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Ioan A, Farkas OM, Cochino AV. Factors Associated With Complete Clinical Response and Remission in a Cohort of Romanian Children With Juvenile Dermatomyositis. J Clin Rheumatol 2024; 30:247-250. [PMID: 38753166 DOI: 10.1097/rhu.0000000000002092] [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: 08/22/2024]
Abstract
OBJECTIVES To describe a Romanian cohort of patients with juvenile dermatomyositis (JDM) and to identify factors associated with disease severity, complete clinical response, and sustained remission. METHODS We retrospectively reviewed data from 30 JDM patients from 2013 to 2022. The inactive disease state was defined as no active skin rash, muscle weakness, or elevated muscle enzymes. A complete clinical response implied a status of inactive disease maintained for six consecutive months while on medication and remission of inactive disease for at least six consecutive months after treatment. Association factors and predictors of time to complete clinical response and time to remission emerged from bivariate correlation (Pearson's coefficient) and univariate survival analysis (Kaplan-Meier analysis). RESULTS The median times to complete clinical response and time to remission for the entire cohort were 30.5 months (2.5 years) and 48.5 months (4.04 years), respectively. Nine patients (30%) had a severe disease course, while twenty-one patients (70%) had a mild/moderate course. The presence of calcinosis, time to corticosteroid discontinuation, history of treatment escalation in the first 18 months, and treatment with azathioprine or biologic DMARDs were strongly associated with a longer time to clinical remission (Pearson's > 0.5, p < 0.05). Seven patients (23%) achieved remission, and none of them relapsed during the subsequent median follow-up of 19 months.
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Affiliation(s)
- Andreea Ioan
- From the Department of Allergology and Clinical Immunology, National Institute for Mother and Child Health Alessandrescu-Rusescu
| | - Oana M Farkas
- From the Department of Allergology and Clinical Immunology, National Institute for Mother and Child Health Alessandrescu-Rusescu
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Sudoł-Szopińska I, Lanckoroński M, Diekhoff T, Ključevšek D, Del Grande F, Doria A. Update on MRI in Rheumatic Diseases. Radiol Clin North Am 2024; 62:821-836. [PMID: 39059974 DOI: 10.1016/j.rcl.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Over the past decade, MRI has significantly advanced the diagnosis of rheumatic disease in both adults and juveniles. In this article, the authors present an update on MRI applications in rheumatology, based on a review of the most recent publications. New developments in adults related to, among others, axial spondyloarthritis, peripheral arthritis, and the whole body-MRI (WB-MRI) are presented. In juveniles, this update addresses the latest advancements in diagnostic MRI of peripheral joints, followed by MRI of the axial skeleton and implementation of the WB-MRI for the screening of inflammation. The authors also discuss topics of interest concerning contrast-enhanced MRI examinations in children.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
| | - Michał Lanckoroński
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Slovenia
| | - Filippo Del Grande
- Clinica di Radiologia EOC, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Ospedale Civico via Tesserete 47, Lugano-Ti 6900, Switzerland
| | - Andrea Doria
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children; Department of Medical Imaging, University of Toronto, Toronto, Canada
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Joseph AJ, Dhakal B, Erla SR, Singh Y, Singh L, Upadhyay AD, Bagri NK, Lodha R, Kabra SK. Prevalence and Clinical Implications of Autoantibodies in Juvenile Dermatomyositis: A Single-Center Experience From India. J Clin Rheumatol 2024:00124743-990000000-00240. [PMID: 39167787 DOI: 10.1097/rhu.0000000000002127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
OBJECTIVE This study aimed to characterize the profile of myositis-specific and myositis-associated autoantibodies (MSAs/MAAs) in an Indian cohort of juvenile dermatomyositis (JDM) patients and correlate them with clinical features and outcomes. METHODS Forty-three children diagnosed with JDM were enrolled for this observational study. Clinical details (presentation, course, and outcome) were noted in a predesigned proforma. Serum samples were tested for 16 MSAs/MAAs by line immunoassay. MSAs/MAAs were correlated with clinical features and outcome (defined as a complete clinical response [≥6 months' disease inactivity on medication] or complete remission [≥6 months' inactivity off all drugs]). RESULTS Thirty-five subjects (81.4%) had at least 1 MSA/MAA detected. The most common antibodies were anti-NXP2 (n = 13, 30.2%), anti-TIF1γ (n = 10, 23.2%), and anti-MDA-5 (n = 8, 18.6%). No patient had anti-Ku, anti-Pm Scl-100, anti-PL-12, anti-EJ, anti-OJ, or anti-Ro52. Thirty-two patients (74.4%) attained a complete clinical response over a median follow-up duration of 14 months, among which 6 (13.9%) achieved complete remission over a median follow-up duration of 30 months. Anti-TIF1γ was associated with younger age at onset (≤3 years) (odds ratio [OR], 6.25; 95% confidence interval [CI], 1.15-34.12; p = 0.034) and disease flares after attaining complete response (OR, 10.18; 95% CI, 1.64-70.93; p = 0.013). Patients with anti-NXP2 had higher odds of severe muscular weakness (OR, 3.73; 95% CI, 0.95-14.59; p = 0.058) and truncal weakness (OR, 3.89; 95% CI, 0.97-15.64; p = 0.056). One child with anti-MDA-5 positivity had interstitial lung disease. We found no association between the MSA/MAA profile and the achievement of complete clinical response or remission. CONCLUSIONS MSAs/MAAs were identified in 81% of children with JDM in our study, which is higher than most other studies. The most frequently observed antibodies displayed a pattern consistent with other studies. Anti-TIF1γ was associated with a younger age at onset and disease flares even after attaining a complete clinical response. Anti-NXP2 had higher odds of severe muscular weakness. These observations suggest consistency in certain phenotypic associations observed across geographic boundaries.
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Affiliation(s)
| | - Baehat Dhakal
- From the All-India Institute of Medical Sciences and
| | | | | | | | - Ashish D Upadhyay
- Central Research Unit, All-India Institute of Medical Sciences, New Delhi, India
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Carriquí-Arenas S, Mosquera JM, Quesada-Masachs E, López M, Clemente D, Boteanu A, Udaondo C, de Inocencio J, Nieto JC, Riancho L, Núñez E, Sánchez-Manubens J, Lirola MJ, Roldán R, Camacho M, Martínez M, Medrano M, Alcañiz P, Antón J, Iglesias E. Clinical characteristics and prognostic factor in juvenile dermatomyositis: data of the Spanish registry. Pediatr Rheumatol Online J 2024; 22:66. [PMID: 39039532 PMCID: PMC11265073 DOI: 10.1186/s12969-024-00999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/16/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Juvenile Dermatomyositis (JDM) is the most common chronic idiopathic inflammatory myopathy in children. The diagnosis is clinical. Baseline laboratory and complementary studies trace the phenotype of these patients. The objective of this study was to describe epidemiological, clinical and laboratory characteristics at diagnosis of JDM patients included in the Spanish JDM registry, as well as to identify prognostic factors on these patients. METHODS We retrospectively reviewed clinical features, laboratory tests, and complementary studies at diagnosis of JDM patients included on the Spanish JDM registry. These data were analyzed to assess whether there was a relationship with the development of complications and time to disease inactivity. RESULTS One hundred and sixteen patients from 17 Spanish paediatric rheumatology centres were included, 76 girls (65%). Median age at diagnosis was 7.3 years (Interquartile range (IQR) 4.5-10.2). All patients had pathognomonic skin lesions at the beginning of the disease. Muscle weakness was present in 86.2%. Median Childhood Muscle Assessment Scale was 34 (IQR 22-47). Twelve patients (34%) had dysphagia and 3,5% dysphonia. Anti-p155 was the most frequently detected myositis specific antibody, followed by anti-MDA5. Twenty-nine patients developed calcinosis and 4 presented with macrophage activation syndrome. 70% reached inactivity in a median time of 8.9 months (IQR 4.5-34.8). 41% relapsed after a median time of 14.4 months (IQR 8.6-22.8) of inactivity. Shorter time to treatment was associated with better prognosis (Hazard ratio (HR) = 0.95 per month of evolution, p = 0.02). Heliotrope rash at diagnosis correlates with higher risk of development complications. CONCLUSIONS We describe heliotrope rash as a risk factor for developing complications in our cohort of JDM patients, an easy-to-evaluate clinical sign that could help us to identify the group of patients we should monitor closely for this complication.
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Affiliation(s)
- Sonia Carriquí-Arenas
- Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain.
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
| | - Juan Manuel Mosquera
- Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Estefanía Quesada-Masachs
- Rheumatology Department, Pediatric Rheumatology Unit, Vall d'Hebron University Hospital, Barcelona Hospital Campus, Barcelona, Spain
| | - Mireia López
- Rheumatology Department, Pediatric Rheumatology Unit, Vall d'Hebron University Hospital, Barcelona Hospital Campus, Barcelona, Spain
| | - Daniel Clemente
- Pediatric Rheumatology Unit, Niño Jesús Hospital, Madrid, Spain
| | - Alina Boteanu
- Rheumatology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Clara Udaondo
- Pediatric Rheumatology Unit, La Paz University Children's Hospital, CIBERINFEC (CIBER research network, Carlos III research institute), Madrid, Spain
| | - Jaime de Inocencio
- Pediatric Rheumatology Unit, University Hospital 12 de octubre, Madrid, Spain
- Pediatrics Complutense, University of Madrid, Madrid, Spain
| | - Juan Carlos Nieto
- Rheumatology Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Leyre Riancho
- Rheumatology Department, Valdecilla Hospital, Santander, Spain
| | - Esmeralda Núñez
- Pediatric Rheumatology Unit, Pediatric Unit. Maternal and Child Hospital, Regional University Hospital of Malaga, Málaga, Spain
| | - Judith Sánchez-Manubens
- Pediatric Rheumatology Unit, Pediatric Department, Parc Taulí University Hospital, Sabadell, Spain
- Investigation and innovation Institute I3PT, University Autónoma, Barcelona, Spain
| | - María José Lirola
- Pediatric, Universtiy Hospital Macarena. IHP Group (Hispalense Institute of Pediatrics), Sevilla, Spain
| | - Rosa Roldán
- Pediatric Rheumatology Unit, Rheumatology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - Marisol Camacho
- Pediatric Rheumatology Unit, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Melania Martínez
- Rheumatology Department, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Marta Medrano
- Rheumatology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Paula Alcañiz
- Pediatra. Pediatric Rheumatology Unit, Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain
| | - Jordi Antón
- Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Universitat de Barcelona (UB), Barcelona, Spain
| | - Estíbaliz Iglesias
- Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
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Tarvin SE, Sherman MA, Kim H, Balmuri N, Brown AG, Chow A, Gewanter HL, de Guzman MM, Huber AM, Kim S, Klein-Gitelman MS, Perron MM, Robinson AB, Sabbagh SE, Savani S, Shenoi S, Spitznagle J, Stingl C, Syverson G, Tory H, Spencer C. Childhood Arthritis and Rheumatology Research Alliance Biologic Disease-Modifying Antirheumatic Drug Consensus Treatment Plans for Refractory Moderately Severe Juvenile Dermatomyositis. Arthritis Care Res (Hoboken) 2024. [PMID: 38937134 DOI: 10.1002/acr.25393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/04/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE The objective was to develop consensus treatment plans (CTPs) for patients with refractory moderately severe juvenile dermatomyositis (JDM) treated with biologic disease-modifying antirheumatic drugs (bDMARDs). METHODS The Biologics Workgroup of the Childhood Arthritis and Rheumatology Research Alliance JDM Research Committee used case-based surveys, consensus framework, and nominal group technique to produce bDMARD CTPs for patients with refractory moderately severe JDM. RESULTS Four bDMARD CTPs were proposed: tumor necrosis factor α (TNFα) inhibitor (adalimumab or infliximab), abatacept, rituximab, and tocilizumab. Each CTP has different options for dosing and/or route. Among 76 respondents, consensus was achieved for the proposed CTPs (93% [67 of 72]) as well as for patient characteristics, assessments, outcome measures, and follow-up. By weighted average, respondents indicated that they would most likely administer rituximab, followed by abatacept, TNFα inhibitor, and tocilizumab. CONCLUSION CTPs for the administration of bDMARDs in refractory moderately severe JDM were developed using consensus methodology. The implementation of the bDMARD CTPs will lay the groundwork for registry-based prospective comparative effectiveness studies.
