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Salam S, Symonds T, Doll H, Rousell S, Randall J, Lloyd-Price L, Hudgens S, Guldberg C, Herbelin L, Barohn RJ, Hanna MG, Dimachkie MM, Machado PM. Measurement properties of the Inclusion Body Myositis Functional Rating Scale. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333617. [PMID: 38960586 DOI: 10.1136/jnnp-2024-333617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES To evaluate the validity, reliability, responsiveness and meaningful change threshold of the Inclusion Body Myositis (IBM) Functional Rating Scale (FRS). METHODS Data from a large 20-month multicentre, randomised, double-blind, placebo-controlled trial in IBM were used. Convergent validity was tested using Spearman correlation with other health outcomes. Discriminant (known groups) validity was assessed using standardised effect sizes (SES). Internal consistency was tested using Cronbach's alpha. Intrarater reliability in stable patients and equivalence of face-to-face and telephone administration were tested using intraclass correlation coefficients (ICCs) and Bland-Altman plots. Responsiveness was assessed using standardised response mean (SRM). A receiver operator characteristic (ROC) curve anchor-based approach was used to determine clinically meaningful IBMFRS change. RESULTS Among the 150 patients, mean (SD) IBMFRS total score was 27.4 (4.6). Convergent validity was supported by medium to large correlations (rs modulus: 0.42-0.79) and discriminant validity by moderate to large group differences (SES=0.51-1.59). Internal consistency was adequate (overall Cronbach's alpha: 0.79). Test-retest reliability (ICCs=0.84-0.87) and reliability of telephone versus face-to-face administration (ICCs=0.93-0.95) were excellent, with Bland-Altman plots showing good agreement. Responsiveness in the worsened group defined by various external constructs was large at both 12 (SRM=-0.76 to -1.49) and 20 months (SRM=-1.12 to -1.57). In ROC curve analysis, a drop in at least two IBMFRS total score points was shown to represent a meaningful decline. CONCLUSIONS When administered by trained raters, the IBMFRS is a reliable, valid and responsive tool that can be used to evaluate the impact of IBM and its treatment on physical function, with a 2-point reduction representing meaningful decline. TRIAL REGISTRATION NUMBER NCT02753530.
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Affiliation(s)
- Sharfaraz Salam
- Department of Neuromuscular Diseases, University College London, London, UK
| | | | - Helen Doll
- Clinical Outcomes Solutions Ltd, Folkestone, UK
| | - Sam Rousell
- Clinical Outcomes Solutions Ltd, Folkestone, UK
| | | | | | | | | | - Laura Herbelin
- Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Richard J Barohn
- Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Michael G Hanna
- Department of Neuromuscular Diseases, University College London, London, UK
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas City Medical Center, Kansas City, Missouri, USA
| | - Pedro M Machado
- Department of Neuromuscular Diseases, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service (NHS) Trust, London, UK
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Connolly CM, Gupta L, Fujimoto M, Machado PM, Paik JJ. Idiopathic inflammatory myopathies: current insights and future frontiers. THE LANCET. RHEUMATOLOGY 2024; 6:e115-e127. [PMID: 38267098 DOI: 10.1016/s2665-9913(23)00322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024]
Abstract
Idiopathic inflammatory myopathies are a group of autoimmune diseases with a broad spectrum of clinical presentations, primarily characterised by immune-mediated muscle injury. Until recently, there was little insight into the pathogenesis of idiopathic inflammatory myopathies, which challenged the recognition of the breadth of heterogeneity of this group of diseases as well as the development of new therapeutics. However, the landscape of idiopathic inflammatory myopathies is evolving. In the past decade, advances in diagnostic tools have facilitated an enhanced understanding of the underlying disease mechanisms in idiopathic inflammatory myopathies, enabling the expansion of therapeutic trials. The fields of transcriptomics, prot§eomics, and machine learning offer the potential to gain greater insights into the underlying pathophysiology of idiopathic inflammatory myopathies. Harnessing insights gained from these sophisticated tools could contribute to the identification of differences at a molecular level among patients, accelerating the development of targeted, tailored therapies. Bolstered by the validation and standardisation of robust outcome measures, many promising therapies are in clinical trial development. Although challenges remain, there is great optimism in the field due to the progress in innovative diagnostics, outcome measures, and therapeutic approaches. In this Review, we discuss the expanding landscape of idiopathic inflammatory myopathies as the frontier of precision medicine becomes imminent.
