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Lupu A, Sasaran MO, Jechel E, Azoicai A, Alexoae MM, Starcea IM, Mocanu A, Nedelcu AH, Knieling A, Salaru DL, Burlea SL, Lupu VV, Ioniuc I. Undercover lung damage in pediatrics - a hot spot in morbidity caused by collagenoses. Front Immunol 2024; 15:1394690. [PMID: 38994372 PMCID: PMC11236559 DOI: 10.3389/fimmu.2024.1394690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Connective tissue represents the support matrix and the connection between tissues and organs. In its composition, collagen, the major structural protein, is the main component of the skin, bones, tendons and ligaments. Especially at the pediatric age, its damage in the context of pathologies such as systemic lupus erythematosus, scleroderma or dermatomyositis can have a significant negative impact on the development and optimal functioning of the body. The consequences can extend to various structures (e.g., joints, skin, eyes, lungs, heart, kidneys). Of these, we retain and reveal later in our manuscript, mainly the respiratory involvement. Manifested in various forms that can damage the chest wall, pleura, interstitium or vascularization, lung damage in pediatric systemic inflammatory diseases is underdeveloped in the literature compared to that described in adults. Under the threat of severe evolution, sometimes rapidly progressive and leading to death, it is necessary to increase the popularization of information aimed at physiopathological triggering and maintenance mechanisms, diagnostic means, and therapeutic directions among medical specialists. In addition, we emphasize the need for interdisciplinary collaboration, especially between pediatricians, rheumatologists, infectious disease specialists, pulmonologists, and immunologists. Through our narrative review we aimed to bring up to date, in a concise and easy to assimilate, general principles regarding the pulmonary impact of collagenoses using the most recent articles published in international libraries, duplicated by previous articles, of reference for the targeted pathologies.
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Affiliation(s)
- Ancuta Lupu
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Maria Oana Sasaran
- Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
| | - Elena Jechel
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Alice Azoicai
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Monica Mihaela Alexoae
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Iuliana Magdalena Starcea
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Adriana Mocanu
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Alin Horatiu Nedelcu
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Anton Knieling
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Delia Lidia Salaru
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Stefan Lucian Burlea
- Public Health and Management Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Vasile Valeriu Lupu
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Ileana Ioniuc
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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Sulaiman W, Mohd Lepatoni F, Tang JJ, Baharudin NB. Juvenile clinically amyopathic dermatomyositis (CADM): Case-based review. THE EGYPTIAN RHEUMATOLOGIST 2023. [DOI: 10.1016/j.ejr.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Papadopoulou C, Chew C, Wilkinson MGL, McCann L, Wedderburn LR. Juvenile idiopathic inflammatory myositis: an update on pathophysiology and clinical care. Nat Rev Rheumatol 2023; 19:343-362. [PMID: 37188756 PMCID: PMC10184643 DOI: 10.1038/s41584-023-00967-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
The childhood-onset or juvenile idiopathic inflammatory myopathies (JIIMs) are a heterogenous group of rare and serious autoimmune diseases of children and young people that predominantly affect the muscles and skin but can also involve other organs, including the lungs, gut, joints, heart and central nervous system. Different myositis-specific autoantibodies have been identified that are associated with different muscle biopsy features, as well as with different clinical characteristics, prognoses and treatment responses. Thus, myositis-specific autoantibodies can be used to subset JIIMs into sub-phenotypes; some of these sub-phenotypes parallel disease seen in adults, whereas others are distinct from adult-onset idiopathic inflammatory myopathies. Although treatments and management have much improved over the past decade, evidence is still lacking for many of the current treatments and few validated prognostic biomarkers are available with which to predict response to treatment, comorbidities (such as calcinosis) or outcome. Emerging data on the pathogenesis of the JIIMs are leading to proposals for new trials and tools for monitoring disease.
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Affiliation(s)
- Charalampia Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
| | - Christine Chew
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Meredyth G Ll Wilkinson
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Lucy R Wedderburn
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK.
