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Allenzara A, Sadeghi N, Alvarez C, Maczuga S, Helm M, Olsen N, Nelson A, Foulke G. Obesity is an independent risk factor for cancer development following diagnosis of dermatomyositis. Semin Arthritis Rheum 2024; 64:152283. [PMID: 37984228 PMCID: PMC10842776 DOI: 10.1016/j.semarthrit.2023.152283] [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: 02/23/2023] [Revised: 09/23/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
Patients with dermatomyositis (DM) are at an increased risk of cancer development, especially around the time of diagnosis of DM. Obesity is also a risk factor in the general population for cancer development. This study aimed to assess the association between cancer in DM patients with and without obesity as defined by ICD code and BMI data. In this analysis of patients with DM, logistic regression modeling of the odds of cancer outcome was performed for patients with DM and obesity compared to those without obesity, adjusted for age and sex. A total of 12,722 patients with DM were identified, of whom 6,055 had available BMI data. DM patients who were coded obese at any point had significantly higher odds 1.98 (95 % Confidence interval (CI) 1.70, 2.30) of a subsequent cancer diagnosis. This association was also found in the subgroup analysis with available BMI where patients with obesity (BMI ≥30 kg/m2) had an increased odds of cancer 1.23 (1.02, 1.49) when compared to patients with BMI <30 kg/m2 with DM. In time to event analysis any obesity code was associated with a 16 % increased hazard of cancer (adjusted hazard ratio 1.16 [95 % CI 1.02, 1.31]). Overall, the most frequent type of cancer was breast cancer, however patients with DM and obesity had higher frequencies of lymphoma, colorectal, melanoma, uterine, renal cancers compared to patients with DM without obesity.
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Affiliation(s)
- Astia Allenzara
- University of North Carolina at Chapel Hill, Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, Chapel Hill, NC, USA.
| | - Nakisa Sadeghi
- University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Carolina Alvarez
- University of North Carolina at Chapel Hill, Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, Chapel Hill, NC, USA
| | - Steve Maczuga
- Penn State Health Milton S Hershey Medical Center, Department of Dermatology, Hershey, PA, USA
| | - Matthew Helm
- Penn State Health Milton S Hershey Medical Center, Department of Dermatology, Hershey, PA, USA
| | - Nancy Olsen
- Penn State Health Milton S Hershey Medical Center, Division of Rheumatology, Hershey, PA, USA
| | - Amanda Nelson
- University of North Carolina at Chapel Hill, Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, Chapel Hill, NC, USA; University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Galen Foulke
- Penn State Health Milton S Hershey Medical Center, Department of Dermatology, Hershey, PA, USA; Penn State Health Milton S Hershey Medical Center, Department of Public Health Sciences, Hershey, PA, USA
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Lagacé F, D’Aguanno K, Prosty C, Laverde-Saad A, Cattelan L, Ouchene L, Oliel S, Genest G, Doiron P, Richer V, Jfri A, O’Brien E, Lefrançois P, Powell M, Moreau L, Litvinov IV, Muntyanu A, Netchiporouk E. The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications. J Cutan Med Surg 2023; 27:NP1-NP36. [PMID: 37401812 PMCID: PMC10486181 DOI: 10.1177/12034754231177582] [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: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. OBJECTIVES AND PROJECT DESCRIPTION The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. FUTURE IMPACT With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Connor Prosty
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Alexandra Laverde-Saad
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Lydia Ouchene
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sarah Oliel
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Genevieve Genest
- Division of Allergy and Immunology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philip Doiron
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Abdulhadi Jfri
- Department of Dermatology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth O’Brien
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Powell
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Moreau
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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3
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Kardes S, Gupta L, Aggarwal R. Cancer and myositis: Who, when, and how to screen. Best Pract Res Clin Rheumatol 2022; 36:101771. [PMID: 35970749 DOI: 10.1016/j.berh.2022.101771] [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: 11/27/2022]
Abstract
Cancer screening in idiopathic inflammatory myopathies (IIMs) is essential because an increased risk of cancer in IIMs has been well demonstrated. However, a consensus regarding cancer screening approaches is lacking. Therefore, the approach presented in this review reflects available evidence and our clinical experiences. Patients with IIMs should be evaluated for 3 distinct types of risk categories: (a) clinical with their history, physical examination, and laboratory parameters; (b) based on IIMs subtypes; and (c) based on serology - myositis specific and associated autoantibodies. Further, according to these characteristics, patients should be classified as low risk, moderate risk, and high risk for cancer. In our approach, all patients with IIM within 3 years of disease onset should undertake cancer screening according to their risk stratification. First, irrespective of risk, all patients should undergo age and gender-appropriate screening as per local guidelines. Patients at low-risk stratification should undertake basic cancer screening with routine blood counts, labs, and imaging; at moderate-risk stratification, patients should undertake enhanced cancer screening including CT chest; and at high-risk stratification, patients should undertake comprehensive cancer screening including PET/CT at baseline. Consensus guidelines among all major stakeholders, including rheumatologists, neurologists, dermatologists, and oncologists representing different parts of the world, establishing uniform cancer screening approaches in patients with IIM, are the need of the hour.
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Affiliation(s)
- Sinan Kardes
- Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Turkey.
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; 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.
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Harada Y, Tominaga M, Iitoh E, Kaieda S, Koga T, Fujimoto K, Chikasue T, Obara H, Kakuma T, Ida H, Kawayama T, Hoshino T. Clinical Characteristics of Anti-TIF-1γ Antibody-Positive Dermatomyositis Associated with Malignancy. J Clin Med 2022; 11:jcm11071925. [PMID: 35407533 PMCID: PMC8999723 DOI: 10.3390/jcm11071925] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
We retrospectively analyzed the clinical and laboratory data of patients diagnosed with anti-transcriptional intermediary factor 1 (TIF-1γ) antibody-positive polymyositis (PM)/dermatomyositis (DM) to clarify the characteristics of this disease. We identified 14 patients with TIF-1γ antibody-positive DM (TIF-1γ DM), 47 with anti-aminoacyl-tRNA synthetase antibody (ARS)-positive PM/DM, and 24 with anti-melanoma differentiation-associated gene 5 antibody (MDA-5)-positive PM/DM treated at the Kurume University Hospital between 2002 and 2020. Patients with TIF-1γ DM were significantly older than the other two groups. Nine patients with TIF-1γ DM were female, thirteen patients had DM, and one had clinically amyopathic DM. Primary malignant lesions were lung (3), uterus (2), colon (2), breast (2), ovary (1), lymphoma (1), and unknown (2). Cutaneous manifestation and dysphagia were the most common symptoms in TIF-1γ DM. Erythema (9/14), the V-neck sign (8/14), heliotrope (9/14), and nailfold telangiectasia (14/14) were significantly more common in TIF-1γ DM. Furthermore, no patients with TIF-1γ DM had interstitial lung abnormality on high-resolution CT. In patients with TIF-1γ DM, the frequency of dysphagia and unusual erythema, particularly that which spreads from the trunk, and nailfold telangiectasia, were characteristic findings. In most patients with TIF-1γ DM, it is necessary to administer other immunosuppressive drugs along with glucocorticoids.
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Affiliation(s)
- Yumi Harada
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Masaki Tominaga
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
- Correspondence: ; Tel.: +81-942-31-7560; Fax: +81-942-31-7703
| | - Eriko Iitoh
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Shinjiro Kaieda
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Takuma Koga
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Kiminori Fujimoto
- Department of Radiology, Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume 830-0011, Japan; (K.F.); (T.C.)
| | - Tomonori Chikasue
- Department of Radiology, Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume 830-0011, Japan; (K.F.); (T.C.)
| | - Hitoshi Obara
- Biostatistics Center, Kurume University, Kurume 830-0011, Japan; (H.O.); (T.K.)
| | - Tatsuyuki Kakuma
- Biostatistics Center, Kurume University, Kurume 830-0011, Japan; (H.O.); (T.K.)
| | - Hiroaki Ida
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Tomotaka Kawayama
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Tomoaki Hoshino
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
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Update on Malignancy in Myositis—Well-Established Association with Unmet Needs. Biomolecules 2022; 12:biom12010111. [PMID: 35053259 PMCID: PMC8773676 DOI: 10.3390/biom12010111] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 12/31/2022] Open
Abstract
Idiopathic inflammatory myopathies are a group of rare connective tissue diseases with a well-documented association with malignancy. The mechanisms underlying the increased risk of neoplasms in the course of myositis are not fully understood. The Pubmed database has been thoroughly screened for articles concerning cancer-associated myositis (CAM). The article summarizes the current state of knowledge on the epidemiology and pathogenesis of CAM. Furthermore, it analyses potential risk and protective factors for developing CAM, with particular emphasis on the association with distinct serological profiles. The review summarizes recommendations proposed so far for the management of CAM and presents a novel scheme for cancer screening proposed by the authors. Moreover, promising areas requiring further research were indicated.
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6
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Oldroyd AGS, Allard AB, Callen JP, Chinoy H, Chung L, Fiorentino D, George MD, Gordon P, Kolstad K, Kurtzman DJB, Machado PM, McHugh NJ, Postolova A, Selva-O'Callaghan A, Schmidt J, Tansley S, Vleugels RA, Werth VP, Aggarwal R. A systematic review and meta-analysis to inform cancer screening guidelines in idiopathic inflammatory myopathies. Rheumatology (Oxford) 2021; 60:2615-2628. [PMID: 33599244 PMCID: PMC8213426 DOI: 10.1093/rheumatology/keab166] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/26/2021] [Accepted: 02/11/2021] [Indexed: 02/04/2023] Open
Abstract
Objectives To identify clinical factors associated with cancer risk in the idiopathic inflammatory myopathies (IIMs) and to systematically review the existing evidence related to cancer screening. Methods A systematic literature search was carried out on Medline, Embase and Scopus. Cancer risk within the IIM population (i.e. not compared with the general population) was expressed as risk ratios (RR) for binary variables and weighted mean differences (WMD) for continuous variables. Evidence relating to cancer screening practices in the IIMs were synthesized via narrative review. Results Sixty-nine studies were included in the meta-analysis. DM subtype (RR 2.21), older age (WMD 11.19), male sex (RR 1.53), dysphagia (RR 2.09), cutaneous ulceration (RR 2.73) and anti-transcriptional intermediary factor-1 gamma positivity (RR 4.66) were identified as being associated with significantly increased risk of cancer. PM (RR 0.49) and clinically amyopathic DM (RR 0.44) subtypes, Raynaud’s phenomenon (RR 0.61), interstitial lung disease (RR 0.49), very high serum creatine kinase (WMD −1189.96) or lactate dehydrogenase (WMD −336.52) levels, and anti-Jo1 (RR 0.45) or anti-EJ (RR 0.17) positivity were identified as being associated with significantly reduced risk of cancer. Nine studies relating to IIM-specific cancer screening were included. CT scanning of the thorax, abdomen and pelvis appeared to be effective in identifying underlying asymptomatic cancers. Conclusion Cancer risk factors should be evaluated in patients with IIM for risk stratification. Screening evidence is limited but CT scanning could be useful. Prospective studies and consensus guidelines are needed to establish cancer screening strategies in IIM patients.
