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Kannappan R, Kumar R, Cichelli K, Brent LH. A Review of Myositis-Associated Interstitial Lung Disease. J Clin Med 2024; 13:4055. [PMID: 39064092 PMCID: PMC11278012 DOI: 10.3390/jcm13144055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
There is a well-established relationship between different subsets of idiopathic inflammatory myopathies (IIMs, myositis) and interstitial lung disease (ILD), with lung complications sometimes presenting prior to myopathic manifestations. The subtypes of myositis include those that are strongly associated with ILD, such as polymyositis (PM) and dermatomyositis (DM). Research has shown that in certain patients, these can then be further divided into subtypes using myositis-specific antibodies (MSAs), which are specific for myositis, and myositis-associated antibodies (MAAs), which can be found in myositis in overlap syndromes with other connective tissue diseases (CTDs). Notably, certain MSAs and MAAs are associated with ILD in patients with myositis. The clinical presentations of ILD in patients with myositis can vary widely and can be insidious in onset and difficult to diagnose. As ILD can progress rapidly in some cases, it is essential that clinicians are able to identify and diagnose ILD in patients with myositis. For this reason, the aim of this review is to highlight the clinical features, diagnostic criteria, important histopathologic, laboratory, and radiographic features, and treatment modalities for those patients with myositis-associated ILD.
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Affiliation(s)
- Renuka Kannappan
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Raagni Kumar
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Kimberly Cichelli
- Section of Rheumatology, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Lawrence H. Brent
- Section of Rheumatology, Temple University Hospital, Philadelphia, PA 19140, USA
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Narváez J, Cañadillas E, Castellví I, Alegre JJ, Vicens-Zygmunt V, Bermudo G, Vidal-Montal P, Molina Molina M, Nolla JM. Rituximab in the treatment of progressive interstitial lung disease associated with the antisynthetase syndrome. Arthritis Res Ther 2024; 26:122. [PMID: 38890654 PMCID: PMC11184916 DOI: 10.1186/s13075-024-03353-2] [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: 10/02/2023] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE To assess the real-world, long-term effectiveness of rituximab (RTX) as a rescue therapy in patients with antisynthetase syndrome and progressive interstitial lung disease (ASS-ILD). METHODS Multicentre observational retrospective longitudinal study of a cohort of patients with ASS-ILD that started treatment with RTX due to recurrent or ongoing progressive ILD despite therapy with glucocorticoids and immunosuppressants. RESULTS Twenty-eight patients were analyzed. Examining the entire study population, before treatment with RTX the mean decline in %pFVC and %pDLCO from the ASS-ILD diagnosis to the initiation of RTX treatment (T0) was -6.44% and -14.85%, respectively. After six months of treatment, RTX reversed the decline in pulmonary function test (PFT) parameters: ∆%pFVC +6.29% (95% CI: -10.07 to 2.51; p=0.002 compared to T0) and ∆%pDLCO +6.15% (95% CI: -10.86 to -1.43; p=0.013). Twenty-four patients completed one year of therapy and 22 two years, maintaining the response in PFT: ∆%pFVC: +9.93% (95% CI: -15.61 to -4.25; p=0.002) and ∆%pDLCO: +7.66% (95% CI: -11.67 to -3.65; p<0.001). In addition, there was a significant reduction in the median dose of prednisone, and it could be suspended in 18% of cases. In 33% of patients who required oxygen therapy at the start of treatment, it could be discontinued. The frequency of adverse events reached 28.5% of cases. CONCLUSION Based on our results, RTX appears to be effective as rescue therapy in most patients with recurrent or progressive ASS-ILD unresponsive to conventional treatment. The use of RTX was well tolerated in the majority of patients.
