Klinik für Pädiatrische Pneumologie, Allergologie und
Neonatologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Ulrike Schara-Schmidt
- Abteilung für Neuropädiatrie, Zentrum für
Neuromuskuläre Erkrankungen im Kindes- und Jugendalter,
Universitätsklinikum Essen, Essen, Germany
| | - Johannes-Peter Haas
- German Center for Rheumatology in Children and Adolescents, Deutsches
Zentrum für Kinder- und Jugendrheumatologie Garmisch-Partenkirchen,
Garmisch-Partenkirchen, Germany
- Center for treatment of pain in young people, Zentrum für
Schmerztherapie junger Menschen, Garmisch-Partenkirchen, Germany
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30
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Gizik J, Meister S, Hartmann M, Sahm D, Georgi M, Baumeister N, Kühne M, Haas JP, Schwirtz A. Physiotherapie und Sport bei Kinderrheuma – Shake your
bones. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1757-2862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungIm Rahmen kindlicher rheumatischer Erkrankungen haben die zumeist schmerzhaften
Entzündungsvorgänge am muskulo-skelettalen System
(z. B.: Gelenke, Muskeln, Sehnen, Gefäße) Auswirkungen
auf die tägliche Mobilität der Betroffenen. Immobilität,
körperliche und sportliche Inaktivität sind oft die Folge. Die
geltenden Richtlinien der Nationalen Empfehlungen für Bewegung und
Bewegungsförderung werden daher oftmals nicht erreicht.
Bewegungsreduzierte oder -inaktive Patienten können jedoch durch
verschiedene Maßnahmen in ihrem Bewegungsverhalten gefördert
werden. Die Physiotherapie bietet eine erste Möglichkeit in
geschütztem Rahmen und unter fachlicher Aufsicht körperlich und
sportlich aktiv zu sein. Neben der Wiederherstellung und Verbesserung des
physiologischen Bewegungsausmaßes liegen die Erhaltung der
Selbstständigkeit und Lebensqualität im Vordergrund der
physiotherapeutischen Behandlung. Dazu zählen Aktivierung, Anbahnung von
physiologischen Bewegungsabläufen, Korrektur von Gelenkachsen und das
Vermitteln von Körperwahrnehmung bei körperlicher
Aktivität. Medizinisches Fachwissen und Verständnis sowie Wissen
über die Anforderungen verschiedener Sportartenprofile
ermöglicht gezielte Hilfestellungen. Durch kontinuierliche, engmaschige
Begleitung und langsame Steigerung von Intensität und Umfang in der
Physiotherapie können Ängste und Bedenken bezüglich dem
Wiedereinstieg bzw. Einstieg in sportliche Betätigung abgebaut werden.
Der jeweilige Gesundheitszustand und die Situation der
Entzündungsaktivität sind maßgebend für die
Therapieinterventionen. Sport gilt heute in der Physiotherapie als
Therapieelement und hilft Beschwerden zu lindern, verbessert körperliche
Defizite und vermittelt dabei Freude an der Bewegung. Für
Alltagsaktivitäten und den Freizeitsport kann eine individuelle
Sportberatung basierend auf dem bestehenden Erkrankungsstatus, dem funktionellen
und sportmotorischen Leistungsniveau sowie den eigenen Interessen wirkungsvoll
zu einem aktiven Lebensstil beitragen. Eine weitere Möglichkeit der
angeleiteten Bewegungsförderung stellt der Schulsport dar. Individuelle,
differenzierte Schulsportteilnahmebescheinigungen verbessern die Inklusion. Ein
auf den Erkrankungsstatus angepasstes und vorgegebenes Trainingsprogramm kann
mithilfe konkreter Vorgaben bei der Umsetzung der sportlichen Ziele
unterstützen. In Zukunft soll ein digital gestütztes
professionelles Monitoring die Bewegungsempfehlungen für zuhause noch
weiter verbessern und helfen den Mangel an flächendeckenden
Beratungsstellen für Erkrankte mit kindlichem Rheuma zu verringern.
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Affiliation(s)
- Josephine Gizik
- Technische Universität München, Fakultät
für Sport- und Gesundheitswissenschaften, Professur für
Biomechanik im Sport, München, Germany
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Sophia Meister
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Matthias Hartmann
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Daniel Sahm
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Mathias Georgi
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Nadja Baumeister
- Technische Universität München, Fakultät
für Sport- und Gesundheitswissenschaften, Professur für
Biomechanik im Sport, München, Germany
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Mareike Kühne
- Technische Universität München, Fakultät
für Sport- und Gesundheitswissenschaften, Professur für
Biomechanik im Sport, München, Germany
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Johannes-Peter Haas
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Ansgar Schwirtz
- Technische Universität München, Fakultät
für Sport- und Gesundheitswissenschaften, Professur für
Biomechanik im Sport, München, Germany
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Ginter DC, Ramien ML, Brundler MA, Swaney LC, Miettunen PM, Luca NJ. A rare case of suspected lupus erythematous panniculitis as the presenting skin feature of juvenile dermatomyositis: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221086317. [PMID: 35355853 PMCID: PMC8958673 DOI: 10.1177/2050313x221086317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Juvenile dermatomyositis is a rare autoimmune myopathy of childhood, associated with systemic vasculopathy, primarily affecting the capillaries. Panniculitis is seen histologically in about 10% of patients with dermatomyositis; however, its clinical presentation is rare, with only 30 cases presented in the literature to date. The histopathology overlaps with other inflammatory disease states, and is almost identical to the panniculitis seen in lupus erythematous panniculitis. In the cases with both panniculitis and dermatomyositis, skin and muscle inflammation is usually the first clinical manifestation. We present a case of a 16-year-old female with panniculitis as the initial presenting feature of juvenile dermatomyositis in the context of a prior diagnosis of indeterminate colitis.
