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Shimoyama T, Yoshida K, Muro Y, Ito H, Matsushita T, Oto Y, Ukichi T, Noda K, Kurosaka D. Magnetic resonance imaging patterns revealing muscle pathology and clinical features in idiopathic inflammatory myopathies. Rheumatology (Oxford) 2024; 63:2684-2693. [PMID: 38410065 DOI: 10.1093/rheumatology/keae125] [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: 08/10/2023] [Revised: 12/18/2023] [Accepted: 02/12/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE Idiopathic inflammatory myopathies (IIMs) are autoimmune disorders significantly impacting skeletal muscles; however, the precise correlation between muscle magnetic resonance imaging (MRI) findings, muscle pathology, disease subtypes and clinical characteristics remains uncertain. Thus, we investigated the association of muscle MRI findings in IIMs with muscle pathology and clinical features. METHODS New-onset IIM patients underwent proximal upper and/or lower limb muscle MRI. Patterns of muscle oedema on MRI were categorised into fascial, honeycomb, peripheral, foggy, dense, or coarse dot patterns and compared with inflammatory cell infiltration sites in corresponding muscle biopsies. The incidence of MRI patterns was examined in patient subgroups using myositis-specific antibodies (MSAs) and 2017 EULAR/ACR classification criteria. Univariate and multivariate analyses were conducted to determine the odds ratios (ORs) of MRI findings for clinical characteristics. RESULTS Fifty-six of 85 patients underwent muscle biopsy. Foggy, honeycomb and fascial patterns at biopsy sites correlated with inflammatory cell infiltration in the endomysium (OR 11.9, P = 0.005), perimysium (OR 6.0, P = 0.014) and fascia (OR 16.9, P < 0.001), respectively. Honeycomb and foggy patterns were characteristic of patients with anti-TIF1γ or anti-Mi2 antibodies and MSA-negative dermatomyositis, and those with anti-SRP or anti-HMGCR antibodies and MSA-negative polymyositis (PM), respectively. The honeycomb pattern positively correlated with malignancy (OR 6.87, P < 0.001) and Gottron sign (OR 8.05, P = 0.002); the foggy pattern correlated with muscle weakness (OR 11.24, P = 0.005). The dense dot pattern was associated with dysphagia (OR 6.27, P = 0.006) and malignancy (OR 8.49, P = 0.002). CONCLUSION Muscle MRI holds promise in predicting muscle pathology, disease subtypes and clinical manifestations of IIMs.
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Affiliation(s)
- Takashi Shimoyama
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ken Yoshida
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Haruyasu Ito
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takayuki Matsushita
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yohsuke Oto
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Taro Ukichi
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Kentaro Noda
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Daitaro Kurosaka
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Gramegna LL, Rinaldi R, Belotti LMB, Vignatelli L, Sighinolfi G, Papa V, Costa R, D'Angelo R, Bianchini C, Graziano C, Cirignotta L, Mule R, Manners DN, Tonon C, Cenacchi G, Lodi R. Magnetic resonance imaging scoring system of the lower limbs in adult patients with suspected idiopathic inflammatory myopathy. Neurol Sci 2024; 45:3461-3470. [PMID: 38383748 PMCID: PMC11176218 DOI: 10.1007/s10072-024-07386-y] [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: 10/06/2023] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE We aim to propose a visual quantitative score for muscle edema in lower limb MRI to contribute to the diagnosis of idiopathic inflammatory myopathy (IIM). MATERIAL AND METHODS We retrospectively evaluated 85 consecutive patients (mean age 57.4 ± 13.9 years; 56.5% female) with suspected IIM (muscle weakness and/or persistent hyper-CPK-emia with/without myalgia) who underwent MRI of lower limbs using T2-weighted fast recovery-fast spin echo images and fat-sat T2 echo planar images. Muscle inflammation was evaluated bilaterally in 11 muscles of the thigh and eight muscles of the leg. Edema in each muscle was graded according to a four-point Likert-type scale adding up to 114 points ([11 + 8)] × 3 × 2). Diagnostic accuracy of the total edema score was explored by assessing sensitivity and specificity using the area under the ROC curve. Final diagnoses were made by a multidisciplinary Expert Consensus Panel applying the Bohan and Peter diagnostic criteria whenever possible. RESULTS Of the 85 included patients, 34 (40%) received a final diagnosis of IIM (IIM group) while 51 (60%) received an alternative diagnosis (non-IIM group). A cutoff score ≥ 18 was able to correctly classify patients having an IIM with an area under the curve of 0.85, specificity of 96%, and sensitivity of 52.9%. CONCLUSION Our study demonstrates that a quantitative MRI score for muscle edema in the lower limbs (thighs and legs) aids in distinguishing IIM from conditions that mimic it.
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Affiliation(s)
- Laura Ludovica Gramegna
- Programma Di Neuroimmagini Funzionali E Molecolari, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Rita Rinaldi
- Clinica Neurologica Rete Neurologica Metropolitana, Sede Neurologia Policlinico S. Orsola, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | | | - Luca Vignatelli
- Epidemiology and Statistics Unit, IRCCS, Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Giovanni Sighinolfi
- Programma Di Neuroimmagini Funzionali E Molecolari, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Valentina Papa
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Roberta Costa
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Roberto D'Angelo
- Clinica Neurologica Rete Neurologica Metropolitana, Sede Neurologia Policlinico S. Orsola, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Claudio Bianchini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | | | - Lorenzo Cirignotta
- Programma Di Neuroimmagini Funzionali E Molecolari, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Rita Mule
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Policlinico Di Sant'Orsola, UO Reumatologia, Bologna, Italy
| | - David Neil Manners
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Caterina Tonon
- Programma Di Neuroimmagini Funzionali E Molecolari, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Giovanna Cenacchi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Raffaele Lodi
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy.
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Ghanbar MI, Danoff SK. Review of Pulmonary Manifestations in Antisynthetase Syndrome. Semin Respir Crit Care Med 2024; 45:365-385. [PMID: 38710221 DOI: 10.1055/s-0044-1785536] [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: 05/08/2024]
Abstract
Antisynthetase syndrome (ASyS) is now a widely recognized entity within the spectrum of idiopathic inflammatory myopathies. Initially described in patients with a triad of myositis, arthritis, and interstitial lung disease (ILD), its presentation can be diverse. Additional common symptoms experienced by patients with ASyS include Raynaud's phenomenon, mechanic's hand, and fever. Although there is a significant overlap with polymyositis and dermatomyositis, the key distinction lies in the presence of antisynthetase antibodies (ASAs). Up to 10 ASAs have been identified to correlate with a presentation of ASyS, each having manifestations that may slightly differ from others. Despite the proposal of three classification criteria to aid diagnosis, the heterogeneous nature of patient presentations poses challenges. ILD confers a significant burden in patients with ASyS, sometimes manifesting in isolation. Notably, ILD is also often the initial presentation of ASyS, requiring pulmonologists to remain vigilant for an accurate diagnosis. This article will comprehensively review the various aspects of ASyS, including disease presentation, diagnosis, management, and clinical course, with a primary focus on its pulmonary manifestations.
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Affiliation(s)
- Mohammad I Ghanbar
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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Patel P, Marinock JM, Ajmeri A, Brent LH. A Review of Antisynthetase Syndrome-Associated Interstitial Lung Disease. Int J Mol Sci 2024; 25:4453. [PMID: 38674039 PMCID: PMC11050089 DOI: 10.3390/ijms25084453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Our objective in this review article is to present a clinical case of a patient with antisynthetase syndrome (ASyS) and provide an overview of the pathogenesis, classification criteria, antibody profiles, clinical features, and current knowledge of treatment options, focusing on interstitial lung disease (ILD). ASyS is an uncommon autoimmune disease with a heterogenous clinical presentation characterized by the presence of autoantibodies against an aminoacyl-tRNA synthetase and manifested by myositis, fever, inflammatory arthritis, Raynaud's phenomenon, mechanics hands, and ILD. ASyS-associated ILD (ASyS-ILD) is the most serious complication of ASyS, which may evolve to rapidly progressive ILD; therefore, it often requires thorough clinical and radiologic evaluation including recognition of a specific clinical phenotype associated with the antisynthetase antibodies (ASAbs) to guide therapeutic interventions.
