1
|
Wang Y, Li Q, Lv X, Liu D, Huang J, An Q, Zhang J, Ju B, Hu N, Mo L, Feng X, Pu D, Hao Z, Luo J, He L. Peripheral Th17/Treg imbalance in Chinese patients with untreated antisynthetase syndrome associated interstitial lung disease. Int Immunopharmacol 2024; 138:112403. [PMID: 38936056 DOI: 10.1016/j.intimp.2024.112403] [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: 11/02/2023] [Revised: 05/15/2024] [Accepted: 06/02/2024] [Indexed: 06/29/2024]
Abstract
Interstitial lung disease (ILD) is a common and fatal manifestation of antisynthetase syndrome (ASS). The aim of this study was to provide new insight into investigate peripheral blood lymphocytes, CD4+ T cells, cytokine levels and their relation to the clinical profile of untreated patients with ASS-ILD. The retrospective study population included thirty patients diagnosed with ASS-ILD and 30 healthy controls (HCs). Baseline clinical and laboratory data were collected for all subjects, including peripheral blood lymphocyte, CD4+ T cell subsets measured by flow cytometry, and serum cytokine levels measured by multiple microsphere flow immunofluorescence. Their correlations with clinical and laboratory findings were analyzed by Pearson's or Spearman's correlation analysis. In addition, the Benjamini-Hochberg method was used for multiple correction to adjust the p-values. Patients with ASS-ILD had lower CD8+ T cells, higher proportion of Th17 cells and Th17/Treg ratio than HCs. Serum cytokine levels (IL-1β, IL-6, IL-12, IL-17, IL-8, IL-2, IL-4, IL-10, TNF-α and IFN-γ) were higher in patients with ASS-ILD than HCs. Moreover, Th17/Treg ratio was negatively correlated with diffusing capacity of carbon monoxide (DLCO)%. Our study demonstrated abnormalities of immune disturbances in patients with ASS-ILD, characterized by decreased CD8+ T cells and an increased Th17/Treg ratio, due to an increase in the Th17 cells. These abnormalities may be the immunological mechanism underlying the development of ILD in ASS.
Collapse
Affiliation(s)
- Yanhua Wang
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Qian Li
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Xiaohong Lv
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Di Liu
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Jing Huang
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Qi An
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Jing Zhang
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Bomiao Ju
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Nan Hu
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Lingfei Mo
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Xiuyuan Feng
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Dan Pu
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Zhiming Hao
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China
| | - Jing Luo
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China.
| | - Lan He
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China.
| |
Collapse
|
2
|
Benjelloun H, Haouassia FE, Chaanoune K, Zaghba N, Yassine N. Diffuse Interstitial Lung Disease Revealing Antisynthetase Syndrome. Cureus 2024; 16:e57513. [PMID: 38707080 PMCID: PMC11067390 DOI: 10.7759/cureus.57513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Interstitial lung disease (ILD) is a frequent manifestation of connective tissue diseases. They may be revelatory of the disease or occur during follow-up. Antisynthetase syndrome (ASS) is a complex and heterogeneous autoimmune disorder. Antisynthetase antibodies, in particular the anti-Jo-1 antibody, characterize this syndrome. The occurrence and severity of ILD determine the prognosis, which in turn determines therapeutic management. We report the case of a 53-year-old female patient presenting with ILD, revealing the diagnosis of ASS. The evolution was favorable with bolus corticosteroids associated with cyclophosphamide.
Collapse
Affiliation(s)
| | | | | | - Nahid Zaghba
- Pulmonary Medicine, Ibn Rochd University Hospital, Casablanca, MAR
| | - Najiba Yassine
- Pulmonology, Ibn Rochd University Hospital, Casablanca, MAR
| |
Collapse
|
3
|
The prognostic role of C-reactive protein to albumin ratio and anti-MDA5 antibody-positive in idiopathic inflammatory myopathy: a retrospective study. Sci Rep 2023; 13:3863. [PMID: 36890164 PMCID: PMC9992913 DOI: 10.1038/s41598-023-30595-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
This cohort study aimed to identify the characteristics and risk factors of adult idiopathic inflammatory myopathy-associated interstitial lung disease (IIM-ILD) and further explore the prognostic factors of IIM-ILD. We extracted data regarding 539 patients with laboratory-confirmed idiopathic inflammatory myopathy (IIM) with or without interstitial lung disease (ILD) from the Second Xiangya Hospital of Central South University between January 2016 and December 2021. The regression analysis was conducted to identify the possible risk factors for ILD as well as mortality. Of 539 IIM patients, 343 (64.6%) were diagnosed with IIM-ILD. The median (IQR) baseline neutrophil-to-lymphocyte ratio (NLR), C-reactive protein to albumin ratio (CAR) and ferritin were 4.1371 (2.6994-6.8143), 0.1685 (0.0641-0.5456) and 393.6 (210.6-532.2), respectively. Risk factors associated with IIM-ILD were older age (p = 0.002), arthralgia (p = 0.014), lung infection (p = 0.027), hemoglobin (p = 0.022), high CAR (p = 0.014), anti-aminoacyl-tRNA synthetase (anti-ARS) antibody-positive (p < 0.001), and anti-MDA5 antibody-positive (p < 0.001). The IIM-ILD patients whose age at diagnosis of disease ≥ 59.5 (HR = 2.673, 95% CI 1.588-4.499, p < 0.001), NLR ≥ 6.6109 (HR = 2.004, 95% CI 1.193-3.368, p = 0.009), CAR ≥ 0.2506 (HR = 1.864, 95% CI 1.041-3.339, p = 0.036), ferritin ≥ 397.68 (HR = 2.451, 95% CI 1.245-4.827, p = 0.009) and anti-MDA5 antibody-positive (HR = 1.928, 95% CI 1.123-3.309, p = 0.017) had a higher mortality rate. High CAR and anti-MDA5 antibody-positive are more likely to be associated with a high mortality rate of IIM-ILD, which can be used as serum biomarkers, especially the CAR, a simple, objective tool to assess the prognosis of IIM.
Collapse
|
4
|
Zhao N, Jiang W, Wu H, Wang P, Wang X, Bai Y, Li Y, Tang Y, Liu Y. Clinical features, prognostic factors, and survival of patients with antisynthetase syndrome and interstitial lung disease. Front Immunol 2022; 13:872615. [PMID: 36032132 PMCID: PMC9399497 DOI: 10.3389/fimmu.2022.872615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aimed to analyze the clinical features and prognostic factors of imaging progression and survival in patients with antisynthetase syndrome (ASS) complicated by interstitial lung disease (ILD) in a large Chinese cohort.MethodsMedical records, imaging, and serological data of 111 patients with ASS-ILD (positive for at least one of the following autoantibodies: anti-Jo1, anti-PL7, anti-PL12, and anti-EJ) from the Affiliated Yantai Yuhuangding Hospital of Qingdao University database were retrospectively investigated. According to the changes in high-resolution computed tomography (HRCT) outcomes at 1 year follow-up, Patients were categorized into three groups: the regression, stability, and deterioration groups. Univariate analysis was performed to evaluate the possible prognostic factors of ILD outcome and death, and multivariate analysis was performed to determine the independent predictors of ASS-ILD outcome and death by logistic regression.ResultsThe number of CD3-CD19+ cells and initial glucocorticoid dosage were correlated with imaging progression, and may be independent risk factors for ILD deterioration. Dyspnea as the first symptom, hypohemoglobinemia, the serum ferritin level, oxygen partial pressure at diagnosis, and different treatment types were important factors affecting survival, and the initial serum ferritin level may be an independent risk factor for survival.ConclusionsThe clinical characteristics of patients with ASS-ILD with different antisynthetase antibody subtypes are different. An increase in the CD3-CD19+ cell level is an independent risk factor for the deterioration of HRCT imaging. Early intensive treatment with high-dose glucocorticoids can effectively improve imaging prognosis of ILD. Patients with significantly elevated serum ferritin levels should be treated intensively.