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Affiliation(s)
- Dylan C Ginter
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michele L Ramien
- Division of Community Pediatrics, Department of Pediatrics, and Division of Dermatology, Department of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Marie-Anne Brundler
- Department of Pathology and Laboratory Medicine and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Laura C Swaney
- Division of General Pediatrics, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Paivi Mh Miettunen
- Section of Pediatric Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Nadia Jc Luca
- Section of Pediatric Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
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Dover S, Stephens S, Clairman H, Abesamis A, Jazi OA, Babij S, Marcuz JA, Naraidoo N, Pan J, Pullenayegum E, Rumsey D, Whitney K, Feldman BM. Feasibility of the wingate anaerobic exercise test as a clinical measure in patients with juvenile dermatomyositis. Pediatr Rheumatol Online J 2022; 20:21. [PMID: 35346243 PMCID: PMC8962236 DOI: 10.1186/s12969-022-00679-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Core sets, while widely adopted for clinical assessment in juvenile dermatomyositis (JDM), have some drawbacks - they are time consuming, were developed primarily for research, and require an experienced multidisciplinary team. We propose the Wingate Anaerobic Test, a 30-s all out test performed on a cycle ergometer, as a potential alternative; it is valid and reliable in this patient population. We aimed to determine the feasibility of performing the Wingate test as part of a typical clinic visit, and to determine if it is correlated to current measures of disease activity. METHODS Patients 5-18 years of age, with JDM, were recruited from the JDM clinic at a large Canadian academic children's hospital. Participants underwent a standard clinic assessment, then completed a Wingate test at the end of the visit. RESULTS Twenty-six patients participated in the study, representing a recruitment rate of 81%; of those, 88% were able to complete the Wingate test. Patients liked the Wingate test and felt it should be included as a regular clinic test. Absolute peak power (watts) on the Wingate test was strongly correlated to the manual muscle test (MMT-8) and the timed squat test. Relative peak power (watts/kg) on the Wingate test was strongly correlated to the timed squat test and the Childhood Myositis Assessment Scale (CMAS). Exploratory principal components analysis revealed that Wingate relative average power explained almost 2/3 of the variance of the CMAS, MMT and timed squats combined. CONCLUSION The Wingate test is a feasible test for children with JDM and correlates well with standard clinical assessments. Given its brevity, it has the potential to replace more standard measures of physical function currently used in clinical assessments for children with JDM. Future work should focus on how best to operationalize Wingate testing in clinic without the use of dedicated personnel.
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Affiliation(s)
- Saunya Dover
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON Canada
| | - Samantha Stephens
- grid.42327.300000 0004 0473 9646Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON Canada
| | - Hayyah Clairman
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON Canada
| | - Andrew Abesamis
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON Canada
| | - Omidali Aghababaei Jazi
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON Canada
| | - Stephanie Babij
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON Canada
| | - Jo-Anne Marcuz
- grid.42327.300000 0004 0473 9646Division of Rheumatology, The Hospital for Sick Children, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646Department of Rehabilitation, The Hospital for Sick Children, Toronto, ON Canada
| | - Natasha Naraidoo
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON Canada
| | - Jing Pan
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON Canada
| | - Eleanor Pullenayegum
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management & Evaluation,, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Dax Rumsey
- grid.17089.370000 0001 2190 316XDivision of Rheumatology, University of Alberta, Edmonton, AB Canada
| | - Kristi Whitney
- grid.42327.300000 0004 0473 9646Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646Division of Rheumatology, The Hospital for Sick Children, Toronto, ON Canada
| | - Brian M. Feldman
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management & Evaluation,, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Karaca Ö, Güngör M, Sakarya Güneş A, Eser Şimşek I, Anık Y, Kara B. Angioedema-like presentation as the presenting finding of juvenile myositis and juvenile dermatomyositis in 2 patients. Int J Rheum Dis 2022; 25:617-625. [PMID: 35238477 DOI: 10.1111/1756-185x.14311] [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: 10/04/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is the most common subtype of idiopathic inflammatory myopathies in childhood. Gottron's papules, shawl sign, periorbital heliotrope rash, and periungual telengiectasis are characteristic skin findings of the disease. Besides characteristic skin involvement, some other skin findings, such as angioedema, may be seen prior or in the course of the disease. The presence of angioedema in JDM is emphasized in this report. CASE PRESENTATIONS We present 2 unrelated girls, aged 2 (case 1) and 12 years (case 2), who had developed symmetrical weakness in the proximal muscles, muscle pain, elevated muscle enzymes and angioedema. Both cases had abnormal muscle magnetic resonance imaging findings, suggestive of inflammatory myositis. Muscle biopsy was performed only in case 1, and major histocompatibility complex-1 expression on myofibers was shown consistent with JDM. Cases were diagnosed as probable and definite JDM, respectively. Angioedema was prominent, particularly in the lips and extremities of both cases, without laboratory evidence of C1 inhibitor deficiency or capillary leak syndrome, and absence of family history. Mast cell-mediated, acquired angioedema was the most likely diagnosis. In both cases, skin and muscle findings improved significantly with steroid treatment. CONCLUSION We suggest that angioedema may be among the characteristic skin findings in JDM, and may be included in subsequent definitions.