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Affiliation(s)
| | - Matthew A Sherman
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Hanna Kim
- National Institute of Arthritis Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | - Amanda G Brown
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock
| | - Albert Chow
- Loma Linda Children's Hospital, Loma Linda, California
| | - Harry L Gewanter
- Children's Hospital of Richmond at Virginia Commonwealth University Health
| | | | - Adam M Huber
- IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan Kim
- University of California, San Francisco
| | - Marisa S Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | - Sonia Savani
- Medical University of South Carolina, Charleston
| | - Susan Shenoi
- University of Washington and Seattle Children's Hospital and Research Center, Seattle
| | - Jacob Spitznagle
- University of Washington and Seattle Children's Hospital and Research Center, Seattle
| | | | | | - Heather Tory
- Connecticut Children's Medical Center, Hartford, and University of Connecticut School of Medicine, Farmington
| | - Charles Spencer
- Batson Children's Hospital, University of Mississippi Medical Center, Jackson
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Sener S, Cam V, Ozen S, Batu ED. Treatment with Janus kinase inhibitors in juvenile dermatomyositis: A review of the literature. Semin Arthritis Rheum 2024; 66:152426. [PMID: 38442462 DOI: 10.1016/j.semarthrit.2024.152426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND/OBJECTIVES Janus kinase (JAK) inhibitors have been increasingly used in the treatment of juvenile dermatomyositis (JDM). This review aims to comprehensively analyze previous studies concerning the utilization of JAK inhibitors in JDM patients. METHODS We conducted a thorough review of MEDLINE and Scopus databases, spanning from their inception to September 1st, 2023, to identify articles involving JDM patients treated with JAK inhibitors. RESULTS Our literature search yielded 26 articles that encompassed 195 patients with JDM who received JAK inhibitors. The median (min-max) age of the patients was 4.9 (1-17) years (F/M:1.2). The most frequently used JAK inhibitor was tofacitinib (57.4 %), and improvement was achieved in 89.7 % of patients treated with tofacitinib. The improvement rate for ruxolitinib, which was the second most frequently used JAK inhibitor (27.2 %), was 69.2 %. For baricitinib (15.4 %), the improvement rate was 92.7 %. The most prevalent indication for JAK inhibitor use was resistant/recurrent skin involvement (34.7 %) followed by resistant/recurrent muscle involvement (28.6 %). Adverse events were reported in 72.1 % of the patients; an increase in infections (especially upper respiratory tract infections) was the most common side effect. CONCLUSION Our findings suggest that JAK inhibitors may be a good therapeutic option, particularly in the management of refractory JDM cases with an acceptable safety profile. However, further controlled studies are essential to establish a higher level of evidence for the optimal use of JAK inhibitors in JDM treatment.
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Affiliation(s)
- Seher Sener
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | - Veysel Cam
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | - Seza Ozen
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | - Ezgi Deniz Batu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey.
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Sherman MA, Farhadi PN, Pak K, Trieu EP, Sarkar K, Targoff IN, Neely ML, Mammen AL, Rider LG. Myositis-Associated Autoantibodies in Patients With Juvenile Myositis Are Associated With Refractory Disease and Mortality. Arthritis Rheumatol 2024; 76:963-972. [PMID: 38272842 PMCID: PMC11136598 DOI: 10.1002/art.42813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Myositis-associated autoantibodies (MAAs) have been associated with overlap myositis, certain disease manifestations such as interstitial lung disease (ILD), and worse prognosis in the idiopathic inflammatory myopathies. MAAs overall remain largely uncharacterized in patients with juvenile-onset myositis. Moreover, it is unknown whether the number of MAAs is associated with disease severity. METHODS Patients with juvenile myositis in cross-sectional natural history studies who underwent testing for myositis autoantibodies were included. Demographics, myositis autoantibodies, clinical characteristics, medications received, and outcomes of those with and without MAAs were compared. Multivariable logistic regression was performed to determine whether the number of MAAs detected was associated with severe disease features. RESULTS Among 551 patients, 36% had an MAA and 13% had more than one MAA. Among those who were MAA positive, there was a higher frequency of overlap myositis (18% vs 5.9%, P < 0.001). MAA positivity was associated with certain clinical features, including Raynaud phenomenon (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.41-4.28) and ILD (OR 3.43, 95% CI 1.75-6.96), as well as a chronic disease course (OR 1.72, 95% CI 1.10-2.72) and mortality (OR 3.76, 95% CI 1.72-8.43). The number of MAAs was also associated with mortality (OR 1.83, 95% CI 1.16-2.86). CONCLUSION MAAs were prevalent in a large cohort of patients with juvenile myositis. ILD, refractory disease, and mortality were associated with MAA positivity. Prospective studies are needed to determine whether early detection of MAAs may lead to improved outcomes for patients with juvenile myositis.
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Affiliation(s)
- Matthew A. Sherman
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Payam Noroozi Farhadi
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Katherine Pak
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Edward P. Trieu
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Kakali Sarkar
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Ira N. Targoff
- Veterans Affairs Medical Center, University of Oklahoma Health Sciences Center, and Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Megan L. Neely
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Andrew L. Mammen
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa G. Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
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Schapiro AH, Morin CE, Wikenheiser-Brokamp KA, Tanimoto AA. Connective tissue disease-associated lung disease in children. Pediatr Radiol 2024; 54:1059-1074. [PMID: 38850285 PMCID: PMC11182853 DOI: 10.1007/s00247-024-05962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/10/2024]
Abstract
Connective tissue diseases are a heterogeneous group of autoimmune diseases that can affect a variety of organ systems. Lung parenchymal involvement is an important contributor to morbidity and mortality in children with connective tissue disease. Connective tissue disease-associated lung disease in children often manifests as one of several radiologic-pathologic patterns of disease, with certain patterns having a propensity to occur in association with certain connective tissue diseases. In this article, key clinical, histopathologic, and computed tomography (CT) features of typical patterns of connective tissue disease-associated lung disease in children are reviewed, with an emphasis on radiologic-pathologic correlation, to improve recognition of these patterns of lung disease at CT and to empower the pediatric radiologist to more fully contribute to the care of pediatric patients with these conditions.
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Affiliation(s)
- Andrew H Schapiro
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kathryn A Wikenheiser-Brokamp
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pathology & Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- The Perinatal Institute Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aki A Tanimoto
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Yokoyama T, Inoue N, Sakumura N, Tasaki Y, Wada T. An Adolescent Case of Anti-MDA5 Antibody-Positive Juvenile Dermatomyositis With Interstitial Lung Disease Successfully Treated by Multitarget Therapy Avoiding Cyclophosphamide: A Case Report and Literature Review. Cureus 2024; 16:e62425. [PMID: 39011211 PMCID: PMC11249054 DOI: 10.7759/cureus.62425] [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: 06/15/2024] [Indexed: 07/17/2024] Open
Abstract
Juvenile dermatomyositis (JDM) patients who test positive for the antimelanoma differentiation-associated gene 5 (MDA5) antibody have a poor prognosis because of rapidly progressing interstitial lung disease (ILD). However, agreement on the best treatment for this condition remains elusive. We encountered a 13-year-old girl with anti-MDA5 antibody-positive JDM who presented with arthritis and was already showing signs of ILD when she was admitted to the hospital. While cyclophosphamide (CY) is commonly used, it can cause gonadal disorders and other complications when administered to adolescent females. Consequently, we chose multitarget therapy, which includes tacrolimus and mycophenolate mofetil. Her ILD and skin symptoms gradually improved, and she was able to maintain remission and avoid CY administration for three years. We conducted a thorough literature review to determine the efficacy and safety of multitarget therapy for anti-MDA5 antibody-positive DM and JDM. Multitarget therapy shows promise as a potentially effective and relatively safe treatment. The ability to avoid CY, which is especially important for adolescent patients concerned about fertility preservation, highlights a significant benefit of this multitarget therapy for anti-MDA5 antibody-positive DM and JDM patients.
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Affiliation(s)
| | - Natsumi Inoue
- Department of Pediatrics, Kanazawa University, Ishikawa, JPN
| | - Naoto Sakumura
- Department of Pediatrics, Kanazawa University, Ishikawa, JPN
| | - Yuko Tasaki
- Department of Pediatrics, Kanazawa University, Ishikawa, JPN
| | - Taizo Wada
- Department of Pediatrics, Kanazawa University, Ishikawa, JPN
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Huang B, Li H, Jiang Q, Li Y, Jiang Z, Cao H, Wang S, Wang X, Li J, Li G. Elevated type I IFN signalling directly affects CD8 + T-cell distribution and autoantigen recognition of the skeletal muscles in active JDM patients. J Autoimmun 2024; 146:103232. [PMID: 38692172 DOI: 10.1016/j.jaut.2024.103232] [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: 09/29/2023] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
The link between type I IFN and adaptive immunity, especially T-cell immunity, in JDM still remained largely unclear. This study aimed to understand the effect of elevated type I IFN signaling on CD8+ T cell-associated muscle damage in juvenile dermatomyositis (JDM). This study used flow cytometry (FC) and RT‒PCR were used to examine the circulating cell ratio and type I IFN response. And scRNA-seq was used to examine peripheral immunity in 6 active JDM patients, 3 stable JDM patients, 3 juvenile IMNM patients and 3 age-matched healthy children. In vivo validation experiments were conducted using a mouse model induced by STING agonists and an experimental autoimmune myositis model (EAM). In vitro experiments were conducted using isolated CD8+ T-cells from JDM patients and mice. We found that active JDM patients showed an extensive type I IFN response and a decreased CD8+ T-cell ratio in the periphery (P < 0.05), which was correlated with muscle involvement (P < 0.05). Both new active JDM patients and all active JDM patients showed decreased CD8+ TCM cell ratios compared with age and gender matched stable JDM patients (P < 0.05). Compared with new pediatirc systemic lupus erythematosus (SLE) patients, new active JDM patients displayed decreased CD8+ T-cell and CD8+ TCM cell ratios (P < 0.05). Active JDM patient skeletal muscle biopsies displayed an elevated type I IFN response, upregulated MHC-I expression and CD8+ T-cell infiltration, which was validated in EAM mice. sc-RNAseq demonstrated that type I IFN signalling is the kinetic factor of abnormal differentiation and enhances the cytotoxicity of peripheral CD8+ T cells in active JDM patients, which was confirmed by in vivo and in vitro validation experiments. In summary, the elevated type I IFN signalling affected the differentiation and function of CD8+ T cells in active JDM patients. Skeletal muscle-infiltrating CD8+ T cells might migrate from the periphery under the drive of type I IFN and increased MHC I signals. Therapies targeting autoantigen-specific CD8+ T cells may represent a potential new treatment direction.
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Affiliation(s)
- Baozhen Huang
- Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Huiyu Li
- Center for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Qian Jiang
- Department of Medical Genetics, Capital Institute of Pediatrics, Beijing, China; Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences, Beijing, China
| | - Yucong Li
- Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Zhaowei Jiang
- Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Huijuan Cao
- Center for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | | | - Xinluan Wang
- Center for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Jianguo Li
- Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics, China.
| | - Gang Li
- Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China.
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Yang L, Guan W, Liu H, Li Y, Gong Y, Lv Q, Zeng Q, Wei Q, Zhang X, Chen W, Chen C, Sun L. Juvenile dermatomyositis with central nervous system involvement: two case reports from a retrospective single-center cohort, with literature review. Front Pediatr 2024; 12:1409950. [PMID: 38873583 PMCID: PMC11169638 DOI: 10.3389/fped.2024.1409950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/20/2024] [Indexed: 06/15/2024] Open
Abstract
Background Juvenile dermatomyositis (JDM) is a systemic autoimmune disease primarily involving the muscles and skin; it can also affect the central nervous system (CNS). The relevant literature provides limited information regarding the characteristics of JDM with CNS involvement. Method We reviewed patients with JDM who were hospitalized at our center between January 2016 and August 2023, with a focus on those with CNS involvement. The aim was to provide detailed case reports on these patients, and to summarize the relevant literature about the characteristics of similar cases. Results Among 193 hospitalized patients with JDM, two (1.03%) had CNS involvement. Two patients, a 5.5-year-old girl and an 11-year-old boy, were admitted with severe proximal muscle weakness and seizures, and presented with active cutaneous vasculitis. Both were ultimately diagnosed with JDM, with CNS involvement. Both patients had confirmed presence of anti-NXP2 antibody through myositis-specific antibody analysis. Additionally, they all exhibited hyperferritinemia and thrombocytopenia. Salvage therapies like intravenous methylprednisolone (IVMP) pulse therapy and/or plasma exchange were administered successfully. At final follow-up, both patients had achieved complete clinical response and full neurological recovery. Our literature review identified nine similar case studies. CNS involvement usually occurred within the first 10 months of the disease course, and most of these patients had fatal outcomes, with a mortality rate of 66.6% (6/9). Including the two patients described herein, the median age for disease onset is 10.5 years (range 4-17 years), and the male: female ratio is 6:5. Seizures are the most common neurological symptom, accompanied by active cutaneous vasculitis. The brain biopsies showed two distinct pathological presentations: one was central nervous system vasculitis, and the other was cerebral macrophage activation syndrome. Conclusions CNS involvement is a rare but life-threatening JDM complication. Herein, our cases and the literature indicate that it typically occurs within the first 10 months of the disease course and manifests as seizures, often accompanied by active cutaneous vasculitis, with fatal outcomes. Timely implementation of salvage therapies, like IVMP pulse therapy and plasma exchange, may significantly impact patient outcomes.
