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Liu Q, Pan M, Cao H, Zheng J, Ruan YP, Zhao XQ. Acquired generalized lipodystrophy in a juvenile dermatomyositis patient. Int J Rheum Dis 2024; 27:e15101. [PMID: 38445875 DOI: 10.1111/1756-185x.15101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/28/2024] [Accepted: 02/14/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Qiong Liu
- Department of Dermatology and Venerology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Meng Pan
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hua Cao
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jie Zheng
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ye-Ping Ruan
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao-Qing Zhao
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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2
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Gonçalves Júnior J, Shinjo SK. Calcinosis in Juvenile Dermatomyositis-Epidemiology, Pathogenesis, Clinical Features, and Treatment: A Systematic Review. Curr Rheumatol Rep 2024; 26:53-68. [PMID: 38060107 DOI: 10.1007/s11926-023-01126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW We performed a systematic review of the literature on the epidemiology, pathogenesis, clinical and laboratory characterization, and treatment of calcinosis in patients with juvenile dermatomyositis (JDM). A qualitative systematic review was conducted from January 1975 to April 2023 according to the PRISMA protocol using three electronic databases: PubMed, Web of Science, and Scopus. Studies were analyzed based on the following eligibility criteria: at least one combination of the terms described in the search strategy appeared in the title, written in English, Portuguese, or Spanish, and addressed the epidemiology, pathogenesis, diagnosis, and treatment of calcinosis in juvenile dermatomyositis. Systematic or scoping reviews, letters, clinical images, book chapters, abstracts, inflammatory myopathy in other connective tissue diseases, idiopathic inflammatory myopathies in adults, and purely qualitative studies were excluded. RECENT FINDINGS Seventy-five studies were included. According to the literature, calcinosis is common in women, around five years old, with three years of disease in association with osteoarticular, cutaneous, pulmonary manifestations, and fever. The pathogenesis is still unknown, but the participation of interleukin 1 and 6, tumor necrosis factor alpha, and innate immunity dysregulation seem to be involved. Common autoantibodies are anti-NXP-2, anti-MDA-5, and anti-Mi-2, and their treatment remains controversial. Prospective, randomized, controlled studies are needed to evaluate treatment protocols and map the natural history of this serious complication. Calcinosis seems to be more common in White female children with muscle weakness, fever, arthritis, severe pulmonary, and skin involvement with anti-NXP-2, anti-MDA-5, and anti-Mi-2 autoantibodies. The multitargets and aggressive treatment is recommended.
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Affiliation(s)
- Jucier Gonçalves Júnior
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brazil.
- Faculdade de Medicina, Universidade Federal Cariri, UFCA, Barbalha, CE, Brazil.
| | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
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Sener S, Cam V, Ozen S, Batu ED. Biologic drugs in the treatment of juvenile dermatomyositis: a literature review. Clin Rheumatol 2024; 43:591-602. [PMID: 37582998 DOI: 10.1007/s10067-023-06740-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023]
Abstract
There is no clear consensus in the literature regarding the choice of biologic therapies and efficacy in juvenile dermatomyositis (JDM). In this review, we aimed to examine previous studies regarding biologic drug use in JDM patients. We screened MEDLINE and Scopus for articles involving JDM patients treated with biologic drugs. We identified 74 articles describing 495 JDM patients treated with biologic drugs (538 biologic treatments) during our literature search. The median (min-max) age of these patients was 9.8 (1-17) years (F/M:1.8). The most frequently used biologic drugs were rituximab (RTX, 50%) and tumor necrosis factor (TNF) inhibitors (34.8%). In a few cases, abatacept (4.3%), anti-interleukin-1 agents (0.9%), tocilizumab (0.9%), bortezomib (0.4%), ustekinumab (0.2%), eculizumab (0.2%), and golimumab (0.2%) were used. RTX was most frequently preferred in patients with severe skin involvement (46.3%). Improvement with RTX was obtained in 60.1% of RTX treatments. Infliximab was most frequently preferred in calcinosis (43.3%), while adalimumab in skin involvement (50%) and etanercept in resistant/recurrent diseases (80%). Improvement was achieved in 44.4% of anti-TNF treatments. Adverse events were observed in 46.8% (58/124) of all treatments. Our results suggest that biologic agents may be a promising alternative for the treatment of particularly resistant JDM cases. Controlled studies are required to provide higher level of evidence for the timing of biologic use in JDM treatment. Key Points • There is no consensus on the choice and efficacy of biologic therapies in JDM. • RTX and TNF inhibitors are the most commonly used biologic drugs. • Biologics were especially preferred in severe skin involvement, calcinosis, and resistant diseases.