Collapse
Affiliation(s)
- Na Zhao
- Department of Rheumatology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Wei Jiang
- Department of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Hongliang Wu
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Ping Wang
- Department of Radiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiaoni Wang
- Department of Radiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yu Bai
- Department of Rheumatology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yao Li
- Department of Rheumatology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yanchun Tang
- Department of Rheumatology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Ying Liu
- Department of Rheumatology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- *Correspondence: Ying Liu,
| |
Collapse
|
5
|
Jiwrajka N, Loizidis G, Patterson KC, Kreider ME, Johnson CR, Miller WT, Barbosa EJM, Patel N, Beers MF, Litzky LA, George MD, Porteous MK. Identification and Prognosis of Patients With Interstitial Pneumonia With Autoimmune Features. J Clin Rheumatol 2022; 28:257-264. [PMID: 35697042 DOI: 10.1097/rhu.0000000000001847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Patients classified as interstitial pneumonia with autoimmune features (IPAF) have interstitial lung disease (ILD) and features of autoimmunity but do not fulfill criteria for connective tissue diseases (CTDs). Our goal was to identify patients classifiable as IPAF, CTD-ILD, and idiopathic pulmonary fibrosis (IPF) from a preexisting pulmonary cohort and evaluate the prognosis of patients with IPAF. METHODS We reviewed the medical records of 456 patients from a single-center pulmonary ILD cohort whose diagnoses were previously established by a multidisciplinary panel that did not include rheumatologists. We reclassified patients as IPAF, CTD-ILD, or IPF. We compared transplant-free survival using Kaplan-Meier methods and identified prognostic factors using Cox models. RESULTS We identified 60 patients with IPAF, 113 with CTD-ILD, and 126 with IPF. Transplant-free survival of IPAF was not statistically significantly different from that of CTD-ILD or IPF. Among IPAF patients, male sex (hazard ratio, 4.58 [1.77-11.87]) was independently associated with worse transplant-free survival. During follow-up, only 10% of IPAF patients were diagnosed with CTD-ILD, most commonly antisynthetase syndrome. CONCLUSION Despite similar clinical characteristics, most patients with IPAF did not progress to CTD-ILD; those who did often developed antisynthetase syndrome, highlighting the critical importance of comprehensive myositis autoantibody testing in this population. As in other types of ILD, male sex may portend a worse prognosis in IPAF. The routine engagement of rheumatologists in the multidisciplinary evaluation of ILD will help ensure the accurate classification of these patients and help clarify prognostic factors.
Collapse
Affiliation(s)
- Nikhil Jiwrajka
- From the Division of Rheumatology, Hospital of the University of Pennsylvania
| | | | | | - Maryl E Kreider
- Division of Pulmonary, Allergy, and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Cheilonda R Johnson
- Division of Pulmonary, Allergy, and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Wallace T Miller
- Department of Radiology, Hospital of the University of Pennsylvania
| | | | - Namrata Patel
- Division of Pulmonary, Allergy, and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Michael F Beers
- Division of Pulmonary, Allergy, and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Leslie A Litzky
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania
| | | | - Mary K Porteous
- Division of Pulmonary, Allergy, and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
6
|
Wen L, Chen X, Cheng Q, Nie L, Xu J, Yan T, Zhang X, Yang H, Sun W, Liu L, Xue J, Du Y. Myositis-specific autoantibodies and their clinical associations in idiopathic inflammatory myopathies: results from a cohort from China. Clin Rheumatol 2022; 41:3419-3427. [PMID: 35859245 DOI: 10.1007/s10067-022-06291-z] [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: 03/23/2022] [Revised: 06/08/2022] [Accepted: 07/08/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the incidence of myositis-specific autoantibodies (MSAs) in a cohort of Chinese patients with idiopathic inflammatory myopathies (IIMs) and to examine their associations with clinical characteristics and long-term prognosis. METHODS Adult patients with confirmed IIMs (n = 515) were studied using the EUROLINE Autoimmune Inflammatory Myopathies 16 Ag (IgG) commercial line blot test to detect MSAs/myositis-associated autoantibodies. We collected the laboratory data and clinical features. The frequencies of MSAs and their associations with clinical phenotypes were evaluated using SPSS 25.0 software. RESULTS At least one MSA was found in 88.2% of the 515 IIM patients studied. The most frequently detected MSAs were anti-MDA5 (25.4%), anti-Jo-1(15.1%), and anti-EJ (9.5%). Autoantibodies against MDA5, TIF1-γ, and NXP2 were significantly correlated with cutaneous involvement (P < 0.001 or P < 0.01). Anti-TIF1-γ-positive patients had an enhanced risk of malignancy (OR = 3.51). Rapidly progressive interstitial lung disease (RP-ILD) was significantly correlated with anti-MDA5 (P < 0.0001). Anti-MDA5-positive patients had increased risks of elevated ferritin and decreased lymphocyte counts (OR = 5.65 and OR = 5.74, respectively). Kaplan-Meier survival revealed that individuals positive for anti-MDA5, especially anti-MDA5 combined with anti-Ro52, had the worst prognosis (P = 0.03). Male, old age, RP-ILD, and elevated ferritin were identified as predictors of poor prognosis in IIM patients. CONCLUSIONS MSAs were present in the majority of the IIM patients. Numerous MSAs were independent factors for identifying exceptional clinical phenotypes. Key Points • This is a large Chinese cohort of IIM patients to analyze possible associations of MSA profiles with clinical characteristics, aiming to provide valuable data for clinical work. • MSAs were present in approximately 90% of IIM patients with distinct clinical subsets. Patients with anti-Jo-1 and non-anti-Jo-1 ASAs exhibited similar characteristics. • The association of anti-TIF1-γ with malignancy was confirmed in adult patients. Patients with IIMs who were positive for both anti-Ro52 and anti-MDA5 had a worse prognosis. • Male, RP-ILD, and heliotrope rash were independent risk factors for a poor prognosis in patients with IIMs.
Collapse
Affiliation(s)
- Lihong Wen
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xin Chen
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Qi Cheng
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Liuyan Nie
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jieying Xu
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
- Department of Neurology, Linping District Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, 311199, Zhejiang, China
| | - Tingting Yan
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
- Department of Rheumatology, Second Affiliate Hospital, Jiaxing University School of Medicine, Jiaxing, China
| | - Xin Zhang
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
- Department of Rheumatology, Ningbo No.6 Hospital, Ningbo, China
| | - Huanhuan Yang
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
- Department of Nephrology, Hangzhou 6th People's Hospital, the Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| | - Wenjia Sun
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Lei Liu
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jing Xue
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Yan Du
- Department of Rheumatology, The Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| |
Collapse
|
7
|
Khatri Chhetri RC, Gole S, Mallari AJP, Dutta A, Zahra F. A Rare Case of Anti-glycyl transfer RNA (tRNA) Synthetase Antibody-Related Non-specific Interstitial Pneumonia. Cureus 2022; 14:e26159. [PMID: 35832751 PMCID: PMC9271357 DOI: 10.7759/cureus.26159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/05/2022] Open
|
8
|
De Zorzi E, Spagnolo P, Cocconcelli E, Balestro E, Iaccarino L, Gatto M, Benvenuti F, Bernardinello N, Doria A, Maher TM, Zanatta E. Thoracic Involvement in Systemic Autoimmune Rheumatic Diseases: Pathogenesis and Management. Clin Rev Allergy Immunol 2022; 63:472-489. [PMID: 35303257 DOI: 10.1007/s12016-022-08926-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 12/15/2022]
Abstract
Thoracic involvement is one of the main determinants of morbidity and mortality in patients with autoimmune rheumatic diseases (ARDs), with different prevalence and manifestations according to the underlying disease. Interstitial lung disease (ILD) is the most common pulmonary complication, particularly in patients with systemic sclerosis (SSc), idiopathic inflammatory myopathies (IIMs) and rheumatoid arthritis (RA). Other thoracic manifestations include pulmonary arterial hypertension (PAH), mostly in patients with SSc, airway disease, mainly in RA, and pleural involvement, which is common in systemic lupus erythematosus and RA, but rare in other ARDs.In this review, we summarize and critically discuss the current knowledge on thoracic involvement in ARDs, with emphasis on disease pathogenesis and management. Immunosuppression is the mainstay of therapy, particularly for ARDs-ILD, but it should be reserved to patients with clinically significant disease or at risk of progressive disease. Therefore, a thorough, multidisciplinary assessment to determine disease activity and degree of impairment is required to optimize patient management. Nevertheless, the management of thoracic involvement-particularly ILD-is challenging due to the heterogeneity of disease pathogenesis, the variety of patterns of interstitial pneumonia and the paucity of randomized controlled clinical trials of pharmacological intervention. Further studies are needed to better understand the pathogenesis of these conditions, which in turn is instrumental to the development of more efficacious therapies.