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Affiliation(s)
- Ling Yang
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- Department of Rheumatology, Children’s Hospital of Fudan University at Xiamen (Xiamen Children’s Hospital), Fujian, China
- National Children’s Medical Center, Shanghai, China
| | - Wanzhen Guan
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Haimei Liu
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Yifan Li
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Yinv Gong
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Qianying Lv
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Qiaoqian Zeng
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Qijiao Wei
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Xiaomei Zhang
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
| | - Weiming Chen
- National Children’s Medical Center, Shanghai, China
- Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, Shanghai, China
| | - Chao Chen
- National Children’s Medical Center, Shanghai, China
- Department of Otolaryngology, Children’s Hospital of Fudan University, Shanghai, China
| | - Li Sun
- Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
- National Children’s Medical Center, Shanghai, China
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12
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Nainia K, Aouzal MA, Ouafik I, Charhbili M, Bouchhab A, Daoudi A, Tizki S, Chakiri R. Juvenile dermatomyositis with Anti-SAE antibodies in a Moroccan child associated with pseudo-angioedema: a case report. Pediatr Rheumatol Online J 2024; 22:57. [PMID: 38773611 PMCID: PMC11107000 DOI: 10.1186/s12969-023-00921-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/02/2023] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Juvenile Dermatomyositis (JDM) is the leading cause of non-infectious inflammatory myopathy in children. It is a heterogeneous group of autoimmune diseases characterized by a variable combination of muscular, dermatological, and visceral involvement. Myositis-specific autoantibodies help define homogeneous subgroups with common clinical characteristics and prognoses. Anti-SAE (small ubiquitin-like modifier 1 (SUMO-1) activating enzyme) antibodies are among the most recently discovered specific autoantibodies. The presence of these antibodies is very rare, making it challenging to define clinical features and prognosis in the juvenile form. We report the first case of an African patient with juvenile dermatomyositis and positive anti-SAE antibodies. CASE REPORT A 5-year-3-month-old Moroccan boy presented to the pediatric emergency department with dysphagia that had been evolving for two days, preceded two months earlier by facial erythema associated with fatigue, lower limb pain, difficulty walking, and progressive inflammatory polyarthralgia. On admission, the child had a heliotrope rash with predominant pseudo-angioedema on the lips, periungual telangiectasia, and Gottron's papules over the bilateral interphalangeal and metatarsophalangeal joints. The patient had a more pronounced proximal muscle weakness in the lower limbs. He had no urticaria, fever, arthritis, calcinosis, cutaneous ulcers, or lipodystrophy. The Joint examination was normal, as was the pleuropulmonary examination. The electroneuromyography showed myogenic changes in all four limbs. Laboratory findings showed elevated levels of creatine phosphokinase and lactate dehydrogenase and a mild inflammatory syndrome. The electrocardiogram was normal. The anti-SAE antibodies were positive. The boy was diagnosed with juvenile dermatomyositis. He received methylprednisolone bolus therapy followed by oral prednisone. The latter was gradually tapered in combination with weekly intramuscular methotrexate. As a result, dysphagia disappeared within 48 h. After two weeks, there was an improvement in the muscular score and a significant regression of facial pseudo-angioedema. CONCLUSION We report the first African patient with anti-SAE autoantibody-positive JDM. He had a typical dermatological manifestation of JDM associated with pseudo-angioedema predominant on the lips; a rarely reported sign in DM and JDM patients. The patient responded well to corticosteroid therapy and methotrexate.
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Affiliation(s)
- Khalila Nainia
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco.
| | - Mohamed Amine Aouzal
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Imane Ouafik
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Mariyam Charhbili
- Pediatrics department, Regional hospital HASSAN II Agadir, Agadir, Morocco
| | - Amal Bouchhab
- Pediatrics department, Regional hospital HASSAN II Agadir, Agadir, Morocco
| | - Abdellatif Daoudi
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Samira Tizki
- Pediatrics department, Faculty of Medicine and Pharmacy of Agadir, University Hospital Center SOUSS MASSA Agadir, Ibn ZOHR University, Agadir, Morocco
| | - Radia Chakiri
- Dermatology department, CHU SOUSS-MASSA, Agadir, Morocco
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Foeldvari I, Torok KS, Antón J, Blakley M, Constantin T, Cutolo M, Denton CP, Fligelstone K, Hinrichs B, Li SC, Maillard S, Marrani E, Moinzadeh P, Orteu CH, Pain CE, Pauling JD, Pilkington C, Rosser F, Smith V, Furst DF. Best clinical practice in the treatment of juvenile systemic sclerosis: expert panel guidance - the result of the International Hamburg Consensus Meeting December 2022. Expert Rev Clin Immunol 2024; 20:387-404. [PMID: 38149621 DOI: 10.1080/1744666x.2023.2298354] [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: 09/06/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Juvenile systemic sclerosis (jSSc) is an orphan disease with a prevalence of 3 in 1,000,000 children. Currently there is only one consensus treatment guideline concerning skin, pulmonary and vascular involvement for jSSc, the jSSc SHARE (Single Hub and Access point for pediatric Rheumatology in Europe) initiative, which was based on data procured up to 2014. Therefore, an update of these guidelines, with a more recent literature and expert experience, and extension of the guidance to more aspects of the disease is needed. AREAS COVERED Treatment options were reviewed, and opinions were provided for most facets of jSSc including general management, some of which differs from adult systemic sclerosis, such as the use of corticosteroids, and specific organ involvement, such as skin, musculoskeletal, pulmonary, and gastroenterology. EXPERT OPINION We are suggesting the treat to target strategy to treat early to prevent cumulative disease damage in jSSc. Conclusions are derived from both expert opinion and available literature, which is mostly based on adult systemic sclerosis (aSSc), given shared pathophysiology, extrapolation of results from aSSc studies was judged reasonable.
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Affiliation(s)
- Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Kathryn S Torok
- University of Pittsburgh and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jordi Antón
- Department of Pediatric Rheumatology. Hospital Sant Joan de Déu and Universitat de Barcelona, Barcelona, Spain
| | - Michael Blakley
- Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tamás Constantin
- Unit of Pediatric Rheumatology, Tűzoltó Street Department, Pediatric Centre, Semmelweis University, Budapest, Hungary
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology-Department of Internal Medicine and Specialties, University of Genoa and IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | | | - Kim Fligelstone
- Scleroderma & Raynaud's United Kindgom (SRUK) (Research Subcommittee, Patient Research Partner), FESCA, London, UK
| | - Bernd Hinrichs
- Children's pulmonology, Asklepios Klinik Nord - Heidberg, Hamburg, Germany
| | - Suzanne C Li
- Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Edoardo Marrani
- Pediatric Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Pia Moinzadeh
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Catherine H Orteu
- UCL Institute of Immunity and Transplantation, Royal Free London NHS Foundation Trust, London, UK
| | - Clare E Pain
- Alder Hey Children's Foundation NHS Trust, Liverpool, UK
| | - John D Pauling
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium and ERN ReCONNET
| | | | - Franziska Rosser
- University of Pittsburgh and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Vanessa Smith
- University of California, Los Angeles, CA, USA
- University of Washington, Seattle, WA, USA
- University of Florence, Florence, Italy
| | - Daniel F Furst
- Division of Rheumatology Fellow, Geffen School of Medicine at the University of California in Los Angeles, Los Angeles, CA, USA
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14
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Liu Q, Pan M, Cao H, Zheng J, Ruan YP, Zhao XQ. Acquired generalized lipodystrophy in a juvenile dermatomyositis patient. Int J Rheum Dis 2024; 27:e15101. [PMID: 38445875 DOI: 10.1111/1756-185x.15101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/28/2024] [Accepted: 02/14/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Qiong Liu
- Department of Dermatology and Venerology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Meng Pan
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hua Cao
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jie Zheng
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ye-Ping Ruan
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao-Qing Zhao
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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15
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Polat MC, Mertek S, Özçakar ZB, Çelikel E, Aydın F, Tekin ZE, Elhan AH, Çelikel Acar B, Çakar N. Adverse events of biological agents in pediatric rheumatologic diseases. Postgrad Med 2024; 136:198-207. [PMID: 38415679 DOI: 10.1080/00325481.2024.2325333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/27/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES To evaluate adverse events (AEs) in pediatric patients with rheumatologic diseases being treated with approved or off-label biologic agents (BAs). METHODS This observational, retrospective, multicenter study was conducted from 2010 to 2022 in patients under 18 years of age with rheumatic diseases who were receiving interleukin-1 antibodies (Anti-IL1), interleukin-6 antibodies (Anti-IL6), and tumor necrosis factor alpha inhibitors (anti-TNF). Efficacy, AEs, and timing of AEs were collected from electronic medical records. RESULTS Three hundred and fifteen BAs were prescribed to 237 patients. Fifty AEs occurred in 44 patients (18.6%). Anti-TNF exposure was present in 8 (72.2%) of 11 patients with latent tuberculosis (TB) and in all 7 patients with herpes infections. Four of 6 patients (66.7%) with recurrent upper respiratory tract infections and 7 of 8 patients (87.5%) with local skin reactions were on Anti-IL1. The cutoff value for latent TB development was determined as 23.5 months by ROC analysis (AUC: 0.684 ± 0.072, p = 0.038, 95% CI: 0.54-0.82). In patients who used BA for 23.5 months or more, the risk of latent TB was 5.94-fold (p = 0.024, 95% CI: 1.26-27.97). Drug rash with eosinophilia and systemic symptoms (DRESS) occurred in 2 patients on anakinra, and anaphylaxis occurred in 1 patient on anti-IL6. There were no cases of malignancy or death in any patient. CONCLUSION The physician should be vigilant for latent TB in patients exposed to BA for more than 2 years. While local skin reactions are more prevalent in patients receiving anti-IL1, severe skin reactions such as DRESS may also occur.
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Affiliation(s)
- Merve Cansu Polat
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Cankaya, Turkey
| | - Saniye Mertek
- Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Birsin Özçakar
- Department of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Çelikel
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Cankaya, Turkey
| | - Fatma Aydın
- Department of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Zahide Ekici Tekin
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Cankaya, Turkey
| | - Atilla Halil Elhan
- Department of Biostatistics, Ankara University Medical School, Ankara, Turkey
| | - Banu Çelikel Acar
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Cankaya, Turkey
| | - Nilgün Çakar
- Department of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
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16
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Stubbs LA, Ogunbona O, Beil E, Szafron V, Adesina A, Anvari S, Lai J, Ramirez A, Ditzler MG, DeGuzman M. Juvenile eosinophilic fasciitis: a single center case series. Pediatr Rheumatol Online J 2024; 22:29. [PMID: 38395889 PMCID: PMC10893626 DOI: 10.1186/s12969-024-00960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/17/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Eosinophilic fasciitis (EF) is a rare disease characterized by skin induration and musculoskeletal abnormalities. Diagnostic criteria for EF are based on adult populations. There is a need to expand the literature on EF in children due to limited reported cases and potential differences compared to adults. METHODS We conducted a retrospective review of medical records for six pediatric patients diagnosed with EF at our institution between November 2011 and April 2023. Inclusion criteria required patients to be under 18 years of age at the time of diagnosis and to have confirmed diagnosis through clinical history, imaging, and histology. RESULTS Most of our cohort were female (83%) and non-Hispanic white (50%). Age at diagnosis ranged from 4 to 16 years. Duration of symptoms before diagnosis varied from 1 to 12 months. Follow-up periods ranged from 14 to 123 months. Concurrent medical conditions included localized scleroderma, acquired thrombophilia, and juvenile idiopathic arthritis. Patients presented with progressive painful swelling, severe joint limitations, and positive prayer sign. Initial regimens involved corticosteroids and methotrexate. Hydroxychloroquine, immunoglobulin, mycophenolate mofetil, rituximab, and tocilizumab were also used depending on the patient's disease severity and course. CONCLUSIONS Juvenile EF may manifest as swelling and progressive induration without apparent skin abnormalities. Unlike adult populations, no underlying malignancies or associations with trauma were observed in our cohort. Our cases did not exhibit systemic involvement observed in previous studies on juvenile EF. While non-specific, the prayer sign may aid in early recognition of juvenile EF and help prevent long-term disability.
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Affiliation(s)
- Leigh A Stubbs
- Department of Pediatrics, Division of Rheumatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Oluwaseun Ogunbona
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
- Department of Pathology and Genomic Medicine, Houston Methodist, Houston, TX, USA
| | - Emily Beil
- Department of Pediatrics, Division of Rheumatology, Texas Children's Hospital, Feigin Tower, 1102 Bates, Ste. 330, Houston, TX, TX 77030, USA
| | - Vibha Szafron
- Department of Pediatrics, Division of Allergy and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Adekunle Adesina
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Sara Anvari
- Department of Pediatrics, Division of Allergy and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Jamie Lai
- Department of Pediatrics, Division of Rheumatology, Texas Children's Hospital, Feigin Tower, 1102 Bates, Ste. 330, Houston, TX, TX 77030, USA
| | - Andrea Ramirez
- Department of Pediatrics, Division of Rheumatology, Texas Children's Hospital, Feigin Tower, 1102 Bates, Ste. 330, Houston, TX, TX 77030, USA
| | - Matthew G Ditzler
- Department of Radiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Marietta DeGuzman
- Department of Pediatrics, Division of Rheumatology, Texas Children's Hospital, Feigin Tower, 1102 Bates, Ste. 330, Houston, TX, TX 77030, USA.