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Affiliation(s)
- Seher Sener
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Veysel Cam
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Yi BY, Marrs J, Acharya P, Sura A, Cidon M. Risk factors for developing calcinosis in juvenile dermatomyositis: subcutaneous and myofascial edema in initial magnetic resonance imaging. Rheumatol Int 2023:10.1007/s00296-023-05385-4. [PMID: 37432516 DOI: 10.1007/s00296-023-05385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Abstract
Calcinosis is a sequela of Juvenile Dermatomyositis (JDM) with significant morbidity. A retrospective study observing risk factors for JDM calcinosis, including a possible association between higher intensity of subcutaneous and myofascial edema in initial magnetic resonance imaging (MRI) and development of calcinosis was performed at a tertiary pediatric medical center. Data from the past 20 years on JDM patients with MRIs at the time of JDM diagnosis were obtained. MRIs were individually evaluated by two pediatric musculoskeletal radiologists who blindly graded the intensity of edema on a 0-4 Likert scale. Clinical data and edema scores were compared between patients who developed calcinosis and who did not. Forty-three patients (14 with calcinosis and 29 without calcinosis) were identified. The calcinosis group contained more racial and ethnic minorities, younger ages of JDM onset and longer time to reach JDM diagnosis. Muscle enzyme levels at JDM diagnosis were lower in the calcinosis group, especially Creatinine Kinase (CK) (p = 0.047) and Alanine Aminotransferase (ALT) (p = 0.015). The median score for edema in both groups was 3 (p = 0.39) with an inter-rater reliability of 95%. There was no association between increased subcutaneous and myofascial edema in MRIs at the time of JDM diagnosis and development of calcinosis. Earlier age of JDM onset, racial and ethnic minority, and delay in JDM diagnosis could be risks for developing calcinosis. The calcinosis group presented with lower muscle enzyme levels at the time of JDM diagnosis, especially CK and ALT with statistical significance. This could reflect delay in diagnosis and treatment.
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Affiliation(s)
- Belina Y Yi
- Division of Rheumatology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Joshua Marrs
- Department of Pediatrics, Los Angeles General Medical Center, Los Angeles, CA, USA
| | - Patricia Acharya
- Department of Radiology, Keck School of Medicine, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Amit Sura
- Department of Radiology, Keck School of Medicine, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Michal Cidon
- Division of Rheumatology, Keck School of Medicine, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA
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Suzon B, Goulabchand R, Louis-Sidney F, Maria A, Najjari R, Chauvet E, Le Quellec A, Bessis D, Guilpain P. Subcutaneous tissue involvement in idiopathic inflammatory myopathies: Systematic literature review including three new cases and hypothetical mechanisms. Autoimmun Rev 2023; 22:103284. [PMID: 36736986 DOI: 10.1016/j.autrev.2023.103284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Involvement of subcutaneous tissue in idiopathic inflammatory myopathies (IIM) is poorly known. METHODS We conducted a systematic review of the literature regarding panniculitis and lipodystrophy/lipoatrophy in juvenile and adult IIM via PubMed/Medline, Embase and Scopus databases. Three local observations are included in this review. Epidemiological, clinical, paraclinical and therapeutic data were collected. RESULTS Panniculitis appears to be more common in adults than in juveniles. It was mainly localised in the upper and lower limbs. Panniculitis improved in most cases with steroids and panniculitis and myositis had a similar course in 83.3% and 72.2% of cases in juveniles and adults, respectively. Lipodystrophy appeared to be more frequent in juveniles and was only observed in dermatomyositis in both juveniles and adults. Lipodystrophy was mainly partial in juveniles and adults. The median time from myositis to the diagnosis of lipodystrophy was 6 years [0-35] and 2.5 years [0-10] in juveniles and adults, respectively. Lipodystrophy was associated with anti-TIF1 gamma auto-antibody positivity, a polycyclic/chronic course of myositis and the occurrence of calcinosis and might be an indicator of poor disease control. CONCLUSION Adipose tissue involvement, particularly lipodystrophy, occurs almost exclusively in dermatomyositis. The insidious onset and lack of awareness of the diagnosis may underestimate its prevalence. Larger studies are needed to identify possible risk factors in these patients, to better potential underlying pathophysiological process, in order to discuss potential therapeutic targets.
