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Driskill E, Zhang Z, Chi J, Cui Q. Increased Rate of Complications Following Total Knee Arthroplasty in Patients Who Have Polymyositis. J Arthroplasty 2024; 39:1731-1735. [PMID: 38211729 DOI: 10.1016/j.arth.2024.01.006] [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: 08/28/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Polymyositis (PM) is a systemic connective tissue disorder that can lead to early onset degenerative joint disease and a need for total knee arthroplasty (TKA). Outcomes of TKA in patients who have PM are not well documented in the literature. The purpose of this study was to evaluate PM as a risk factor for complications after TKA. METHODS Using a national private payer insurance database from 2010 to 2022, PM patients undergoing primary TKA were compared to 10:1 matched controls based on age, sex, and comorbidities. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. 90-day emergency department visits and inpatient readmissions were also documented. A total of 25,039 patients undergoing primary TKA were queried, of which 2,290 had PM. RESULTS Compared to the matched controls, patients who had PM demonstrated higher rates of medical and surgical complications, including pulmonary embolism (1.0% versus 0.5%, P = .001), cerebrovascular accident (1.3% versus 0.7%, P = .002), wound complications (3.4% versus 2.1%, P < .001), and periprosthetic joint infection at 1 year (1.7% versus 1.3%, P = .042) and 2 years (2.6% versus 1.9%, P = .006). Patients who had PM displayed elevated 90-day emergency department (14.9% versus 13.3%, P = .032) and hospital readmission rate (7.1% versus 4.8%, P < .001). CONCLUSIONS Patients who have PM are at higher risks of postoperative medical and surgical complications, including pulmonary embolism, cerebrovascular accident, wound complication, and periprosthetic joint infection. Given these results, it is helpful for orthopedic surgeons and patients to consider these risks when considering TKA for patients who have PM.
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Affiliation(s)
- Elizabeth Driskill
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia; Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
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Nishikawa T, Fujita T, Morishima T, Okawa S, Hino T, Yasui T, Shioyama W, Oka T, Miyashiro I, Fujita M. Prognostic Effect of Incidental Pulmonary Embolism on Long-Term Mortality in Cancer Patients. Circ J 2024; 88:198-204. [PMID: 33597323 DOI: 10.1253/circj.cj-20-1160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of incidental pulmonary embolism (PE) on long-term prognosis in cancer patients is unclear. This study assessed the characteristics of cancer and venous thromboembolism (VTE) and the effect of incidental PE identified by oncologists on long-term survival of patients with cancer. METHODS AND RESULTS This single-center, retrospective, cohort study used hospital-based cancer registry data from the Osaka International Cancer Institute linked with electronic medical records and administrative data from Japan's Diagnosis Procedure Combination Per-diem Payment System. Overall, 15,689 cancer patients underwent contrast-enhanced thoracic computed tomography during 2010-2018. After excluding patients with missing data, symptomatic patients, or patients with suspected PE, 174 with incidental PE (PE+ group) and 13,197 with no PE (PE- group) were identified. The total incidence of incidental PE was 1.3%. No deaths from thrombotic events were identified in the PE+ group. Both groups were adjusted for cancer- and VTE-related characteristics using inverse probability weighting. After adjusting for immortal time bias in the PE+ group, Kaplan-Meier analysis revealed that all-cause mortality was higher in the PE+ group (hazard ratio, 2.26; 95% confidence interval, 1.53-3.33). A Cox proportional hazard model revealed that metastatic cancer and a history of curative treatment were significant prognostic factors, whereas central PE and residual proximal deep vein thrombosis were not. CONCLUSIONS Incidental PE in cancer patients indicates poorer prognosis. Cancer-related but not thrombosis-related factors determine prognosis.
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Affiliation(s)
| | - Takeshi Fujita
- Department of Onco-Cardiology, Osaka International Cancer Institute
| | | | - Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute
| | - Terutaka Hino
- Department of Medical Informatics, Osaka International Cancer Institute
| | - Taku Yasui
- Department of Onco-Cardiology, Osaka International Cancer Institute
| | - Wataru Shioyama
- Department of Onco-Cardiology, Osaka International Cancer Institute
| | - Toru Oka
- Department of Onco-Cardiology, Osaka International Cancer Institute
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute
| | - Masashi Fujita
- Department of Onco-Cardiology, Osaka International Cancer Institute
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3
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Chirumamilla Y, Edupuganti S, Bachuwa G, Alkotob L. Right atrial thrombus leading to pulmonary embolism in a patient with dermatomyositis and COVID-19 managed with FlowTriever device thrombectomy. BMJ Case Rep 2023; 16:e255385. [PMID: 37945279 PMCID: PMC10649501 DOI: 10.1136/bcr-2023-255385] [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] [Indexed: 11/12/2023] Open
Abstract
A woman in her late 40s presented with complaints of shortness of breath, right-sided pleuritic chest pain and diffuse myalgias. She was diagnosed with deep vein thrombosis (DVT) 3 weeks earlier and had been compliant with her oral anticoagulation therapy. Investigations revealed a pulmonary embolism (PE) involving the right distal pulmonary artery on a CT angiogram of the chest. She was also found to have an incidental SARS-CoV-2 (COVID-19) infection and an elevated creatine kinase value. Anticoagulation with intravenous heparin was initiated according to the DVT/PE protocol. The following morning, a medium-sized mobile mass was identified in her right atrium on performing a transthoracic echocardiogram. Due to concerns of embolisation of the mass which could result in obstruction, right ventricular strain and ultimately haemodynamic instability, a thrombectomy was performed using the FlowTriever device under transthoracic echocardiography guidance. The right atrial mass was successfully removed and the patient was transitioned to another oral anticoagulant agent. On discharge, a muscle biopsy was performed and aided in the diagnosis of dermatomyositis and the patient received intravenous Ig, steroids and methotrexate.
