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Kaplan MM, Tekin ZE, Çelikel E, Güngörer V, Karagöl C, Öner N, Polat MC, Öztürk D, Özçelik E, Ekici MI, Dağlı PA, Erten Ş, Acar BÇ. Age-Related Differences Between Juvenile and Adult Autoimmune Inflammatory Myopathies. J Clin Rheumatol 2024:00124743-990000000-00291. [PMID: 39668125 DOI: 10.1097/rhu.0000000000002180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
BACKGROUND Clinical features and prognosis of autoimmune inflammatory myopathies (AIMs) can vary depending on the age of disease onset. The aim of this study was to compare the demographic characteristics, clinical features, laboratory findings, and long-term prognosis of juvenile and adult AIMs. METHODS Patients diagnosed with AIM between 2009 and 2023 in the pediatric rheumatology and rheumatology departments of our hospital were included in this medical records review study. Demographic characteristics, clinical features, laboratory findings, treatments, and prognosis of juvenile and adult AIM patients were compared with statistical methods. RESULTS Of the 94 patients diagnosed with AIM, 34 (36.2%) patients were juvenile and 60 (63.8%) patients were adult. At the time of diagnosis, while Gottron papules, dysphonia, and subcutaneous edema were more common in juvenile patients, fever was more common in adult patients (p = 0.003, p = 0.05, p = 0.005 p = 0.05, respectively). During follow-up, while calcinosis was more common in juvenile patients, lung involvement and malignancy were more common in adult patients (p = 0.022, p = 0.009, p = 0.006, respectively). The methylprednisolone pulse therapy requirement was significantly higher in juvenile patients (p = 0.0001). Clinically inactive disease was more common in juvenile patients (p = 0.01). CONCLUSIONS AIM with different onset ages is associated with distinct clinical manifestations and outcomes. The present study reported that in AIM patients, lung involvement and malignancy increase with age while clinically inactive disease decreases.
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Affiliation(s)
- Melike Mehveş Kaplan
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Zahide Ekici Tekin
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Elif Çelikel
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Vildan Güngörer
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Cüneyt Karagöl
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Nimet Öner
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Merve Cansu Polat
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Didem Öztürk
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Emine Özçelik
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Mehveş Işıklar Ekici
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Pınar Akyüz Dağlı
- Division of Rheumatology, Department of Internal Medicine, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Şükran Erten
- Division of Rheumatology, Department of Internal Medicine, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
| | - Banu Çelikel Acar
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, Turkey
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Lessard LER, Robert M, Fenouil T, Mounier R, Landel V, Carlesimo M, Hot A, Chazaud B, Laumonier T, Streichenberger N, Gallay L. Contribution of major histocompatibility complex class II immunostaining in distinguishing idiopathic inflammatory myopathy subgroups: A histopathological cohort study. J Neuropathol Exp Neurol 2024; 83:1060-1075. [PMID: 39283714 DOI: 10.1093/jnen/nlae098] [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] [Indexed: 11/21/2024] Open
Abstract
Idiopathic inflammatory myopathies (IIM) are rare, acquired muscle diseases; their diagnosis of is based on clinical, serological, and histological criteria. MHC-I-positive immunostaining, although non-specific, is used as a marker for IIM diagnosis; however, the significance of major histocompatibility complex (MHC)-II immunostaining in IIM remains debated. We investigated patterns of MHC-II immunostaining in myofibers and capillaries in muscle biopsies from 103 patients with dermatomyositis ([DM], n = 31), inclusion body myositis ([IBM], n = 24), anti-synthetase syndrome ([ASyS], n = 10), immune-mediated necrotizing myopathy ([IMNM], n = 18), or overlap myositis ([OM], n = 20). MHC-II immunostaining of myofibers was abnormal in 63/103 of patients (61%) but the patterns differed according to the IIM subgroup. They were diffuse in IBM (96%), negative in IMNM (83%), perifascicular in ASyS (70%), negative (61%) or perifascicular (32%) in DM, and either clustered (40%), perifascicular (30%), or diffuse heterogeneous (15%) in OM. Capillary MHC-II immunostaining also identified quantitative (capillary dropout, n = 47/88, 53%) and qualitative abnormalities, that is, architectural abnormalities, including dilated and leaky capillaries, (n = 79/98, 81%) in all IIM subgroups. Thus, MHC-II myofiber expression patterns allow distinguishing among IIM subgroups. We suggest the addition of MHC-II immunostaining to routine histological panels for IIM diagnosis.
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Affiliation(s)
- Lola E R Lessard
- Service d'Electroneuromyographie et de pathologies neuromusculaires, Hôpital Neurologique, GHE, Hospices Civils de Lyon, Lyon, France
- Institut NeuroMyoGène, Unité Physiopathologie et Génétique du Neurone et du Muscle, CNRS UMR 5261, Inserm U1315, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Robert
- Service de Médecine interne et immunologie clinique, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Tanguy Fenouil
- Institut de Pathologie Multisite des Hospices Civils de Lyon-Site Est, GHE, Hospices Civils de Lyon, Lyon, France
- Centre de Recherche en Cancérologie de Lyon, Inserm U1052, CNRS UMR 5286, Lyon, France
| | - Rémi Mounier
- Institut NeuroMyoGène, Unité Physiopathologie et Génétique du Neurone et du Muscle, CNRS UMR 5261, Inserm U1315, Université Claude Bernard Lyon 1, Lyon, France
| | - Véréna Landel
- Direction de la Recherche en Santé, Hospices Civils de Lyon, Lyon, France
| | - Marie Carlesimo
- Institut de Pathologie Multisite des Hospices Civils de Lyon-Site Est, GHE, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Service de Médecine interne et immunologie clinique, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Bénédicte Chazaud
- Institut NeuroMyoGène, Unité Physiopathologie et Génétique du Neurone et du Muscle, CNRS UMR 5261, Inserm U1315, Université Claude Bernard Lyon 1, Lyon, France
| | - Thomas Laumonier
- Laboratoire "Cell Therapy & Musculoskeletal Disorders", Département de Chirurgie Orthopédique, Hôpital Universitaire et Faculté de Médecine, Genève, Switzerland
| | - Nathalie Streichenberger
- Institut NeuroMyoGène, Unité Physiopathologie et Génétique du Neurone et du Muscle, CNRS UMR 5261, Inserm U1315, Université Claude Bernard Lyon 1, Lyon, France
- Institut de Pathologie Multisite des Hospices Civils de Lyon-Site Est, GHE, Hospices Civils de Lyon, Lyon, France
| | - Laure Gallay
- Service de Médecine interne et immunologie clinique, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France
- Laboratoire "Cell Therapy & Musculoskeletal Disorders", Département de Chirurgie Orthopédique, Hôpital Universitaire et Faculté de Médecine, Genève, Switzerland
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Sparling AC, Ward JM, Sarkar K, Schiffenbauer A, Farhadi PN, Smith MA, Rahman S, Zerrouki K, Miller FW, Li JL, Casey KA, Rider LG. Neutrophil and mononuclear leukocyte pathways and upstream regulators revealed by serum proteomics of adult and juvenile dermatomyositis. Arthritis Res Ther 2024; 26:196. [PMID: 39529136 PMCID: PMC11552237 DOI: 10.1186/s13075-024-03421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 10/21/2024] [Indexed: 11/16/2024] Open
Abstract
OBJECTIVES Serum protein abundance was assessed in adult and juvenile dermatomyositis (DM and JDM) patients to determine differentially regulated proteins, altered pathways, and candidate disease activity biomarkers. METHODS Serum protein expression from 17 active adult DM and JDM patients each was compared to matched, healthy control subjects by a multiplex immunoassay. Pathway analysis and protein clustering of the differentially regulated proteins were examined to assess underlying mechanisms. Candidate disease activity biomarkers were identified by correlating protein expression with disease activity measures. RESULTS Seventy-eight of 172 proteins were differentially expressed in the sera of DM and JDM patients compared to healthy controls. Forty-eight proteins were differentially expressed in DM, 32 proteins in JDM, and 14 proteins in both DM and JDM. Twelve additional differentially expressed proteins were identified after combining the DM and JDM cohorts. C-X-C motif chemokine ligand 10 (CXCL10) was the most strongly upregulated protein in both DM and JDM sera. Other highly upregulated proteins in DM included S100 calcium binding protein A12 (S100A12), CXCL9, and nicotinamide phosphoribosyltransferase (NAMPT), while highly upregulated proteins in JDM included matrix metallopeptidase 3 (MMP3), growth differentiation factor 15 (GDF15), and von Willebrand factor (vWF). Pathway analysis indicated that phosphoinositide 3-kinase (PI3K), p38 mitogen-activated protein kinase (MAPK), and toll-like receptor 7 (TLR7) signaling were activated in DM and JDM. Additional pathways specific to DM or JDM were identified. A protein cluster associated with neutrophils and mononuclear leukocytes and a cluster of interferon-associated proteins were observed in both DM and JDM. Twenty-two proteins in DM and 24 proteins in JDM sera correlated with global, muscle, and/or skin disease activity. Seven proteins correlated with disease activity measures in both DM and JDM sera. IL-1 receptor like 1 (IL1RL1) emerged as a candidate global disease activity biomarker in DM and JDM. CONCLUSION Coordinate analysis of protein expression in DM and JDM patient sera by a multiplex immunoassay validated previous gene expression studies and identified novel dysregulated proteins, altered signaling pathways, and candidate disease activity biomarkers. These findings may further inform the assessment of DM and JDM patients and aid in the identification of potential therapeutic targets.
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Affiliation(s)
- A Clare Sparling
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Building 10, CRC Rm 6-5700, MSC 1301 10 Center Drive, Bethesda, MD, 20892-1301, USA
| | - James M Ward
- Integrative Bioinformatics Support Group, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, NC, USA
| | - Kakali Sarkar
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Building 10, CRC Rm 6-5700, MSC 1301 10 Center Drive, Bethesda, MD, 20892-1301, USA
| | - Adam Schiffenbauer
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Building 10, CRC Rm 6-5700, MSC 1301 10 Center Drive, Bethesda, MD, 20892-1301, USA
| | - Payam Noroozi Farhadi
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Building 10, CRC Rm 6-5700, MSC 1301 10 Center Drive, Bethesda, MD, 20892-1301, USA
| | | | - Saifur Rahman
- BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | | | - Frederick W Miller
- Integrative Bioinformatics Support Group, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, NC, USA
| | - Jian-Liang Li
- Integrative Bioinformatics Support Group, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, NC, USA
| | - Kerry A Casey
- BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Building 10, CRC Rm 6-5700, MSC 1301 10 Center Drive, Bethesda, MD, 20892-1301, USA.
