1
|
Maier JA, Castiglioni S, Petrelli A, Cannatelli R, Ferretti F, Pellegrino G, Sarzi Puttini P, Fiorina P, Ardizzone S. Immune-Mediated Inflammatory Diseases and Cancer - a dangerous liaison. Front Immunol 2024; 15:1436581. [PMID: 39359726 PMCID: PMC11445042 DOI: 10.3389/fimmu.2024.1436581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/29/2024] [Indexed: 10/04/2024] Open
Abstract
Patients with Immune-Mediated Inflammatory Diseases (IMIDs) are known to have an elevated risk of developing cancer, but the exact causative factors remain subject to ongoing debate. This narrative review aims to present the available evidence concerning the intricate relationship between these two conditions. Environmental influences and genetic predisposition lead to a dysregulated immune response resulting in chronic inflammation, which is crucial in the pathogenesis of IMIDs and oncogenic processes. Mechanisms such as the inflammatory microenvironment, aberrant intercellular communication due to abnormal cytokine levels, excessive reparative responses, and pathological angiogenesis are involved. The chronic immunosuppression resulting from IMIDs treatments further adds to the complexity of the pathogenic scenario. In conclusion, this review highlights critical gaps in the current literature, suggesting potential avenues for future research. The intricate interplay between IMIDs and cancer necessitates more investigation to deepen our understanding and improve patient management.
Collapse
Affiliation(s)
- Jeanette A Maier
- Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
| | - Sara Castiglioni
- Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
| | - Alessandra Petrelli
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | | | | | | | - Piercarlo Sarzi Puttini
- Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
- IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milano, Italy
| | - Paolo Fiorina
- Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
| |
Collapse
|
2
|
Tang KY, Zhang HL, Zhang XY, Jin HZ. Clinical and laboratory features between anti-TIF1γ dermatomyositis with and without malignancy: 37 case series and a review. J Dermatol 2024. [PMID: 39258818 DOI: 10.1111/1346-8138.17426] [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: 03/12/2024] [Revised: 06/21/2024] [Accepted: 07/26/2024] [Indexed: 09/12/2024]
Abstract
We aimed to analyze the clinical profile and malignancy indicators in dermatomyositis (DM) with anti-transcriptional intermediary factor 1 antibody (anti-TIF1γ-Ab). A comparison was made between clinical information of anti-TIF1γ DM patients with and without malignancy. Additionally, a review of the literature on anti-TIF1γ DM and malignancy was conducted by searching PubMed and EMBASE databases. In our cohort of 37 patients, 27.0% (10/37) developed malignancy. The timeframe during which these 10 patients developed malignancy ranged from 21 months prior to the diagnosis of DM to 36 months following the diagnosis of DM. Specifically, one patient was diagnosed with breast cancer at the age of 36. Comparing the groups with and without malignancy, we found that age over 65 years (40% vs 7.4%, P = 0.035), a shorter duration from the onset of symptoms to the diagnosis of DM (2.5 vs 10 months, P = 0.003), and higher erythrocyte sedimentation rate (ESR) levels (23 vs 10 mm/h, P = 0.048) were found to be associated with an increased risk of malignancy. Conversely, the presence of Gottron's papules (63% vs 20%, P = 0.029) may suggest a lower likelihood of malignancy. The literature review revealed that the prevalence of myositis-associated malignancy was 40.7% (340/836), with variations ranging from 19% to 82.9% across different series. In summary, factors such as age over 65 years, a shorter duration between symptom onset and diagnosis of DM, and elevated ESR levels may indicate an increased risk of malignancy in anti-TIF1γ DM patients.
Collapse
Affiliation(s)
- Ke-Yun Tang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Han-Lin Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xin-Yi Zhang
- Department of Internal Medicine, Yale School of Medicine, Connecticut, New Haven, USA
- Department of Cellular & Molecular Physiology, Yale School of Medicine, Connecticut, New Haven, USA
| | - Hong-Zhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| |
Collapse
|
3
|
Yuan Z, Chen C, Zeng S, Wang Z, Zhong S. TIF1-γ Positive Dermatomyositis with Spontaneous Muscular Hematoma in the Context of Ovarian Cancer: A Novel Survival Case Report. J Inflamm Res 2024; 17:3915-3920. [PMID: 38911988 PMCID: PMC11193459 DOI: 10.2147/jir.s469401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024] Open
Abstract
Background Dermatomyositis (DM) represents a group of inflammatory myopathies, with TIF1-γ positive DM strongly associated with malignancies. Spontaneous muscular hematoma in DM patients is exceedingly rare and often prognosticates a severe clinical outcome, especially in the context of concurrent malignancy. Case Presentation We describe a novel survival case of a patient with TIF1-γ positive DM and an underlying ovarian tumor who developed a spontaneous muscular hematoma. Despite the traditionally poor prognosis of these conditions, the patient survived through a comprehensive treatment regimen. This included targeted chemotherapy for ovarian cancer (Carboplatin and Paclitaxel), alongside corticosteroids, immunoglobulins, and immunosuppressants for DM, as well as component blood transfusions, coagulation correction therapy to control hematoma, and integrated management: nutritional support, lung function exercise, volume management. Results The integrated treatment strategy stabilized the patient's condition and resolved the hematoma, a significant achievement given the usual high mortality rate of such complications. Conclusion This case underscores the importance of a multidisciplinary approach in the early diagnosis and treatment of TIF1-γ positive DM with complex comorbidities, including spontaneous muscular hematoma and ovarian cancer. It highlights the potential for favorable outcomes with aggressive and coordinated treatment strategies.
Collapse
Affiliation(s)
- Zhu Yuan
- Department of Intensive Care Medicine, Army Medical Center of PLA, Chongqing, People’s Republic of China
| | - Chunyan Chen
- Department of Intensive Care Medicine, Army Medical Center of PLA, Chongqing, People’s Republic of China
| | - Shuai Zeng
- Department of Laboratory Pathology, Unit 32280 of the People’s Liberation Army, Leshan City, Sichuan Province, People’s Republic of China
| | - Zhen Wang
- Department of Intensive Care Medicine, Army Medical Center of PLA, Chongqing, People’s Republic of China
| | - Shili Zhong
- Department of Intensive Care Medicine, Army Medical Center of PLA, Chongqing, People’s Republic of China
| |
Collapse
|
4
|
Connolly CM, Gupta L, Fujimoto M, Machado PM, Paik JJ. Idiopathic inflammatory myopathies: current insights and future frontiers. THE LANCET. RHEUMATOLOGY 2024; 6:e115-e127. [PMID: 38267098 DOI: 10.1016/s2665-9913(23)00322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024]
Abstract
Idiopathic inflammatory myopathies are a group of autoimmune diseases with a broad spectrum of clinical presentations, primarily characterised by immune-mediated muscle injury. Until recently, there was little insight into the pathogenesis of idiopathic inflammatory myopathies, which challenged the recognition of the breadth of heterogeneity of this group of diseases as well as the development of new therapeutics. However, the landscape of idiopathic inflammatory myopathies is evolving. In the past decade, advances in diagnostic tools have facilitated an enhanced understanding of the underlying disease mechanisms in idiopathic inflammatory myopathies, enabling the expansion of therapeutic trials. The fields of transcriptomics, prot§eomics, and machine learning offer the potential to gain greater insights into the underlying pathophysiology of idiopathic inflammatory myopathies. Harnessing insights gained from these sophisticated tools could contribute to the identification of differences at a molecular level among patients, accelerating the development of targeted, tailored therapies. Bolstered by the validation and standardisation of robust outcome measures, many promising therapies are in clinical trial development. Although challenges remain, there is great optimism in the field due to the progress in innovative diagnostics, outcome measures, and therapeutic approaches. In this Review, we discuss the expanding landscape of idiopathic inflammatory myopathies as the frontier of precision medicine becomes imminent.
Collapse
Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Pedro M Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK; Centre for Rheumatology, University College London, London, UK; National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK; Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
5
|
Allenzara A, Sadeghi N, Alvarez C, Maczuga S, Helm M, Olsen N, Nelson A, Foulke G. Obesity is an independent risk factor for cancer development following diagnosis of dermatomyositis. Semin Arthritis Rheum 2024; 64:152283. [PMID: 37984228 PMCID: PMC10842776 DOI: 10.1016/j.semarthrit.2023.152283] [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: 02/23/2023] [Revised: 09/23/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
Patients with dermatomyositis (DM) are at an increased risk of cancer development, especially around the time of diagnosis of DM. Obesity is also a risk factor in the general population for cancer development. This study aimed to assess the association between cancer in DM patients with and without obesity as defined by ICD code and BMI data. In this analysis of patients with DM, logistic regression modeling of the odds of cancer outcome was performed for patients with DM and obesity compared to those without obesity, adjusted for age and sex. A total of 12,722 patients with DM were identified, of whom 6,055 had available BMI data. DM patients who were coded obese at any point had significantly higher odds 1.98 (95 % Confidence interval (CI) 1.70, 2.30) of a subsequent cancer diagnosis. This association was also found in the subgroup analysis with available BMI where patients with obesity (BMI ≥30 kg/m2) had an increased odds of cancer 1.23 (1.02, 1.49) when compared to patients with BMI <30 kg/m2 with DM. In time to event analysis any obesity code was associated with a 16 % increased hazard of cancer (adjusted hazard ratio 1.16 [95 % CI 1.02, 1.31]). Overall, the most frequent type of cancer was breast cancer, however patients with DM and obesity had higher frequencies of lymphoma, colorectal, melanoma, uterine, renal cancers compared to patients with DM without obesity.
Collapse
Affiliation(s)
- Astia Allenzara
- University of North Carolina at Chapel Hill, Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, Chapel Hill, NC, USA.
| | - Nakisa Sadeghi
- University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Carolina Alvarez
- University of North Carolina at Chapel Hill, Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, Chapel Hill, NC, USA
| | - Steve Maczuga
- Penn State Health Milton S Hershey Medical Center, Department of Dermatology, Hershey, PA, USA
| | - Matthew Helm
- Penn State Health Milton S Hershey Medical Center, Department of Dermatology, Hershey, PA, USA
| | - Nancy Olsen
- Penn State Health Milton S Hershey Medical Center, Division of Rheumatology, Hershey, PA, USA
| | - Amanda Nelson
- University of North Carolina at Chapel Hill, Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, Chapel Hill, NC, USA; University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Galen Foulke
- Penn State Health Milton S Hershey Medical Center, Department of Dermatology, Hershey, PA, USA; Penn State Health Milton S Hershey Medical Center, Department of Public Health Sciences, Hershey, PA, USA
| |
Collapse
|
6
|
van Erp MAJM, Slaats FMA, Emmen JMA, van Hamont D. Paraneoplastic anti-TIF1-gamma-positive dermatomyositis as expression of cervical squamous cell carcinoma recurrence. BMJ Case Rep 2024; 17:e253636. [PMID: 38262717 PMCID: PMC10826498 DOI: 10.1136/bcr-2022-253636] [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: 01/25/2024] Open
Abstract
Idiopathic inflammatory myopathies are neuromuscular disorders characterised by muscle weakness and histologically inflammation within the muscle. Dermatomyositis and polymyositis are highly associated with a wide range of cancers, especially in antitranscriptional intermediary factor-1 (TIF1)-gamma-positive myositis. We present a case of paraneoplastic dermatomyositis in a patient with a medical history of a FIGO stage 1B1 cervical squamous cell carcinoma. Anti-TIF1-gamma autoantibodies were detected by myositis lineblot analysis and a PET-CT scan revealed an abnormality positioned at the right ovary. She underwent laparoscopic exploration and pathological analysis of the PET-positive abnormality showed a lymphogenic metastasis of a squamous cell carcinoma, competitive with cervical carcinoma recurrence. She started chemoradiation as curative oncological treatment. The dermatomyositis was successfully treated with high-dose corticosteroids. Physicians should be aware of the association between myositis and the increased risk of malignancies.