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Affiliation(s)
| | - Srujan Edupuganti
- Internal Medicine/Pediatrics, Hurley Medical Center, Flint, Michigan, USA
| | - Ghassan Bachuwa
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Luay Alkotob
- Department of Cardiovascular Medicine, Hurley Medical Center, Flint, MI, USA
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Menichelli D, Cormaci VM, Marucci S, Franchino G, Del Sole F, Capozza A, Fallarino A, Valeriani E, Violi F, Pignatelli P, Pastori D. Risk of venous thromboembolism in autoimmune diseases: A comprehensive review. Autoimmun Rev 2023; 22:103447. [PMID: 37714419 DOI: 10.1016/j.autrev.2023.103447] [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: 05/30/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023]
Abstract
Autoimmune diseases have specific pathophysiologic mechanisms leading to an increased risk of arterial and venous thrombosis. The risk of venous thromboembolism (VTE) varies according to the type and stage of the disease, and to concomitant treatments. In this review, we revise the most common autoimmune disease such as antiphospholipid syndrome, inflammatory myositis, polymyositis and dermatomyositis, rheumatoid arthritis, sarcoidosis, Sjogren syndrome, autoimmune haemolytic anaemia, systemic lupus erythematosus, systemic sclerosis, vasculitis and inflammatory bowel disease. We also provide an overview of pathophysiology responsible for the risk of VTE in each autoimmune disorder, and report current indications to anticoagulant treatment for primary and secondary prevention of VTE.
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Affiliation(s)
- Danilo Menichelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, 00161 Rome, Italy
| | - Vito Maria Cormaci
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Silvia Marucci
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giovanni Franchino
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesco Del Sole
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Alessandro Capozza
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Alessia Fallarino
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Emanuele Valeriani
- Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesco Violi
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
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Shah M, Shinjo SK, Day J, Gupta L. Cardiovascular manifestations in idiopathic inflammatory myopathies. Clin Rheumatol 2023; 42:2557-2575. [PMID: 37148365 PMCID: PMC10497702 DOI: 10.1007/s10067-023-06599-4] [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: 03/17/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 05/08/2023]
Abstract
Cardiovascular involvement in idiopathic inflammatory myopathies (IIM) is an understudied area which is gaining increasing recognition in recent times. Recent advances in imaging modalities and biomarkers have allowed the detection of subclinical cardiovascular manifestations in IIM. However, despite the availability of these tools, the diagnostic challenges and underestimated prevalence of cardiovascular involvement in these patients remain significant. Notably, cardiovascular involvement remains one of the leading causes of mortality in patients with IIM. In this narrative literature review, we outline the prevalence and characteristics of cardiovascular involvement in IIM. Additionally, we explore investigational modalities for early detection of cardiovascular involvement, as well as newer approaches in screening to facilitate timely management. Key points • Cardiac involvement in IIM in majority cases is subclinical and a major cause of mortality. • Cardiac magnetic resonance imaging is sensitive for detection of subclinical cardiac involvement.
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Affiliation(s)
- Meera Shah
- Department of Rheumatology, Indraprastha Apollo Hospital, New Delhi, Delhi, 110076, India
| | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK.
- Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK.
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Idolor O, Edigin E, Hino C, He E, Rao J, Ugoh AC, Onobraigho P, Omoike E, Okpujie V, Ezeafulukwe CJ, Eseaton PO, Manadan A, Downey C. Polymyositis/dermatomyositis readmissions: analysis of the nationwide readmission database. Clin Rheumatol 2023; 42:2833-2839. [PMID: 37407906 DOI: 10.1007/s10067-023-06690-w] [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: 03/27/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND There is a scarcity of national population-based studies on polymyositis (PM)/dermatomyositis (DM) readmissions in the USA. In this study, we aim to describe the rates, reasons for readmissions, and characteristics of readmissions for adults hospitalized for PM/DM in the USA. METHODS We analyzed the 2018 Nationwide Readmissions Database (NRD). We included index hospitalizations for all adult DM/PM patients with a principal diagnosis of PM/DM using ICD-10 codes. We excluded elective and traumatic readmissions. Using a "rank" command in STATA, the most common specific principal diagnosis of readmissions was outlined. Chi-square tests were used to compare baseline characteristics between readmissions and index hospitalizations. STATA 16 was used for analysis. RESULTS A total of 1610, 1286, and 842 index hospitalizations with a principal diagnosis of PM/DM, that were discharged alive, were included in the 30-, 90-, and 180-day readmission analysis, respectively. Among these, 193 (12%), 276 (21.5%), and 240 (28.5%) were readmitted within 30, 90, and 180 days, respectively. PM and sepsis were the most common reasons for reasons across the 3 timeframes. 30-day readmissions were responsible for an aggregate of 4.1 million US dollars in total hospital cost and 1518 hospital days in 2018. Compared to index hospitalizations, 30-day readmissions have higher Charlson Comorbidity Index scores, severe-extreme loss of function, obesity, and deep venous thrombosis. CONCLUSION About a third of PM/DM hospitalized patients are readmitted within 180 days. Readmissions constitute a significant economic burden to the health care system. PM and sepsis are the main reasons for readmissions. Key points • About a third of polymyositis (PM)/dermatomyositis (DM) hospitalized patients are readmitted within 180 days • PM and sepsis are the main reasons for readmissions. • Readmissions of PM/DM Patients constitute a significant economic burden to the health care system. • Compared to index hospitalizations, 30-day readmissions have higher Charlson comorbidity index scores, severe-extreme loss of function, obesity, and deep venous thrombosis.