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17
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Georgi I, Georgi M, Haas JP. [Advances in the diagnostics and treatment of juvenile dermatomyositis]. Z Rheumatol 2024; 83:41-51. [PMID: 38157051 DOI: 10.1007/s00393-023-01454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 01/03/2024]
Abstract
Juvenile dermatomyositis (JDM) is by far the most frequent inflammatory myopathy in childhood and adolescence. It is clinically characterized by inflammatory changes of the skin and muscles but as a multisystemic disease can also affect the skeletal system, the gastrointestinal tract, lungs and heart. Intrinsic (multigenetic risk) and extrinsic factors (triggers) are involved in the pathogenesis resulting in endothelial damage, involvement of fascies, activation of the interferon system and autoimmune reactions including formation of myositis-specific autoantibodies (MSA). In contrast to dermatomyositis in adults, in children and adolescents there are no associations with malignant diseases. The variable expression, the rarity of the disease and the risk of long-term damage and complications necessitate pediatric rheumatological experience in the diagnostics and treatment. Recently, new approaches in drug treatment have substantially improved the outcome and prognosis but a multidisciplinary treatment (including physicians, physiotherapists, psychologists, social workers) is mandatory, especially in the first phases of the disease. Particularly important is a professionally correct treatment of the functional sequelae, which are a particular focus of this article.
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Affiliation(s)
- Ingrid Georgi
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Kinderklinik Garmisch-Partenkirchen, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland
| | - Mathias Georgi
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Kinderklinik Garmisch-Partenkirchen, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland
| | - Johannes-Peter Haas
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Kinderklinik Garmisch-Partenkirchen, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland.
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Sener S, Cam V, Ozen S, Batu ED. Biologic drugs in the treatment of juvenile dermatomyositis: a literature review. Clin Rheumatol 2024; 43:591-602. [PMID: 37582998 DOI: 10.1007/s10067-023-06740-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023]
Abstract
There is no clear consensus in the literature regarding the choice of biologic therapies and efficacy in juvenile dermatomyositis (JDM). In this review, we aimed to examine previous studies regarding biologic drug use in JDM patients. We screened MEDLINE and Scopus for articles involving JDM patients treated with biologic drugs. We identified 74 articles describing 495 JDM patients treated with biologic drugs (538 biologic treatments) during our literature search. The median (min-max) age of these patients was 9.8 (1-17) years (F/M:1.8). The most frequently used biologic drugs were rituximab (RTX, 50%) and tumor necrosis factor (TNF) inhibitors (34.8%). In a few cases, abatacept (4.3%), anti-interleukin-1 agents (0.9%), tocilizumab (0.9%), bortezomib (0.4%), ustekinumab (0.2%), eculizumab (0.2%), and golimumab (0.2%) were used. RTX was most frequently preferred in patients with severe skin involvement (46.3%). Improvement with RTX was obtained in 60.1% of RTX treatments. Infliximab was most frequently preferred in calcinosis (43.3%), while adalimumab in skin involvement (50%) and etanercept in resistant/recurrent diseases (80%). Improvement was achieved in 44.4% of anti-TNF treatments. Adverse events were observed in 46.8% (58/124) of all treatments. Our results suggest that biologic agents may be a promising alternative for the treatment of particularly resistant JDM cases. Controlled studies are required to provide higher level of evidence for the timing of biologic use in JDM treatment. Key Points • There is no consensus on the choice and efficacy of biologic therapies in JDM. • RTX and TNF inhibitors are the most commonly used biologic drugs. • Biologics were especially preferred in severe skin involvement, calcinosis, and resistant diseases.
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Affiliation(s)
- Seher Sener
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Veysel Cam
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Balan S, Madan S. Idiopathic Inflammatory Myopathies. Indian J Pediatr 2023:10.1007/s12098-023-04896-z. [PMID: 37919486 DOI: 10.1007/s12098-023-04896-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
Idiopathic inflammatory myopathies (IIMs) are a diverse group of diseases characterized by proximal muscle weakness and inflammation in skeletal muscle. Phenotypically, the subtypes include dermatomyositis, polymyositis, inclusion body myositis, and amyopathic dermatomyositis. The most common IIM in children is juvenile dermatomyositis (JDM). In contrast to adult dermatomyositis (DM), children are likely to have frequent relapses, vasculopathy, and long-term metabolic and other complications like lipodystrophy, insulin resistance, and calcinosis. Significant advances in our understanding of pathogenesis, disease course, and treatment of JDM has changed the therapeutic landscape and improved outcomes in children. Myositis-specific autoantibodies and myositis-associated autoantibodies have unique clinical associations, disease course and help predict response to therapy. A multidisciplinary approach including exercise programs and psychosocial support is essential. The first line of treatment is a combination of corticosteroids and methotrexate (MTX). Other targeted immunosuppressive therapy is used in refractory cases. Early recognition and timely referral to a specialist center remain pivotal to improving the mortality and morbidity associated with this disease.
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Affiliation(s)
- Suma Balan
- Department of Rheumatology and Clinical Immunology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala, 682 041, India.
| | - Sumanth Madan
- Department of Rheumatology and Clinical Immunology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala, 682 041, India
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Rosina S, Rebollo-Giménez AI, Consolaro A, Ravelli A. Treat-to-Target in Pediatric Rheumatic Diseases. Curr Rheumatol Rep 2023; 25:226-235. [PMID: 37584859 DOI: 10.1007/s11926-023-01112-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW To summarize the current evidence on the adoption of the treat-to-target (T2T) strategy in pediatric rheumatic diseases (PRD). RECENT FINDINGS The recent advances in the management of PRD have markedly increased the ability to achieve disease remission. Complete disease quiescence is regarded as the ideal therapeutic goal because its attainment leads to lesser long-term damage and physical disability, and to optimization of quality of life. Studies in adult rheumatic diseases have shown that patient outcomes are improved if complete suppression of the inflammatory process is aimed for by frequent adjustments of therapy according to quantitative indices. This approach, which underlies the T2T concept, has been applied in strategic trials in rheumatoid arthritis (RA). Furthermore, recommendations for the T2T have been issued for RA and other adult rheumatic diseases. There is currently a growing interest for the introduction of T2T in PRD, and recommendations for treating juvenile idiopathic arthritis (JIA) to target were promulgated. A similar initiative has been undertaken for childhood-onset systemic lupus erythematosus. Preliminary therapeutic studies have explored the T2T design in JIA. The T2T strategy is a modern therapeutic approach that holds the promise of improving the outcomes in patients with PRD.
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Affiliation(s)
- Silvia Rosina
- UOC Reumatologia E Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | | | - Alessandro Consolaro
- UOC Reumatologia E Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento Di Neuroscienze, Scienze Materno-Infantili, Università Degli Studi Di Genova, RiabilitazioneGenoa, Oftalmologia, Geneticae , Italy
| | - Angelo Ravelli
- Dipartimento Di Neuroscienze, Scienze Materno-Infantili, Università Degli Studi Di Genova, RiabilitazioneGenoa, Oftalmologia, Geneticae , Italy
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Zhang J, Sun L, Shi X, Li S, Liu C, Li X, Lu M, Deng J, Tan X, Guan W, Li G, Wen X, Liu P, Li C. Janus kinase inhibitor, tofacitinib, in refractory juvenile dermatomyositis: a retrospective multi-central study in China. Arthritis Res Ther 2023; 25:204. [PMID: 37853451 PMCID: PMC10583374 DOI: 10.1186/s13075-023-03170-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES Juvenile dermatomyositis (JDM) is a chronic autoimmune disease. Some patients remain in an active state even though they were administrated with a combination of corticosteroid and methotrexate. Existing research has suggested that interferon and Janus kinase played an important role in pathogenesis. Existing research has suggested the efficacy of JAK inhibitors (JAKi). Our retrospective study aimed to investigate the efficacy of tofacitinib in refractory JDM patients. METHODS A total of eighty-eight patients in China who had been diagnosed with JDM and subjected to tofacitinib therapy for over 3 months were retrospectively analyzed. Skin and muscle manifestations were assessed using the Cutaneous Assessment Tool-binary method (CAT-BM), Childhood Myositis Assessment Scale (CMAS), and kinase. Pulmonary function was assessed using a high-resolution CT (computerized tomography) scan and pulmonary symptoms. All patients were subjected to regular follow-up, and core measures were assessed every 3 months after initiation. Furthermore, the data were analyzed using the Wilcoxon single test, Mann-Whitney U test, and chi-square test. RESULTS Compared with the baseline data, skin and muscle manifestations were found significantly improved during the respective follow-up visit. At the most recent follow-up, nearly 50% of patients achieved a clinical complete response and six patients received tofacitinib monotherapy. Sixty percent of patients suffering from interstitial lung disease well recovered on high-resolution CT. Seventy-five percent of patients showed a reduction in the size or number of calcinosis, and 25% of patients showed completely resolved calcinosis. CONCLUSION In this study, the result suggested that tofacitinib therapy exerted a certain effect on skin manifestations, muscle manifestations, interstitial lung disease (ILD), calcinosis, as well as downgrade of medication. In-depth research should be conducted to focus on the correlation between the pathogenesis of JDM and JAKi.
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Affiliation(s)
- Junmei Zhang
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Li Sun
- Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, No. 399 Wanyuan Road, Shanghai, 201102, China
| | - XinWei Shi
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Shipeng Li
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Cuihua Liu
- Department of Nephrology and Rheumatology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
- Department of Nephrology and Rheumatology, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450018, China
| | - Xiaoqing Li
- Department of Rheumatology and Immunology, Xi'an Children's Hospital, Xi'an, 710002, China
| | - Meiping Lu
- Department of Rheumatology Immunology and Allergy, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Jianghong Deng
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiaohua Tan
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wanzhen Guan
- Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, No. 399 Wanyuan Road, Shanghai, 201102, China
| | - Guomin Li
- Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, No. 399 Wanyuan Road, Shanghai, 201102, China
| | - Xinran Wen
- Department of Rheumatology and Immunology, Xi'an Children's Hospital, Xi'an, 710002, China
| | - Ping Liu
- Department of Nephrology and Rheumatology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
- Department of Nephrology and Rheumatology, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450018, China
| | - Caifeng Li
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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22
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Conti F, Moratti M, Leonardi L, Catelli A, Bortolamedi E, Filice E, Fetta A, Fabi M, Facchini E, Cantarini ME, Miniaci A, Cordelli DM, Lanari M, Pession A, Zama D. Anti-Inflammatory and Immunomodulatory Effect of High-Dose Immunoglobulins in Children: From Approved Indications to Off-Label Use. Cells 2023; 12:2417. [PMID: 37830631 PMCID: PMC10572613 DOI: 10.3390/cells12192417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/23/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The large-scale utilization of immunoglobulins in patients with inborn errors of immunity (IEIs) since 1952 prompted the discovery of their key role at high doses as immunomodulatory and anti-inflammatory therapy, in the treatment of IEI-related immune dysregulation disorders, according to labelled and off-label indications. Recent years have been dominated by a progressive imbalance between the gradual but constant increase in the use of immunoglobulins and their availability, exacerbated by the SARS-CoV-2 pandemic. OBJECTIVES To provide pragmatic indications for a need-based application of high-dose immunoglobulins in the pediatric context. SOURCES A literature search was performed using PubMed, from inception until 1st August 2023, including the following keywords: anti-inflammatory; children; high dose gammaglobulin; high dose immunoglobulin; immune dysregulation; immunomodulation; immunomodulatory; inflammation; intravenous gammaglobulin; intravenous immunoglobulin; off-label; pediatric; subcutaneous gammaglobulin; subcutaneous immunoglobulin. All article types were considered. IMPLICATIONS In the light of the current imbalance between gammaglobulins' demand and availability, this review advocates the urgency of a more conscious utilization of this medical product, giving indications about benefits, risks, cost-effectiveness, and administration routes of high-dose immunoglobulins in children with hematologic, neurologic, and inflammatory immune dysregulation disorders, prompting further research towards a responsible employment of gammaglobulins and improving the therapeutical decisional process.
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Affiliation(s)
- Francesca Conti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
| | - Mattia Moratti
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Lucia Leonardi
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Arianna Catelli
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Elisa Bortolamedi
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Emanuele Filice
- Department of Pediatrics, Maggiore Hospital, 40133 Bologna, Italy;
| | - Anna Fetta
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy
| | - Marianna Fabi
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Elena Facchini
- Pediatric Oncology and Hematology Unit “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.F.); (M.E.C.)
| | - Maria Elena Cantarini
- Pediatric Oncology and Hematology Unit “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.F.); (M.E.C.)
| | - Angela Miniaci
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
| | - Duccio Maria Cordelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
| | - Daniele Zama
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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de Andrade RLF, Mendonça JA, Piotto DP, Guimarães JB, Terreri MT. Could ultrasound and muscle elastography be associated with clinical assessment, laboratory and nailfold capillaroscopy in juvenile dermatomyositis patients? Adv Rheumatol 2023; 63:48. [PMID: 37803481 DOI: 10.1186/s42358-023-00330-2] [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: 05/30/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Juvenile Dermatomyositis (JDM) is the most common idiopathic inflammatory myopathy in children. Imaging exams are useful for muscle assessment, with ultrasonography (US) being a promising tool in detecting disease activity and tissue damage. There are few studies about muscle elastography. OBJECTIVES Our aim was to associate clinical, laboratory, and nailfold capillaroscopy (NC) assessments with US in JDM patients; and to compare the findings of US and Strain Elastography (SE) from patients and healthy controls. METHODS An analytic cross-sectional study was performed with JDM patients and healthy controls. Patients underwent clinical exam to access muscle strength and completed questionnaires about global assessment of the disease and functional capacity. Patients were submitted to NC and measurement of muscle enzymes. All subjects underwent US assessment, using gray scale, Power Doppler (PD), and SE. RESULTS Twenty-two JDM patients and fourteen controls, aged between 5 and 21 years, matched for age and sex were assessed. In qualitative and semi-quantitative gray scale, we observed a higher frequency of alterations in patients (p < 0.001), while in PD, there was a higher frequency of positivity in patients' deltoids and anterior tibialis (p < 0.001). Active disease was associated with an important change in the semi-quantitative gray scale in deltoids (p = 0.007), biceps brachii (p = 0.001) and quadriceps femoris (p = 0.005). The SE demonstrated a high negative predictive value of 87.2. CONCLUSION US was able, through gray scale, to differentiate JDM patients from controls, while PD achieved such differentiation only for deltoids and anterior tibialis. The semi-quantitative gray scale showed disease activity in proximal muscles. SE was not able to differentiate patients from controls.