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Affiliation(s)
- Puja Patel
- Section of Rheumatology, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Jenna M. Marinock
- Department of Medicine, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Aamir Ajmeri
- Department of Thoracic Medicine, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Lawrence H. Brent
- Section of Rheumatology, Temple University Hospital, Philadelphia, PA 19140, USA
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Zhen C, Zhao B, He J, Wei L, Yan C, Dai T, Hou Y. Myofascial edema of gastrocnemius: A prominent MRI characteristic in dermatomyositis patients with anti-transcriptional intermediate factor 1-γ antibody. CNS Neurosci Ther 2024; 30:e14647. [PMID: 38385674 PMCID: PMC10883095 DOI: 10.1111/cns.14647] [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: 10/31/2023] [Revised: 01/28/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
AIMS This study was designed to evaluate the magnetic resonance imaging (MRI) patterns of the lower limb muscles in dermatomyositis (DM) with anti-transcriptional intermediate factor 1-γ (anti-TIF1-γ) antibody. METHODS This retrospective, observational, cross-sectional study enrolled 12 adult DM patients with anti-TIF1-γ antibody. Muscles were assessed for fascial edema, subcutaneous-tissue edema, muscle edema, and fatty replacement. These features were analyzed in relation to clinical characteristics. RESULTS All 12 patients underwent hip and thigh MRI, and 8 completed calf MRI. All patients showed myofascial edema, muscle edema, and fatty replacement, and 8 out of 12 further exhibited subcutaneous-tissue edema. Specifically, myofascial edema of the gastrocnemius was observed in all patients (8/8). The vastus intermedialis and vastus lateralis muscles showed the most severe muscle edema, whereas the caput breve of the biceps femoris, semitendinosus, and soleus muscles exhibited the most severe fatty replacement. Although only 1 patient exhibited asymmetric muscle weakness, 9 showed asymmetric muscle edema, and 10 showed asymmetric fatty replacement. Changes in muscle edema positively correlated with creatine kinase (CK) levels. CONCLUSIONS Myofascial edema of gastrocnemius was a prominent characteristic of anti-TIF1-γ-positive DM. Early detection of muscle edema, as well as CK levels, may be helpful for monitoring disease activity.
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Affiliation(s)
- Chao Zhen
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
- Department of Neurology, Qingdao HospitalUniversity of Health and Rehabilitation Sciences (Qingdao Municipal Hospital)QingdaoChina
| | - Bing Zhao
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
| | - Jingzhen He
- Department of RadiologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Li Wei
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
| | - Chuanzhu Yan
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
- Department of Central Laboratory and Mitochondrial Medicine Laboratory, Qilu Hospital (Qingdao), Cheeloo College of MedicineShandong UniversityQingdaoChina
- Brain Science Research Institute, Shandong UniversityJinanChina
| | - Tingjun Dai
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
| | - Ying Hou
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of NeurologyQilu Hospital of Shandong UniversityJinanChina
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Gorijavolu M, Bairwa D, Ganapathy S, Dunga S, Gopal A, Ananthakrishnan R, Thabah MM, Negi VS, Kavadichanda CG. Semi-quantitative thigh magnetic resonance imaging scores in assessing disease activity and determining long-term clinical outcome in idiopathic inflammatory myopathies: a causal mediation analysis. Rheumatology (Oxford) 2024; 63:111-118. [PMID: 37079733 DOI: 10.1093/rheumatology/kead174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/03/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES To evaluate the relationship of thigh MRI (t-MRI) with manual muscle testing-8 (MMT-8), muscle enzymes and autoantibodies. To determine the causal and mediating factors resulting in poor recovery of MMT-8 in inflammatory myositis (IIM). METHODS This was a single-centre retrospective study in IIM patients. t-MRI was semi-quantitatively scored for muscle oedema, fascial oedema, muscle atrophy and fatty infiltration. Spearman correlation of t-MRI scores was done with muscle enzymes at baseline, and MMT-8 at baseline and on follow-up. Causal mediation analysis was performed with age, sex, symptom duration, autoantibodies, diabetes and BMI as independent variables, follow-up MMT-8 as dependent and t-MRI scores as mediating variables. RESULTS Baseline evaluation was done on 59 and follow-up on 38 patients. Median follow-up of the cohort was 31 (10-57) months. Baseline MMT-8 negatively correlated with muscle oedema (r = -0755), fascial oedema (r = -0.443) and muscle atrophy (r = -0.343). Creatinine kinase (r = 0.422) and aspartate transaminase (r = 0.480) positively correlated with muscle oedema. Follow-up MMT-8 correlated negatively with baseline atrophy (r = -0.497) and fatty infiltration (r = -0.531). On follow-up, MMT-8 males had positive total effect (estimate (95%CI)) via atrophy [2.93 (0.44, 4.89)] and fatty infiltration [2.08 (0.54, 3.71)]. Antisynthetase antibody had a positive total effect via fatty infiltration [4.50 (0.37, 7.59)]. Age had a negative total effect via atrophy [-0.09 (0.19, -0.01)] and fatty infiltration [-0.07 (-0.15, -0.01)]. Disease duration had a negative total effect via fatty infiltration [-0.18 (-0.27, -0.02)]. CONCLUSION Baseline fatty infiltration and muscle atrophy resulting from older age, female sex, longer disease duration and absent anti-synthetase antibodies, partly mediate muscle recovery in IIM.
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Affiliation(s)
- Mamatha Gorijavolu
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Devender Bairwa
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Sachit Ganapathy
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Saikumar Dunga
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Aishwarya Gopal
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Ramesh Ananthakrishnan
- Department of Radiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Molly Mary Thabah
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Vir Singh Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Chengappa G Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Opinc-Rosiak AH, Makowska JS. Environmental exposures as risk factors for idiopathic inflammatory myopathies. J Autoimmun 2023; 140:103095. [PMID: 37797402 DOI: 10.1016/j.jaut.2023.103095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/25/2023] [Indexed: 10/07/2023]
Abstract
Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of rare autoimmune diseases, with increasing incidence rates observed in the recent years. The pathogenesis of IIM remains not fully understood, and the interaction of genetic and environmental factors is suspected. It is unclear whether the observed upward trend in the IIM incidence is solely due to improved access to effective diagnostics or perhaps due to increased exposure to external risk factors. The PUBMED database was thoroughly searched for articles describing environmental exposures potentially triggering the onset of IIM. The article summarizes the current knowledge available on this subject, taking into account various environmental factors, including among others UV radiation, infectious agents with SARS-CoV-2, inhaled particles, or iatrogenic effects. Limitations and unmet needs requiring further studies were highlighted.
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Affiliation(s)
| | - Joanna S Makowska
- Department of Rheumatology, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland.
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de Visser M, Carlier P, Vencovský J, Kubínová K, Preusse C. 255th ENMC workshop: Muscle imaging in idiopathic inflammatory myopathies. 15th January, 16th January and 22nd January 2021 - virtual meeting and hybrid meeting on 9th and 19th September 2022 in Hoofddorp, The Netherlands. Neuromuscul Disord 2023; 33:800-816. [PMID: 37770338 DOI: 10.1016/j.nmd.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023]
Abstract
The 255th ENMC workshop on Muscle Imaging in Idiopathic Inflammatory myopathies (IIM) aimed at defining recommendations concerning the applicability of muscle imaging in IIM. The workshop comprised of clinicians, researchers and people living with myositis. We aimed to achieve consensus on the following topics: a standardized protocol for the evaluation of muscle images in various types of IIMs; the exact parameters, anatomical localizations and magnetic resonance imaging (MRI) techniques; ultrasound as assessment tool in IIM; assessment methods; the pattern of muscle involvement in IIM subtypes; the application of MRI as biomarker in follow-up studies and clinical trials, and the place of MRI in the evaluation of swallowing difficulty and cardiac manifestations. The following recommendations were formulated: In patients with suspected IIM, muscle imaging is highly recommended to be part of the initial diagnostic workup and baseline assessment. MRI is the preferred imaging modality due to its sensitivity to both oedema and fat accumulation. Ultrasound may be used for suspected IBM. Repeat imaging should be considered if patients do not respond to treatment, if there is ongoing diagnostic uncertainty or there is clinical or laboratory evidence of disease relapse. Quantitative MRI is established as a sensitive biomarker in IBM and could be included as a primary or secondary outcome measure in early phase clinical trials, or as a secondary outcome measure in late phase clinical trials. Finally, a research agenda was drawn up.