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Affiliation(s)
- Benoit Suzon
- Department of Internal Medicine, Martinique University Hospital, Fort-de-France, Martinique, France; EpiCliV Research Unit, University of French West Indies, Fort-de-France, Martinique, France
| | - Radjiv Goulabchand
- Department of Internal Medicine, Nîmes University Hospital, France; Institute for Regenerative Medicine and Biotherapy, INSERM U1183, Montpellier, France
| | - Fabienne Louis-Sidney
- EpiCliV Research Unit, University of French West Indies, Fort-de-France, Martinique, France; Department of Rheumatology, Martinique University Hospital, France
| | - Alexandre Maria
- Institute for Regenerative Medicine and Biotherapy, INSERM U1183, Montpellier, France; Department of Internal Medicine and Immuno-Oncologie (MedI(2)O), Montpellier University Hospital, France; Montpellier-1 University, Faculty of Medicine, France
| | - Redwann Najjari
- Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France
| | - Elodie Chauvet
- Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France
| | - Alain Le Quellec
- Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France
| | - Didier Bessis
- Department of Dermatology, Montpellier University Hospital, France
| | - Philippe Guilpain
- Institute for Regenerative Medicine and Biotherapy, INSERM U1183, Montpellier, France; Montpellier-1 University, Faculty of Medicine, France; Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France.
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Hughes M, Herrick AL. Diagnosis and management of systemic sclerosis-related calcinosis. Expert Rev Clin Immunol 2023; 19:45-54. [PMID: 36333952 DOI: 10.1080/1744666x.2023.2144835] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Calcinosis is common in patients with systemic sclerosis (SSc) and refers to the sub-epidermal deposition of calcium salts in the skin. SSc-related calcinosis is associated with significant morbidity, including through cutaneous ulceration and predisposition to become infected. AREAS COVERED After briefly addressing aetiopathogenesis, we describe the clinical burden of SSc-associated calcinosis and provide a structured and practical clinical approach to diagnosis and assessment, including discussion of the role of different imaging modalities. The multi-faceted treatment of SSc-associated calcinosis is presented under three broad headings of 'general measures,' and 'medical treatment' and 'surgical treatment.' We adopted a narrative approach to identify relevant manuscripts to inform our review. EXPERT OPINION SSc-related calcinosis is an area of major unmet clinical need and for too long has been a neglected area of research. Safe and effective treatments are badly needed to improve patient quality of life and outcomes. To facilitate future clinical trials, we require increased understanding of pathogenesis (to inform selection of potential targeted therapies) and reliable outcome measures, including those which will measure the impact and severity of calcinosis from the patient perspective. International collaborative research is ongoing to develop outcome measures and treatments for this potentially devastating complication of SSc.