Collapse
Affiliation(s)
- Mirthe A J M van Erp
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Frank M A Slaats
- Department of Rheumatology, Amphia Hospital, Breda, The Netherlands
| | - Judith M A Emmen
- Result Laboratory of Clinical Chemistry and Haematology, Amphia Hospital, Breda, The Netherlands
| | - Dennis van Hamont
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| |
Collapse
|
7
|
Hounoki H, Onose T, Yamazaki M, Asano R, Yamaguchi S, Shinoda K, Tobe K, Noguchi A, Hirabayashi K. A Case Report of Anti-TIF1- γAntibody-Positive Dermatomyositis Concomitant with Small Cell Neuroendocrine Carcinoma of the Urinary Bladder. Case Rep Rheumatol 2023; 2023:8837463. [PMID: 38116495 PMCID: PMC10730251 DOI: 10.1155/2023/8837463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/15/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
Small cell neuroendocrine carcinoma is rare among urinary bladder cancer types, and to date, there are no case reports of concurrent antitranscriptional intermediary factor 1-γantibody-positive dermatomyositis. We describe the case of a 69-year-old Japanese man who presented with elevated creatine kinase levels and haematuria on medical examination. Approximately one month later, he developed dysphagia. Laryngoscopy confirmed laryngeal dysfunction. He also presented with muscle weakness and a skin rash. Magnetic resonance imaging of the upper extremities suggested bilateral brachial muscle myositis. He was diagnosed as having dermatomyositis and was later found to be positive for antitranscriptional intermediary factor 1-γ antibody. Computed tomography revealed an intravesical space-occupying lesion and right iliac lymphadenopathy, suggesting urinary bladder cancer. The patient was admitted to our hospital for treatment. Urinary bladder biopsy confirmed small cell neuroendocrine carcinoma because tumour cells were positive for synaptophysin, CD56, and chromogranin A. Thus, the patient was diagnosed as having an antitranscriptional intermediary factor 1-γantibody-positive dermatomyositis concomitant with urinary bladder small cell neuroendocrine carcinoma. The patient was treated with glucocorticoid and intravenous immune globulin therapy for dermatomyositis. Radiotherapy was selected for the carcinoma. Although muscle weakness and skin symptoms improved with treatment, dysphagia persisted. Furthermore, expression of the transcriptional intermediary factor 1-γ protein in tumour cells was also confirmed by immunohistochemistry, but the significance is unknown. It should be noted that antitranscriptional intermediary factor 1-γantibody-positive dermatomyositis can occur concomitantly with such a rare malignancy.
Collapse
Affiliation(s)
- Hiroyuki Hounoki
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Takafumi Onose
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Miho Yamazaki
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Ryoko Asano
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Satoshi Yamaguchi
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Shinoda
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Akira Noguchi
- Department of Diagnostic Pathology, University of Toyama, Toyama, Japan
| | | |
Collapse
|
8
|
Khoo T, Chinoy H. Anti-HMGCR immune-mediated necrotising myopathy: Addressing the remaining issues. Autoimmun Rev 2023; 22:103468. [PMID: 37884200 DOI: 10.1016/j.autrev.2023.103468] [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: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
The discovery of autoantibodies directed against the 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) enzyme has defined a sub-set of immune-mediated necrotising myopathy (IMNM) which is strongly associated with exposure to statin medications. Although understanding of anti-HMGCR IMNM has grown considerably with the reporting of multiple cohorts in North America, Europe, Asia and Oceania, there remain many unanswered questions. The true incidence of anti-HMGCR IMNM is not known and heterogeneity of phenotype and treatment response within this autoantibody sub-group is being increasingly recognised. Statin-naïve adults and juvenile patients with anti-HMGCR potentially share characteristics distinct from statin-exposed patients, alluding to unique pathogenesis. Conflicting data exists on whether malignancies are associated with anti-HMGCR and further clarification is required to determine the degree of cancer screening required. Treatment approaches to anti-HMGCR IMNM are heterogeneous but generally highlight the efficacy of intravenous immunoglobulin. Even with multimodal immunosuppression, patients with anti-HMGCR remain prone to relapse, with younger patients generally manifesting more refractory disease. In this Review, we aim to summarise the current literature on anti-HMGCR and discuss the remaining issues.
Collapse
Affiliation(s)
- Thomas Khoo
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, South Australia, Australia; Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, United Kingdom.
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, United Kingdom
| |
Collapse
|
9
|
Oldroyd AGS, Callen JP, Chinoy H, Chung L, Fiorentino D, Gordon P, Machado PM, McHugh N, Selva-O'Callaghan A, Schmidt J, Tansley SL, Vleugels RA, Werth VP, Aggarwal R. International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening: an International Myositis Assessment and Clinical Studies Group (IMACS) initiative. Nat Rev Rheumatol 2023; 19:805-817. [PMID: 37945774 PMCID: PMC10834225 DOI: 10.1038/s41584-023-01045-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
Adult-onset idiopathic inflammatory myopathy (IIM) is associated with an increased cancer risk within the 3 years preceding and following IIM onset. Evidence- and consensus-based recommendations for IIM-associated cancer screening can potentially improve outcomes. This International Guideline for IIM-Associated Cancer Screening provides recommendations addressing IIM-associated cancer risk stratification, cancer screening modalities and screening frequency. The international Expert Group formed a total of 18 recommendations via a modified Delphi approach using a series of online surveys. First, the recommendations enable an individual patient's IIM-associated cancer risk to be stratified into standard, moderate or high risk according to the IIM subtype, autoantibody status and clinical features. Second, the recommendations outline a 'basic' screening panel (including chest radiography and preliminary laboratory tests) and an 'enhanced' screening panel (including CT and tumour markers). Third, the recommendations advise on the timing and frequency of screening via basic and enhanced panels, according to risk status. The recommendations also advise consideration of upper or lower gastrointestinal endoscopy, nasoendoscopy and 18F-FDG PET-CT scanning in specific patient populations. These recommendations are aimed at facilitating earlier IIM-associated cancer detection, especially in those who are at a high risk, thus potentially improving outcomes, including survival.
Collapse
Affiliation(s)
- Alexander G S Oldroyd
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Jeffrey P Callen
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Department of Medicine and Dermatology, Stanford University, Stanford, CA, USA
- Palo Alto Health Care System, Palo Alto, CA, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Pedro M Machado
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
- Department of Neuromuscular Diseases, Division of Medicine, University College London, London, UK
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Neil McHugh
- Department of Life Sciences, University of Bath, Bath, UK
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Vall D'Hebron General Hospital, Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jens Schmidt
- Department of Neurology, Neuromuscular Centre, University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah L Tansley
- Department of Life Sciences, University of Bath, Bath, UK
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust Bath, Bath, UK
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Division of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Rohit Aggarwal
- Myositis Center and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| |
Collapse
|
10
|
Kilinc OC, Ugurlu S. Clinical features of dermatomyositis patients with anti-TIF1 antibodies: A case based comprehensive review. Autoimmun Rev 2023; 22:103464. [PMID: 37863375 DOI: 10.1016/j.autrev.2023.103464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Dermatomyositis is chronic autoimmune disease primarily affecting skin and muscles. Antibodies are key players of pathogenesis and are in strong correlation with distinct clinical phenotypes. We present a case and a comprehensive review of the literature on dermatomyositis patients with Anti TIF1 antibodies. METHODS PubMed and Web of Science databases were reviewed. 166 articles were identified; 95 of them were evaluated; 79 of them included to the study. 45 of the included articles were case reports 9 were case series and 25 were research articles. In total 1065 patients were identified but number of patients with available information for different clinical features varied. RESULTS 69.6% of the patients with Anti TIF1-γ were female. Prevalence of malignancy was 42.6% among patients with Anti TIF1-γ. Muscle weakness (83%), Gottron sign (82.2%), heliotrope rash (73.7%), nailfold capillary changes (67.7%), dysphagia (38.4%), and joint involvement (31.1%) were the most common clinical features seen in patients with Anti TIF1-γ. Interstitial lung disease (ILD) was reported among 8.7% of patients with Anti TIF1-γ. Advanced age, male gender, dysphagia, and V-neck rash were significant risk factors for malignancy, whereas juvenile age, ILD, TIF1-β antibodies and joint involvement were associated with a decreased risk for malignancy. Advanced age, malignancy, dysphagia, and muscle involvement were associated with an increased risk for mortality. CONCLUSIONS Patients with advanced age, male gender, dysphagia, and V-neck rash require strict cancer screening. Patients with advanced age, malignancy, dysphagia, and muscle involvement have poor prognosis and should receive aggressive treatment.
Collapse
Affiliation(s)
- Ozgur C Kilinc
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| |
Collapse
|
11
|
Khoo T, Lilleker JB, Thong BYH, Leclair V, Lamb JA, Chinoy H. Epidemiology of the idiopathic inflammatory myopathies. Nat Rev Rheumatol 2023; 19:695-712. [PMID: 37803078 DOI: 10.1038/s41584-023-01033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/08/2023]
Abstract
The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of systemic autoimmune diseases that affect the skeletal muscles and can also involve the skin, joints, lungs and heart. The epidemiology of IIM is obscured by changing classification criteria and the inherent shortcomings of case identification using healthcare record diagnostic coding. The incidence of IIM is estimated to range from 0.2 to 2 per 100,000 person-years, with prevalence from 2 to 25 per 100,000 people. Although the effects of age and gender on incidence are known, there is only sparse understanding of ethnic differences, particularly in indigenous populations. The incidence of IIM has reportedly increased in the twenty-first century, but whether this is a genuine increase is not yet known. Understanding of the genetic risk factors for different IIM subtypes has advanced considerably. Infections, medications, malignancy and geography are also commonly identified risk factors. Potentially, the COVID-19 pandemic has altered IIM incidence, although evidence of this occurrence is limited to case reports and small case series. Consideration of the current understanding of the epidemiology of IIM can highlight important areas of interest for future research into these rare diseases.
Collapse
Affiliation(s)
- Thomas Khoo
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neuroscience, Manchester Academic Health Science Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Valérie Leclair
- Department of Medicine, Division of Rheumatology, McGill University, Montreal, Canada
| | - Janine A Lamb
- Epidemiology and Public Health Group, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
| |
Collapse
|
12
|
Mecoli CA, Chee B, Chen M, Wang X, Albayda J, Paik JJ, Tiniakou E, Adler B, Kelly W, Mammen AL, Platz EA, Casciola-Rosen L, Christopher-Stine L, Shah AA. Diagnostic Yield of Computed Tomography for Cancer Detection in a Tertiary Referral Population of Idiopathic Inflammatory Myositis Patients. Arthritis Care Res (Hoboken) 2023; 75:2142-2150. [PMID: 36913182 PMCID: PMC10497706 DOI: 10.1002/acr.25114] [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: 10/11/2022] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To inform guidance for cancer detection in patients with idiopathic inflammatory myopathy (IIM), we evaluated the diagnostic yield of computed tomography (CT) imaging for cancer screening/surveillance within distinct IIM subtypes and myositis-specific autoantibody strata. METHODS We conducted a single-center, retrospective cohort study in IIM patients. Overall diagnostic yield (number of cancers diagnosed/number of tests performed), percentage of false positives (number of biopsies performed not leading to cancer diagnosis/number of tests performed), and test characteristics were determined on CT of the chest and abdomen/pelvis. RESULTS Within the first 3 years since IIM symptom onset, a total of 9 of 1,011 (0.9%) chest CT scans and 12 of 657 (1.8%) abdomen/pelvis CT scans detected cancer. Diagnostic yields for both CT of the chest and CT of the abdomen/pelvis were highest in dermatomyositis, specifically anti-transcription intermediary factor 1γ (2.9% and 2.4% for CT of the chest and abdomen/pelvis, respectively). The highest percentage of false positives was in patients with antisynthetase syndrome (ASyS) (4.4%) and immune-mediated necrotizing myopathy (4.4%) on CT of the chest, and ASyS (3.8%) on CT of the abdomen/pelvis. Patients ages <40 years old at IIM onset had both low diagnostic yields (0% and 0.5%) and high false-positive rates (1.9% and 4.4%) for CT of the chest and abdomen/pelvis, respectively. CONCLUSION In a tertiary referral cohort of IIM patients, CT imaging has a wide range of diagnostic yield and frequency of false positives for contemporaneous cancer. These findings suggest that cancer detection strategies targeted according to IIM subtype, autoantibody positivity, and age may maximize cancer detection while minimizing the harms and costs of over-screening.