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Affiliation(s)
- Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge. Bellvitge Biomedical Research Institute (IDIBELL), Feixa Llarga, s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Elena Cañadillas
- Department of Rheumatology, Hospital Clínico, Universitario Lozano Blesa, Zaragoza, Spain
| | - Iván Castellví
- Department of Rheumatology. Hospital, Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan José Alegre
- Department of Rheumatology. Hospital, Universitario Dr Peset, Valencia, Spain
| | - Vanesa Vicens-Zygmunt
- Interstitial Lung Disease Unit, Department of Pneumology. Hospital, Universitario de Bellvitge. Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Guadalupe Bermudo
- Interstitial Lung Disease Unit, Department of Pneumology. Hospital, Universitario de Bellvitge. Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Paola Vidal-Montal
- Department of Rheumatology, Hospital Universitario de Bellvitge. Bellvitge Biomedical Research Institute (IDIBELL), Feixa Llarga, s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - María Molina Molina
- Interstitial Lung Disease Unit, Department of Pneumology. Hospital, Universitario de Bellvitge. Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Joan Miquel Nolla
- Department of Rheumatology, Hospital Universitario de Bellvitge. Bellvitge Biomedical Research Institute (IDIBELL), Feixa Llarga, s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
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Wu S, Xiao X, Zhang Y, Zhang X, Wang G, Peng Q. Novel endotypes of antisynthetase syndrome identified independent of anti-aminoacyl transfer RNA synthetase antibody specificity that improve prognostic stratification. Ann Rheum Dis 2024; 83:775-786. [PMID: 38395605 DOI: 10.1136/ard-2023-225284] [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: 11/14/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES To systemically analyse the heterogeneity in the clinical manifestations and prognoses of patients with antisynthetase syndrome (ASS) and evaluate the transcriptional signatures related to different clinical phenotypes. METHODS A total of 701 patients with ASS were retrospectively enrolled. The clinical presentation and prognosis were assessed in association with four anti-aminoacyl transfer RNA synthetase (ARS) antibodies: anti-Jo1, anti-PL7, anti-PL12 and anti-EJ. Unsupervised machine learning was performed for patient clustering independent of anti-ARS antibodies. Transcriptome sequencing was conducted in clustered ASS patients and healthy controls. RESULTS Patients with four different anti-ARS antibody subtypes demonstrated no significant differences in the incidence of rapidly progressive interstitial lung disease (RP-ILD) or prognoses. Unsupervised machine learning, independent of anti-ARS specificity, identified three endotypes with distinct clinical features and outcomes. Endotype 1 (RP-ILD cluster, 23.7%) was characterised by a high incidence of RP-ILD and a high mortality rate. Endotype 2 (dermatomyositis (DM)-like cluster, 14.5%) corresponded to patients with DM-like skin and muscle symptoms with an intermediate prognosis. Endotype 3 (arthritis cluster, 61.8%) was characterised by arthritis and mechanic's hands, with a good prognosis. Transcriptome sequencing revealed that the different endotypes had distinct gene signatures and biological processes. CONCLUSIONS Anti-ARS antibodies were not significant in stratifying ASS patients into subgroups with greater homogeneity in RP-ILD and prognoses. Novel ASS endotypes were identified independent of anti-ARS specificity and differed in clinical outcomes and transcriptional signatures, providing new insights into the pathogenesis of ASS.
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Affiliation(s)
- Shiyu Wu
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People's Republic of China
- Department of Rheumatology, Key Lab of Myositis, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Xinyue Xiao
- Department of Rheumatology, Key Lab of Myositis, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yingfang Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People's Republic of China
- Department of Rheumatology, Key Lab of Myositis, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Xinxin Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People's Republic of China
- Department of Rheumatology, Key Lab of Myositis, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Guochun Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People's Republic of China
- Department of Rheumatology, Key Lab of Myositis, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Qinglin Peng
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People's Republic of China
- Department of Rheumatology, Key Lab of Myositis, China-Japan Friendship Hospital, Beijing, People's Republic of China
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Patel P, Marinock JM, Ajmeri A, Brent LH. A Review of Antisynthetase Syndrome-Associated Interstitial Lung Disease. Int J Mol Sci 2024; 25:4453. [PMID: 38674039 PMCID: PMC11050089 DOI: 10.3390/ijms25084453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Our objective in this review article is to present a clinical case of a patient with antisynthetase syndrome (ASyS) and provide an overview of the pathogenesis, classification criteria, antibody profiles, clinical features, and current knowledge of treatment options, focusing on interstitial lung disease (ILD). ASyS is an uncommon autoimmune disease with a heterogenous clinical presentation characterized by the presence of autoantibodies against an aminoacyl-tRNA synthetase and manifested by myositis, fever, inflammatory arthritis, Raynaud's phenomenon, mechanics hands, and ILD. ASyS-associated ILD (ASyS-ILD) is the most serious complication of ASyS, which may evolve to rapidly progressive ILD; therefore, it often requires thorough clinical and radiologic evaluation including recognition of a specific clinical phenotype associated with the antisynthetase antibodies (ASAbs) to guide therapeutic interventions.