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Affiliation(s)
- Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, the University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, the University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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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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Suzon B, Goulabchand R, Maria A, Najjari R, Le Quellec A, Bessis D, Louis-Sidney F, Guilpain P. Atteintes du tissu adipeux au cours des myopathies inflammatoires : revue systématique de la littérature augmentée de trois observations. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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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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Yildirim DG, Akdulum İ, Talim B, Demir E, Buyan N, Bakkaloğlu SA. Milk of calcium: A rare manifestation of juvenile dermatomyositis. Arch Rheumatol 2021; 36:302-304. [PMID: 34527937 PMCID: PMC8418756 DOI: 10.46497/archrheumatol.2021.8197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/25/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Deniz Gezgin Yildirim
- Department of Pediatrics, Division of Pediatric Rheumatology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - İsmail Akdulum
- Department of Radiology, Division of Pediatric Radiology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Beril Talim
- Department of Pathology Unit, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ercan Demir
- Department of Pediatrics, Division of Pediatric Neurology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Necla Buyan
- Department of Pediatrics, Division of Pediatric Rheumatology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Department of Pediatrics, Division of Pediatric Rheumatology, Gazi University, Faculty of Medicine, Ankara, Turkey
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Cobo-Ibáñez T, Sánchez-Piedra C, Nuño-Nuño L, Castellví I, Carrión-Barberà I, Romero-Bueno F, Narváez J, Trallero-Araguás E, Tomero E, Ruiz-Lucea ME, Larena C, Carrasco Cubero C, Jovaní V, Barbadillo C, Sivera F, Belzunegui J, Pérez Gómez A, Gómez Gómez A, Delgado-Frías E, Pego-Reigosa JM, Joven B, Ibáñez M, Martínez-González O, Ruiz-Román A, Camins J, Ortega-Castro R, Trenor Larra P, Rodríguez López M, Freire M, Alcocer P, Holgado S, Rúa-Figueroa I, Lozano N, Martínez-Barrio J. Myo-Spain: Spanish Registry of patients with idiopathic inflammatory myopathy. Methodology. ACTA ACUST UNITED AC 2021; 18:253-259. [PMID: 34400117 DOI: 10.1016/j.reumae.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To describe the methods of the Spanish Registry of patients with idiopathic inflammatory myopathy (IIM) (Myo-Spain), as well as its strengths and limitations. The main objective of the project is to analyse the evolution and clinical management of a cohort of patients with IIM. METHODS Observational, longitudinal, ambispective and multicentre study of a cohort of patients with IIM seen in rheumatology units in Spain. All patients with a diagnosis of IMM will be included in the regular follow-up of the participating centres, regardless of age on initiation of the process. Incident cases will be all patients who at the beginning of the study have been diagnosed for less than 12 months and prevalent cases for more than 12 months. The registry will include data from the visit at baseline, one year and two years. Socio-demographic, clinical, analytical variables, complications, comorbidities, association with other rheumatic diseases, hospital admissions, mortality and treatments will be collected. In addition, indices, scales and questionnaires of activity, muscle involvement, damage, disability, and quality of life will be determined. The recruitment period will be 23 months. The purpose is to obtain a cohort of 400 patients with IMM. CONCLUSIONS Myo-Spain registry provides the opportunity to develop a cohort of incident and prevalent patients with IMM in Spain. Myo-Spain will be able to assess in detail the clinical characteristics of the disease at different times. The comprehensive information collected during the visits is expected to provide a broad source of data for future analysis.
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Affiliation(s)
- Tatiana Cobo-Ibáñez
- Servicio de Reumatología, Hospital Universitario Infanta Sofía, Universidad Europea, Madrid, Spain
| | | | - Laura Nuño-Nuño
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain
| | - Iván Castellví