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Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Pedro M Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK; Centre for Rheumatology, University College London, London, UK; National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK; Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Hua C, Bhai S, Cheng J, Hinojosa J, Wilson L, Lubinus M, Bhashyam AR. Tendon Transfers to Improve Grip and Pinch in Patients with Sporadic Inclusion Body Myositis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5418. [PMID: 38025613 PMCID: PMC10656093 DOI: 10.1097/gox.0000000000005418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023]
Abstract
Background Sporadic inclusion body myositis (sIBM) is a rare and slowly progressive skeletal muscle disease that can cause hand dysfunction, which is a major source of disability. Tendon transfers have been reliably used to improve function in other neuromuscular settings. Given that sIBM patients often present with flexion impairments and mostly functioning extensors, we investigated the potential opportunity for tendon transfer surgery to improve hand dysfunction in sIBM patients. Methods We conducted a scoping review for studies of sIBM and tendon transfers, extracted descriptions of hand function and surgical technique, and recorded results in terms of hand function. We also conducted an institutional review board-approved survey with 470 participants to determine baseline patient-reported function and to determine participant perceptions and expectations for tendon transfer surgery to improve hand function in sIBM. Results We identified three published case reports on tendon transfers in sIBM patients with subjectively improved grip and pinch strength, but standardized measures of hand function or quality-of-life were not reported. Within the surveyed cohort, half of participants reported that they would consider surgery, yet only 8% had been referred to a hand surgeon. Fifty four percent of participants reported that they would consider surgery if there would be 1-2 years of benefit after surgery. All participants who would consider surgery also had significant upper extremity disability. Discussion Tendon transfer surgery has the potential to improve quality-of-life for sIBM patients, and there is significant patient interest in this approach. To objectively assess its efficacy, we propose conducting a surgical trial.
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Affiliation(s)
- Catherine Hua
- From the Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
| | - Salman Bhai
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Tex
- Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, Tex
- Myositis Support and Understanding, Lincoln, Del
| | - Jonathan Cheng
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Jose Hinojosa
- Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, Tex
| | - Lynn Wilson
- Myositis Support and Understanding, Lincoln, Del
| | | | - Abhiram R. Bhashyam
- From the Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
- Myositis Support and Understanding, Lincoln, Del
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Machado PM, McDermott MP, Blaettler T, Sundgreen C, Amato AA, Ciafaloni E, Freimer M, Gibson SB, Jones SM, Levine TD, Lloyd TE, Mozaffar T, Shaibani AI, Wicklund M, Rosholm A, Carstensen TD, Bonefeld K, Jørgensen AN, Phonekeo K, Heim AJ, Herbelin L, Barohn RJ, Hanna MG, Dimachkie MM. Safety and efficacy of arimoclomol for inclusion body myositis: a multicentre, randomised, double-blind, placebo-controlled trial. Lancet Neurol 2023; 22:900-911. [PMID: 37739573 DOI: 10.1016/s1474-4422(23)00275-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Inclusion body myositis is the most common progressive muscle wasting disease in people older than 50 years, with no effective drug treatment. Arimoclomol is an oral co-inducer of the cellular heat shock response that was safe and well-tolerated in a pilot study of inclusion body myositis, reduced key pathological markers of inclusion body myositis in two in-vitro models representing degenerative and inflammatory components of this disease, and improved disease pathology and muscle function in mutant valosin-containing protein mice. In the current study, we aimed to assess the safety, tolerability, and efficacy of arimoclomol in people with inclusion body myositis. METHODS This multicentre, randomised, double-blind, placebo-controlled study enrolled adults in specialist neuromuscular centres in the USA (11 centres) and UK (one centre). Eligible participants had a diagnosis of inclusion body myositis fulfilling the European Neuromuscular Centre research diagnostic criteria 2011. Participants were randomised (1:1) to receive either oral arimoclomol 400 mg or matching placebo three times daily (1200 mg/day) for 20 months. The randomisation sequence was computer generated centrally using a permuted block algorithm with randomisation numbers masked to participants and trial staff, including those assessing outcomes. The primary endpoint was the change from baseline to month 20 in the Inclusion Body Myositis Functional Rating Scale (IBMFRS) total score, assessed in all randomly assigned participants, except for those who were randomised in error and did not receive any study medication, and those who did not meet inclusion criteria. Safety analyses included all randomly assigned participants who received at least one dose of study medication. This trial is registered with ClinicalTrials.gov, number NCT02753530, and is completed. FINDINGS Between Aug 16, 2017 and May 22, 2019, 152 participants with inclusion body myositis were randomly assigned to arimoclomol (n=74) or placebo (n=78). One participant was randomised in error (to arimoclomol) but not treated, and another (assigned to placebo) did not meet inclusion criteria. 