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Affiliation(s)
- Ömer Karaca
- Kocaeli University Medical Faculty, Division of Child Neurology, Department of Pediatrics, Izmit, Turkey
| | - Mesut Güngör
- Kocaeli University Medical Faculty, Division of Child Neurology, Department of Pediatrics, Izmit, Turkey
| | - Ayfer Sakarya Güneş
- Division of Child Neurology, Department of Pediatrics, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Işıl Eser Şimşek
- Kocaeli University Medical Faculty, Division of Child Allergy and Immunology, Department of Pediatrics, Izmit, Turkey
| | - Yonca Anık
- Kocaeli University Medical Faculty, Department of Radiology, Izmit, Turkey
| | - Bülent Kara
- Kocaeli University Medical Faculty, Division of Child Neurology, Department of Pediatrics, Izmit, Turkey
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Pediatric Patient with Heliotrope Rash and Proximal Muscle Weakness. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Loarce-Martos J, Larena C, Blázquez MÁ, Joven BE, Carreira PE, Martínez-Barrio J, Monteagudo I, López-Longo FJ, Ruiz L, López-Robledillo JC, Almodóvar R, Llorente I, Tomero E, García-de la Peña P, Moruno H, Pérez A, Cobo-Ibáñez T, Lojo Oliveira L, Barbadillo MC, García-De Yébenes MJ, Nuño-Nuño L. Clinical Characteristics of Juvenile Idiopathic Inflammatory Myopathy and Comparison With Adult Patients: Analysis From a Multicentric Cohort in Spain. J Clin Rheumatol 2022; 28:e195-e202. [PMID: 33492027 DOI: 10.1097/rhu.0000000000001696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
METHODS This study reviewed the medical records of patients from the REMICAM cohort, a multicentric longitudinal study carried out in patients with IIM, followed up between 1980 and 2014 in 12 hospitals in Madrid, Spain. Patients with definite or probable JPM, JDM, adult DM, and adult PM according to the modified Bohan and Peter criteria were selected. We compared the characteristics between JDM and JPM, and between JIIM and adult IIM. RESULTS Eighty-six juvenile patients (75 JDMs and 11 JPMs) and 283 adult patients (133 DMs and 150 PMs) were included. Compared with patients with JDM, patients with JPM were older at diagnosis, had more fever and arthritis, and were less frequently treated with disease-modifying antirheumatic drugs (these differences were not statistically significant). Compared with patients with adult DM, those with JDM presented more frequently with calcinosis (33.8% vs 6.9%, p < 0.0001) and had less severe infections (4.3% vs 23.4%, p < 0.0001), malignancies (1.3% vs 25.6%, p < 0.0001), and mortality (3.5% vs 33%, p < 0.0001). Patients with JDM were treated less frequently with azathioprine (10.8% vs 44.7%, p < 0.0001). CONCLUSIONS Our findings confirm that JIIMs are a heterogeneous group of diseases with relevant differences compared with adult IIMs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Pérez
- Hospital Universitario Príncipe de Asturias
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Varnier GC, Consolaro A, Maillard S, Pilkington C, Ravelli A. Comparison of treatments and outcomes of children with juvenile dermatomyositis followed at two European tertiary care referral centers. Rheumatology (Oxford) 2021; 60:5419-5423. [PMID: 33528490 DOI: 10.1093/rheumatology/keab089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/11/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To compare the treatment approaches and disease outcomes of children with JDM followed in two European tertiary care peadiatric rheumatology centres. METHODS The medical notes of patients with JDM seen at Istituto Giannina Gaslini (IGG) of Genoa, Italy or Great Ormond Street Hospital (GOSH) of London, UK between January 2000 and December 2015 within 6 months after disease onset and followed for at least 6 months were reviewed. Demographic, clinical and therapeutic data were collected. At each visit, the caring physician was asked to rate the disease state subjectively. RESULTS A total of 127 patients were included, 88 at GOSH and 39 at IGG. At 24 months, the median values of muscle strength and disease activity were at the normal end of the scale and around three quarters of patients were said to have inactive disease. Also, at 2 years, 38.6% and 36% of British and Italian patients, respectively, had damage. Cyclophosphamide, azathioprine, infliximab, rituximab and mycophenolate mofetil were used more frequently by UK physicians, whereas ciclosporin, intravenous immunoglobulin and hydroxychloroquine were prescribed by Italian physicians. CONCLUSION This study shows a significant difference in the choice of medications between pediatric rheumatologists practising in the two centres. Despite this, a high proportion of patients had inactive disease at 2 years and there was a low frequency of damage: modern treatments have improved outcomes.
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Affiliation(s)
- Giulia Camilla Varnier
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze MaternoInfantili, Università degli Studi di Genova, Genoa, Italy.,Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Alessandro Consolaro
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze MaternoInfantili, Università degli Studi di Genova, Genoa, Italy.,Dipartimento Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Susan Maillard
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - Angelo Ravelli
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze MaternoInfantili, Università degli Studi di Genova, Genoa, Italy.,Dipartimento Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Paediatrics, Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Witczak BN, Bollerslev J, Godang K, Schwartz T, Flatø B, Molberg Ø, Sjaastad I, Sanner H. Body composition in longstanding juvenile dermatomyositis; Associations with disease activity, muscle strength and cardiometabolic measures. Rheumatology (Oxford) 2021; 61:2959-2968. [PMID: 34718443 DOI: 10.1093/rheumatology/keab805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 10/15/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To (i) compare body composition parameters in patients with longstanding juvenile dermatomyositis (JDM) and controls and (ii) explore associations between body composition and disease activity/inflammation, muscle strength, health-related quality of life (HRQL) and cardiometabolic measures. METHODS In a cross-sectional study, we included 59 patients (median disease duration 16.7 y; median age 21.5 y) and 59 age- and sex-matched controls. Active/inactive disease were defined by the PRINTO criteria. Body composition was assessed by total body dual-energy absorptiometry (DXA), inflammation by hs-CRP and cytokines, muscle strength by manual muscle test (MMT-8), HRQL by 36-item short form survey physical component score (SF-36 PCS) and cardiometabolic function by echocardiography (systolic and diastolic function) and serum-lipids. RESULTS DXA analyses revealed lower appendicular lean mass index (ALMI) (reflecting limb skeletal muscle mass), higher body fat percentage (BF%) and higher android: gynoid fat ratio (A: G ratio) (reflecting central fat distribution) in patients than controls, despite similar BMI. Patients with active disease had lower ALMI and higher BF% than those with inactive disease; lower ALMI and higher BF% were associated with inflammation (elevated monocyte attractant protein-1 (MCP-1) and hs-CRP). Lower ALMI was associated with reduced muscle strength; higher BF% was associated with impaired HRQL. Central fat distribution (higher A: G ratio) was associated with impaired cardiac function and unfavorable serum-lipids. CONCLUSION : Despite normal BMI, patients with JDM, especially those with active disease, had unfavorable body composition, which was associated with impaired HRQL/muscle strength and cardiometabolic function. The association between central fat distribution and cardiometabolic alterations is a novel finding in JDM.