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Wallwork RS, Paik JJ, Kim H. Current evidence for janus kinase inhibitors in adult and juvenile dermatomyositis and key comparisons. Expert Opin Pharmacother 2024; 25:1625-1645. [PMID: 39136388 DOI: 10.1080/14656566.2024.2392021] [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: 06/21/2024] [Accepted: 08/09/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Adult dermatomyositis (DM) and juvenile dermatomyositis (JDM) are rare autoimmune diseases with characteristic skin rashes, weakness, and other systemic features. Upregulated interferon signaling has been consistently described in both adult and juvenile DM which makes janus kinase inhibitors (jakinibs) an attractive therapeutic agent that has a targeted mechanism of action. AREAS COVERED Herein is a review of the growing literature of jakinib use in adult and juvenile DM, including reports on specific disease features and safety of jakinibs in this population and a comparison between adult and juvenile DM. We performed a literature review using PubMed including all English-language publications before 1 February 2024 and abstracts from key recent rheumatology conferences. EXPERT OPINION Jakinibs are an exciting and promising treatment in both adult and juvenile DM. Current Phase 2 and 3 randomized placebo-controlled trials of jakinibs in both adult and JDM will provide significant insights into the efficacy of this class of medication as a potentially more mechanistically targeted treatment of both skin and muscle disease. In fact, these results will likely inform the treatment paradigm of dermatomyositis in that it may even be considered as first or second line. The next five years in the therapeutic landscape of both juvenile and adult DM is an exciting time for both patients and medical providers.
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Affiliation(s)
- Rachel S Wallwork
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie J Paik
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanna Kim
- National Institute of Arthritis Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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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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Feng W, Ma XN, Wu Q, Zhong XQ, Chen SL, Lin CS, Xu Q. Serum 25-hydroxyvitamin D levels and dermatomyositis: A 2-sample mendelian randomization study. Int J Rheum Dis 2024; 27:e15204. [PMID: 38831528 DOI: 10.1111/1756-185x.15204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/15/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Previous studies have reported low serum 25-hydroxyvitamin D [25(OH)D] levels in dermatomyositis (DM) patients, but the exact causal relationship between them remains elusive. Our aim is to confirm the causal relationship between 25(OH)D and DM risk through a Mendelian randomization study. METHODS Retrieve genome-wide association study (GWAS) data on 25(OH)D (n = 441 291) and DM (n cases = 201, n controls = 172 834) from the GWAS database (https://gwas.mrcieu.ac.uk/). Select single-nucleotide polymorphisms (SNPs) strongly correlated with 25(OH)D as instrumental variables (IVs). The primary analytical approach involves the use of the inverse-variance weighted method (IVW), supplemented by MR-Egger regression and weighted median methods to enhance the reliability of the results. Heterogeneity and sensitivity analyses were conducted using Cochran's Q and leave-one-out approaches, respectively. RESULTS The IVW analysis confirmed a positive causal relationship between genetic variation in 25(OH)D levels and DM (OR = 2.36, 95% CI = 1.01-5.52, p = .048). Although not statistically significant (all p > .05), the other methods also suggested a protective effect of 25(OH)D on DM. Based on MR-Egger intercepts and Cochran's Q analysis, the selected SNPs showed no horizontal pleiotropy and heterogeneity. Sensitivity analysis demonstrated the robustness of the results against individual SNPs. CONCLUSION We provide the first evidence of a causal relationship between 25(OH)D levels and DM. Our findings support the importance of measuring serum 25(OH)D levels and considering vitamin D supplementation in clinical practice for patients with DM.
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Affiliation(s)
- Wei Feng
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Na Ma
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qi Wu
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Qin Zhong
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shu-Lin Chen
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chang-Song Lin
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiang Xu
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Cintron D, Chang JC, Sadun RE. Transition to Adult Rheumatology Care: A Disease-Specific Guide. J Clin Rheumatol 2024; 30:159-167. [PMID: 38527973 DOI: 10.1097/rhu.0000000000002062] [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: 03/27/2024]
Abstract
ABSTRACT Young adults with childhood-onset rheumatic diseases are more frequently establishing and continuing care with adult rheumatologists. The transfer of care can be challenging for both the young adult patients and their adult rheumatologists, in large part due to differences between pediatric-onset rheumatic diseases and their adult-onset counterparts, or due to the rarity of some pediatric-onset rheumatic conditions. Other challenges are due to cultural differences between pediatric and adult medical care and to the young adult needing to increasingly perform self-management skills that were previously managed by parents or other caregivers. In this review, we will provide a summary of strategies for working effectively with young adults as they transition to adult care. We will then discuss a subset of childhood-onset rheumatic diseases-including juvenile idiopathic arthritis, localized scleroderma, autoinflammatory diseases, pediatric-onset systemic lupus erythematosus, juvenile-onset dermatomyositis, and autoimmune encephalitis-for which clinical manifestations, management, and prognosis frequently differ between pediatric onset and adult onset. Our aim is to highlight differences that make caring for this population of transitioning young adults unique, providing tools and knowledge to empower the adult rheumatologist to care for these young adults in ways that are evidence-based, effective, efficient, and rewarding.
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Affiliation(s)
| | - Joyce C Chang
- Boston Children's Hospital and Harvard Medical School, Boston, MA
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Saketkoo LA, Valenzuela A, Kim S, McCann LJ, Lood C, Wahezi DM, Werth VP, Yi B, Alexanderson H, Maillard S, Pilkington C, Fligelstone K, Limbach B, Orandi AB, Regardt M, Russell AM, Davuluri S, deGroot I, Ernste F, Paik JJ, von Muhlen CA, Dimachkie MM, Machado PM, Naddaf E, Shafranski BM, Gupta L, Zulian F, Chung L. Moving forward together: collaborative landscapes of research in idiopathic inflammatory myopathies and calcinosis. Rheumatology (Oxford) 2024; 63:1189-1191. [PMID: 37449887 DOI: 10.1093/rheumatology/kead331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, Louisiana State University and Tulane University Medical Schools, New Orleans, LA, USA
| | - Antonia Valenzuela
- Department of Rheumatology and Clinical Immunology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susan Kim
- Department of Pediatrics, Division of Pediatric Rheumatology, University of California, San Francisco, CA, USA
| | - Liza J McCann
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Christian Lood
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Dawn M Wahezi
- Division of Pediatric Rheumatology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - Belina Yi
- Division of Rheumatology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Helene Alexanderson
- Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, and Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Susan Maillard
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Kim Fligelstone
- Federation of European Scleroderma Associations (FESCA), Scleroderma & Raynaud's UK (SRUK), European League Against Rheumatism (EULAR), People with Arthritis & Rheumatism Across Europe (PARE), London, UK
| | - Barbara Limbach
- CureJM, Childhood Arthritis and Rheumatism Alliance (CARRA), Wolcottville, IN, USA
| | - Amir B Orandi
- Pediatric and Adolescent Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Malin Regardt
- Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital and Division for Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Anne-Marie Russell
- Exeter Respiratory Innovations Center University of Exeter and Royal Devon University Hospitals NHS Trust, Devon, UK
| | - Srijana Davuluri
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ingrid deGroot
- Spierziekten Nederland (Dutch patient association for NeuroMuscular Diseases), Dutch Myositis Network, TMA Medical Advisory Board, Rotterdam, The Netherlands
| | - Floranne Ernste
- Mayo Clinic, Division of Rheumatology, Department of Internal Medicine, Rochester, MN, USA
| | - Julie J Paik
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Mazen M Dimachkie
- Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, Department of Rheumatology & Queen Square Centre for Neuromuscular Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - Elie Naddaf
- Department of Neurology, Mayo Clinic, Rochester, MN, 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
| | - Francesco Zulian
- Rheumatology Unit, Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Lorinda Chung
- Department of Medicine and Dermatology, Division of Immunology & Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
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Rosina S, Consolaro A, Pistorio A, Rebollo-Giménez A, Bracaglia C, Dolezalova P, Guilaisne Bernard-Medina A, Herlin T, Trachana M, Vargová V, Wouters C, Carenini L, Ruperto N, Ravelli A. Defining criteria for disease activity states in juvenile dermatomyositis based on the Juvenile Dermatomyositis Activity Index. RMD Open 2024; 10:e003093. [PMID: 38307698 PMCID: PMC10840041 DOI: 10.1136/rmdopen-2023-003093] [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: 02/20/2023] [Accepted: 05/22/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To develop and validate the cut-offs in the Juvenile DermatoMyositis Activity Index (JDMAI) to distinguish the states of inactive disease (ID), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) in children with juvenile dermatomyositis (JDM). METHODS For cut-off definition, data from 139 patients included in a randomised clinical trial were used. Among the six versions of the JDMAI, JDMA1 (score range 0-40) and JDMAI2 (score range 0-39) were selected. Optimal cut-offs were determined against external criteria by calculating different percentiles of score distribution and through receiver operating characteristic curve analysis. External criteria included the modified Pediatric Rheumatology International Trials Organization (PRINTO) criteria for clinically ID in JDM (for ID) and PRINTO levels of improvement in the clinical trial (for LDA and HDA). MDA cut-offs were set at the score interval between LDA and HDA cut-offs. Cut-off validation was conducted by assessing construct and discriminative ability in two cohorts including a total of 488 JDM patients. RESULTS The calculated JDMAI1 cut-offs were ≤2.4 for ID, ≤6.6 for LDA, 6.7-11 for MDA and >11 for HDA. The calculated JDMAI2 cut-offs were ≤5.2 for ID, ≤8.5 for LDA, 8.6-11.3 for MDA and >11.3 for HDA. The cut-offs discriminated strongly among disease activity states defined subjectively by caring physicians and parents, parents' satisfaction or non-satisfaction with illness outcome, levels of pain, fatigue, physical functional impairment and physical well-being. CONCLUSIONS Both JDMAI1 and JDMAI2 cut-offs revealed good metrologic properties in validation analyses and are, therefore, suited for application in clinical practice and research.