Collapse
Affiliation(s)
- Elena De Zorzi
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy.
| | - Elisabetta Cocconcelli
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Luca Iaccarino
- Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Mariele Gatto
- Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | | | - Nicol Bernardinello
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Andrea Doria
- Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Toby M Maher
- Keck School of Medicine University of Southern California, Los Angeles California, USA.,Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | | |
Collapse
|
9
|
OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:4570-4578. [DOI: 10.1093/rheumatology/keac090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/26/2022] [Indexed: 11/13/2022] Open
|
10
|
NK Cell Patterns in Idiopathic Inflammatory Myopathies with Pulmonary Affection. Cells 2021; 10:cells10102551. [PMID: 34685530 PMCID: PMC8534165 DOI: 10.3390/cells10102551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pulmonary affection (PA) is associated with a substantial increase in morbidity and mortality in patients with idiopathic inflammatory myopathies (IIM). However, the underlying immune mechanisms of PA remain enigmatic and prompt deeper immunological analyses. Importantly, the Janus-faced role of natural killer (NK) cells, capable of pro-inflammatory as well as regulatory effects, might be of interest for the pathophysiologic understanding of PA in IIM. METHODS To extend our understanding of immunological alterations in IIM patients with PA, we compared the signatures of NK cells in peripheral blood using multi-color flow cytometry in IIM patients with (n = 12, of which anti-synthetase syndrome = 8 and dermatomyositis = 4) or without PA (n = 12). RESULTS We did not observe any significant differences for B cells, CD4, and CD8 T cells, while total NK cell numbers in IIM patients with PA were reduced compared to non-PA patients. NK cell alterations were driven by a particular decrease of CD56dim NK cells, while CD56bright NK cells remained unchanged. Comparisons of the cell surface expression of a large panel of NK receptors revealed an increased mean fluorescence intensity of NKG2D+ on NK cells from patients with PA compared with non-PA patients, especially on the CD56dim subset. NKG2D+ and NKp46+ cell surface levels were associated with reduced vital capacity, serving as a surrogate marker for clinical severity of PA. CONCLUSION Our data illustrate that PA in IIM is associated with alterations of the NK cell repertoire, suggesting a relevant contribution of NK cells in certain IIMs, which might pave the way for NK cell-targeted therapeutic approaches.
Collapse
|
11
|
Moussa N, Khemakhem R, Snoussi M, Fekih W, Bahloul Z, Kammoun S. [Diffuse infiltrating lung disease secondary to antisynthetase syndrome: a case report]. Pan Afr Med J 2021; 39:30. [PMID: 34394821 PMCID: PMC8348253 DOI: 10.11604/pamj.2021.39.30.22654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/26/2021] [Indexed: 11/11/2022] Open
Abstract
Les pneumopathies infiltrantes diffuses (PID) constituent une manifestation fréquente des connectivites. Elles peuvent être révélatrices de la maladie ou survenir au cours du suivi. Le syndrome des anti-synthétases (SAS) est une connectivité auto-immune complexe et hétérogène. Des anticorps de type «anti synthétases», en particulier l'anticorps anti-Jo-1 caractérise ce syndrome. Le pronostic du SAS étant conditionné par la survenue d´une PID et de sa sévérité dictant ainsi la prise en charge thérapeutique du SAS. Nous rapportons l´observation d´une patiente âgée de 57 ans se présentant avec un tableau d´une PID aigue fébrile révélant le diagnostic d´un SAS. L´évolution a été favorable sous boli de corticoïdes associés au cyclophosphamide.
Collapse
Affiliation(s)
- Nadia Moussa
- Service de Pneumologie, Hôpital Universitaire Hédi Chaker, Sfax, Tunisie
| | - Rim Khemakhem
- Service de Pneumologie, Hôpital Universitaire Hédi Chaker, Sfax, Tunisie
| | - Mouna Snoussi
- Service de Médecine Interne, Hôpital Universitaire Hédi Chaker, Sfax, Tunisie
| | - Wafa Fekih
- Service de Pneumologie, Hôpital Universitaire Hédi Chaker, Sfax, Tunisie
| | - Zouhir Bahloul
- Service de Médecine Interne, Hôpital Universitaire Hédi Chaker, Sfax, Tunisie
| | - Sami Kammoun
- Service de Pneumologie, Hôpital Universitaire Hédi Chaker, Sfax, Tunisie
| |
Collapse
|
12
|
Jiang M, Dong X, Zheng Y. Clinical characteristics of interstitial lung diseases positive to different anti-synthetase antibodies. Medicine (Baltimore) 2021; 100:e25816. [PMID: 34106621 PMCID: PMC8133147 DOI: 10.1097/md.0000000000025816] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 04/13/2021] [Indexed: 11/26/2022] Open
Abstract
To analyze the clinical, serological, and imaging characteristics of patients with interstitial lung diseases (ILD) positive to different anti-aminoacyl-tRNA synthetase (anti-ARS) antibodies.The clinical data, serological indexes, pulmonary high-resolution computed tomography (HRCT) imaging features and pulmonary functions, and bronchoalveolar lavage fluid of 84 ILD patients with anti-ARS antibody positive in Beijing Chao-yang Hospital, Capital Medical University were reviewed.(1) Anti-ARS antibodies included anti-Jo-1 (42.86%), anti-PL-7 (26.19%), anti-PL-12 (10.71%), anti-EJ (14.29%), and anti-OJ (5.95%). (2) Nonspecific interstitial pneumonia was the main type of patients with ILD positive to antibodies of anti-Jo-1, anti-PL-7, and anti-EJ, organizing pneumonia was the main type of patients with ILD positive to anti-PL-12 antibody and usual interstitial pneumonia was the main type of patients with ILD positive to anti-OJ antibody. (3) Only 14.29% of the patients had typical "triad syndrome" (interstitial pneumonia, myositis, and non-erosive arthritis). Myositis mainly occurred in patients with ILD positive to antibodies of anti-PL-7, anti-Jo-1, and anti-EJ. The incidence of arthritis in ILD patients with anti-Jo-1 was higher than that in ILD patients with anti-PL-12 and anti-EJ (P < .05). The incidence of mechanic's hand in ILD patients with anti-Jo-1 was higher than that in ILD patients with anti-PL-12 (P < .05).ILD positive to anti-Jo-1 antibody is associated with multiple organ involvement, mainly manifested as myositis, mechanic's hand, and arthritis. As other clinical manifestations of some ILD patients are relatively hidden, ILD patients should pay attention to the screening of the anti-ARS antibodies and guard against anti-synthetase syndrome.
Collapse
Affiliation(s)
- Minna Jiang
- Department of Rheumatology, Beijing Huairou Hospital
| | - Xin Dong
- Department of Rheumatology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yi Zheng
- Department of Rheumatology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
13
|
Treatment in Antisynthetase Syndrome-Associated Interstitial Lung Disease. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021. [DOI: 10.1007/s40674-021-00177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
14
|
Fox SC, Trivedi AP. A 47-Year Old Woman With Rapidly Progressive Hypoxemic Respiratory Failure. Chest 2021; 159:e69-e73. [PMID: 33563457 DOI: 10.1016/j.chest.2020.08.2119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/17/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022] Open
Abstract
CASE PRESENTATION A 47-year-old Hispanic woman presented to a pulmonology clinic with 2 weeks of cough productive of white sputum and worsening dyspnea on exertion, requiring increasing supplemental oxygen. In addition, she reported fatigue, night sweats, diffuse myalgias, and extremity weakness. She denied hemoptysis, fevers, chills, weight loss, or rash. Her medical history is significant for undifferentiated rapidly progressive hypoxemic respiratory failure 2 years before her current presentation. At that time, she presented to the ED with 3 weeks of progressive shortness of breath and cough. Chest CT imaging showed bilateral infiltrates concerning for infection, and she was treated empirically for community-acquired pneumonia. She developed worsening hypoxemic respiratory failure despite broadening of her antibiotics and subsequently required intubation. Her course was further complicated by pulseless electrical activity arrest with return of spontaneous circulation and development of shock requiring multiple vasopressors. Because of difficulty with oxygenation, she was referred to our center for extracorporeal membrane oxygenation evaluation and was ultimately started on venous-arterial extracorporeal membrane oxygenation. Bronchoscopy with BAL was negative for bacterial, viral, and fungal origins, and initial autoimmune evaluation (antinuclear antibody and rheumatoid factor) was negative, except an elevated creatine kinase (CK) to 3,000. Her course was complicated by heparin-induced thrombocytopenia, and as a result she suffered limb ischemia requiring amputation of her left lower extremity. Elevated CK at that time was attributed to compartment syndrome before amputation. The patient recovered clinically with supportive care and was ultimately discharged on 2 L supplemental oxygen, with a diagnosis of acute respiratory failure of unclear origin. The patient had stability in her clinical symptoms until this current presentation.