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Affiliation(s)
- Birgit Nomeland Witczak
- Institute for Experimental Medical Research and KG Jebsen center for cardiac research, Oslo University Hospital-Ullevål, and University of Oslo, Oslo, Norway
| | - Jens Bollerslev
- Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Section of Specialized Endocrinology, Department of Endocrinology, Preventive Medicine and Morbid Obesity, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Department of Endocrinology, Preventive Medicine and Morbid Obesity, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Thomas Schwartz
- Institute for Experimental Medical Research and KG Jebsen center for cardiac research, Oslo University Hospital-Ullevål, and University of Oslo, Oslo, Norway.,Bjørknes University College, Oslo, Norway
| | - Berit Flatø
- Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Rheumatology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Øyvind Molberg
- Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Rheumatology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research and KG Jebsen center for cardiac research, Oslo University Hospital-Ullevål, and University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital-Ullevål, Oslo, Norway
| | - Helga Sanner
- Bjørknes University College, Oslo, Norway.,Department of Rheumatology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
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Livermore P, Gibson F, Mulligan K, Wedderburn LR, McCann LJ, Gray S. Mapping the current psychology provision for children and young people with juvenile dermatomyositis. Rheumatol Adv Pract 2021; 5:rkab062. [PMID: 34671713 PMCID: PMC8522803 DOI: 10.1093/rap/rkab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Juvenile Dermatomyositis (JDM) is a rare, chronic autoimmune condition of
childhood, with known psychosocial implications. In this study, we sought to
establish current psychological support for children and young people across
the UK with rheumatic conditions, with a specific focus on those with
JDM. Methods Electronic surveys were distributed to the 15 centres that belong to the JDM
Research Group in the UK, collecting responses from health-care
professionals in the fields of medicine, nursing and psychology. Results One hundred per cent of professionals from medicine and nursing replied from
all 15 centres. Of these, 7 (47%) did not have a named psychologist
as part of their rheumatology team, despite the majority [13 (87%)]
having >200 paediatric rheumatology patients. Of the remaining
centres, hospital psychology provision varied considerably. When rating
their service, only 3 (8%) of 40 professionals scored their service
as five (where one is poor and five is excellent); there were wide
discrepancies in these scores. Many challenges were discussed, including
limited psychology provision, lack of time and difficulties in offering
support across large geographical areas. Conclusion Many of the challenges discussed are applicable to other centres worldwide.
Suggestions have been proposed that might help to improve the situation for
children and young people with rheumatic conditions, including JDM. Based on
these findings, we suggest that rheumatology teams maximize use of these
data to advocate and work toward more comprehensive psychology provision and
support in their individual centres.
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Affiliation(s)
- Polly Livermore
- Rheumatology Department, University College London Great Ormond Street Institute of Child Health.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust.,NIHR Biomedical Research Centre at Great Ormond Street Hospital.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust.,School of Health Sciences, University of Surrey, Guildford
| | - Kathleen Mulligan
- Centre of Health Services Research, University of London.,East London NHS Foundation Trust, London
| | - Lucy R Wedderburn
- Rheumatology Department, University College London Great Ormond Street Institute of Child Health.,NIHR Biomedical Research Centre at Great Ormond Street Hospital.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London
| | - Liza J McCann
- Rheumatology Department, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Suzanne Gray
- Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Jones JT, Smith C. The First Reported Case of Juvenile Dermatomyositis in an Adolescent with Down Syndrome and the Clinical Considerations for Therapy. Open Rheumatol J 2021. [DOI: 10.2174/1874312902115010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Down Syndrome (DS) is one of the most common birth conditions in the United States of America, with approximately 5300 births annually, resulting in an estimated birth prevalence of 12.6 per 10,000 live births and a population prevalence in the USA since 2010 of 6.7 per 10,000 inhabitants. Children with DS have complex medical challenges that present due to changes in their immune system that results in increased rates of infection, malignancy, and autoimmune disease. Juvenile Dermatomyositis (JDM) is a rare, autoimmune disease, and the most common inflammatory myopathy of childhood. Reports suggest an increased incidence of arthritis in children with DS, but there have been no reports of JDM in children with DS. Additionally, those with DS pose unique challenges with an increase in adverse effects and ineffectiveness of immunosuppressive therapy.
Case :
We describe the first case of an adolescent female with DS who developed JDM with a positive anti-p155/140 antibody and characteristic clinical phenotype. We discuss increased awareness of autoimmune disease in adolescents with DS and clinical considerations for therapy with immunosuppression.
Conclusion:
Adolescents with DS are at increased risk for autoimmune disease, including JDM. Awareness, early recognition of the signs and symptoms of autoimmune disease in those with DS is important, so appropriate therapy can be implemented.
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Cotter C, Rudd E, Williamson E, Philippidou M, Tewari A. Anti-Ku-positive juvenile dermatomyositis. Clin Exp Dermatol 2021; 47:425-427. [PMID: 34528293 DOI: 10.1111/ced.14937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- C Cotter
- Department of Dermatology, King's College Hospital, London, UK
| | - E Rudd
- Department of Dermatology, King's College Hospital, London, UK
| | - E Williamson
- Department of Dermatology, King's College Hospital, London, UK
| | - M Philippidou
- Department of Dermatology, King's College Hospital, London, UK
| | - A Tewari
- Department of Dermatology, King's College Hospital, London, UK
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Papadopoulou C, Hong Y, Krol P, Al Obaidi M, Pilkington C, Wedderburn LR, Brogan PA, Eleftheriou D. The Vasculopathy of Juvenile Dermatomyositis: Endothelial Injury, Hypercoagulability, and Increased Arterial Stiffness. Arthritis Rheumatol 2021; 73:1253-1266. [PMID: 33393715 DOI: 10.1002/art.41639] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Vasculopathy is considered central to the pathogenesis of juvenile dermatomyositis (DM) and is associated with severe extramuscular manifestations. We undertook this study to investigate the hypothesis that the vasculopathy of juvenile DM can be noninvasively tracked by examining biomarkers of endothelial injury, subclinical inflammation, hypercoagulability, and vascular arterial stiffness. METHODS The study population was a UK cohort of children with juvenile DM. Circulating endothelial cells (CECs) and microparticles (MPs) were identified using immunomagnetic bead extraction and flow cytometry, respectively. Plasma thrombin generation was determined using a fluorogenic assay. Cytokine and chemokine levels were measured by electrochemiluminescence. Arterial stiffness was assessed using pulse wave velocity (PWV). Results were expressed as the median and interquartile range (IQR), and statistical significance was assessed using nonparametric analyses. RESULTS Ninety patients with juvenile DM and 79 healthy control subjects were included. The median age of the patients was 10.21 years (IQR 6.68-13.40), and the median disease duration was 1.63 years (IQR 0.28-4.66). CEC counts were higher in all patients with juvenile DM compared to controls (median 96 cells/ml [IQR (40-192] and 12 cells/ml [IQR 8-24], respectively; P < 0.0001). Circulating MP numbers were also significantly higher in patients with active juvenile DM compared to controls (median 204.7 × 103 /ml [IQR 87.9-412.6] and 44.3 × 103 /ml [IQR 15.0-249.1], respectively; P < 0.0001). MPs were predominantly of platelet and endothelial origin. Enhanced plasma thrombin generation was demonstrated in patients with active juvenile DM compared to those with inactive disease (P = 0.0003) and controls (P < 0.0001). Carotid-radial PWV adjusted for age was increased in patients with juvenile DM compared to controls (P = 0.003). CONCLUSION We observed increased endothelial injury and increased levels of proinflammatory cytokines in patients with active juvenile DM. MP profiles reflected distinct disease activity status in juvenile DM and are markers of vascular pathology, platelet activation, and thrombotic propensity. Ongoing long-term vascular injury may result in increased arterial stiffness in patients with juvenile DM.