Collapse
Affiliation(s)
| | - Brant Chee
- Johns Hopkins University School of Medicine, Baltimore, Maryland, and Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland
| | - Mengkun Chen
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - XingYao Wang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jemima Albayda
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie J Paik
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni Tiniakou
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brittany Adler
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Will Kelly
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew L Mammen
- Johns Hopkins University School of Medicine, Baltimore, Maryland, and the NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Elizabeth A Platz
- Johns Hopkins Bloomberg School of Public Health and Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | | | | | - Ami A Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
13
|
Connolly CM, Xu L, Mecoli CA, Adler BL, Tiniakou E, Albayda J, Christopher-Stine L, Paik JJ. Bullous periorbital oedema in anti-p155/140-positive dermatomyositis: a case series. Rheumatology (Oxford) 2023; 62:e237-e239. [PMID: 36749007 PMCID: PMC10393435 DOI: 10.1093/rheumatology/kead065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lillian Xu
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher A Mecoli
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brittany L Adler
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eleni Tiniakou
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jemima Albayda
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
14
|
Fiorentino D, Mecoli CA, Igusa T, Albayda J, Paik JJ, Tiniakou E, Adler B, Mammen AL, Shah AA, Rosen A, Christopher-Stine L, Casciola-Rosen L. Association of Anti-CCAR1 Autoantibodies With Decreased Cancer Risk Relative to the General Population in Patients With Anti-Transcriptional Intermediary Factor 1γ-Positive Dermatomyositis. Arthritis Rheumatol 2023; 75:1238-1245. [PMID: 36762496 PMCID: PMC10313743 DOI: 10.1002/art.42474] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/19/2022] [Accepted: 12/15/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To describe the disease specificity, clinical phenotype, and risk of cancer in dermatomyositis (DM) patients with autoantibodies against cell division cycle and apoptosis regulator protein 1 (anti-CCAR1). METHODS The frequency of anti-CCAR1 autoantibodies was measured by enzyme-linked immunosorbent assay in the serum of DM patients from 2 independent cohorts (Johns Hopkins and Stanford), with patients with several other rheumatic diseases and healthy controls used as comparators. Clinical features and the risk of cancer incidence relative to that in the general population were determined in anti-CCAR1-positive DM patients. RESULTS Anti-CCAR1 antibodies were significantly associated with anti-transcriptional intermediary factor 1γ (anti-TIF1γ) antibodies present in the serum of patients with DM: 80 (32%) of 252 anti-TIF1γ-positive DM patients versus 14 (8%) of 186 anti-TIF1γ-negative DM patients were positive for anti-CCAR1 antibodies (P < 0.001). Anti-CCAR1 antibodies were not detected in any of the 32 serum samples from healthy controls, and were present at very low frequencies in the sera of patients with other rheumatic diseases: 1 (2.3%) of 44 patients with anti-hydroxymethylglutaryl-coenzyme A reductase-positive necrotizing myopathy, 1 (2.3%) of 44 patients with inclusion body myositis, and 3 (6.5%) of 46 patients with systemic lupus erythematosus were positive for anti-CCAR1 antibodies. Upon examining data on occurrence of cancer from the onset of DM onward, the observed number of cancers diagnosed in anti-TIF-1γ-positive DM patients was significantly greater than expected in both cohorts, with a standardized incidence ratio (SIR) of 3.49 (95% confidence interval [95% CI] 2.39-4.92) in the Johns Hopkins cohort and a SIR of 4.54 (95% CI 3.04-6.52) in the Stanford cohort (each P < 0.001). DM patients who were both anti-TIF1γ positive and anti-CCAR1 positive had lower SIRs for cancer, with a SIR of 1.78 (95% CI 0.77-3.51) (P = 0.172) in the Johns Hopkins cohort and a SIR of 1.61 (95% CI 0.44-4.13) (P = 0.48) in the Stanford cohort. CONCLUSION Anti-CCAR1 autoantibodies are specific for anti-TIF1γ-positive DM. Their presence in anti-TIF1γ-positive patients attenuates the risk of cancer to a level comparable to that seen in the general population.
Collapse
Affiliation(s)
- David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Christopher A Mecoli
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tak Igusa
- Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Jemima Albayda
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie J Paik
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni Tiniakou
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brittany Adler
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew L Mammen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, and Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Ami A Shah
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Antony Rosen
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Christopher-Stine
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Livia Casciola-Rosen
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
15
|
Connolly CM, Paik JJ. Clinical pearls and promising therapies in myositis. Expert Rev Clin Immunol 2023; 19:797-811. [PMID: 37158055 PMCID: PMC10330909 DOI: 10.1080/1744666x.2023.2212162] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Idiopathic inflammatory myopathies (IIMs) represent a diverse group of systemic autoimmune disorders with variable clinical manifestations and disease course. Currently, the challenges of IIMs are multifold, including difficulties in timely diagnosis owing to clinical heterogeneity, limited insights into disease pathogenesis, as well as a restricted number of available therapies. However, advances utilizing myositis-specific autoantibodies have facilitated the definition of subgroups as well as the prediction of clinical phenotypes, disease course, and response to treatment. AREAS COVERED Herein we provide an overview of the clinical presentations of dermatomyositis, anti-synthetase syndrome, immune-mediated necrotizing myopathy, and inclusion body myositis. We then provide an updated review of available and promising therapies for each of these disease groups. We synthesize current treatment recommendations in the context of case-based construct to facilitate application to patient care. Finally, we provide high-yield, clinical pearls relevant to each of the subgroups that can be incorporated into clinical reasoning. EXPERT OPINION There are many exciting developments on the horizon for IIM. As insights into pathogenesis evolve, the therapeutic armamentarium is expanding with many novel therapies in development, holding promise for more targeted treatment approaches.
Collapse
Affiliation(s)
- Caoilfhionn M. Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie J. Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
16
|
Mecoli CA, Igusa T, Chen M, Wang X, Albayda J, Paik JJ, Tiniakou E, Adler B, Richardson C, Kelly W, Danoff S, Mammen AL, Platz EA, Rosen A, Christopher-Stine L, Casciola-Rosen L, Shah AA. Subsets of Idiopathic Inflammatory Myositis Enriched for Contemporaneous Cancer Relative to the General Population. Arthritis Rheumatol 2023; 75:620-629. [PMID: 35878018 PMCID: PMC9873833 DOI: 10.1002/art.42311] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/17/2022] [Accepted: 07/13/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study investigates cancer risk in idiopathic inflammatory myopathy (IIM) relative to the general population. METHODS We conducted a single-center, retrospective cohort study of IIM patients and malignancy. Myositis-specific and -associated autoantibodies were determined by Euroimmun line blot, enzyme-linked immunosorbent assay, and immunoprecipitation. We calculated standardized prevalence ratios (SPRs) and adjusted for calendar year, age, sex, race, and ethnicity by comparing observed cancers in IIM patients versus expected cancers in the general population using the Surveillance, Epidemiology, and End Results registry. RESULTS Of 1,172 IIM patients, 203 (17%) patients with a cancer history were studied. Over a median follow-up of 5.2 years, the observed number of IIM patients diagnosed with cancer was increased 1.43-fold (SPR 1.43 [95% confidence interval (95% CI) 1.15-1.77]; P = 0.002). Within 3 years of IIM symptom onset, an increased SPR was observed for anti-transcription intermediary factor 1γ (anti-TIF1γ)-positive patients for ovarian and breast cancer (ovarian SPR 18.39 [95% CI 5.01-47.08], P < 0.001; breast SPR 3.84 [95% CI 1.99-6.71], P < 0.001). As expected, anti-TIF1γ positivity was associated with a significantly elevated SPR; however, only 55% (36 of 66) of all cancers within 3 years of dermatomyositis onset were observed in anti-TIF1γ-positive patients. Other myositis-specific autoantibodies, including anti-Mi-2, anti-small ubiquitin-like modifier activating enzyme (SAE), and anti-nuclear matrix protein 2 (NXP-2), accounted for 26% (17 of 66) of cancers diagnosed within 3 years of dermatomyositis onset. No cancer association, positive or negative, was observed for patients with antisynthetase, anti-melanoma differentiation-associated protein 5 (anti-MDA-5), or anti-hydroxymethylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies. CONCLUSION In a tertiary referral center population, anti-TIF1γ was most strongly associated with breast and ovarian cancer. Patients with antisynthetase, anti-MDA-5, or anti-HMGCR antibodies had the same cancer risk as the general population.
Collapse
Affiliation(s)
- Christopher A Mecoli
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tak Igusa
- Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Mengkun Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - XingYao Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jemima Albayda
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie J Paik
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni Tiniakou
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brittany Adler
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carrie Richardson
- Feinberg School of Medicine, Northwestern University, Division of Rheumatology, Chicago, Illinois
| | - Will Kelly
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sonye Danoff
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew L Mammen
- Department of Medicine and Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, and Muscle Disease Unit, National Institute of Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Antony Rosen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Christopher-Stine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Livia Casciola-Rosen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ami A Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
17
|
Patasova K, Lundberg IE, Holmqvist M. Genetic Influences in Cancer-Associated Myositis. Arthritis Rheumatol 2023; 75:153-163. [PMID: 36053262 PMCID: PMC10107284 DOI: 10.1002/art.42345] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/28/2022] [Accepted: 08/31/2022] [Indexed: 02/02/2023]
Abstract
Idiopathic inflammatory myopathies (IIMs) comprise a heterogeneous group of rare immune-mediated disorders that primarily affect muscles but also lead to dysfunction in other organs. Five different clinical subphenotypes of IIM have been distinguished: dermatomyositis, polymyositis, inclusion body myositis, antisynthetase syndrome, and immune-mediated necrotizing myopathy. Excess mortality and morbidity associated with IIM are largely attributed to comorbidities, particularly cancer. The risk of malignancy is not equally distributed among IIM groups and is particularly high among patients with dermatomyositis. The cancer risk peaks around 3 years on either side of the IIM diagnosis and remains elevated even 10 years after the onset of the disease. Lung, colorectal, and ovarian neoplasms typically arise before the onset of IIM, whereas melanoma, cervical, oropharyngeal, and nonmelanoma skin cancers usually develop after IIM diagnosis. Given the close temporal proximity between IIM diagnosis and the emergence of malignancy, it has been proposed that IIM could be a consequence rather than a cause of cancer, a process known as a paramalignant phenomenon. Thus, a separate group of IIMs related to paramalignant phenomenon has been distinguished, known as cancer-associated myositis (CAM). Although the relationship between IIM and cancer is widely recognized, the pathophysiology of CAM remains elusive. Given that genetic factors play a role in the development of IIM, dissection of the molecular mechanisms shared between IIM and cancer presents an opportunity to examine the role of autoimmunity in cancer development and progression. In this review, the evidence supporting the contribution of genetics to CAM will be discussed.