- Servicio de Reumatología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Javier Narváez
- Servicio de Reumatología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Eva Tomero
- Servicio de Reumatología, Hospital La Princesa, Madrid, Spain
| | | | - Carmen Larena
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Vega Jovaní
- Servicio de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Francisca Sivera
- Servicio de Reumatología, Hospital General Universitario de Elda, Elda, Spain
| | - Joaquín Belzunegui
- Servicio de Reumatología, Hospital Universitario Donostia, San Sebastián, Spain
| | - Ana Pérez Gómez
- Servicio de Reumatología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Alejandro Gómez Gómez
- Servicio de Reumatología, Hospital Universitario Infanta Sofía, Universidad Europea, Madrid, Spain
| | | | - José María Pego-Reigosa
- Servicio de Reumatología, Complejo Hospitalario Universitario de Vigo, Vigo, Spain, Grupo IRIDIS (Investigation in Rheumatology and Immunemediated Diseases) Instituto de Investigación Sanitaria Galicia Sur (IISGS)
| | - Beatriz Joven
- Servicio de Reumatología, Hospital 12 de Octubre, Madrid, Spain
| | - Mónica Ibáñez
- Servicio de Reumatología, Hospital Universitario Son Llàtzer, Mallorca, Spain
| | | | | | - Jordi Camins
- Servicio de Reumatología, Hospital General de Granollers, Granollers, Spain
| | - Rafaela Ortega-Castro
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Pilar Trenor Larra
- Servicio de Reumatología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Marina Rodríguez López
- Servicio de Reumatología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Mercedes Freire
- Servicio de Reumatología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Patricia Alcocer
- Servicio de Reumatología, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Susana Holgado
- Servicio de Reumatología, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Iñigo Rúa-Figueroa
- Servicio de Reumatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, Spain
| | - Nuria Lozano
- Servicio de Reumatología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Julia Martínez-Barrio
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Cobo-Ibáñez T, Sánchez-Piedra C, Nuño-Nuño L, Castellví I, Carrión-Barberà I, Romero-Bueno F, Narváez J, Trallero-Araguás E, Tomero E, Ruiz-Lucea ME, Larena C, Carrasco Cubero C, Jovaní V, Barbadillo C, Sivera F, Belzunegui J, Pérez Gómez A, Gómez Gómez A, Delgado-Frías E, Pego-Reigosa JM, Joven B, Ibáñez M, Martínez-González O, Ruiz-Román A, Camins J, Ortega-Castro R, Trenor Larra P, Rodríguez López M, Freire M, Alcocer P, Holgado S, Rúa-Figueroa I, Lozano N, Martínez-Barrio J. Myo-Spain: Spanish Registry of Patients with Idiopathic Inflammatory Myopathy. Methodology. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00065-6. [PMID: 33867271 DOI: 10.1016/j.reuma.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/19/2021] [Accepted: 01/27/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe the methods of the Spanish Registry of patients with idiopathic inflammatory myopathy (IIM) (Myo-Spain), as well as its strengths and limitations. The main objective of the project is to analyse the evolution and clinical management of a cohort of patients with IIM. METHODS Observational, longitudinal, ambispective and multicentre study of a cohort of patients with IIM seen in rheumatology units in Spain. All patients with a diagnosis of IMM will be included in the regular follow-up of the participating centres, regardless of age on initiation of the process. Incident cases will be all patients who at the beginning of the study have been diagnosed for less than 12 months and prevalent cases for more than 12 months. The registry will include data from the visit at baseline, one year and two years. Socio-demographic, clinical, analytical variables, complications, comorbidities, association with other rheumatic diseases, hospital admissions, mortality and treatments will be collected. In addition, indices, scales and questionnaires of activity, muscle involvement, damage, disability, and quality of life will be determined. The recruitment period will be 23 months. The purpose is to obtain a cohort of 400 patients with IMM. CONCLUSIONS Myo-Spain registry provides the opportunity to develop a cohort of incident and prevalent patients with IMM in Spain. Myo-Spain will be able to assess in detail the clinical characteristics of the disease at different times. The comprehensive information collected during the visits is expected to provide a broad source of data for future analysis.