Collapse
Affiliation(s)
- Samuel C Fox
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL.
| | - Abhaya P Trivedi
- Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL
| |
Collapse
|
15
|
Jee AS, Sheehy R, Hopkins P, Corte TJ, Grainge C, Troy LK, Symons K, Spencer LM, Reynolds PN, Chapman S, de Boer S, Reddy T, Holland AE, Chambers DC, Glaspole IN, Jo HE, Bleasel JF, Wrobel JP, Dowman L, Parker MJS, Wilsher ML, Goh NSL, Moodley Y, Keir GJ. Diagnosis and management of connective tissue disease-associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand. Respirology 2020; 26:23-51. [PMID: 33233015 PMCID: PMC7894187 DOI: 10.1111/resp.13977] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/26/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022]
Abstract
Pulmonary complications in CTD are common and can involve the interstitium, airways, pleura and pulmonary vasculature. ILD can occur in all CTD (CTD-ILD), and may vary from limited, non-progressive lung involvement, to fulminant, life-threatening disease. Given the potential for major adverse outcomes in CTD-ILD, accurate diagnosis, assessment and careful consideration of therapeutic intervention are a priority. Limited data are available to guide management decisions in CTD-ILD. Autoimmune-mediated pulmonary inflammation is considered a key pathobiological pathway in these disorders, and immunosuppressive therapy is generally regarded the cornerstone of treatment for severe and/or progressive CTD-ILD. However, the natural history of CTD-ILD in individual patients can be difficult to predict, and deciding who to treat, when and with what agent can be challenging. Establishing realistic therapeutic goals from both the patient and clinician perspective requires considerable expertise. The document aims to provide a framework for clinicians to aid in the assessment and management of ILD in the major CTD. A suggested approach to diagnosis and monitoring of CTD-ILD and, where available, evidence-based, disease-specific approaches to treatment have been provided.
Collapse
Affiliation(s)
- Adelle S Jee
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
| | - Robert Sheehy
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Peter Hopkins
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia.,Queensland Lung Transplant service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
| | - Christopher Grainge
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Respiratory Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Lauren K Troy
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Karen Symons
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Lissa M Spencer
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Paul N Reynolds
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.,Lung Research Laboratory, University of Adelaide, Adelaide, SA, Australia
| | - Sally Chapman
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sally de Boer
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand
| | - Taryn Reddy
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Anne E Holland
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Daniel C Chambers
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia.,Queensland Lung Transplant service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Ian N Glaspole
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Helen E Jo
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
| | - Jane F Bleasel
- Central Clinical School, University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jeremy P Wrobel
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia.,Department of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Leona Dowman
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,Physiotherapy Department, Austin Health, Melbourne, VIC, Australia
| | - Matthew J S Parker
- Central Clinical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Margaret L Wilsher
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Respiratory Services, Auckland District Health Board, Auckland, New Zealand.,Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nicole S L Goh
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Respiratory Medicine, Austin Hospital, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Yuben Moodley
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,University of Western Australia, Institute for Respiratory Health, Perth, WA, Australia.,Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
| | - Gregory J Keir
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
16
|
Xing X, Li A, Li C. Anti-Ro52 antibody is an independent risk factor for interstitial lung disease in dermatomyositis. Respir Med 2020; 172:106134. [PMID: 32905890 DOI: 10.1016/j.rmed.2020.106134] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023]
Abstract
AIM Recent studies have shown that anti-Ro52 antibody is associated with both interstitial lung disease (ILD) and the degree of disease severity in juvenile patients with dermatomyositis (DM). We found that more than half of adult patients with DM were positive for anti-Ro52 antibody. In this study, we analysed the correlation between anti-Ro52 antibody and ILD in adult patients with DM. METHOD Serum samples were collected from 153 adult inpatients with DM, at the First Medical Centre of PLA General Hospital, Beijing, China, who met the classification criteria of idiopathic inflammatory myopathies from March 1, 2016 to September 30, 2019. The patients were followed up to May 31, 2020. Immunoblotting was used to detect 16 types of myositis-specific autoantibodies (MSAs) and myositis-associated autoantibodies (MAAs) from serum samples. High-resolution computed tomography (HRCT) was used to calculate the ILD score, and tumours were screened. Clinical data and HRCT scores were evaluated and analysed retrospectively. RESULTS Our results showed that anti-Ro52 antibodies were the most commonly found antibodies in patients with DM, with a positive rate of 52.9%. Anti-Ro52, anti-aminoacyl-tRNA synthetase (anti-ARS), and anti-melanoma differentiation-related gene 5 (anti-MDA5) antibodies were found to be risk factors for ILD development. Anti-Ro52 antibodies had a strong predictive effect on ILD in patients with DM. CONCLUSION The occurrence of ILD is highly likely in patients with DM who are positive for the anti-Ro52 antibodies. Thus, anti-Ro52 antibodies is an independent risk factor for ILD in patients with DM.
Collapse
Affiliation(s)
- Xiaojing Xing
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Haidian District, Fuxing Road, 100853, Beijing, China.
| | - Anqi Li
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Haidian District, Fuxing Road, 100853, Beijing, China; Medical College of Nankai University, 300071, Tianjin, China
| | - Chengxin Li
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Haidian District, Fuxing Road, 100853, Beijing, China
| |
Collapse
|
17
|
Gupta R, Kumar S, Gow P, Hsien-Cheng Chang L, Yen L. Anti-MDA5-associated dermatomyositis. Intern Med J 2020; 50:484-487. [PMID: 32270621 DOI: 10.1111/imj.14789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/11/2019] [Accepted: 07/28/2019] [Indexed: 11/26/2022]
Abstract
Anti-MDA5-associated dermatomyositis (MDA5-associated DM) is an uncommon presentation of idiopathic inflammatory myositis, typically amyopathic, associated with rapidly progressive, treatment refractory interstitial lung disease and poor prognosis, particularly in patients with concomitant rapidly progressive interstitial lung disease (RP-ILD). We report two cases of MDA5-associated DM with fatal outcome in one of the patients, despite 'aggressive triple therapy' for RP-ILD.
Collapse
Affiliation(s)
- Rajiv Gupta
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| | - Sunil Kumar
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| | - Peter Gow
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| | | | - Linda Yen
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| |
Collapse
|
18
|
Liu Y, Liu X, Xie M, Chen Z, He J, Wang Z, Dai J, Cai H. Clinical characteristics of patients with anti-EJ antisynthetase syndrome associated interstitial lung disease and literature review. Respir Med 2020; 165:105920. [DOI: 10.1016/j.rmed.2020.105920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/01/2023]
|
19
|
Sclafani A, D'Silva KM, Little BP, Miloslavsky EM, Locascio JJ, Sharma A, Montesi SB. Presentations and outcomes of interstitial lung disease and the anti-Ro52 autoantibody. Respir Res 2019; 20:256. [PMID: 31718649 PMCID: PMC6852961 DOI: 10.1186/s12931-019-1231-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/01/2019] [Indexed: 12/31/2022] Open
Abstract
Background Distinct clinical presentations of interstitial lung disease (ILD) with the myositis-specific antibodies, including anti-synthetase antibodies, are well-recognized. However, the association between ILD and the myositis-associated antibodies, including anti-Ro52, is less established. Our objectives were to compare presenting phenotypes of patients with anti-Ro52 alone versus in combination with myositis-specific autoantibodies and to identify predictors of disease progression or death. Methods We performed a retrospective cohort study of 73 adults with ILD and a positive anti-Ro52 antibody. We report clinical features, treatment, and outcomes. Results The majority of patients with ILD and anti-Ro52 had no established connective tissue disease (78%), and one-third had no rheumatologic symptoms. Thirteen patients (17.8%) required ICU admission for respiratory failure, with 84.6% all-cause mortality. Of the 73 subjects, 85.7% had a negative SS-A, and 49.3% met criteria for idiopathic pneumonia with autoimmune features (IPAF). The 50 patients with anti-Ro52 alone were indistinguishable from patients with anti-Ro52 plus a myositis-specific autoantibody. ICU admission was associated with poor outcomes (HR 12.97, 95% CI 5.07–34.0, p < 0.0001), whereas rheumatologic symptoms or ANA > = 1:320 were associated with better outcomes (HR 0.4, 95% CI 0.16–0.97, p = 0.04, and HR 0.29, 95% CI 0.09–0.81, p = 0.03, respectively). Conclusions Presentations of ILD with the anti-Ro52 antibody are heterogeneous, and outcomes are similar when compared to anti-Ro52 plus myositis-specific antibodies. Testing for anti-Ro52 may help to phenotype unclassifiable ILD patients, particularly as part of the serologic criteria for IPAF. Further research is needed to investigate treatment of ILD in the setting of anti-Ro52 positivity.