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Affiliation(s)
- Silvia Rosina
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Alessandro Consolaro
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DiNOGMI), University of Genoa, Genova, Italy
| | - Angela Pistorio
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ana Rebollo-Giménez
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Claudia Bracaglia
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesu, Rome, Italy
| | - Pavla Dolezalova
- 1st Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Ana Guilaisne Bernard-Medina
- Servicio de Reumatología, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Mexico
| | - Troels Herlin
- Pediatric Rheumatology Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Trachana
- Thessaloniki University School of Medicine, First Department of Pediatrics, Pediatric Immunology and Rheumatology Referral Center, Hippokration General Hospital, Thessaloniki, Greece
| | - Veronika Vargová
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Kosice, Slovakia
| | - Carine Wouters
- Pediatric Rheumatology and Immune-inflammatory diseases, and KU Leuven - University of Leuven, Department of Microbiology and Immunology, Laboratory Immunobiology, UZ Leuven - Universitair ziekenhuis, Leuven, Belgium
| | - Laura Carenini
- UOC Servizio Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicolino Ruperto
- UOC Servizio Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DiNOGMI), University of Genoa, Genova, Italy
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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10
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Cervantes BA, Gowda P, Rider LG, Miller FW, Chen MY, Schiffenbauer A. Development of a computed tomography calcium scoring technique for assessing calcinosis distribution, pattern and burden in dermatomyositis. Rheumatology (Oxford) 2024; 63:58-63. [PMID: 37286372 PMCID: PMC10765154 DOI: 10.1093/rheumatology/kead256] [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: 01/12/2023] [Revised: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES To utilize whole-body CT imaging and calcium scoring techniques as tools for calcinosis assessment in a prospective cohort of patients with adult and juvenile dermatomyositis (DM and JDM, respectively). METHODS Thirty-one patients (14 DM and 17 JDM) who fulfilled Bohan and Peter Classification criteria as probable or definite DM, the EULAR-ACR criteria for definite DM, and with calcinosis identified by physical examination or prior imaging studies were included. Non-contrast whole-body CT scans were obtained using low-dose radiation procedures. Scans were read qualitatively and quantitated. We calculated the sensitivity and specificity of calcinosis detection of physician physical exam against CT. We quantified calcinosis burden using the Agatston scoring technique. RESULTS We identified five distinct calcinosis patterns: Clustered, Disjoint, Interfascial, Confluent and Fluid-filled. Novel locations of calcinosis were observed, including the cardiac tissue, pelvic and shoulder bursa, and the spermatic cord. Quantitative measures using Agatston scoring for calcinosis were used in regional distributions across the body. Physician physical exams had a sensitivity of 59% and a specificity of 90% compared with CT detection. A higher calcium score correlated with higher Physician Global Damage, Calcinosis Severity scores, and disease duration. CONCLUSION Whole-body CT scans and the Agatston scoring metric define distinct calcinosis patterns and provide novel insights relating to calcinosis in DM and JDM patients. Physicians' physical examinations underrepresented the presence of calcium. Calcium scoring of CT scans correlated with clinical measures, which suggests that this method may be used to assess calcinosis and follow its progression.
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Affiliation(s)
- Briana A Cervantes
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Prateek Gowda
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Marcus Y Chen
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Adam Schiffenbauer
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
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11
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Paik JJ, Lubin G, Gromatzky A, Mudd PN, Ponda MP, Christopher-Stine L. Use of Janus kinase inhibitors in dermatomyositis: a systematic literature review. Clin Exp Rheumatol 2023; 41:348-358. [PMID: 35766013 PMCID: PMC10105327 DOI: 10.55563/clinexprheumatol/hxin6o] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022]
Abstract
Dermatomyositis (DM) is an idiopathic inflammatory myopathy that commonly manifests with proximal muscle weakness and is associated with extramuscular pathology, including characteristic skin lesions such as Gottron's papules and heliotrope rash, as well as lung, gastrointestinal, joint, and cardiac involvement. Systemic corticosteroids are a cornerstone of therapy, and more recently intravenous immunoglobulin (IVIG; OCTAGAM®) has been approved by the US Food and Drug Administration for the treatment of adults with DM. Both steroids and IVIG represent nonspecific anti-inflammatory therapy, and more targeted approaches are lacking. Transcriptomics has identified upregulation of interferon (IFN)-regulated genes as key features of both adult DM and juvenile DM (JDM). Accordingly, blocking IFN signalling through inhibition of the Janus kinase (JAK) pathway represents a potential treatment option for DM. Placebo-controlled trial data assessing the use of JAK inhibitors for the treatment of DM are limited; as such, a systematic literature review was undertaken to assess the evidence of JAK inhibitors in the treatment of patients with DM. Terms related to DM and JAK inhibitors were searched using PubMed, Embase, Web of Science, Scopus, and Dimensions to identify peer-reviewed publications reporting patients with DM who were treated with a JAK inhibitor. Baseline demographics, clinical characteristics, and treatment outcome data were extracted. A total of 48 publications reporting 145 unique patients (adult DM, n=84; JDM, n=61) were identified. Among cases of adult DM, 61 of 84 (73%) had refractory skin disease at baseline, and all (61 of 61) reported improvement in cutaneous symptoms. Of patients with adult DM, 16 of 84 (19%) had refractory muscle disease at baseline, and all (16 of 16) reported improvement in muscle symptoms. In patients with adult DM complicated by interstitial lung disease (ILD; n=33), 31 (94%) patients improved with JAK inhibitor treatment. Among cases of JDM with refractory skin disease at baseline (60 of 61), most patients (57 of 60; 95%) showed improvements in skin symptoms after JAK inhibitor treatment. Of patients with JDM with refractory muscle disease at baseline (36 of 61), most (30 of 36; 83%) reported improvement in muscle symptoms. Four patients with JDM and ILD experienced improvement in lung disease activity following treatment with a JAK inhibitor. Among both DM and JDM cases, all patients (17 with DM and 16 with JDM) who had elevated serum IFN and/or IFN-stimulated gene expression at baseline showed reduction in IFN or IFN gene expression. Although the conclusions that can be drawn from this analysis are limited because of the differences in assessments used across publications, overall treatment of patients with DM or JDM with a JAK inhibitor was associated with significant improvement of a wide range of DM manifestations, including skin lesions, muscle weakness, and ILD. Our systematic literature review suggests that JAK inhibitors may be a viable treatment option for DM/JDM, and randomised controlled trials are necessary to confirm these findings.
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Affiliation(s)
- Julie J. Paik
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
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12
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Kronzer VL, Kimbrough BA, Crowson CS, Davis JM, Holmqvist M, Ernste FC. Incidence, Prevalence, and Mortality of Dermatomyositis: A Population-Based Cohort Study. Arthritis Care Res (Hoboken) 2023; 75:348-355. [PMID: 34549549 PMCID: PMC8934743 DOI: 10.1002/acr.24786] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aimed to determine the population-based incidence, prevalence, and mortality of dermatomyositis (DM) using European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) criteria. METHODS This population-based cohort study included incident DM from January 1, 1995 to December 31, 2019. We manually reviewed all individuals with at least 1 code for DM or polymyositis to determine if they met EULAR/ACR criteria, subspecialty physician diagnosis, and/or Bohan and Peter criteria. We age- and sex-adjusted incidence and prevalence estimates to the US non-Hispanic White year 2000 population and estimated prevalence on January 1, 2015. Standardized mortality ratios (SMRs) with 95% confidence intervals (95% CIs) compared observed to expected mortality adjusting for age, sex, and year. RESULTS We identified 40 cases of verified DM, with 29 cases incident in Olmsted County from 1995 to 2019. The mean age was 57 years, 26 (90%) were female, and 12 (41%) had clinically amyopathic DM (CADM). The median follow-up time was 8.2 years. The overall adjusted incidence of DM was 1.1 (95% CI 0.7-1.5) per 100,000 person-years, and prevalence was 13 (95% CI 6-19) per 100,000. The SMR was significantly elevated among the myopathic DM cases (3.1 [95% CI 1.1-6.8]) but not CADM cases (1.1 [95% CI 0.2-3.3]). The positive predictive value of ≥2 DM codes was only 40 of 82 (49%). CONCLUSION This population-based study found that DM incidence and prevalence were higher than previously reported. Mortality was significantly elevated for myopathic DM but not for CADM.
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Affiliation(s)
| | | | - Cynthia S. Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - John M. Davis
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marie Holmqvist
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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13
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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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14
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Assessment of Thigh MRI Radiomics and Clinical Characteristics for Assisting in Discrimination of Juvenile Dermatomyositis. J Clin Med 2022; 11:jcm11226712. [PMID: 36431189 PMCID: PMC9693341 DOI: 10.3390/jcm11226712] [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] [Received: 08/25/2022] [Revised: 09/30/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) is an important non-invasive examination in the early diagnosis of juvenile dermatomyositis (JDM). We aimed to evaluate the feasibility of radiomics to establish a quantitative analysis of MRI images. Radiomics and machine learning were used to retrospectively analyze MRI T2 fat suppression sequences and relevant clinical data. The model associated with radiomics features was established using a cohort of patients who underwent thigh MRI at the children's hospital from June 2014 to September 2021. In total, 75 patients with JDM and 75 control children were included in the training cohort (n = 102) and validation cohort (n = 48). The independent factors including lower muscle strength (OR, 0.75; 95% CI, 0.59-0.90), higher creatine kinase (CK) level (OR, 1.65; 95% CI, 1.20-2.38), and higher radiomics score (OR, 2.30; 95% CI, 1.63-3.62) were associated with a clinical diagnosis of JDM. The combined model achieved good discrimination performance compared the radiomics score model under linear discriminant analyses in the training cohort (AUC, 0.949; 95% CI, 0.912-0.986 vs. AUC, 0.912; 95% CI, 0.858-0.967; p = 0.02) and in the validation cohort (AUC, 0.945; 95% CI, 0.878-1 vs. AUC, 0.905; 95% CI, 0.812-0.998; p = 0.03). The combined model showed the diagnostic value was not weaker than the biopsy (AUC, 0.950; 95% CI, 0.919-0.981, n = 150 vs. AUC, 0.952; 95% CI, 0.889-1, n = 72; p = 0.95) and electromyogram (EMG) (AUC, 0.950; 95% CI, 0.919-0.981 vs. AUC, 0.900; 95% CI, 0.852-0.948; p = 0.10) among all the patients. The combination of radiomics features extracted from the MRI and non-invasive clinical characteristics obtained a pronounced discriminative performance to assist in discriminating JDM.
