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Ghanbar MI, Danoff SK. Review of Pulmonary Manifestations in Antisynthetase Syndrome. Semin Respir Crit Care Med 2024; 45:365-385. [PMID: 38710221 DOI: 10.1055/s-0044-1785536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Antisynthetase syndrome (ASyS) is now a widely recognized entity within the spectrum of idiopathic inflammatory myopathies. Initially described in patients with a triad of myositis, arthritis, and interstitial lung disease (ILD), its presentation can be diverse. Additional common symptoms experienced by patients with ASyS include Raynaud's phenomenon, mechanic's hand, and fever. Although there is a significant overlap with polymyositis and dermatomyositis, the key distinction lies in the presence of antisynthetase antibodies (ASAs). Up to 10 ASAs have been identified to correlate with a presentation of ASyS, each having manifestations that may slightly differ from others. Despite the proposal of three classification criteria to aid diagnosis, the heterogeneous nature of patient presentations poses challenges. ILD confers a significant burden in patients with ASyS, sometimes manifesting in isolation. Notably, ILD is also often the initial presentation of ASyS, requiring pulmonologists to remain vigilant for an accurate diagnosis. This article will comprehensively review the various aspects of ASyS, including disease presentation, diagnosis, management, and clinical course, with a primary focus on its pulmonary manifestations.
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Affiliation(s)
- Mohammad I Ghanbar
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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Yoshida A, Gono T, Okazaki Y, Shirai Y, Takeno M, Kuwana M. Severe digital ischemia as an unrecognized manifestation in patients with antisynthetase autoantibodies: Case series and systematic literature review. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:204-216. [PMID: 36211206 PMCID: PMC9537703 DOI: 10.1177/23971983221090857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/11/2022] [Indexed: 10/03/2023]
Abstract
Objective Severe digital ischemia, including digital ulcers and gangrene, is considered rare in patients with antisynthetase antibodies. This study aimed to elucidate the clinical features of antisynthetase-positive patients complicated with digital ulcers and/or gangrene using a systematic literature review and case series in a single-center cohort. Methods A systematic literature review was conducted to identify reports describing antisynthetase-positive cases with digital ulcers and/or gangrene. Our cohort of consecutive patients with antisynthetase antibodies was stratified by the history of severe digital ischemia. Demographic and clinical features and outcomes in patients with severe digital ischemia identified in the systematic literature review and our cohort were compared with those in patients without severe digital ischemia in our cohort. Results The systematic literature review revealed 12 antisynthetase-positive patients with severe digital ischemia from one case series and eight case reports. Seven (7%) of 100 patients with antisynthetase antibodies in our cohort had a record of severe digital ischemia. Severe digital ischemia was often found at presentation and was associated with the classification of systemic sclerosis with or without myositis overlap. Clinical features associated with severe digital ischemia in antisynthetase-positive patients included Raynaud's phenomenon (p < 0.001), digital pitting scars (p = 0.001), and nailfold capillary abnormality (p = 0.02). Outcomes of severe digital ischemia were generally favorable with vasodilators. Conclusion Severe digital ischemia is an overlooked complication in antisynthetase-positive patients. Antisynthetase antibodies should be measured in patients presenting with digital ulcers or gangrene, especially in those with systemic sclerosis phenotype and features associated with antisynthetase antibodies in the absence of systemic sclerosis-specific autoantibodies.
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Affiliation(s)
- Akira Yoshida
- Department of Allergy and Rheumatology,
Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takahisa Gono
- Department of Allergy and Rheumatology,
Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Scleroderma/Myositis Center of
Excellence, Nippon Medical School Hospital, Tokyo, Japan
| | - Yuka Okazaki
- Department of Allergy and Rheumatology,
Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuichiro Shirai
- Department of Allergy and Rheumatology,
Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Scleroderma/Myositis Center of
Excellence, Nippon Medical School Hospital, Tokyo, Japan
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology,
Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Department of Allergy and Rheumatology,
Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology,
Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Scleroderma/Myositis Center of
Excellence, Nippon Medical School Hospital, Tokyo, Japan
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Hanaoka H, Kaneko Y, Suzuki S, Takada T, Hirakata M, Takeuchi T, Kuwana M. A unique case of polymyositis with anti-signal recognition particle antibody complicated by subacute interstitial lung disease and subluxing arthropathy, resembling anti-synthetase syndrome. Mod Rheumatol 2016; 26:979-980. [PMID: 26707188 DOI: 10.3109/14397595.2015.1129693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Yuko Kaneko
- a Division of Rheumatology, Department of Internal Medicine
| | - Shigeaki Suzuki
- b Department of Neurology , Keio University School of Medicine , Tokyo , Japan , and