Collapse
Affiliation(s)
- A Sclafani
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, 100 Blossom St, Cox 201, Boston, MA, 02114, USA.
| | - K M D'Silva
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - B P Little
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - E M Miloslavsky
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - J J Locascio
- Biostatistics Center and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A Sharma
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - S B Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, 100 Blossom St, Cox 201, Boston, MA, 02114, USA
| |
Collapse
|
20
|
Fukamatsu H, Hirai Y, Miyake T, Kaji T, Morizane S, Yokoyama E, Hamada T, Oono T, Koyama Y, Norikane S, Iwatsuki K. Clinical manifestations of skin, lung and muscle diseases in dermatomyositis positive for anti‐aminoacyl tRNA synthetase antibodies. J Dermatol 2019; 46:886-897. [DOI: 10.1111/1346-8138.15049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 07/22/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Hiroko Fukamatsu
- Department of Dermatology Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| | - Yoji Hirai
- Department of Dermatology Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| | - Tomoko Miyake
- Department of Dermatology Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| | - Tatsuya Kaji
- Department of Dermatology Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| | - Shin Morizane
- Department of Dermatology Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| | - Emi Yokoyama
- Department of Dermatology Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| | - Toshihisa Hamada
- Department of Dermatology Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| | - Takashi Oono
- Department of DermatologyJapanese Red Cross Okayama Hospital OkayamaJapan
| | - Yoshinobu Koyama
- Division of Rheumatology Center for Autoimmune Diseases Japanese Red Cross Okayama Hospital Okayama Japan
| | | | - Keiji Iwatsuki
- Department of Dermatology Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| |
Collapse
|
21
|
Marin FL, Sampaio HP. Antisynthetase Syndrome and Autoantibodies: A Literature Review and Report of 4 Cases. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1094-1103. [PMID: 31344020 PMCID: PMC6676984 DOI: 10.12659/ajcr.916178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Case series Patient: Female, 25 • Female, 39 • Male, 27 • Female, 42 Final Diagnosis: Antisynthetase syndrome Symptoms: Arthralgia • dyspnea • muscle weakness Medication: — Clinical Procedure: Immunosuppressive therapy Specialty: Rheumatology
Collapse
Affiliation(s)
- Flávia Luiza Marin
- Postgraduate Program in Pathophysiology in Medical Clinic, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Henrique Pereira Sampaio
- Department of Rheumatology, Division of Medical Clinic, Section of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| |
Collapse
|
22
|
Huapaya JA, Silhan L, Pinal-Fernandez I, Casal-Dominguez M, Johnson C, Albayda J, Paik JJ, Sanyal A, Mammen AL, Christopher-Stine L, Danoff SK. Long-Term Treatment With Azathioprine and Mycophenolate Mofetil for Myositis-Related Interstitial Lung Disease. Chest 2019; 156:896-906. [PMID: 31238042 DOI: 10.1016/j.chest.2019.05.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/01/2019] [Accepted: 05/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The efficacy of azathioprine (AZA) and mycophenolate mofetil (MMF) for interstitial lung disease (ILD) has been described, but mainly in connective tissue disease-associated ILD. The objective of this study was to evaluate the effect of AZA and MMF on lung function and prednisone dose in myositis-related ILD (M-ILD). METHODS In this retrospective study, patients with M-ILD seen at Johns Hopkins and treated with AZA or MMF and no other steroid-sparing agents were included. Linear mixed-effects models adjusted for sex, age, antisynthetase antibody, and smoking status were used to compare the change in FVC % predicted, diffusing capacity of the lungs for carbon monoxide (Dlco) % predicted, and prednisone dose. RESULTS Sixty-six patients with M-ILD were treated with AZA and 44 with MMF. At treatment initiation, mean FVC % predicted and Dlco % predicted were significantly lower in the AZA group than in the MMF group. In both groups, FVC % predicted improved and the prednisone dose was reduced over 2 to 5 years; however, for Dlco % predicted, only the AZA group improved. The adjusted model showed no significant difference in posttreatment FVC % predicted or Dlco % predicted between groups (mean difference of 1.9 and -8.2, respectively), but a 6.6-mg lower dose of prednisone at 36 months in the AZA group. Adverse events were more frequent with AZA than MMF (33.3% vs 13.6%; P = .04). CONCLUSIONS In M-ILD, AZA treatment was associated with improved FVC % predicted and Dlco % predicted, and lower prednisone dose. Patients treated with MMF had improved FVC % predicted and lower prednisone dose. After 36 months, patients treated with AZA received a lower prednisone dose than those treated with MMF.
Collapse
Affiliation(s)
- Julio A Huapaya
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Leann Silhan
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Iago Pinal-Fernandez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Maria Casal-Dominguez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cheilonda Johnson
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jemima Albayda
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie J Paik
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abanti Sanyal
- Johns Hopkins University School of Public Health, Baltimore, MD
| | - Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lisa Christopher-Stine
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
| |
Collapse
|
23
|
Long-term treatment with human immunoglobulin for antisynthetase syndrome-associated interstitial lung disease. Respir Med 2019; 154:6-11. [PMID: 31176796 DOI: 10.1016/j.rmed.2019.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/26/2019] [Accepted: 05/19/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Interstitial lung disease-associated antisynthetase syndrome (AS-ILD) carries significant morbidity and mortality. Corticosteroids and immunosuppressive drugs are the mainstay of treatment. Human immunoglobulin (IVIg), an immunomodulator without immunosuppressive properties, is effective in myositis but the evidence supporting its use in ILD is scarce. OBJECTIVE To describe clinical outcomes of AS-ILD patients receiving IVIg. METHODS Retrospective analysis of AS-ILD patients. Linear mixed models using restricted maximum likelihood estimation was used to estimate the change in lung function and corticosteroid dose over time. RESULTS Data from 17 patients was analyzed. Median follow-up was 24.6 months. Fourteen patients had refractory disease. The mean percent-predicted forced vital capacity (FVC%) (p = 0.048) and percent-predicted diffusing capacity of the lung for carbon monoxide (DLCO%) (p = 0.0223) increased over time, while the mean prednisone dose (p < 0.001) decreased over time. Seven patients achieved a >10% increase in FVC%, including two who used IVIg as initial treatment. Five patients showed a >10% increase in DLCO% and TLC%. Nine (53%) patients experienced side effects. CONCLUSIONS IVIg may be a useful complementary therapy in active progressive AS-ILD but is associated with potential side effects. Fssssurther investigation is required to determine the value of IVIg as an initial treatment in AS-ILD.
Collapse
|
24
|
Hu C, Wu C, Yang E, Huang H, Xu D, Hou Y, Zhao J, Li M, Xu Z, Zeng X, Wang Q. Serum KL-6 is associated with the severity of interstitial lung disease in Chinese patients with polymyositis and dermatomyositis. Clin Rheumatol 2019; 38:2181-2187. [PMID: 30888566 DOI: 10.1007/s10067-019-04501-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/13/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This cross-sectional study was designed to assess the clinical significance of the serum KL-6 in the diagnosis of interstitial lung disease (ILD) in patients with idiopathic inflammatory myopathy (IIM). METHODS We measured serum KL-6 levels in 184 patients with IIM using a chemiluminescent enzyme immunoassay and compared KL-6 levels between patients with and without ILD, according to other clinical features. RESULTS IIM patients with ILD had significantly higher serum KL-6 levels than those without ILD (776.5 [372.3-1378.8] vs. 297.5 [204.75-599.3] U/ml, P < 0.001). At a cut-off of 461.5 U/ml identified by ROC curve, serum KL-6 yielded a sensitivity of 70.2% and specificity of 73.9% for ILD in IIM patients. IIM patients with an elevated serum KL-6 were more likely to have clinical symptoms of mechanic's hands (P = 0.002), anti-Jo-1 antibody positivity (P = 0.021), dysphagia (P = 0.039), hoarseness (P < 0.001), and polyarthritis/polyarthralgia (P < 0.001). Significant inverse correlations were found between serum KL-6 levels and pulmonary function tests (P < 0.01), including forced vital capacity (FVC, %Pred), total lung capacity (TLC, %Pred), and diffusing capacity for carbon monoxide (DLCO, %Pred). CONCLUSIONS Serum KL-6 offers high sensitivity and specificity for the diagnosis of IIM-associated ILD and is inversely correlated with pulmonary function deterioration. Serum KL-6 may represent a promising biomarker for monitoring ILD severity in IIM patients.
Collapse
Affiliation(s)
- Chaojun Hu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Chanyuan Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Enhao Yang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Hui Huang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Yong Hou
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Zuojun Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China. .,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China.
