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Liang J, Wan L, Yao Y, Cui X, He Y, Li S, Jiang M, Sun Y, Cao H, Lin J. An externally validated clinical-laboratory nomogram for myocardial involvement in adult idiopathic-inflammatory-myopathy patients. Clin Rheumatol 2024; 43:1959-1969. [PMID: 38587715 PMCID: PMC11111495 DOI: 10.1007/s10067-024-06948-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/09/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES This study aimed at identifying clinical and laboratory risk factors for myocardial involvement (MI) in idiopathic inflammatory myopathies (IIMs) patients as well as constructing a risk-predicted nomogram for prediction and early identification of MI. METHODS An IIMs cohort in southeastern China was constructed, including 504 adult IIMs patients who met the inclusion and exclusion criteria, and were hospitalized at four divisions of the First Affiliated Hospital, Zhejiang University School of Medicine from January 1st 2018 to April 30st 2022. After dividing patients into the training cohort and the validation cohort, risk factors for MI were identified through least absolute shrinkage and selection operator regression and multivariate logistic regression. A risk-predicted nomogram was established and validated internally and externally for discrimination, calibration and practicability. RESULTS In this cohort, 17.7% of patients developed MI and the survival was significantly inferior to that of IIMs patients without MI (P < 0.001). In the training cohort, age > 55 years old (P < 0.001), disease activity > 10 points (P < 0.001), interleukin-17A (IL-17A) > 7.5 pg/ml (P < 0.001), lactic dehydrogenase (LDH) > 425 U/L (P < 0.001), anti-mitochondrial antibodies (AMAs, P = 0.017), and anti-MDA5 antibody (P = 0.037) were significantly correlated with development of MI. A nomogram was established by including the above values to predict MI and was found efficient in discrimination, calibration, and practicability through internal and external validation. CONCLUSION This study developed and validated a nomogram model to predict the risk of MI in adult IIMs patients, which can benefit the prediction and early identification of MI as well as timely intervention in these patients.
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Affiliation(s)
- Junyu Liang
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Liyan Wan
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Yake Yao
- Department of Respiratory Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Cui
- Department of Cardiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ye He
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Shuangshuang Li
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Mengdi Jiang
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Yiduo Sun
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China
| | - Heng Cao
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China.
| | - Jin Lin
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Zhejiang Province, Hangzhou, 310003, China.
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He Y, Liang J, Cao H, Lin J. The potential role of 18 F-FDG PET/CT in dermatomyositis with cardiac involvement: A case report. Int J Rheum Dis 2023. [PMID: 36744420 DOI: 10.1111/1756-185x.14599] [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: 08/18/2022] [Revised: 10/02/2022] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dermatomyositis (DM) is a chronic inflammatory muscle disease. Cardiac involvement is reported to be a main cause of death in DM but typically remains subclinical. Delayed or missed diagnosis renders more severe prognosis in DM patients. CASE SUMMARY A 69-year-old man with a 6-month history of shortness of breath, cough and characteristic cutaneous lesions was diagnosed with DM complicated with interstitial lung disease on his first admission. Within 47 days, the patient developed progressive heart failure with dyspnea. The levels of B-type natriuretic peptide and Troponin I drastically increased and the cardiac function prominently decreased. According to the result of cardiac magnetic resonance, he was finally diagnosed with DM combined with cardiac involvement. Interestingly, the abnormal cardiac metabolism on 18 F-fluorodeoxyglucose positron emission tomography / computed tomography FDG PET/CT had been found before the cardiac involvement was clinically identified. CONCLUSIONS 18 F-FDG PET/CT may play a potential role in early recognition of cardiac involvement in patients with DM, although more data is still needed.
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Affiliation(s)
- Ye He
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Junyu Liang
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Heng Cao
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jin Lin
- Department of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Bentick G, Fairley J, Nadesapillai S, Wicks I, Day J. Defining the clinical utility of PET or PET-CT in idiopathic inflammatory myopathies: A systematic literature review. Semin Arthritis Rheum 2022; 57:152107. [DOI: 10.1016/j.semarthrit.2022.152107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/22/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
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Yang J, Yan B. Rare complications of anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis: Time to nip them in the bud. Front Immunol 2022; 13:1009546. [PMID: 36275649 PMCID: PMC9584642 DOI: 10.3389/fimmu.2022.1009546] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis (MDA5+ DM) is an infrequent autoimmune disease, which mainly distributes in Asians and females. MDA5+ DM usually presents various skin lesions and positive anti-MDA5 antibody (a myositis-specific autoantibody for itself) with amyopathic or hypomyopathic features. For MDA5+ DM patients, rapidly progressive interstitial lung disease is a common complication with a high-speed deterioration and a poor prognosis. Besides, there are other complications of MDA5+ DM patients, including pneumomediastinum, macrophage activation syndrome and spontaneous intramuscular hemorrhage. These complications were rare but lethal, so it is necessary to explore their diagnosis methods, therapies and potential mechanisms, which are helpful for early diagnoses and timely treatment. To date, several cases and studies have shown distinctive features, diagnoses and treatments of these three rare complications, and there are also some differences among them. In this review, we outlined the characteristics, administration and potential pathogenesis of these rare complications of MDA5+ DM.
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Albayda J, Demonceau G, Carlier PG. Muscle imaging in myositis: MRI, US, and PET. Best Pract Res Clin Rheumatol 2022; 36:101765. [PMID: 35760742 DOI: 10.1016/j.berh.2022.101765] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Imaging is an important tool in the evaluation of idiopathic inflammatory myopathies. It plays a role in diagnosis, assessment of disease activity and follow-up, and as a non-invasive biomarker. Among the different modalities, nuclear magnetic resonance imaging (MRI), ultrasound (US), and positron emission tomography (PET) may have the most clinical utility in myositis. MRI is currently the best modality to evaluate skeletal muscle and provides excellent characterization of muscle edema and fat replacement through the use of T1-weighted and T2-weighted fat suppressed/STIR sequences. Although MRI can be read qualitatively for the presence of abnormalities, a more quantitative approach using Dixon sequences and the generation of water T2 parametric maps would be preferable for follow-up. Newer protocols such as diffusion-weighted imaging, functional imaging measures, and spectroscopy may be of interest to provide further insights into myositis. Despite the advantages of MRI, image acquisition is relatively time-consuming, expensive, and not accessible to all patients. The use of US to evaluate skeletal muscle in myositis is gaining interest, especially in chronic disease, where fat replacement and fibrosis are detected readily by this modality. Although easily deployed at the bedside, it is heavily dependent on operator experience to recognize disease states. Further, systematic characterization of muscle edema by US is still needed. PET provides valuable information on muscle function at a cellular level. Fluorodeoxyglucose (FDG-PET) has been the most common application in myositis to detect pathologic uptake indicative of inflammation. The use of neurodegenerative markers is now also being utilized for inclusion body myositis. These different modalities may prove to be complementary methods for myositis evaluation.
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Affiliation(s)
- Jemima Albayda
- Division of Rheumatology, Johns Hopkins University, Baltimore, USA.
| | | | - Pierre G Carlier
- Université Paris-Saclay, CEA, DRF, Service Hospitalier Frederic Joliot, Orsay, France
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