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Affiliation(s)
- Charalampia Papadopoulou
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Ying Hong
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Petra Krol
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK, and Skåne University Hospital, Lund, Sweden
| | - Muthana Al Obaidi
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Clarissa Pilkington
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Lucy R Wedderburn
- University College London Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, NIHR Great Ormond Street Hospital Biomedical Research Centre, and Centre for Adolescent Rheumatology Versus Arthritis, London, UK
| | - Paul A Brogan
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Despina Eleftheriou
- University College London Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, and Centre for Adolescent Rheumatology Versus Arthritis, London, UK
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Dvergsten JA, Reed AM, Landerman L, Pisetsky DS, Ilkayeva O, Huffman KM. Metabolomics Analysis Identifies a Lipidomic Profile in Treatment Naïve Juvenile Dermatomyositis Patients versus Healthy Control Subjects. Rheumatology (Oxford) 2021; 61:1699-1708. [PMID: 34185053 PMCID: PMC8996785 DOI: 10.1093/rheumatology/keab520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/16/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives To perform an exploratory study to identify a JDM serum metabolic profile that differs from healthy controls (HCs) and responds to immunosuppressive treatment. Methods Blood was collected from 9 HCs and 10 patients diagnosed with probable (n = 4) or definite (n = 6) JDM based on the criteria of Bohan and Peter for myositis, with 7 of the 10 providing longitudinal samples following initiation of treatment; these patients comprised the treatment-naïve cohort. Sera underwent mass spectroscopy–based measurements of targeted metabolic intermediates, including 15 amino acids, 45 acylcarnitines (ACs), 15 ceramides and 29 sphingomyelins. Principal components analysis reduced metabolites into smaller sets of factors each comprised of correlated metabolic intermediates. Factor scores and metabolite concentrations were compared with HCs using two-sample t-tests while treatment effects were evaluated using paired t-tests. Results Of eight principal components analysis–derived metabolite factors (one AC, two amino acids, three sphingosine and two ceramide), two were significantly associated with JDM: one AC factor containing mostly long-chain ACs (P = 0.049) and one ceramide factor (P < 0.01). For 12 individual ACs, mostly long chain, and three ceramides, concentrations were significantly greater for JDM than HCs. Factors based on these individual metabolites showed decreasing scores with treatment (P = 0.03 and P < 0.01, respectively). Conclusion While additional validation is needed, these lipids have potential as JDM serum diagnostic and/or treatment biomarkers. Additionally, the significant association of long-chain ACs and ceramides with JDM offers insights regarding pathogenesis, implicating dysregulation of mitochondrial fatty acid β-oxidation.
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Affiliation(s)
- Jeffrey A Dvergsten
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC, USA
| | - Ann M Reed
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC, USA
| | - Lawrence Landerman
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC, USA
| | - David S Pisetsky
- Department of Medicine and Immunology, Duke University Medical Center and Research Service, Durham VA Medical Center, Durham, NC, USA
| | - Olga Ilkayeva
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Kim M Huffman
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
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Perron MM, Vasquez-Canizares N, Tarshish G, Wahezi DM. Myositis autoantibodies in a racially diverse population of children with idiopathic inflammatory myopathies. Pediatr Rheumatol Online J 2021; 19:92. [PMID: 34118936 PMCID: PMC8199392 DOI: 10.1186/s12969-021-00574-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/20/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Juvenile idiopathic inflammatory myopathies (JIIMs) is a group of autoimmune disorders, including juvenile dermatomyositis (JDM), juvenile polymyositis (JPM) and overlap myositis, that are characterized by proximal muscle weakness, elevated levels of serum muscle enzymes, and pathognomonic skin findings. While the exact etiology of JIIMs is unclear, the presence of myositis specific autoantibodies (MSAs) have been associated with certain clinical phenotypes, organ involvement and disease prognosis. To date, there have been few studies of the associations between MSA presence and patient ethnicity. It is important to understand the extent to which ethnicity impacts disease manifestations, organ involvement and clinical outcomes. The goal of our study is to determine MSA and myositis associated autoantibody (MAA) presence, clinical phenotype, and disease course in a racially diverse population of pediatric patients with JIIMs. METHODS Patients age 2-21 years with a prior diagnosis of JDM, JPM or overlap myositis, who had been tested for MSA/MAA, were eligible for study inclusion. Clinical and laboratory data were collected retrospectively via manual chart review in this single-center study. Descriptive statistics were performed to summarize each variable. Given the small sample size, non-parametric testing was performed using Fischer's exact test, Wilcoxon rank sum test and Kruskal-Wallis test. RESULTS Thirty one patients were included in the analysis. Race and ethnicity were self-reported as Hispanic (48.4%), white (25.8%), and Black (25.8%). The most prevalent MSAs were anti-MDA5 (25.8%), anti-p155/140 (22.6%) and anti-MJ (19.4%). Presence of autoantibodies (p = 0.04) and pulmonary disease (p = 0.03) were significantly higher in patients of Black or Hispanic descent compared with white descent. Anti-MDA5 antibodies, cutaneous ulceration, cardiopulmonary involvement, hospitalizations and one death were only reported in patients with Black or Hispanic descent. Patients with anti-MDA5 antibodies were more likely to be male (p = 0.04) and to have cutaneous ulceration (p = 0.02). CONCLUSIONS This study describes the prevalence of MSA/MAA in a racially diverse group of patients with JIIM and further delineates clinical phenotype and disease complications in these groups. We found a relatively high proportion of children with anti-MDA5 antibodies and described potentially worse clinical courses in children of Black or Hispanic descent. Further investigation is warranted to examine these findings.