Collapse
Affiliation(s)
- Karina Patasova
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid E Lundberg
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Holmqvist
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
18
|
Long-term risks of malignancy in myositis-specific antibody-positive idiopathic inflammatory myopathy. Rheumatol Int 2023; 43:335-343. [PMID: 36175662 DOI: 10.1007/s00296-022-05214-0] [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: 07/23/2022] [Accepted: 09/12/2022] [Indexed: 02/07/2023]
Abstract
To identify the long-term risks of malignancy in patients with myositis-specific antibody (MSA)-positive idiopathic inflammatory myopathy (IIM). This retrospective cohort study included 216 IIM patients (aged > 18 years). Of these, 109 patients were positive for antibodies against anti-aminoacyl-tRNA synthetase (ARS), melanoma differentiation-associated gene 5 (MDA5), Mi-2, and transcriptional intermediary factor 1-γ (TIF1-γ). Age- and sex-matched standardized incidence ratios (SIRs) were calculated to compare the incidence of malignancy in IIM patients to that of the general population. The malignancy-free survival rate was estimated by Kaplan-Meier methods. Our study included 109 patients, 64 with anti-ARS, 28 with anti-MDA5, 9 with anti-Mi-2, and 8 with anti-TIF1-γ antibodies; 16 and 5 patients were diagnosed with a malignancy within 3 years before or after and within 4 to 10 years after their IIM onset, respectively. The SIRs of malignancy within 3 years of IIM onset for each MSA were calculated as follows: 2.12 (95% confidence interval [CI] 0.98-4.35) for anti-ARS, 1.87 (95% CI 0.48-4.97) for anti-MDA5, 2.11 (95% CI 0.11-13.69) for anti-Mi-2, and 9.30 (95% CI 2.98-25.58) for anti-TIF1-γ antibodies. The SIR at 4 to 10 years after IIM onset in patients with an anti-MDA5 antibody was 4.62 (95% CI 1.19-14.72); other MSAs did not have statistically significant SIRs. The long-term SIR of malignancy in patients with an anti-MDA5 antibody was 4.62 (95% CI 1.19-14.72), and the SIR among patients with an anti-TIF1-γ antibody within 3 years of IIM onset was 9.30 (95% CI 2.98-25.58). Screening for malignancies in patients with late phase of IIM and an anti-MDA5 antibody may be beneficial.
Collapse
|
19
|
Zhao Y, Su H, Yin X, Hou H, Wang Y, Xu Y, Li X, Zhang N, Sun W, Wei W. Cancer associated autoantibodies in idiopathic inflammatory myopathies: A retrospective cohort from a single center in China. Med Clin (Barc) 2023; 160:10-16. [PMID: 35842306 DOI: 10.1016/j.medcli.2022.03.023] [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: 02/12/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Idiopathic inflammatory myopathies (IIMs) are systemic, heterogeneous diseases, which mainly affect skeletal muscle. Myositis with cancer is often referred to as cancer-associated myositis (CAM), which is associated with poor prognosis. This study aimed to determine the cancer associated myositis-specific autoantibodies (MSAs) and to elucidate their associations with clinical features in Chinese patients with IIMs. METHODS This retrospective study enrolled 312 patients with IIMs who were treated at Tianjin Medical University General Hospital, China, from January 2015 to December 2020. Clinical data were collected. Serum MSAs, including anti-Mi-2, anti-TIF1-γ, anti-NXP2, anti-SAE, anti-MDA5, anti-SRP, anti-Jo-1, anti-PL-7, anti-PL-12, anti-OJ, anti-EJ and anti-HMGCR antibodies were detected. Cancer-associated MSAs, their phenotypic and survival features were estimated through SPSS 20.0. RESULTS The results revealed that anti-TIF1-γ antibody and anti-SAE antibody were cancer-associated autoantibodies with odds ratios (95% CI) of 8.70 (3.35-22.64) and 22.31 (4.32-115.05), respectively. Skin lesions, proximal weakness, dysphagia and dysarthria were observed more frequently in patients carrying anti-TIF1-γ antibody. By contrast, patients with anti-TIF1-γ antibody had a lower frequencies of fever, arthritis/arthralgia and interstitial lung disease (ILD). Anti-TIF1-γ antibody positive CAM comprised about half of CAM entities and had the characteristic of close temporal association with cancer detection/recurrence. Female-dominant, common reproductive system tumors were other clinical features of this subset. Besides, patients with anti-TIF1-γ antibody positive had significantly lower survival rates than the anti-TIF1-γ antibody negative group. CONCLUSIONS Anti-TIF1-γ antibody and anti-SAE antibody were cancer-associated autoantibodies. Anti-TIF1-γ antibody positive CAM was a subset that comprised about half of CAM entities and had the characteristic of poor prognosis.
Collapse
Affiliation(s)
- Yin Zhao
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Haiyuan Su
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Xiaoyang Yin
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Hou Hou
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Ying'ai Wang
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Yong Xu
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Xin Li
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Nang Zhang
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Wenwen Sun
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China
| | - Wei Wei
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300020, China.
| |
Collapse
|
20
|
Geng Z, Ye C, Zhu X. Malignancies in systemic rheumatic diseases: A mini review. Front Immunol 2023; 14:1095526. [PMID: 36926334 PMCID: PMC10011115 DOI: 10.3389/fimmu.2023.1095526] [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: 11/24/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
There is an increased risk of malignancies in patients with many systemic rheumatic diseases, which negatively impact on their quality of life. The risk and types of malignancies can differ by the type of rheumatic diseases. Possible mechanisms linking them are dynamic and complicated, including chronic inflammation and damage in rheumatic disease, inability to clear oncogenic infections, shared etiology and some anti-rheumatic therapies. Although certain disease-modifying anti-rheumatic drugs (DMARDs) have been proved to be potentially carcinogenic, the majority of them were not associated with increased risk of most malignancies in patients with systemic rheumatic diseases.
Collapse
Affiliation(s)
- Zhe Geng
- Department of Hematology, Central Hospital of Wuhan, Wuhan, China
| | - Cong Ye
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojian Zhu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
21
|
Fiorentino DF, Casciola-Rosen L. Autoantibodies and Cancer Association: the Case of Systemic Sclerosis and Dermatomyositis. Clin Rev Allergy Immunol 2022; 63:330-341. [PMID: 35593962 PMCID: PMC10666558 DOI: 10.1007/s12016-022-08944-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
Several rheumatic diseases have a perplexing association with cancer. Unraveling this mysterious connection is likely to provide deeper understanding regarding mechanisms governing the onset of both autoimmunity and cancer immunity, in addition to providing clinicians much needed guidance around whom and when to screen for occult malignancy. Systemic sclerosis (scleroderma) and dermatomyositis are two diseases in which the association with internal malignancy is well-described and can be considered as models from which to gain important insights that likely have broader applicability. The past 15 years have witnessed a striking acceleration in understanding how these two diseases are related to cancer emergence-an important crack in this inscrutable armor has been the discovery and characterization of disease-specific autoantigens that are closely tied with risk of cancer emergence. The best-described examples of this are antibodies against anti-RNA polymerase III (anti-POL3) and transcription intermediary factor 1-gamma (anti-TIF1γ). Patients with systemic sclerosis and cancer that are diagnosed within a short time interval of each other frequently have anti-POL3 antibodies. Antibodies against the minor spliceosome protein RNA-Binding Region Containing 3 (RNPC3) are also associated with increased cancer incidence in systemic sclerosis. Similarly, in the dermatomyositis spectrum, the majority of anti-TIF1γ-associated cancers are detected around the time of DM onset (most often within 1 year). Antibodies against Nuclear Matrix Protein 2 are also potentially associated with increased cancer emergence in dermatomyositis. The systemic sclerosis/anti-POL3 connection with close cancer onset led to the first experiments directly supporting the concept that rheumatic disease may in fact be a manifestation of cancer. It is now clear that studying these diseases through the lens of autoantibodies can reveal relationships and insights that would otherwise remain obscured. Extending these studies, new findings show that antibodies against RNA polymerase I large subunit are associated with protection against short interval cancers in anti-POL3-positive systemic sclerosis patients. These insights highlight the fact that autoantigen discovery related to cancer emergence remains an important priority; such new tools will enable the testing of specific hypotheses regarding mechanisms governing disease emergence and development of effective anti-tumor responses. Autoantibody phenotype will likely play an important role in the development of cancer screening guidelines that are critically needed by clinicians taking care of these patients. In this review, we will summarize the current state of knowledge regarding the different ways in which autoantibodies are connected with systemic sclerosis/dermatomyositis and malignancy and highlight potential paths forward.
Collapse
Affiliation(s)
- David F Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Livia Casciola-Rosen
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
22
|
Marzęcka M, Niemczyk A, Rudnicka L. Autoantibody Markers of Increased Risk of Malignancy in Patients with Dermatomyositis. Clin Rev Allergy Immunol 2022; 63:289-296. [PMID: 35147864 PMCID: PMC9464248 DOI: 10.1007/s12016-022-08922-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 01/13/2023]
Abstract
Dermatomyositis is a chronic inflammatory disease involving the skin and muscles. It most commonly occurs in adults with preponderance in females, but pediatric occurrence is also possible. The risk of malignancy in adult patients with dermatomyositis was reported to be 4.66-fold higher compared to that in the general population. A significantly increased risk of malignancy was reported within the first 12 months following the diagnosis of dermatomyositis (standardized incidence ratio equaled 17). One of the characteristic laboratory findings associated with dermatomyositis is the presence of circulating autoantibodies which are classified into two subgroups: myositis-specific and myositis-associated autoantibodies. It was shown that specific types of antibodies might be associated with an increased risk of malignancy. Current literature data indicate that the strongest correlation with malignant diseases was reported in anti-TIF1-γ-positive patients who were at a 9.37-fold higher risk of cancer. A 3.68-fold increase in the risk of cancer was also reported among patients with anti-NXP2 antibodies. Malignant diseases were reported in 14-57% of patients with anti-SAE antibodies. The presence of other autoantibodies may also be associated with an increased risk of malignancy. These data indicate that patients with circulating anti-TIF1-γ, anti-NXP2, and anti-SAE should be very closely monitored for dermatomyositis-associated malignant comorbidities. The aim of this review is to summarize the current data regarding the link between malignancy and the presence of specific antibodies in patients with dermatomyositis.
Collapse
Affiliation(s)
- Milena Marzęcka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Niemczyk
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
| |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW This review summarizes and comments on current knowledge in dermatomyositis. RECENT FINDINGS The 2018 European Neuromuscular Centre classification of dermatomyositis has been challenging by the discovery of clinicopathological features associated with dermatomyositis-specific antibody (DMSA) that were not incorporated in the original criteria. These features include but may not be limited to the presence of perifascicular necrosis in anti-Mi-2 dermatomyositis; presence of diffuse nonperifascicular sarcoplasmic myxovirus resistance protein A expression in anti-MDA5 dermatomyositis; and dermatomyositis sine dermatitis in anti-NXP-2 dermatomyositis. Variations and subclassifications within the same DMSA subtypes are observed: anti-MDA5 dermatomyositis is clinically subcategorized into good, intermediate, and poor prognostic subgroups; concurrent anti-CCAR1 and anti-TIF1-γ positivity identify anti-TIF1-γ-positive patient with a lower risk for cancer-associated myositis. Owing to distinct IFN1-signaling pathway activation in dermatomyositis, JAK-STAT inhibitor - the pathway-targeted therapy, have been studied with promising results in refractory dermatomyositis and some new-onset dermatomyositis. In addition, the potential serum biomarkers for IFN1 pathway activation are being investigated for their performance in monitoring the disease activity and the efficacy of the treatment. SUMMARY DMSA, evidence of prominent IFN1 pathway activation, and risk/severity-associated biomarkers would likely play major roles in future dermatomyositis classification, disease monitoring, and treatment decision.