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Affiliation(s)
- Renata Lopes Francisco de Andrade
- Department of Pediatrics, Section of Rheumatology, Federal University of São Paulo - UNIFESP, Dr Bacelar, St, 173. Vila Clementino, São Paulo, 01026-000, Brazil.
| | - José Alexandre Mendonça
- Department of Rheumatology, Pontifical Catholic University from Campinas - PUC/Campinas, John Boyd Dunlop, s/n, Avenue, Campinas, 13034-685, Brazil
| | - Daniela Petry Piotto
- Department of Pediatrics, Section of Rheumatology, Federal University of São Paulo - UNIFESP, Dr Bacelar, St, 173. Vila Clementino, São Paulo, 01026-000, Brazil
| | - Julio Brandão Guimarães
- Department of Radiology and Image Diagnosis, Federal University of São Paulo - UNIFESP, Napoleão de Barros, St, 800, São Paulo, 04024-000, Brazil
| | - Maria Teresa Terreri
- Department of Pediatrics, Section of Rheumatology, Federal University of São Paulo - UNIFESP, Dr Bacelar, St, 173. Vila Clementino, São Paulo, 01026-000, Brazil
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24
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Werth VP, Aggarwal R, Charles-Schoeman C, Schessl J, Levine T, Kopasz N, Worm M, Bata-Csörgő Z. Efficacy of intravenous immunoglobulins (IVIg) in improving skin symptoms in patients with dermatomyositis: a post-hoc analysis of the ProDERM study. EClinicalMedicine 2023; 64:102234. [PMID: 37799613 PMCID: PMC10550512 DOI: 10.1016/j.eclinm.2023.102234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
Background Dermatomyositis (DM) is a rare autoimmune disease characterized by skin involvement, with or without proximal muscle weakness. Recently, following the ProDERM study, intravenous immunoglobulin (IVIg) was approved for treatment of DM. Until ProDERM evidence from large, placebo-controlled studies supporting its use for dermatological symptoms, was lacking. Here we present efficacy data from ProDERM of IVIg versus placebo for treatment of the cutaneous aspect of DM. Methods ProDERM was a double-blind, randomized, multicenter, Phase 3 study. In the First Period (Weeks 0-16), adults with active DM received 2.0 g/kg IVIg (Octagam 10%; Octapharma AG) or placebo every 4 weeks. In the open-label Extension Period (Weeks 16-40), all patients received IVIg for 6 additional cycles. Cutaneous disease was assessed using measures including modified cutaneous DM disease area and severity index activity (CDASI-A) and damage (CDASI-D) scores, and myositis disease activity assessment tool (MDAAT) including visual analogue scale (VAS). This trial is registered with ClinicalTrials.gov, NCT02728752. Findings The study took place from February 2017 to November 2019. 95 patients received IVIg (N = 47) or placebo (N = 48) in the First Period. Together, 664 IVIg infusion cycles were administered (median dose, 2.0 g/kg). At Week 16, mean CDASI-A change from baseline was -9.36 (95% CI: -12.52, -6.19) in the IVIg group versus -1.16 (-3.32, 0.99) in placebo group (p < 0.0001). At the end of the Extension Period, mean changes from baseline were -10.44 (95% CI: -13.94, -6.94) and -10.03 (-13.12, -6.94), respectively. Similar changes were seen for CDASI-D and VAS of MDAAT. These observations were seen regardless of baseline disease severity. Interpretation ProDERM is the first large prospective, randomized trial to demonstrate the efficacy of IVIg to improve the cutaneous manifestations of DM. IVIg treatment significantly improved dermatological symptoms in patients with DM, regardless of disease severity before treatment, suggesting that IVIg is effective for even the most severe cutaneous DM. Funding This study was sponsored by Octapharma Pharmazeutika Produktionsges m.b.H.
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Affiliation(s)
- Victoria P. Werth
- Corporal Michael J. Crescenz VAMC and the University of Pennsylvania, Philadelphia, PA, USA
| | - Rohit Aggarwal
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Joachim Schessl
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians University of Munich, Munich, Germany
| | | | | | - Margitta Worm
- Clinic of Dermatology, Venerology and Allergology, Charité, Berlin, Germany
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Strauss T, Günther C, Schnabel A, Wolf C, Hahn G, Lee-Kirsch MA, Brück N. Rapid and sustained response to JAK inhibition in a child with severe MDA5 + juvenile dermatomyositis. Pediatr Rheumatol Online J 2023; 21:104. [PMID: 37726751 PMCID: PMC10507825 DOI: 10.1186/s12969-023-00894-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Juvenile dermatomyositis (jDM) is the most common idiopathic inflammatory myopathy of childhood. Amyopathic or hypomyopathic courses have been described. CASE PRESENTATION We present the case of a 4-year-old patient with MDA5 antibody positive jDM and interstitial lung disease. In our patient, typical symptoms of jDM with classical skin lesions, arthritis, proximal muscle weakness, and ulcerative calcifications were observed. Due to the severity of the disease and the pulmonary changes, therapy with the Janus kinase (JAK) inhibitor ruxolitinib was added to the therapy with corticosteroids, intravenous immunoglobulins (IVIG) and hydroxychloroquine leading to a fast and sustained remission. CONCLUSION While there is growing evidence that JAK inhibition is a promising therapeutic option in jDM our case report shows that this approach may also be effective in MDA5-positive jDM with high risk features.
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Affiliation(s)
- Timmy Strauss
- Faculty of Medicine, Department of Pediatrics, Pediatric Rheumatology and Immunology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Claudia Günther
- Faculty of Medicine, Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anja Schnabel
- Faculty of Medicine, Department of Pediatrics, Pediatric Rheumatology and Immunology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christine Wolf
- Faculty of Medicine, Department of Pediatrics, Molecular Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Hahn
- Faculty of Medicine, Department of Radiology, Pediatric Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Min Ae Lee-Kirsch
- Faculty of Medicine, Department of Pediatrics, Molecular Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Normi Brück
- Faculty of Medicine, Department of Pediatrics, Pediatric Rheumatology and Immunology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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26
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Shenoi S, Edison SE, Haynes S, Patten J. Implementation of an embedded behavioral health care model in a pediatric rheumatology subspecialty juvenile myositis clinic. Front Psychiatry 2023; 14:1192711. [PMID: 37636819 PMCID: PMC10447969 DOI: 10.3389/fpsyt.2023.1192711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Youth with chronic medical illness, such as juvenile myositis (JM), require specialized behavioral health care. However, access to such care is challenging due to the youth mental health crisis, which impacts accessibility of mental health services in the community, as well as challenges accessing behavioral health care above and beyond the demands of care related to their JM management. In this paper we describe an embedded behavioral health care model, including the establishment and implementation of such a model, at a pediatric hospital where youth with JM receive medical care in a Center of Excellence (CoE). We describe a unique partnership with a philanthropic organization; the challenges and benefits of delivering care within this model; as well as recommendations for maximizing its effectiveness. Ultimately, we provide an example of a successful embedded behavioral health care program for youth with rare disease, which may be applied to other institutions providing similar care.
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Affiliation(s)
- Susan Shenoi
- Seattle Children’s Hospital and Research Center, University of Washington, Seattle, WA, United States
| | - Suzanne E. Edison
- Mental Health Coordinator, Cure JM Foundation, Leesburg, VA, United States
| | - Stacey Haynes
- Seattle Children’s Hospital and Research Center, University of Washington, Seattle, WA, United States
| | - Joanna Patten
- Seattle Children’s Hospital and Research Center, University of Washington, Seattle, WA, United States
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27
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Kaplan MM, Çelikel E, Güngörer V, Ekici Tekin Z, Gürsu HA, Polat SE, Cinel G, Çelikel Acar B. Cardiac involvement in a case of juvenile dermatomyositis with positive anti-melanoma differentiation associated protein 5 antibody. Int J Rheum Dis 2023; 26:1582-1585. [PMID: 36852875 DOI: 10.1111/1756-185x.14630] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023]
Abstract
Juvenile dermatomyositis (JDM) is an autoimmune disease characterized by muscle weakness and specific skin lesions, as well as non-muscular involvement such as interstitial lung disease (ILD), cardiac involvement and arthritis. Anti-melanoma differentiation-associated protein 5 (anti-MDA5)-positive JDM patients are typically characterized by the presence of skin ulcers and rapidly progressing ILD (RP-ILD). Although cardiac involvement is not an expected involvement in anti-MDA5-positive JDM cases, it is significant because it can be fatal. In this report, an anti-MDA5 myositis-specific autoantibody-positive JDM case referred with the diagnosis of psoriatic arthritis in whom cardiomyopathy and arrhythmia were detected in follow-up is presented. Since cardiac involvement is associated with mortality, it would be useful to follow up anti-MDA5 positive patients for cardiac involvement in addition to lung involvement. Tofacitinib is a promising treatment option in treatment-resistant JDM.
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Affiliation(s)
- Melike Mehveş Kaplan
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Elif Çelikel
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Vildan Güngörer
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Zahide Ekici Tekin
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Hazım Alper Gürsu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Sanem Eryılmaz Polat
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Güzin Cinel
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Banu Çelikel Acar
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Bhat R, Tonutti A, Timilsina S, Selmi C, Gershwin ME. Perspectives on Mycophenolate Mofetil in the Management of Autoimmunity. Clin Rev Allergy Immunol 2023:10.1007/s12016-023-08963-3. [PMID: 37338709 DOI: 10.1007/s12016-023-08963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
Before becoming a cornerstone in the treatment of numerous immune-mediated diseases, mycophenolate mofetil (MMF) was first introduced as an immunosuppressive agent in transplant immunology and later received the attention of rheumatologists and clinicians involved in the management of autoimmune diseases. MMF is now a widespread immunosuppressive drug for the treatment of several conditions, including lupus nephritis, interstitial lung disease associated with systemic sclerosis, and anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis while being efficacious also as rescue therapy in various orphan diseases, including dermatomyositis and IgA-associated nephropathy. Similarly, case reports or series support a possible use of MMF in other rare autoimmune diseases. Beyond modulating lymphocyte activation, MMF acts on other immune and non-immune cells and these effects may explain the therapeutic profile of this medication. The effects of MMF are broadly characterized by the impact on the immune system and the antiproliferative and antifibrotic changes induced. In this latter case, mechanistic data on fibroblasts may in the future allow to reevaluate the use of MMF in selected patients with inflammatory arthritis or systemic sclerosis. Attention must be paid towards the possible occurrence of adverse events, such as gastrointestinal complaints and teratogenicity, while the risk of infections and cancer related to MMF needs to be further investigated.
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Affiliation(s)
- Rithika Bhat
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, USA
| | - Antonio Tonutti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Suraj Timilsina
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, USA
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - M Eric Gershwin
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, USA.
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Papadopoulou C, Chew C, Wilkinson MGL, McCann L, Wedderburn LR. Juvenile idiopathic inflammatory myositis: an update on pathophysiology and clinical care. Nat Rev Rheumatol 2023; 19:343-362. [PMID: 37188756 PMCID: PMC10184643 DOI: 10.1038/s41584-023-00967-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
The childhood-onset or juvenile idiopathic inflammatory myopathies (JIIMs) are a heterogenous group of rare and serious autoimmune diseases of children and young people that predominantly affect the muscles and skin but can also involve other organs, including the lungs, gut, joints, heart and central nervous system. Different myositis-specific autoantibodies have been identified that are associated with different muscle biopsy features, as well as with different clinical characteristics, prognoses and treatment responses. Thus, myositis-specific autoantibodies can be used to subset JIIMs into sub-phenotypes; some of these sub-phenotypes parallel disease seen in adults, whereas others are distinct from adult-onset idiopathic inflammatory myopathies. Although treatments and management have much improved over the past decade, evidence is still lacking for many of the current treatments and few validated prognostic biomarkers are available with which to predict response to treatment, comorbidities (such as calcinosis) or outcome. Emerging data on the pathogenesis of the JIIMs are leading to proposals for new trials and tools for monitoring disease.
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Affiliation(s)
- Charalampia Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
| | - Christine Chew
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Meredyth G Ll Wilkinson
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Lucy R Wedderburn
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK.
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK.
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK.
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK.