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Affiliation(s)
- Megan Mariko Perron
- Children's Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY, 10467, USA. .,Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Natalia Vasquez-Canizares
- grid.414114.50000 0004 0566 7955Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Gabriel Tarshish
- grid.414114.50000 0004 0566 7955Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Dawn M. Wahezi
- grid.414114.50000 0004 0566 7955Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467 USA
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Abstract
Type I interferons (IFN-Is) are a very important group of cytokines that are produced by innate immune cells but also act on adaptive immune cells. IFN-Is possess antiviral, antitumor, and anti-proliferative effects, as well are associated with the initiation and maintenance of autoimmune disorders. Studies have shown that aberrantly expressed IFN-Is and/or type I IFN-inducible gene signatures in the serum or tissues of patients with autoimmune disorders are linked to their pathogenesis, clinical manifestations, and disease activity. Type I interferonopathies with mutations in genes impacting the type I IFN signaling pathway have shown symptoms and characteristics similar to those of systemic lupus erythematosus (SLE). Furthermore, both interventions in animal models and clinical trials of therapies targeting the type I IFN signaling pathway have shown efficacy in the treatment of autoimmune diseases. Our review aims to summarize the functions and targeted therapies (as well as clinical trials) of IFN-Is in both adult and pediatric autoimmune diseases, such as SLE, pediatric SLE (pSLE), rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), Sjögren syndrome (SjS), and systemic sclerosis (SSc), discussing the potential abnormal regulation of transcription factors and epigenetic modifications and providing a potential mechanism for pathogenesis and therapeutic strategies for future clinical use.
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Disease characteristics and clinical outcomes of adults and children with anti-MDA-5 antibody-associated myositis: a prospective observational bicentric study. Rheumatol Int 2021; 42:1155-1165. [PMID: 34050793 DOI: 10.1007/s00296-021-04897-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/15/2021] [Indexed: 12/14/2022]
Abstract
To study the demographic, clinical and serologic characteristics of anti-MDA5-positive DM from two geographically and ethnically disparate inception cohorts in India. To identify the clinical and serological parameters at inception that could predict mortality among these individuals. Individuals with anti-MDA5 antibody-positive DM diagnosed between 2017 and 2020 from two centres in India were prospectively followed up. The clinical and serological characteristics at baseline and the treatment outcome at follow-up were assessed for this study. Anti-MDA5 antibody was positive in 25 (7.5%) out of the 330 individuals with myositis. These 25 (21 adults, 4 juvenile) patients were followed up for a median duration of 14 months. Among adults, a majority had cutaneous manifestations 21 (84%) followed by, arthritis 17 (80%), and interstitial lung disease 12 (ILD, 57.1%). Four (19%) had rapidly progressive ILD (RP-ILD). Eight (38%) presented as clinically amyopathic DM. Among cutaneous manifestations, majority (62%) had classic features (gottron's papules/sign, heliotrope rash) while 8 (38%) had cutaneous ulceration and 2 each had periorbital edema and tendon rupture. Eight (38%) were positive for anti-Ro-52 antibody. Out of 21 adults, 8 (38%) succumbed to the diseases. RP-ILD (n = 4; 19%), ulcerative gottron's (n = 5) and anti-Ro-52 (n = 8) were significantly associated with mortality (p < 0.05). Upon binary logistic regression, positive anti-Ro-52 antibody predicted mortality [HR 17.3 (95%CI 1.4-210, p = 0.025)]. All juvenile anti-MDA5-positive DMs had classic cutaneous features with 2 of them having ulcerative gottron's. None of the juvenile patients had ILD and everyone survived till the last follow-up. Indian adults with anti-MDA5 DM have high mortality. Rarer atypical features like tendon rupture or periorbital edema could assist in diagnosis. Ulcerative gottron's, positive anti-Ro 52 antibodies, and RP-ILD are valuable clinical-serological markers that portend poor prognosis.
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Chevalier G, Fakih O, Lhose A, Ballot-Schmit C, Prati C, Puzenat E, Aubin F. Long-term outcome in patients with juvenile dermatomyositis: A case series. Arch Pediatr 2021; 28:475-479. [PMID: 34034928 DOI: 10.1016/j.arcped.2021.04.006] [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: 11/10/2020] [Revised: 03/29/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Follow-up of juvenile dermatomyositis (JDM) patients has demonstrated the impact of the disease on several organs in the long term. OBJECTIVE As there is little information on the long-term outcome of JDM, we aimed to assess long-term outcomes in a series of JDM patients. METHODS After selection of JDM patients, a consultation with a dermatologist and a rheumatologist was held for each patient. Cutaneous, muscle, and disease damage was assessed using different validated scores including the abbreviated Cutaneous Assessment Tool (aCAT), 8-muscle Manual Muscle Testing (MMT8), Childhood Myositis Assessment Scale (CMAS), Myositis Damage Index (MDI), Childhood Health Assessment Questionnaire (CHAQ), and Health Assessment Questionnaire (HAQ). Long-term disease outcomes were recorded including growth and pubertal development, educational and vocational achievement, and development of comorbidities. RESULTS Seven patients were included in the study. After a mean follow-up of 14.9±8.8 years, the mean aCAT score was 0.57±1.4 and only one patient had a positive aCAT activity score. The mean aCAT damage score was 1.4±1.3 and five (71%) patients had a score of ≥1. Five (71.4%) patients had normal muscle strength with an MMT8 score of >72, and none had severe muscle weakness (MMT8 ≤32, and CMAS<35). The mean total extent of damage according to the MDI was ≥1 in five (71%) patients and mainly involved the skin. Two (29%) patients had mild disability according to the CHAQ/HAQ disability index. In terms of quality of life, no patient had a score of<40 (1 SD below the mean for healthy controls). CONCLUSIONS Based on validated cutaneous and musculoskeletal scores, our study demonstrated the good functional outcomes of JDM at long-term follow-up.