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Affiliation(s)
- Alexander G S Oldroyd
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Andrew B Allard
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Jeffrey P Callen
- Division of Medicine, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Department of Medicine and Dermatology, Stanford University, Stanford, USA.,Palo Alto Health Care System, Palo Alto, USA
| | - David Fiorentino
- Department of Dermatology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Michael D George
- Division of Rheumatology, Philadelphia, PA, USA.,Division of Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kate Kolstad
- Department of Dermatology, School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Anna Postolova
- Department of Immunology and Rheumatology, Stanford Health Care, Stanford, CA, USA
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Unity, Vall D'Hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jens Schmidt
- Department of Neurology, Neuromuscular Centre, Göttingen, Germany
| | - Sarah Tansley
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Department of Neurology, Neuromuscular Centre, Göttingen, Germany
| | - Ruth Ann Vleugels
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.,Division of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Irekeola AA, Shueb RH, E. A. R. ENS, Wada Y, Abdul Rahman Z, Ahmad S, Mohamud R, Mat Lazim N, Yean CY. Prevalence of Nasopharyngeal Carcinoma in Patients with Dermatomyositis: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13081886. [PMID: 33919987 PMCID: PMC8071042 DOI: 10.3390/cancers13081886] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/25/2021] [Accepted: 04/03/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary This first systematic review and meta-analysis on the prevalence of nasopharyngeal carcinoma in patients suffering dermatomyositis was necessitated by the absence of a true and reliable prevalence estimate necessary to adequately inform medical preparedness and decisions. Following a careful review of literature and data analyses, a prevalence of 3.3% was found. It is hoped that a clear knowledge of the actual prevalence of nasopharyngeal carcinoma in dermatomyositis patients would not only help sensitize clinicians and patients about the frequency of these disease conditions but would also enhance the adoption of precautions essential to mitigate their co-occurrence in patients. Abstract For more than 50 years, nasopharyngeal carcinoma (NPC) has been associated with dermatomyositis (DM), a rare idiopathic inflammatory disorder that mainly affects the skin and muscles. Although the association between these rare diseases is well-documented, the actual prevalence of NPC in DM patients remains unknown. Here, a systematic review and meta-analysis of published data was conducted in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Electronic databases including PubMed, Scopus, ScienceDirect, and Google Scholar were searched without year or language restrictions for studies reporting the occurrence of NPC in DM patients. The study protocol was lodged with PROSPERO (CRD42021225335). A total of 95 studies covering 303 cases of NPC among 16,010 DM patients was included. Summary estimates were calculated using the random-effects model. The pooled prevalence of NPC in DM was 3.3% (95% CI, 2.5–4.3). When stratified according to study location, higher prevalence estimates were obtained for Hong Kong (36.5%), Malaysia (27.7%), and Singapore (11.9%). There was a predominance of cases among male DM patients compared with females, and most patients were aged 40 and above. Many of the NPC cases were found to be diagnosed after the diagnosis of DM. It is therefore pertinent to screen for NPC in DM patients, especially among older DM patients in the Asian region.
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Affiliation(s)
- Ahmad Adebayo Irekeola
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
- Microbiology Unit, Department of Biological Sciences, College of Natural and Applied Sciences, Summit University Offa, Offa PMB 4412, Nigeria
| | - Rafidah Hanim Shueb
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence:
| | - Engku Nur Syafirah E. A. R.
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
| | - Yusuf Wada
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
- Department of Zoology, Faculty of Life Sciences, Ahmadu Bello University, Zaria 810211, Nigeria
| | - Zaidah Abdul Rahman
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
- Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Suhana Ahmad
- Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (S.A.); (R.M.)
| | - Rohimah Mohamud
- Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (S.A.); (R.M.)
| | - Norhafiza Mat Lazim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Chan Yean Yean
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.A.I.); (E.N.S.E.A.R.); (Y.W.); (Z.A.R.); (C.Y.Y.)
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Prevalence of interstitial lung disease in polymyositis and dermatomyositis: A meta-analysis from 2000 to 2020. Semin Arthritis Rheum 2020; 51:175-191. [PMID: 33383294 DOI: 10.1016/j.semarthrit.2020.11.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/18/2020] [Accepted: 11/12/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Interstitial lung disease (ILD) is the most important prognostic factor for mortality in patients with polymyositis (PM) and dermatomyositis (DM), but the prevalence of ILD in PM/DM may vary between countries. The aim of this study was to determine the overall prevalence of ILD in global patients with PM/DM. METHODS We performed a systematic literature review of studies published from Jan 1, 2000 to April 30, 2020 on ILD and PM/DM. We extracted data and pooled the prevalence by using a random-effect model due to high heterogeneity. Heterogeneity was assessed by subgroup analysis and sensitivity analysis. RESULTS A total of 34 studies with 10,130 patients were included in our meta-analysis. Pooled data demonstrated that the global prevalence of ILD in patients with PM/DM was 0.41 (95% confidence interval [CI] 0.35-0.48). However, this prevalence varied with geographical locations and time trends. The prevalence of ILD in PM/DM was 0.5 (95% CI 0.42-0.57) in Asia, 0.23 (95% CI 0.15-0.31) in America, and 0.26 (95% CI 0.18-0.34) in Europe. A higher prevalence of ILD was reported in studies published in 2011-2015 (0.43, 95% CI 0.34-0.52) and 2016-2020 (0.45, 95% CI 0.35-0.54), compared with those published in 2000-2010 (0.27, 95% CI 0.16-0.39). The pooled prevalence of ILD in patients with DM, PM, and clinically amyopathic dermatomyositis subtype was 0.42 (95% CI 0.35-0.49), 0.35 (95% CI 0.27-0.42), and 0.53 (95% CI 0.32-0.74), respectively. Patients with anti-Jo-1 and anti-melanoma differentiation-associated gene 5 antibodies were more likely to develop ILD than other myositis-specific autoantibodies. CONCLUSION The global prevalence of ILD in patients with PM/DM was approximately 41% and the condition was predominant in Asians. This highlights potential genetic and environmental differences in the pathogenesis of ILD in patients with PM/DM. More studies are required to elucidate the specific associations.
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Dani L, Ian Che W, Lundberg IE, Hellgren K, Holmqvist M. Overall and site-specific cancer before and after diagnosis of idiopathic inflammatory myopathies: A nationwide study 2002-2016. Semin Arthritis Rheum 2020; 51:331-337. [PMID: 33508731 DOI: 10.1016/j.semarthrit.2020.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the association between idiopathic inflammatory myopathy (IIM) and cancer before and after IIM diagnosis. METHODS We used prospectively collected nationwide register data to design a case-control study to investigate the occurrence of cancer before IIM, and a cohort study to investigate the occurrence of cancer after IIM. Patients diagnosed with IIM between 2002 and 2016 in Sweden, were compared to the general population. The association between cancer and IIM was estimated before and after IIM diagnosis via logistic regression and Cox regression models, respectively. RESULTS We included 1419 patients with IIM and 7045 individuals from the general population. The overall odds of cancer before IIM diagnosis were increased in IIM compared to the general population, adjusted odds ratio (AOR) 1.5, 95% confidence interval (CI) 1.3-1.8. This association was also noted after IIM diagnosis, adjusted hazard ratio (AHR) 1.7 (95% CI 1.4-2.0), or one additional cancer in every 125 IIM patients per year. Colorectal (AOR 2.1), lung (AOR 5.4) and ovarian (AOR 7.0) cancers were associated with IIM before diagnosis. Oropharyngeal (AHR 9.1) and cervical (AHR 3.8) cancers, malignant melanoma (AHR 3.2) and non-melanoma skin cancer (AHR 3.1) were associated with IIM after diagnosis. Adenocarcinomas were associated with dermatomyositis before diagnosis and squamous cell cancers after IIM diagnosis. Lymphatic hematopoietic cancers were associated with IIM both before and after diagnosis. CONCLUSIONS The cancer types that occur before IIM diagnosis differ from the ones that occur after diagnosis. This may have an impact on screening decisions for IIM.
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Affiliation(s)
- Lara Dani
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Weng Ian Che
- Clinical Epidemiology Division, Departement of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid E Lundberg
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Hellgren
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Clinical Epidemiology Division, Departement of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Marie Holmqvist
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Clinical Epidemiology Division, Departement of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Allenbach Y, Benveniste O, Stenzel W, Boyer O. Immune-mediated necrotizing myopathy: clinical features and pathogenesis. Nat Rev Rheumatol 2020; 16:689-701. [PMID: 33093664 DOI: 10.1038/s41584-020-00515-9] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Immune-mediated necrotizing myopathy (IMNM) is a group of inflammatory myopathies that was distinguished from polymyositis in 2004. Most IMNMs are associated with anti-signal recognition particle (anti-SRP) or anti-3-hydroxy-3-methylglutaryl-coA reductase (anti-HMGCR) myositis-specific autoantibodies, although ~20% of patients with IMNM remain seronegative. These associations have led to three subclasses of IMNM: anti-SRP-positive IMNM, anti-HMGCR-positive IMNM and seronegative IMNM. IMNMs are frequently rapidly progressive and severe, displaying high serum creatine kinase levels, and failure to treat IMNMs effectively may lead to severe muscle impairment. In patients with seronegative IMNM, disease can be concomitant with cancer. Research into IMNM pathogenesis has shown that anti-SRP and anti-HMGCR autoantibodies cause weakness and myofibre necrosis in mice, suggesting that, as well as being diagnostic biomarkers of IMNM, they may play a key role in disease pathogenesis. Therapeutically, treatments such as rituximab or intravenous immunoglobulins can now be discussed for IMNM, and targeted therapies, such as anticomplement therapeutics, may be a future option for patients with refractory disease.