Collapse
Affiliation(s)
- Jantima Tanboon
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Neuromuscular Research, National Institute of Neuroscience (NIN), National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience (NIN), National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
- Department of Genome Medicine Development
- Department of Clinical Genome Analysis, Medical Genome Center (MGC), National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| |
Collapse
|
24
|
Kardes S, Gupta L, Aggarwal R. Cancer and myositis: Who, when, and how to screen. Best Pract Res Clin Rheumatol 2022; 36:101771. [PMID: 35970749 DOI: 10.1016/j.berh.2022.101771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cancer screening in idiopathic inflammatory myopathies (IIMs) is essential because an increased risk of cancer in IIMs has been well demonstrated. However, a consensus regarding cancer screening approaches is lacking. Therefore, the approach presented in this review reflects available evidence and our clinical experiences. Patients with IIMs should be evaluated for 3 distinct types of risk categories: (a) clinical with their history, physical examination, and laboratory parameters; (b) based on IIMs subtypes; and (c) based on serology - myositis specific and associated autoantibodies. Further, according to these characteristics, patients should be classified as low risk, moderate risk, and high risk for cancer. In our approach, all patients with IIM within 3 years of disease onset should undertake cancer screening according to their risk stratification. First, irrespective of risk, all patients should undergo age and gender-appropriate screening as per local guidelines. Patients at low-risk stratification should undertake basic cancer screening with routine blood counts, labs, and imaging; at moderate-risk stratification, patients should undertake enhanced cancer screening including CT chest; and at high-risk stratification, patients should undertake comprehensive cancer screening including PET/CT at baseline. Consensus guidelines among all major stakeholders, including rheumatologists, neurologists, dermatologists, and oncologists representing different parts of the world, establishing uniform cancer screening approaches in patients with IIM, are the need of the hour.
Collapse
Affiliation(s)
- Sinan Kardes
- Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Turkey.
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK.
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| |
Collapse
|
25
|
Development of dermatomyositis after anti-transcriptional intermediary factor 1-γ antibody seroconversion during treatment for small cell lung cancer. BMC Pulm Med 2022; 22:191. [PMID: 35549684 PMCID: PMC9097056 DOI: 10.1186/s12890-022-01974-4] [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: 11/17/2021] [Accepted: 04/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Inflammatory myositis, such as dermatomyositis, is sometimes complicated by cancer and is recognized as cancer-associated myositis. Although some autoimmune antibodies are considered to be involved in the development of myositis in cancer patients, the precise mechanism has not been clarified. The findings of the present case shed light on the mechanism by which anti-transcriptional intermediary factor 1 (TIF1)-γ Ab was produced and the pathogenesis of cancer-associated myositis. Case presentation We describe a case of dermatomyositis that developed in a 67-year-old man who had been diagnosed with small cell lung cancer of clinical T4N3M0 stage IIIB/limited disease during treatment. He received systemic chemotherapy and radiation therapy, and dermatomyositis developed along with a significant decrease in tumor size. TIF1-γ Ab, which is one of the myositis-specific antibodies, was found to be seroconverted. In addition, immunohistochemical analysis showed that cancer cells were positive for the TIF1-γ antigen. Conclusion The findings of the present case suggest that transcriptional intermediary factor 1-γ, which is released from tumor cells, induces the production of TIF1-γ Ab, leading to the development of dermatomyositis. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01974-4.
Collapse
|
26
|
Zhang L, Yang H, Yang H, Liu H, Tian X, Jiang W, Peng Q, Wang G, Lu X. Serum levels of anti-transcriptional intermediary factor 1-γ autoantibody associated with the clinical, pathological characteristics and outcomes of patients with dermatomyositis. Semin Arthritis Rheum 2022; 55:152011. [PMID: 35489170 DOI: 10.1016/j.semarthrit.2022.152011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the association of the serum levels of anti-transcriptional intermediary factor 1 (TIF1)-γ autoantibodies with the clinical and pathological characteristics, as well as the prognosis of adult patients with dermatomyositis (DM). METHODS Eighty-seven adult DM patients with anti-TIF1-γ autoantibodies positive screened by immunoblotting assay were enrolled in the study. The presence and levels of anti-TIF1-γ autoantibodies were examined through enzyme-linked immunosorbent assay (ELISA). Muscle biopsy specimens were obtained from 52 patients, and immunohistochemistry was performed to visualize major histocompatibility complex (MHC)-I, CD3, CD20 and C5b-9. Muscle biopsy scores and disease activity were evaluated. RESULTS A total of 80 patients were positive for anti-TIF1-γ autoantibodies confirmed by ELISA assay, including 30 cancer-associated myositis (CAM) and 50 non-CAM. Serum levels of anti-TIF1-γ autoantibodies did not significantly differ between the CAM and non-CAM groups. The levels of anti-TIF1-γ were associated with disease activity scores. A total of 63.9% of non-CAM patients displayed a classical DM pathological phenotype. Conversely, CAM patients presented with classical DM (25%), immune-mediated necrotizing myopathy (25%), non-specific myositis (32.3%), and normal (18%) phenotypes of muscle biopsy. Anti-TIF1-γ autoantibody levels were positively associated with muscle biopsy total scores, muscle fiber scores and inflammatory infiltration scores in the non-CAM patients but not in the CAM patients. The survival rate of CAM patients presenting with high anti-TIF1-γ autoantibody levels was lower than that of patients with low levels. However, no difference in survival rate was observed in the non-CAM group between high and low autoantibody levels. CONCLUSION The distinct associations of anti-TIF1-γ autoantibody levels with disease activity, muscle histopathology damage and outcome indicated that different pathogenesis might be involved in DM with or without cancer.
Collapse
Affiliation(s)
- Lining Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, 100029 Beijing, China; Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Hanbo Yang
- Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Hongxia Yang
- Peking University China-Japan Friendship School of Clinical Medicine, 100029 Beijing, China; Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Hongyan Liu
- Department of Pathology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Xiaolan Tian
- Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Wei Jiang
- Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Qinglin Peng
- Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China
| | - Xin Lu
- Peking University China-Japan Friendship School of Clinical Medicine, 100029 Beijing, China; Department of Rheumatology, China-Japan Friendship Hospital, 100029 Beijing, China.
| |
Collapse
|
27
|
Clinical significance of anti-transcriptional intermediary factor 1-γ antibody in patients with dermatomyositis: a monocentric cross-sectional study. Clin Rheumatol 2022; 41:2439-2448. [DOI: 10.1007/s10067-022-06170-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/22/2022] [Accepted: 04/04/2022] [Indexed: 12/16/2022]
|
28
|
Suga T, Oiwa H, Ishida M, Iwamoto Y. Clinical value of cancer-associated myositis-specific antibodies, anti-transcriptional intermediary factor 1-γ, and anti-nuclear matrix protein 2 antibodies in a retrospective cohort of dermatomyositis/polymyositis in a Japanese community hospital. Clin Rheumatol 2022; 41:2803-2808. [DOI: 10.1007/s10067-022-06166-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/18/2022] [Accepted: 04/03/2022] [Indexed: 11/03/2022]
|
29
|
Marasandra Ramesh H, Gude SS, Venugopal S, Peddi NC, Gude SS, Vuppalapati S. The Role of Myositis-Specific Autoantibodies in the Dermatomyositis Spectrum. Cureus 2022; 14:e22978. [PMID: 35415038 PMCID: PMC8990210 DOI: 10.7759/cureus.22978] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 12/23/2022] Open
Abstract
Dermatomyositis (DM) is a systemic autoimmune disease that affects skeletal muscles, the skin, and the lungs. It is characterized by autoantibodies, tissue inflammation, parenchymal cell damage, death, and vasculopathy. In terms of epidemiology, DM affects both children and adults. The current pathophysiology of DM is described as an autoimmune attack on the afflicted organs driven by environmental variables such as UV exposure, medications, infections, and lifestyle choices in genetically predisposed people. DM is also a paraneoplastic condition, which means that cancer may arise before, along with, or following the development of the symptoms of DM. Myositis-specific autoantibodies are associated with phenotypical features and are used for sub-classification of dermatomyositis patients. Because the risk of interstitial lung disease (ILD), internal malignancy, destructive disease trajectory, and maybe a response to medication differs by DM myositis-specific antibody (MSA) group, a better knowledge of MSAs and the validation and standardization of tests employed for detection is crucial for improving diagnosis and treatment. The diagnostic sensitivity and specificity of tests for various MSAs are not ideal, just like with any other test. However, more antibody tests are anticipated to make their way into formal schemata for diagnosis and actionable risk assessment in DM due to worldwide standardization and more extensive research. In this review, we outline crucial aspects for interpreting clinical and pathologic relationships with MSA in DM and critical knowledge and practice gaps that will optimize the clinical benefit and utility of MSAs as diagnostic and prognostic markers.
Collapse
Affiliation(s)
| | | | - Shravya Venugopal
- Internal Medicine, Kasturba Medical College, Mangalore, Mangalore, IND
| | | | | | - Sravya Vuppalapati
- Paediatrics, PES Institute of Medical Sciences and Research, Kuppam, IND
| |
Collapse
|
30
|
Zhao L, Xie S, Zhou B, Shen C, Li L, Pi W, Gong Z, Zhao J, Peng Q, Zhou J, Peng J, Zhou Y, Zou L, Song L, Zhu H, Luo H. Machine Learning Algorithms Identify Clinical Subtypes and Cancer in Anti-TIF1γ+ Myositis: A Longitudinal Study of 87 Patients. Front Immunol 2022; 13:802499. [PMID: 35237262 PMCID: PMC8883045 DOI: 10.3389/fimmu.2022.802499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/20/2022] [Indexed: 01/09/2023] Open
Abstract
BackgroundAnti-TIF1γ antibodies are a class of myositis-specific antibodies (MSAs) and are closely associated with adult cancer-associated myositis (CAM). The heterogeneity in anti-TIF1γ+ myositis is poorly explored, and whether anti-TIF1γ+ patients will develop cancer or not is unknown at their first diagnosis. Here, we aimed to explore the subtypes of anti-TIF1γ+ myositis and construct machine learning classifiers to predict cancer in anti-TIF1γ+ patients based on clinical features.MethodsA cohort of 87 anti-TIF1γ+ patients were enrolled and followed up in Xiangya Hospital from June 2017 to June 2021. Sankey diagrams indicating temporal relationships between anti-TIF1γ+ myositis and cancer were plotted. Elastic net and random forest were used to select and rank the most important variables. Multidimensional scaling (MDS) plot and hierarchical cluster analysis were performed to identify subtypes of anti-TIF1γ+ myositis. The clinical characteristics were compared among subtypes of anti-TIF1γ+ patients. Machine learning classifiers were constructed to predict cancer in anti-TIF1γ+ myositis, the accuracy of which was evaluated by receiver operating characteristic (ROC) curves.ResultsForty-seven (54.0%) anti-TIF1γ+ patients had cancer, 78.7% of which were diagnosed within 0.5 years of the myositis diagnosis. Fourteen variables contributing most to distinguishing cancer and non-cancer were selected and used for the calculation of the similarities (proximities) of samples and the construction of machine learning classifiers. The top 10 were disease duration, percentage of lymphocytes (L%), percentage of neutrophils (N%), neutrophil-to-lymphocyte ratio (NLR), sex, C-reactive protein (CRP), shawl sign, arthritis/arthralgia, V-neck sign, and anti-PM-Scl75 antibodies. Anti-TIF1γ+ myositis patients can be clearly separated into three clinical subtypes, which correspond to patients with low, intermediate, and high cancer risk, respectively. Machine learning classifiers [random forest, support vector machines (SVM), extreme gradient boosting (XGBoost), elastic net, and decision tree] had good predictions for cancer in anti-TIF1γ+ myositis patients. In particular, the prediction accuracy of random forest was >90%, and decision tree highlighted disease duration, NLR, and CRP as critical clinical parameters for recognizing cancer patients.ConclusionAnti-TIF1γ+ myositis can be separated into three distinct subtypes with low, intermediate, and high risk of cancer. Machine learning classifiers constructed with clinical characteristics have favorable performance in predicting cancer in anti-TIF1γ+ myositis, which can help physicians in choosing appropriate cancer screening programs.