150 participants (114 [76%] male and 36 [24%] female) were included in the efficacy analyses, 73 in the arimoclomol group and 77 in the placebo group. 126 completed the trial on treatment (56 [77%] and 70 [90%], respectively) and the most common reason for treatment discontinuation was adverse events. At month 20, mean IBMFRS change from baseline was not statistically significantly different between arimoclomol and placebo (-3·26, 95% CI -4·15 to -2·36 in the arimoclomol group vs -2·26, -3·11 to -1·41 in the placebo group; mean difference -0·99 [95% CI -2·23 to 0·24]; p=0·12). Adverse events leading to discontinuation occurred in 13 (18%) of 73 participants in the arimoclomol group and four (5%) of 78 participants in the placebo group. Serious adverse events occurred in 11 (15%) participants in the arimoclomol group and 18 (23%) in the placebo group. Elevated transaminases three times or more of the upper limit of normal occurred in five (7%) participants in the arimoclomol group and one (1%) in the placebo group. Tubulointerstitial nephritis was observed in one (1%) participant in the arimoclomol group and none in the placebo group. INTERPRETATION Arimoclomol did not improve efficacy outcomes, relative to placebo, but had an acceptable safety profile in individuals with inclusion body myositis. This is one of the largest trials done in people with inclusion body myositis, providing data on disease progression that might be used for subsequent clinical trial design. FUNDING US Food and Drug Administration Office of Orphan Products Development and Orphazyme.
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Affiliation(s)
- Pedro M Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK.
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Anthony A Amato
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Emma Ciafaloni
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Miriam Freimer
- Department of Neurology, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Summer B Gibson
- Neuromuscular Division, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sarah M Jones
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Todd D Levine
- Department of Neurology, HonorHealth, Phoenix, AZ, USA
| | - Thomas E Lloyd
- Departments of Neurology and Neuroscience, Johns Hopkins University, Baltimore, MD, USA
| | - Tahseen Mozaffar
- Division of Neuromuscular Disorders, University of California, Irvine, Orange, CA, USA
| | - Aziz I Shaibani
- Nerve and Muscle Center of Texas, Baylor College of Medicine, Houston, TX, USA
| | - Matthew Wicklund
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | | | | | | | - Andrew J Heim
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Laura Herbelin
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Richard J Barohn
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Michael G Hanna
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
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Symonds T, Randall J, Lloyd-Price L, Hudgens S, Dimachkie MM, Guldberg C, Machado PM. Study to Assess Content Validity and Interrater and Intrarater Reliability of the Inclusion Body Myositis Functional Rating Scale. Neurol Clin Pract 2023; 13:e200168. [PMID: 37324533 PMCID: PMC10263485 DOI: 10.1212/cpj.0000000000200168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/28/2023] [Indexed: 06/17/2023]
Abstract
Background and Objectives Sporadic inclusion body myositis (IBM) is a rare, muscle-wasting disease that negatively affects health-related quality of life. Although a measure that has been developed to assess the impact of IBM, the IBM Functional Rating Scale (IBMFRS) has limited evidence of content validity or reliability, and what constitutes a meaningful change threshold; this study was conducted to address these gaps. Methods Adult patients with a clinical diagnosis of IBM from the United Kingdom and disease area expert health care professionals from the United States and United Kingdom took part in this study. This study consisted of 5 stages including phone interviews (physicians), face-to-face interviews (patients), face-to-face ratings, phone ratings, and ratings of videos using the IBMFRS. Results The IBMFRS adequately captures all core functional impacts of IBM, which was corroborated by both patient participants and physicians when debriefing the measure. Physicians and patient participants all thought any change on the measure would be meaningful change for a patient, either improvement or worsening. The quantitative analysis demonstrated good interrater reliability for face-to-face ratings (intraclass correlation coefficient [ICC] >0.7) and for video ratings (ICC >0.9). Intrarater reliability was excellent for face-to-face and video ratings (ICC >0.9). Equivalence between the modes of administration, face-to-face vs phone, was also excellent (ICC >0.9). Discussion The IBMFRS is content valid in assessing the key functional impacts of IBM, and any change would be meaningful. It is reliable both within and across raters, and there is equivalence between different modes of administration (face-to-face vs phone).