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Affiliation(s)
- Osahon Idolor
- Department of Internal Medicine, Piedmont Athens Regional, Athens, GA, USA
| | - Ehizogie Edigin
- Division of Rheumatology, Loma Linda University Health, Loma Linda, USA.
| | - Christopher Hino
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Emily He
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Janhavi Rao
- Department of Internal Medicine, Riverside University Medical Center, Riverside, CA, USA
| | - Amaka Cynthia Ugoh
- Department of Family Medicine, University of Benin Teaching Hospital, Benin, Nigeria
| | - Precious Onobraigho
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin, Nigeria
| | - Eugene Omoike
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin, Nigeria
| | - Victory Okpujie
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin, Nigeria
| | | | - Precious Obehi Eseaton
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Augustine Manadan
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Christina Downey
- Division of Rheumatology, Loma Linda University Health, Loma Linda, USA
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Xing R, Xiang F, Dong L, Shen G. Spontaneous intramuscular hemorrhage in cancer-associated dermatomyositis: a case and literature review. BMC Musculoskelet Disord 2023; 24:542. [PMID: 37393235 DOI: 10.1186/s12891-023-06651-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Spontaneous intramuscular hemorrhage (SIH) is a rare but life-threatening complication of dermatomyositis (DM). The pathogenetic mechanism and management of intramuscular hematoma in these patients remains unclear. Here we discuss a case of recurrent hemorrhage in a patient with cancer-associated DM, and review the relevant literature for timely diagnosis and treatment. CASE PRESENTATION A 53-year-old male patient presented with rashes, muscle weakness, and dysphagia and was diagnosed with DM. During treatment, he developed SIH of the arm and right psoas major muscle successively. MRI showed extensive edema of the right shoulder girdle muscle and muscle groups of the upper arm. During the second SIH, a CT scan showed new-onset hematoma formation in the right psoas major muscle. The detection of D-dimer, thrombin-antithrombin III complex (TAT), plasmin-α2-plasmininhibitor complex (PIC) and tissue plasminogen activator-inhibitor complex (t-PAIC) indicated predominant hyperfibrinolysis over thrombosis. Blood transfusion and supportive treatment were immediately performed, and the hematoma did not expand. However, his abdominal distension was not relieved after active treatment. Further electronic gastroscopy discovered gastric sinus ulcers, and histopathology of the biopsy confirmed signet-ring cell carcinoma. CONCLUSIONS Although patients with cancer-associated DM have an increased risk of thrombosis, prophylactic anticoagulation therapy needs deliberate consideration. It is important to monitor the coagulation parameters dynamically during anticoagulation therapy. Especially when the level of D-dimer is high, and it is uncertain whether the patient is in a state of thrombosis or hyperfibrinolysis, the detection of TAT, PIC, t-PAIC can help to determine whether to initiate anticoagulation therapy.
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Affiliation(s)
- Rui Xing
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, Hubei Province, China
| | - Fenfen Xiang
- Department of Endocrinology, Rheumatology and Immunology, Huanggang Central Hospital of Yangtze University, Huanggang, 438000, Hubei Province, China
| | - Lingli Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, Hubei Province, China
| | - Guifen Shen
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, Hubei Province, China.
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8
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Misra DP, Ahmed S, Goyal M, Sharma A, Agarwal V. Venous Thromboembolism in the Inflammatory Rheumatic Diseases. Rheum Dis Clin North Am 2023; 49:97-127. [PMID: 36424029 DOI: 10.1016/j.rdc.2022.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a cardiovascular event whose risk is increased in most inflammatory rheumatic diseases (IRDs). Mechanisms that increase VTE risk include antiphospholipid antibodies (APLs), particularly anticardiolipin antibodies, anti-beta2glycoprotein I antibodies and lupus anticoagulant present together, and inflammation-mediated endothelial injury. Patients with IRDs should receive long-term anticoagulation drugs when the risk of VTE recurrence is high. In the light of recent warnings from regulatory agencies regarding heightened VTE risk with Janus kinase inhibitors, these drugs should be initiated only after a careful assessment of VTE risk in those with IRDs.
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Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, C block, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Rae Bareli Road, Lucknow 226014, India.
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar 751024, India. https://twitter.com/sakir_rheum
| | - Mohit Goyal
- Department of Rheumatology and Clinical Immunology, CARE Pain and Arthritis Centre, Udaipur 313002, Rajasthan, India. https://twitter.com/drmohitgoyal
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India. https://twitter.com/Amansharmapgi
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, C block, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Rae Bareli Road, Lucknow 226014, India. https://twitter.com/vikasagrIMMUNO
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9
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Wang Y, Zeng Q, Cai X, Meng Y, Zhang C, Fan J, Aibibula M, Feng N, Luo L, Ma X. Pericardial effusion in idiopathic inflammatory myopathies: A cross-sectional study from Asia and review of the literature. Int J Immunopathol Pharmacol 2022; 36:3946320221145784. [PMID: 36541856 PMCID: PMC9791290 DOI: 10.1177/03946320221145784] [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] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Pericardial effusion is a rare clinical manifestation in idiopathic inflammatory myopathies (IIMs). It has been described in a small number of literature studies worldwide. We describe the clinical and laboratory characteristics of 19 IIM patients combined with pericardial effusion, and compare them with previously reported cases. The single-center observational-study-inspired collected of 156 IIM patients with complete data from January 1, 2016 to January 1, 2021 in the First Affiliated Hospital of Xinjiang Medical University, of which 19 patients had pericardial effusion. METHODS The clinical characteristics of 19 IIM patients complicated with pericardial effusion were investigated by descriptive analysis and compared with previously reported cases. RESULTS 19 cases of IIM patients had pericardial effusion (12.2%), patients without a large amount of pericardial effusion or pericardial tamponade. There was a predominance of women in the patients with 78.9% pericardial effusion . In the clinical examination, 10 cases showed chest tightness (52.6%), pulmonary fibrosis (47.4%), and the frequency of muscle nuclear magnetic, which suggested that muscle lymphocyte infiltration rate was 63.2%. Anti-Ro-52 antibody and anti-Jo-1 antibody were positive (26.3%, 42.1%). IIM patients with pericardial effusion were accompanied by decreased serum albumin levels and elevated ESR. In the literature review, the most common clinical characteristics of IIM patients with pericardial effusion were female, pulmonary fibrosis, shortness of breath, positive anti-Ro-52 pulmonary fibrosis, and anti-Jo-1 antibody. CONCLUSION In the study, 19 patients of IIMs with pericardial effusion present with chest tightness, and are accompanied by pulmonary fibrosis, positive anti-Jo-1 antibody, and anti-Ro-52 antibody. It is suggested that pericardial effusion in IIM patients may be related to anti-synthetase antibody.