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Affiliation(s)
- Yves Allenbach
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Inserm U974, Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Olivier Benveniste
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Inserm U974, Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Paris, France.
| | - Werner Stenzel
- Department of Neuropathology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Olivier Boyer
- Normandie University, UNIROUEN, Inserm U1234, Department of Immunology and Biotherapy, Rouen University Hospital, Rouen, France
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11
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Shao C, Li S, Sun Y, Zhang Y, Xu K, Zhang X, Huang H. Clinical characteristics and prognostic analysis of Chinese dermatomyositis patients with malignancies. Medicine (Baltimore) 2020; 99:e21899. [PMID: 32846853 PMCID: PMC7447382 DOI: 10.1097/md.0000000000021899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Although a strong association between idiopathic inflammatory myositis (IIM) and malignancy has been widely reported, few studies have solely focused on the concurrence of dermatomyositis (DM) and malignancies (DM-malignancy).We conducted a retrospective analysis of 37 DM-malignancy cases among 363 DM patients admitted to our hospital between January 2012 and December 2017.(1) The mean age at DM diagnosis was higher for DM-malignancy patients than for DM-non-malignancy patients [(54.76 ± 9.77) years vs (48.57 ± 12.82) years, t = 2.84, P = .005]. (2) Gynecological malignancies (35.90%/14 cases) were the most common malignancies. Malignancies were diagnosed before DM for 7 DM-malignancy patients. The interval between the DM and malignancy diagnoses for the remaining 32 DM-malignancy patients was less than 6 months for 18 patients (46.15%), less than 1 years for 23 patients (58.9%), and less than 2 years for 29 patients (74.26%). (3) There was no significant difference either in antinuclear antibody or anti-Ro-52 positivity between the 2 groups (P > .05). (4) Multivariate analysis demonstrated that DM onset age ≥50 years and concurrence with ILD increased the risk of death for DM patients [hazard ratio (HR): 1.62 and 2.72; 95% confidence interval (CI): (1.08-2.43) and (1.47-5.02); P = .02 and 0.001, respectively], and male gender decreased the risk of death [HR 0.66, 95% CI (0.44-0.98), P = .04]. DM-malignancy patients were older than DM-non-malignancy patients. Gynecological malignancies were the most common malignancies among these patients. A DM onset age ≥50 years, female sex and the presence of ILD were independent risk factors for death.
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Affiliation(s)
- Chi Shao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
| | - Shan Li
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
| | - Yuxin Sun
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
| | - Ying Zhang
- International Medical Service Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
| | - Kai Xu
- Radiological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
| | - Xin Zhang
- Medical Records Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, China
| | - Hui Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District
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12
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Moghadam-Kia S, Oddis CV, Ascherman DP, Aggarwal R. Risk Factors and Cancer Screening in Myositis. Rheum Dis Clin North Am 2020; 46:565-576. [DOI: 10.1016/j.rdc.2020.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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13
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Motegi SI, Sekiguchi A, Ikeuchi H, Sakairi T, Ogawa H, Fujii T, Sohda M, Yajima T, Ida S, Takayasu Y, Shimoda Y, Hiromura K, Saeki H, Shirabe K, Chikamatsu K, Yokoo H, Oyama T, Ishikawa O. Clinical features of anti-transcription intermediary factor 1γ (TIF1γ)-positive dermatomyositis with internal malignancy and investigation of the involvement of TIF1γ expression in tumors in the pathogenesis of cancer-associated dermatomyositis. J Dermatol 2020; 47:1395-1402. [PMID: 32734678 DOI: 10.1111/1346-8138.15526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
Anti-transcription intermediary factor 1γ (anti-TIF1γ) antibody (Ab) is significantly associated with internal malignancies in adult patients with dermatomyositis (DM). Although pathogenesis of cancer-associated DM is unknown, TIF1γ overexpression in tumors has been considered to be critical for the development of DM. The objective of this study was to investigate clinical characteristics of patients with anti-TIF1γ Ab-positive DM and elucidate risk factors that are potentially associated with internal malignancy. In addition, we compared the expression of TIF1γ in tumor tissues of patients with anti-TIF1γ Ab-positive DM, anti-TIF1γ Ab-negative DM and without DM in order to investigate the pathogenesis of cancer-associated DM. We analyzed 77 Japanese patients with DM, and found 19 patients to be positive for anti-TIF1γ Ab. Patients with anti-TIF1γ Ab-positive DM were older and presented heliotrope rash and flagellate erythema more frequently than patients without anti-TIF1γ Ab (P < 0.05). Interstitial lung disease (ILD) and rapidly progressive ILD, as well as palmar violaceous erythema, were less frequent in patients with anti-TIF1γ Ab than in patients without. Furthermore, internal malignancy and dysphagia were significantly more frequent in the anti-TIF1γ Ab-positive group (P < 0.01). Male sex and dysphagia were significantly associated with internal malignancy in patients with anti-TIF1γ Ab-positive DM (P < 0.01 and <0.05, respectively). Using immunohistochemistry, we examined the TIF1γ expression in tumors of 11 patients with cancer-associated DM (anti-TIF1γ Ab-positive, nine; anti-TIF1γ Ab-negative, two) and 25 patients without DM. TIF1γ was highly expressed in all tumors, and there was no significant difference in TIF1γ expression between patients with and without DM. Furthermore, TIF1γ expressions in tumors were similar irrespective of the presence of anti-TIF1γ Ab. These results suggest that anti-TIF1γ antibody may not be simply induced by overexpression of TIF1γ in tumors in patients with DM, but that other mechanisms may exist.
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Affiliation(s)
- Sei-Ichiro Motegi
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akiko Sekiguchi
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hidekazu Ikeuchi
- Department of, Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toru Sakairi
- Department of, Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroomi Ogawa
- Department of, General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takaaki Fujii
- Department of, General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Makoto Sohda
- Department of, General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshiki Yajima
- Department of, General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shota Ida
- Department of, Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yukihiro Takayasu
- Department of, Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuki Shimoda
- Department of, Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Keiju Hiromura
- Department of, Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Saeki
- Department of, General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ken Shirabe
- Department of, General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuaki Chikamatsu
- Department of, Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideaki Yokoo
- Department of, Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tetsunari Oyama
- Department of, Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Osamu Ishikawa
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Li S, Sun Y, Shao C, Xu K, Huang H. Diffuse large B-cell lymphoma in a patient with dermatomyositis-associated interstitial lung disease: A case report. Thorac Cancer 2019; 10:2035-2039. [PMID: 31452347 PMCID: PMC6775007 DOI: 10.1111/1759-7714.13171] [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: 07/06/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022] Open
Abstract
A 63‐year‐old man presented to our clinic complaining of cough and exertional dyspnea. He was diagnosed with dermatomyositis‐associated interstitial lung disease (DM‐ILD) with typical rashes, an elevated creatine kinase level and chest high‐resolution computed tomography (CT) manifestations. His symptoms and lung shadows improved after treatment with corticosteroids, immunosuppressants and pirfenidone, although his serum creatine kinase level remained elevated. An expanding nodule in the lower left lung and lymphadenopathy in the right cardiophrenic angle were visible on the repeated chest CT scan during follow‐up approximately one year later. Empirical antibiotics had no effect. A positron emission tomography‐computed tomography (PET‐CT) scan showed an increased standard uptake value (SUV) in the newly emerged pulmonary nodule, mediastinal lymphadenopathy and multiple hepatic masses. He was diagnosed with diffuse large B‐cell lymphoma following liver biopsy. After eight cycles of rituximab‐cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP) chemotherapy, the lymphoma was cured clinically, and his interstitial lung disease (ILD) had improved. Tumor surveillance should be performed during DM‐ILD follow‐up, and rituximab could be a promising choice for DM‐ILD concurrent with lymphoma.
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Affiliation(s)
- Shan Li
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuxin Sun
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chi Shao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kai Xu
- Radiological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hui Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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15
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Kim H, Sung YK, Choi S, Im SG, Jung SY, Jang EJ, Yoo DH, Cho SK. Increased risk of malignancy in patients aged over 50 with idiopathic inflammatory myositis compared to patients with osteoarthritis of the knee. Mod Rheumatol 2019; 30:870-877. [PMID: 31442092 DOI: 10.1080/14397595.2019.1660041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To estimate risk of malignancy in patients with idiopathic inflammatory myositis (IIM) compared to patients with knee osteoarthritis (OA).Methods: Patients with IIM and knee OA aged over 50, who had no history of malignancy, were identified using Korean National claims database from January 2012 to December 2014. They had been observed until a malignancy was diagnosed or up to the end of the study, December 2015. The incidence rate (IR) of malignancy in IIM patients was calculated and compared with knee OA patients using standardized incidence ratio (SIR).Results: A total of 634 polymyositis (PM) and 556 dermatomyositis (DM) patients were included. Overall, 100 solid (IR 270.4/10,000 person-years (PY), 95% confidence interval (CI) 217.4-323.4) and 12 hematologic malignancies (IR 32.4/10,000 PY, 95% CI 14.1-50.8) occurred. Compared with knee OA, risk of overall (SIR 1.5, 95% CI 1.2-1.8), solid (SIR 1.4, 95% CI 1.1-1.6), and hematologic malignancy (SIR 5.7, 95% CI 2.5-9.0) were increased in IIM patients. This was due to increased incidence of malignancy in DM (hematologic malignancy, SIR 8.7, 95% CI 2.7-14.7, solid malignancy, SIR 1.5, 95% CI 1.1-1.9).Conclusion: Patients with IIM, especially DM, have an increased risk of malignancy compared to patients with knee OA.
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Affiliation(s)
- Hyoungyoung Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Seongmi Choi
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Republic of Korea
| | - Seul Gi Im
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Republic of Korea.,Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, Republic of Korea
| | - Dae Hyun Yoo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
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Clinical characteristics and prognosis of polymyositis and dermatomyositis associated with malignancy: a 25-year retrospective study. Rheumatol Int 2019; 39:1733-1739. [PMID: 31444556 DOI: 10.1007/s00296-019-04428-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 08/19/2019] [Indexed: 12/21/2022]
Abstract
The objective of this study was to identify factors predictive of malignancy in patients with polymyositis (PM) and dermatomyositis (DM) in Japan. We conducted a retrospective study of PM and DM patients who were admitted to our hospital between January 1992 and September 2017. Among 134 patients, 29 (21.6%) were diagnosed with cancer in the 3 years prior to and 3 years after the initial diagnosis of PM or DM. According to multivariate analyses, male sex [odds ratio (OR) = 3.65, p = 0.03], old age (OR = 1.05, p = 0.02), and a past history of diabetes mellitus (OR = 10.4, p = 0.005) were associated with an increased risk of malignancy. The absence of interstitial lung disease (ILD) (OR = 0.25, p = 0.03) was also associated with an increased risk of malignancy. Diabetes mellitus was observed in 28.6% of PM and DM patients with malignancy, but in only 7.3% of those with malignancy. Survival was significantly lower in patients with malignancy than in those without malignancy (p < 0.001). Independent factors associated with malignancies in patients with PM or DM were male sex, old age, the absence of ILD, and, especially, a past history of diabetes mellitus.