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Affiliation(s)
- Tara Symonds
- Clinical Outcomes Solutions (TS, JR, LL-P), Folkestone, United Kingdom; Clinical Outcomes Solutions (SH), Tucson, AZ; The University of Kansas Medical Center (MMD); Orphazyme A/S (CG), Copenhagen, Denmark; and Department of Neuromuscular Diseases (PMM), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Jason Randall
- Clinical Outcomes Solutions (TS, JR, LL-P), Folkestone, United Kingdom; Clinical Outcomes Solutions (SH), Tucson, AZ; The University of Kansas Medical Center (MMD); Orphazyme A/S (CG), Copenhagen, Denmark; and Department of Neuromuscular Diseases (PMM), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Lucy Lloyd-Price
- Clinical Outcomes Solutions (TS, JR, LL-P), Folkestone, United Kingdom; Clinical Outcomes Solutions (SH), Tucson, AZ; The University of Kansas Medical Center (MMD); Orphazyme A/S (CG), Copenhagen, Denmark; and Department of Neuromuscular Diseases (PMM), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Stacie Hudgens
- Clinical Outcomes Solutions (TS, JR, LL-P), Folkestone, United Kingdom; Clinical Outcomes Solutions (SH), Tucson, AZ; The University of Kansas Medical Center (MMD); Orphazyme A/S (CG), Copenhagen, Denmark; and Department of Neuromuscular Diseases (PMM), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Mazen M Dimachkie
- Clinical Outcomes Solutions (TS, JR, LL-P), Folkestone, United Kingdom; Clinical Outcomes Solutions (SH), Tucson, AZ; The University of Kansas Medical Center (MMD); Orphazyme A/S (CG), Copenhagen, Denmark; and Department of Neuromuscular Diseases (PMM), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Christina Guldberg
- Clinical Outcomes Solutions (TS, JR, LL-P), Folkestone, United Kingdom; Clinical Outcomes Solutions (SH), Tucson, AZ; The University of Kansas Medical Center (MMD); Orphazyme A/S (CG), Copenhagen, Denmark; and Department of Neuromuscular Diseases (PMM), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Pedro M Machado
- Clinical Outcomes Solutions (TS, JR, LL-P), Folkestone, United Kingdom; Clinical Outcomes Solutions (SH), Tucson, AZ; The University of Kansas Medical Center (MMD); Orphazyme A/S (CG), Copenhagen, Denmark; and Department of Neuromuscular Diseases (PMM), UCL Queen Square Institute of Neurology, University College London, United Kingdom
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Michelle EH, Pinal-Fernandez I, Casal-Dominguez M, Albayda J, Paik JJ, Tiniakou E, Adler B, Mecoli CA, Danoff SK, Christopher-Stine L, Mammen AL, Lloyd TE. Clinical Subgroups and Factors Associated With Progression in Patients With Inclusion Body Myositis. Neurology 2023; 100:e1406-e1417. [PMID: 36690456 PMCID: PMC10065210 DOI: 10.1212/wnl.0000000000206777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/18/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Sporadic inclusion body myositis (IBM) is the most common acquired myopathy in individuals older than 50 years. The disorder is slowly progressive, and although many therapies have been investigated, response has generally been poor. Clinical heterogeneity may influence treatment responsiveness; however, data regarding heterogeneity in IBM are limited and often conflicting. We aim to identify clinically distinct subgroups within a large IBM cohort and prognostic factors for disease progression. METHODS Clinical, histologic, radiologic, and electrophysiologic data were analyzed for all patients with IBM and other forms of myositis enrolled in a longitudinal cohort from The Johns Hopkins Myositis Center from 2003 to 2018. Patients with IBM were included if they met at least one of the following criteria: Griggs possible, European Neuromuscular Centre 2011 probable, or Lloyd-Greenberg data-derived criteria for IBM. Univariate, multivariate, and graphical analyses were used to identify prognostic factors in patients with IBM. Thus, linear and logistic regressions were used to adjust for potential confounding variables. The evolution of creatine kinase and muscle strength was studied using multilevel linear regression models. Nonmodifiable risk factors (sex, race, disease duration, and age at the onset of first symptoms) were used as adjusting covariates for the regression analyses. RESULTS Among the 335 patients meeting the inclusion criteria for IBM, 64% were male with an average age of disease onset of 58.7 years and delay to diagnosis of 5.2 years. Initial misdiagnosis (52%) and immunosuppressant treatment (42%) were common. Less than half (43%) of muscle biopsies demonstrated all 3 pathologic hallmarks: endomysial inflammation, mononuclear cell invasion, and rimmed vacuoles. Black patients had significantly weaker arm abductors, hip flexors, and knee flexors compared with non-Black patients. Female patients had stronger finger flexors and knee extensors compared with their male counterparts. Younger age (<50 years) at onset was not associated with increased weakness. DISCUSSION Our study demonstrates that female and Black patients have distinct clinical phenotypes and trajectories within the overarching IBM clinical phenotype. These subgroups may have different responses to therapies, which may influence the design of future clinical trials in IBM.