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Affiliation(s)
- Marianne de Visser
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centre, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Jiří Vencovský
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Kateřina Kubínová
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Corinna Preusse
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Department of Neuropathology, Berlin, Germany
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Abel A, Lazaro E, Ralazamahaleo M, Pierrisnard E, Suzon B, Bonnet F, Mercié P, Macey J, Agossou M, Viallard JF, Deligny C, Rivière E. Phenotypic Profiles Among 72 Caucasian and Afro-Caribbean Patients with Antisynthetase Syndrome Involving Anti-PL7 or Anti-PL12 Autoantibodies. Eur J Intern Med 2023; 115:104-113. [PMID: 37330316 DOI: 10.1016/j.ejim.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Antisynthetase syndrome (ASyS) is a rare autoimmune disease. We aimed to determine clinical, biological, radiological, and evolutive profiles of ASyS patients with anti-PL7 or anti-PL12 autoantibodies. METHODS We performed a retrospective study that included adults with overt positivity for anti-PL7/anti-PL12 autoantibodies and at least one Connors' criterion. RESULTS Among 72 patients, 69% were women, 29 had anti-PL7 and 43 anti-PL12 autoantibodies, median age was 60.3 years, and median follow-up period was 52.2 months. At diagnosis, 76% of patients had interstitial lung disease, 61% had arthritis, 39% myositis, 25% Raynaud's phenomenon, 18% mechanic's hands, and 17% had fever. The most frequent pattern on initial chest computed tomography was non-specific interstitial pneumonia and 67% had fibrosis at last follow-up. During follow-up, 12 patients had pericardial effusion (18%), 19 had pulmonary hypertension (29%), 9 (12.5%) had neoplasms, and 14 (19%) died. Sixty-seven patients (93%) received at least one steroid or immunosuppressive drug. Patients with anti-PL12 autoantibodies were younger (p=0.01) and more frequently exhibited anti-SSA autoantibodies (p=0.01); patients with anti-PL7 autoantibodies had more severe weakness and higher maximum creatine kinase levels (p=0.03 and 0.04, respectively). Initial severe dyspnoea was more common in patients from the West Indies (p=0.009), with lower predicted values of forced vital capacity, forced expiratory volume in 1s, and total lung capacity (p=0.01, p=0.02, p=0.01, respectively) contributing to a more severe 'respiratory' initial presentation. CONCLUSIONS The high mortality and significant numbers of cardiovascular events, neoplasms and lung fibrosis in anti-PL7/12 patients justify close monitoring and question addition of antifibrotic drugs.
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Affiliation(s)
- Aurore Abel
- Department of Internal Medicine, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France; Department of internal Medicine and Infectious Diseases Department, Haut Leveque Hospital, University Hospital Centre of Bordeaux, F33604 Pessac, France
| | - Estibaliz Lazaro
- Department of internal Medicine and Infectious Diseases Department, Haut Leveque Hospital, University Hospital Centre of Bordeaux, F33604 Pessac, France; Université de Bordeaux, UMR CNRS 5164 Immunoconcept, F33000 Bordeaux, France
| | - Mamy Ralazamahaleo
- Université de Bordeaux, UMR CNRS 5164 Immunoconcept, F33000 Bordeaux, France; CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, F33000 Bordeaux, France
| | - Emma Pierrisnard
- Laboratoire d'immunologie, Cité Hospitalière de Mangot-Vulcin, CHU de Martinique
| | - Benoit Suzon
- Department of Internal Medicine, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Fabrice Bonnet
- CHU de Bordeaux, Service de médecine interne et maladies infectieuses, Hôpital Saint-André, F33000 Bordeaux, France; University Bordeaux, ISPED, Inserm U1219, Bordeaux Population Health Research Center, teamGHIGS. F33000 Bordeaux, France
| | - Patrick Mercié
- Department of Internal Medicine and Clinical Immunology, Saint Andre Hospital, University Hospital Centre of Bordeaux, F33000 Bordeaux, France; Univ. Bordeaux, INSERM, BRIC, U1312, F-33000 Bordeaux,France
| | - Julie Macey
- CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
| | - Moustapha Agossou
- Departement of respiratory care, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Jean-Francois Viallard
- Department of internal Medicine and Infectious Diseases Department, Haut Leveque Hospital, University Hospital Centre of Bordeaux, F33604 Pessac, France; INSERM, Biology of Cardiovascular Diseases, U1034, University of Bordeaux, F33604 Pessac, France
| | - Christophe Deligny
- Department of Internal Medicine, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Etienne Rivière
- Department of internal Medicine and Infectious Diseases Department, Haut Leveque Hospital, University Hospital Centre of Bordeaux, F33604 Pessac, France; INSERM, Biology of Cardiovascular Diseases, U1034, University of Bordeaux, F33604 Pessac, France.
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Zhang W, Zheng Y, Wang Y, Xiong H, Que C, Zhang X, Zhu Y, Zhao Y, Yu M, Meng L, Lv H, Zhang W, Hao H, Xiao J, Yuan Y, Wang Z. Thigh MRI in antisynthetase syndrome, and comparisons with dermatomyositis and immune-mediated necrotizing myopathy. Rheumatology (Oxford) 2022; 62:310-320. [PMID: 35512205 DOI: 10.1093/rheumatology/keac269] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate MRI changes to define muscle-lesion specific patterns in patients with antisynthetase syndrome (ASS), and compare them with those in other common idiopathic inflammatory myopathy subtypes. METHODS Qualitative and semi-quantitative thigh MRI evaluations were conducted in patients with ASS, DM and immune-mediated necrotizing myopathy (IMNM). RESULTS This study included 51 patients with ASS, 56 with DM and 61 with IMNM. Thigh MRI revealed muscle oedema (62.7%), myofascial oedema (90.2%), subcutaneous-tissue oedema (60.8%) and fatty infiltration of muscles (68.6%) in patients with ASS. Compared with IMNM, ASS and DM were associated with more frequent adductor-muscle relative sparing (40.6% vs 3.6%, P<0.001, and 25.6% vs 3.6%, P<0.001) and subcutaneous-tissue oedema (60.8% vs 23.0%, P<0.001, and 57.1% vs 23.0%, P<0.001). Although ASS and DM exhibited similar oedema patterns, there were certain subtle differences between them. The ASS group was less frequently symmetric (60.6% vs 88.4%, P=0.005, and 60.6% vs 80.0%, P=0.048), but more frequently showed myofascial oedema of the tensor fasciae latae (80.4% vs 48.2%, P<0.001, and 80.4% vs 31.1%, P<0.001) than either the DM or IMNM groups. The receiver operating characteristic curve analysis showed an optimal combination of thigh MRI findings had an area under the curve with 0.893 for diagnosing ASS. CONCLUSION Thigh MRI in ASS exhibited frequent myofascial oedema. ASS oedema patterns resembled those of DM more than those of IMNM. Bilateral asymmetry, adductor-muscle relative sparing and remarkable myofascial oedema of tensor fasciae latae were the most characteristic ASS imaging findings.