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Kundrick A, Kirby J, Ba D, Leslie D, Olsen N, Foulke G. Positron emission tomography costs less to patients than conventional screening for malignancy in dermatomyositis. Semin Arthritis Rheum 2019; 49:140-144. [DOI: 10.1016/j.semarthrit.2018.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/22/2018] [Accepted: 10/29/2018] [Indexed: 01/16/2023]
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Kaneko Y, Nunokawa T, Taniguchi Y, Yamaguchi Y, Gono T, Masui K, Kawakami A, Kawaguchi Y, Sato S, Kuwana M, Okano Y, Nishina N, Tamura M, Kirino Y, Ikeda K, Kikuchi J, Kubo M, Tanino Y, Kaieda S, Naniwa T, Watanabe M, Harada T, Ukichi T, Kazuyori T, Kameda H, Kaburaki M, Matsuzawa Y, Yoshida S, Yoshioka Y, Hirai T, Asakawa K, Wada Y, Ishii K, Fujiwara S, Saraya T, Morimoto K, Hara T, Suzuki H, Shibuya H, Muro Y, Aki R, Shibayama T, Ohshima S, Yasuda Y, Terada M, Kawahara Y. Clinical characteristics of cancer-associated myositis complicated by interstitial lung disease: a large-scale multicentre cohort study. Rheumatology (Oxford) 2019; 59:112-119. [DOI: 10.1093/rheumatology/kez238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/29/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
To clarify the incidence, risk factors, and impact of malignancy in patients with PM/DM-associated interstitial lung disease (ILD).
Methods
This study used data from 497 patients with PM/DM-associated ILD enrolled in a multicentre, retrospective and prospective cohort of incident cases. Cancer-associated myositis (CAM) was defined as malignancy diagnosed within 3 years before or after PM/DM diagnosis. Demographic and clinical information was recorded at the time of diagnosis, and data about the occurrence of mortality and malignancy was collected.
Results
CAM was identified in 32 patients with PM/DM-associated ILD (6.4%). Patients with CAM were older (64 vs 55 years, P < 0.001), presented with arthritis less frequently (24% vs 49%, P = 0.01), and showed a lower level of serum Krebs von den Lungen-6 (687 vs 820 IU/l, P = 0.03) than those without CAM. The distribution of myositis-specific autoantibodies, including anti-melanoma differentiation–associated gene 5, anti-aminoacyl tRNA synthetase, and anti-transcriptional intermediary factor 1-γ antibodies, did not differ between the groups. Survival analysis demonstrated that CAM patients had a poorer survival than non-CAM patients (P = 0.006), primarily due to excess deaths by concomitant malignancy, while mortality due to ILD-related respiratory failure was similar between the groups (P = 0.51).
Conclusion
Concomitant malignancy can occur in patients with PM/DM-associated ILD, and has significant impact on mortality. Older age, lack of arthritis, and a lower level of serum Krebs von den Lungen-6 at diagnosis are predictors of concomitant malignancy.
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Affiliation(s)
- Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Takahiro Nunokawa
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yoshinori Taniguchi
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Kochi, Japan
| | - Yukie Yamaguchi
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Takahisa Gono
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Japan
| | - Kenichi Masui
- Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasushi Kawaguchi
- Department of Rheumatology, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Shinji Sato
- Division of Rheumatology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Japan
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Palakkuzhiyil N, Namitha R, Rakhesh SV, Thomas R, Uvais NA. Dermatomyositis associated with adenocarcinoma of the lung: A case report. J Family Med Prim Care 2019; 8:754-756. [PMID: 30984709 PMCID: PMC6436299 DOI: 10.4103/jfmpc.jfmpc_467_18] [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: 11/19/2022] Open
Abstract
The association of dermatomyositis and underlying malignancies, especially small cell and squamous cell carcinoma of the lung, has been recognized a long time ago. We report the case of a 63-year-old male chronic smoker with adenocarcinoma lung associated with dermatomyositis. The occurrence of dermatomyositis should be considered as a potential presentation of paraneoplastic syndromes and physicians encountering similar clinical situations should perform extensive diagnostic work-up to exclude underlying neoplastic lesions.
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Affiliation(s)
- Naseem Palakkuzhiyil
- Department of Neurology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - R Namitha
- Department of Pulmonology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - S V Rakhesh
- Department of Dermatology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - Rinu Thomas
- Department of Internal Medicine, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - N A Uvais
- Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
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Daido W, Yamasaki M, Morio Y, Funaishi K, Ishiyama S, Deguchi N, Taniwaki M, Ohashi N, Hattori N. A Rare Combination of Dermatomyositis, Interstitial Pneumonia, and Lung Cancer in a Patient Treated with Immunosuppressive Therapy and Chemotherapy. Intern Med 2018; 57:849-853. [PMID: 29225267 PMCID: PMC5891526 DOI: 10.2169/internalmedicine.9642-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We herein report the rare case of co-occurring dermatomyositis (DM), interstitial pneumonia (IP), and lung cancer in a 59-year-old man. Computed tomography (CT) and positron emission tomography-CT showed the presence of a left lung tumor with IP, which was diagnosed as lung adenocarcinoma by a CT-guided tumor biopsy. We diagnosed DM based on the presence of myalgia, Gottron's papules, and anti-aminoacyl-tRNA synthetase antibody positivity in the patient. Co-occurrence of the above-mentioned three diseases is rare, and acute exacerbation of IP is a major cause of death in such cases. These patients can be treated with immunosuppressive therapy followed by chemotherapy.
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Affiliation(s)
- Wakako Daido
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Japan
| | - Masahiro Yamasaki
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Japan
| | - Yuka Morio
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Japan
| | - Kunihiko Funaishi
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Japan
| | - Sayaka Ishiyama
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Japan
| | - Naoko Deguchi
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Japan
| | - Masaya Taniwaki
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Japan
| | - Nobuyuki Ohashi
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Japan
- Ohashi Clinic, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Institute of Biomedical and Health Science, Hiroshima University, Japan
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Jung HI, Park JS, Lee MY, Park B, Kim HJ, Park SH, Choi WI, Lee CW. Prevalence of lung cancer in patients with interstitial lung disease is higher than in those with chronic obstructive pulmonary disease. Medicine (Baltimore) 2018; 97:e0071. [PMID: 29538197 PMCID: PMC5882384 DOI: 10.1097/md.0000000000010071] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We aimed to explore lung cancer prevalence in interstitial lung disease (ILD) patients with or without connective tissue disorder (CTD) and idiopathic pulmonary fibrosis (IPF) in comparison with chronic obstructive pulmonary disorder (COPD).We evaluated lung cancer prevalence associated with ILD and IPF using Korean Health Insurance Review and Assessment Service (HIRA) data from January to December 2011. This database (HIRA-NPS-2011-0001) was sampled using random sampling of outpatients; 1,375,842 sample cases were collected, and 670,258 (age ≥ 40 ys) were evaluated. Patients with ILDs, IPF, CTD, or COPD were identified using the International Classification of Disease-10 diagnostic codes.Lung cancer prevalence rates per 100,000 persons for the sample population and those with ILD, IPF, CTD-ILD, and COPD were 420, 7334, 7404, 7272, and 4721, respectively. Lung cancer prevalence was significantly higher in those with ILD than in those with COPD (P < .01).More attention should be paid to lung cancer development in those with ILD as well as COPD.
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Affiliation(s)
| | | | - Mi-Young Lee
- Preventive Medicine, Keimyung University School of Medicine
| | - ByeongJu Park
- Department of Statistics, Kyungpook National University
| | | | | | - Won-Il Choi
- Department of Internal Medicine, School of Medicine, and Institute for Medical Science, Keimyung University, Daegu
| | - Choong Won Lee
- Department of Occupational and Environmental Medicine, Sungso Hospital, Andong, Republic of Korea
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22
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Milone M. Diagnosis and Management of Immune-Mediated Myopathies. Mayo Clin Proc 2017; 92:826-837. [PMID: 28473041 DOI: 10.1016/j.mayocp.2016.12.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/17/2016] [Accepted: 12/28/2016] [Indexed: 01/02/2023]
Abstract
Immune-mediated myopathies (IMMs) are a heterogeneous group of acquired muscle disorders characterized by muscle weakness, elevated creatine kinase levels, and myopathic electromyographic findings. Most IMMs feature the presence of inflammatory infiltrates in muscle. However, the inflammatory exudate may be absent. Indeed, necrotizing autoimmune myopathy (NAM), also called immune-mediated necrotizing myopathy, is characterized by a necrotizing pathologic process with no or minimal inflammation in muscle. The recent discovery of antibodies associated with specific subtypes of autoimmune myopathies has played a major role in characterizing these diseases. Although diagnostic criteria and classification of IMMs currently are under revision, on the basis of the clinical and muscle histopathologic findings, IMMs can be differentiated as NAM, inclusion body myositis (IBM), dermatomyositis, polymyositis, and nonspecific myositis. Because of recent developments in the field of NAM and IBM and the controversies around polymyositis, this review will focus on NAM, IBM, and dermatomyositis.
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Affiliation(s)
- Margherita Milone
- Neuromuscular Medicine Division, Department of Neurology, Mayo Clinic, Rochester, MN.