Collapse
Affiliation(s)
- Lijuan Zhao
- Department of Rheumatology, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
- Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital of Central South University, Changsha, China
| | - Shuoshan Xie
- Department of Nephrology, Hunan Provincial People’s Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Bin Zhou
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chuyu Shen
- Department of Rheumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liya Li
- Department of Rheumatology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Weiwei Pi
- Department of Oncology, The First People’s Hospital of Changde City, Changde, China
| | - Zhen Gong
- Department of Rheumatology, Yiyang Central Hospital, Yiyang, China
| | - Jing Zhao
- Department of Rheumatology, The First Affiliated Hospital of Jishou University, Jishou, China
| | - Qi Peng
- Department of Rheumatology, Yueyang People’s Hospital, Yueyang, China
| | - Junyu Zhou
- Department of Rheumatology, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
- Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital of Central South University, Changsha, China
| | - Jiaqi Peng
- Huaihua No.1 People’s Hospital Affiliated to Nanhua University, Huaihua, China
| | - Yan Zhou
- Department of Obstetrics and Gynecology, Zhuzhou Central Hospital, Zhuzhou, China
| | - Lingxiao Zou
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Liang Song
- Huaihua No.1 People’s Hospital Affiliated to Nanhua University, Huaihua, China
| | - Honglin Zhu
- Department of Rheumatology, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
- Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Honglin Zhu, ; Hui Luo,
| | - Hui Luo
- Department of Rheumatology, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
- Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Honglin Zhu, ; Hui Luo,
| |
Collapse
|
31
|
Mulhearn B, Li D, McMorrow F, Lu H, McHugh NJ, Tansley SL. A Commercial Anti-TIF1γ ELISA Is Superior to Line and Dot Blot and Should Be Considered as Part of Routine Myositis-Specific Antibody Testing. Front Immunol 2022; 13:804037. [PMID: 35154119 PMCID: PMC8831764 DOI: 10.3389/fimmu.2022.804037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives Anti-TIF1γ is an important autoantibody in the diagnosis of cancer-associated dermatomyositis and the most common autoantibody in juvenile onset dermatomyositis. Its reliable detection is important to instigate further investigations into underlying malignancy in adults. We previously showed that commercial assays using line and dot blots do not reliably detect anti-TIF1γ. We aimed to test a new commercial ELISA and compare with previously obtained protein immunoprecipitation. Methods Radio-labelled immunoprecipitation had previously been used to determine the autoantibody status of patients with immune-mediated inflammatory myopathies and several healthy controls. ELISA was undertaken on healthy control and anti-TIF1γ sera and compared to previous immunoprecipitation data. Results A total of 110 serum samples were analysed: 42 myositis patients with anti- TIF1γ and 68 autoantibody negative healthy control sera. Anti-TIF1γ was detected by ELISA in 41 out of 42 of the anti-TIF1γ-positive samples by immunoprecipitation, and in none of the healthy controls, giving a sensitivity of 97.6% and specificity of 100%. The false negative rate was 2%. Conclusion ELISA is an affordable and time-efficient method which is accurate in detecting anti-TIF1γ.
Collapse
Affiliation(s)
- Ben Mulhearn
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, United Kingdom
- *Correspondence: Ben Mulhearn,
| | - Danyang Li
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Fionnuala McMorrow
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Hui Lu
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Neil J. McHugh
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Sarah L. Tansley
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, United Kingdom
| |
Collapse
|
32
|
Turnier JL, Kahlenberg JM. Using autoantibody signatures to define cancer risk in dermatomyositis. J Clin Invest 2022; 132:e156025. [PMID: 35040442 PMCID: PMC8759773 DOI: 10.1172/jci156025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dermatomyositis is an idiopathic inflammatory myopathy with a highly heterogeneous disease course. Although there is a known increase in cancer risk surrounding the time of dermatomyositis diagnosis, the mechanisms driving this increased risk are not well understood. Further, there are no current standardized cancer screening guidelines for dermatomyositis patients. In this issue of the JCI, Fiorentino, Mecoli, et al. discovered additional autoantibodies in patients with dermatomyositis and anti-TIF1-γ autoantibodies, a known risk factor for malignancy. They observed a decreased cancer risk with an increasing number of autoantibodies. Importantly, these findings indicate that more detailed autoantibody phenotyping at diagnosis might better predict cancer risk and also suggest that diversity and kinetics of the host immune response might influence cancer development.
Collapse
Affiliation(s)
| | - J. Michelle Kahlenberg
- Department of Internal Medicine, Division of Rheumatology
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
33
|
Fiorentino DF, Mecoli CA, Rosen MC, Chung LS, Christopher-Stine L, Rosen A, Casciola-Rosen L. Immune responses to CCAR1 and other dermatomyositis autoantigens are associated with attenuated cancer emergence. J Clin Invest 2022; 132:150201. [PMID: 35040440 PMCID: PMC8759791 DOI: 10.1172/jci150201] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The temporal clustering of a cancer diagnosis with dermatomyositis (DM) onset is strikingly associated with autoantibodies against transcriptional intermediary factor 1-γ (TIF1-γ). Nevertheless, many patients with anti–TIF1-γ antibodies never develop cancer. We investigated whether additional autoantibodies are found in anti–TIF1-γ–positive patients without cancer. METHODS Using a proteomic approach, we defined 10 previously undescribed autoantibody specificities in 5 index anti–TIF1-γ–positive DM patients without cancer. These were subsequently examined in discovery (n = 110) and validation (n = 142) cohorts of DM patients with anti–TIF1-γ autoantibodies. RESULTS We identified 10 potentially novel autoantibodies in anti–TIF1-γ–positive DM patients, 6 with frequencies ranging from 3% to 32% in 2 independent DM cohorts. Autoantibodies recognizing cell division cycle and apoptosis regulator protein 1 (CCAR1) were the most frequent, and were significantly negatively associated with contemporaneous cancer (discovery cohort OR 0.27 [95% CI 0.7–1.00], P = 0.050; validation cohort OR 0.13 [95% CI 0.03–0.59], P = 0.008). When cancer did emerge, it occurred significantly later in anti-CCAR1–positive compared with anti-CCAR1–negative patients (median time from DM onset 4.3 vs. 0.85 years, respectively; P = 0.006). Cancers that emerged were more likely to be localized (89% of anti-CCAR1–positive cancers presenting at stage 0 or 1 compared with 42% of patients without anti-CCAR1 antibodies, P = 0.02). As the number of additional autoantibody specificities increased in anti–TIF1-γ–positive DM patients, the frequency of cancer decreased (P < 0.001). CONCLUSION As the diversity of immune responses in anti–TIF1-γ DM patients increases, the likelihood of cancer emerging decreases. Our findings have important relevance for cancer risk stratification in DM patients and for understanding natural immune regulation of cancer in humans. TRIAL REGISTRATION Not applicable. FUNDING SOURCES The NIH, the Donald B. and Dorothy L. Stabler Foundation, and the Huayi and Siuling Zhang Discovery Fund.
Collapse
Affiliation(s)
- David F Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Christopher A Mecoli
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew C Rosen
- Department of Neurobiology, The University of Chicago, Chicago, Illinois, USA
| | - Lorinda S Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Antony Rosen
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Livia Casciola-Rosen
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
34
|
Asano R, Shinoda K, Tsuda R, Hounoki H, Kawataka M, Makino T, Imura J, Hamaguchi Y, Tobe K. Anti-TIF1γ antibody-positive dermatomyositis in a 15-year-old boy with Epstein-Barr virus-related nasopharyngeal cancer receiving nivolumab. Rheumatology (Oxford) 2021; 60:e197-e199. [PMID: 33367923 DOI: 10.1093/rheumatology/keaa832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryoko Asano
- First Department of Internal Medicine, Toyama, Japan
| | | | - Reina Tsuda
- First Department of Internal Medicine, Toyama, Japan
| | | | | | | | - Johji Imura
- Department of Diagnostic Pathology, University of Toyama, Toyama, Japan
| | - Yasuhito Hamaguchi
- Department of Dermatology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, Toyama, Japan
| |
Collapse
|
35
|
Al Awqati MZ, Sluzevich JC, Berianu F. Ulcerative Paraneoplastic Dermatomyositis in the Setting of Positive Transcriptional Intermediary Factor 1-γ Antibody. J Rheumatol 2021; 48:1340. [PMID: 34329179 DOI: 10.3899/jrheum.200399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
36
|
Tomaras S, Kekow J, Feist E. Idiopathische inflammatorische Myopathien: Aktuelles zu Diagnose und Klassifikation. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1383-5737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungAuf dem Sektor der Kollagenosen ist der wissenschaftliche Fortschritt bei der Myositis in den letzten 15–20 Jahren bemerkenswert. Durch kontinuierliche Forschung und intensive Vernetzung der Myositis-Experten ist es gelungen, neue Untergruppen zu identifizieren und somit für die Prognose wichtige Organmanifestationen rechtzeitig zu erkennen. Vor dem Hintergrund dieser Neuerungen verfolgt diese Übersichtsarbeit sowohl das Ziel, möglichst alle Facetten der Erkrankung zu präsentieren, als auch die moderne Einteilung der idiopathischen inflammatorischen Myopathien zu erläutern. Außerdem werden die neuen Klassifikationskriterien vorgestellt, die die Kriterien von Bohan und Peter aus dem Jahr 1975 abgelöst haben. Im Artikel werden ihre Stärken und Schwächen sowie ihr Optimierungspotenzial diskutiert.
Collapse
Affiliation(s)
- Stylianos Tomaras
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
| | - Jörn Kekow
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
| | - Eugen Feist
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
| |
Collapse
|
37
|
Preusse C, Eede P, Heinzeling L, Freitag K, Koll R, Froehlich W, Schneider U, Allenbach Y, Benveniste O, Schänzer A, Goebel HH, Stenzel W, Radke J. NanoString technology distinguishes anti-TIF-1γ + from anti-Mi-2 + dermatomyositis patients. Brain Pathol 2021; 31:e12957. [PMID: 34043263 PMCID: PMC8412076 DOI: 10.1111/bpa.12957] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/19/2022] Open
Abstract
Dermatomyositis (DM) is a systemic idiopathic inflammatory disease affecting skeletal muscle and skin, clinically characterized by symmetrical proximal muscle weakness and typical skin lesions. Recently, myositis-specific autoantibodies (MSA) became of utmost importance because they strongly correlate with distinct clinical manifestations and prognosis. Antibodies against transcription intermediary factor 1γ (TIF-1γ) are frequently associated with increased risk of malignancy, a specific cutaneous phenotype and limited response to therapy in adult DM patients. Anti-Mi-2 autoantibodies, in contrast, are typically associated with classic DM rashes, prominent skeletal muscle weakness, better therapeutic response and prognosis, and less frequently with cancer. Nevertheless, the sensitivity of autoantibody testing is only moderate, and alternative reliable methods for DM patient stratification and prediction of cancer risk are needed. To further investigate these clinically distinct DM subgroups, we herein analyzed 30 DM patients (n = 15 Mi-2+ and n = 15 TIF-1 γ+ ) and n = 8 non-disease controls (NDC). We demonstrate that the NanoString technology can be used as a very sensitive method to clearly differentiate these two clinically distinct DM subgroups. Using the nCounter PanCancer Immune Profiling Panel™, we identified a set of significantly dysregulated genes in anti-TIF-1γ+ patient muscle biopsies including VEGFA, DDX58, IFNB1, CCL5, IL12RB2, and CD84. Investigation of type I IFN-regulated transcripts revealed a striking type I interferon signature in anti-Mi-2+ patient biopsies. Our results help to stratify both subgroups and predict, which DM patients require an intensified diagnostic procedure and might have a poorer outcome. Potentially, this could also have implications for the therapeutic approach.