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Affiliation(s)
- Wenhao Zhang
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Yiming Zheng
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Yikang Wang
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | | | | | | | - Ying Zhu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yawen Zhao
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Meng Yu
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Lingchao Meng
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - He Lv
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Hongjun Hao
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Jiangxi Xiao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
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11
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Wells M, Alawi S, Thin KYM, Gunawardena H, Brown AR, Edey A, Pauling JD, Barratt SL, Adamali HI. A multidisciplinary approach to the diagnosis of antisynthetase syndrome. Front Med (Lausanne) 2022; 9:959653. [PMID: 36186825 PMCID: PMC9515890 DOI: 10.3389/fmed.2022.959653] [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: 06/01/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Antisynthetase syndrome is a subtype of idiopathic inflammatory myopathy, strongly associated with the presence of interstitial lung disease. Diagnosis is made by identifying myositis-specific antibodies directed against aminoacyl tRNA synthetase, and relevant clinical and radiologic features. Given the multisystem nature of the disease, diagnosis requires the careful synthesis of subtle clinical and radiological features with the interpretation of specialized autoimmune serological testing. This is provided in a multidisciplinary environment with input from rheumatologists, respiratory physicians, and radiologists. Differentiation from other idiopathic interstitial lung diseases is key; treatment and prognosis differ between patients with antisynthetase syndrome and idiopathic interstitial lung disease. In this review article, we look at the role of the multidisciplinary team and its individual members in the initial diagnosis of the antisynthetase syndrome, including the role of physicians, radiologists, and the wider team.
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Affiliation(s)
- Matthew Wells
- Department of Rheumatology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Sughra Alawi
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, United Kingdom
| | - Kyaing Yi Mon Thin
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, United Kingdom
| | - Harsha Gunawardena
- Department of Rheumatology, North Bristol NHS Trust, Bristol, United Kingdom
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, United Kingdom
| | - Adrian R Brown
- Immunology Laboratory, North Bristol NHS Trust, Bristol, United Kingdom
| | - Anthony Edey
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, United Kingdom
| | - John D Pauling
- Department of Rheumatology, North Bristol NHS Trust, Bristol, United Kingdom
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, United Kingdom
| | - Shaney L Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, United Kingdom
| | - Huzaifa I Adamali
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, United Kingdom
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12
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O'Donnell LF, Cortese A, Rossor AM, Laura M, Blake J, Skorupinska M, Lunn MP, Thornton JS, Currò R, Morrow JM, Reilly MM. Exploratory analysis of lower limb muscle MRI in a case series of patients with SORD neuropathy. J Neurol Neurosurg Psychiatry 2022; 94:jnnp-2022-329432. [PMID: 35868853 DOI: 10.1136/jnnp-2022-329432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/27/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Luke Francis O'Donnell
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Andrea Cortese
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia PV, Italy
| | - Alexander M Rossor
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Matilde Laura
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Julian Blake
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Department of Clinical Neurophysiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Mariola Skorupinska
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Michael P Lunn
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - John S Thornton
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Riccardo Currò
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia PV, Italy
| | - Jasper M Morrow
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Mary M Reilly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
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13
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Albayda J, Demonceau G, Carlier PG. Muscle imaging in myositis: MRI, US, and PET. Best Pract Res Clin Rheumatol 2022; 36:101765. [PMID: 35760742 DOI: 10.1016/j.berh.2022.101765] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Imaging is an important tool in the evaluation of idiopathic inflammatory myopathies. It plays a role in diagnosis, assessment of disease activity and follow-up, and as a non-invasive biomarker. Among the different modalities, nuclear magnetic resonance imaging (MRI), ultrasound (US), and positron emission tomography (PET) may have the most clinical utility in myositis. MRI is currently the best modality to evaluate skeletal muscle and provides excellent characterization of muscle edema and fat replacement through the use of T1-weighted and T2-weighted fat suppressed/STIR sequences. Although MRI can be read qualitatively for the presence of abnormalities, a more quantitative approach using Dixon sequences and the generation of water T2 parametric maps would be preferable for follow-up. Newer protocols such as diffusion-weighted imaging, functional imaging measures, and spectroscopy may be of interest to provide further insights into myositis. Despite the advantages of MRI, image acquisition is relatively time-consuming, expensive, and not accessible to all patients. The use of US to evaluate skeletal muscle in myositis is gaining interest, especially in chronic disease, where fat replacement and fibrosis are detected readily by this modality. Although easily deployed at the bedside, it is heavily dependent on operator experience to recognize disease states. Further, systematic characterization of muscle edema by US is still needed. PET provides valuable information on muscle function at a cellular level. Fluorodeoxyglucose (FDG-PET) has been the most common application in myositis to detect pathologic uptake indicative of inflammation. The use of neurodegenerative markers is now also being utilized for inclusion body myositis. These different modalities may prove to be complementary methods for myositis evaluation.
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Affiliation(s)
- Jemima Albayda
- Division of Rheumatology, Johns Hopkins University, Baltimore, USA.
| | | | - Pierre G Carlier
- Université Paris-Saclay, CEA, DRF, Service Hospitalier Frederic Joliot, Orsay, France
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14
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Walter AW, Lim J, Raaphorst J, Smithuis FF, den Harder JM, Eftimov F, Potters W, Saris CGJ, de Visser M, van Schaik IN, de Haan RJ, van der Kooi AJ, Verhamme C. Ultrasound and MR muscle imaging in new onset idiopathic inflammatory myopathies at diagnosis and after treatment: a comparative pilot study. Rheumatology (Oxford) 2022; 62:300-309. [PMID: 35536176 PMCID: PMC9788821 DOI: 10.1093/rheumatology/keac263] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/25/2022] [Accepted: 04/24/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To prospectively compare ultrasound (US) and whole-body MRI for detection of muscle abnormalities compatible with idiopathic inflammatory myopathies (IIM). METHODS Newly diagnosed IIM patients underwent US (14 muscles) and MRI (36 muscles) at diagnosis and after nine weeks monotherapy with intravenous immunoglobulin. Muscles were compatible with IIM when quantitative US echo-intensity (EI) z scores was ≥1.5, semi-quantitative US Heckmatt score was ≥2, qualitative US was abnormal, or when MRI showed oedema on T2-weighted images. At patient level, findings were classified as abnormal when quantitative US EI z scores was >1.5 (n = 3 muscles), >2.5 (n = 2 muscles) or >3.5 (n = 1 muscle), or if ≥3 muscles showed abnormalities as described above for the other diagnostic methods. RESULTS At diagnosis, in 18 patients US of 252 muscles revealed abnormalities in 36 muscles (14%) with quantitative, in 153 (61%) with semi-quantitative and in 168 (67%) with qualitative analysis. MRI showed oedema in 476 out of 623 muscles (76%). Five patients (28%) reached abnormal classification with quantitative US, 16 (89%) with semi-quantitative and qualitative US, and all patients (100%) with MRI. Nine-week follow-up of 12 patients showed no change over time with quantitative US or MRI, and a decrease in abnormalities with semi-quantitative US (P <0.01), and qualitative US (P <0.01). CONCLUSION At diagnosis, MRI was more sensitive than US to detect muscle abnormalities compatible with IIM. Semi-quantitative US and qualitative US detected abnormalities in the majority of the patients while evaluating fewer muscles than MRI and showed change over time after nine weeks of treatment.