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Tiniakou E, Mammen AL. Idiopathic Inflammatory Myopathies and Malignancy: a Comprehensive Review. Clin Rev Allergy Immunol 2017; 52:20-33. [PMID: 26429706 DOI: 10.1007/s12016-015-8511-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of autoimmune diseases (collectively known as myositis) affecting the skeletal muscles as well as other organ systems such as skin, lungs, and joints. The primary forms of myositis include polymyositis (PM), dermatomyositis (PM), and immune-mediated necrotizing myopathy (IMNM). Patients with these diseases experience progressive proximal muscle weakness, have characteristic muscle biopsy findings, and produce autoantibodies that are associated with unique clinical features. One distinguishing feature of these patients is that they are also known to have an increased risk of cancer. Since the first description of the association in 1916, it has been extensively reported in the medical literature. However, there have been significant variations between the different studies with regard to the degree of cancer risk in patients with IIM. These discrepancies can, in part, be attributed to differences in the definition of malignancy-associated myositis used in different studies. In recent years, significant advances have been made in defining specific features of IIM that are associated with the development of malignancy. One of these has been myositis-specific antibodies (MSAs), which are linked to distinct clinical phenotypes and categorize patients into groups with more homogeneous features. Indeed, patients with certain MSAs seem to be at particularly increased risk of malignancy. This review attempts a systematic evaluation of research regarding the association between malignancy and myositis.
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Affiliation(s)
- Eleni Tiniakou
- Division of Rheumatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew L Mammen
- Division of Rheumatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. .,Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Expression, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 50 South Drive, Room 1146, Building 50, MSC 8024, Bethesda, MD, 20892, USA.
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Enomoto Y, Inui N, Yoshimura K, Nishimoto K, Mori K, Kono M, Fujisawa T, Enomoto N, Nakamura Y, Iwashita T, Suda T. Lung cancer development in patients with connective tissue disease-related interstitial lung disease: A retrospective observational study. Medicine (Baltimore) 2016; 95:e5716. [PMID: 27977621 PMCID: PMC5268067 DOI: 10.1097/md.0000000000005716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Previous studies have reported that patients with idiopathic pulmonary fibrosis occasionally develop lung cancer (LC). However, in connective tissue disease (CTD)-related interstitial lung disease (ILD), there are few data regarding the LC development. The aim of the present study was to evaluate the clinical significance of LC development in patients with CTD-ILD. A retrospective review of our database of 562 patients with ILD between 2000 and 2014 identified 127 patients diagnosed with CTD-ILD. The overall and cumulative incidences of LC were calculated. In addition, the risk factors and prognostic impact of LC development were evaluated. The median age at the ILD diagnosis was 63 years (range 37-84 years), and 73 patients (57.5%) were female. The median follow-up period from the ILD diagnosis was 67.4 months (range 10.4-322.1 months). During the period, 7 out of the 127 patients developed LC (overall incidence 5.5%). The cumulative incidences at 1, 3, and 5 years were 0.0%, 1.8%, and 2.9%, respectively. The risk of LC development was significantly higher in patients with higher smoking pack-year (odds ratio [OR] 1.028; 95% confidence interval [CI] 1.008-1.049; P = 0.007) and emphysema on chest high-resolution computed tomography (OR 14.667; 95% CI 2.871-74.926; P = 0.001). The median overall survival time after developing LC was 7.0 months (95% CI 4.9-9.1 months), and the most common cause of death was LC, not ILD. According to the Cox proportional hazard model analysis with time-dependent covariates, patients who developed LC showed significantly poorer prognosis than those who did not (hazard ratio 87.86; 95% CI 19.56-394.67; P < 0.001). In CTD-ILD, clinicians should be careful with the risk of LC development in patients with a heavy smoking history and subsequent emphysema. Although not so frequent, the complication could be a poor prognostic determinant.
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Affiliation(s)
- Yasunori Enomoto
- Second Division, Department of Internal Medicine
- Department of Regenerative and Infectious Pathology
| | - Naoki Inui
- Second Division, Department of Internal Medicine
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | | | | | | | - Masato Kono
- Second Division, Department of Internal Medicine
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26
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Qiang JK, Kim WB, Baibergenova A, Alhusayen R. Risk of Malignancy in Dermatomyositis and Polymyositis. J Cutan Med Surg 2016; 21:131-136. [PMID: 27534779 DOI: 10.1177/1203475416665601] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is variation in the risk of malignancy in dermatomyositis (DM) and polymyositis (PM) in the existing literature. OBJECTIVE To conduct a meta-analysis to estimate the risk of malignancy in DM and PM as compared with the general population. METHODS Medline and Embase Database abstracts were searched through August 2014 using the search terms myositis, neoplasms, and paraneoplastic syndromes. Population-based, observational studies in English were included. Meta-analyses were conducted using random-effects models. RESULTS A total of 5 studies with 4538 DM or PM patients were included in the analysis. The overall relative risk was 4.66 for DM and 1.75 for PM. By gender, the standardized incidence ratio (SIR) of malignancy among DM patients was 5.29 for males and 4.56 for females; the SIR of malignancy among PM patients was 1.62 for males and 2.02 for females. By time since diagnosis, the SIR of malignancy among DM patients was 17.29 in the first year, 2.7 between 1 and 5 years, and 1.37 after 5 years. By age group, the SIR among DM patients was 2.79 for patients between 15 and 44 years and 3.13 beyond 45 years. CONCLUSIONS Both DM and PM are associated with increased risk of malignancy, but the risk is higher in DM. The risk of malignancy is present in both genders and all age groups and is highest in the first year after diagnosis but persists beyond the fifth year in DM. Adults should be evaluated for malignancy at diagnosis, followed by long-term surveillance.
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Affiliation(s)
- Judy K Qiang
- 1 Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Whan B Kim
- 2 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Akerke Baibergenova
- 3 Divison of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Raed Alhusayen
- 3 Divison of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Esposito ACC, Munhoz T, Ocanha JP, Miot HA. Syndrome in question. An Bras Dermatol 2016; 91:387-9. [PMID: 27438215 PMCID: PMC4938292 DOI: 10.1590/abd1806-4841.20164298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 03/11/2015] [Indexed: 11/21/2022] Open
Abstract
Dermatomyositis is a rare inflammatory disease, autoimmune, with proximal
myopathy associated with characteristic dermatological manifestations. In
adults, 20-50% of the cases are paraneoplastic manifestation, being mandatory
the workup for malignancy Herein we report a case of a woman with classic
dermatological presentation of dermatomyositis and newly diagnosed breast
cancer. In general, the clinical presentation of paraneoplastic dermatomyositis
is more exuberant and manifestations may precede, concur or succeed the
diagnosis of neoplasia. The prognosis of cases associated with breast cancer is
worse than the idiopathic form. Treatment is based mainly on the resolution of
the underlying disease, beyond immunosuppressants.
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Affiliation(s)
| | - Tânia Munhoz
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Brazil
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28
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Fang YF, Wu YJJ, Kuo CF, Luo SF, Yu KH. Malignancy in dermatomyositis and polymyositis: analysis of 192 patients. Clin Rheumatol 2016; 35:1977-1984. [PMID: 27210465 DOI: 10.1007/s10067-016-3296-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 04/18/2016] [Accepted: 05/01/2016] [Indexed: 12/15/2022]
Abstract
This study aims to investigate the prevalence and predictive risk factors of malignancy in patients with polymyositis (PM) and dermatomyositis (DM). The medical records of 192 PM/DM patients followed up in a medical center between January 2000 and December 2013 were reviewed. Among the 192 patients, 33 patients (17.2 %) had associated cancer. Both PM and DM are significantly associated with cancer, although the risk of cancer appears to be somewhat higher among patients with DM (23.0 %) than among those with PM (8.9 %). Nasopharyngeal cancer (30.3 %) and breast cancer (18.2 %) comprised the most common malignant diseases associated with PM/DM. Univariate analysis showed that an older age at PM/DM onset, heliotrope rash, Gottron's sign, dysphagia, and low creatine phosphokinase (CPK) level were associated with increased malignancy. Multivariate analysis revealed that independent predictors of malignancy in PM/DM were age >40 years at PM/DM onset (adjusted OR 3.44; 95 % CI 1.08-10.98; p = 0.037) and heliotrope rash (adjusted OR 2.96; 95 % CI 1.04-8.43; p = 0.042). During the follow-up period, 66 (34.4 %) patients died and the overall patient survival rates were 83.1 % at 1 year, 78.9 % at 2 years, 74.2 % at 5 years, and 65.5 % at 10 years. This study demonstrates a high frequency of malignancy (17.2 %) in DM/PM patients. Nasopharyngeal cancer and breast cancer were the most common cancer types in DM/PM patients in our study. Cancer screening should be offered to patients with newly diagnosed DM/PM. Moreover, all patients should be evaluated for the possibility of an underlying malignancy during treatment.
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Affiliation(s)
- Yao-Fan Fang
- Division of Rheumatology, Allergy, and Immunology, Chang-Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kuei-Shan (333), Taoyuan, Taiwan
| | - Yeong-Jian Jan Wu
- Division of Rheumatology, Allergy, and Immunology, Chang-Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kuei-Shan (333), Taoyuan, Taiwan.,Division of Rheumatology, Allergy, and Immunology, Keelung Branch of Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy, and Immunology, Chang-Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kuei-Shan (333), Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy, and Immunology, Chang-Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kuei-Shan (333), Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy, and Immunology, Chang-Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kuei-Shan (333), Taoyuan, Taiwan.
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Allenbach Y, Keraen J, Bouvier AM, Jooste V, Champtiaux N, Hervier B, Schoindre Y, Rigolet A, Gilardin L, Musset L, Charuel JL, Boyer O, Jouen F, Drouot L, Martinet J, Stojkovic T, Eymard B, Laforêt P, Behin A, Salort-Campana E, Fain O, Meyer A, Schleinitz N, Mariampillai K, Grados A, Benveniste O. High risk of cancer in autoimmune necrotizing myopathies: usefulness of myositis specific antibody. Brain 2016; 139:2131-5. [PMID: 27086869 DOI: 10.1093/brain/aww054] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/31/2016] [Indexed: 01/19/2023] Open
Abstract
Cancer can occur in patients with inflammatory myopathies. This association is mainly observed in dermatomyositis, and myositis-specific antibodies have allowed us to delineate patients at an increased risk. Malignancy is also reported in patients with necrotizing autoimmune myopathies, but the risk remains elusive. Anti-signal recognition particle or anti-HMGCR antibodies have been specifically associated with necrotizing autoimmune myopathies. We aimed at screening the incidence of cancer in necrotizing autoimmune myopathies. A group of patients (n = 115) with necrotizing autoimmune myopathies with or without myositis-specific antibodies was analysed. Malignancy occurred more frequently in seronegative necrotizing autoimmune myopathies patients and in HMGCR-positive patients compared to anti-signal recognition particle positive patients. Synchronous malignancy was diagnosed in 21.4% and 11.5% of cases, respectively, and incidence of cancer was higher compared to the general population in both groups. No specific type of cancer was predominant. Patients suffering from a synchronous cancer had a decreased median survival time. Cancer screening is necessary in seronegative necrotizing autoimmune myopathies and in HMGCR-positive patients but not in anti-signal recognition particle-positive patients.