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Lin TW, Hu YC, Chiang BL. Characterization of the biomarkers related to the clinical course and outcomes of juvenile dermatomyositis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:416-423. [PMID: 36572597 DOI: 10.1016/j.jmii.2022.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the clinical characteristics of children diagnosed with juvenile dermatomyositis (JDM) in a tertiary medical centre in Taiwan and to identify important biomarkers for predicting the disease course and outcomes of JDM. METHODS We retrospectively reviewed patients with JDM diagnosed at the National Taiwan University Hospital between 1 January 2001 and 31 December 2021. The endpoints for disease assessment included complete clinical response or remission. The JDM courses were divided into monocyclic, polycyclic, and chronic continuous statuses. The significant relationship between the predictors and outcomes was further analysed. RESULTS A total of 47 patients were included in this study. The mean age at disease onset was 7.5 years. The female-to-male ratio was 1.35. The most common initial presentations were Gottron's sign (74%), followed by muscle weakness (66%) and facial rash (66%). Among all included patients, 35 (74.5%) patients achieved complete clinical remission, 15 (31.9%) had a monocyclic course, six (12.7%) had a polycyclic course, and 24 (51.1%) had a chronic continuous course. Negative facial rash and arthralgia were favourable factors for achieving complete clinical remission. Muscle weakness, higher lactate dehydrogenase (LDH), and higher erythrocyte sedimentation rate (ESR) at disease onset were related to the chronic continuous course. The most common long-term complication was calcinosis (29.8%). CONCLUSION Juvenile dermatomyositis is a rare disease, and only a few studies have been conducted in Asia. Our results identified the important predictors of the disease course and outcomes. The chronic continuous course requires more attention and aggressive treatment.
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Affiliation(s)
- Ting-Wei Lin
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Chiao Hu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
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Huang B, Wang X, Niu Y, Ding Y, Wang X, Tan Q, Li Y, Liu Y, Chi Y, Wang Y, Zhou Z, Li J. Long-term follow-up of Janus-kinase inhibitor and novel active disease biomarker in juvenile dermatomyositis. Rheumatology (Oxford) 2023; 62:1227-1237. [PMID: 35904570 DOI: 10.1093/rheumatology/keac399] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the use of Janus kinase inhibitor (JAKi) in treating JDM and develop cytokine biomarkers of active disease. METHODS This study involved a retrospective cohort study that evaluated JAKi in 101 JDM patients as well as a cross-sectional study of cytokines in 128 JDM patients and 30 controls between November 2017 and December 2021 in the Affiliated Children's Hospital of Capital Institute of Pediatrics (China). RESULTS During the median follow-up period of 19 months, 65.5% of the patients had improved rashes, and CAT-BM scores decreased. Overall, 39.6% of JDM patients eliminated glucocorticoids. Muscle strength was improved in all patients who had abnormal muscle strength before JAKi use. Patients and parents provided positive subjective reviews of JAKi, and no serious adverse events were reported. Potential side effects of JAKi included abnormal leukopoenia (14/95) and cough (16/83), which affected over 10% of the JDM patients. In the cytokine analysis, 12/34 cytokines were significantly elevated in active JDM patients. Compared with active JDM patients with multiple phenotypes, active JDM patients with only rashes demonstrated lower cytokine levels. Anti-NXP2-positive active patients had lower cytokine levels compared with those without positive anti-NXP2 antibodies. Among all increased cytokines, IL-1RA changed most dramatically, reaching over 793 times the mean of normal values. We developed a panel composed of six cytokines to differentiate active or stable status in our cohort (area under the curve = 0.8486, P < 0.05). CONCLUSION The preliminary evidence suggested that JAKi is a relatively safe and effective alternative for JDM patients. Cytokine profiles could well reflect the inflammatory status of JDM patients.
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Affiliation(s)
- Baozhen Huang
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong
| | - Xinning Wang
- Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics
| | - Yanlin Niu
- Beijing Center for Disease Prevention and Control, Institute for Nutrition and Food Hygiene, Beijing
| | - Yuchuan Ding
- Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics
| | - Xiaolei Wang
- Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics
| | - Qingqing Tan
- Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics
| | - Yucong Li
- Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics
| | - Yuan Liu
- Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics
| | - Ying Chi
- Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics
| | - Yuan Wang
- Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics
| | - Zhixuan Zhou
- Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics
| | - Jianguo Li
- Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics
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Varnier GC, Consolaro A, Cheng IL, Silva Riveiro A, Pilkington C, Ravelli A. Experience with the use of mycophenolate mofetil in juvenile idiopathic inflammatory myopathies. Rheumatology (Oxford) 2023; 62:SI163-SI169. [PMID: 35929784 DOI: 10.1093/rheumatology/keac404] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy and safety of MMF in juvenile idiopathic inflammatory myopathies (JIIMs). METHODS Patients diagnosed with JIIM and treated with MMF enrolled in the Juvenile Dermatomyositis Research Group (JDRG) in the UK or followed at the Giannina Gaslini Institute in Genoa, Italy, were included. The following information was collected retrospectively at MMF initiation, at 3, 6 and 12 months after treatment start, and at last follow-up visit: clinical manifestations, laboratory data, physicians' subjective assessment of disease activity, standardized outcome measures of muscle strength/endurance, cutaneous disease activity, physical function, global disease activity, cumulative damage, and ongoing treatment. RESULTS Of the 29 patients included, 23 had juvenile DM and 6 had overlap myositis. During administration of MMF, improvement in measures of muscle strength, skin disease activity, and overall disease activity was seen, with an increase in the frequency of normal scores for Manual Muscle Test-8 from 50.0% to 83.3%, Childhood Myositis Activity Score from 53.5% to 88.9%, muscle component of DAS from 55.2% to 84.2%, skin component of DAS from 31.0% to 42.1%, visual analogue scale for skin disease activity from 25.0% to 47.4%, and visual analogue scale for overall disease activity from 7.1% to 42.1%. The number of patients with inactive disease increased from 10.3% at baseline to 68.5% at last follow-up. CS dose was significantly reduced, from 0.3 to 0.1 mg/kg/day. No relevant side effects were reported. CONCLUSION Our experience suggests that MMF is a valuable therapeutic option for the management of JIIM.
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Affiliation(s)
- Giulia Camilla Varnier
- Università degli Studi di Genova, Genoa, Italy.,Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Alessandro Consolaro
- Università degli Studi di Genova, Genoa, Italy.,Clinica Pediatrica e Reumatologica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Iek Leng Cheng
- Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | | | | | - Angelo Ravelli
- Università degli Studi di Genova, Genoa, Italy.,Clinica Pediatrica e Reumatologica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Sherman MA, Kim H, Banschbach K, Brown A, Gewanter HL, Lang B, Perron M, Robinson AB, Spitznagle J, Stingl C, Syverson G, Tory HO, Spencer CH, Tarvin SE. Treatment escalation patterns to start biologics in refractory moderate juvenile dermatomyositis among members of the Childhood Arthritis and Rheumatology Research Alliance. Pediatr Rheumatol Online J 2023; 21:3. [PMID: 36609397 PMCID: PMC9825021 DOI: 10.1186/s12969-022-00785-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite new and better treatments for juvenile dermatomyositis (JDM), not all patients with moderate severity disease respond adequately to first-line therapy. Those with refractory disease remain at higher risk for disease and glucocorticoid-related complications. Biologic disease-modifying antirheumatic drugs (DMARDs) have become part of the arsenal of treatments for JDM. However, prospective comparative studies of commonly used biologics are lacking. METHODS The Childhood Arthritis and Rheumatology Research Alliance (CARRA) JDM biologics workgroup met in 2019 and produced a survey assessing current treatment escalation practices for JDM, including preferences regarding use of biologic treatments. The cases and questions were developed using a consensus framework, requiring 80% agreement for consensus. The survey was completed online in 2020 by CARRA members interested in JDM. Survey results were analyzed among all respondents and according to years of experience. Chi-square or Fisher's exact test was used to compare the distribution of responses to each survey question. RESULTS One hundred twenty-one CARRA members responded to the survey (denominators vary for each question). Of the respondents, 88% were pediatric rheumatologists, 85% practiced in the United States, and 43% had over 10 years of experience. For a patient with moderately severe JDM refractory to methotrexate, glucocorticoids, and IVIG, approximately 80% of respondents indicated that they would initiate a biologic after failing 1-2 non-biologic DMARDs. Trials of methotrexate and mycophenolate were considered necessary by 96% and 60% of respondents, respectively, before initiating a biologic. By weighed average, rituximab was the preferred biologic over abatacept, tocilizumab, and infliximab. Over 50% of respondents would start a biologic by 4 months from diagnosis for patients with refractory moderately severe JDM. There were no notable differences in treatment practices between respondents by years of experience. CONCLUSION Most respondents favored starting a biologic earlier in disease course after trialing up to two conventional DMARDs, specifically including methotrexate. There was a clear preference for rituximab. However, there remains a dearth of prospective data comparing biologics in refractory JDM. These findings underscore the need for biologic consensus treatment plans (CTPs) for refractory JDM, which will ultimately facilitate comparative effectiveness studies and inform treatment practices.
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Affiliation(s)
- Matthew A. Sherman
- grid.94365.3d0000 0001 2297 5165Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike 50 South Drive Building 50, Room 1142, 20892 Bethesda, MD USA ,grid.239560.b0000 0004 0482 1586Division of Rheumatology, Children’s National Hospital, Washington, DC USA
| | - Hanna Kim
- grid.420086.80000 0001 2237 2479Juvenile Myositis Pathogenesis and Therapeutics Unit, National Institute of Arthritis Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - Katelyn Banschbach
- grid.240741.40000 0000 9026 4165Division of Rheumatology, Department of Pediatrics, University of Washington/Seattle Children’s Hospital, Seattle, WA USA
| | - Amanda Brown
- grid.241054.60000 0004 4687 1637University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR USA
| | - Harry L. Gewanter
- grid.414220.1Children’s Hospital of Richmond at VCU, Richmond, VA USA
| | - Bianca Lang
- grid.55602.340000 0004 1936 8200IWK Health, Dalhousie University, Halifax, NS Canada
| | - Megan Perron
- grid.413957.d0000 0001 0690 7621Department of Pediatric Rheumatology, Children’s Hospital Colorado, Aurora, CO USA
| | - Angela Byun Robinson
- grid.239578.20000 0001 0675 4725Pediatric Rheumatology, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
| | - Jacob Spitznagle
- grid.240741.40000 0000 9026 4165Division of Rheumatology, Department of Pediatrics, University of Washington/Seattle Children’s Hospital, Seattle, WA USA
| | - Cory Stingl
- grid.416230.20000 0004 0406 3236Department of Pediatrics, Spectrum Health, Grand Rapids, MI USA
| | - Grant Syverson
- grid.490404.d0000 0004 0425 6409Sanford Health, Fargo, ND USA
| | - Heather O. Tory
- grid.63054.340000 0001 0860 4915Connecticut Children’s Medical Center, Hartford, CT, USA and University of Connecticut School of Medicine, Farmington, Farmington, CT USA
| | - Charles H. Spencer
- grid.410721.10000 0004 1937 0407University of Mississippi Medical Center, Batson Children’s Hospital, Jackson, MS USA
| | - Stacey E. Tarvin
- grid.257413.60000 0001 2287 3919Division of Rheumatology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN USA
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Pinotti CS, Cannon L, Dvergsten JA, Wu EY. Calcinosis in juvenile dermatomyositis: Updates on pathogenesis and treatment. Front Med (Lausanne) 2023; 10:1155839. [PMID: 36936211 PMCID: PMC10017873 DOI: 10.3389/fmed.2023.1155839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Calcinosis, or the deposition of insoluble calcium salts in the skin, subcutaneous tissue, fascia, tendons, and muscles, is a feared complication of juvenile dermatomyositis. Calcinosis is estimated to affect up to 40% of patients with juvenile dermatomyositis and contributes to significant disease morbidity. Calcinosis can be challenging to treat, and the most effective treatment remains unknown because of a lack of comparative studies. We aim to review the literature published in the last 5 years to summarize updates on the pathogenesis and treatment of calcinosis in juvenile dermatomyositis and describe future areas for research.
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Affiliation(s)
- Caitlan S. Pinotti
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University, Durham, NC, United States
- *Correspondence: Caitlan S. Pinotti,
| | - Laura Cannon
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | - Jeffrey A. Dvergsten
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University, Durham, NC, United States
| | - Eveline Y. Wu
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
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Albakri AM, Subki AH, Albeity A, Halabi H. Dermatomyositis Flare After a COVID-19 Infection Successfully Treated with Rituximab: A Case Report and Literature Review. J Inflamm Res 2022; 15:6047-6053. [PMID: 36348728 PMCID: PMC9637344 DOI: 10.2147/jir.s369477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/20/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there has been a sudden surge in the incidence of several immune-mediated diseases, including dermatomyositis. The reported cases of COVID-19-related dermatomyositis are heterogeneous in their clinical presentation and implemented therapies. CASE STUDY We report a 23-year-old female patient diagnosed with a 3-year history of dermatomyositis. She has been well-controlled on maintenance therapy. However, 6 weeks after a mild COVID-19 infection, she developed a dermatomyositis flare. She improved only after aggressive treatment with pulse steroids, intravenous immunoglobulin, and rituximab. CONCLUSION Exacerbation of dermatomyositis can be encountered following a COVID-19 infection, even if the infection is mild. Aggressive therapy should be considered in such cases. The prognosis, however, is generally favorable.