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Affiliation(s)
- Yue Wang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, China,The Affiliated Cardiovascular Hospital of Qingdao University, Qingdao, China
| | - Qiang Zeng
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, China
| | - Xuanlin Cai
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yan Meng
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, China,First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chenxi Zhang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jiahui Fan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, China
| | - Madinaimu Aibibula
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, China
| | - Ning Feng
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li Luo
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xiumin Ma
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, China,First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China,Xiumin Ma, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi 830011, China.
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10
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Kuszmiersz P, Siwiec-Koźlik A, Pacholczak-Madej R, Rams A, Celińska-Lowenhoff M, Iwaniec T, Kosałka-Węgiel J, Zaręba L, Dziedzic R, Bazan-Socha S, Dropiński J. Thrombin generation potential is increased in patients with autoimmune inflammatory myopathies. Adv Med Sci 2022; 67:346-352. [PMID: 36084366 DOI: 10.1016/j.advms.2022.08.005] [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: 04/19/2022] [Revised: 07/19/2022] [Accepted: 08/22/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Dermatomyositis and polymyositis (DM/PM) are rare autoimmune inflammatory myopathies, characterized by an increased risk of cardiovascular and thromboembolic events, likely related to the prothrombotic plasma properties. The aim of this study was to assess the in vitro thrombin generation profile as a biomarker of plasma procoagulant properties in DM/PM patients. METHODS In 58 clinically stable DM/PM patients and 67 controls matched for sex, age, body mass index, we measured plasma thrombin generation potential using the Calibrated Automated Thrombinography (CAT) and analyzed its relationship with clinical disease characteristics, including autoantibodies profile. RESULTS Patients with DM/PM had a 21% increase in endogenous thrombin potential (ETP), 36% higher peak thrombin concentration, and 11% faster thrombin generation, compared to controls (p < 0.001, all, also after adjustment for potential confounders). Interestingly, although both diseases did not differ in thrombin generation potential, heterogenous variables predicted elevated ETPs in both of them. In DM, that was higher fibrinogen, C-reactive protein, and total cholesterol, whereas in PM, presence of arthritis and increased blood platelet count. Surprisingly, thrombin formation capacity remained in a robust inverse relationship with serum troponin (r = -0.67, p < 0.001) in the patient group. CONCLUSIONS DM/PM patients are characterized by an increased thrombin generation potential, suggesting prothrombotic plasma properties in both diseases. However, more studies are needed to verify its rationale and role in DM/PM clinical course and unfavorable clinical outcomes.
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Affiliation(s)
- Piotr Kuszmiersz
- Jagiellonian University Medical College, Department of Rheumatology and Immunology, Cracow, Poland
| | - Andżelika Siwiec-Koźlik
- Jagiellonian University Medical College, Department of Rheumatology and Immunology, Cracow, Poland
| | - Renata Pacholczak-Madej
- Jagiellonian University Medical College, Department of Anatomy, Cracow, Poland; National Cancer Institute, Maria Skłodowska-Curie Memorial Institute, Kraków Branch, Poland
| | - Anna Rams
- Jagiellonian University Medical College, Department of Internal Medicine, Cracow, Poland
| | | | - Teresa Iwaniec
- Jagiellonian University Medical College, Department of Haematology, Cracow, Poland
| | - Joanna Kosałka-Węgiel
- Jagiellonian University Medical College, Department of Rheumatology and Immunology, Cracow, Poland
| | - Lech Zaręba
- University of Rzeszow, Interdisciplinary Centre for Computational Modeling, Rzeszow, Poland
| | - Radosław Dziedzic
- Jagiellonian University Medical College, Students' Scientific Group of Immune Diseases and Hypercoagulation, Cracow, Poland
| | - Stanisława Bazan-Socha
- Jagiellonian University Medical College, Department of Internal Medicine, Cracow, Poland
| | - Jerzy Dropiński
- Jagiellonian University Medical College, Department of Internal Medicine, Cracow, Poland.
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11
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Effect of Clinical Nursing Pathway Intervention Based on Evidence-Based Medicine on Venous Thrombosis in Long-Term Bedridden Patients. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5120569. [PMID: 35320999 PMCID: PMC8938046 DOI: 10.1155/2022/5120569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
Abstract
Background Venous thrombosis is a type of medical condition that establishes as deep vein thrombosis of the limb or pulmonary embolism. This disease arises as a result of interrelating hereditary, ecological, and interactive risk aspects. Clinical nursing pathways also known as critical pathways are pathways that guide nurses when developing a patient's care plan. However, the effect of nursing intervention on venous thrombosis in long-term bedridden patients from the perspective of evidence-based medicine had not been reported. Methods A total of 170 patients hospitalized in the hospital from January 2021 to October 2021 were selected, and the bed time was more than 2 weeks. The patients were randomly divided into the control group and observation group. 85 cases in the control group received routine nursing in cardiology, and 85 cases in the observation group received clinical nursing pathway. Venous thrombosis, lower limb pain, swelling, D-dimer level, hemodynamic parameters, and nursing satisfaction were compared in two groups. Results The incidence of deep venous thrombosis in the observation group was 8.2%, lower than 24.7% in the control group (P < 0.05). The incidence of lower limb pain and elevated D-dimer in the observation group was lower than that in the control group (P < 0.05). The improvement of hemodynamic parameters such as SBP, DBP, CBV, PR, CI, and CO in the study group was better than that in the control group (P < 0.05). The satisfaction of the observation group was 90.58%, which was higher than that of the control group (82.35%) (P < 0.05). Conclusion Clinical nursing pathway can improve patients' nursing efficiency, improve the treatment effect, shorten hospital stay, and improve nursing satisfaction.