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15
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Goldman N, Han J, LaChance A. Diagnosis and Management of Cutaneous Manifestations of Autoimmune Connective Tissue Diseases. Clin Cosmet Investig Dermatol 2022; 15:2285-2312. [PMID: 36320926 PMCID: PMC9618245 DOI: 10.2147/ccid.s360801] [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: 09/16/2022] [Accepted: 10/19/2022] [Indexed: 11/20/2022]
Abstract
The cutaneous features of autoimmune connective tissue disease pose a unique challenge to patients and clinicians managing these conditions. In this review, we outline the key elements of diagnosis and treatment of cutaneous lupus erythematosus, dermatomyositis, systemic sclerosis, and morphea. This article also aims to present an update on gold standard as well as new and emerging therapies for these conditions. Overall, dermatologists can play a key role in diagnosing and treating autoimmune connective tissue diseases and this review intends to provide an up-to-date toolkit to guide clinical dermatologists in this endeavor.
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Affiliation(s)
- Nathaniel Goldman
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- New York Medical College, School of Medicine, Valhalla, NY, USA
| | - Joseph Han
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Avery LaChance
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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16
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Corona-Sanchez EG, Martínez-García EA, Lujano-Benítez AV, Pizano-Martinez O, Guerra-Durán IA, Chavarria-Avila E, Aguilar-Vazquez A, Martín-Márquez BT, Arellano-Arteaga KJ, Armendariz-Borunda J, Perez-Vazquez F, García-De la Torre I, Llamas-García A, Palacios-Zárate BL, Toriz-González G, Vazquez-Del Mercado M. Autoantibodies in the pathogenesis of idiopathic inflammatory myopathies: Does the endoplasmic reticulum stress response have a role? Front Immunol 2022; 13:940122. [PMID: 36189221 PMCID: PMC9520918 DOI: 10.3389/fimmu.2022.940122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/24/2022] [Indexed: 12/20/2022] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) are a group of rare, acquired autoimmune diseases characterized by profound muscle weakness and immune cell invasion into non-necrotic muscle. They are related to the presence of antibodies known as myositis-specific antibodies and myositis-associated antibodies, which are associated with various IIM phenotypes and the clinical prognosis. The possibility of the participation of other pathological mechanisms involved in the inflammatory response in IIM has been proposed. Such mechanisms include the overexpression of major histocompatibility complex class I in myofibers, which correlates with the activation of stress responses of the endoplasmic reticulum (ER). Taking into account the importance of the ER for the maintenance of homeostasis of the musculoskeletal system in the regulation of proteins, there is probably a relationship between immunological and non-immunological processes and autoimmunity, and an example of this might be IIM. We propose that ER stress and its relief mechanisms could be related to inflammatory mechanisms triggering a humoral response in IIM, suggesting that ER stress might be related to the triggering of IIMs and their auto-antibodies’ production.
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Affiliation(s)
- Esther Guadalupe Corona-Sanchez
- Instituto de Investigación en Reumatología y del Sistema Músculo Esqueletico, Departamento de Biología Molecular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Universidad de Guadalajara-Cuerpo Académico (UDG-CA)-703, Inmunología y Reumatología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Erika Aurora Martínez-García
- Instituto de Investigación en Reumatología y del Sistema Músculo Esqueletico, Departamento de Biología Molecular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Universidad de Guadalajara-Cuerpo Académico (UDG-CA)-703, Inmunología y Reumatología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Andrea Verónica Lujano-Benítez
- Instituto de Investigación en Reumatología y del Sistema Músculo Esqueletico, Departamento de Biología Molecular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Doctorado en Ciencias Biomedicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Oscar Pizano-Martinez
- Instituto de Investigación en Reumatología y del Sistema Músculo Esqueletico, Departamento de Biología Molecular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Universidad de Guadalajara-Cuerpo Académico (UDG-CA)-703, Inmunología y Reumatología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Departamento de Morfología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Ivette Alejandra Guerra-Durán
- Instituto de Investigación en Reumatología y del Sistema Músculo Esqueletico, Departamento de Biología Molecular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Efrain Chavarria-Avila
- Instituto de Investigación en Reumatología y del Sistema Músculo Esqueletico, Departamento de Biología Molecular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Departamento de Disciplinas Filosófico Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Andrea Aguilar-Vazquez
- Instituto de Investigación en Reumatología y del Sistema Músculo Esqueletico, Departamento de Biología Molecular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Doctorado en Ciencias Biomedicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Beatriz Teresita Martín-Márquez
- Instituto de Investigación en Reumatología y del Sistema Músculo Esqueletico, Departamento de Biología Molecular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Universidad de Guadalajara-Cuerpo Académico (UDG-CA)-703, Inmunología y Reumatología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Kevin Javier Arellano-Arteaga
- Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Especialidad de Medicina Interna, Padrón Nacional de Posgrados de Calidad (PNPC) Consejo Nacional de Ciencia y Tecnología (CONACyT), Guadalajara, Mexico
| | - Juan Armendariz-Borunda
- Instituto de Biología Molecular en Medicina, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Guadalajara, Mexico
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Zapopan, Mexico
| | - Felipe Perez-Vazquez
- Departamento de Disciplinas Filosófico Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Ignacio García-De la Torre
- Departamento de Inmunología y Reumatología, Hospital General de Occidente y Universidad de Guadalajara, Guadalajara, Mexico
| | - Arcelia Llamas-García
- Hospital Civil de Guadalajara “Dr. Juan I. Menchaca, ” Especialidad de Reumatología, Padrón Nacional de Posgrados de Calidad (PNPC) Consejo Nacional de Ciencia y Tecnología (CONACyT), Guadalajara, Mexico
| | - Brenda Lucía Palacios-Zárate
- Hospital Civil de Guadalajara “Dr. Juan I. Menchaca, ” Especialidad de Reumatología, Padrón Nacional de Posgrados de Calidad (PNPC) Consejo Nacional de Ciencia y Tecnología (CONACyT), Guadalajara, Mexico
| | - Guillermo Toriz-González
- Instituto Transdisciplinar de Investigación y Servicios (ITRANS), Universidad de Guadalajara, Zapopan, Mexico
| | - Monica Vazquez-Del Mercado
- Instituto de Investigación en Reumatología y del Sistema Músculo Esqueletico, Departamento de Biología Molecular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Universidad de Guadalajara-Cuerpo Académico (UDG-CA)-703, Inmunología y Reumatología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Hospital Civil de Guadalajara “Dr. Juan I. Menchaca, ” Especialidad de Reumatología, Padrón Nacional de Posgrados de Calidad (PNPC) Consejo Nacional de Ciencia y Tecnología (CONACyT), Guadalajara, Mexico
- *Correspondence: Monica Vazquez-Del Mercado,
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Gupta D, Goldberg L, Dickinson A, Hughes M, Anand V, Stokke J, Corden MH. An 8-Year-Old Boy With Prolonged Fever and Subcutaneous Nodules. Pediatrics 2022; 149:186710. [PMID: 35490281 DOI: 10.1542/peds.2021-052974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
An 8-year-old boy with asthma presented with prolonged fever, malaise, extremity weakness, polyarthralgias, malar rash, and subcutaneous nodules. Physical examination was remarkable for a faint malar rash, flesh-colored papules on the dorsal aspect of the fingers, arthritis of multiple joints in the hands, and subcutaneous nodules. The nodules were firm, nontender, and distributed over multiple extremities and the trunk. The patient was admitted to expedite workup. Initial laboratory test results revealed leukopenia, mild elevation of the aminotransferases, an elevated erythrocyte sedimentation rate, and normal level of creatine kinase. His echocardiogram was normal. Infectious disease studies were negative. Additional examination revealed dilated capillaries in his nail beds and bilateral hip weakness. MRI of his extremities was negative for myositis or calcification of the nodules. We obtained a biopsy of the subcutaneous nodules, and because the patient remained afebrile during the hospitalization, we discharged him from the hospital with outpatient follow-up. Our expert panel reviews the course of the patient's evaluation and investigation, as well as the implications of his diagnosis based on the tissue pathology from the nodule biopsy.
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Affiliation(s)
| | | | | | - Meagan Hughes
- Dermatology.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Vikram Anand
- Infectious Diseases.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jamie Stokke
- Cancer and Blood Disease Institute.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mark H Corden
- Hospital Medicine, Department of Pediatrics, Children's Hospital Los Angeles.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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18
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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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19
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Yoshida S, Matsumoto H, Fujita Y, Yokose K, Temmoku J, Matsuoka N, Yashiro-Furuya M, Asano T, Sato S, Suzuki E, Yago T, Yaguchi T, Aita T, Kusano M, Yamamoto T, Watanabe H, Migita K. Anti-Mi-2 and anti-TIF1-γ Double-Positive Juvenile Dermatomyositis Treated under Diagnosis of Chronic Eczema: A Case Report. TOHOKU J EXP MED 2022; 256:303-308. [PMID: 35296571 DOI: 10.1620/tjem.2022.j006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shuhei Yoshida
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Haruki Matsumoto
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Kohei Yokose
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Jumpei Temmoku
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Naoki Matsuoka
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | | | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Eiji Suzuki
- Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation
| | - Toru Yago
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Takae Yaguchi
- Department of General Internal Medicine, Fukushima Medical University School of Medicine
| | - Tetsuro Aita
- Department of General Internal Medicine, Fukushima Medical University School of Medicine
| | - Misaki Kusano
- Department of Dermatology, Fukushima Medical University School of Medicine
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University School of Medicine
| | - Hiroshi Watanabe
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine
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20
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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: 2] [Impact Index Per Article: 1.0] [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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21
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So H, So J, Lam TTO, Wong VTL, Ho R, Li WL, Lau CS, Tam LS. Seasonal Effect on Disease Onset and Presentation in Anti-MDA5 Positive Dermatomyositis. Front Med (Lausanne) 2022; 9:837024. [PMID: 35187011 PMCID: PMC8854504 DOI: 10.3389/fmed.2022.837024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the seasonal variation of disease onset and presentation in an ethno-geographically homogeneous cohort of patients with anti-MDA5 positive dermatomyositis (DM). Methods This was a multi-centered, retrospective cohort study. Adult Chinese anti-MDA5 positive DM patients were identified from the Hong Kong Myositis Registry and the Clinical Data Analysis and Reporting System from 2015 to 2020. Equal number of IIM patients without anti-MDA5 antibody were selected as controls. Line blot immunoassay was used to detect the autoantibodies. The onset of disease, presenting clinical features and subsequent complications were analyzed for any seasonality. Results A total of 110 patients with anti-MDA5 positive DM were studied. The mean age at diagnosis was 53.0 ± 12.3 years and the mean follow-up duration was 20.6 ± 23.1 months. Two third of the patients (66%) had the clinically amyopathic phenotype. Most patients (86%) had interstitial lung disease (ILD) and 42% developed rapidly progressive ILD (RP-ILD). The mortality was 40% and the commonest cause was RP-ILD. Chi-square test showed significantly less patients had symptom onset in July to September. However, no particular seasonal pattern was observed in the anti-MDA5 negative IIM controls. RP-ILD occurred more frequently in patients with disease onset in October to December. Anti-MDA5 positive DM patients with disease onset in warmer months (April to September) were more likely to have clinical muscle involvement. Conclusion Apparent seasonal patterns were noted in our ethno-geographically identical anti-MDA5 positive DM patients, but not in IIM patients in general. Certain environmental factors, particularly infection, might be implicated.