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College &Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China. .,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China.
| |
Collapse
|
25
|
The spectrum and clinical significance of myositis-specific autoantibodies in Chinese patients with idiopathic inflammatory myopathies. Clin Rheumatol 2019; 38:2171-2179. [PMID: 30863950 DOI: 10.1007/s10067-019-04503-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/24/2019] [Accepted: 03/05/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study is to analyze the prevalence of myositis-specific autoantibodies (MSAs) and to elucidate their associations with clinical features in Chinese patients with polymyositis (PM) and dermatomyositis (DM). METHODS Twelve subsets of MSAs including anti-Mi-2, anti-TIF1-γ, anti-MDA5, anti-NXP2, anti-SAE1, anti-SRP, anti-Jo-1, anti-PL-7, anti-PL-12, anti-EJ, anti-OJ, and anti-HMGCR antibodies were tested. Four hundred and ninety-seven PM/DM patients were enrolled. Clinical features and laboratory data were collected. The frequency of MSAs and the correlations with clinical phenotypes were calculated by SPSS 21.0. RESULTS MSAs were present in 65.4% in PM/DM patients. Anti-TIF1-γ (14.3%), anti-MDA5 (12.5%), and anti-Jo-1 (10.1%) were the three commonest MSAs. Anti-SAE1 (OR 14.877, 95% CI 1.427-155.074), anti-SRP (OR 4.339, 95% CI 1.529-12.312) and anti-TIF1-γ (OR 2.790, 95% CI 1.578-4.935) were associated with dysphagia. In contrast, anti-MDA5 (OR 0.356, 95% CI 0.148-0.856) might decrease the frequency of this manifestation. Interstitial lung disease (ILD) was observed more frequently in patients carrying anti-EJ (OR 14.202, 95% CI 1.696-118.902), anti-Jo-1 (OR 11.111, 95% CI 3.306-37.335), and anti-MDA5 (OR 3.109, 95% CI 1.578-6.128). On the contrary, anti-Mi-2 (OR 0.180, 95% CI 0.055-0.589), anti-TIF1-γ (OR 0.163, 95% CI 0.080-0.333), and anti-HMGCR (OR 0.058, 95% CI 0.007-0.451) were protective factors against developing ILD. Anti-TIF1-γ was an independent risk factor for cancer-associated myositis (OR 4.237, 95% CI 1.712-10.487). CONCLUSIONS PM/DM patients had high frequencies of MSAs. Several MSAs were independent factors in determining unique clinical phenotypes.
Collapse
|
26
|
Mira-Avendano I, Abril A, Burger CD, Dellaripa PF, Fischer A, Gotway MB, Lee AS, Lee JS, Matteson EL, Yi ES, Ryu JH. Interstitial Lung Disease and Other Pulmonary Manifestations in Connective Tissue Diseases. Mayo Clin Proc 2019; 94:309-325. [PMID: 30558827 DOI: 10.1016/j.mayocp.2018.09.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/24/2018] [Accepted: 09/17/2018] [Indexed: 12/22/2022]
Abstract
Lung involvement in connective tissue diseases is associated with substantial morbidity and mortality, most commonly in the form of interstitial lung disease, and can occur in any of these disorders. Patterns of interstitial lung disease in patients with connective tissue disease are similar to those seen in idiopathic interstitial pneumonias, such as idiopathic pulmonary fibrosis. It may be difficult to distinguish between the 2 ailments, particularly when interstitial lung disease presents before extrapulmonary manifestations of the underlying connective tissue disease. There are important clinical implications in achieving this distinction. Given the complexities inherent in the management of these patients, a multidisciplinary evaluation is needed to optimize the diagnostic process and management strategies. The aim of this article was to summarize an approach to diagnosis and management based on the opinion of experts on this topic.
Collapse
Affiliation(s)
- Isabel Mira-Avendano
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL.
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, FL
| | - Charles D Burger
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL
| | - Paul F Dellaripa
- Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Aryeh Fischer
- Department of Medicine, University of Colorado, Denver, Aurora, CO
| | - Michael B Gotway
- Division of Cardiothoracic Radiology, Mayo Clinic, Scottsdale, AZ
| | - Augustine S Lee
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL
| | - Joyce S Lee
- Department of Medicine, University of Colorado, Denver, Aurora, CO
| | - Eric L Matteson
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN
| | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
27
|
Hozumi H, Fujisawa T, Nakashima R, Yasui H, Suzuki Y, Kono M, Karayama M, Furuhashi K, Enomoto N, Inui N, Nakamura Y, Mimori T, Suda T. Efficacy of Glucocorticoids and Calcineurin Inhibitors for Anti-aminoacyl-tRNA Synthetase Antibody–positive Polymyositis/dermatomyositis–associated Interstitial Lung Disease: A Propensity Score–matched Analysis. J Rheumatol 2019; 46:509-517. [DOI: 10.3899/jrheum.180778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2018] [Indexed: 12/15/2022]
Abstract
Objective.The optimal treatment strategy for anti-aminoacyl-tRNA synthetase antibody–positive polymyositis/dermatomyositis-associated interstitial lung disease (anti-ARS-PM/DM-ILD) is yet to be established. We aimed to evaluate the efficacy of glucocorticoids and calcineurin inhibitors (CNI) in patients with ARS-PM/DM-ILD.Methods.Progression-free survival (PFS) and overall survival rates were retrospectively evaluated in 32 consecutive patients with ARS-PM/DM-ILD. Disease progression was defined as deterioration in PM/DM-ILD (including recurrence). Predictive factors associated with PFS were analyzed by Cox hazards analysis. The efficacy of first-line prednisolone (PSL) plus CNI therapy was compared with that of PSL monotherapy using propensity score–matched analysis.Results.Overall, 20 (62.5%) and 12 (37.5%) patients received first-line therapy with PSL + CNI and PSL, respectively. The 2-year PFS and 5-year survival rates in the overall cohort were 68.8% and 96.9%, respectively. On multivariate analysis, arterial oxygen pressure (HR 0.86) and PSL monotherapy (vs PSL + CNI; HR 7.29) showed an independent association with PFS. Baseline characteristics of propensity score-matched PSL + CNI and PSL groups were similar. The 2-year PFS rate was significantly higher in the matched PSL + CNI group than in the matched PSL group. All patients who experienced disease progression during first-line therapy were subsequently treated with second-line therapies. The 5-year survival rates of both the matched PSL + CNI and PSL groups were favorable.Conclusion.Propensity score–matched analysis demonstrated that first-line PSL + CNI therapy for patients with ARS-PM/DM-ILD significantly improved the PFS compared with PSL monotherapy, although there was no significant difference regarding longterm survival.
Collapse
|
28
|
Kamiya H, Panlaqui OM, Izumi S, Sozu T. Systematic review and meta-analysis of prognostic factors for idiopathic inflammatory myopathy-associated interstitial lung disease. BMJ Open 2018; 8:e023998. [PMID: 30559160 PMCID: PMC6303632 DOI: 10.1136/bmjopen-2018-023998] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To clarify prognostic factors for idiopathic inflammatory myopathy (IIM)-associated interstitial lung disease (ILD). DESIGN Systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation system. DATA SOURCES Medline, EMBASE and Science Citation Index Expanded were searched through 9 August 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES The review includes primary studies addressing all-cause mortality of IIM-associated ILD. Potential prognostic factors were any clinical information related to the outcome. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted relevant data independently and assessed risk of bias using the Quality in Prognostic Studies tool. Meta-analysis was conducted using a random effects model and if inappropriate the results were reported qualitatively. Prognostic factors were determined based on statistically significant results derived from multivariate analysis. RESULTS Of a total of 5892 articles returned, 32 were deemed eligible for analysis and cumulatively, these studies reported 28 potential prognostic factors for all-cause mortality. Each study was subject to certain methodological constraints. The four prognostic factors, which demonstrated statistically significant results on both univariate and multivariate analyses, were as follows: age (MD 5.90, 3.17-8.63/HR 1.06, 1.02-1.10 and 2.31, 1.06-5.06), acute/subacute interstitial pneumonia (A/SIP) (OR 4.85, 2.81-8.37/HR 4.23, 1.69-12.09 and 5.17, 1.94-13.49), percentage of predicted forced vital capacity (%FVC) (OR 0.96, 0.95-0.98/HR 0.96, 0.93-0.99) and anti-Jo-1 antibody (OR 0.35, 0.18-0.71/HR 0.004, 0.00003-0.54) (univariate/multivariate, 95% CI). Other prognostic factors included ground glass opacity/attenuation (GGO/GGA) and extent of radiological abnormality. The quality of the presented evidence was rated as either low or very low. CONCLUSIONS Older age, A/SIP, lower value of %FVC, GGO/GGA and extent of radiological abnormality were demonstrated to predict poor prognosis for IIM-associated ILD while a positive test for anti-Jo-1 antibody indicated better prognosis. However, given the weak evidence they should be interpreted with caution. TRIAL REGISTRATION NUMBER CRD42016036999.