Collapse
Affiliation(s)
- Corinna Preusse
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology with Institute for Translational Neurology, Münster University Hospital (UKM), Münster, Germany
| | - Pascale Eede
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Lucie Heinzeling
- Department of Dermatology, University Hospital of Erlangen, Erlangen, Germany.,Department of Dermatology, LMU, Munich, Germany
| | - Kiara Freitag
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Berlin, Germany
| | - Randi Koll
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany
| | - Waltraud Froehlich
- Department of Dermatology, University Hospital of Erlangen, Erlangen, Germany
| | - Udo Schneider
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Anne Schänzer
- Department of Neuropathology, Justus Liebig Universität Giessen, Giessen, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Josefine Radke
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| |
Collapse
|
38
|
Analysis of human total antibody repertoires in TIF1γ autoantibody positive dermatomyositis. Commun Biol 2021; 4:419. [PMID: 33772100 PMCID: PMC7997983 DOI: 10.1038/s42003-021-01932-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 02/03/2021] [Indexed: 12/17/2022] Open
Abstract
We investigate the accumulated microbial and autoantigen antibody repertoire in adult-onset dermatomyositis patients sero-positive for TIF1γ (TRIM33) autoantibodies. We use an untargeted high-throughput approach which combines immunoglobulin disease-specific epitope-enrichment and identification of microbial and human antigens. We observe antibodies recognizing a wider repertoire of microbial antigens in dermatomyositis. Antibodies recognizing viruses and Poxviridae family species are significantly enriched. The identified autoantibodies recognise a large portion of the human proteome, including interferon regulated proteins; these proteins cluster in specific biological processes. In addition to TRIM33, we identify autoantibodies against eleven further TRIM proteins, including TRIM21. Some of these TRIM proteins share epitope homology with specific viral species including poxviruses. Our data suggest antibody accumulation in dermatomyositis against an expanded diversity of microbial and human proteins and evidence of non-random targeting of specific signalling pathways. Our findings indicate that molecular mimicry and epitope spreading events may play a role in dermatomyositis pathogenesis. Megremis, Walker at al. identify immunogenic epitopes in dermatomyositis patients. They identify antibodies recognizing a wider diversity of microbial antigens including poxviruses, and autoantibodies recognizing a large portion of the human proteome. Shared epitope homology between viral and human proteins suggests that molecular mimicry and epitope spreading events may play a role in dermatomyositis pathogenesis.
Collapse
|
39
|
Hodgkinson LM, Wu TT, Fiorentino DF. Dermatomyositis autoantibodies: how can we maximize utility? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:433. [PMID: 33842654 PMCID: PMC8033377 DOI: 10.21037/atm-20-5175] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The past 15 years has seen significant advances in the characterization of myositis-specific autoantibodies (MSAs) and their associated phenotypes in patients with dermatomyositis (DM). As more careful studies are performed, it is clear that unique combinations of clinical and pathological phenotypes are associated with each MSA, despite the fact that there is considerable heterogeneity within antibody classes as well as overlap across the groups. Because risk for interstitial lung disease (ILD), internal malignancy, adverse disease trajectory, and, potentially response to therapy differ by DM MSA group, a deeper understanding of MSAs and validation and standardization of assays used for detection are critical for optimizing diagnosis and treatment. Like any test, the diagnostic sensitivity and specificity of assays for various MSAs is not perfect. Currently tests for MSAs are helpful at minimum for a clinician to assess relative risk or contribute to diagnosis and perhaps counsel the appropriate patient about what to expect. With international standardization and larger studies it is likely that more antibody tests will make their way into formal schemata for diagnosis and actionable risk assessment in DM. In this review, we summarize key considerations for interpreting the clinical and pathologic associations with MSA in DM and identify critical gaps in knowledge and practice that will maximize their clinical utility and utility for understanding disease pathogenesis.
Collapse
Affiliation(s)
| | - Tiffany Tingshuen Wu
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | | |
Collapse
|
40
|
Khanna U, Galimberti F, Li Y, Fernandez AP. Dermatomyositis and malignancy: should all patients with dermatomyositis undergo malignancy screening? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:432. [PMID: 33842653 PMCID: PMC8033297 DOI: 10.21037/atm-20-5215] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Dermatomyositis is an autoimmune disease that occurs in association with underlying malignancy in a subset of patients. Given this association, diagnosis of dermatomyositis typically triggers malignancy screening. Although various malignancy screening protocols have been proposed, none have been extensively studied or taken into account prevalence of dermatomyositis-associated malignancies. We utilized peer-reviewed manuscripts identified by a Medline search from May 2000 to April 2020 to present a focused review concerning the association between dermatomyositis and malignancy, and controversies related to screening for malignancies most commonly occurring in dermatomyositis patients. This information was then synthesized to propose a rational strategy for approaching malignancy screening in dermatomyositis patients. Our review supports that risk of malignancy in dermatomyositis patients is well-established. However, the subset of dermatomyositis patients in whom the benefits of malignancy screening outweigh the risks of harm is unknown. Additionally, an evidence-based malignancy screening protocol for dermatomyositis patients that optimizes the risk:benefit ratio does not exist. Given the clear harms that can result, we propose that shared decision-making strategies be implemented to determine whether pursuit of malignancy screening conforms with dermatomyositis patients’ desires and values. Physicians should be clear about potential risks and benefits of malignancy screening, and discuss clinical and serologic features present that may suggest/refute underlying malignancy during conversations aimed at shared decision-making. Research is greatly needed to determine which dermatomyositis patients warrant malignancy screening, which tests should be performed, and the intensity with which they should be ordered. Only after such work is done can malignancy screening in dermatomyositis patients be considered to have high value.
Collapse
Affiliation(s)
- Urmi Khanna
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fabrizio Galimberti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yumeng Li
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anthony P Fernandez
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
41
|
Lambert-Eaton Myasthenic Syndrome and Dermatomyositis With Anti-TIF1-gamma Autoantibody: A Unique Association of Autoimmune Neuromuscular Conditions Without Malignancy. J Clin Neuromuscul Dis 2021; 22:164-168. [PMID: 33596001 DOI: 10.1097/cnd.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Lambert-Eaton myasthenic syndrome (LEMS) is a presynaptic neuromuscular junction disorder, and dermatomyositis (DM) is an idiopathic inflammatory myopathy. LEMS and DM are uncommon conditions that can present similarly and are often associated with autoantibodies. Concomitant LEMS and DM have only been reported a few times, and most of those cases were paraneoplastic. We present the first reported case of a patient with antivoltage gated calcium channel antibody positive LEMS who subsequently developed DM with antitranscription intermediary factor 1-gamma (anti-TIF1-γ) antibodies. Interestingly, both conditions occurred without evidence of malignancy. This diagnosis of LEMS and DM with characteristic clinical, electrodiagnostic, and histopathological evidence led to a beneficial modification of the patient's therapeutic regimen. Due to the fact that overlapping concurrent neuromuscular conditions are rare, a high clinical suspicion is needed to identify, evaluate (including appropriate cancer screenings), and appropriately treat these patients.
Collapse
|
42
|
Li Y, Jia X, Sun X, Shi L, Lin F, Gan Y, Zhang X, Gao X, Miao M, Hong D, Li Y, He J. Risk factors for cancer-associated myositis: A large-scale multicenter cohort study. Int J Rheum Dis 2020; 24:268-273. [PMID: 33369084 DOI: 10.1111/1756-185x.14046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to identify the risk factors and prognosis of patients with cancer-associated myositis (CAM). METHOD Four hundred and eighty-seven patients with dermatomyositis (DM), clinical amyopathic dermatomyositis (CADM) and polymyositis (PM) from 3 clinical centers were enrolled retrospectively in this study. Clinical and laboratory data of CAM and non-CAM patients were compared. Logistic regression analysis was used to identify risk factors of CAM. RESULTS Out of the 487 patients with DM/CADM/PM, 7.0% (34/487) of patients were classified as CAM. Older age (53.91 ± 13.32 vs. 48.76 ± 14.34 years), heliotrope rash (61.8% vs. 41.9%), shawl sign (41.2% vs. 22.1%), V sign (58.8% vs. 38.6%) were observed significantly more commonly in patients with CAM than those without CAM (all P < .05). Fever (17.7% vs. 37.8%), arthralgia/arthritis (23.5% vs. 45.7%), interstitial lung disease (ILD, 38.2% vs 68.9%) were significantly less common in the CAM group than the non-CAM group. Age at onset (odds ratio [OR] 1.036, 95% CI 1.001-1.072, P = .042), shawl sign (OR 2.748, 95% CI 1.107-6.822, P = .029), anti-transition initiation factor (TIF)-1γ antibody (OR 4.012, 95% CI 1.268-12.687, P = .018) were identified as the initial risk factors for the onset of CAM, and ILD was identified as a protective factor for CAM (OR 0.292, 95% CI 0.115-0.739, P = .009). All-cause mortality was significantly higher in CAM patients compared with non-CAM patients (P = .001). CONCLUSION The mortality of patients with CAM was higher than DM/CADM/PM patients without cancer. Malignancy should be screened in DM/CADM/PM patients especially with risk factors, including older age, shawl sign, anti-TIF-1γ antibody, and lack of ILD.
Collapse
Affiliation(s)
- Yimin Li
- Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, China
| | - Xiaohui Jia
- Department of Rheumatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaolin Sun
- Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, China
| | - Lianjie Shi
- Department of Rheumatology, Peking University International Hospital, Beijing, China
| | - Fuan Lin
- Department of Rheumatology, People's Hospital of Jianyang City, Jianyang, China
| | - Yuzhou Gan
- Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, China
| | - Xuewu Zhang
- Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, China
| | - Xiaojuan Gao
- Department of Rheumatology, Ningde Hospital, Affiliated Hospital of Fujian Medical University, Ningde, China
| | - Miao Miao
- Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuhui Li
- Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, China
| | - Jing He
- Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, China
| |
Collapse
|
43
|
Dani L, Ian Che W, Lundberg IE, Hellgren K, Holmqvist M. Overall and site-specific cancer before and after diagnosis of idiopathic inflammatory myopathies: A nationwide study 2002-2016. Semin Arthritis Rheum 2020; 51:331-337. [PMID: 33508731 DOI: 10.1016/j.semarthrit.2020.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the association between idiopathic inflammatory myopathy (IIM) and cancer before and after IIM diagnosis. METHODS We used prospectively collected nationwide register data to design a case-control study to investigate the occurrence of cancer before IIM, and a cohort study to investigate the occurrence of cancer after IIM. Patients diagnosed with IIM between 2002 and 2016 in Sweden, were compared to the general population. The association between cancer and IIM was estimated before and after IIM diagnosis via logistic regression and Cox regression models, respectively. RESULTS We included 1419 patients with IIM and 7045 individuals from the general population. The overall odds of cancer before IIM diagnosis were increased in IIM compared to the general population, adjusted odds ratio (AOR) 1.5, 95% confidence interval (CI) 1.3-1.8. This association was also noted after IIM diagnosis, adjusted hazard ratio (AHR) 1.7 (95% CI 1.4-2.0), or one additional cancer in every 125 IIM patients per year. Colorectal (AOR 2.1), lung (AOR 5.4) and ovarian (AOR 7.0) cancers were associated with IIM before diagnosis. Oropharyngeal (AHR 9.1) and cervical (AHR 3.8) cancers, malignant melanoma (AHR 3.2) and non-melanoma skin cancer (AHR 3.1) were associated with IIM after diagnosis. Adenocarcinomas were associated with dermatomyositis before diagnosis and squamous cell cancers after IIM diagnosis. Lymphatic hematopoietic cancers were associated with IIM both before and after diagnosis. CONCLUSIONS The cancer types that occur before IIM diagnosis differ from the ones that occur after diagnosis. This may have an impact on screening decisions for IIM.