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Affiliation(s)
- Elizabeth Harlan Michelle
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Iago Pinal-Fernandez
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Maria Casal-Dominguez
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Jemima Albayda
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Julie J Paik
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Eleni Tiniakou
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Brittany Adler
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Christopher A Mecoli
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Sonye K Danoff
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Lisa Christopher-Stine
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Andrew L Mammen
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Thomas E Lloyd
- From the Departments of Neurology (E.H.M., I.P.-F., M.C.-D., A.L.M., T.E.L.), and Medicine (J.A., J.J.P., E.T., B.A., C.A.M., S.K.D., L.C.-S.), Johns Hopkins University School of Medicine, Baltimore, MD; Muscle Disease Unit (I.P.-F., M.C.-D., A.L.M.), Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and Faculty of Health Sciences and Faculty of Computer Science (I.P.-F.), Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain.
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Nagy S, Khan A, Machado PM, Houlden H. Inclusion body myositis: from genetics to clinical trials. J Neurol 2023; 270:1787-1797. [PMID: 36399165 PMCID: PMC9971047 DOI: 10.1007/s00415-022-11459-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022]
Abstract
Inclusion body myositis (IBM) belongs to the group of idiopathic inflammatory myopathies and is characterized by a slowly progressive disease course with asymmetric muscle weakness of predominantly the finger flexors and knee extensors. The disease leads to severe disability and most patients lose ambulation due to lack of curative or disease-modifying treatment options. Despite some genes reported to be associated with hereditary IBM (a distinct group of conditions), data on the genetic susceptibility of sporadic IBM are very limited. This review gives an overview of the disease and focuses on the current genetic knowledge and potential therapeutic implications.
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Affiliation(s)
- Sara Nagy
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK.
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Alaa Khan
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
- Molecular Diagnostic Unit, Clinical Laboratory Department, King Abdullah Medical City in Makkah, Mecca, Saudi Arabia
| | - Pedro M Machado
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
- Division of Medicine, Centre for Rheumatology, University College London, London, UK
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
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Alamr M, Pinto MV, Naddaf E. Atypical presentations of inclusion body myositis: Clinical characteristics and long-term outcomes. Muscle Nerve 2022; 66:686-693. [PMID: 36052422 DOI: 10.1002/mus.27716] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 08/15/2022] [Accepted: 08/28/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTIONS/AIMS Inclusion body myositis (IBM) typically presents with progressive weakness preferentially involving finger flexors and quadriceps. Atypical presentations have been less commonly reported. Here, we aim to describe the clinical characteristics and long-term outcomes of IBM patients with atypical presentations. METHODS We retrospectively searched the Mayo Clinic medical records to identify IBM patients with atypical disease onset, seen between 2015 and 2020. RESULTS We identified 357 IBM patients, of whom 50 (14%) had an atypical presentation. Thirty-eight patients were diagnosed with IBM because they fulfilled one of the European Neuromuscular Center diagnostic categories at a later stage, 10 had all IBM histopathological features, and 2 were diagnosed on the basis of clinical and laboratory data. The most common presentation was dysphagia (50%), followed by asymptomatic hyperCKemia (24%; CK, creatine kinase), then foot drop (12%). 6% of patients presented with proximal arm weakness, 4% with axial weakness and 4% with facial diplegia. Median time from symptom onset to diagnosis was 9 y. Median age at diagnosis was 70.5 y. 16% of patients needed a walking aid. When tested, 86.5% of patients had impaired swallowing and 56% had elevated cytosolic nucleotidase-1A antibodies. Only 1/26 patients who received immunotherapy had minimal improvement. Upon follow-up, most patients had generalization of their weakness with a decline in their strength summated score of 0.082/mo. DISCUSSION A significant proportion of IBM patients may have an atypical presentation. Recognition of such heterogeneity could improve early diagnosis, prevent unnecessary immunotherapy, and provide insight for future diagnostic criteria development and clinical trials.