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Affiliation(s)
- Ahmed Mohammed Albakri
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed Hussein Subki
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia,Correspondence: Ahmed Hussein Subki; Hussein Halabi, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, POBox: 43129, Jeddah, 21561, Saudi Arabia, Tel +966566724288, Email ;
| | - Abdurahman Albeity
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Hussein Halabi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Muacevic A, Adler JR, Chan KYW, Yeung HMR. Immunoglobulin-Induced Aseptic Meningitis in Juvenile Dermatomyositis: A Case Report. Cureus 2022; 14:e31808. [PMID: 36579229 PMCID: PMC9780508 DOI: 10.7759/cureus.31808] [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: 11/22/2022] [Indexed: 11/24/2022] Open
Abstract
Aseptic meningitis is a known but unusual serious adverse effect of intravenous immunoglobulin (IVIG). It usually resembles infectious meningitis, which makes its diagnosis challenging. In this report, we present the case of a five-and-a-half-year-old Chinese girl with juvenile dermatomyositis (JDM) who presented with signs of meningismus 21 hours after the initiation of IVIG infusion. Her blood work at diagnosis showed neutrophilia and lymphopenia. The cerebrospinal fluid (CSF) analysis demonstrated neutrophilic pleocytosis, hyperproteinorrachia, and normoglycorrhachia. All microbiological tests were negative. The child fully recovered within 72 hours without neurological sequelae. IVIG-induced aseptic meningitis remains a diagnosis of exclusion. Although it is rare, pediatricians should be aware of this complication and avoid unnecessary investigations or treatment.
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Clinical and autoantibody phenotypes of juvenile dermatomyositis. Reumatologia 2022; 60:281-291. [PMID: 36186835 PMCID: PMC9494788 DOI: 10.5114/reum.2022.119045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Juvenile dermatomyositis (JDM) is a heterogeneous autoimmune inflammatory myositis with symmetrical proximal muscle weakness and a characteristic rash. Juvenile dermatomyositis is characterized by variable presentation and phenotypes. Detection of myositis autoantibodies is useful in improving JDM diagnosis and predicting the prognosis. In this literature review based on case series we analyze clinical and autoantibody phenotypes of JDM in four patients who were hospitalized in one regional center in Ukraine during the last 3 years and three of them presented in the time of the COVID-19 pandemic. The reviewed literature showed the last updates for the JDM diagnosis and the role of myositis autoantibodies in the prediction of disease course, systemic involvement, and malignancy risk. The presence of anti-synthetase syndrome in all presented patients, mainly due to anti-PL-7 autoantibodies, encourages further study with more patients and with detection of other myositis-specific autoantibodies to identify or refute certain regional features.
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Cancarini P, Nozawa T, Whitney K, Bell-Peter A, Marcuz JA, Taddio A, Guo J, Dover S, Feldman BM. The clinical features of juvenile dermatomyositis: A single-centre inception cohort. Semin Arthritis Rheum 2022; 57:152104. [PMID: 36183479 DOI: 10.1016/j.semarthrit.2022.152104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Juvenile Dermatomyositis (JDM), a severe and rare autoimmune disease, is the most common idiopathic inflammatory myopathy in children. We describe the clinical features of a large single-centre cohort. METHODS We studied an inception cohort (0-18 years old) referred for diagnosis to the JDM clinic at The Hospital for Sick Children (SickKids), between January 1989 and September 2017. Probable or definite diagnosis of JDM was done according to the 2017 ACR/EULAR Criteria. We excluded children who had treatment started at another hospital. The data were collected retrospectively from clinical charts and the SickKids JDM database. RESULTS 172/230 (74.8%) patients were included. They were most often female (female:male = 1.8:1); the age at diagnosis was 8.5±4.3 years. There was a positive family history for autoimmune disease in 52%, mainly rheumatoid arthritis. No patient died. The most common signs at inception were muscle weakness (85.5%), nailfold capillary abnormalities (83.4%), Gottron papules (78.5%), heliotrope rash (66.3%), abnormal gait (55.8%), and malar/facial rash (54.7%). The prevalence of Gottron papules, heliotrope rash, facial/malar rash, nailfold capillary abnormalities, Raynaud phenomenon, dysphonia/dysphagia (a frequent cause of hospitalization), mouth ulcers, calcinosis, eye problems, joint involvement, acanthosis nigricans and lipodystrophy increased during follow-up. Muscle enzymes, namely CK, ALT, AST, were often normal or only slightly raised despite active muscle disease; conversely LD was often high. Anti-Nuclear Autoantibodies were positive in 49.7% of patients at diagnosis. The course of the disease was: 29.1% monocyclic, 5.3% polycyclic, 33.1% chronic. The course of 56 patients (32.5%) was not classifiable due to length of follow-up. Corticosteroids were used as treatment in almost all our patients and 30% required intravenous therapy due to the severity of the presentation; methotrexate was added in 64%, more often in recent years. Unresponsive patients were treated mostly with intravenous immunoglobulins (IVIG). CONCLUSIONS The information obtained from this relatively large number of patients adds to the growing knowledge base of this rare disease. TRIAL REGISTRATION SickKids Research Ethics Board approved the study.
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Affiliation(s)
- Paola Cancarini
- Operative Unit of Pediatrics, ASST del Garda, Desenzano del Garda (BS), Italy
| | - Tomo Nozawa
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan; Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Kristi Whitney
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Canada
| | - Audrey Bell-Peter
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Jo-Anne Marcuz
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Canada
| | - Andrea Taddio
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" and University of Trieste, Trieste, Italy
| | - Jessica Guo
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Saunya Dover
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Brian M Feldman
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada; Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Treatment Guidelines in Pediatric Rheumatic Diseases. Rheum Dis Clin North Am 2022; 48:725-746. [DOI: 10.1016/j.rdc.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mondal S, Barman P, Vignesh P. Cardiovascular Abnormalities in Juvenile Dermatomyositis: A Scoping Review for the Clinical Rheumatologists. Front Med (Lausanne) 2022; 9:827539. [PMID: 35814777 PMCID: PMC9263083 DOI: 10.3389/fmed.2022.827539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Juvenile dermatomyositis (JDM) is a common form of inflammatory myositis in children. Vasculopathy and endothelial dysfunction play significant roles in the pathogenesis of JDM. Cardiac involvement in JDM is often underestimated, and it may be a potential indicator of poor prognosis. Cardiac dysfunction in JDM can occur both in the acute and chronic stages of the disease. Amongst the acute complications, acute congestive heart failure (CHF), myocarditis, arrhythmia, and complete heart block are common. However, these remain unrecognized due to a lack of overt clinical manifestations. Increased rates of cardiovascular abnormalities have been noted with anti-SRP and anti-Jo 1 auto-antibody positivity. Long-term follow-up studies in JDM have shown an increased prevalence of hypertension, atherosclerosis, coronary artery disease, and metabolic syndrome in adolescence and adulthood. Monitoring of body-mass index, blood pressure, and laboratory evaluation of fasting glucose and lipid profile may help in identifying metabolic syndrome in children with JDM. Steroid-sparing agents, daily exercise, and a healthy diet may reduce such long-term cardiac morbidities. Current use of multimodality imaging such as stress-echocardiography, contrast-enhanced echocardiography, cardiac magnetic resonance imaging, and positron emission tomography has increased the diagnostic yield of subclinical heart disease during acute and chronic stages of JDM. This review elaborates on different aspects of cardiac dysfunction in JDM. It also emphasizes the importance of cardiac screening in long-term follow-up of children with JDM.
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Ledenko T, Sorić Hosman I, Ćorić M, Gagro A. Case Report: Simultaneously Developed Amyopathic Dermatomyositis and Autoimmune Sclerosing Cholangitis - a Coincidence or a Shared Immunopathogenesis? Front Immunol 2022; 13:825799. [PMID: 35281002 PMCID: PMC8906471 DOI: 10.3389/fimmu.2022.825799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
Inflammatory rheumatic diseases (IRD) and autoimmune liver diseases (AILD) share many similarities regarding epidemiology, genetics, immunology and therapeutic regimens, so it is not surprising that approximately 20% of patients with AILD are diagnosed with an IRD as well. Clinical features and biochemical hallmarks of IRD and AILD often intertwine and cross diagnostic criteria. Therefore, the real distinction of underlying disorders in a patient with these comorbidities may be challenging. The present report is the first report of simultaneously developed juvenile dermatomyositis (JDM) and autoimmune sclerosing cholangitis (ASC) with both entities fulfilling the latest guidelines for a definite diagnosis. Both of these diagnoses are difficult to definitely establish since ASC has a similar serologic profile as autoimmune hepatitis and liver histological analysis is frequently non-specific, whereas clinically amyopathic JDM diagnosis depends mostly on classical dermatological symptoms, while the rest of the diagnostic criteria, including the necessity for skin or muscle biopsy and the presence of myositis specific antibodies, are still not uniformed. In spite of these challenges, our patient clearly met European League Against Rheumatism/American College of Rheumatology classification criteria for CAJDM and The European Society for Pediatric Gastroenterology, Hepatology and Nutrition diagnostic criteria for ASC. Since elevated serum transaminases, the presence of serum antinuclear antibodies and hypergammaglobulinemia could be explained as a part of both JDM and ASC, the underlying pathophysiology remains debatable. Intriguingly, JDM and ASC share genetic predisposition including human leukocyte antigen allele DRB1*0301 and tumor necrosis factor α 308A allele. Furthermore, both humoral and cellular components of the adaptive immune system contribute to the pathogenesis of JDM and ASC. Moreover, recent findings indicate that the loss of the CD28 expression on T-cells plays a significant role in their pathogenesis along with the Th17 immune pathway. Despite these common features that suggest shared autoimmunity, AILD and autoimmune myositis are traditionally studied and managed independently. The lack of therapies that target the underlying cause results in a high rate of adverse events due to unspecific immunosuppressive therapy. Shared autoimmunity is an ideal area to develop new, targeted immunotherapy that would hopefully be beneficial for more than one disease.
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Affiliation(s)
- Tomislav Ledenko
- Department of Pediatrics, Zadar General Hospital, Zadar, Croatia
| | - Iva Sorić Hosman
- Department of Pediatrics, Zadar General Hospital, Zadar, Croatia
| | - Marijana Ćorić
- Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Alenka Gagro
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Division of Pulmonology, Allergology, Immunology and Rheumatology, Department of Pediatrics, Children's Hospital Zagreb, Zagreb, Croatia
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Dressler F, Maurer B. [Dermatomyositis and juvenile dermatomyositis]. Z Rheumatol 2022; 82:233-245. [PMID: 35486206 DOI: 10.1007/s00393-022-01205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Abstract
Dermatomyositis (DM) is an inflammatory multisystem disease of unknown etiology, which can already occur in children but first onset can also be in older adulthood. Myalgia and muscle weakness can occur later in the course of the disease or even be completely absent in some forms. Classical signs on the skin include heliotrope rash, facial erythema, Gottron's papules and nailfold capillary abnormalities. For the diagnosis, screening for the presence of myositis-specific autoantibodies has become increasingly more relevant. Muscle enzymes may be elevated but not in approximately one third of patients. In the absence of typical clinical or serologic findings, additional examination methods such as nailfold capillaroscopy, magnetic resonance imaging, electromyography, skin or muscle biopsies may help to establish the diagnosis. Depending on the clinical and serological subtype, additional screening for gastrointestinal or cardiopulmonary involvement should be considered. In adults, an age-appropriate tumor screening should also be performed. Apart from corticosteroids as induction therapy, biologics and small molecule inhibitors are gaining in importance in addition to conventional disease-modifying anti-rheumatic drugs and intravenous immunoglobulins. The prognosis for DM and juvenile DM (JDM) has improved. Most patients recover at least to some extent; however, a few patients die and a minority develop persisting muscle atrophy or severe calcinosis.
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Affiliation(s)
- Frank Dressler
- Kinderklinik, Medizinische Hochschule Hannover, 30623, Hannover, Deutschland.
| | - Britta Maurer
- Universitätsklinik für Rheumatologie und Immunologie, Inselspital Bern, 3010, Bern, Schweiz.
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Wang YT, Zhang Y, Tang T, Luo C, Liu MY, Xu L, Wang L, Tang XM. Anti-nuclear matrix protein 2+ juvenile dermatomyositis with severe skin ulcer and infection: A case report and literature review. World J Clin Cases 2022; 10:3579-3586. [PMID: 35611208 PMCID: PMC9048553 DOI: 10.12998/wjcc.v10.i11.3579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is an idiopathic inflammatory myopathy that occurs in childhood. It is characterized by muscle weakness and a characteristic rash. Previous literature reports have rarely described JDM with severe skin ulcers and infections.
CASE SUMMARY Herein, we describe a case of a 2-year-old female patient who suffered from JDM, whose myositis-specific autoantibodies were positive for anti-nuclear matrix protein 2 antibody, with progressively worsening skin ulcers and severe infections. The patient was treated with glucocorticoids and various immunosuppressants. Nevertheless, further progression of the disease and the combination of primary disease and severe infection in the later period were fatal.
CONCLUSION In children, anti-nuclear matrix protein 2+ JDM combined with skin ulcers often indicates severe disease. In such cases, personalized treatment for the primary disease and infection prevention and control are essential.