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Affiliation(s)
- Tatiana Cobo-Ibáñez
- Servicio de Reumatología, Hospital Universitario Infanta Sofía, Universidad Europea, Madrid, España
| | | | - Laura Nuño-Nuño
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
| | - Iván Castellví
- Servicio de Reumatología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Narváez
- Servicio de Reumatología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Eva Tomero
- Servicio de Reumatología, Hospital La Princesa, Madrid, España
| | | | - Carmen Larena
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Vega Jovaní
- Servicio de Reumatología, Hospital General Universitario de Alicante, Alicante, España
| | | | - Francisca Sivera
- Servicio de Reumatología, Hospital General Universitario de Elda, Elda, España
| | - Joaquín Belzunegui
- Servicio de Reumatología, Hospital Universitario Donostia, San Sebastián, España
| | - Ana Pérez Gómez
- Servicio de Reumatología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España
| | - Alejandro Gómez Gómez
- Servicio de Reumatología, Hospital Universitario Infanta Sofía, Universidad Europea, Madrid, España
| | - Esmeralda Delgado-Frías
- Servicio de Reumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - José María Pego-Reigosa
- Servicio de Reumatología, Complejo Hospitalario Universitario de Vigo, Vigo, España, Grupo IRIDIS (Investigation in Rheumatology and Immunemediated Diseases) Instituto de Investigación Sanitaria Galicia Sur (IISGS)
| | - Beatriz Joven
- Servicio de Reumatología, Hospital 12 de Octubre, Madrid, España
| | - Mónica Ibáñez
- Servicio de Reumatología, Hospital Universitario Son Llàtzer, Mallorca, España
| | | | | | - Jordi Camins
- Servicio de Reumatología, Hospital General de Granollers, Granollers, España
| | - Rafaela Ortega-Castro
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Universidad de Córdoba. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - Pilar Trenor Larra
- Servicio de Reumatología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Marina Rodríguez López
- Servicio de Reumatología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - Mercedes Freire
- Servicio de Reumatología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Patricia Alcocer
- Servicio de Reumatología, Hospital Universitario HM Sanchinarro, Madrid, España
| | - Susana Holgado
- Servicio de Reumatología, Hospital Germans Trias i Pujol, Barcelona, España
| | - Iñigo Rúa-Figueroa
- Servicio de Reumatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, España
| | - Nuria Lozano
- Servicio de Reumatología, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Julia Martínez-Barrio
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Leung AKC, Lam JM, Alobaida S, Leong KF, Wong AHC. Juvenile Dermatomyositis: Advances in Pathogenesis, Assessment, and Management. Curr Pediatr Rev 2021; 17:273-287. [PMID: 33902423 DOI: 10.2174/1573396317666210426105045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Juvenile dermatomyositis is the most common inflammatory myopathy in the pediatric age group and a major cause of mortality and morbidity in individuals with childhood rheumatic diseases. Mounting evidence suggests that early diagnosis and timely aggressive treatment are associated with better outcomes. OBJECTIVE The purpose of this article is to provide readers with an update on the evaluation, diagnosis, and the treatment of juvenile dermatomyositis. METHODS A PubMed search was performed in Clinical Queries using the key term "juvenile dermatomyositis" in the search engine. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature. The information retrieved from the above search was used in the compilation of the present article. RESULTS Juvenile dermatomyositis is a chronic autoimmune inflammatory condition characterized by systemic capillary vasculopathy that primarily affects the skin and muscles with possible involvement of other organs. In 2017, the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) developed diagnostic criteria for juvenile idiopathic inflammatory myopathies and juvenile dermatomyositis. In the absence of muscle biopsies which are infrequently performed in children, scores (in brackets) are assigned to four variables related to muscle weakness, three variables related to skin manifestations, one variable related to other clinical manifestations, and two variables related to laboratory measurements to discriminate idiopathic inflammatory myopathies from non-idiopathic inflammatory myopathies as follows: objective symmetric weakness, usually progressive, of the proximal upper extremities (0.7); objective symmetric weakness, usually progressive, of the proximal lower extremities (0.8); neck flexors relatively weaker than neck extensors (1.9); leg proximal muscles relatively weaker than distal muscles (0.9); heliotrope rash (3.1); Gottron papules (2.1); Gottron sign (3.3); dysphagia or esophageal dysmotility (0.7); the presence of anti-Jo-1 autoantibody (3.9); and elevated serum levels of muscle enzymes (1.3). In the absence of muscle biopsy, a definite diagnosis of idiopathic inflammatory myopathy can be made if the total score is ≥7.5. Patients whose age at onset of symptoms is less than 18 years and who meet the above criteria for idiopathic inflammatory myopathy and have a heliotrope rash, Gottron papules or Gottron sign are deemed to have juvenile dermatomyositis. The mainstay of therapy at the time of diagnosis is a high-dose corticosteroid (oral or intravenous) in combination with methotrexate. CONCLUSION For mild to moderate active muscle disease, early aggressive treatment with high-dose oral prednisone alone or in combination with methotrexate is the cornerstone of management. Pulse intravenous methylprednisolone is often preferred to oral prednisone in more severely affected patients, patients who respond poorly to oral prednisone, and those with gastrointestinal vasculopathy. Other steroid-sparing immunosuppressive agents such as cyclosporine and cyclophosphamide are reserved for patients with contraindications or intolerance to methotrexate and for refractory cases, as the use of these agents is associated with more adverse events. Various biological agents have been used in the treatment of juvenile dermatomyositis. Data on their efficacy are limited, and their use in the treatment of juvenile dermatomyositis is considered investigational.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta,Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, British Columbia,Canada
| | - Saud Alobaida
- Department of Dermatology, King Faisal Specialist Hospital & Research Centre, Riyadh,Saudi Arabia
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur,Malaysia
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta,Canada
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Bolko L, Gitiaux C, Allenbach Y. [Dermatomyositis: new antibody, new classification]. Med Sci (Paris) 2019; 35 Hors série n° 2:18-23. [PMID: 31859626 DOI: 10.1051/medsci/2019178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dermatomyositis are rare chronic auto-immune diseases characterized by cutaneous involvement. Diagnosis could be made in childhood or in aldult. There are some different clinical and histological presentation associated with different myositis specific antibody. There are five dermatomyositis specific autoantibodies, anti-Mi2, anti-Tif1-γ, anti-NXP2, anti-MDA5, and anti-SAE. Anti-Mi2 are associated with "classical form" of DM with cutaneous and muscular involvement. Anti-Tif1γ and anti-NXP2 are found in juvenile and adult dermatomyositis, and are associated with recurrent diseases with cutaneous involvement at the forefront. In adults, they are associated with cancer. Anti-MDA5 antibodies are associated with a systemic involvement and an interstitial lung disease. Finally, anti-SAE have been found only in adults, with a classic form.
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Affiliation(s)
- Loïs Bolko
- Service de Rhumatologie Maison Blanche, CHU de Reims, Reims, France
| | - Cyril Gitiaux
- Centre de référence des pathologies neuromusculaires Paris Nord Est, service de neurophysiologie clinique, Hôpital universitaire Necker Enfants Malades, APHP.5, Université de Paris, France
| | - Yves Allenbach
- Service de médecine interne et immunologie clinique, APHP Pitié-Salpêtrière, Paris, France
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Abstract
PURPOSE OF REVIEW Juvenile dermatomyositis is a heterogeneous disease with variable clinical outcomes. Here, we describe the recognised subtypes of idiopathic inflammatory myositis which occur in children, with particular reference to disease-associated autoantibodies. RECENT FINDINGS Large cohort studies have demonstrated that myositis autoantibodies are common in juvenile dermatomyositis and can be found in the majority of patients. They identify homogenous clinical subgroups and inform prognosis, particularly the risks of developing interstitial lung disease. Descriptions of immune-mediated necrotising myositis in juvenile patients have highlighted a rare but important clinical subset typically associated with severe muscle disease and treatment resistance. It is increasingly apparent that autoantibodies can provide detailed information on prognosis and the likely disease associations in those with juvenile dermatomyositis. Further work is needed to establish how this knowledge should influence our approach to treatment.
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Affiliation(s)
- Danyang Li
- University of Bath, Claverton Down, Bath, BA2 7AY, UK
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Wakiguchi H. Multispecialty approach for improving outcomes in juvenile dermatomyositis. J Multidiscip Healthc 2019; 12:387-394. [PMID: 31213823 PMCID: PMC6549682 DOI: 10.2147/jmdh.s171095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/11/2019] [Indexed: 11/23/2022] Open
Abstract
Juvenile dermatomyositis (JDM) is a pediatric rheumatic disease characterized by inflammation of the muscle and skin. Prognosis of JDM in children has improved in general owing to medical progress; however, pathogenesis and management of JDM in children and prognosis in refractory JDM remain challenging. For elucidation of JDM pathophysiology and establishment of appropriate treatment for JDM, pediatric rheumatologists need to adopt a multispecialty approach that involves experts in genetics, immunology, pathology, musculoskeletal medicine, dermatology, pulmonology, cardiology, hematology, gastroenterology, endocrinology, ophthalmology, psychology, radiology, pharmacology, physiotherapy, surgery, preventive medicine, and adult rheumatology. Such collaborations will potentially lead to improved outcomes in children with JDM.
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Affiliation(s)
- Hiroyuki Wakiguchi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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