Ding Y, Ge Y. Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis complicated with macrophage activation syndrome.
Ther Adv Chronic Dis 2022;
13:20406223221098128. [PMID:
35586303 PMCID:
PMC9109495 DOI:
10.1177/20406223221098128]
[Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/13/2022] [Indexed: 12/31/2022] Open
Abstract
Background:
Anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody-positive
dermatomyositis (DM) has low survival rate, whereas macrophage activation
syndrome (MAS) is a severe and life-threatening syndrome associated with
autoimmune diseases. Their coexistence is very rare. This study aimed to
describe the prevalence, clinical characteristics, and outcomes of anti-MDA5
antibodies-positive DM patients complicated with MAS.
Methods:
In this retrospective study, we enrolled DM patients with anti-MDA5
antibodies, who were hospitalized between 2016 and 2020 and included
patients diagnosed with MAS.
Results:
We identified four (2%) DM patients with anti-MDA5 antibodies. They were
females with interstitial lung disease (ILD). The level of aspartate
aminotransferase (AST), lactate dehydrogenase (LDH), and ferritin were
significantly higher in the MAS group than those without MAS
(p < 0.05). Patients with MAS were significantly
more likely to develop a dysphagia (p = 0.012). Literature
review revealed eight similar cases. Together with the present study, we
identified 12 patients complicated with ILD. The median age of disease onset
was 52 years with a male to female ratio of 1:6. The median duration between
DM onset and MAS diagnosis was 3 months. The mortality of MAS in anti-MDA5
antibody-positive DM was 50%. Patients who died were older than those who
survived (56.7 years versus 35.5 years;
p = 0.015).
Conclusions:
MAS was rare in anti-MDA5 antibody-positive DM. The higher the level of AST,
LDH, and ferritin, the greater the risk of MAS. They were associated with
high mortality rates, particularly in older patients.
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