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Affiliation(s)
- G Chevalier
- Service de Dermatologie, Inserm 1098 RIGHT, Université de Franche Comté, Centre Hospitalier Universitaire, 3, boulevard Fleming, 25030 Besançon, France
| | - O Fakih
- Service de Rhumatologie, Inserm 1098 RIGHT, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - A Lhose
- Service de Rhumatologie, Centre Hospitalier, Belfort, France
| | - C Ballot-Schmit
- Service de Rhumatologie, Centre Hospitalier, Belfort, France
| | - C Prati
- Service de Rhumatologie, Inserm 1098 RIGHT, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - E Puzenat
- Service de Dermatologie, Inserm 1098 RIGHT, Université de Franche Comté, Centre Hospitalier Universitaire, 3, boulevard Fleming, 25030 Besançon, France
| | - F Aubin
- Service de Dermatologie, Inserm 1098 RIGHT, Université de Franche Comté, Centre Hospitalier Universitaire, 3, boulevard Fleming, 25030 Besançon, France.
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Zhen C, Wang Y, Wang H, Wang X. The risk of ischemic stroke in patients with idiopathic inflammatory myopathies: a systematic review and meta-analysis. Clin Rheumatol 2021; 40:4101-4108. [PMID: 33934269 DOI: 10.1007/s10067-021-05751-2] [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: 08/20/2020] [Revised: 03/22/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Idiopathic inflammatory myopathies (IIM) are a group of chronic rheumatic diseases that can affect multiple systems; the risk of ischemic stroke in patients with IIM remains controversial. We aimed to systematically evaluate the risk of ischemic stroke in IIMs. METHODS The PubMed, Embase, and Cochrane library were searched for relevant studies. Pooled relative risk (RR) with a 95% confidence interval (CI) was calculated as effect size to evaluate the risk of ischemic stroke in patients with IIM. Random effects model was chosen when I2 > 50%. We pooled all studies in a first total analysis to assess the risk of ischemic stroke in IIM. Subgroup analyses were conducted based on the subtypes of IIM (dermatomyositis) and country. Sensitivity analysis was performed to identify the heterogeneity sources. RESULTS A total of 6 studies with 5,114 IIM cases and 14,516,099 controls were included, and the results demonstrated that IIMs were associated with an increased risk of ischemic stroke (RR = 2.41, 95% CI: 1.31, 4.45). Subgroup analysis indicated that patients with dermatomyositis (DM) had a 49% excess risk of ischemic stroke than controls; Asian patients with IIM had an increased risk of ischemic stroke, although not for American patients. CONCLUSION IIMs, especially patients with DM, are associated with an increased risk of ischemic stroke. Appropriate intervention may be taken into account for patients with IIM, especially when accompanied by other traditional risk factors of ischemic stroke. Key Points • This study evaluated the risk of ischemic stroke in patients with IIMs. • Generally, IIMs are associated with an increased risk of ischemic stroke. • Patients with DM had a 49% excess risk of ischemic stroke than controls. • Subgroup analysis showed that Asian patients with IIMs were at increased risk of ischemic stroke, but not Americans.
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Affiliation(s)
- Chao Zhen
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao, Shandong Province, 266071, China
| | - Yabo Wang
- Department of Emergency, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Haifeng Wang
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao, Shandong Province, 266071, China
| | - Xin Wang
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao, Shandong Province, 266071, China.
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Wang K, Zhang Z, Meng D, Li J. Investigating genetic drivers of juvenile dermatomyositis pathogenesis using bioinformatics methods. J Dermatol 2021; 48:1007-1020. [PMID: 33891717 DOI: 10.1111/1346-8138.15856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
Juvenile dermatomyositis (JDM) is a chronic autoimmune disease. The pathogenic mechanisms remain ill-defined. The purpose of this study was to identify key genes related to JDM. Microarray datasets were downloaded from the Gene Expression Omnibus database. The differentially expressed genes (DEG) were identified. Then, Gene Ontology, Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis, and protein-protein interaction (PPI) network were carried out. In addition, the hub genes were selected by cytoHubba. The expression profile and diagnostic capacity (receiver-operator curve [ROC]) of interested hub genes were verified. Gene set enrichment analysis (GSEA) was also carried out. Moreover, the signature of hub genes was then used as a search query to explore the Connectivity Map (CMAP). A total of 128 DEG were identified. The enriched functions and pathways of the DEG include response to virus, negative regulation of cell migration, cadmium ion transmembrane transport, defense response to Gram-negative bacterium, positive regulation of megakaryocyte differentiation, and negative regulation of angiogenesis. Twenty-one hub genes were identified. The expression levels of the interested genes were also confirmed. ROC analysis confirmed that the expression of these genes can distinguish JDM from controls. GSEA showed that these genes are mainly related to "inflammatory response", "complement", "interferon-α response", "IL6/JAK/STAT3 signaling", "TGF-β signaling", "IL2/STAT5 signaling" and "TNF-α signaling via NF-κB". The CMAP research found some compounds with the potential to counteract the effects of the dysregulated molecular signature in JDM. In this study, bioinformatics methods were used to identify DEG, which helps us understand the molecular mechanisms of JDM and provide candidate targets for diagnosis and treatment of JDM.