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12
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Chen X, Huang S, Jin Q, Ge Y, Lei J, Huang Z, Zhang L, Wang G. Thromboembolic events in idiopathic inflammatory myopathy: a retrospective study in China. Clin Rheumatol 2022; 41:2431-2438. [PMID: 35404027 DOI: 10.1007/s10067-022-06140-z] [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: 12/07/2021] [Revised: 02/20/2022] [Accepted: 03/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the clinical characteristics and risk factors for thromboembolic events in patients with idiopathic inflammatory myopathy (IIM). METHODS We retrospectively analyzed 1144 consecutive patients with IIM for arterial and venous thromboses and compared them with age- and sex-matched IIM patients without thrombosis. Logistic regression analysis was used to analyze risk factors for thrombosis. RESULTS Twenty-four (2.1%) patients had arterial or venous thromboses (mean age, 62.6 ± 11.6 years; range, 33-81 years). Thromboembolic events occurred in 54.2% (13/24) of patients within 6 months before or after IIM diagnosis. Thrombosis patients had a higher Cutaneous Dermatomyositis Disease Area and Severity Index score (p = 0.028), higher myositis disease activity assessment visual analogue scale score (MYOACT) (p < 0.001), and a greater proportion of them had varicose veins (p = 0.001), surgical history in the past 3 months (p = 0.039), malignancy (p = 0.018), and infection (p < 0.001). The manual muscle test 8 score (p < 0.001) and albumin level (p = 0.003) were lower in thrombosis patients. There was no significant difference between the two groups in glucocorticoid pulse therapy; however, intravenous immunoglobulin therapy was more commonly used in thrombosis patients (p = 0.04). In multivariable regression models, malignancy, infection, longer duration of glucocorticoid treatment, and higher MYOACT were risk factors for thrombosis. The cumulative survival time of IIM patients with thrombosis was significantly shorter than that of controls. CONCLUSIONS Malignancy, infection, longer duration of glucocorticoid use, and increased myositis disease activity are risk factors for thrombosis. Patients with these risk factors should undergo screening for thrombosis. Key Points • To investigate the clinical characteristics and risk factors for thromboembolism events in patients with IIM, we performed a retrospective study with IIM patients who experienced a thromboembolic event. • We found that malignancy, infection, longer duration of glucocorticoid treatment, and a higher level of myositis disease activity were risk factors for thrombosis. • The results suggest that patients with the above risk factors should undergo screening for thrombosis.
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Affiliation(s)
- Xixia Chen
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Sizhuang Huang
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Qiwen Jin
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Yongpeng Ge
- Department of Rheumatology, China-Japan Friendship Hospital, 2 Yinghua Road, Chaoyang District, Beijing, China
| | - Jieping Lei
- Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Zhenguo Huang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Lu Zhang
- Department of Rheumatology, China-Japan Friendship Hospital, 2 Yinghua Road, Chaoyang District, Beijing, China.
| | - Guochun Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
- Department of Rheumatology, China-Japan Friendship Hospital, 2 Yinghua Road, Chaoyang District, Beijing, China.
- The Key Laboratory of Myositis, China-Japan Friendship Hospital, Beijing, China.
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13
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Yin Y, Chi J, Bai Y. A case report of dermatomyositis with the missed diagnosis of non-small cell lung cancer and concurrence of pulmonary tuberculosis. Open Med (Wars) 2022; 17:423-426. [PMID: 35340620 PMCID: PMC8898925 DOI: 10.1515/med-2022-0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/23/2021] [Accepted: 02/12/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
A 42-year-old man with four months of retrosternal pain and two months of skin rashes and proximal muscle weakness was diagnosed with dermatomyositis (DM) based on muscle enzyme analysis and needle electromyography. Chest computed tomography (CT) showed scattered inflammation nodules in both lungs’ upper lobes with negative sputum smear for lung cancer and pulmonary tuberculosis (TB). A good clinical response to oral prednisone was obtained, except for the retrosternal pain in the preceding two months. Urgent CT pulmonary angiography ruled out pulmonary thromboembolism but revealed squamous cell lung cancer with metastases in the sternum and mediastinal lymph nodes. In retrospect, we found osteolytic destruction consistent with sternal metastasis on CT taken at the initial treatment of DM, which was missed by radiologists. Simultaneously, the man was diagnosed with pulmonary TB based on rapid mycobacterial TB detection. This case report indicates the radiologic errors and highlights the importance of a thorough search for underlying lung cancer and pulmonary TB in patients with DM, especially in countries with a high TB burden.