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Affiliation(s)
- Ho So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jacqueline So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Tommy Tsz-On Lam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Victor Tak-Lung Wong
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong SAR, China
| | - Roy Ho
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China
| | - Wai Ling Li
- Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Chak Sing Lau
- Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Chak Sing Lau
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Lai-Shan Tam
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22
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Turnier JL, Kahlenberg JM. Using autoantibody signatures to define cancer risk in dermatomyositis. J Clin Invest 2022; 132:e156025. [PMID: 35040442 PMCID: PMC8759773 DOI: 10.1172/jci156025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dermatomyositis is an idiopathic inflammatory myopathy with a highly heterogeneous disease course. Although there is a known increase in cancer risk surrounding the time of dermatomyositis diagnosis, the mechanisms driving this increased risk are not well understood. Further, there are no current standardized cancer screening guidelines for dermatomyositis patients. In this issue of the JCI, Fiorentino, Mecoli, et al. discovered additional autoantibodies in patients with dermatomyositis and anti-TIF1-γ autoantibodies, a known risk factor for malignancy. They observed a decreased cancer risk with an increasing number of autoantibodies. Importantly, these findings indicate that more detailed autoantibody phenotyping at diagnosis might better predict cancer risk and also suggest that diversity and kinetics of the host immune response might influence cancer development.
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Affiliation(s)
| | - J. Michelle Kahlenberg
- Department of Internal Medicine, Division of Rheumatology
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
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23
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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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24
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Morphological Characteristics of Idiopathic Inflammatory Myopathies in Juvenile Patients. Cells 2021; 11:cells11010109. [PMID: 35011672 PMCID: PMC8750180 DOI: 10.3390/cells11010109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 12/16/2022] Open
Abstract
Background: In juvenile idiopathic inflammatory myopathies (IIMs), morphological characteristic features of distinct subgroups are not well defined. New treatment strategies require a precise diagnosis of the subgroups in IIM, and, therefore, knowledge about the pathomorphology of juvenile IIMs is warranted. Methods: Muscle biopsies from 15 patients (median age 8 (range 3–17) years, 73% female) with IIM and seven controls were analyzed by standard methods, immunohistochemistry, and transmission electron microscopy (TEM). Detailed clinical and laboratory data were accessed retrospectively. Results: Proximal muscle weakness and skin symptoms were the main clinical symptoms. Dermatomyositis (DM) was diagnosed in 9/15, antisynthetase syndrome (ASyS) in 4/15, and overlap myositis (OM) in 2/15. Analysis of skeletal muscle tissues showed inflammatory cells and diffuse upregulation of MHC class I in all subtypes. Morphological key findings were COX-deficient fibers as a striking pathology in DM and perimysial alkaline phosphatase positivity in anti-Jo-1-ASyS. Vascular staining of the type 1 IFN-surrogate marker, MxA, correlated with endothelial tubuloreticular inclusions in both groups. None of these specific morphological findings were present in anti-PL7-ASyS or OM patients. Conclusions: Morphological characteristics discriminate IIM subtypes in juvenile patients, emphasizing differences in aetiopathogenesis and supporting the notion of individual and targeted therapeutic strategies.
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25
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Benvenuto S, Gortani G, Bussani R, Poropat F, Murru FM, Carrozzi M, Tommasini A, Taddio A. Severe onset of inflammatory myositis in a child: think to paraneoplastic myositis. Ital J Pediatr 2021; 47:146. [PMID: 34210321 PMCID: PMC8252287 DOI: 10.1186/s13052-021-01098-1] [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: 10/10/2020] [Accepted: 06/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Juvenile idiopathic inflammatory myopathies (JIIMs) are a group of heterogenous, acquired, autoimmune disorders that affect the muscle. While the association between IIMs and malignancy has been widely reported in adults, cancer-associated myositis (CAM) is rare in children, so that routine malignancy screening is not generally performed. This report shows a case of severe CAM in a child. Case presentation An 11-years-old girl presented with worsening dyspnea after a 3-weeks history of progressive proximal weakness, myalgia, dysphagia, and weight loss. Her past history was remarkable for a type I Arnold-Chiari malformation associated with an anterior sacral meningocele. Physical examination showed severe hypotony and hypotrophy. Pulse oximetry and blood test showed a type II respiratory failure (SpO2 88%, pCO2 68 mmHg) and increased muscle enzyme levels (CPK 8479 U/L, AST 715 U/L, ALT 383 U/L, LDH 1795 U/L). The patient needed invasive mechanical ventilation. Inflammatory myositis was considered and treatment with intravenous methylprednisolone (30 mg/Kg/day for 3 days followed by 2 mg/Kg/day) and IVIG (1 g/kg/day for 2 days) was started. Muscle biopsy showed endomysial and perimysial necrosis and inflammation. The presence of serum anti-TIF1-γ antibody positivity led to a malignancy screening. Whole-body MRI showed a mature teratoma underneath sacral meningocele and both lesions were surgically removed. Given the histological and clinical severity of the myopathy, mycophenolate (500 mg twice a day) and rituximab (360 mg/m2, 4 weekly infusions) were added. Due to extreme muscular wasting, severe malnutrition and intolerance to enteral feeding the patient needed a transient tracheostomy and parenteral nutrition, followed by physiotherapy, speech therapy and nocturnal non-invasive ventilation. A complete remission was achieved 3 months after. Conclusions Among cancer-associated autoantibodies (CAAs) in adult patients, anti-TIF1-γ carries the highest risk of CAM, which recognizes with a high likelihood a paraneoplastic pathogenesis. In children, anti-TIF1-γ antibody has been associated with severe cutaneous disease, lipodystrophy, and chronic disease course, but not with CAM, which is overall rare in younger patients. Severe onset of a JIIM, especially if anti-TIF1-γ antibody positive, should prompt suspect of a CAM and lead to a screening for malignancy.
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Affiliation(s)
| | - Giulia Gortani
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Federico Poropat
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Flora Maria Murru
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Carrozzi
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alberto Tommasini
- University of Trieste, Via dell'Istria 65/1, Trieste, Italy.,Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Andrea Taddio
- University of Trieste, Via dell'Istria 65/1, Trieste, Italy.,Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
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Okiyama N. Clinical Features and Cutaneous Manifestations of Juvenile and Adult Patients of Dermatomyositis Associated with Myositis-Specific Autoantibodies. J Clin Med 2021; 10:jcm10081725. [PMID: 33923564 PMCID: PMC8073628 DOI: 10.3390/jcm10081725] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Dermatomyositis is one of the idiopathic inflammatory myopathies, which is characterized with specific skin manifestations, and considered as an autoimmune disease. Dermatomyositis is a heterogeneous disorder with various presences, severities and characteristics of myositis, dermatitis, and interstitial lung disease. Our and others' data showed that myositis-specific autoantibodies have been associated with distinct clinical features. This article reviewed the epidemiology and characteristic clinical features of the different types of antibody-associated dermatomyositis in adult and juvenile patients, which include the severity of myopathy, the potential complication of interstitial lung disease, potential association with malignancies, and characteristic cutaneous manifestations.
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Affiliation(s)
- Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
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27
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28
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Sag E, Demir S, Bilginer Y, Talim B, Haliloglu G, Topaloglu H, Ozen S. Clinical features, muscle biopsy scores, myositis specific antibody profiles and outcome in juvenile dermatomyositis. Semin Arthritis Rheum 2020; 51:95-100. [PMID: 33360233 DOI: 10.1016/j.semarthrit.2020.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Juvenile dermatomyositis (JDM) is the most common inflammatory myopathy of childhood. OBJECTIVE To analyze clinical features, paraclinical examinations, MSAs, treatment response and long-term outcome in a JDM cohort METHODS: 58 patients (35F, 23 M) from a tertiary referral center in the last two decades are included. RESULTS Mean age at onset was 8.1 ± 4.3, with a mean follow-up period of 5.66±3.59 years. Dermatological manifestations (91%) and muscle weakness (76%) were the key diagnostic elements. Elevated serum creatine kinase levels (86%), electromyography (23/25), muscle MRI (12/15), and muscle biopsy (n = 35) were compatible with the diagnosis. Out of 46 patients tested, 34 (76%) had autoantibodies, with NXP2 (21.7%), followed by TIF1g (17.4%), MDA5 (8.7%), and Mi-2 (8.7%). Presence of TIF1g and NXP2 indicated a severe course; and Ku a much severe course compared to previous studies. Corticosteroids (100%) combined with methotrexate (93%) was the initial treatment. Biological disease modifying anti-rheumatic drugs (DMARDs) were used in 22% of the cohort. Calcinosis (36%) was the most common long-term complication, associated with disease onset ≤6 years, higher muscle biopsy scores and MDA5 positivity. Complete remission was achieved in 65.5% of the patients in a median 24 (IQR 11.8-42.5) months with a relapse rate of 26.3%. 43.9% of NXP2 and 33.3% of TIF-1 g positive patients had a relapse. Course was monophasic (31%), polyphasic (17.2%), chronic (51.8%) without mortality. CONCLUSION Integration of clinical features with laboratory and biopsy findings may help to predict prognosis and guide treatment in JDM. In our cohort calcinosis was associated with age, MDA5 autoantibodies, and muscle biopsy scores.
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Affiliation(s)
- Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara 06100, Turkey
| | - Selcan Demir
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara 06100, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara 06100, Turkey
| | - Beril Talim
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Goknur Haliloglu
- Division of Pediatric Neurology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Haluk Topaloglu
- Division of Pediatric Neurology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara 06100, Turkey.