Collapse
Affiliation(s)
- Hiroyuki Kamiya
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Ogee Mer Panlaqui
- Department of Intensive Care Medicine, Northern Hospital, Epping, Victoria, Australia
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takashi Sozu
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| |
Collapse
|
29
|
Affiliation(s)
- Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa Italy and Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Ingrid E. Lundberg
- Division of rheumatology, Department of Medicine, Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
30
|
Affiliation(s)
- Yoshinori Tanino
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Japan
| |
Collapse
|
31
|
The Association of Anti-Aminoacyl-Transfer Ribonucleic Acid Synthetase Antibodies in Patients With Rheumatoid Arthritis and Interstitial Lung Disease. Arch Rheumatol 2018; 33:26-32. [PMID: 29900970 DOI: 10.5606/archrheumatol.2018.6401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/15/2017] [Indexed: 12/31/2022] Open
Abstract
Objectives This study aims to analyze the distribution and clinicopathological characteristics of anti-aminoacyl-transfer ribonucleic acid (tRNA) synthetase (ARS) antibodies in rheumatoid arthritis patients. Patients and methods We retrospectively studied the anti-ARS antibody levels in 228 RA patients' (44 males, 184 females; mean age 62.9±14.0 years; range 23 to 88 years) sera from their medical charts. We determined the association with anti-cyclic citrullinated peptide antibody levels, interstitial lung disease (ILD), rheumatoid factor, and methotrexate or biological disease modifying antirheumatic drug treatments. Results Anti-ARS antibodies were detected in 14 RA patients (6.1%). ILD complications were significantly higher among anti-ARS antibody-positive patients (57.1% vs 22.4%, p<0.05). Levels of anti-threonyl-tRNA-synthetase (anti-PL-7) and anti-alanyl-tRNA-synthetase (anti-PL-12), two anti-ARS antibodies, were higher in RA patients with concurrent ILD (both p<0.05). Myositis and ILD worsening were not observed in three anti-ARS antibody- positive patients despite biological disease modifying antirheumatic drug administration. There was no difference in anti-cyclic citrullinated peptide and rheumatoid factor specificities between patients with or without ARS antibodies. Conclusion Anti-ARS antibodies were detected in RA patients, with higher prevalence in patients with concurrent ILD. RA patients, specifically those with ILD complications, should be tested for anti-ARS antibodies.
Collapse
|
32
|
Abstract
Inflammatory disorders of the skeletal muscle include polymyositis (PM), dermatomyositis (DM), (immune mediated) necrotizing myopathy (NM), overlap syndrome with myositis (overlap myositis, OM) including anti-synthetase syndrome (ASS), and inclusion body myositis (IBM). Whereas DM occurs in children and adults, all other forms of myositis mostly develop in middle aged individuals. Apart from a slowly progressive, chronic disease course in IBM, patients with myositis typically present with a subacute onset of weakness of arms and legs, often associated with pain and clearly elevated creatine kinase in the serum. PM, DM and most patients with NM and OM usually respond to immunosuppressive therapy, whereas IBM is largely refractory to treatment. The diagnosis of myositis requires careful and combinatorial assessment of (1) clinical symptoms including pattern of weakness and paraclinical tests such as MRI of the muscle and electromyography (EMG), (2) broad analysis of auto-antibodies associated with myositis, and (3) detailed histopathological work-up of a skeletal muscle biopsy. This review provides a comprehensive overview of the current classification, diagnostic pathway, treatment regimen and pathomechanistic understanding of myositis.
Collapse
Affiliation(s)
- Jens Schmidt
- Department of Neurology, Muscle Immunobiology Group, Neuromuscular Center, University Medical Center Göttingen, Göttingen, Germany,Correspondence to: Prof. Dr. Jens Schmidt, MD, FEAN, FAAN, Muscle Immunobiology Group, Neuromuscular Center, Department of Neurology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Tel.: +49 551 39 22355; Fax: +49 551 39 8405; E-mail:
| |
Collapse
|
33
|
Doyle TJ, Dhillon N, Madan R, Cabral F, Fletcher EA, Koontz DC, Aggarwal R, Osorio JC, Rosas IO, Oddis CV, Dellaripa PF. Rituximab in the Treatment of Interstitial Lung Disease Associated with Antisynthetase Syndrome: A Multicenter Retrospective Case Review. J Rheumatol 2018; 45:841-850. [PMID: 29606668 DOI: 10.3899/jrheum.170541] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess clinical outcomes including imaging findings on computed tomography (CT), pulmonary function testing (PFT), and glucocorticoid (GC) use in patients with the antisynthetase syndrome (AS) and interstitial lung disease (ILD) treated with rituximab (RTX). METHODS We retrospectively identified all patients at 2 institutions with AS-ILD who were treated with RTX. Baseline demographics, PFT, and chest CT were assessed before and after RTX. Two radiologists independently evaluated CT using a standardized scoring system. RESULTS Twenty-five subjects at the Brigham and Women's Hospital (n = 13) and University of Pittsburgh Medical Center (n = 12) were included. Antisynthetase antibodies were identified in all patients (16 Jo1, 6 PL-12, 3 PL-7). In 21 cases (84%), the principal indication for RTX use was recurrent or progressive ILD, owing to failure of other agents. Comparing pre- and post-RTX pulmonary variables at 12 months, CT score and forced vital capacity were stable or improved in 88% and 79% of subjects, respectively. Total lung capacity (%) increased from 56 ± 13 to 64 ± 13 and GC dose decreased from 18 ± 9 to 12 ± 12 mg/day. Although DLCO (%) declined slightly at 1 year, it increased from 42 ± 17 to 70 ± 20 at 3 years. The most common imaging patterns on CT were nonspecific interstitial pneumonia (NSIP; n = 13) and usual interstitial pneumonia/fibrotic NSIP (n = 5), of which 5 had concurrent elements of cryptogenic organizing pneumonia. CONCLUSION Stability or improvement in pulmonary function or severity of ILD on CT was seen in most patients. Use of RTX was well tolerated in the majority of patients. RTX may play a therapeutic role in patients with AS-ILD, and further clinical investigation is warranted.
Collapse
Affiliation(s)
- Tracy J Doyle
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Namrata Dhillon
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Rachna Madan
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Fernanda Cabral
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Elaine A Fletcher
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Diane C Koontz
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Rohit Aggarwal
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Juan C Osorio
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Ivan O Rosas
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Chester V Oddis
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Paul F Dellaripa
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. .,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital.
| |
Collapse
|
34
|
Esposito ACC, Gige TC, Miot HA. Syndrome in question: antisynthetase syndrome (anti-PL-7). An Bras Dermatol 2017; 91:683-685. [PMID: 27828653 PMCID: PMC5087238 DOI: 10.1590/abd1806-4841.20164449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/22/2015] [Indexed: 11/22/2022] Open
Abstract
Antisynthetase syndrome is a rare autoimmune disease characterized by
interstitial lung disease and/or inflammatory myositis, with positive
antisynthetase antibodies (anti-Jo-1, anti-PL-7, anti-PL-12, ZO, OJ, anti-KE or
KS). Other symptoms described include: non-erosive arthritis, fever, Raynaud's
phenomenon, and "mechanic's hands." The first therapeutic option is
corticotherapy, followed by other immunosuppressants. The prognosis of the
disease is quite limited when compared to other inflammatory myopathies with
negative antisynthetase antibodies.
Collapse
Affiliation(s)
| | - Tatiana Cristina Gige
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Botucatu, SP, Brazil
| | - Hélio Amante Miot
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Botucatu, SP, Brazil
| |
Collapse
|
35
|
Síndrome por anticuerpos antisintetasa. Multidisciplinariedad y compromiso. Med Clin (Barc) 2017; 148:164-165. [DOI: 10.1016/j.medcli.2016.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/01/2016] [Indexed: 11/22/2022]
|
36
|
Management of connective tissue diseases associated interstitial lung disease: a review of the published literature. Curr Opin Rheumatol 2016; 28:236-45. [PMID: 27027811 DOI: 10.1097/bor.0000000000000270] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Interstitial lung disease (ILD), though a common and often a severe manifestation of many connective tissue diseases (CTD), is challenging to manage because of its variable presentation and the relative lack of guidelines to assist the clinician. In this review, we discuss the approach to diagnosis, treatment, and monitoring patients with CTD-associated ILD, with a focus on systemic sclerosis (SSc), rheumatoid arthritis (RA), and idiopathic inflammatory myopathy (IIM). RECENT FINDINGS High-resolution computed tomography scan and pulmonary function testing can be reliably used to diagnose ILD and monitor progression, and often to determine its likely histologic subtype and severity. In SSc-ILD, randomized controlled trials show ILD stabilization with cyclophosphamide treatment; preliminary data from another randomized controlled trial demonstrates similar findings with mycophenolate. There are no robust clinical trials supporting specific treatments for RA-ILD or IIM-ILD, but rituximab in RA-ILD, and cyclophosphamide, mycophenolate and calcineurin inhibitors in IIM-ILD show promise. SUMMARY Though ILD contributes substantially to morbidity and mortality in patients with CTD, there are minimal data to guide its management except in SSc-ILD.