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Affiliation(s)
- Yuting Yin
- Department of Respiratory and Critical Care Medicine, Chongqing Shapingba District People’s Hospital , Chongqing , 400010 , China
| | - Jing Chi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University , Yuzhong District , Chongqing , 400010 , China
| | - Yang Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University , No. 1 Youyi Road, Yuzhong District , Chongqing , 400010 , China
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14
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Hu Z, Cao Y, Zhang Y, Xiang Q, Chen H, Song Z, Qiang Y, Zhou S, Cui H, Luo J, Wang Y, Yang Y, Xie X, Zhou W, Shuai S, Xiong A. Comment on: Cardiovascular events in adult polymyositis and dermatomyositis: a meta-analysis of observational studies: Reply. Rheumatology (Oxford) 2021; 61:e180-e182. [PMID: 34962986 DOI: 10.1093/rheumatology/keab952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ziyi Hu
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yuzi Cao
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yan Zhang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Qilang Xiang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Huini Chen
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Zhuoyao Song
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yiying Qiang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Shifeng Zhou
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hongxu Cui
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jie Luo
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ye Wang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yuan Yang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Xiaobo Xie
- Department of Internal Medicine, Nanchong Jialing District Poeple's Hospital, Nanchong, Sichuan, China
| | - Wenjun Zhou
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.,Inflammation and Immunology Key Laboratory of Nanchong City, Nanchong, Sichuan, China
| | - Shiquan Shuai
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.,Inflammation and Immunology Key Laboratory of Nanchong City, Nanchong, Sichuan, China
| | - Anji Xiong
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.,Inflammation and Immunology Key Laboratory of Nanchong City, Nanchong, Sichuan, China
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15
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Xiong A, Hu Z, Zhou S, Qiang Y, Song Z, Chen H, Xiang Q, Zhang Y, Cao Y, Cui H, Luo J, Wang Y, Yang Y, Cui B, Li M, Shuai S. Cardiovascular events in adult polymyositis and dermatomyositis: a meta-analysis of observational studies. Rheumatology (Oxford) 2021; 61:2728-2739. [PMID: 34791063 DOI: 10.1093/rheumatology/keab851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/11/2021] [Accepted: 11/06/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES We aimed to review whether polymyositis (PM) and dermatomyositis (DM) patients have an increased cardiovascular (CV) risk, including ischaemic heart disease (IHD), cerebrovascular accidents (CVA), and venous thromboembolism (VTE). METHODS We searched PubMed, Embase, and the Cochrane database for relevant studies from inception to February 2021. RESULTS Twenty-two studies comprising 25,433 patients were included. With PM/DM versus general populations, the risk was significantly increased for CV events (relative risk (RR)=2.37, 95%CI:1.86-3.02). The RR of CV events for males with PM/DM was higher than for females (RR = 1.43; 95%CI:1.17-1.74). PM/DM patients followed for one to five years had a significantly higher CV risk than those followed for five to ten years (RR = 3.51, 95%CI:1.95-6.32). The risk was increased for North Americans (RR = 4.28, 95%CI:2.57-7.11), Europeans (RR = 2.29, 95%CI:1.58-3.31), and Asians (RR = 2.03, 95%CI:1.41-2.90). Our meta-analysis found that the elevated CV event risk was related to PM (RR = 2.35, 95%CI:1.51-3.66) and DM (RR = 2.55, 95%CI:1.66-3.93). Subgroup analyses showed that the risk was significantly increased for IHD (RR = 1.76, 95%CI:1.40-2.21), CVA morbidity (RR = 1.31, 95%CI:1.03-1.67), and ischaemic stroke (IS) (RR = 1.47, 95%CI:1.26-1.73), with no statistically significant increased risk of haemorrhagic stroke mortality (RR = 1.43, 95%CI:0.92-2.21). The CV event risk was increased for VTE (RR = 4.60, 95%CI:3.17-6.66), deep venous thrombosis (DVT) (RR = 5.53, 95%CI:3.25-9.39), and pulmonary embolism (PE) (RR = 5.26, 95%CI:2.62-10.55). CONCLUSION This meta-analysis found that PM/DM patients had a ∼2.37 times increased CV risk, particularly males diagnosed in the previous five years. PM/DM may be an independent risk factor for developing IHD, IS, DVT, and PE.
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Affiliation(s)
- Anji Xiong
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China.,Inflammation and Immunology Key Laboratory of Nanchong City, Sichuan, China
| | - Ziyi Hu
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Shifeng Zhou
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Yiying Qiang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhuoyao Song
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Huini Chen
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Qilang Xiang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Yan Zhang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Yuzi Cao
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Hongxu Cui
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Jie Luo
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Ye Wang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Yuan Yang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Beibei Cui
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Menglan Li
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China.,Inflammation and Immunology Key Laboratory of Nanchong City, Sichuan, China
| | - Shiquan Shuai
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China.,Inflammation and Immunology Key Laboratory of Nanchong City, Sichuan, China
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16
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Zhen C, Wang Y, Wang H, Wang X. The risk of ischemic stroke in patients with idiopathic inflammatory myopathies: a systematic review and meta-analysis. Clin Rheumatol 2021; 40:4101-4108. [PMID: 33934269 DOI: 10.1007/s10067-021-05751-2] [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: 08/20/2020] [Revised: 03/22/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Idiopathic inflammatory myopathies (IIM) are a group of chronic rheumatic diseases that can affect multiple systems; the risk of ischemic stroke in patients with IIM remains controversial. We aimed to systematically evaluate the risk of ischemic stroke in IIMs. METHODS The PubMed, Embase, and Cochrane library were searched for relevant studies. Pooled relative risk (RR) with a 95% confidence interval (CI) was calculated as effect size to evaluate the risk of ischemic stroke in patients with IIM. Random effects model was chosen when I2 > 50%. We pooled all studies in a first total analysis to assess the risk of ischemic stroke in IIM. Subgroup analyses were conducted based on the subtypes of IIM (dermatomyositis) and country. Sensitivity analysis was performed to identify the heterogeneity sources. RESULTS A total of 6 studies with 5,114 IIM cases and 14,516,099 controls were included, and the results demonstrated that IIMs were associated with an increased risk of ischemic stroke (RR = 2.41, 95% CI: 1.31, 4.45). Subgroup analysis indicated that patients with dermatomyositis (DM) had a 49% excess risk of ischemic stroke than controls; Asian patients with IIM had an increased risk of ischemic stroke, although not for American patients. CONCLUSION IIMs, especially patients with DM, are associated with an increased risk of ischemic stroke. Appropriate intervention may be taken into account for patients with IIM, especially when accompanied by other traditional risk factors of ischemic stroke. Key Points • This study evaluated the risk of ischemic stroke in patients with IIMs. • Generally, IIMs are associated with an increased risk of ischemic stroke. • Patients with DM had a 49% excess risk of ischemic stroke than controls. • Subgroup analysis showed that Asian patients with IIMs were at increased risk of ischemic stroke, but not Americans.