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK.
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK.
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK.
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Silvestre-Torner N, Díaz Delgado-Peñas R, Collado-Ramos P, Román-Sainz J, Gruber-Velasco F, Imbernón-Moya A, Dorado-Fernández M, Nogales-Moro A. Periorbital rash and scaly plaques in a 13-year–old boy. JAAD Case Rep 2022; 23:147-150. [PMID: 35509500 PMCID: PMC9058562 DOI: 10.1016/j.jdcr.2022.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
The juvenile idiopathic inflammatory myopathies (JIIM) are a group of rare, chronic, autoimmune illnesses that affect muscle and, to a lesser extent, skin. The presence of new-onset weakness and, in juvenile dermatomyositis, typical rahes, should lead to consideration of these diagnoses. Careful evaluation to exclude alternative diagnoses is needed. Investigations include a variety of blood tests, imaging, and possibly muscle biopsy. Validated clinical assessments are available for monitoring. Standard treatment includes corticosteroids and methotrexate and often extends beyond 1 year. Outcomes are generally good, but disease persistence remains problematic. Early involvement of providers with expertise in JIIM is essential.
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Affiliation(s)
- Adam M Huber
- Division of Pediatric Rheumatology, IWK Health Centre, Dalhousie University, 5850 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada.
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Campos LMA, Sallum AME, Camargo CZ, Andrade LEC, Kayser C. Improvement of nailfold capillary microangiopathy after immunosuppressant therapy in a child with clinically amyopathic juvenile dermatomyositis. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:487-490. [PMID: 29037322 DOI: 10.1016/j.rbre.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 03/15/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Lúcia Maria Arruda Campos
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil.
| | - Adriana M E Sallum
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil
| | - Cintia Z Camargo
- Universidade Federal de São Paulo (UNIFESP), Departamento de Reumatologia, São Paulo, SP, Brazil
| | - Luís Eduardo C Andrade
- Universidade Federal de São Paulo (UNIFESP), Departamento de Reumatologia, São Paulo, SP, Brazil
| | - Cristiane Kayser
- Universidade Federal de São Paulo (UNIFESP), Departamento de Reumatologia, São Paulo, SP, Brazil
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Campos LMA, Sallum AM, Camargo CZ, Andrade LEC, Kayser C. Melhoria na microangiopatia capilar periungueal após terapia imunossupressora em uma criança com dermatomiosite juvenil clinicamente amiopática. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Napolitano M, Megna M, Squillace L, Costa C, Scalvenzi M. Juvenile amyopathic dermatomyositis. GIORN ITAL DERMAT V 2017; 154:215-216. [PMID: 28704993 DOI: 10.23736/s0392-0488.17.05696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Maddalena Napolitano
- "Vincenzo Tiberio" Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy -
| | - Matteo Megna
- Department of Dermatology, "Federico II" University of Naples, Naples, Italy
| | - Lorenzo Squillace
- Department of Dermatology, "Federico II" University of Naples, Naples, Italy
| | - Claudia Costa
- Department of Dermatology, "Federico II" University of Naples, Naples, Italy
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Sontheimer RD. MDA5 autoantibody-another indicator of clinical diversity in dermatomyositis. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:160. [PMID: 28480196 DOI: 10.21037/atm.2017.03.94] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Allenbach and colleagues have recently reported for the first time the results of an intriguing study of the histopathologic, immunopathologic and gene expression differences in muscle biopsy tissue from adult dermatomyositis (DM) patients who do and do not have circulating MDA5 autoantibodies (anti-MDA5). Anti-MDA5 were originally identified in a clinically-defined subset of DM patients whose disease was expressed predominately in the skin for unusually long periods of time without accompanying muscle weakness [i.e., "clinically-amyopathic DM" (CADM)] and were at risk for acute, rapidly-progressive form of interstitial lung disease (ILD). As an academic dermatologist in the United States of America (USA) having a career-long interest in the CADM subset, I would like to share my perspective on the results of the work by Allenbach and colleagues and offer some suggestions for additional study in this area. But to do so most effectively, I first would like to review the clinical concept of CADM and its association with anti-MDA5 antibody production and a potentially-fatal form of (ILD).