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Affiliation(s)
- Ya-Ting Wang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Yu Zhang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Tao Tang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Chong Luo
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Ming-Yue Liu
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Li Xu
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Li Wang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Xue-Mei Tang
- Department of Rheumatology and Immunology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
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Pathophysiological Mechanisms and Treatment of Dermatomyositis and Immune Mediated Necrotizing Myopathies: A Focused Review. Int J Mol Sci 2022; 23:ijms23084301. [PMID: 35457124 PMCID: PMC9030619 DOI: 10.3390/ijms23084301] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 12/15/2022] Open
Abstract
Idiopathic inflammatory myopathies (IIM), collectively known as myositis, are a composite group of rare autoimmune diseases affecting mostly skeletal muscle, although other organs or tissues may also be involved. The main clinical feature of myositis is subacute, progressive, symmetrical muscle weakness in the proximal arms and legs, whereas subtypes of myositis may also present with extramuscular features, such as skin involvement, arthritis or interstitial lung disease (ILD). Established subgroups of IIM include dermatomyositis (DM), immune-mediated necrotizing myopathy (IMNM), anti-synthetase syndrome (ASyS), overlap myositis (OM) and inclusion body myositis (IBM). Although these subgroups have overlapping clinical features, the widespread variation in the clinical manifestations of IIM suggests different pathophysiological mechanisms. Various components of the immune system are known to be important immunopathogenic pathways in IIM, although the exact pathophysiological mechanisms causing the muscle damage remain unknown. Current treatment, which consists of glucocorticoids and other immunosuppressive or immunomodulating agents, often fails to achieve a sustained beneficial response and is associated with various adverse effects. New therapeutic targets have been identified that may improve outcomes in patients with IIM. A better understanding of the overlapping and diverging pathophysiological mechanisms of the major subgroups of myositis is needed to optimize treatment. The aim of this review is to report on recent advancements regarding DM and IMNM.
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Hinze C, Dressler F, Schara-Schmidt U, Haas JP. Juvenile Dermatomyositis. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1769-4299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDie juvenile Dermatomyositis (JDM) ist die häufigste chronische
entzündliche Myopathie des Kindesalters. In dieser Übersicht
soll der aktuelle Kenntnisstand hinsichtlich der Diagnostik, Behandlung und
Überwachung der JDM dargestellt werden. So liegen häufig
myositis-spezifische Antikörper vor, die mit klinischen
Phänotypen und dem Verlauf der Erkrankung korrelieren. Typ I Interferone
spielen eine wichtige Rolle in der Pathogenese der Erkrankung.
Möglicherweise kann diese Beobachtung in der Zukunft zu gezielten
Therapien führen. Da langfristig schwerwiegende Komplikationen, wie
z. B. Kalzinosen oder Lipodystrophie, drohen, besonders bei auf Dauer
unzureichend kontrollierter Erkrankung, ist eine möglichst rasche und
effektive Behandlung anzustreben. Zu diesem Zweck sollte eine intensive
Remissionsinduktionstherapie, gefolgt von einer zielgerichteten Therapie
angestrebt werden. Verschiedene validierte Messinstrumente stehen zur
Verfügung, um den Verlauf der Erkrankung zu beurteilen. Die
Pro-KIND-Initiative der Gesellschaft für Kinder- und Jugendrheumatologie
hat Praxis- und Konsens-basiert in Deutschland sowohl eine diagnostische als
auch eine Treat-to-Target-Behandlungsstrategie entwickelt. Im Rahmen nationaler
und internationaler Kollaborationen soll sich die Behandlung der JDM in der
Zukunft weiter verbessern.
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Affiliation(s)
- Claas Hinze
- Klinik für Pädiatrische Rheumatologie und Immunologie,
Universitätsklinikum Münster, Münster,
Germany
| | - Frank Dressler
- Klinik für Pädiatrische Pneumologie, Allergologie und
Neonatologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Ulrike Schara-Schmidt
- Abteilung für Neuropädiatrie, Zentrum für
Neuromuskuläre Erkrankungen im Kindes- und Jugendalter,
Universitätsklinikum Essen, Essen, Germany
| | - Johannes-Peter Haas
- German Center for Rheumatology in Children and Adolescents, Deutsches
Zentrum für Kinder- und Jugendrheumatologie Garmisch-Partenkirchen,
Garmisch-Partenkirchen, Germany
- Center for treatment of pain in young people, Zentrum für
Schmerztherapie junger Menschen, Garmisch-Partenkirchen, Germany
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Mehta P, Rathore U, Naveen R, Chatterjee R, Agarwal V, Aggarwal R, Gupta L. Prevalent Drug Usage Practices in Adults and Children With Idiopathic Inflammatory Myopathies: Registry-Based Analysis From the MyoCite Cohort. J Clin Rheumatol 2022; 28:89-96. [PMID: 35067505 DOI: 10.1097/rhu.0000000000001813] [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: 11/26/2022]
Abstract
BACKGROUND Idiopathic inflammatory myopathies (IIMs) form a heterogeneous group of disorders with a deficit of quality evidence regarding its management. Therefore, we aimed to explore the prevalent treatment practices in the MyoCite cohort from India. METHODS Drug usage patterns, their predictors, drug retention rates, efficacy, and adverse drug reactions were analyzed for adults and children newly diagnosed with IIM (2017-2020) and followed prospectively and compared with real-world data by performing a medical records review. GraphPad Prism version 8.4.2 was used for statistical analysis. RESULTS Of 181 adults (male-to-female ratio, 1:4.6) and 30 children (M:F, 1.3:1), dermatomyositis (41% adults, 93% children) was the most common subtype. Methotrexate (MTX) was the drug of choice (67% adult, 90% children) followed by azathioprine (AZA) and mycophenolate mofetil (MMF). The MMF, AZA, cyclophosphamide, and rituximab (RTX) were preferred for those with antisynthetase syndrome (ASSD) and those with lung involvement, whereas MTX was avoided in them. Functional class and family income did not determine drug preferences. Glucocorticoids were initiated at a lower dose in overlap myositis (45% vs 80%, p = 0.001), and the time to achieve the lowest dose of glucocorticoids was longer than 24 months for ASSD (77% vs 14%, p = 0.002).Over a median of 35 months, the overall retention rate was the highest for RTX (75%) followed by MTX (58%). Relapse-free survival was the highest for RTX followed by MTX. The most common reasons for discontinuation were adverse drug reactions for MTX and MMF, inefficacy for AZA, and cost for RTX. CONCLUSIONS In this first analysis of drug usage and retention in patients with IIM in Northern India, MTX emerged as the most preferred drug in both adults and children, with the exception of those with ASSD or lung disease. Organ involvement and subtype of IIM are key determinants of drug preference. Overall, RTX and MTX were well-tolerated with high retention rates, followed by AZA and MMF.
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Affiliation(s)
- Pankti Mehta
- From the Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Upendra Rathore
- From the Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - R Naveen
- From the Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rudrarpan Chatterjee
- From the Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Vikas Agarwal
- From the Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rohit Aggarwal
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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Pediatric Patient with Heliotrope Rash and Proximal Muscle Weakness. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Dabbak I, Rodero MP, Aeschlimann FA, Authier FJ, Bodemer C, Quartier P, Bondet V, Charuel JL, Duffy D, Gitiaux C, Bader-Meunier B. Efficacy and tolerance of corticosteroids and methotrexate in patients with juvenile dermatomyositis: a retrospective cohort study. Rheumatology (Oxford) 2022; 61:4514-4520. [PMID: 35199139 DOI: 10.1093/rheumatology/keac107] [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: 12/10/2021] [Revised: 02/10/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the efficacy and tolerance of the conventional first-line treatment by methotrexate (MTX) and corticosteroids (CS) in patients with juvenile dermatomyositis (JDM) regardless of severity. METHODS We conducted a monocentric retrospective study of patients with newly-diagnosed JDM treated with MTX and CS from 2012 to 2020. Proportion of clinically inactive disease (CID) within six months of MTX initiation was evaluated using both PRINTO criteria (evaluating muscle inactive disease) and Disease Activity Score (evaluating skin inactive disease). We compared responders and non-responders using univariate analyses. RESULTS Forty-five patients with JDM, out of which thirty (67%) severe JDM, were included. After six months of treatment with MTX and CS, complete CID, muscle CID and skin CID were achieved in 14/45 (31%), 19/45 (42%) and 15/45 (33%) patients respectively. The absence of myositis-specific (MSA) or myositis-associated autoantibodies (MAA) at diagnosis was associated with a better overall, cutaneous and muscular therapeutic response, compared with antibody-positive forms (p< 0.01). Requirement for ICU (p= 0.029) and cutaneous ulcerations (p= 0.018) were associated to a less favorable muscle response. MTX was stopped due to intolerance in six patients (13%) before month 6. CONCLUSION Conventional first-line treatment with MTX was not efficient in a large subset of JDM patients, especially in patients with MSA-positive forms, and in patients with severe JDM. Larger multicentre cohorts are required to confirm these data and to identify new predictive biomarkers of MTX response, in order to treat patients with JDM as early as possible with appropriate targeted drugs.
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Affiliation(s)
- Imène Dabbak
- Department of Paediatric Hematology-Immunology and Rheumatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France
| | - Mathieu P Rodero
- Chimie & Biologie, Modélisation et Immunologie pour la Thérapie (CBMIT), Paris University, CNRS, UMR8601, Paris, France
| | - Florence A Aeschlimann
- Department of Paediatric Hematology-Immunology and Rheumatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,Imagine Institute, Inserm U 1163, Université de Paris, Paris, France
| | - François-Jérôme Authier
- INSERM U955-Team Relaix, Faculty of Medicine, University of Paris-Est Creteil, Creteil, France.,Department of Pathology, Reference Centre for Neuromuscular Diseases, Henri Mondor University Hospitals, AP-HP, Créteil, France
| | - Christine Bodemer
- Imagine Institute, Inserm U 1163, Université de Paris, Paris, France.,Department of Pediatric Dermatology and Dermatology, National Reference Centre for Genodermatosis and Rare Diseases of the Skin (MAGEC), Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Pierre Quartier
- Department of Paediatric Hematology-Immunology and Rheumatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,Chimie & Biologie, Modélisation et Immunologie pour la Thérapie (CBMIT), Paris University, CNRS, UMR8601, Paris, France
| | - Vincent Bondet
- Institut Pasteur, Translational Immunology Lab, Université de Paris, Paris, France
| | - Jean-Luc Charuel
- Department of Immunology, Laboratory of Immunochemistry, Pitié-Salpêtrière Charles Foix, AP-HP, Paris, France
| | - Darragh Duffy
- Institut Pasteur, Translational Immunology Lab, Université de Paris, Paris, France
| | - Cyril Gitiaux
- Department of Paediatric Neurophysiology, Necker-Enfants Malades Hospital, AP-HP, Université de Paris, Paris, France.,Reference Centre for Neuromuscular Diseases, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Brigitte Bader-Meunier
- Department of Paediatric Hematology-Immunology and Rheumatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,Chimie & Biologie, Modélisation et Immunologie pour la Thérapie (CBMIT), Paris University, CNRS, UMR8601, Paris, France
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Bose S, Madke B. A comprehensive review of immunosuppressive drugs in pediatric dermatoses: Part II – methotrexate and mycophenolate mofetil. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2022. [DOI: 10.4103/ijpd.ijpd_84_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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50
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Loarce-Martos J, Larena C, Blázquez MÁ, Joven BE, Carreira PE, Martínez-Barrio J, Monteagudo I, López-Longo FJ, Ruiz L, López-Robledillo JC, Almodóvar R, Llorente I, Tomero E, García-de la Peña P, Moruno H, Pérez A, Cobo-Ibáñez T, Lojo Oliveira L, Barbadillo MC, García-De Yébenes MJ, Nuño-Nuño L. Clinical Characteristics of Juvenile Idiopathic Inflammatory Myopathy and Comparison With Adult Patients: Analysis From a Multicentric Cohort in Spain. J Clin Rheumatol 2022; 28:e195-e202. [PMID: 33492027 DOI: 10.1097/rhu.0000000000001696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
METHODS This study reviewed the medical records of patients from the REMICAM cohort, a multicentric longitudinal study carried out in patients with IIM, followed up between 1980 and 2014 in 12 hospitals in Madrid, Spain. Patients with definite or probable JPM, JDM, adult DM, and adult PM according to the modified Bohan and Peter criteria were selected. We compared the characteristics between JDM and JPM, and between JIIM and adult IIM. RESULTS Eighty-six juvenile patients (75 JDMs and 11 JPMs) and 283 adult patients (133 DMs and 150 PMs) were included. Compared with patients with JDM, patients with JPM were older at diagnosis, had more fever and arthritis, and were less frequently treated with disease-modifying antirheumatic drugs (these differences were not statistically significant). Compared with patients with adult DM, those with JDM presented more frequently with calcinosis (33.8% vs 6.9%, p < 0.0001) and had less severe infections (4.3% vs 23.4%, p < 0.0001), malignancies (1.3% vs 25.6%, p < 0.0001), and mortality (3.5% vs 33%, p < 0.0001). Patients with JDM were treated less frequently with azathioprine (10.8% vs 44.7%, p < 0.0001). CONCLUSIONS Our findings confirm that JIIMs are a heterogeneous group of diseases with relevant differences compared with adult IIMs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Pérez
- Hospital Universitario Príncipe de Asturias
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