| | - Tetsuya Takada
- a Division of Rheumatology, Department of Internal Medicine
| | | | | | - Masataka Kuwana
- a Division of Rheumatology, Department of Internal Medicine.,c Department of Allergy and Rheumatology , Nippon Medical School Graduate School of Medicine , Tokyo , Japan
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Cavagna L, Nuño L, Scirè CA, Govoni M, Longo FJL, Franceschini F, Neri R, Castañeda S, Giraldo WAS, Caporali R, Iannone F, Fusaro E, Paolazzi G, Pellerito R, Schwarting A, Saketkoo LA, Ortego-Centeno N, Quartuccio L, Bartoloni E, Specker C, Murcia TP, La Corte R, Furini F, Foschi V, Corral JB, Airò P, Cavazzana I, Martínez-Barrio J, Hinojosa M, Giannini M, Barsotti S, Menke J, Triantafyllias K, Vitetta R, Russo A, Bajocchi G, Bravi E, Barausse G, Bortolotti R, Selmi C, Parisi S, Montecucco C, González-Gay MA. Clinical Spectrum Time Course in Anti Jo-1 Positive Antisynthetase Syndrome: Results From an International Retrospective Multicenter Study. Medicine (Baltimore) 2015; 94:e1144. [PMID: 26266346 PMCID: PMC4616698 DOI: 10.1097/md.0000000000001144] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Anti Jo-1 antibodies are the main markers of the antisynthetase syndrome (ASSD), an autoimmune disease clinically characterized by the occurrence of arthritis, myositis, and interstitial lung disease (ILD). These manifestations usually co-occur (for practical purpose complete forms) in the same patient, but cases with only 1 or 2 of these findings (for practical purpose incomplete forms) have been described. In incomplete forms, the ex novo occurrence of further manifestations is possible, although with frequencies and timing not still defined. The aim of this international, multicenter, retrospective study was to characterize the clinical time course of anti Jo-1 positive ASSD in a large cohort of patients. Included patients should be anti Jo-1 positive and with at least 1 feature between arthritis, myositis, and ILD. We evaluated the differences between complete and incomplete forms, timing of clinical picture appearance and analyzed factors predicting the appearance of further manifestations in incomplete ASSD. Finally, we collected 225 patients (58 males and 167 females) with a median follow-up of 80 months. At the onset, complete ASSD were 44 and incomplete 181. Patients with incomplete ASSD had frequently only 1 of the classic triad findings (110 cases), in particular, isolated arthritis in 54 cases, isolated myositis in 28 cases, and isolated ILD in 28 cases. At the end of follow-up, complete ASSD were 113, incomplete 112. Only 5 patients had an isolated arthritis, only 5 an isolated myositis, and 15 an isolated ILD. During the follow-up, 108 patients with incomplete forms developed further manifestations. Single main feature onset was the main risk factor for the ex novo appearance of further manifestation. ILD was the prevalent ex novo manifestation (74 cases). In conclusion, ASSD is a condition that should be carefully considered in all patients presenting with arthritis, myositis, and ILD, even when isolated. The ex novo appearance of further manifestations in patients with incomplete forms is common, thus indicating the need for an adequate clinical and instrumental follow-up. Furthermore, the study clearly suggested that in ASSD multidisciplinary approach involving Rheumatology, Neurology, Pneumology, and Internal Medicine specialists is mandatory.
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Affiliation(s)
- Lorenzo Cavagna
- From the Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foudation, Pavia, Italy (LC, RC, CM); Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain (LN); Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy (CAS); UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara, Ferrara, Italy (M Govoni, RLC, F Furini, VF); Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain (FJLL, JM-B, MH); Rheumatology Unit, University and AO Spedali Civili, Brescia, Italy (F Franceschini, PA, IC); Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (RN, SB); Department of Rheumatology, Hospital Universitario de la Princesa, IIS Princesa, Madrid, Spain (SC); Department of Rheumatology, University Hospital Ramón y Cajal, Madrid, Spain (WASG, JBC); Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, University of Bari, Bari, Italy (FI, M Giannini); Department of Rheumatology, Città Della Salute e della Scienza, Torino, Italy (EF, SP); Rheumatology Unit, Santa Chiara Hospital, Trento, Italy (GP, G Barausse, RB); Division of Rheumatology, Mauriziano Hospital, Turin, Italy (RP, RV, AR); Department of Internal Medicine, Rheumatology and Clinical Immunology, University Hospital Johannes-Gutenberg, Mainz, Germany (AS, JM); Tulane University Lung Center Tulane/UMC Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA (LAS); Systemic Autoimmune Diseases Unit, Hospital Clínico San Cecilio, Granada, Spain (NO-C); Clinic of Rheumatology, Department of Medical and Biological Sciences (DSMB), Santa Maria della Misericordia Hospital, Udine, Italy (LQ); Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy (E Bartoloni); Department for Rheumatology and Clinical Immunology, St. Josef Krankenhaus, University Clinic, Essen, Germany (C Specker); Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain (TPM, MAG-G); ACURA Rheumatology Center, Bad Kreuznach, Germany (KT); Rheumatology Unit, Department of Internal Medicine, S. Maria Hospital-IRCCS, Reggio Emilia, Italy (G Bajocchi); Rheumatology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy (E Bravi); and Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milano, Italy (C Selmi)
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