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Dourmishev LA. Inflammatory Myopathies with Cutaneous Involvement: from Diagnosis to Therapy. Folia Med (Plovdiv) 2017; 59:7-13. [DOI: 10.1515/folmed-2017-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/19/2016] [Indexed: 01/17/2023] Open
Abstract
AbstractThe group of idiopathic inflammatory myopathies (IIM) include various disorders of skeletal muscles with or without skin involvement. The most common types are dermatomyositis (DM), polymyositis (PM), inclusion body myositis (IBM) and necrotizing autoimmune myopathy (NAM). Dermatomyositis subdivides into various clinical forms such as juvenile, amyopathic or paraneoplastic dermatomyositis, scleromyositis, overlap or anti-synthetase syndromes, etc.Recently, numerous new antibodies defining the characteristic clinical phenotype have been described as anti-MDA5 antibodies associated with interstitial lung disease and amyopathic dermatomyositis or anti-TIF1γ antibodies as markers for paraneoplastic dermatomyositis. Moreover, new clinical entities as drug-induced dermatomyositis are presumed, since some medications may induce, or trigger inflammatory myopathies.Knowledge of the complex methods and techniques required to diagnose the disease is of great importance in clinical practice. The variety of clinical variants needs diagnosis because of the differing prognosis and therapeutic modalities.
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Kim S, Kahn P, Robinson AB, Lang B, Shulman A, Oberle EJ, Schikler K, Curran ML, Barillas-Arias L, Spencer CH, Rider LG, Huber AM. Childhood Arthritis and Rheumatology Research Alliance consensus clinical treatment plans for juvenile dermatomyositis with skin predominant disease. Pediatr Rheumatol Online J 2017; 15:1. [PMID: 28077146 PMCID: PMC5225591 DOI: 10.1186/s12969-016-0134-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/29/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is the most common form of the idiopathic inflammatory myopathies in children. A subset of children have the rash of JDM without significant weakness, and the optimal treatments for these children are unknown. The goal of this study was to describe the development of consensus clinical treatment plans (CTPs) for children with JDM who have active skin rashes, without significant muscle involvement, referred to as skin predominant JDM in this manuscript. METHODS The Children's Arthritis and Rheumatology Research Alliance (CARRA) is a North American consortium of pediatric rheumatology health care providers. CARRA members collaborated to determine consensus on typical treatments for JDM patients with skin findings without significant weakness, to develop CTPs for this subgroup of patients. We used a combination of Delphi surveys and nominal group consensus meetings to develop these CTPs. RESULTS Consensus was reached on patient characteristics and outcome assessment, and CTPs were developed and finalized for patients with skin predominant JDM. Treatment option A included hydroxychloroquine alone, Treatment option B included hydroxychloroquine and methotrexate, and Treatment option C included hydroxychloroquine, methotrexate and corticosteroids. CONCLUSIONS Three CTPs were developed for use in children with skin predominant JDM, which reflect typical treatment approaches. These are not considered to be specific recommendations or standard of care. Using the CARRA network and prospective data collection, we will be able to apply statistical methods in the future to allow comparisons of JDM patients following these consensus treatment plans.
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Affiliation(s)
- Susan Kim
- Division of Pediatric Rheumatology, Benioff Children's Hospital, University of California at San Francisco, 550 16th St, San Francisco, CA, USA.