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Affiliation(s)
- Mazen Alamr
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Marcus V Pinto
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elie Naddaf
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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9
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Abstract
PURPOSE OF REVIEW To discuss recent developments in our understanding of epidemiology, diagnostics, biomarkers, pathology, pathogenesis, outcome measures, and therapeutics in inclusion body myositis (IBM). RECENT FINDINGS Recent epidemiology data confirms a relatively higher prevalence in the population aged above 50 years and the reduced life expectancy. Association with cancer and other systemic disorders is better defined. The role of magnetic resonance imaging (MRI) and ultrasound in diagnosis as well as in following disease progression has been elucidated. There are new blood and imaging biomarkers that show tremendous promise for diagnosis and as outcome measures in therapeutic trials. Improved understanding of the pathogenesis of the disease will lead to better therapeutic interventions, but also highlights the importance to have sensitive and responsive outcome measures that accurately quantitate change. SUMMARY There are exciting new developments in our understanding of IBM which should lead to improved management and therapeutic options.
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Affiliation(s)
- Mari Perez-Rosendahl
- Department of Pathology & Laboratory Medicine, School of Medicine, University of California, Irvine
| | - Tahseen Mozaffar
- Department of Pathology & Laboratory Medicine, School of Medicine, University of California, Irvine
- Department of Neurology, School of Medicine, University of California, Irvine
- Institute for Immunology, School of Medicine, University of California, Irvine
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10
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Goyal NA, Greenberg SA, Cauchi J, Araujo N, Li V, Wencel M, Irani T, Wang LH, Palma AM, Villalta SA, Mozaffar T. Correlations of disease severity outcome measures in inclusion body myositis. Neuromuscul Disord 2022; 32:800-805. [PMID: 36050251 PMCID: PMC10069380 DOI: 10.1016/j.nmd.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Abstract
This study aimed to evaluate the correlation between various outcome measures used to assess disease severity and progression in inclusion body myositis (IBM) clinical trials. A cross-sectional study, involving 51 IBM patients meeting the European Neuromuscular Center (ENMC) 2011 criteria for clinically defined or probable IBM, was completed at the University of California, Irvine. Clinical details, demographic data, and functional data including timed get up (TGU), manual muscle testing, hand grip, pinch dynamometry, as well as IBM functional rating scale (IBMFRS), modified Rankin score, forced vital capacity (FVC), and modified ocular bulbar facial respiratory scale (mOBFRS) were collected on all patients. Descriptive statistics and Pearson's r correlation were performed to analyze the data. Age of the patient did not correlate with any of the outcome measures. Greater severity of IBMFRS scores correlated with longer disease duration as well as greater severity for FVC, strength outcomes, TGU, modified Rankin, and mOBFRS. Additionally, TGU strongly correlated with muscle strength measurements, modified Rankin, and mOBFRS. mOBFRS moderately correlated with IBMFRS, muscle strength, FVC, TGU and modified Rankin score. We demonstrate moderate to strong correlations among the disease severity outcome measures in this study.
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Affiliation(s)
- Namita A Goyal
- Department of Neurology, University of California, Irvine, CA, United States.
| | - Steven A Greenberg
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jonathan Cauchi
- Department of Neurology, University of California, Irvine, CA, United States
| | - Nadia Araujo
- Department of Neurology, University of California, Irvine, CA, United States
| | - Vivian Li
- Department of Neurology, University of California, Irvine, CA, United States
| | - Marie Wencel
- Department of Neurology, University of California, Irvine, CA, United States
| | - Tyler Irani
- Department of Neurology, University of California, Irvine, CA, United States
| | - Leo H Wang
- Department of Neurology, University of Washington Medical Center, Seattle, WA, United States
| | - Anton M Palma
- Institute for Clinical and Translational Science, University of California, Irvine, CA, United States
| | - S Armando Villalta
- Department of Neurology, University of California, Irvine, CA, United States; Institute for Immunology, United States; Department of Physiology and Biophysics, United States
| | - Tahseen Mozaffar
- Department of Neurology, University of California, Irvine, CA, United States; Institute for Immunology, United States; Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, United States
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11
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Naddaf E. Inclusion body myositis: Update on the diagnostic and therapeutic landscape. Front Neurol 2022; 13:1020113. [PMID: 36237625 PMCID: PMC9551222 DOI: 10.3389/fneur.2022.1020113] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Inclusion body myositis (IBM) is a progressive muscle disease affecting patients over the age of 40, with distinctive clinical and histopathological features. The typical clinical phenotype is characterized by prominent involvement of deep finger flexors and quadriceps muscles. Less common presentations include isolated dysphagia, asymptomatic hyper-CKemia, and axial or limb weakness beyond the typical pattern. IBM is associated with marked morbidity as majority of patients eventually become wheelchair dependent with limited use of their hands and marked dysphagia. Furthermore, IBM mildly affects longevity with aspiration pneumonia and respiratory complications being the most common cause of death. On muscle biopsy, IBM is characterized by a peculiar combination of endomysial inflammation, rimmed vacuoles, and protein aggregation. These histopathological features are reflective of the complexity of underlying disease mechanisms. No pharmacological treatment is yet available for IBM. Monitoring for swallowing and respiratory complications, exercise, and addressing mobility issues are the mainstay of management. Further research is needed to better understand disease pathogenesis and identify novel therapeutic targets.