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29
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Khadilkar SV, Dhamne MC. What is New in Idiopathic Inflammatory Myopathies: Mechanisms and Therapies. Ann Indian Acad Neurol 2020; 23:458-467. [PMID: 33223661 PMCID: PMC7657284 DOI: 10.4103/aian.aian_400_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 11/18/2022] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of disorders that cause muscle weakness and also have extramuscular manifestations involving various organ systems; namely the lung, skin, heart, and joints. Previously classified broadly as dermatomyositis (DM) and polymyositis now the spectrum of the disease has evolved into more clinical subtypes. There are now five clinicoserological subtypes recognized worldwide DM, antisynthetase syndrome (AS), overlap myositis (OM), immune mediated necrotizing myopathy (IMNM), and inclusion body myositis. Each of these subtypes has a unique phenotype and specific antibodies associated. With the evolving treatment options from the use of immunosuppressive medications to the use of targeted therapy with biologic agents, and further understanding of the pathogenesis of inflammatory myositis, we may have more effective treatment options. We discuss in this review, various myositis-associated antibodies associated with each clinicoserological subtype of IIM and their role. We also describe the evolving therapies and the evidence for the newer biologic therapies in the treatment of IIMs.
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Affiliation(s)
- Satish V Khadilkar
- Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Megha C Dhamne
- Department of Neurology, Dr. L H Hiranandani Hospital, Mumbai, Maharashtra, India
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Zhong D, Wu C, Bai J, Xu D, Zeng X, Wang Q. Co-expression network analysis reveals the pivotal role of mitochondrial dysfunction and interferon signature in juvenile dermatomyositis. PeerJ 2020; 8:e8611. [PMID: 32110496 PMCID: PMC7034382 DOI: 10.7717/peerj.8611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022] Open
Abstract
Background Juvenile dermatomyositis (JDM) is an immune-mediated disease characterized by chronic organ inflammation. The pathogenic mechanisms remain ill-defined. Methods Raw microarray data of JDM were obtained from the gene expression omnibus (GEO) database. Based on the GSE3307 dataset with 39 samples, weighted correlation network analysis (WGCNA) was performed to identify key modules associated with pathological state. Functional enrichment analyses were conducted to identify potential mechanisms. Based on the criteria of high connectivity and module membership, candidate hub genes were selected. A protein-protein interaction network was constructed to identify hub genes. Another dataset (GSE11971) was used for the validation of real hub genes. Finally, the real hub genes were used to screen out small-molecule compounds via the Connectivity map database. Results Three modules were considered as key modules for the pathological state of JDM. Functional enrichment analysis indicated that responses to interferon and metabolism were dysregulated. A total of 45 candidate hub genes were selected according to the pre-established criteria, and 20 genes could differentiate JDM from normal controls by validation of another external dataset (GSE11971). These real hub genes suggested the pivotal role of mitochondrial dysfunction and interferon signature in JDM. Furthermore, drug repositioning highlighted the importance of acacetin, helveticoside, lanatoside C, deferoxamine, LY-294002, tanespimycin and L01AD from downregulated genes with the potential to perturb the development of JDM, while betonicine, felodipine, valproic acid, trichostatin A and sirolimus from upregulated genes provided potentially therapeutic goals for JDM. Conclusions There are 20 real hub genes associated with the pathological state of JDM, suggesting the pivotal role of mitochondrial dysfunction and interferon signature in JDM. This analysis predicted several kinds of small-molecule compounds to treat JDM.
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Affiliation(s)
- Danli Zhong
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Chanyuan Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jingjing Bai
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Okiyama N, Fujimoto M. Cutaneous manifestations of dermatomyositis characterized by myositis-specific autoantibodies. F1000Res 2019; 8. [PMID: 31824645 PMCID: PMC6880256 DOI: 10.12688/f1000research.20646.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2019] [Indexed: 01/30/2023] Open
Abstract
Dermatomyositis (DM) is an inflammatory myopathy with characteristic skin manifestations, the pathologies of which are considered autoimmune diseases. DM is a heterogeneous disorder with various phenotypes, including myositis, dermatitis, and interstitial lung disease (ILD). Recently identified myositis-specific autoantibodies have been associated with distinct clinical features. For example, anti-melanoma differentiation-associated protein 5 antibodies have a high specificity for clinically amyopathic DM presenting rapidly progressive ILD. Furthermore, anti-transcriptional intermediary factor 1γ antibodies found in patients with juvenile and adult DM are closely correlated with malignancies, especially in elderly patients. Finally, patients with anti-aminoacyl-transfer RNA synthetase antibodies share characteristic clinical symptoms, including myositis, ILD, arthritis/arthralgia, Raynaud’s phenomenon, and fever; thus, the term “anti-synthetase syndrome” is also used. With a focus on the characteristic cutaneous manifestations in each subgroup classified according to myositis-specific autoantibodies, we introduce the findings of previous reports, including our recent analysis indicating that skin eruptions can be histopathologically classified into myositis-specific autoantibody-associated subgroups and used to determine the systemic pathologies of the different types of antibody-associated DM.
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Affiliation(s)
- Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
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Mammen AL, Allenbach Y, Stenzel W, Benveniste O. 239th ENMC International Workshop: Classification of dermatomyositis, Amsterdam, the Netherlands, 14-16 December 2018. Neuromuscul Disord 2019; 30:70-92. [PMID: 31791867 DOI: 10.1016/j.nmd.2019.10.005] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/21/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, 50 South Drive, Building 50, Room 1146, MD 20892, United States.
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié Salpetrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Werner Stenzel
- Department of Neuropathology, Charité-Universitatsmedizin, Berlin, Germany
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié Salpetrière Hospital, AP-HP Sorbonne University, Paris, France
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Yang SH, Chang C, Lian ZX. Polymyositis and dermatomyositis - challenges in diagnosis and management. J Transl Autoimmun 2019; 2:100018. [PMID: 32743506 PMCID: PMC7388349 DOI: 10.1016/j.jtauto.2019.100018] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
Polymyositis (PM) and dermatomyositis (DM) are different disease subtypes of idiopathic inflammatory myopathies (IIMs). The main clinical features of PM and DM include progressive symmetric, predominantly proximal muscle weakness. Laboratory findings include elevated creatine kinase (CK), autoantibodies in serum, and inflammatory infiltrates in muscle biopsy. Dermatomyositis can also involve a characteristic skin rash. Both polymyositis and dermatomyositis can present with extramuscular involvement. The causative factor is agnogenic activation of immune system, leading to immunologic attacks on muscle fibers and endomysial capillaries. The treatment of choice is immunosuppression. PM and DM can be distinguished from other IIMs and myopathies by thorough history, physical examinations and laboratory evaluation and adherence to specific and up-to-date diagnosis criteria and classification standards. Treatment is based on correct diagnosis of these conditions. Challenges of diagnosis and management influences the clinical research and practice of Polymyositis and dermatomyositis. Diagnostic criteria have been updated and novel therapies have been developed in PM/DM. Pathogenesis investigation and diagnosis precision improvement may help to guide future treatment strategies.
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Key Words
- APC, antigen presenting cell
- AZA, Azathioprine
- CAM, cancer associated myositis
- CK, creatine kinase
- DM, dermatomyositis
- Dermatomyositis
- Diagnosis criteria
- EMG, electromyography
- HLA, human leukocyte antigen
- IIM, idiopathic inflammatory myopathies
- ILD, interstitial lung disease
- IV, intravenous
- Idiopathic inflammatory myopathy
- JDM, juvenile dermatomyositis
- MAA, myositis associated antibody
- MAC, membrane attack complex
- MHC, major histocompatibility complex
- MMF, mycophenolate mofetil
- MRI, magnetic resonance imaging
- MSA, myositis specific antibody
- MTX, methotrexate
- MUAP, motor unit action potential
- NAM, necrotizing autoimmune myopathy
- PM, polymyositis
- Polymyositis
- TNF, tumor necrosis factor
- Treatment
- Treg, regulatory T cell
- UVR, ultraviolet radiation
- sIBM, sporadic inclusion body myositis
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Affiliation(s)
- Shu-Han Yang
- Chronic Disease Laboratory, Institutes for Life Sciences and School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, Davis, CA, USA.,Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Zhe-Xiong Lian
- Chronic Disease Laboratory, Institutes for Life Sciences and School of Medicine, South China University of Technology, Guangzhou, 510006, China
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Hoeppli RE, Pesenacker AM. Targeting Tregs in Juvenile Idiopathic Arthritis and Juvenile Dermatomyositis-Insights From Other Diseases. Front Immunol 2019; 10:46. [PMID: 30740105 PMCID: PMC6355674 DOI: 10.3389/fimmu.2019.00046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/09/2019] [Indexed: 12/22/2022] Open
Abstract
Regulatory T cells (Tregs) are believed to be dysfunctional in autoimmunity. Juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM) result from a loss of normal immune regulation in specific tissues such as joints or muscle and skin, respectively. Here, we discuss recent findings in regard to Treg biology in oligo-/polyarticular JIA and JDM, as well as what we can learn about Treg-related disease mechanism, treatment and biomarkers in JIA/JDM from studies of other diseases. We explore the potential use of Treg immunoregulatory markers and gene signatures as biomarkers for disease course and/or treatment success. Further, we discuss how Tregs are affected by several treatment strategies already employed in the therapy of JIA and JDM and by alternative immunotherapies such as anti-cytokine or co-receptor targeting. Finally, we review recent successes in using Tregs as a treatment target with low-dose IL-2 or cellular immunotherapy. Thus, this mini review will highlight our current understanding and identify open questions in regard to Treg biology, and how recent findings may advance biomarkers and new therapies for JIA and JDM.