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Affiliation(s)
- Kai Wang
- Department of Rheumatology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Zhongyuan Zhang
- Department of Rheumatology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Deqian Meng
- Department of Rheumatology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Ju Li
- Department of Rheumatology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
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Sabbagh SE, Neely J, Chow A, DeGuzman M, Lai J, Lvovich S, McGrath T, Pereira M, Pinal-Fernandez I, Roberts J, Rouster-Stevens K, Schmeling H, Sura A, Tarshish G, Tucker L, Rider LG, Kim S. Risk factors associated with Pneumocystis jirovecii pneumonia in juvenile myositis in North America. Rheumatology (Oxford) 2021; 60:829-836. [PMID: 32889531 DOI: 10.1093/rheumatology/keaa436] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/24/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Pneumocystis jirovecii pneumonia (PJP) is associated with significant morbidity and mortality in adult myositis patients; however, there are few studies examining PJP in juvenile myositis [juvenile idiopathic inflammatory myopathy (JIIM)]. The purpose of this study was to determine the risk factors and clinical phenotypes associated with PJP in JIIM. METHODS An research electronic data capture (REDCap) questionnaire regarding myositis features, disease course, medications and PJP infection characteristics was completed by treating physicians for 13 JIIM patients who developed PJP (PJP+) from the USA and Canada. Myositis features and medications were compared with 147 JIIM patients without PJP (PJP-) from similar geographic regions who enrolled in National Institutes of Health natural history studies. RESULTS PJP+ patients were more often of Asian ancestry than PJP- patients [odds ratio (OR) 8.7; 95% CI 1.3, 57.9]. Anti- melanoma differentiation associated protein 5 (MDA5) autoantibodies (OR 12.5; 95% CI 3.0, 52.4), digital infarcts (OR 43.8; 95% CI 4.2, 460.2), skin ulcerations (OR 12.0; 95% CI 3.5, 41.2) and interstitial lung disease (OR 10.6; 95% CI 2.1, 53.9) were more frequent in PJP+ patients. Before PJP diagnosis, patients more frequently received pulse steroids, rituximab and more immunosuppressive therapy compared with PJP- patients. Seven PJP+ patients were admitted to the intensive care unit and four patients died due to PJP or its complications. CONCLUSIONS PJP is a severe infection in JIIM that can be associated with mortality. Having PJP was associated with more immunosuppressive therapy, anti-MDA5 autoantibodies, Asian race and certain clinical features, including digital infarcts, cutaneous ulcerations and interstitial lung disease. Prophylaxis for PJP should be considered in juvenile myositis patients with these features.
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Affiliation(s)
- Sara E Sabbagh
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA.,Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jessica Neely
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Albert Chow
- Division of Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA.,Division of Pediatric Rheumatology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Marietta DeGuzman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Rheumatology, Texas Children's Hospital, Houston, TX, USA
| | - Jamie Lai
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Rheumatology, Texas Children's Hospital, Houston, TX, USA.,University of Colorado School of Medicine, Division of Pediatric Rheumatology, Children's Hospital Colorado, Aurora, CO, USA
| | - Svetlana Lvovich
- Section of Rheumatology, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Tara McGrath
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, USA.,BC Children's Hospital, Vancouver, BC, Canada
| | - Maria Pereira
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Rheumatology, Texas Children's Hospital, Houston, TX, USA
| | - Iago Pinal-Fernandez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Jordan Roberts
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Heinrike Schmeling
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Anjali Sura
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.,Department of Pediatrics, Upstate University Hospital, Syracuse, NY, USA
| | - Gabriel Tarshish
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Lori Tucker
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, USA.,BC Children's Hospital, Vancouver, BC, Canada
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Susan Kim
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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Sabbagh SE, Pinal-Fernandez I, Casal-Dominguez M, Albayda J, Paik JJ, Miller FW, Rider LG, Mammen AL, Christopher-Stine L. Anti-mitochondrial autoantibodies are associated with cardiomyopathy, dysphagia, and features of more severe disease in adult-onset myositis. Clin Rheumatol 2021; 40:4095-4100. [PMID: 33851273 PMCID: PMC8463345 DOI: 10.1007/s10067-021-05730-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/25/2022]
Abstract
We analyzed the prevalence of anti-mitochondrial autoantibodies (AMA) in adult- and juvenile-onset myositis longitudinal cohorts and investigated phenotypic differences in myositis patients with AMA. We screened sera from myositis patients including 619 adult- and 371 juvenile-onset dermatomyositis (DM, JDM), polymyositis (PM, JPM), inclusion body myositis (IBM), or amyopathic DM patients and from healthy controls, including 164 adults and 92 children, for AMA by ELISA. Clinical characteristics were compared between myositis patients with and without AMA. AMA were present in 5% of adult myositis patients (16 of 216 DM, 10 of 222 PM, 4 of 140 IBM, 1 of 19 amyopathic DM), 1% of juvenile myositis patients (3 of 302 JDM, 1 of 25 JPM), and 1% of both adult and juvenile healthy controls. In patients with adult-onset myositis, AMA were associated with persistent muscle weakness, Raynaud’s phenomenon, dysphagia, and cardiomyopathy. Adult myositis patients with AMA may have more severe or treatment refractory disease, as they more frequently received glucocorticoids and intravenous immunoglobulin. In juvenile myositis, children with AMA often had falling episodes and dysphagia, but no other clinical features or medications were significantly associated with AMA. AMA are present in 5% of adult myositis patients and associated with cardiomyopathy, dysphagia, and other signs of severe disease. The prevalence of AMA is not increased in patients with juvenile myositis compared to age-matched healthy controls. Our data suggest that the presence of AMA in adult myositis patients should prompt screening for cardiac and swallowing involvement.
Key Points • Approximately 5% of a large North American cohort of adult myositis patients have anti-mitochondrial autoantibodies. • Adults with anti-mitochondrial autoantibodies often have chronic weakness, Raynaud’s, dysphagia, cardiomyopathy, and more severe disease. • Anti-mitochondrial autoantibodies are rare in juvenile myositis and not associated with a specific clinical phenotype. |
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Affiliation(s)
- Sara E Sabbagh
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.,Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Iago Pinal-Fernandez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Maria Casal-Dominguez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jemima Albayda
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie J Paik
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa Christopher-Stine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins Myositis Center, Division of Rheumatology, Johns Hopkins University School of Medicine, Bayview Medical Office, 5200 Eastern Ave #301, Baltimore, MD, 21224, USA.
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