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Affiliation(s)
- Anne W Walter
- Correspondence to: Anne Walter, Department of Neurology, Amsterdam UMC, University of Amsterdam, PO Box 22700 DE Amsterdam, The Netherlands. E-mail:
| | | | - Joost Raaphorst
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Neuroscience
| | - Frank F Smithuis
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam Movement Sciences, Amsterdam
| | - J Michiel den Harder
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam Movement Sciences, Amsterdam
| | - Filip Eftimov
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Neuroscience
| | - Wouter Potters
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Neuroscience
| | - Christiaan G J Saris
- Department of Neurology, Radboud UMC, Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Neuroscience
| | - Ivo N van Schaik
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Neuroscience,Board, Spaarne Gasthuis, Haarlem
| | - Rob J de Haan
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Neuroscience
| | - Camiel Verhamme
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Neuroscience
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15
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Wu MJ, Liao WA, Lin PY, Sun YT. Muscle Biopsy: A Requirement for Precision Medicine in Adult-Onset Myopathy. J Clin Med 2022; 11:jcm11061580. [PMID: 35329906 PMCID: PMC8951002 DOI: 10.3390/jcm11061580] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Muscle biopsy is a fundamental procedure to assist the final diagnosis of myopathy. With the recent advances in molecular diagnosis, serology tests, and mechanism-based classification in myopathy, the précised diagnosis for myopathy required the applications of multiple tools. This study intends to reappraise the benefit of muscle biopsy in adult-onset myopathy under the setting of an optimized muscle biopsy protocol and comprehensive serology tests. A one-group pretest-posttest study design was used. The pre- and post-biopsy diagnoses and treatments in 69 adult patients were compared. Muscle biopsy yielded 85.5% of definitive diagnoses, including changes in pre-biopsy diagnoses (40.6%) and narrowing down the suspicious myopathies (49.3%). The demographic data and clinical parameters between the group “with change” and “without change” after biopsy were not different. Among those with changes in diagnosis, 39.3% also had a corresponding shift in treatment, which benefits the patients significantly. Regarding the most common adult-onset myopathy, idiopathic inflammatory myopathy (IIM), 41% of patients with pre-biopsy diagnosis as IIM had changes in their IIM subtype diagnosis, and 53% was finally not IIM after muscle biopsy. Although there have been advances in molecular diagnosis recently, muscle biopsy still undoubtedly critically guided the diagnosis and treatment of adult-onset myopathy in the era of precision medicine.
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Affiliation(s)
- Meng-Ju Wu
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (M.-J.W.); (P.-Y.L.)
| | - Wei-An Liao
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Po-Yu Lin
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (M.-J.W.); (P.-Y.L.)
| | - Yuan-Ting Sun
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (M.-J.W.); (P.-Y.L.)
- Department of Medical Genomics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Correspondence:
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16
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Zanframundo G, Faghihi-Kashani S, Scirè CA, Bonella F, Corte TJ, Doyle TJ, Fiorentino D, Gonzalez-Gay MA, Hudson M, Kuwana M, Lundberg IE, Mammen A, McHugh N, Miller FW, Monteccucco C, Oddis CV, Rojas-Serrano J, Schmidt J, Selva-O'Callaghan A, Werth VP, Sakellariou G, Aggarwal R, Cavagna L. Defining anti-synthetase syndrome: a systematic literature review. Clin Exp Rheumatol 2022; 40:309-319. [PMID: 35225224 PMCID: PMC10411341 DOI: 10.55563/clinexprheumatol/8xj0b9] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Anti-synthetase syndrome (ASSD) is a heterogeneous autoimmune disease characterised by multi-system involvement with a wide variety of manifestations. Validated classification criteria are necessary to improve recognition and prevent misclassification, especially given the lack of reliable and standardised autoantibody testing. We systematically reviewed the literature to analyse proposed ASSD criteria, characteristics, and diagnostic performance. METHODS We searched PubMed and Embase databases (01/01/1984 to 06/11/2018) and the ACR and EULAR meeting abstracts (2017-2018). Sensitivities, specificities, positive, negative likelihood ratios and risk of bias were calculated for ASSD criteria and key variables reported in the literature. We performed meta-analysis when appropriate. RESULTS We retrieved 4,358 studies. We found 85 proposed ASSD criteria from a total of 82 studies. All but one study included anti-synthetase autoantibody (ARS) positivity in the ASSD criteria. Most studies required only one ASSD feature plus anti-ARS to define ASSD (n=64, 78%), whereas 16 studies required more than one ASSD variable plus anti-ARS. The only criteria not including anti-ARS positivity required 5 ASSD clinical features. We found limited data and wide variability in the diagnostic performance of each variable and definition proposed in the literature. Given these limitations we only meta-analysed the performance of individual muscle biopsy and clinical variables in diagnosing ASSD, which performed poorly. CONCLUSIONS The current ASSD criteria include a variety of serological, clinical, and histological features with wide variability amongst proposed definitions and the performance of these definitions has not been tested. This systematic literature review suggests the need for additional data and consensus-driven classification criteria for ASSD.
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Affiliation(s)
- Giovanni Zanframundo
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Sara Faghihi-Kashani
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Germany
| | | | | | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Miguel A Gonzalez-Gay
- Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Andrew Mammen
- National Institute of Arthritis and Musculoskeletal and Skin Disorders, National Institutes of Health, Bethesda, MD, and Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | | | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jorge Rojas-Serrano
- Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, México
| | - Jens Schmidt
- Department of Neurology, University Medical Center Göttingen; Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin; and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | | | - Victoria P Werth
- University of Pennsylvania, Perelman School of Medicine and Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | | | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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17
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Lizarazo D, Cifuentes K, Forero PA, Páez H. Anti-Synthetase Syndrome Complicated by Pyogenic Myositis. Curr Med Imaging 2021; 18:776-779. [PMID: 34951371 DOI: 10.2174/1573405618666211222161022] [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: 05/27/2021] [Revised: 09/27/2021] [Accepted: 10/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anti-synthetase syndrome is a rare autoimmune disorder characterized by autoantibodies against aminoacyl-tRNA-synthetases. Inflammatory myopathy and interstitial lung disease could be present among other manifestations. Anti-Jo-1 is the most common antisynthetase antibody and is the most likely to present with the classic triad (interstitial lung disease, myositis, and arthritis) and have more muscle and joint involvement than patients with other antisynthetase antibodies. CASE REPORT Here, we present a case of a 60-year-old female patient, with a previous diagnosis of myositis, secondary to the anti-synthetase syndrome, with a complication by pyogenic myositis. CONCLUSION Diagnosis is made by a multidisciplinary approach, occasionally muscle and/or lung biopsy are needed. Imaging studies, Especially magnetic resonance imaging, based on findings such as muscle and fascial edema, and fatty tissue replacement, allow an optimal approach.
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Affiliation(s)
- David Lizarazo
- 116 street # 9-02 ZIP: 110111 Fundación Santa Fe de Bogotá . Colombia
| | - Karen Cifuentes
- 116 street # 9-02 ZIP: 110111. Fundación Santa Fe de Bogotá . Colombia
| | | | - Hernan Páez
- 116 street # 9-02 ZIP: 110111 Fundación Santa Fe de Bogotá. Colombia
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18
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Malartre S, Bachasson D, Mercy G, Sarkis E, Anquetil C, Benveniste O, Allenbach Y. MRI and muscle imaging for idiopathic inflammatory myopathies. Brain Pathol 2021; 31:e12954. [PMID: 34043260 PMCID: PMC8412099 DOI: 10.1111/bpa.12954] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 12/22/2022] Open
Abstract
Although idiopathic inflammatory myopathies (IIM) are a heterogeneous group of diseases nearly all patients display muscle inflammation. Originally, muscle biopsy was considered as the gold standard for IIM diagnosis. The development of muscle imaging led to revisiting not only the IIM diagnosis strategy but also the patients' follow-up. Different techniques have been tested or are in development for IIM including positron emission tomography, ultrasound imaging, ultrasound shear wave elastography, though magnetic resonance imaging (MRI) remains the most widely used technique in routine. Whereas guidelines on muscle imaging in myositis are lacking here we reviewed the relevance of muscle imaging for both diagnosis and myositis patients' follow-up. We propose recommendations about when and how to perform MRI on myositis patients, and we describe new techniques that are under development.