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Affiliation(s)
- Yves Allenbach
- 1 Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France 2 INSERM U974, UPMC Sorbonne Universités, Paris, France
| | - Jeremy Keraen
- 1 Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France
| | - Anne-Marie Bouvier
- 3 Registre Bourguignon des Cancers Digestifs, INSERM U866, CHU Dijon, France
| | - Valérie Jooste
- 3 Registre Bourguignon des Cancers Digestifs, INSERM U866, CHU Dijon, France
| | - Nicolas Champtiaux
- 1 Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France
| | - Baptiste Hervier
- 1 Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France
| | - Yoland Schoindre
- 1 Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France
| | - Aude Rigolet
- 1 Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France
| | - Laurent Gilardin
- 1 Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France
| | - Lucile Musset
- 4 Département d'Immunochimie, Hôpital Pitié-Salpêtrière, AP-HP, UPMC Sorbonne Universités, Paris, France
| | - Jean-Luc Charuel
- 4 Département d'Immunochimie, Hôpital Pitié-Salpêtrière, AP-HP, UPMC Sorbonne Universités, Paris, France
| | - Olivier Boyer
- 5 Laboratoire d'Immunologie, U905, Hôpital Universitaire de Rouen, Université Normandie, IRIB, Inserm, Rouen, France
| | - Fabienne Jouen
- 5 Laboratoire d'Immunologie, U905, Hôpital Universitaire de Rouen, Université Normandie, IRIB, Inserm, Rouen, France
| | - Laurent Drouot
- 5 Laboratoire d'Immunologie, U905, Hôpital Universitaire de Rouen, Université Normandie, IRIB, Inserm, Rouen, France
| | - Jeremie Martinet
- 5 Laboratoire d'Immunologie, U905, Hôpital Universitaire de Rouen, Université Normandie, IRIB, Inserm, Rouen, France
| | - Tanya Stojkovic
- 6 Centre de référence de pathologie neuromusculaire Paris-Est, Institut de Myologie, Hôpital Pitié-Salpêtrière, AP-HP, UPMC Sorbonne Universités, Paris, France
| | - Bruno Eymard
- 6 Centre de référence de pathologie neuromusculaire Paris-Est, Institut de Myologie, Hôpital Pitié-Salpêtrière, AP-HP, UPMC Sorbonne Universités, Paris, France
| | - Pascal Laforêt
- 6 Centre de référence de pathologie neuromusculaire Paris-Est, Institut de Myologie, Hôpital Pitié-Salpêtrière, AP-HP, UPMC Sorbonne Universités, Paris, France
| | - Antony Behin
- 6 Centre de référence de pathologie neuromusculaire Paris-Est, Institut de Myologie, Hôpital Pitié-Salpêtrière, AP-HP, UPMC Sorbonne Universités, Paris, France
| | - Emmanuelle Salort-Campana
- 7 Centre de référence des maladies neuromusculaires et de la SLA, Centre hospitalier universitaire la Timone, Université Aix-Marseille, Marseille, France
| | - Olivier Fain
- 8 Département de Médecine Interne, Hôpital Saint Antoine, AP-HP, UPMC Sorbonne Universités, Paris, France
| | - Alain Meyer
- 9 Département de Physiologie, Nouvel Hôpital civil, Strasbourg, France
| | - Nicolas Schleinitz
- 10 Département de Médecine Interne, Centre hospitalier universitaire la Timone, Université Aix-Marseille, Marseille, France
| | - Kuberaka Mariampillai
- 1 Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France 2 INSERM U974, UPMC Sorbonne Universités, Paris, France
| | - Aurelie Grados
- 1 Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France
| | - Olivier Benveniste
- 1 Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France 2 INSERM U974, UPMC Sorbonne Universités, Paris, France
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Clinical characteristics of patients with anti-TIF1-γ antibodies. Reumatologia 2016; 54:14-8. [PMID: 27407271 PMCID: PMC4847327 DOI: 10.5114/reum.2016.58756] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/26/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Inflammatory myopathies are a group of idiopathic, heterogeneous systemic diseases affecting predominantly skeletal muscles, though they can also involve the skin and internal organs. The association between cancer and idiopathic inflammatory myopathies, particularly dermatomyositis, which is termed cancer-associated myositis (CAM), has been reported in the medical literature. A newly described autoantibody to a 155-kDa nuclear protein, identified as transcription intermediary factor 1-gamma (TIF1-γ), has proven useful for cancer screening in patients with dermatomyositis. MATERIAL AND METHODS Based on our database of laboratory results, between November 2014 and January 2016, we found 80 patients with a positive autoimmune inflammatory myopathy immunoblot profile. RESULTS Eleven of 80 patients revealed the presence of anti-TIF1-γ antibodies: 8 women and 3 men with average age 54.2 years. Dermatomyositis (DM) was diagnosed in 6 cases, polymyositis in 1 case, myositis limited to ocular muscles and rhabdomyolysis in 1 case each, and undifferentiated connective tissue disease in 2 cases. Neoplasm was found in 4 cases. All of those patients had DM. The average time between DM and diagnosis of neoplasm was 7.5 months (from 1 to 18 months). CONCLUSIONS The association between cancer and idiopathic inflammatory myopathies, particularly DM, is well known, and cancer screening should be obligatory in such patients. So far there is no consensus as to the method or frequency with which patients with an idiopathic inflammatory myopathy should be tested to rule out neoplasm. Detection of anti-TIF1-γ antibodies in patients with DM gives the clinicians the very important suggestion of CAM. It seems reasonable that these patients should have more detailed and often repeated differential diagnostics.
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Ikeda S, Arita M, Misaki K, Mishima S, Takaiwa T, Nishiyama A, Ito A, Furuta K, Yokoyama T, Tokioka F, Noyama M, Yoshioka H, Ishida T. Incidence and impact of interstitial lung disease and malignancy in patients with polymyositis, dermatomyositis, and clinically amyopathic dermatomyositis: a retrospective cohort study. SPRINGERPLUS 2015; 4:240. [PMID: 26101728 PMCID: PMC4474966 DOI: 10.1186/s40064-015-1013-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/05/2015] [Indexed: 01/30/2023]
Abstract
The aims of this study were to retrospectively review Japanese consecutive cases of polymyositis (PM), dermatomyositis (DM), and clinically amyopathic dermatomyositis (CADM), focusing on interstital lung disease (ILD) and malignancy, and to document any differences in the incidence, clinical features, and impact on prognosis among patients with PM, DM, and CADM. We retrospectively reviewed 62 consecutive patients diagnosed with PM, DM, and CADM according to Bohan and Peter’s criteria (PM/DM) and Sontheimer’s criteria and Gerami’s criteria (CADM), focusing on ILD and malignancy. ILD occurrence rates were 48 % (11/23) in patients with PM, 46 % (11/24) in DM, and 100 % (15/15) in CADM. Malignancy occurred during diagnosis or the observation period in 14 patients; 86 % were without ILD, and 64 % were DM without ILD. Multivariate logistic regression analysis showed that the risk of newly diagnosed malignancy was significantly lower in patients with ILD [odds ratio, 0.0688; 95 % confidence interval (CI), 0.00127–0.372; p = 0.00190] and significantly higher in patients with DM (odds ratio, 5.21; 95 % CI, 1.17–23.1; p = 0.0299) than in other patients. Patients with malignancies had shorter survival than those without malignancies; no clinically meaningful difference in survival was observed among the different myositis types and for presence of ILD. In CADM-ILD, 80 % fatal cases died from refractory ILD ≤90 days from the first visit; neither death nor recurrence occurred subsequently. In conclusion, a positive association between DM and malignancy and a negative association between ILD and malignancy were noted. In the present study, malignancy was a predictor of poor long-term prognosis, but ILD were not. ILD associated with CADM contributed greatly to poor short-term prognosis, but neither death nor recurrence occurred subsequently.
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Affiliation(s)
- Satoshi Ikeda
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Machiko Arita
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Kenta Misaki
- Department of Rheumatology, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Shohei Mishima
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Takuya Takaiwa
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Akihiro Nishiyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Akihiro Ito
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Kenjiro Furuta
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Toshihide Yokoyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Fumiaki Tokioka
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Maki Noyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Hiroshige Yoshioka
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama 710-8602 Japan
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Abstract
BACKGROUND An association between dermatomyositis (DM) and cancer has been reported since 1916; however, estimates of the associated risk vary widely. For cost-effectiveness reasons it might be important to elucidate the degree of overall cancer risk in DM. OBJECTIVE The aim of this systematic review was to investigate the association of cancer in DM by performing a meta-analysis of cohort studies. DATA SOURCES A systematic literature search of PubMed, Ovid MEDLINE, EMBASE, Web of Science, Scopus, and the Cochrane Collaboration was conducted without language restriction, to 1 May 2014. STUDY SELECTION Inclusion criteria included cohort studies assessing overall cancer risk in DM. Two reviewers independently performed the study selection. Inter-rater reliability for inclusion decisions was quantified using Cohen's κ statistic. Disagreements were resolved by discussion. DATA EXTRACTION AND SYNTHESIS Desired variables were extracted from eligible studies independently by two investigators and disagreements were resolved by discussion. Quality of the selected studies was assessed using a modification of a recently employed system designed with reference to Meta-analysis Of Observational Studies in Epidemiology (MOOSE), Quality Assessment Tool for Systematic Reviews of Observational Studies (QATSO), and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Summary estimates were derived using a random-effects model. MAIN OUTCOME(S) AND MEASURE(S) Main outcome was the calculated relative risk of developing cancer after diagnosis of DM compared with the general population, estimated as the age- and sex-adjusted standardized incidence ratio (SIR). We hypothesized a priori that the relative risk would be higher in patients diagnosed with DM. RESULTS A total of 1,272 articles were initially identified but only ten studies met the inclusion criteria. Selected studies included seven population-based and three hospital-based DM cohorts that ranged from 49 to 1,012 patients and had mean follow-up times from 3.7 to 10.4 years. The pooled SIR for the incidence of overall cancer in DM patients was 4.79 (95% confidence interval 3.71-5.87) with significant heterogeneity (I(2) = 85.8%). However, the heterogeneity had no substantial influence on the pooled SIR for overall cancer in DM according to the sensitivity analysis. CONCLUSIONS Compared with the general population, DM patients are at a significantly increased risk for developing cancer. Understanding the magnitude of this risk is highly relevant toward assisting healthcare providers in clinical decision making, such as screening DM patients for cancer.