| | - Philip Kahn
- Division of Pediatric Rheumatology, New York University Langone Medical Center, 550 First Avenue, New York, NY USA
| | - Angela B. Robinson
- Pediatric Rheumatology, Rainbow Babies and Children’s Hospital, 11100 Euclid Ave MS6008B, Cleveland, OH USA
| | - Bianca Lang
- Department of Pediatrics, IWK Health Centre and Dalhousie University, 5980 University Ave, Halifax, NS Canada
| | - Andrew Shulman
- Pediatric Rheumatology, Children’s Hospital of Orange County, 1201 W La Veta Ave, Irvine, CA USA
| | - Edward. J. Oberle
- Department of Pediatrics, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH USA
| | - Kenneth Schikler
- Divisions of Adolescent Medicine and Pediatric Rheumatology, Department of Pediatrics, University of Louisville School of Medicine, 571 South Floyd St, Louisville, KY USA
| | - Megan Lea Curran
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL USA
| | - Lilliana Barillas-Arias
- Department of Pediatrics, Rheumatology, Albany Medical Center, 43 New Scotland Ave, Albany, NY USA
| | - Charles H. Spencer
- Department of Pediatrics, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH USA
| | - Lisa G. Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, 10 Center Drive, Bethesda, MD USA
| | - Adam M. Huber
- Department of Pediatrics, IWK Health Centre and Dalhousie University, 5980 University Ave, Halifax, NS Canada
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Doh EJ, Moon J, Shin S, Seo SH, Park HS, Yoon HS, Cho S. Tumoral Calcinosis as an Initial Complaint of Juvenile-Onset Amyopathic Dermatomyositis. Ann Dermatol 2016; 28:375-80. [PMID: 27274638 PMCID: PMC4884716 DOI: 10.5021/ad.2016.28.3.375] [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: 12/18/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 11/08/2022] Open
Abstract
Calcinosis is rarely observed in juvenile-onset amyopathic dermatomyositis in contrast to juvenile-onset dermatomyositis. A 6-year-old female presented with several 0.5 to 2 cm-sized painless grouped masses on both knees for 3 years. The patient also presented with multiple erythematous scaly patches and plaques on both elbows, knuckles, buttock, ankles and cheeks. Her mother had similar skin lesions which were erythematous scaly patches on the knuckles and elbows, since her childhood. When skin biopsy was performed from a left knee nodule, liquid chalky discharge was observed. The biopsy results were consistent with calcinosis cutis. Other biopsies from erythematous patch of the patient and erythematous patch of her mother showed vacuolization of basal cell layer with inflammatory cell infiltrations. Laboratory findings showed normal range of serum phosphorus (4.5 mg/dl), calcium (9.3 mg/dl), 1,25-dihydroxy-vitamin D (10.8 ng/ml) and parathyroid hormone levels (11 pg/ml). Both patient and her mother had no history of muscle weakness and showed normal levels of muscle-specific enzyme. Both patients were diagnosed with juvenile-onset amyopathic dermatomyositis based on histopathology and cutaneous manifestations with no evidence of muscle weakness and no serum muscle enzyme abnormalities. Tumoral calcium deposits observed in daughter was diagnosed as dystrophic calcinosis which can be rarely seen in juvenile-onset amyopathic dermatomyositis. The patient is being treated with oral acetazolamide (40 mg/kg/d) for calcinosis.
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Affiliation(s)
- Eun Jin Doh
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jungyoon Moon
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sue Shin
- Department of Laboratory Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Soo Hyun Seo
- Department of Laboratory Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun Sun Park
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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Pagnini I, Vitale A, Selmi C, Cimaz R, Cantarini L. Idiopathic Inflammatory Myopathies: an Update on Classification and Treatment with Special Focus on Juvenile Forms. Clin Rev Allergy Immunol 2015; 52:34-44. [DOI: 10.1007/s12016-015-8512-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Yun D, Stein SL. Review of the cutaneous manifestations of autoimmune connective tissue diseases in pediatric patients. World J Dermatol 2015; 4:80-94. [DOI: 10.5314/wjd.v4.i2.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/25/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
Autoimmune connective tissue diseases are chronic inflammatory disorders associated with complex genetic and environmental interplay resulting in a variety of cutaneous and systemic manifestations. Pediatric onset of these disorders carries a unique diagnostic pressure for the clinician due to the potential years of disease burden and complications. Mortality and morbidity from these disorders has fallen dramatically over the past fifty years due to increasing awareness of these disease sequelae and utilization of systemic treatment modalities when necessary. This review highlights the clinical features that are unique to pediatric presentations of lupus erythematosus, juvenile idiopathic arthritis, juvenile dermatomyositis, juvenile onset systemic sclerosis and morphea. Each of these disorders has a distinct appearance corresponding to a particular cutaneous and systemic clinical course and prognosis. Awareness of the associated potential systemic complications can also alert the clinician to make astute management decisions when confronted with a probable rheumatologic case. Cutaneous symptoms may predate onset of systemic symptoms and by keeping the rheumatologic differential diagnoses in mind, the dermatologist can play a key role in potentially offsetting autoimmune disease burden in children.