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Affiliation(s)
- Samuel Malartre
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Damien Bachasson
- Neuromuscular Physiology Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Guillaume Mercy
- Department of Medical Imaging, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles-Foix, Sorbonne Université, Paris, France
| | - Elissone Sarkis
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Céline Anquetil
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
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19
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Texture analysis of muscle MRI: machine learning-based classifications in idiopathic inflammatory myopathies. Sci Rep 2021; 11:9821. [PMID: 33972636 PMCID: PMC8110584 DOI: 10.1038/s41598-021-89311-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/15/2021] [Indexed: 12/15/2022] Open
Abstract
To develop a machine learning (ML) model that predicts disease groups or autoantibodies in patients with idiopathic inflammatory myopathies (IIMs) using muscle MRI radiomics features. Twenty-two patients with dermatomyositis (DM), 14 with amyopathic dermatomyositis (ADM), 19 with polymyositis (PM) and 19 with non-IIM were enrolled. Using 2D manual segmentation, 93 original features as well as 93 local binary pattern (LBP) features were extracted from MRI (short-tau inversion recovery [STIR] imaging) of proximal limb muscles. To construct and compare ML models that predict disease groups using each set of features, dimensional reductions were performed using a reproducibility analysis by inter-reader and intra-reader correlation coefficients, collinearity analysis, and the sequential feature selection (SFS) algorithm. Models were created using the linear discriminant analysis (LDA), quadratic discriminant analysis (QDA), support vector machine (SVM), k-nearest neighbors (k-NN), random forest (RF) and multi-layer perceptron (MLP) classifiers, and validated using tenfold cross-validation repeated 100 times. We also investigated whether it was possible to construct models predicting autoantibody status. Our ML-based MRI radiomics models showed the potential to distinguish between PM, DM, and ADM. Models using LBP features provided better results, with macro-average AUC values of 0.767 and 0.714, accuracy of 61.2 and 61.4%, and macro-average recall of 61.9 and 59.8%, in the LDA and k-NN classifiers, respectively. In contrast, the accuracies of radiomics models distinguishing between non-IIM and IIM disease groups were low. A subgroup analysis showed that classification models for anti-Jo-1 and anti-ARS antibodies provided AUC values of 0.646–0.853 and 0.692–0.792, with accuracy of 71.5–81.0 and 65.8–78.3%, respectively. ML-based TA of muscle MRI may be used to predict disease groups or the autoantibody status in patients with IIM and is useful in non-invasive assessments of disease mechanisms.
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Yamazaki K, Ohta A, Akioka S, Yamasaki Y, Ohara A, Nakaseko H, Nishimura K, Kobayashi N, Nishida Y, Sato S, Takezaki S, Kishi T, Hashimoto M, Kobayashi I, Mori M. External validation of the EULAR/ACR idiopathic inflammatory myopathies classification criteria with a Japanese paediatric cohort. Rheumatology (Oxford) 2021; 60:802-808. [PMID: 32810274 DOI: 10.1093/rheumatology/keaa274] [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: 12/26/2019] [Revised: 03/03/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the performance of the EULAR/ACR idiopathic inflammatory myopathies (IIMs) classification criteria to classify juvenile IIMs (JIIMs) in an Asian paediatric population. METHODS Sixty-eight JIIM patients and 49 non-JIIM patients diagnosed at seven major paediatric rheumatology centres in Japan between 2008 and 2015 were enrolled. Retrospective data were collected, and each patient's data form was submitted. The expert group reviewed the forms and re-examined the diagnoses. The EULAR/ACR criteria were then applied and the probability of having JIIM was determined for each case. The sensitivity and specificity of the EULAR/ACR criteria were compared with those of other existing criteria. RESULTS The sensitivity/specificity of the EULAR/ACR classification criteria were 92.1/100% with muscle biopsy data (n = 38); 86.7/100% without muscle biopsy data (n = 30) and 89.7/100% in our total cohort (n = 68). The sensitivity of Bohan and Peter's criteria and Tanimoto's criteria were 80.9 and 64.7% in our total cohort, respectively. Among 68 physician-diagnosed JIIM patients, seven cases (three JDM and four overlap myositis) were not classified as JIIM because the probability did not reach the cut-off point (55%). The three JDM patients all presented with only one of the three skin manifestations that are listed in the criteria: Gottron's sign. CONCLUSION Our validation study with Japanese JIIM cases indicates that the EULAR/ACR classification criteria for IIM generally perform better than existing diagnostic criteria for myositis.
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Affiliation(s)
- Kazuko Yamazaki
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Akiko Ohta
- Division of Public Health, Department of Social Medicine, Faculty of Medicine, Saitama Medical University, Moroyama, Japan
| | - Shinji Akioka
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuichi Yamasaki
- Department of Pediatrics, Kagoshima University Hospitals, Kagoshima, Japan
| | - Asami Ohara
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Haruna Nakaseko
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Kenichi Nishimura
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | - Yutaka Nishida
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Satoshi Sato
- Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Shunichiro Takezaki
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Kishi
- Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University, Kyoto, Japan
| | - Ichiro Kobayashi
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Tokyo Medical and Dental University, Tokyo, Japan
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Khan AM, Ahmad F, Rehman U, Jindal H, Harimohan H. A Clinical Case of Polymyositis Complicated by Antisynthetase Syndrome. Cureus 2021; 13:e12737. [PMID: 33614339 PMCID: PMC7883527 DOI: 10.7759/cureus.12737] [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] [Accepted: 01/16/2021] [Indexed: 11/26/2022] Open
Abstract
Antisynthetase syndrome is an autoimmune condition that manifests clinically through signs and symptoms, such as interstitial lung disease, myositis, Raynaud's phenomenon, fever, hyperkeratotic fingertips (mechanic's hands), and arthritis. It is associated with antibodies against aminoacyl tRNA synthetase enzyme, the most common autoantibody being the anti-Jo-1. An 18-year-old girl presented with weakness of both the upper and lower limb, swelling and generalized body pain, difficulty in swallowing. MRI of the thigh was highly suggestive of myositis with symmetrical bilateral involvement. Based on proximal muscle weakness, elevated creatine phosphokinase (CPK), and lactate dehydrogenase (LDH), strongly positive anti-nuclear antibodies human epithelial cell type-2 (ANA-HEp2), and a normal nerve conduction velocity test with precise MRI findings, a diagnosis of polymyositis was made. She was given bolus intravenous methylprednisolone for five days, followed by oral methylprednisolone with subcutaneous methotrexate weekly. She reported a 50% improvement in muscle weakness; however, partial bulbar weakness persisted at the time of discharge. On her next follow-up, her blood investigations for auto-antibodies were done. The autoantibodies anti-Jo-1 (3+), Ro-52 (2+), and Mi-2β (2+) were found to be positive. These investigations, coupled with the clinical features she was presenting, finally led us to conclude that it was a case of polymyositis complicated by the antisynthetase syndrome.
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Affiliation(s)
- Aadil M Khan
- Internal Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Faim Ahmad
- Internal Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | | | - Himanshu Jindal
- General Medicine, Ganesh Shankar Vidyarthi Memorial Medical College and Lala Lajpat Rai Hospital, Kanpur, IND
| | - Hridya Harimohan
- Internal Medicine, Kerala Institute of Medical Sciences, Trivandrum, IND
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Opinc AH, Makowska JS. Antisynthetase syndrome - much more than just a myopathy. Semin Arthritis Rheum 2020; 51:72-83. [PMID: 33360231 DOI: 10.1016/j.semarthrit.2020.09.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 01/06/2023]
Abstract
The aim of the study was to summarize current knowledge on antisynthetase syndrome (ASS), including its epidemiology, pathogenesis, proposed so far diagnostic criteria, heterogeneity of clinical manifestations, prognostic factors and therapeutic possibilities. PubMed database was screened for "antisynthetase syndrome" OR "antisynthetase antibodies" between February and April 2020. Aminoacyl-tRNA synthetases participate in the immune system activation as antigens, but also serve chemoattractive and cytokine-resembling roles, initiating innate and adaptive pathways. Exposure to various inhaled antigens may induce the autoimmune cascade leading to ASS. NK cells with its impaired INF-y production as well as formation of NETs by neutrophils contribute to pathogenesis. The prevalence of symptoms vary significantly depending on the study with muscular, articular and pulmonary involvement being the most frequently observed. Although classified as subtype of idiopathic inflammatory myopathies, myositis may not necessarily be the prominent manifestation. Since clinical presentation is heterogeneous and symptoms can emerge gradually, ASS could be considered as a heterogeneous spectrum rather than a homogenous disease entity. The currently available classification criteria do not fully correspond with the clinical patterns of the disease. Therapy is based on glucocorticosteroids and other immunosuppressive agents. Randomized controlled trials, dedicated for patients with ASS, are needed to form treatment algorithms.