Collapse
|
37
|
Aggarwal R, Dhillon N, Fertig N, Koontz D, Qi Z, Oddis CV. A Negative Antinuclear Antibody Does Not Indicate Autoantibody Negativity in Myositis: Role of Anticytoplasmic Antibody as a Screening Test for Antisynthetase Syndrome. J Rheumatol 2016; 44:223-229. [DOI: 10.3899/jrheum.160618] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the utility of anticytoplasmic autoantibody (anti-CytAb) in antisynthetase antibody–positive (anti-SynAb+) patients.Methods.Anti-SynAb+ patients were evaluated for antinuclear antibody (ANA) and anti-CytAb [cytoplasmic staining on indirect immunofluorescence (IIF)] positivity. Anti-SynAb+ patients included those possessing anti-Jo1 and other antisynthetase autoantibodies. Control groups included scleroderma, systemic lupus erythematosus, Sjögren syndrome, rheumatoid arthritis, and healthy subjects. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy of anti-CytAb, and ANA were assessed. Anti-CytAb and ANA testing was done by IIF on human epithelial cell line 2, both reported on each serum sample without knowledge of the clinical diagnosis or final anti-SynAb results.Results.Anti-SynAb+ patients (n = 202; Jo1, n = 122; non-Jo1, n = 80) between 1985–2013 with available serum samples were assessed. Anti-CytAb showed high sensitivity (72%), specificity (89%), NPV (95%), and accuracy (86%), but only modest PPV (54%) for anti-SynAb positivity. In contrast, ANA showed only modest sensitivity (50%) and poor specificity (6%), PPV (9%), NPV (41%), and accuracy (12%). Positive anti-CytAb was significantly greater in the anti-SynAb+ patients than ANA positivity (72% vs 50%, p < 0.001), and 81/99 (82%) ANA-negative patients in the anti-SynAb+ cohort had positive anti-CytAb. In contrast, the control groups showed high rates for ANA positivity (93.5%), but very low rates for anti-CytAb positivity (11.5%). Combining anti-CytAb or Jo1 positivity showed high sensitivity (92%) and specificity (89%) for identification of anti-SynAb+ patients.Conclusion.Assessing patients for anti-CytAb serves as an excellent screen for anti-SynAb+ patients using simple IIF. Cytoplasmic staining should be assessed and reported for patients suspected of having antisynthetase syndrome and a negative ANA should not be used to exclude this diagnosis.
Collapse
|
38
|
Zamora AC, Hoskote SS, Abascal-Bolado B, White D, Cox CW, Ryu JH, Moua T. Clinical features and outcomes of interstitial lung disease in anti-Jo-1 positive antisynthetase syndrome. Respir Med 2016; 118:39-45. [PMID: 27578469 DOI: 10.1016/j.rmed.2016.07.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 06/28/2016] [Accepted: 07/12/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Interstitial lung disease (ILD) is a common extra-muscular manifestation of antisynthetase (AS) syndrome. ILD prevalence is higher with anti-Jo-1 antibody positivity. Data on long-term outcomes in these patients are lacking. METHODS Over 15 years, we identified subjects with anti-Jo-1 positive AS syndrome and ILD. Demographics, pulmonary function testing (PFT), high-resolution computed tomography (HRCT), histopathology, and long-term survival were analyzed. RESULTS We identified 103 subjects (mean age 49.2 years, female predominance [70%]). The predominant myopathy was polymyositis (64%) followed by dermatomyositis (24%). In approximately half of studied subjects, AS syndrome and ILD were diagnosed within 6 months of each other. The majority had restriction on PFTs (98%). Non-specific interstitial pneumonia (NSIP) was the most common HRCT pattern (52%), followed by NSIP overlapping with organizing pneumonia (OP) (22%). Thirty-nine subjects had biopsy data. Ten-year survival was 68%. Multivariable analysis adjusted for age at ILD diagnosis, gender, FVC and DLCO, revealed that male gender (HR = 2.60, p = 0.04) and DLCO at presentation (HR = 0.94, p = 0.05) significantly predicted mortality. CONCLUSIONS We present a large cohort of anti-Jo-1 positive AS syndrome with ILD and note good overall survival.
Collapse
Affiliation(s)
- Ana C Zamora
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sumedh S Hoskote
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Beatriz Abascal-Bolado
- Division of Pulmonary Medicine, Instituto de Investigacion Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Darin White
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
39
|
Andersson H, Aaløkken TM, Günther A, Mynarek GK, Garen T, Lund MB, Molberg Ø. Pulmonary Involvement in the Antisynthetase Syndrome: A Comparative Cross-sectional Study. J Rheumatol 2016; 43:1107-13. [DOI: 10.3899/jrheum.151067] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 01/09/2023]
Abstract
Objective.Interstitial lung disease (ILD) is a major component of the antisynthetase syndrome, but quantitative data on longterm pulmonary outcome in antisynthetase syndrome are limited. In this study, the main aims were to compare pulmonary function tests (PFT) and the 6-min walking distance (6MWD) between patients with antisynthetase syndrome and healthy sex- and age-matched controls, to evaluate the extent of ILD by lung high-resolution computed tomography (HRCT), and to assess correlations between PFT measures and ILD extent.Methods.Concurrent PFT and 6MWD were performed in 68 patients with antisynthetase syndrome and their individually matched controls. Additionally, in the patients, the extent of ILD was determined in 10 HRCT sections, expressed as percentage of total lung volumes.Results.Median disease duration in the antisynthetase syndrome cohort was 71 months. Compared with the matched controls, the patients with antisynthetase syndrome had mean 28%, 27%, and 53% lower absolute values of forced vital capacity (FVC), forced expiratory volume in 1 s, and DLCO (p < 0.001). Mean difference in 6MWD between patients and controls was 116 m (p < 0.001). Median extent of ILD by HRCT was 20% (range 0–73) and correlated with FVC and DLCO. Pulmonary outcome did not differ between Jo1 and non-Jo1 subsets.Conclusion.To our knowledge, this study is the first to demonstrate a highly significant difference in PFT between patients with antisynthetase syndrome with 6 years of followup and healthy controls. DLCO displayed the highest difference with mean 53% lower value in the patients. FVC and DLCO correlated significantly with ILD extent, indicating these variables as appropriate outcome measures in antisynthetase syndrome–associated ILD.
Collapse
|
40
|
Abstract
In common rheumatologic diseases skin findings are an important diagnostic clue for astute clinicians. Skin manifestations can help identify systemic disease or may require therapy uniquely targeted at the cutaneous problem. This article discusses 3 common rheumatologic conditions seen in adults by dermatologists: cutaneous lupus, dermatomyositis, and morphea. The focus is on the cutaneous findings and clinical presentation. Some approaches to treatment are explored. Clues to help identify systemic disease are also highlighted.
Collapse
Affiliation(s)
- Andrea Kalus
- Dermatology Division, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98115, USA.
| |
Collapse
|
41
|
|
42
|
Kawasumi H, Gono T, Kawaguchi Y, Yamanaka H. Recent Treatment of Interstitial Lung Disease with Idiopathic Inflammatory Myopathies. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2015; 9:9-17. [PMID: 26279636 PMCID: PMC4514184 DOI: 10.4137/ccrpm.s23313] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/01/2015] [Accepted: 06/13/2015] [Indexed: 01/16/2023]
Abstract
Interstitial lung disease (ILD) is a prognostic factor for poor outcome in polymyositis (PM)/dermatomyositis (DM). The appropriate management of ILD is very important to improve the prognosis of patients with PM/DM. ILD activity and severity depend on the disease subtype. Therefore, clinicians should determine therapeutic strategies according to the disease subtype in each patient with PM/DM. Anti-melanoma differentiation-associated gene 5 antibody and hyperferritinemia predict the development and severity of rapidly progressive (RP) ILD, particularly in East Asian patients. Combination therapy with corticosteroids, intravenous cyclophosphamide pulse, and calcineurin inhibitors should be administered in RP-ILD. In contrast, patients with anti-aminoacyl-tRNA synthetase (ARS) show better responses to corticosteroids alone. However, ILDs with anti-ARS often display disease recurrence or become refractory to corticosteroid monotherapy. Recent studies have demonstrated that the administration of tacrolimus or rituximab in addition to corticosteroids may be considered in ILD patients with anti-ARS. Large-scale, multicenter randomized clinical trials should be conducted in the future to confirm that the aforementioned agents exhibit efficacy in ILD patients with PM/DM. The pathophysiology of ILD with PM/DM should also be elucidated in greater detail to develop effective therapeutic strategies for patients with ILD in PM/DM.
Collapse
Affiliation(s)
- Hidenaga Kawasumi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahisa Gono
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasushi Kawaguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
43
|
Ohkubo H, Fukumitsu K, Niimi A. Refractory Interstitial Lung Disease of Dermatomyositis: A Proposal for a Prospective Trial for Establishing Evidence. Intern Med 2015; 54:2099-100. [PMID: 26328631 DOI: 10.2169/internalmedicine.54.5035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | | | | |
Collapse
|