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Affiliation(s)
- Chao Zhen
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao, Shandong Province, 266071, China
| | - Yabo Wang
- Department of Emergency, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Haifeng Wang
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao, Shandong Province, 266071, China
| | - Xin Wang
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao, Shandong Province, 266071, China.
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17
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Dourmishev L, Guleva D, Pozharashka J, Drenovska K, Miteva L, Vassileva S. Autoimmune connective tissue diseases in the COVID-19 pandemic. Clin Dermatol 2021; 39:56-63. [PMID: 33972054 PMCID: PMC7833035 DOI: 10.1016/j.clindermatol.2020.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Autoimmune connective tissue diseases are a heterogeneous group of clinical entities sharing a common feature-an impairment of structural components like collagen and elastin, arising by autoimmune mechanisms. Because most patients are on a long-term immunosuppressive therapy, which renders them vulnerable to infections, a new challenge appears in front of physicians in the coronavirus disease 2019 (COVID-19) era. Immune mechanisms are substantial for the control and ceasing of viral infections, and their impairment may cause serious complications; however, data from immunosuppressed transplant patients do not reveal a higher frequency or diseases' severity in those infected by COVID-19. Several immunotherapies used to treat autoimmune connective tissue diseases favorably modulate the immune response of severe acute respiratory syndrome coronavirus (SARS-CoV-2)-infected patients. The present review highlights the problems of susceptibility, severity, and therapeutic options in patients with autoimmune connective tissue diseases during the COVID-19 pandemic. The relationship between autoimmune connective tissue diseases and COVID-19 infection is explained with antiviral protection genes expression, hypercytokinemia, and lymphohistiocytosis/macrophage activation mechanisms. Recommendations concerning therapy for prevention during the pandemic period or in case of concomitant COVID-19 infection are also presented. Clinical trials are ongoing regarding COVID-19 therapy blocking the cytokine response. © 2021 Elsevier Inc. All rights reserved.
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Affiliation(s)
- Lyubomir Dourmishev
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria.
| | - Dimitrina Guleva
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - Joana Pozharashka
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - Kossara Drenovska
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - Lyubka Miteva
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - Snejina Vassileva
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
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18
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Doyle AJ, Meyer J, Breen K, Hunt BJ. N-Methyl-3,4-methylendioxymethamphetamine (MDMA)-related coagulopathy and rhabdomyolysis: A case series and literature review. Res Pract Thromb Haemost 2020; 4:829-834. [PMID: 32685891 PMCID: PMC7354411 DOI: 10.1002/rth2.12360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 11/11/2022] Open
Abstract
Coagulation changes, thrombosis, and hemorrhage have been described in patients following N-methyl-3,4-methylenedioxymethylamphetamine (MDMA) intoxication who subsequently developed serotonin syndrome and rhabdomyolysis. The clinical features and mechanism of this remain poorly described. We describe 5 sequential cases admitted to critical care due to severe recreational MDMA toxicity where coagulopathy occurred, and discuss key clinical issues. All patients presented with hyperpyrexia then developed subsequent rhabdomyolysis accompanied by a coagulopathy within 24 hours of presentation. This included a severe thrombocytopenia, prolonged coagulation times, grossly elevated D-dimer levels, and hypofibrogenemia. Multiorgan dysfunction was seen in all patients, including stroke in one patient and major hemorrhage in another. In 2 cases, low-dose low-molecular-weight heparin was used early after presentation, with no significant bleeding complications. Blood products usage was high but variable between the patients with lower use in those who received low-molecular-weight heparin early. Other treatments included intravascular therapeutic cooling, renal replacement therapy with large filter pores and cyprohepatidine. Current evidence suggests that in this group, rhabdomyolysis with subsequent myosin release may be a profound activator of coagulation leading to disseminated intravascular coagulation. Myosin-activated coagulation seems a potential cause of MDMA-related coagulopathy in the setting of rhabdomyolysis and serotonin syndrome. Further studies are needed to validate this and explore the use of low-molecular-weight heparin to reduce the clinical effects of this coagulopathy.
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Affiliation(s)
- Andrew J. Doyle
- Centre for Thrombosis & HaemophiliaSt Thomas' HospitalLondonUK
| | - Joel Meyer
- Department of Intensive Care MedicineSt Thomas' HospitalLondonUK
| | - Karen Breen
- Centre for Thrombosis & HaemophiliaSt Thomas' HospitalLondonUK
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19
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Pacot L, Pouchot J, De Prost N, Senant M, Tartour E, Le Pimpec-Barthes F, Israel-Biet D, Dragon-Durey MA. Interstitial Lung Disease-Complicated Anti-MDA5 Antibody in Clinically Amyopathic Dermatomyositis Patients: Report of Two Cases With Distinct Clinical Features. Front Med (Lausanne) 2020; 7:77. [PMID: 32211415 PMCID: PMC7076087 DOI: 10.3389/fmed.2020.00077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/25/2020] [Indexed: 12/25/2022] Open
Abstract
Two patients presented simultaneously to our hospital with distinct clinical features associated with the presence of anti-MDA5 antibodies: the first one was admitted for a skin rash resembling to a toxic epidermal necrosis (Lyell syndrome) and the second one presented with pulmonary manifestations attributed to a diffuse fibrosing interstitial pneumonitis on chest CT-scan. In addition to the skin lesions involving 40% of the body surface area, the first patient developed a rapid diffuse interstitial pneumonitis with respiratory distress justifying the initiation of a systemic immunosuppressive treatment. However, she died 3 weeks after her admission from mesenteric thrombosis associated with septic shock. The second patient respiratory condition worsened despite an intensive immunosuppressive treatment with high doses of intravenous methylprednisolone and cyclophosphamide and plasmapheresis, and required lung transplantation. Anti-MDA5 antibody titer declined and disappeared on anti-rejection treatment. These two cases underline the diagnostic conundrum and the therapeutic difficulties in patients with anti-MDA5 antibodies and clinically amyopathic dermatomyositis (CADM) or interstitial lung disease (ILD), who may undergo rapidly-progressive and fatal outcome. Presence of anti-MDA5 antibodies should always be suspected when confronted to CADM patients with cutaneous ulcerations or ILD to allow a rapid and adapted treatment initiation.