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Affiliation(s)
| | - Joanna Samanta Makowska
- Department of Rheumatology, Medical University of Lodz, ul. Pieniny 30, 92-115 Łódź, Poland.
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23
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Karino K, Kono M, Kono M, Sakamoto K, Fujieda Y, Kato M, Amengual O, Oku K, Yasuda S, Atsumi T. Myofascia-dominant involvement on whole-body MRI as a risk factor for rapidly progressive interstitial lung disease in dermatomyositis. Rheumatology (Oxford) 2020; 59:1734-1742. [PMID: 31925431 DOI: 10.1093/rheumatology/kez642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/26/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Rapidly progressive interstitial lung disease (RPILD) is a major cause of death in patients with DM. Although clinically amyopathic DM (CADM) represents risk for RPILD, the incidence rate of RPILD in patients with CADM varies widely. Whole-body (WB) MRI can reveal involvement of systemic muscle and myofascia. The objective of this study was to explore the risk factors for RPILD in patients with DM using WB-MRI. METHODS This retrospective study comprised 41 patients with DM who underwent WB-MRI before the initiation of treatment in our hospital. Muscular and myofascial signals were scored on 42 muscular groups. The myofascia/muscle ratio was calculated and used to define the relevance of myofascia-dominant involvement. RPILD was defined as worsening of dyspnoea, hypoxaemia and radiographic ILD/fibrosis within 3 months from the onset of respiratory symptoms. RESULTS Among the 41 patients, 17 had CADM and 30 had ILD, including 10 patients with RPILD. All patients including those with CADM showed abnormal signal intensity in both muscle and myofascia (median score: 15 and 23, respectively). Muscle signal scores positively correlated with the serum creatine kinase level (r = 0.714; P< 0.001). Patients with RPILD showed a significantly higher myofascia/muscle ratio than those without RPILD (1.929 vs 1.200; P= 0.027). Logistic regression analysis identified higher myofascia/muscle ratio as independent risk factors for developing RPILD. CONCLUSION Myofascia-dominant involvement was defined and appreciated in patients with DM using WB-MRI. This may be one of the risk factors for RPILD.
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Affiliation(s)
- Kohei Karino
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Michihiro Kono
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Michihito Kono
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keita Sakamoto
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuichiro Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Olga Amengual
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenji Oku
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Kubínová K, Mann H, Vrána J, Vencovský J. How Imaging Can Assist with Diagnosis and Monitoring of Disease in Myositis. Curr Rheumatol Rep 2020; 22:62. [DOI: 10.1007/s11926-020-00939-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Park EH, Yoon CH, Kang EH, Baek HJ. Utility of Magnetic Resonance Imaging and Positron Emission Tomography in Rheumatic Diseases. JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.3.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Eun Hye Park
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Chong-Hyeon Yoon
- Division of Rheumatology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gachon University College of Medicine Gil Medical Center, Incheon, Korea
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Botman E, Teunissen BP, Raijmakers P, de Graaf P, Yaqub M, Treurniet S, Schoenmaker T, Bravenboer N, Micha D, Pals G, Bökenkamp A, Netelenbos JC, Lammertsma AA, Eekhoff EM. Diagnostic Value of Magnetic Resonance Imaging in Fibrodysplasia Ossificans Progressiva. JBMR Plus 2020; 4:e10363. [PMID: 32537549 PMCID: PMC7285757 DOI: 10.1002/jbm4.10363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 01/28/2023] Open
Abstract
Using [18F] Sodium Fuoride (NaF) Positron Emission Tomography (PET) it is not only possible to identify the ossifying potency of a flare-up, but also to identify an asymptomatic chronic stage of fibrodysplasia ossificans progressiva (FOP). The purpose of this study was to investigate the diagnostic role of a more widely available imaging modality, Magnetic Resonance Imaging (MRI), which is of special interest for studies in pediatric FOP patients. MRI and [18F]NaF PET/CT images at time of inclusion and subsequent follow-up CT scans of 4 patients were analyzed retrospectively. Presence, location, and intensity of edema identified by MRI were compared with activity on [18F]NaF PET. Occurrence or progression of heterotopic ossification (HO) was examined on the follow-up CT images. Thirteen different lesions in various muscle groups were identified: five lesions with only edema, five lesions with both edema and increased [18F]NaF uptake, one lesion with only increased [18F]NaF uptake, and two lesions with neither edema nor uptake of [18F]NaF. Mild edema, found in three lesions, was present at asymptomatic sites, which did not show increased [18F] NaF uptake or progression of HO on consecutive CT images. Moderate edema was found in three symptomatic lesions, with increased [18F]NaF on PET and progression of HO on CT. Severe edema was identified in four lesions. Interestingly, two of these lesions did not develop HO during follow-up; one of these two even gave obvious symptoms of a flare-up. MRI can identify whether symptoms are the result of an acute flare-up by the presence of moderate to severe edema. The occurrence of severe edema on MRI was not always related to an ossifying lesion. The additional diagnostic value of MRI requires further investigation, but MRI does not seem to fully replace the diagnostic characteristics of [18F]NaF PET/CT in FOP. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Esmée Botman
- Department of Internal Medicine section Endocrinology, Amsterdam Bone Center Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Amsterdam The Netherlands
| | - Bernd P Teunissen
- Department of Radiology & Nuclear Medicine Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Pieter Raijmakers
- Department of Radiology & Nuclear Medicine Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Pim de Graaf
- Department of Radiology & Nuclear Medicine Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Sanne Treurniet
- Department of Internal Medicine section Endocrinology, Amsterdam Bone Center Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Amsterdam The Netherlands
| | - Ton Schoenmaker
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam The Netherlands
| | - Nathalie Bravenboer
- Department of Clinical Chemistry, Amsterdam Bone Center, Amsterdam Movement Sciences Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Dimitra Micha
- Department of Clinical Genetics, Amsterdam Bone Center Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Gerard Pals
- Department of Clinical Genetics, Amsterdam Bone Center Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Arend Bökenkamp
- Department of Paediatric Nephrology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - J Coen Netelenbos
- Department of Radiology & Nuclear Medicine Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Elisabeth Mw Eekhoff
- Department of Internal Medicine section Endocrinology, Amsterdam Bone Center Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Amsterdam The Netherlands
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Recent developments in classification criteria and diagnosis guidelines for idiopathic inflammatory myopathies. Curr Opin Rheumatol 2019; 30:606-613. [PMID: 30138132 PMCID: PMC6170146 DOI: 10.1097/bor.0000000000000549] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose of review The aim of this review was to summarize key developments in classification and diagnosis of the idiopathic inflammatory myopathies (IIMs). Recent findings The recently published European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for the IIMs provide a comprehensive, accurate and data-driven approach to identification of IIM cases appropriate for inclusion in research studies. Further, recent studies have advanced understanding of clinical manifestations of the IIMs and delineated the role of imaging, particularly magnetic resonance. Summary The recent publication of the EULAR/ACR classification criteria will potentially greatly improve IIM research through more accurate case identification and standardization across studies. Future inclusion of newly recognized clinical associations with the MSAs may further improve the criteria's accuracy and utility. Clear and comprehensive understanding of associations between clinical manifestations, prognosis and multisystem involvement can aid diagnostic assessment; recent advances include delineation of such associations and expansion of the role of imaging.
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Selva-O'Callaghan A, Pinal-Fernandez I, Trallero-Araguás E, Milisenda JC, Grau-Junyent JM, Mammen AL. Classification and management of adult inflammatory myopathies. Lancet Neurol 2019; 17:816-828. [PMID: 30129477 DOI: 10.1016/s1474-4422(18)30254-0] [Citation(s) in RCA: 221] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/19/2018] [Accepted: 06/27/2018] [Indexed: 12/16/2022]
Abstract
Inflammatory myopathies, collectively known as myositis, are heterogeneous disorders characterised by muscle inflammation, and frequently accompanied by extramuscular manifestations that affect the skin, lung, and joints. Patients with inflammatory myopathies were previously classified as having dermatomyositis if characteristic rashes accompanied the muscle involvement, and as having polymyositis if no rashes were present. Five main types of inflammatory myopathies are now widely recognised: dermatomyositis, immune-mediated necrotising myopathy, sporadic inclusion-body myositis, overlap myositis (including antisynthetase syndrome), and polymyositis. The discovery of autoantibodies that are specifically associated with characteristic clinical phenotypes has been instrumental to the understanding of inflammatory myopathies. Treatment is still largely based on expert opinion, but several studies have shown effectiveness of different therapies in various subsets of inflammatory myopathies. These advances will undoubtedly improve the outcomes of patients with inflammatory myopathies.