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12
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Laurent D, Riek J, Sinclair CDJ, Houston P, Roubenoff R, Papanicolaou DA, Nagy A, Pieper S, Yousry TA, Hanna MG, Thornton JS, Machado PM. Longitudinal Changes in MRI Muscle Morphometry and Composition in People With Inclusion Body Myositis. Neurology 2022; 99:e865-e876. [PMID: 36038279 PMCID: PMC10513877 DOI: 10.1212/wnl.0000000000200776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Limited data suggest that quantitative MRI (qMRI) measures have potential to be used as trial outcome measures in sporadic inclusion body myositis (sIBM) and as a noninvasive assessment tool to study sIBM muscle pathologic processes. Our aim was to evaluate changes in muscle structure and composition using a comprehensive multiparameter set of qMRI measures and to assess construct validity and responsiveness of qMRI measures in people with sIBM. METHODS This was a prospective observational cohort study with assessments at baseline (n = 30) and 1 year (n = 26). qMRI assessments include thigh muscle volume (TMV), inter/intramuscular adipose tissue (IMAT), muscle fat fraction (FF), muscle inflammation (T2 relaxation time), IMAT from T2* relaxation (T2*-IMAT), intermuscular connective tissue from T2* relaxation (T2*-IMCT), and muscle macromolecular structure from the magnetization transfer ratio (MTR). Physical performance assessments include sIBM Physical Functioning Assessment (sIFA), 6-minute walk distance, and quantitative muscle testing of the quadriceps. Correlations were assessed using the Spearman correlation coefficient. Responsiveness was assessed using the standardized response mean (SRM). RESULTS After 1 year, we observed a reduction in TMV (6.8%, p < 0.001) and muscle T2 (6.7%, p = 0.035), an increase in IMAT (9.7%, p < 0.001), FF (11.2%, p = 0.030), connective tissue (22%, p = 0.995), and T2*-IMAT (24%, p < 0.001), and alteration in muscle macromolecular structure (ΔMTR = -26%, p = 0.002). A decrease in muscle T2 correlated with an increase in T2*-IMAT (r = -0.47, p = 0.008). Deposition of connective tissue and IMAT correlated with deterioration in sIFA (r = 0.38, p = 0.032; r = 0.34, p = 0.048; respectively), whereas a decrease in TMV correlated with a decrease in quantitative muscle testing (r = 0.36, p = 0.035). The most responsive qMRI measures were T2*-IMAT (SRM = 1.50), TMV (SRM = -1.23), IMAT (SRM = 1.20), MTR (SRM = -0.83), and T2 relaxation time (SRM = -0.65). DISCUSSION Progressive deterioration in muscle quality measured by qMRI is associated with a decline in physical performance. Inflammation may play a role in triggering fat infiltration into muscle. qMRI provides valid and responsive measures that might prove valuable in sIBM experimental trials and assessment of muscle pathologic processes. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that qMRI outcome measures are associated with physical performance measures in patients with sIBM.
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Affiliation(s)
- Didier Laurent
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom.