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Poddighe D, Cavagna L, Brazzelli V, Bruni P, Marseglia GL. A hyper-ferritinemia syndrome evolving in recurrent macrophage activation syndrome, as an onset of amyopathic juvenile dermatomyositis: a challenging clinical case in light of the current diagnostic criteria. Autoimmun Rev 2014; 13:1142-8. [PMID: 24879966 DOI: 10.1016/j.autrev.2014.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/20/2014] [Indexed: 02/06/2023]
Abstract
Juvenile dermatomyositis is an immune-mediated inflammatory multi-system disease involving mainly striated muscles and skin. Typical dermatological features are fundamental to establish the diagnosis, especially whenever the myopathy is very mild or absent, as it occurs in the form called as amyopathic juvenile dermatomyositis. Sometimes, systemic rheumatic diseases can develop a hyperferritinemia syndrome characterized by hemophagocytosis, namely macrophage activation syndrome, which represents a severe and life-threatening complication. Here, we describe a complex clinical history characterized by a hyper-ferritinemia syndrome after infectious mononucleosis, leading to recurrent episodes of macrophage activation syndrome. Finally, the late onset of several skin changes brought to a diagnosis of amyopathic juvenile dermatomyositis.
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Affiliation(s)
- Dimitri Poddighe
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Milan, Italy.
| | - Lorenzo Cavagna
- Department of Rheumatology, IRCCS Fondazione Policlinico San Matteo di Pavia, Italy
| | - Valeria Brazzelli
- Department of Dermatology, IRCCS Fondazione Policlinico San Matteo di Pavia, Italy
| | - Paola Bruni
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Milan, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, IRCCS Fondazione Policlinico San Matteo e Universita' degli Studi di Pavia, Italy
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Rider LG, Katz JD, Jones OY. Developments in the classification and treatment of the juvenile idiopathic inflammatory myopathies. Rheum Dis Clin North Am 2013; 39:877-904. [PMID: 24182859 PMCID: PMC3817412 DOI: 10.1016/j.rdc.2013.06.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This review updates recent trends in the classification of the juvenile idiopathic inflammatory myopathies (JIIM) and the emerging standard of treatment of the most common form of JIIM, juvenile dermatomyositis. The JIIM are rare, heterogeneous autoimmune diseases that share chronic muscle inflammation and weakness. A growing spectrum of clinicopathologic groups and serologic phenotypes defined by the presence of myositis autoantibodies are now recognized, each with differing demographics, clinical manifestations, laboratory findings, and prognoses. Although daily oral corticosteroids remain the backbone of treatment, disease-modifying anti-rheumatic drugs are almost always used adjunctively and biologic therapies may benefit patients with recalcitrant disease.
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Affiliation(s)
- Lisa G Rider
- Environmental Autoimmunity Group, Program of Clinical Research, National Institute of Environmental Health Sciences, National Institutes of Health, CRC 4-2352, MSC 1301, 10 Center Drive, Bethesda, MD 20892-1301, USA; Myositis Center, Division of Rheumatology, Department of Medicine, George Washington University, G-400, 2150 Pennsylvania Avenue Northwest, Washington, DC 20037, USA.