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Affiliation(s)
- Laurence Pacot
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Paris, France
| | - Nicolas De Prost
- Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France
| | - Marie Senant
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris-Descartes, Paris, France
| | - Eric Tartour
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris-Descartes, Paris, France
| | | | - Dominique Israel-Biet
- Université Paris-Descartes, Paris, France.,Service de Pneumologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Marie-Agnes Dragon-Durey
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris-Descartes, Paris, France
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20
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Dilemma in management of hemorrhagic myositis in dermatomyositis. Rheumatol Int 2019; 40:331-336. [DOI: 10.1007/s00296-019-04501-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/11/2019] [Indexed: 01/22/2023]
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Meta-Analysis of Polymyositis and Dermatomyositis Microarray Data Reveals Novel Genetic Biomarkers. Genes (Basel) 2019; 10:genes10110864. [PMID: 31671645 PMCID: PMC6895911 DOI: 10.3390/genes10110864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023] Open
Abstract
Polymyositis (PM) and dermatomyositis (DM) are both classified as idiopathic inflammatory myopathies. They share a few common characteristics such as inflammation and muscle weakness. Previous studies have indicated that these diseases present aspects of an auto-immune disorder; however, their exact pathogenesis is still unclear. In this study, three gene expression datasets (PM: 7, DM: 50, Control: 13) available in public databases were used to conduct meta-analysis. We then conducted expression quantitative trait loci analysis to detect the variant sites that may contribute to the pathogenesis of PM and DM. Six-hundred differentially expressed genes were identified in the meta-analysis (false discovery rate (FDR) < 0.01), among which 317 genes were up-regulated and 283 were down-regulated in the disease group compared with those in the healthy control group. The up-regulated genes were significantly enriched in interferon-signaling pathways in protein secretion, and/or in unfolded-protein response. We detected 10 single nucleotide polymorphisms (SNPs) which could potentially play key roles in driving the PM and DM. Along with previously reported genes, we identified 4 novel genes and 10 SNP-variant regions which could be used as candidates for potential drug targets or biomarkers for PM and DM.
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Faverio P, De Giacomi F, Bonaiti G, Stainer A, Sardella L, Pellegrino G, Sferrazza Papa GF, Bini F, Bodini BD, Carone M, Annoni S, Messinesi G, Pesci A. Management of Chronic Respiratory Failure in Interstitial Lung Diseases: Overview and Clinical Insights. Int J Med Sci 2019; 16:967-980. [PMID: 31341410 PMCID: PMC6643124 DOI: 10.7150/ijms.32752] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/05/2019] [Indexed: 01/11/2023] Open
Abstract
Interstitial lung diseases (ILDs) may be complicated by chronic respiratory failure (CRF), especially in the advanced stages. Aim of this narrative review is to evaluate the current evidence in management of CRF in ILDs. Many physiological mechanisms underlie CRF in ILDs, including lung restriction, ventilation/perfusion mismatch, impaired diffusion capacity and pulmonary vascular damage. Intermittent exertional hypoxemia is often the initial sign of CRF, evolving, as ILD progresses, into continuous hypoxemia. In the majority of the cases, the development of CRF is secondary to the worsening of the underlying disease; however, associated comorbidities may also play a role. When managing CRF in ILDs, the need for pulmonary rehabilitation, the referral to lung transplant centers and palliative care should be assessed and, if necessary, promptly offered. Long-term oxygen therapy is commonly prescribed in case of resting or exertional hypoxemia with the purpose to decrease dyspnea and improve exercise tolerance. High-Flow Nasal Cannula oxygen therapy may be used as an alternative to conventional oxygen therapy for ILD patients with severe hypoxemia requiring both high flows and high oxygen concentrations. Non-Invasive Ventilation may be used in the chronic setting for palliation of end-stage ILD patients, although the evidence to support this application is very limited.
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Affiliation(s)
- Paola Faverio
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Federica De Giacomi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Giulia Bonaiti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Anna Stainer
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Luca Sardella
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Giulia Pellegrino
- Casa di Cura del Policlinico, Dipartimento di Scienze Neuroriabilitative, Milan, Italy
| | | | - Francesco Bini
- UOC Pulmonology, Department of Internal Medicine, Ospedale ASST-Rhodense, Garbagnate Milanese, Italy
| | - Bruno Dino Bodini
- Pulmonology Unit, Ospedale Maggiore della Carità, University of Piemonte Orientale, Novara, Italy
| | - Mauro Carone
- UOC Pulmonology and Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS di Cassano Murge (BA), Italy
| | - Sara Annoni
- Physical therapy and Rehabilitation Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Grazia Messinesi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Alberto Pesci
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
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23
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Doutre MS. [What's new in internal medicine?]. Ann Dermatol Venereol 2018; 145 Suppl 7:VIIS24-VIIS31. [PMID: 30583754 DOI: 10.1016/s0151-9638(18)31286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
What's new in internal medicine will be dedicated to three topics: i) inflammatory myopathies constituting a heterogenous group of diseases whose clinical manifestations, immunological abnormalities, treatment response and outcomes vary widely; ii) alterations of gut microbiota contributing to the occurrence or development of a range of conditions, including autoimmune diseases for which further work is necessary to understand the correlation of dysbiosis with these diseases; iii) the reciprocal relationship between obesity, metabolic syndrome, atherosclerosis and autoimmune diseases. New data concerning systemic sclerosis, cutaneous vasculitis, adult Still's disease, autoantibodies anti DFS70, Epstein Barr virus and autoimmune diseases were also highlighted.
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Affiliation(s)
- M-S Doutre
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burget, 33000 Bordeaux, France.
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