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Sato S, Yashiro M, Asano T, Kobayashi H, Watanabe H, Ohira H. Impact of aging on the clinical features and treatment of polymyositis in adults. Mod Rheumatol 2015; 25:748-51. [DOI: 10.3109/14397595.2015.1016256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Albert TJ, Bastawrous S, Raugi GJ, Hirschmann JV. A 62-year-old man with skin rash and an abnormal chest radiograph. Chest 2015; 147:e90-e94. [PMID: 25732478 DOI: 10.1378/chest.14-1100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A 62-year-old man developed a scalp rash 2 months ago, followed by bilateral eyelid swelling. The nonpruritic rash then spread to involve most of his skin. He also had fatigue, muscle weakness, mild muscle soreness with activity, and dysphagia for solid foods for the last 3 weeks. He had no other symptoms. He had a 50 pack-year history of smoking and drank two to three shots of alcohol daily.
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Affiliation(s)
- Tyler J Albert
- Department of Medicine, VA Puget Sound Medical Center, Department of Medicine, Seattle WA
| | - Sarah Bastawrous
- Department of Radiology, VA Puget Sound Medical Center, University of Washington School of Medicine, Seattle WA.
| | - Gregory J Raugi
- Department of Medicine, VA Puget Sound Medical Center, Division of Dermatology, University of Washington School of Medicine, Seattle WA
| | - Jan V Hirschmann
- Department of Medicine, VA Puget Sound Medical Center, Department of Medicine, Seattle WA
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Jones J, Wortmann R. Idiopathic inflammatory myopathies—a review. Clin Rheumatol 2015; 34:839-44. [DOI: 10.1007/s10067-015-2891-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/31/2015] [Indexed: 11/30/2022]
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Yang Z, Lin F, Qin B, Liang Y, Zhong R. Polymyositis/dermatomyositis and malignancy risk: a metaanalysis study. J Rheumatol 2014; 42:282-91. [PMID: 25448790 DOI: 10.3899/jrheum.140566] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the association between polymyositis (PM)/dermatomyositis (DM) and risks of malignancy. METHODS We searched Pubmed for articles dated before August 16, 2013. Studies were included if they met the following criteria: (1) a cohort or observational study; (2) PM or DM as one of the exposures of interest; (3) cancer as an outcome of interest; and (4) the rate ratio (RR) or standardized incidence ratio (SIR) were available with their 95% CI. We used random-effects or fixed-effects models to calculate the pooled RR according to the heterogeneity test. RESULTS Twenty publications were included. Compared with the general population, the pooled RR for patients with PM, DM, and PM/DM were 1.62 (95% CI 1.19-2.04), 5.50 (4.31-6.70), and 4.07 (3.02-5.12), respectively. The increased risks were more significant in patients within the first year of myositis diagnosis, male patients, and population-based studies (for DM). A significant association was also found between PM or DM and most site-specific malignancies. However, both PM and DM were not associated with stomach and prostate cancers. Significant heterogeneity was found between studies on association between PM/DM and overall malignancy, but not between PM/DM and the majority of site-specific malignancies, suggesting that that inherent malignancy difference may be a major source of heterogeneity. CONCLUSION The present metaanalysis indicates that PM and DM are significantly associated with increased risks of overall malignancy and most site-specific malignancies. The number of studies on association between PM or DM and some malignancies is too small to draw a firm conclusion. Accordingly, more research is needed for these malignancies.
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Affiliation(s)
- Zaixing Yang
- From the Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai; the Department of General Surgery, Taizhou First People's Hospital, Taizhou, Zhejiang, China.Z. Yang, MD, Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University; F. Lin, MD, Department of General Surgery, Taizhou First People's Hospital; B. Qin, MD; Y. Liang, MD; R. Zhong, PhD, Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University
| | - Feng Lin
- From the Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai; the Department of General Surgery, Taizhou First People's Hospital, Taizhou, Zhejiang, China.Z. Yang, MD, Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University; F. Lin, MD, Department of General Surgery, Taizhou First People's Hospital; B. Qin, MD; Y. Liang, MD; R. Zhong, PhD, Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University
| | - Baodong Qin
- From the Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai; the Department of General Surgery, Taizhou First People's Hospital, Taizhou, Zhejiang, China.Z. Yang, MD, Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University; F. Lin, MD, Department of General Surgery, Taizhou First People's Hospital; B. Qin, MD; Y. Liang, MD; R. Zhong, PhD, Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University
| | - Yan Liang
- From the Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai; the Department of General Surgery, Taizhou First People's Hospital, Taizhou, Zhejiang, China.Z. Yang, MD, Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University; F. Lin, MD, Department of General Surgery, Taizhou First People's Hospital; B. Qin, MD; Y. Liang, MD; R. Zhong, PhD, Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University.
| | - Renqian Zhong
- From the Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai; the Department of General Surgery, Taizhou First People's Hospital, Taizhou, Zhejiang, China.Z. Yang, MD, Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University; F. Lin, MD, Department of General Surgery, Taizhou First People's Hospital; B. Qin, MD; Y. Liang, MD; R. Zhong, PhD, Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University
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Ungprasert P, Bethina NK, Jones CH. Malignancy and idiopathic inflammatory myopathies. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 5:569-72. [PMID: 24350067 PMCID: PMC3842696 DOI: 10.4103/1947-2714.120788] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Association between idiopathic inflammatory myopathies (IIMs) and malignancy is well known and has been extensively reported in the literature. However, in the recent years, several new studies were published allowing us to better understand the clinical characteristics and pathophysiology of cancer-associated IIMs. We conducted a literature review of cancer-associated IIMs focusing on new data that was published in the recent years.
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Affiliation(s)
- Patompong Ungprasert
- Department of Internal Medicine, Bassett Medicaxl Center and Columbia University, College of Physicians and Surgeons, Cooperstown, New York 13326, USA
| | - Narandra K Bethina
- Department of Internal Medicine, Rheumatology and Clinical Immunology Division, The University of Vermont College of Medicine, Burlington 05405, USA
| | - Christine H Jones
- Department of Internal Medicine, Rheumatology and Clinical Immunology Division, The University of Vermont College of Medicine, Burlington 05405, USA
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Wang J, Guo G, Chen G, Wu B, Lu L, Bao L. Meta-analysis of the association of dermatomyositis and polymyositis with cancer. Br J Dermatol 2014; 169:838-47. [PMID: 23909921 DOI: 10.1111/bjd.12564] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although some features of dermatomyositis (DM) and polymyositis (PM) have been reported as possible prognostic indicators for cancer development, previous studies were small in size and were unable to establish a definitive relationship between neoplasms and DM and PM. OBJECTIVES To evaluate risk factors for developing malignancies in patients with DM and PM. METHODS Meta-analysis of the studies reported in the literature was performed to unveil risk factors for developing cancer among patients with DM and PM. The included studies were either cohort or retrospective case-control studies with information on cancer status. Risk for malignancy was determined as the odds ratio (OR) or weighted mean difference (WMD) with a 95% confidence interval (CI), determined by fixed and random effects models. Stata 10.0 software was used to identify possible publication bias. RESULTS Twenty studies with 380 patients and 1575 controls were included in the analysis. The factors that may increase the risk of cancer in patients with DM and PM were older age (WMD 11·41, 95% CI 9·84-12·98), male sex (OR 1·92, 95% CI 1·49-2·48), cutaneous necrosis (OR 5·52, 95% CI 3·49-8·74) and dysphagia (OR 2·41, 95% CI 1·50-3·86), whereas those that may provide protection against cancer included arthritis (OR 0·38, 95% CI 0·24-0·61) and interstitial lung disease (OR 0·32, 95% CI 0·20-0·51). CONCLUSIONS Our data suggest that age, sex, cutaneous necrosis, dysphagia, arthritis and lung complications may influence susceptibility to cancer in patients with DM and PM.
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Affiliation(s)
- J Wang
- Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Lu X, Yang H, Shu X, Chen F, Zhang Y, Zhang S, Peng Q, Tian X, Wang G. Factors predicting malignancy in patients with polymyositis and dermatomyostis: a systematic review and meta-analysis. PLoS One 2014; 9:e94128. [PMID: 24713868 PMCID: PMC3979740 DOI: 10.1371/journal.pone.0094128] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/12/2014] [Indexed: 12/17/2022] Open
Abstract
Objective To define potential factors that could predict concomitant neoplastic diseases in patients diagnosed with PM/DM, which could inform screening decisions. Methods Two researchers independently reviewed articles from Pubmed (MEDLINE), EMBASE, Cochrane Plus Library and ISI Web of Knowledge with no restrictions on study design or language. Given that some of the studies combined PM and DM patients as research subjects while others included only DM patients, data were subjected to meta-analyses for all combined PM/DM studies and studies that included only DM patients to obtain informative results. Results For PM/DM patients, the following factors are all associated with an increased risk of malignancy: older age, age greater than 45, male sex, dysphagia, cutaneous necrosis, cutaneous vasculitis, rapid onset of myostis (<4 weeks), elevated CK, higher ESR, higher CRP levels. Several factors were associated with lower-than-average risk, including the presence of ILD, arthritis/arthralgia, Raynaud's syndrome, or anti-Jo-1 antibody. For DM patients, results indicated an increased risk of malignancy with older age, male sex, the presence of cutaneous necrosis, elevated ESR (>35 mm/hr), higher CRP levels, or anti-p155 antibody. In addition, the presence of anti-ENA antibodies seem to be related to reduced risk of malignancy. Conclusion Awareness and implementation of early-stage cancer screening in PM/DM patients who have these identified factors – such as being older than 45, male sex, cutaneous necrosis, cutaneous vasculitis – are of crucial importance from public health and clinical perspectives and provide insight into the etiopathogenesis of CAM.