| | - Jon Riek
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom
| | - Christopher D J Sinclair
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom
| | - Parul Houston
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom
| | - Ronenn Roubenoff
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom
| | - Dimitris A Papanicolaou
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom
| | - Attila Nagy
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom
| | - Steve Pieper
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom
| | - Tarek A Yousry
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom
| | - Michael G Hanna
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom
| | - John S Thornton
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom
| | - Pedro M Machado
- From the Novartis Institutes for Biomedical Research (D.L., P.H., R.R., D.A.P.), Basel, Switzerland; BioTel Research (J.R.), Rochester, NY; Neuroradiological Academic Unit (C.D.J.S., T.A.Y., J.S.T.), UCL Institute of Neurology, London, United Kingdom; Isomics Inc. (A.N., S.P.), Cambridge, MA; Department of Medical Physics and Informatics (A.N.), University of Szeged, Hungary; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery; Department of Neuromuscular Diseases (M.G.H., P.M.M.), UCL Queen Square Institute of Neurology, University College London; and Centre for Rheumatology (P.M.M.), Department of Inflammation, Division of Medicine, University College London, United Kingdom
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Roy B, Zubair A, Petschke K, O'Connor KC, Paltiel AD, Nowak RJ. Reliability of patient self-reports to clinician-assigned functional scores of inclusion body myositis. J Neurol Sci 2022; 436:120228. [DOI: 10.1016/j.jns.2022.120228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022]
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Lu K, Yong KXX, Skorupinska I, Deriziotis S, Collins JD, Henley SMD, Hanna MG, Rossor MN, Ridha BH, Machado PM. A cross-sectional study of memory and executive functions in patients with sporadic inclusion body myositis. Muscle Nerve 2022; 65:105-109. [PMID: 34605039 DOI: 10.1002/mus.27426] [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: 04/30/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION/AIMS Sporadic inclusion body myositis (IBM) is a degenerative and inflammatory acquired myopathy characterized by muscle deposition of various proteins typically associated with Alzheimer disease and other neurodegenerative diseases. Although cognitive impairment is not noted as a clinical feature of IBM, evidence is lacking. In this study we investigated whether cognitive performance of patients with IBM differs from population norms, focusing on cognitive domains affected in early Alzheimer disease (memory, executive function), and to test whether disease duration and the level of disability of IBM are associated with cognitive function. METHODS Twenty-four patients with IBM (mean [standard deviation]: age, 62.0 [7.2] years; disease duration, 9.6 [4.8] years) were assessed cross-sectionally on neuropsychological tests covering multiple cognitive domains, including the Preclinical Alzheimer Cognitive Composite (PACC). Performance was compared with published normative data adjusted for age, sex, and education (National Alzheimer's Coordinating Center; N = 3268). Associations were examined between PACC score, disease duration, and level of disability (assessed using the IBM Functional Rating Scale [IBMFRS]). RESULTS Across all cognitive tests, group performance was within ±1 standard deviation of the normative mean. There was no evidence of associations between PACC score and either disease duration (ρ = -0.04, P = .87) or IBMFRS total score (ρ = 0.14, P = .52). DISCUSSION Memory and executive function in patients with IBM did not differ from normative data, and we observed no evidence of associations between the cognitive composite and disease duration or level of disability. This addresses a question frequently asked by patients and will be of value for clinicians and patients alike.
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Affiliation(s)
- Kirsty Lu
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Keir X X Yong
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Iwona Skorupinska
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK
| | - Stephanie Deriziotis
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Jessica D Collins
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Susie M D Henley
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Michael G Hanna
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Martin N Rossor
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Basil H Ridha
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Pedro M Machado
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
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15
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Pinto MV, Laughlin RS, Klein CJ, Mandrekar J, Naddaf E. Inclusion body myositis: correlation of clinical outcomes with histopathology, electromyography and laboratory findings. Rheumatology (Oxford) 2021; 61:2504-2511. [PMID: 34617994 DOI: 10.1093/rheumatology/keab754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether histopathological, electromyographic and laboratory markers correlate with clinical measures in Inclusion Body Myositis (IBM). METHODS We reviewed our electronic medical records to identify patients with IBM according to ENMC 2011 criteria, seen between 2015 and 2020. We only included patients who had a muscle biopsy and needle electromyography (EMG) performed on the same muscle (opposite or same side). We used a detailed grading system (0- normal to 4- severe) to score histopathological and EMG findings. Clinical severity was assessed by the modified Rankin scale (mRS), muscle strength sum score (SSS), quadriceps strength and severity of dysphagia on swallow evaluation. Serum markers of interest were creatine kinase level, and cN-1A antibodies. RESULTS We included 50 IBM patients, with a median age of 69 years; 64% were males. Median disease duration at diagnosis was 51 months. On muscle biopsy, endomysial inflammation mainly correlated with dysphagia, and inversely correlated with mRS. Vacuoles and congophilic inclusions did not correlate with any of the clinical measures. On EMG, the shortness of motor unit potential (MUP) duration correlated with all clinical measures. Myotonic discharges, and not fibrillation potentials, correlated with the severity of inflammation. Serum markers did not have a statistically-significant correlation with any of the clinical measures. CONCLUSIONS Dysphagia was the main clinical feature of IBM correlating with endomysial inflammation. Otherwise, inclusion body myositis clinical measures had limited correlation with histopathological features in this study. The shortness of MUP duration correlated with all clinical measures.
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Affiliation(s)
- Marcus V Pinto
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jay Mandrekar
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Elie Naddaf
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Hogrel JY. Still seeking the holy grail of outcome measures in inclusion body myositis. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2021-326460. [PMID: 33849998 DOI: 10.1136/jnnp-2021-326460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Jean-Yves Hogrel
- Neuromuscular Investigation Center, Institute of Myology, Paris, France
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