Collapse
Affiliation(s)
- Lara Dani
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Weng Ian Che
- Clinical Epidemiology Division, Departement of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid E Lundberg
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Hellgren
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Clinical Epidemiology Division, Departement of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Marie Holmqvist
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Clinical Epidemiology Division, Departement of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
44
|
McCann LJ, Hedrich CM. Is it time to re-think juvenile-onset Rheumatic and Musculoskeletal Diseases? - First steps towards individualised treatments to meet agreed targets. Clin Immunol 2020; 223:108647. [PMID: 33310069 DOI: 10.1016/j.clim.2020.108647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Liza J McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK; Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Christian M Hedrich
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK; Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK.
| |
Collapse
|
45
|
Chen H, Yang H, Cheng QX, Ge YP, Peng QL, Zhang YM, Cheng GH, Wang GC, Lu X. A novel autoantibody targeting calreticulin is associated with cancer in patients with idiopathic inflammatory myopathies. Clin Transl Immunology 2020; 9:e1195. [PMID: 33082955 PMCID: PMC7558046 DOI: 10.1002/cti2.1195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/15/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022] Open
Abstract
Objectives To investigate the prevalence and clinical significance of anti‐calreticulin autoantibodies (anti‐CRT Ab) in a large cohort of idiopathic inflammatory myopathy (IIM) patients. Methods Sera from 469 patients with IIM, 196 patients with other connective tissue diseases, 28 patients with solid tumors and 81 healthy controls were screened for anti‐CRT Ab by enzyme‐linked immunosorbent assay using human recombinant CRT protein. Sera from 35 IIM patients were tested using an immunoprecipitation assay to confirm the presence of anti‐CRT Ab. Subsequently, IIM–cancer patients were identified and divided into new‐onset, remission and recurrent groups based on their cancer status. The relationships between anti‐CRT Ab levels and IIM disease activity were also investigated. Results Serum anti‐CRT Ab was detected positive in 81 of the 469 (17.3%) IIM patients. Immunoprecipitated bands were observed at a molecular weight of 60 kDa corresponding to the CRT protein. The IIM patients with anti‐CRT Ab more frequently had cancers compared to the patients without anti‐CRT Ab. Moreover, the prevalence of anti‐CRT Ab differed according to the cancer status. The IIM patients with recurrent cancers had a much higher prevalence of anti‐CRT Ab than those with cancers in remission. Also, serum anti‐CRT Ab levels positively correlated with disease activity at baseline and at follow‐up visits. Conclusion We report the existence of serum anti‐CRT Ab in IIM patients and demonstrate the possible association of anti‐CRT Ab with malignancy in IIM patients. Serum anti‐CRT Ab could serve as a novel candidate marker of cancer in IIM patients.
Collapse
Affiliation(s)
- He Chen
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| | - Heng Yang
- Center for Systems Medicine Institute of Basic Medical Sciences Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100005 China.,Suzhou Institute of Systems Medicine Suzhou Jiangsu 215123 China
| | - Qiu-Xiang Cheng
- Center for Systems Medicine Institute of Basic Medical Sciences Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100005 China.,Suzhou Institute of Systems Medicine Suzhou Jiangsu 215123 China
| | - Yong-Peng Ge
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| | - Qing-Lin Peng
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| | - Ya-Mei Zhang
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| | - Gen-Hong Cheng
- Department of Microbiology, Immunology and Molecular Genetics University of California Los Angeles CA 90095 USA
| | - Guo-Chun Wang
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| | - Xin Lu
- Department of Rheumatology China-Japan Friendship Hospital Beijing 100029 China
| |
Collapse
|
46
|
Monitoring disease activity and damage in adult and juvenile idiopathic inflammatory myopathy. Curr Opin Rheumatol 2020; 32:553-561. [PMID: 32890032 DOI: 10.1097/bor.0000000000000749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW We have reviewed the literature to identify significant advances related to disease activity and damage in the idiopathic inflammatory myopathies (IIMs) from January 2019 to July 2020. RECENT FINDINGS New observations in the field from 2019 to 2020 have resulted in a better understanding of the clinical association and pathogenic origins of IIM. The use of patient-reported outcome measures and perspectives, identifying biomarkers and making better use of autoantibody testing are summarized. Basic sciences have led to an improved understanding of the role of NETosis in calcinosis, and of interferon type 1, in IIM. Preliminary insights are offered into Covid-19 in the setting of IIM, and the use of potential tools for monitoring disease remotely, which may assume larger importance for optimal disease management during a global pandemic. The wider exploration of newer imaging modalities and the use of nailfold capillaroscopy is a further step in better management of the condition. SUMMARY The summarized research in IIM is a step forward in being able to further define, and to distinguish disease activity from damage, in order to potentially aid future clinical diagnosis and management in this challenging disease.
Collapse
|
47
|
Abstract
PURPOSE OF REVIEW To provide an overview of recent discoveries related to myositis-specific autoantibodies (MSAs) and assays used for their measurement. RECENT FINDINGS New autoantibody specificities have been reported including a MSA directed against eukaryotic initiation factor 3 and a myositis-associated autoantibody directed against heat shock factor 1. The association of anti-TIF1γ with cancer-associated dermatomyositis dependent on age has been confirmed in several large cohorts. Despite MSAs being almost entirely mutually exclusive, several myositis autoantigens are overexpressed in regenerating muscle and do not correlate with the corresponding MSA in any one patient. Further mechanisms may determine the final MSA specificity and are likely to include the need for autoantigen processing and presentation with adaptive T-cell help. The presence of CD4-positive T cells specific for histidyl tRNA synthetase protein in bronchial lavage fluid from antisynthetase patients lends support to this view. Finally, it is widely held that MSA do play an important role in clinical practice among some evidence and concern about commercial assay reliability. SUMMARY MSAs continue to provide important tools for clinical diagnosis and management as well as insights into disease mechanisms. Further improvement in the standardization and reliability of routine detection of MSAs is a high priority.
Collapse
|
48
|
Merry E, Smrke A, Halai K, Patel G, Thway K, Jones RL, Benson C. Paraneoplastic dermatomyositis associated with metastatic leiomyosarcoma of unknown primary. Clin Sarcoma Res 2020; 10:15. [PMID: 32864095 PMCID: PMC7448307 DOI: 10.1186/s13569-020-00140-w] [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: 07/17/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Sarcomas are rare and heterogeneous tumours of mesenchymal origin, with over 100 histological subtypes. Paraneoplastic dermatomyositis has rarely been described in sarcoma. This is the first documented case of paraneoplastic dermatomyositis in a patient with metastatic leiomyosarcoma. Case presentation A 43-year-old female diagnosed with metastatic leiomyosarcoma of unknown primary presented with a mild rash in sun-exposed areas of her face and upper chest, with no other neuromuscular symptoms. This rash resolved with systemic treatment with doxorubicin for metastatic leiomyosarcoma. Imaging assessment confirmed overall stable disease after chemotherapy completion. She presented acutely 2 months later with new onset rash in a shawl-like distribution, periorbital oedema and proximal muscle weakness. Based on the characteristic cutaneous signs and symmetrical proximal muscle weakness, abnormal electromyography and raised skeletal muscle enzymes with a positive anti-transcription intermediary factor-1 gamma antibody result, a diagnosis of paraneoplastic dermatomyositis was made. Re-evaluation of her metastatic leiomyosarcoma revealed disease progression. Second-line chemotherapy was commenced once the dermatomyositis was controlled on steroid therapy. Systemic anti-cancer therapy was again associated with mild improvement in dermatomyositis symptoms. Discussion Paraneoplastic dermatomyositis heralded disease progression after first-line chemotherapy; however, in hindsight, subtle cutaneous features were present at sarcoma diagnosis. The temporal relationship between paraneoplastic dermatomyositis and metastatic leiomyosarcoma is key in this case, as fluctuations in dermatomyositis severity correlated with growth of metastatic disease. Understanding this relationship may provide clues for tumour progression and prompt timely initiation of anti-cancer therapy. It is important to recognise that in addition to the more common cancers associated with paraneoplastic dermatomyositis, it can also occur in rarer tumours such as leiomyosarcoma.
Collapse
Affiliation(s)
- Eve Merry
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ UK
| | - Alannah Smrke
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ UK
| | - Kapil Halai
- Rheumatology Department, Ashford and St Peter's NHS Hospitals NHS Foundation Trust, London, TW15 3AA UK
| | - Gulam Patel
- Rheumatology Department, Ashford and St Peter's NHS Hospitals NHS Foundation Trust, London, TW15 3AA UK
| | - Khin Thway
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ UK
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ UK.,The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB UK
| | - Charlotte Benson
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ UK
| |
Collapse
|
49
|
Shao C, Li S, Sun Y, Zhang Y, Xu K, Zhang X, Huang H. Clinical characteristics and prognostic analysis of Chinese dermatomyositis patients with malignancies. Medicine (Baltimore) 2020; 99:e21899. [PMID: 32846853 PMCID: PMC7447382 DOI: 10.1097/md.0000000000021899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Although a strong association between idiopathic inflammatory myositis (IIM) and malignancy has been widely reported, few studies have solely focused on the concurrence of dermatomyositis (DM) and malignancies (DM-malignancy).We conducted a retrospective analysis of 37 DM-malignancy cases among 363 DM patients admitted to our hospital between January 2012 and December 2017.(1) The mean age at DM diagnosis was higher for DM-malignancy patients than for DM-non-malignancy patients [(54.76 ± 9.77) years vs (48.57 ± 12.82) years, t = 2.84, P = .005]. (2) Gynecological malignancies (35.90%/14 cases) were the most common malignancies. Malignancies were diagnosed before DM for 7 DM-malignancy patients. The interval between the DM and malignancy diagnoses for the remaining 32 DM-malignancy patients was less than 6 months for 18 patients (46.15%), less than 1 years for 23 patients (58.9%), and less than 2 years for 29 patients (74.26%). (3) There was no significant difference either in antinuclear antibody or anti-Ro-52 positivity between the 2 groups (P > .05). (4) Multivariate analysis demonstrated that DM onset age ≥50 years and concurrence with ILD increased the risk of death for DM patients [hazard ratio (HR): 1.62 and 2.72; 95% confidence interval (CI): (1.08-2.43) and (1.47-5.02); P = .02 and 0.001, respectively], and male gender decreased the risk of death [HR 0.66, 95% CI (0.44-0.98), P = .04]. DM-malignancy patients were older than DM-non-malignancy patients. Gynecological malignancies were the most common malignancies among these patients. A DM onset age ≥50 years, female sex and the presence of ILD were independent risk factors for death.
Collapse
Affiliation(s)
- Chi Shao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
| | - Shan Li
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
| | - Yuxin Sun
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
| | - Ying Zhang
- International Medical Service Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
| | - Kai Xu
- Radiological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
| | - Xin Zhang
- Medical Records Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, China
| | - Hui Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
| |
Collapse
|
50
|
Bekele DI, Patnaik MM. Autoimmunity, Clonal Hematopoiesis, and Myeloid Neoplasms. Rheum Dis Clin North Am 2020; 46:429-444. [DOI: 10.1016/j.rdc.2020.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|