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Nofal A, El-Din ES. Hydroxyurea-induced dermatomyositis: true amyopathic dermatomyositis or dermatomyositis-like eruption? Int J Dermatol 2012; 51:535-41. [PMID: 22515579 DOI: 10.1111/j.1365-4632.2011.05105.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hydroxyurea-induced dermatomyositis is a rare adverse reaction of long-term hydroxyurea therapy. It has been reported under different names; however, the exact classification and nomenclature of this eruption have been the subject of much debate, and a more precise term is still awaiting. Herein, we review the different aspects of this reaction and suggest a new term that might help to minimize the confusion about its nomenclature. MATERIALS AND METHODS We describe a 68-year-old woman who had been on long-term hydroxyurea therapy for the treatment of chronic myeloid leukemia for nine years. She presented with typical dermatomyositis-like lesions and many of the other mucocutaneous adverse effects of hydroxyurea. RESULTS Skin examination revealed typical Gottron's papules on the dorsa of the hands, atrophy, xerosis, acquired ichthyosis, photosensitivity, cutaneous, oral and nail hyperpigmentation, acral erythema, palmoplantar keratoderma, actinic keratoses, and leg ulcers. There was no clinical or laboratory evidence of proximal muscle weakness. Cessation of hydroxyurea was associated with remarkable improvement of the skin lesions. CONCLUSION Hydroxyurea-induced dermatomyositis is a rare drug-induced dermatomyositis characterized by skin lesions identical to classic dermatomyositis without clinical or laboratory evidence of myositis. We propose that the term hydroxyurea-induced amyopathic dermatomyositis that adequately describes the findings reported in this subset of patients would be more precise and specific.
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Affiliation(s)
- Ahmad Nofal
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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Abdel-Kader N, Jiménez-Sánchez MD, Vargas C, Méndez C. [A child with calcinosis and dermatological signs of connective tissue disease]. An Pediatr (Barc) 2012; 78:60-1. [PMID: 22595638 DOI: 10.1016/j.anpedi.2011.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 10/15/2011] [Accepted: 12/13/2011] [Indexed: 11/24/2022] Open
Affiliation(s)
- N Abdel-Kader
- Servicio de Reumatología, Hospital Universitario Virgen Macarena, Sevilla, España.
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Walling HW, Swick BL. Update on the management of chronic eczema: new approaches and emerging treatment options. Clin Cosmet Investig Dermatol 2010; 3:99-117. [PMID: 21437065 PMCID: PMC3047944 DOI: 10.2147/ccid.s6496] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Indexed: 01/24/2023]
Abstract
Atopic dermatitis (AD) is a common disease with worldwide prevalence, affecting up to 20% of children and 3% of adults. Recent evidence regarding pathogenesis has implicated epidermal barrier defects deriving from filagrin mutations with resulting secondary inflammation. In this report, the authors comprehensively review the literature on atopic dermatitis therapy, including topical and systemic options. Most cases of AD will benefit from emollients to enhance the barrier function of skin. Topical corticosteroids are first-line therapy for most cases of AD. Topical calcineurin inhibitors (tacrolimus ointment, pimecrolimus cream) are considered second line therapy. Several novel barrier-enhancing prescription creams are also available. Moderate to severe cases inadequately controlled with topical therapy may require phototherapy or systemic therapy. The most commonly employed phototherapy modalites are narrow-band UVB, broadband UVB, and UVA1. Traditional systemic therapies include short-term corticosteroids, cyclosporine (considered to be the gold standard), methotrexate, azathioprine, mycophenolate mofetil, and most recently leflunamide. Biologic therapies include recombinant monoclonal antibodies acting on the immunoglobulin E / interleukin-5 pathway (omalizumab, mepolizumab), acting as tumor necrosis factor-α inhibitors (infliximab, etanercept, adalimumab), and acting as T-cell (alefacept) and B-cell (rituxumab) inhibitors, as well as interferon γ and intravenous immunoglobulin. Efficacy, safety, and tolerability are reviewed for each medication.
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