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Affiliation(s)
- Puja Patel
- Section of Rheumatology, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Jenna M. Marinock
- Department of Medicine, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Aamir Ajmeri
- Department of Thoracic Medicine, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Lawrence H. Brent
- Section of Rheumatology, Temple University Hospital, Philadelphia, PA 19140, USA
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Good SD, Sparks JA, Volkmann ER. Screening, diagnosis, and monitoring of interstitial lung disease in autoimmune rheumatic diseases: A narrative review. REVISTA COLOMBIANA DE REUMATOLOGIA 2024; 31:S3-S14. [PMID: 39238598 PMCID: PMC11376317 DOI: 10.1016/j.rcreu.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Interstitial lung disease (ILD) is a common and serious manifestation of autoimmune rheumatic diseases. While the prevalence of ILD differs among the individual autoimmune rheumatic diseases, ILD remains an important cause of morbidity and mortality in systemic sclerosis, systemic lupus erythematosus, mixed connective tissue disease, primary Sjögren's disease, rheumatoid arthritis, and idiopathic inflammatory myositis. The present review summarizes recent literature on autoimmune-associated ILD with a focus on screening and monitoring for ILD progression. Reflecting on the currently available evidence, the authors propose a guideline for monitoring for progression in patients with newly diagnosed autoimmune-associated ILD. This review also highlights clinical and biological predictors of progressive pulmonary fibrosis and describes opportunity for further study in the rapidly evolving area of rheumatology and pulmonology.
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Affiliation(s)
- Samuel D Good
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Elizabeth R Volkmann
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
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Ghias A, Chawla S, Agarwala P. Patient With Pulmonary Symptoms, Dysphagia, and Raynaud Disease. JAMA 2023; 330:658-659. [PMID: 37498616 DOI: 10.1001/jama.2023.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
A nonsmoking patient with gastroesophageal reflux disease and Raynaud disease had 4 weeks of dysphagia and a 4.54-kg weight loss over 3 months, cough productive of yellow sputum, and dyspnea on exertion. White blood cell count and creatine kinase and aldolase levels were elevated; antinuclear antibody assay findings were positive; and chest CT showed bibasilar pulmonary consolidations and ground glass opacities. What is the diagnosis and what would you do next?
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Affiliation(s)
- Aisha Ghias
- Department of Internal Medicine, NYU Langone Health, Mineola, New York
| | - Shalinee Chawla
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Langone Health, Mineola, New York
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Pokharel A, Karageorgiou I, Acharya I, Billups T, Bateman J. Antisynthetase Syndrome With Paraneoplastic Antibodies. Cureus 2023; 15:e40354. [PMID: 37366475 PMCID: PMC10290814 DOI: 10.7759/cureus.40354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Antisynthetase syndrome (ASyS) is an uncommon systemic autoimmune disorder characterized by the presence of autoantibodies targeting aminoacyl-transfer RNA (tRNA) synthetase. The syndrome displays a diverse range of clinical manifestations affecting multiple organs, thereby posing a diagnostic challenge. In this report, we present an unusual case of a patient diagnosed with ASyS, displaying positive anti-PL-12 antibodies along with paraneoplastic antibodies. To the best of our knowledge, this is the first documented case in the existing literature describing ASyS with the presence of anti-PL-12 antibodies and concomitant paraneoplastic antibodies in the context of ductal carcinoma in situ.
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Affiliation(s)
| | | | - Indira Acharya
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA
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Zekić T. Rituximab as the first-line therapy in anti-synthetase syndrome-related interstitial lung disease. Rheumatol Int 2023; 43:1015-1021. [PMID: 36928934 DOI: 10.1007/s00296-023-05302-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
Anti-synthetase syndrome (ASS) is an idiopathic inflammatory myopathy (IIM). In comparison to interstitial lung disease (ILD) in polymyositis and dermatomyositis (PM/DM), ILD in ASS is more frequent, has a more aggressive phenotype, a greater involvement of the lungs, and a more rapid onset of pulmonary symptoms. Continuous declines in predicted forced vital capacity (FVC) and dyspnea were the main features of patients who developed end-stage ILD. The severity of ASS at diagnosis dictates when and which immunosuppressant will be started. There is an experience for the usage of RTX in the first, second, and subsequent lines, as well as for reintroduction and salvage therapies. Not all ASS patients will develop severe illness and require intense immunosuppression. Some features associated with poor prognosis include older age, acute or subacute onset, lack of response to steroids, and lower baseline values for FVC and DLCO. Here we hypothesize that RTX should be the first line of treatment for high-risk ILD in ASS to preserve lung function and then maintenance therapy should be continued with the same or another drug depending on the recovery of lung function.
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Affiliation(s)
- Tatjana Zekić
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia.
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