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Affiliation(s)
- Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Vall d'Hebron General Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Iago Pinal-Fernandez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ernesto Trallero-Araguás
- Rheumatology Unit, Vall d'Hebron General Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José César Milisenda
- Internal Medicine Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Médica en Red Enfermedades Raras
| | - Josep Maria Grau-Junyent
- Internal Medicine Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Médica en Red Enfermedades Raras
| | - Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ukichi T, Yoshida K, Matsushima S, Kawakami G, Noda K, Furuya K, Kurosaka D. MRI of skeletal muscles in patients with idiopathic inflammatory myopathies: characteristic findings and diagnostic performance in dermatomyositis. RMD Open 2019; 5:e000850. [PMID: 30997152 PMCID: PMC6443133 DOI: 10.1136/rmdopen-2018-000850] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/15/2019] [Accepted: 03/05/2019] [Indexed: 01/03/2023] Open
Abstract
Objective To define the characteristic findings on MRI of skeletal muscles in patients with dermatomyositis (DM) relative to those in patients with other idiopathic inflammatory myopathies (IIMs) and to assess their diagnostic performance in DM. Methods Thirty-six patients with DM, 17 patients with amyopathic DM, 19 patients with polymyositis and 16 patients with non-IIM classified by the 2017 European League Against Rheumatism/American College of Rheumatology criteria were included in this study. The following MRI findings (short-tau inversion recovery [STIR] and gadolinium-enhanced fat-suppressed T1-weighted imaging [Gd-T1WI]) for proximal limb muscles were compared between the disease groups and between myositis-specific autoantibodies/myositis-associated autoantibodies (MSAs/MAAs)-positive and MSAs/MAAs-negative groups: structures with high signal intensity (HSI) (subcutaneous, fascia, muscle); distributions of HSI areas in muscle (diffuse, patchy, peripheral) and patterns of HSI in muscle (honeycomb, foggy, strong HSI). Univariate, multivariate and receiver-operating characteristic [ROC] analyses were performed to assess the diagnostic performance of MRI in DM. Results The characteristic MRI findings in patients with DM were subcutaneous HSI, fascial HSI, peripheral distribution and honeycomb pattern. The MRI findings in the MSAs/MAAs-positive group included more frequent fascial HSI but less frequent foggy pattern compared with the MSAs/MAAs-negative group. Likelihood of DM score ≥ 3 (obtained by counting the number of characteristic MRI findings in patients with DM) showed good diagnostic performance in DM (STIR: sensitivity 72.2%, specificity 88.5%, area under ROC curve [AUC] 84.9%; Gd-T1WI: sensitivity 81.2%, specificity 91.5%, AUC 89.9%). Conclusion The characteristic MRI findings of skeletal muscles can predict patients with DM as well as patients with MSAs/MAAs.
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Affiliation(s)
- Taro Ukichi
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ken Yoshida
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Matsushima
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Go Kawakami
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Noda
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Furuya
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Daitaro Kurosaka
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW The purpose of this review article is to highlight the current role of diagnostic imaging in the assessment of inflammatory myopathies. RECENT FINDINGS Recent research demonstrates that imaging plays an important role in evaluating patients with symptoms of an inflammatory myopathy. In general, MRI is the pivotal imaging modality for assessing inflammatory myopathies, revealing precise anatomic details because of changes in the signal intensity of the muscles. Whole-body MR imaging has become increasingly important over the last several years. US is also a valuable imaging modality for scanning muscles. Together with the clinical history, familiarity with the imaging features of inflammatory myopathies is essential for formulating an accurate diagnosis.
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Abstract
PURPOSE OF REVIEW To provide the most recent evidence on anti-Jo-1 syndrome. RECENT FINDINGS Several new evidences on anti-Jo-1 syndrome have recently emerged. It has been clearly established that, at disease onset, the classic clinical triad (arthritis, myositis and interstitial lung disease - ILD) is only rarely observed. Indeed, disease onset with an isolated arthritis is common. Patients presenting with an isolated manifestation are at high risk for the subsequent occurrence of initially lacking triad findings. Moreover, the ex-novo occurrence of accompanying features such as Raynaud's phenomenon, mechanic's hands and fever during follow-up is a strong risk factor for the occurrence of overt antisynthetase syndrome (ASSD) with further triad manifestations. Several contributions on ILD involvement and prognosis have been published, as well as the distinctive muscle MRI characteristics compared with healthy controls, and a novel definition of a rare skin manifestation (hiker's feet). SUMMARY Recent evidence has shed a light on the need for a better understanding of the clinical course, imaging modalities and prognosis of anti-Jo-1 syndrome, providing some relevant elements to allow early diagnosis of this often unrecognized disease.
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Rider LG, Aggarwal R, Machado PM, Hogrel JY, Reed AM, Christopher-Stine L, Ruperto N. Update on outcome assessment in myositis. Nat Rev Rheumatol 2018; 14:303-318. [PMID: 29651119 PMCID: PMC6702032 DOI: 10.1038/nrrheum.2018.33] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The adult and juvenile myositis syndromes, commonly referred to collectively as idiopathic inflammatory myopathies (IIMs), are systemic autoimmune diseases with the hallmarks of muscle weakness and inflammation. Validated, well-standardized measures to assess disease activity, known as core set measures, were developed by international networks of myositis researchers for use in clinical trials. Composite response criteria using weighted changes in the core set measures of disease activity were developed and validated for adult and juvenile patients with dermatomyositis and adult patients with polymyositis, with different thresholds for minimal, moderate and major improvement in adults and juveniles. Additional measures of muscle strength and function are being validated to improve content validity and sensitivity to change. A health-related quality of life measure, which incorporates patient input, is being developed for adult patients with IIM. Disease state criteria, including criteria for inactive disease and remission, are being used as secondary end points in clinical trials. MRI of muscle and immunological biomarkers are promising approaches to discriminate between disease activity and damage and might provide much-needed objective outcome measures. These advances in the assessment of outcomes for myositis treatment, along with collaborations between international networks, should facilitate further development of new therapies for patients with IIM.
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Affiliation(s)
- Lisa G. Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
| | - Rohit Aggarwal
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA
| | - Pedro M. Machado
- Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | | | - Ann M. Reed
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicolino Ruperto
- Istituto Giannina Gaslini, Clinica Pediatria e Reumatologia, PRINTO, Genoa, Italy
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Abstract
PURPOSE OF REVIEW Idiopathic inflammatory myopathy (IIM) classification criteria have been a subject of debate for many decades. Despite several limitations, the Bohan and Peter criteria are still widely used. The aim of this review is to discuss the evolution of IIM classification criteria. RECENT FINDINGS New IIM classification criteria are periodically proposed. The discovery of myositis-specific and myositis-associated autoantibodies led to the development of clinico-serological criteria, while in-depth description of IIM morphological features improved histopathology-based criteria. The long-awaited European League Against Rheumatism and American College of Rheumatology (EULAR/ACR) IIM classification criteria were recently published. The Bohan and Peter criteria are outdated and validated classification criteria are necessary to improve research in IIM. The new EULAR/ACR IIM classification criteria are thus a definite improvement and an important step forward in the field.
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Affiliation(s)
- Valérie Leclair
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Rheumatology Unit, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Ingrid E Lundberg
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Rheumatology Unit, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
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MRI scoring methods used in evaluation of muscle involvement in patients with idiopathic inflammatory myopathies. Curr Opin Rheumatol 2017; 29:623-631. [DOI: 10.1097/bor.0000000000000435] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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