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Affiliation(s)
- Romy E Hoeppli
- Department of Surgery, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Anne M Pesenacker
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, United Kingdom
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35
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Sakurai N, Hino-Shishikura A, Nozawa T, Kamide H, Ohara A, Nishimura K, Kikuchi M, Hara R, Mori M, Ito S. Clinical significance of subcutaneous fat and fascial involvement in juvenile dermatomyositis. Mod Rheumatol 2018; 29:808-813. [DOI: 10.1080/14397595.2018.1511026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nodoka Sakurai
- Department of Pediatrics, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Department of Pediatrics, Sapporo Medical University, Sapporo, Japan
| | - Ayako Hino-Shishikura
- Department of Radiology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Tomo Nozawa
- Department of Pediatrics, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Hiroyuki Kamide
- Department of Radiology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Asami Ohara
- Department of Pediatrics, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Kenichi Nishimura
- Department of Pediatrics, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Masako Kikuchi
- Department of Pediatrics, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Ryoki Hara
- Department of Pediatrics, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
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Abstract
The juvenile idiopathic inflammatory myopathies (JIIM) are a group of rare, chronic, autoimmune illnesses that affect muscle and, to a lesser extent, skin. The presence of new-onset weakness and, in juvenile dermatomyositis, typical rahes, should lead to consideration of these diagnoses. Careful evaluation to exclude alternative diagnoses is needed. Investigations include a variety of blood tests, imaging, and possibly muscle biopsy. Validated clinical assessments are available for monitoring. Standard treatment includes corticosteroids and methotrexate and often extends beyond 1 year. Outcomes are generally good, but disease persistence remains problematic. Early involvement of providers with expertise in JIIM is essential.
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Affiliation(s)
- Adam M Huber
- Division of Pediatric Rheumatology, IWK Health Centre, Dalhousie University, 5850 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada.
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De Iorio M, Gallot N, Valcarcel B, Wedderburn L. A Bayesian semiparametric Markov regression model for juvenile dermatomyositis. Stat Med 2018; 37:1711-1731. [PMID: 29462840 DOI: 10.1002/sim.7613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/12/2017] [Accepted: 12/30/2017] [Indexed: 11/07/2022]
Abstract
Juvenile dermatomyositis (JDM) is a rare autoimmune disease that may lead to serious complications, even to death. We develop a 2-state Markov regression model in a Bayesian framework to characterise disease progression in JDM over time and gain a better understanding of the factors influencing disease risk. The transition probabilities between disease and remission state (and vice versa) are a function of time-homogeneous and time-varying covariates. These latter types of covariates are introduced in the model through a latent health state function, which describes patient-specific health over time and accounts for variability among patients. We assume a nonparametric prior based on the Dirichlet process to model the health state function and the baseline transition intensities between disease and remission state and vice versa. The Dirichlet process induces a clustering of the patients in homogeneous risk groups. To highlight clinical variables that most affect the transition probabilities, we perform variable selection using spike and slab prior distributions. Posterior inference is performed through Markov chain Monte Carlo methods. Data were made available from the UK JDM Cohort and Biomarker Study and Repository, hosted at the UCL Institute of Child Health.
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Affiliation(s)
- Maria De Iorio
- Department of Statistical Science, University College London, London, UK
| | | | - Beatriz Valcarcel
- Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lucy Wedderburn
- UCL Institute for Child Health, Great Ormond Street Hospital for Children NHS Trust, Arthritis Research UK Centre for Adolescent Rheumatology at UCL and GOSH/ICH NIHR Biomedical Research Centre, London, UK
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Rosina S, Varnier GC, Mazzoni M, Lanni S, Malattia C, Ravelli A. Innovative Research Design to Meet the Challenges of Clinical Trials for Juvenile Dermatomyositis. Curr Rheumatol Rep 2018; 20:29. [PMID: 29637406 DOI: 10.1007/s11926-018-0734-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW This paper aims to provide a summary of the recent therapeutic advances and the latest research on outcome measures for clinical trials in juvenile dermatomyositis (JDM). RECENT FINDINGS Recent randomized controlled trials (RCTs) have demonstrated the superiority of the combination of prednisone with methotrexate over other conventional therapies and the potential effectiveness of rituximab in refractory cases. A multinational project has led to develop new criteria for the definition of minimal, moderate, and major improvement in future JDM clinical trials. This effort has been paralleled by the establishment of criteria for clinically inactive disease. The validation of the first composite disease activity score for JDM is in progress. The new outcome measures will increase the reliability of assessment of clinical response in JDM clinical trials and foster future multinational RCTs aimed to investigate novel treatment strategies for refractory forms of JDM.
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Affiliation(s)
| | | | | | - Stefano Lanni
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Clara Malattia
- Università degli Studi di Genova, Genoa, Italy.,Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Angelo Ravelli
- Università degli Studi di Genova, Genoa, Italy. .,Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy.
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Ueki M, Kobayashi I, Takezaki S, Tozawa Y, Okura Y, Yamada M, Kuwana M, Ariga T. Myositis-specific autoantibodies in Japanese patients with juvenile idiopathic inflammatory myopathies. Mod Rheumatol 2018. [PMID: 29532710 DOI: 10.1080/14397595.2018.1452353] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The aim of our study is to clarify the association of myositis-specific autoantibodies (MSAs) with clinical and laboratory features in Japanese patients with juvenile idiopathic inflammatory myopathies (JIIMs). METHODS We retrospectively analyzed the frequency of MSAs and their association with clinical or laboratory findings in 25 Japanese patients with JIIMs in Hokkaido district. RESULTS Eighteen of the 25 patients (72%) were positive for MSAs; seven with anti-melanoma differentiation associated gene (MDA) 5 (28%), five with anti-transcriptional intermediary factor (TIF)-1γ (20%), four with anti-MJ/nuclear matrix protein (NXP)-2 (16%), two with anti-Jo-1 (8%), one with anti- HMG-CoA reductase, one with anti-signal recognition peptide (SRP) antibodies (4% each), including co-existence and transition of MSAs in one patient each. Anti-MDA5 antibodies were related to interstitial lung disease (ILD) and arthritis but not to amyopathic juvenile dermatomyositis. Drug-free remission was achieved, once ILD was overcome in this group. Anti-TIF-1γ antibodies were associated with typical rashes and mild myositis. Anti-MJ/NXP2 and anti-SRP antibodies were associated with severe muscle weakness. No patient was complicated with malignancy. CONCLUSION Anti-MDA5 antibodies are prevalent and closely associated with ILD in our series compared with other countries. There was no apparent difference in clinical features associated with other MSAs among races.
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Affiliation(s)
- Masahiro Ueki
- a Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Ichiro Kobayashi
- a Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan.,b Center for Pediatric Allergy and Rheumatology , KKR Sapporo Medical Center , Sapporo , Japan
| | - Shunichiro Takezaki
- a Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Yusuke Tozawa
- a Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Yuka Okura
- b Center for Pediatric Allergy and Rheumatology , KKR Sapporo Medical Center , Sapporo , Japan
| | - Masafumi Yamada
- a Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Masataka Kuwana
- c Department of Allergy and Rheumatology , Nippon Medical School Graduate School of Medicine , Tokyo , Japan
| | - Tadashi Ariga
- a Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
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Pachman LM, Khojah AM. Advances in Juvenile Dermatomyositis: Myositis Specific Antibodies Aid in Understanding Disease Heterogeneity. J Pediatr 2018; 195:16-27. [PMID: 29576174 PMCID: PMC5881602 DOI: 10.1016/j.jpeds.2017.12.053] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/27/2017] [Accepted: 12/18/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Lauren M Pachman
- Department of Pediatrics , Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Cure JM Center of Excellence in Juvenile Myositis (JM) Research, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Amer M Khojah
- Department of Pediatrics, Division of Pediatric Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Mulroy E, Cleland J, Child N, Pereira J, Anderson NE. A tough one to swallow. Pract Neurol 2018; 18:250-254. [PMID: 29567648 DOI: 10.1136/practneurol-2017-001860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Eoin Mulroy
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - James Cleland
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Nicholas Child
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer Pereira
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Neil E Anderson
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
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Abstract
The idiopathic inflammatory myopathies of childhood consist of a heterogeneous group of autoimmune diseases characterised by proximal muscle weakness and pathognomonic skin rashes. The overall prognosis of juvenile myositis has improved significantly over recent years, but the long-term outcome differs substantially from patient to patient, suggestive of distinct clinical phenotypes with variable responses to treatment. High doses of corticosteroids remain the cornerstone of therapy along with other immunosuppressant therapies depending on disease severity and response. The advent of biological drugs has revolutionised the management of various paediatric rheumatologic diseases, including inflammatory myopathies. There are few data from randomised controlled trials to guide management decisions; thus, several algorithms for the treatment of juvenile myositis have been developed using international expert opinion. The general treatment goals now include elimination of active disease and normalisation of physical function, so as to preserve normal growth and development, and to prevent long-term damage and deformities. This review summarises the newer and possible future therapies of juvenile inflammatory myopathies, including evidence supporting their efficacy and safety.
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Skevaki C, Van den Berg J, Jones N, Garssen J, Vuillermin P, Levin M, Landay A, Renz H, Calder PC, Thornton CA. Immune biomarkers in the spectrum of childhood noncommunicable diseases. J Allergy Clin Immunol 2017; 137:1302-16. [PMID: 27155027 DOI: 10.1016/j.jaci.2016.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 02/07/2023]
Abstract
A biomarker is an accurately and reproducibly quantifiable biological characteristic that provides an objective measure of health status or disease. Benefits of biomarkers include identification of therapeutic targets, monitoring of clinical interventions, and development of personalized (or precision) medicine. Challenges to the use of biomarkers include optimizing sample collection, processing and storage, validation, and often the need for sophisticated laboratory and bioinformatics approaches. Biomarkers offer better understanding of disease processes and should benefit the early detection, treatment, and management of multiple noncommunicable diseases (NCDs). This review will consider the utility of biomarkers in patients with allergic and other immune-mediated diseases in childhood. Typically, biomarkers are used currently to provide mechanistic insight or an objective measure of disease severity, with their future role in risk stratification/disease prediction speculative at best. There are many lessons to be learned from the biomarker strategies used for cancer in which biomarkers are in routine clinical use and industry-wide standardized approaches have been developed. Biomarker discovery and validation in children with disease lag behind those in adults; given the early onset and therefore potential lifelong effect of many NCDs, there should be more studies incorporating cohorts of children. Many pediatric biomarkers are at the discovery stage, with a long path to evaluation and clinical implementation. The ultimate challenge will be optimization of prevention strategies that can be implemented in children identified as being at risk of an NCD through the use of biomarkers.