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Affiliation(s)
- Xin Lu
- China-Japan Friendship Hospital, Beijing, China
| | - Hanbo Yang
- China-Japan Friendship Hospital, Beijing, China
| | | | - Fang Chen
- China-Japan Friendship Hospital, Beijing, China
| | - Yinli Zhang
- China-Japan Friendship Hospital, Beijing, China
| | | | | | | | - Guochun Wang
- China-Japan Friendship Hospital, Beijing, China
- * E-mail:
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Shen C, Che G. Dermatomyositis as an antecedent sign of lung cancer in an eldly patient: a case report. J Thorac Dis 2014; 6:E15-8. [PMID: 24605239 DOI: 10.3978/j.issn.2072-1439.2014.01.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 01/13/2014] [Indexed: 02/05/2023]
Abstract
Dermatomyositis (DM) is associated with an increased risk of lung cancer. Misdiagnosed the squamous carcinoma of lung with DM is illustrated by the case who was a 73-year-old male and underwent successful surgical lobectomy presented here. The lack of examination of chest computed tomography (CT) is also emphasized. DM in an adult is a rare clinical entity. To facilitate the preoperative diagnosis and avoid the misdiagnosis of this disease, more etiological factors need to be considered.
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu 610041, China
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41
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Femia A, Vleugels RA. Pediatric Autoimmune Connective Tissue Diseases: An Update on Disease Characteristics, Associations, and Management. CURRENT DERMATOLOGY REPORTS 2013. [DOI: 10.1007/s13671-013-0058-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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42
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Cutaneous dermatomyositis: an updated review of treatment options and internal associations. Am J Clin Dermatol 2013; 14:291-313. [PMID: 23754636 DOI: 10.1007/s40257-013-0028-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Dermatomyositis is a specific type of inflammatory myopathy with characteristic cutaneous findings. Patients may have skin disease without clinically apparent muscle disease, but this disorder is best thought of as a systemic process. Therefore, all patients with dermatomyositis skin lesions need appropriate evaluation for muscle disease, esophageal dysfunction, cardiopulmonary disease, and potential internal malignancy. There are many therapies that have been used for patients with dermatomyositis, but most are based upon case series or expert opinion rather than meta-analyses or randomized, placebo-controlled trials. Even those therapies that have been subjected to randomized, blinded, placebo-controlled trials include a mixture of patients with idiopathic inflammatory myopathy and do not utilize a validated assessment tool for measuring cutaneous disease responses. In this review, we discuss the therapies available as well as the internal associations with dermatomyositis.
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Lazarou IN, Guerne PA. Classification, diagnosis, and management of idiopathic inflammatory myopathies. J Rheumatol 2013; 40:550-64. [PMID: 23504386 DOI: 10.3899/jrheum.120682] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The detection and characterization of a large array of autoantibodies, including at least 8 different antisynthetase, anti-SRP, -200/100 (HMGCR), -Mi-2, -CADM-140 (MDA5), -SAE, -p155, -MJ (NXP-2), and -PMS1, frequently associated with distinct and well-defined clinicopathological features, allowed for significant improvement in the definition and diagnosis of idiopathic inflammatory myopathies (IIM). Classification remains difficult, with lingering divergence between the different specialties involved in IIM care, but several categories clearly stand out, including dermatomyositis (DM), overlap myositis (OM), polymyositis, necrotizing myositis, and sporadic inclusion body myositis (s-IBM). Biopsy and histological analysis remain crucial, particularly in the absence of autoantibodies, to accurately specify the diagnosis and rule out mimics such as muscular dystrophies and metabolic myopathies. Numerous infectious agents (in particular human immunodeficiency virus and human T cell lymphotrophic virus-1) and drugs (statins, tumor necrosis factor inhibitors, and proton pump inhibitors) can cause mimic IIM that must also be excluded. Pharmacological treatment, in addition to glucocorticoids and immunoglobulins, now includes mycophenolate mofetil and rituximab, which proved helpful in resistant cases, particularly rituximab in DM and OM. Exercise, initially seen as potentially deleterious, recently was shown to be efficacious and safe. IIM can thus be reasonably well controlled in most cases, although aggressive disease remains refractory to treatment, including some cases of necrotizing myopathy. Sporadic IBM still seems resistant to all medications tested to date.
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Affiliation(s)
- Ilias N Lazarou
- Department of Rheumatology, University Hospital of Geneva, Geneva, Switzerland.
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Kupetsky EA, Rincon F. The Prevalence of Systemic Diseases Associated with Dermatoses and Stroke in the United States: A Cross-Sectional Study. Dermatology 2013; 227:330-7. [DOI: 10.1159/000354912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 08/06/2013] [Indexed: 11/19/2022] Open
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45
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Tanaka TI, Geist SMRY. Dermatomyositis: a contemporary review for oral health care providers. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:e1-8. [DOI: 10.1016/j.oooo.2012.07.434] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 06/18/2012] [Accepted: 07/09/2012] [Indexed: 12/17/2022]
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46
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Lung cancer and interstitial lung diseases: a systematic review. Pulm Med 2012; 2012:315918. [PMID: 22900168 PMCID: PMC3414065 DOI: 10.1155/2012/315918] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 12/21/2022] Open
Abstract
Interstitial lung diseases (ILDs) represent a heterogeneous group of more than two hundred diseases of either known or unknown etiology with different pathogenesis and prognosis. Lung cancer, which is the major cause of cancer death in the developed countries, is mainly attributed to cigarette smoking and exposure to inhaled carcinogens. Different studies suggest a link between ILDs and lung cancer, through different pathogenetic mechanisms, such as inflammation, coagulation, dysregulated apoptosis, focal hypoxia, activation, and accumulation of myofibroblasts as well as extracellular matrix accumulation. This paper reviews current evidence on the association between lung cancer and interstitial lung diseases such as idiopathic pulmonary fibrosis, sarcoidosis, systemic sclerosis, dermatomyositis/polymyositis, rheumatoid arthritis, systemic lupus erythematosus, and pneumoconiosis.
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47
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Limaye V, Luke C, Tucker G, Hill C, Lester S, Blumbergs P, Roberts-Thomson P. The incidence and associations of malignancy in a large cohort of patients with biopsy-determined idiopathic inflammatory myositis. Rheumatol Int 2012; 33:965-71. [PMID: 22833242 DOI: 10.1007/s00296-012-2489-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/07/2012] [Indexed: 12/11/2022]
Abstract
The South Australian (SA) myositis database has registered all patients with biopsy-proven inflammatory myositis in SA from 1980 to 2009. We determined the incidence and associations of malignancy in myositis by linking this database with the SA cancer registry. Standardized incidence ratios (SIR) for malignancy were determined using the total SA population over the same time period, stratified by age and gender. The SIR for cancer in the myositis population (n = 373) was 1.39, p = 0.047. There was a trend towards an increased SIR in dermatomyositis but no increased risk of malignancy in polymyositis or inclusion body myositis. Malignancies of the lung and prostate were the commonest and 28 % of malignancies occurred within one year of IIM diagnosis. The odds of developing cancer were significantly raised in the presence of a shawl sign, male gender, and in patients with overlap syndrome or rheumatoid arthritis whilst myalgia was a significant protective factor. HLA-A28 allele was overrepresented in patients with malignancy (11 vs 2 %, p = 0.006). Patients in SA with myositis are at modestly increased risk for malignancy. We report clinical and genetic risk factors allowing the identification of patients at greatest risk for malignancy.
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Affiliation(s)
- Vidya Limaye
- Department of Rheumatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.
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48
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Affiliation(s)
- Christina Lam
- Department of Dermatology; Brigham and Women's Hospital; Boston; Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology; Brigham and Women's Hospital; Boston; Massachusetts
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Ogata A, Endo M, Aoi J, Takahashi O, Kadomatsu T, Miyata K, Tian Z, Jinnin M, Fukushima S, Ihn H, Oike Y. The role of angiopoietin-like protein 2 in pathogenesis of dermatomyositis. Biochem Biophys Res Commun 2012; 418:494-9. [PMID: 22281496 DOI: 10.1016/j.bbrc.2012.01.052] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 01/10/2012] [Indexed: 02/06/2023]
Abstract
Dermatomyositis (DM) is an autoimmune disease marked by chronic inflammation of skin and muscle tissues and characterized clinically by proximal muscle weakness and skin eruption, including heliotrope rash, and Gottron's sign. Treatment with a non-specific immunosuppressive agent or anti-inflammatory corticosteroids is beneficial, although some patients are resistant to these therapies. Proinflammatory cytokines derived from infiltrating inflammatory cells and activated resident cells within skin and muscle tissues likely promote chronic inflammation in DM pathogenesis; however, molecular mechanisms underlying the disease are not completely defined. Here we show that mRNA and protein levels of angiopoietin-like protein 2 (Angptl2), a recently identified chronic inflammation mediator, are abundant in keratinocytes from DM patients' skin eruptions. To examine whether skin cell-derived Angptl2 promotes DM manifestations, we analyzed transgenic (Tg) mice expressing Angptl2 driven by the keratinocyte specific promoter K14 (K14-Angptl2) and therefore constitutively expressing Angptl2 in skin tissue. We found that K14-Angptl2 Tg mice exhibited skin phenotypes similar to those observed in DM patients. In addition, treatment of keratinocytes with exogenous Angptl2 activated the NF-κB inflammatory cascade, resulting in increased expression of the proinflammatory cytokines IL-1β and IL-6. We propose that keratinocyte-derived Angptl2 functions in DM pathogenesis by inducing chronic inflammation in skin tissue.
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Affiliation(s)
- Aki Ogata
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
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Abstract
There are several key observations on paraneoplastic myopathies: The risk of cancer associated with DM is very high, whereas risk of cancer associated with PM is mildly increased Most cancers develop within one year of the onset of myositis, although the risk remains high up to 5 years after diagnosis. The most common cancers associated with DM are adenocarcinoma, including lung, ovary, cervical, stomach, pancreas, colorectal and lymphoma, whereas PM is associated with a high risk of lymphoma. The clinical course of myopathy is closely linked with the course of cancer. Certain clinical features are associated with CAM including severe treatment resistant skin manifestations, severe muscle weakness, respiratory muscle weakness, and dysphagia, while some clinical features are protective such as arthritis, Raynaud, and ILD. Screening should be based on age, gender, ethnicity, and the geographic area of the patient; however, certain high-risk patients may require more extensive screening including tumor markers and thoracoabdominal–pelvic CT scans. Certain autoantibodies including anti-p155 and the absence of more common autoantibodies are associated with a higher risk of CAM, while the presence of antisynthetase autoantibodies lowers the risk for CAM. Although the pathogenesis of CAM is unclear, a plausible hypothesis is that immune responses generated against antigens commonly targeted in myositis are related to antitumor responses in affected individuals.
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Affiliation(s)
- Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, 3601 5th Avenue, Suite 2B, 243, Pittsburgh, PA 15213, USA.
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