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Affiliation(s)
- Chrysanthi Skevaki
- International Inflammation (in-FLAME) Network of the World Universities Network; Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, University Hospital Giessen and Marburg GmbH Baldingerstr, Marburg, Germany
| | - Jolice Van den Berg
- International Inflammation (in-FLAME) Network of the World Universities Network; Department of Immunology/Microbiology Rush University Medical Center Chicago, Chicago, Ill
| | - Nicholas Jones
- International Inflammation (in-FLAME) Network of the World Universities Network; Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Johan Garssen
- International Inflammation (in-FLAME) Network of the World Universities Network; Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Beta Faculty, Utrecht University, Utrecht, The Netherlands
| | - Peter Vuillermin
- International Inflammation (in-FLAME) Network of the World Universities Network; Child Health Research Unit, Barwon Health, School of Medicine, Deakin University, Geelong, Australia
| | - Michael Levin
- International Inflammation (in-FLAME) Network of the World Universities Network; Division of Asthma and Allergy, University of Cape Town, and the Department of Pediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa
| | - Alan Landay
- International Inflammation (in-FLAME) Network of the World Universities Network; Department of Immunology/Microbiology Rush University Medical Center Chicago, Chicago, Ill
| | - Harald Renz
- International Inflammation (in-FLAME) Network of the World Universities Network; Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, University Hospital Giessen and Marburg GmbH Baldingerstr, Marburg, Germany
| | - Philip C Calder
- International Inflammation (in-FLAME) Network of the World Universities Network; Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, and NIHR Southampton Biomedical Research Centre, Southampton University Hospital NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Catherine A Thornton
- International Inflammation (in-FLAME) Network of the World Universities Network; Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, Wales.
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Stübgen JP. Juvenile dermatomyositis/polymyositis and lymphoma. J Neurol Sci 2017; 377:19-24. [PMID: 28477693 DOI: 10.1016/j.jns.2017.03.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/18/2017] [Accepted: 03/21/2017] [Indexed: 12/12/2022]
Abstract
In patients with juvenile dermatomyositis/polymyositis (JDM/PM), malignancy is a rare phenomenon. An extensive workup for neoplastic disease is not routinely indicated, but should be considered if unusual physical findings are noted at JDM/PM diagnosis or during follow-up period. The objective of this literature review was to assess for any association between, and disease profile of, JDM/PM and lymphoma in childhood. Risk determinants of the possible development of lymphoma in the pediatric population with JDM/PM appear to be the degree and duration of inflammatory activity with chronic B-cell activation and/or antigen stimulation; a paraneoplastic relationship is unlikely.
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Affiliation(s)
- Joerg-Patrick Stübgen
- Department of Neurology, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065-4885, USA.
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Hussain A, Rawat A, Jindal AK, Gupta A, Singh S. Autoantibodies in children with juvenile dermatomyositis: A single centre experience from North-West India. Rheumatol Int 2017; 37:807-812. [PMID: 28331982 DOI: 10.1007/s00296-017-3707-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 03/16/2017] [Indexed: 01/13/2023]
Abstract
The objective of this study is to determine autoantibody profile in children with juvenile dermatomyositis (JDM). Children who were diagnosed with JDM (either recently diagnosed during the study period or follow-up patients) were included in the study. Autoantibodies were detected with commercially available Immunodot kit. Thirty patients were included in the study. Nine out of thirty patients (30%) were positive for one of the 12 autoantibodies tested. Anti-SRP antibody was most common antibody detected in 3 patients followed by anti-MDA-5 antibody in 2 patients; while anti-Jo1 antibody, anti-TIF1-γ antibody, anti-Mi-2 antibody, and anti-PM-Scl antibody were positive in 1 patient each. A different disease phenotype was observed with each autoantibody. The patient with anti-Jo1 antibody had a severe systemic disease in the form of interstitial lung disease; patients with anti-MDA-5 antibody and anti-Mi2 antibody had more severe skin disease with mild muscle disease and patients with anti-SRP antibody had significant skin and muscle disease. Anti-TIF1-γ and anti-PM-Scl antibodies were seen in patients with features of overlap syndrome (myositis-scleroderma). Estimation of autoantibodies may serve as an adjunct tool in delineating and defining distinct clinical phenotypes in children diagnosed with juvenile dermatomyositis. They may also help in prognostication.
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Affiliation(s)
- Altaf Hussain
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Amit Rawat
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Ankur Kumar Jindal
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Anju Gupta
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Surjit Singh
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Kalampokis I, Venturi GM, Poe JC, Dvergsten JA, Sleasman JW, Tedder TF. The Regulatory B Cell Compartment Expands Transiently During Childhood and Is Contracted in Children With Autoimmunity. Arthritis Rheumatol 2017; 69:225-238. [PMID: 27429419 PMCID: PMC5195882 DOI: 10.1002/art.39820] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/14/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Regulatory B cells that inhibit immune responses through interleukin-10 (IL-10) secretion (B10 cells) have been characterized in adult subjects with autoimmune disease. The aim of this study was to characterize B10 cells in individuals across the entire age range of normal human development and changes in their frequency and numbers in children with autoimmunity. METHODS The phenotype and numbers of B10 cells in blood were examined in healthy individuals and children with autoimmunity, using flow cytometry. B10 cell function was assessed by measuring the effect of B cell-derived IL-10 on interferon-γ (IFNγ) expression by CD4+ T cells. Serum cytokine levels were measured by enzyme-linked immunosorbent assay. RESULTS The frequency of B10 cells transiently increased during childhood, when up to 30% of B cells were competent to produce IL-10, compared with the low frequencies in healthy newborns (3-4%) and adults (7-9%). The surface phenotype of B10 cells in children revealed age-dependent variability. B10 cells from children were distinct from proinflammatory cytokine-producing B cells and down-regulated IFNγ production by CD4+ T cells in vitro. Compared with age-matched healthy controls, children with autoimmunity had lower numbers and frequencies of B10 cells (decreased by 39% and 48%, respectively), higher IFNγ levels, and lower IL-21 levels in serum. IFNγ inhibited, whereas IL-21 promoted, B cell IL-10 competence in vitro. CONCLUSION B10 cells, a functionally defined cell subset with a variable surface phenotype reflective of overall B cell development, transiently expand during childhood. B10 cell frequencies and numbers were decreased in children with autoimmunity, which may be explained in part by alterations in serum IFNγ and IL-21 that differentially regulate B10 cell development.
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Affiliation(s)
- Ioannis Kalampokis
- Department of Immunology, Duke University Medical Center, Durham, NC 27710
| | | | - Jonathan C. Poe
- Department of Immunology, Duke University Medical Center, Durham, NC 27710
| | | | - John W. Sleasman
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710
| | - Thomas F. Tedder
- Department of Immunology, Duke University Medical Center, Durham, NC 27710
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Benveniste O, Rider LG. 213th ENMC International Workshop: Outcome measures and clinical trial readiness in idiopathic inflammatory myopathies, Heemskerk, The Netherlands, 18-20 September 2015. Neuromuscul Disord 2016; 26:523-34. [PMID: 27312023 PMCID: PMC5118225 DOI: 10.1016/j.nmd.2016.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Olivier Benveniste
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France; INSERM U974, UPMC Sorbonne Universités, Paris, France.
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA.
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Song Y, Lee S, Yoo DH, Jang KS, Bae J. Strain sonoelastography of inflammatory myopathies: comparison with clinical examination, magnetic resonance imaging and pathologic findings. Br J Radiol 2016; 89:20160283. [PMID: 27401595 DOI: 10.1259/bjr.20160283] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate strain sonoelastography (SSE) in patients with inflammatory myopathies (IM) compared with clinical examination, MRI and pathologic findings. METHODS 18 lesions from 17 consecutive patients with IM (5 males and 12 females; mean age, 41.2 years; range, 11-67 years) were assessed with SSE after MRI. The ratio of strain in the target muscle (A) and a nearby normal muscle (B), defined as the strain index value (SR) (B/A), was calculated automatically. Elastograms were assigned an elasticity score according to the degree and distribution of strain induced by manual compression. Ultrasonography and MRI were analyzed in conjunction with clinical information, biochemical data, final clinical diagnosis and grading of pathology. Correlations between SR and qualitative analyses of MRI and ultrasonography, elasticity score, biochemical data and final clinical diagnosis were analyzed using Pearson's correlation coefficient. RESULTS The SR of the target muscles was high in patients with IM (mean 3.14; range, 0.95-5.93 ± 1.42). The correlations between SR and pathologic grading and elasticity score were statistically significant (p < 0.05). There was no significant agreement between SR and other clinical and radiologic parameters. CONCLUSION Muscle hardness, as semi-quantitatively measured by SSE, was increased in cases of IM. The correlation between the SR and the pathologic grading suggests that SSE could be an important tool in not only the diagnosis of but also in measuring the degree of muscular inflammation. ADVANCES IN KNOWLEDGE This work describes a correlation between tissue elasticity and pathology in IM.
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Affiliation(s)
- Yoonah Song
- 1 Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Seunghun Lee
- 1 Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Dae Hyun Yoo
- 2 Department of Rheumatology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Ki-Seok Jang
- 3 Department of Pathology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Jiyoon Bae
- 4 Department of Pathology, National Police Hospital, Seoul, Republic of Korea
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Timpane S, Brandling-Bennett H, Kristjansson AK. Autoimmune collagen vascular diseases: Kids are not just little people. Clin Dermatol 2016; 34:678-689. [PMID: 27968927 DOI: 10.1016/j.clindermatol.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Morphea, dermatomyositis (DM), and discoid lupus erythematosus (DLE) are autoimmune collagen vascular diseases that can present at any age. In all three of these diseases, the tenants of diagnosis and treatment are largely the same in both children and adults, with a few notable differences. Children with morphea are more likely to present with the linear subtype and have a higher incidence of extracutaneous manifestations. Children often need early aggressive systemic treatment to try to prevent long-term sequelae of morphea. In DM, adult disease has a clear association with malignancy that is not seen in children. Adults have a higher rate of pulmonary involvement and increased mortality, whereas calcinosis is more common in juvenile DM. DLE in adults is generally considered to have a low rate of progression from discoid lesions alone to systemic lupus erythematosus (SLE). DLE is less common in children, but several studies have suggested a higher rate of progression from DLE to SLE in children compared with adults.
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Affiliation(s)
- Sean Timpane
- Resident, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Heather Brandling-Bennett
- Assistant Professor, Department of Pediatrics, Division of Dermatology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Arni K Kristjansson
- Assistant Professor of Dermatology, University of Connecticut School of Medicine, Farmington, CT
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Affiliation(s)
- Lindsey MacFarlane
- From the Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School - both in Boston
| | - Nora Osman
- From the Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School - both in Boston
| | - Susan Ritter
- From the Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School - both in Boston
| | - Amy L Miller
- From the Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School - both in Boston
| | - Joseph Loscalzo
- From the Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School - both in Boston
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