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Betteridge Z, Tansley S, Shaddick G, Chinoy H, Cooper RG, New RP, Lilleker JB, Vencovsky J, Chazarain L, Danko K, Nagy-Vincze M, Bodoki L, Dastmalchi M, Ekholm L, Lundberg IE, McHugh N. Frequency, mutual exclusivity and clinical associations of myositis autoantibodies in a combined European cohort of idiopathic inflammatory myopathy patients. J Autoimmun 2019; 101:48-55. [PMID: 30992170 PMCID: PMC6580360 DOI: 10.1016/j.jaut.2019.04.001] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 01/30/2023]
Abstract
Objectives To determine prevalence and co-existence of myositis specific autoantibodies (MSAs) and myositis associated autoantibodies (MAAs) and associated clinical characteristics in a large cohort of idiopathic inflammatory myopathy (IIM) patients. Methods Adult patients with confirmed IIM recruited to the EuroMyositis registry (n = 1637) from four centres were investigated for the presence of MSAs/MAAs by radiolabelled-immunoprecipitation, with confirmation of anti-MDA5 and anti-NXP2 by ELISA. Clinical associations for each autoantibody were calculated for 1483 patients with a single or no known autoantibody by global linear regression modelling. Results MSAs/MAAs were found in 61.5% of patients, with 84.7% of autoantibody positive patients having a sole specificity, and only three cases (0.2%) having more than one MSA. The most frequently detected autoantibody was anti-Jo-1 (18.7%), with a further 21 specificities each found in 0.2–7.9% of patients. Autoantibodies to Mi-2, SAE, TIF1, NXP2, MDA5, PMScl and the non-Jo-1 tRNA-synthetases were strongly associated (p < 0.001) with cutaneous involvement. Anti-TIF1 and anti-Mi-2 positive patients had an increased risk of malignancy (OR 4.67 and 2.50 respectively), and anti-SRP patients had a greater likelihood of cardiac involvement (OR 4.15). Interstitial lung disease was strongly associated with the anti-tRNA synthetases, anti-MDA5, and anti-U1RNP/Sm. Overlap disease was strongly associated with anti-PMScl, anti-Ku, anti-U1RNP/Sm and anti-Ro60. Absence of MSA/MAA was negatively associated with extra-muscular manifestations. Conclusions Myositis autoantibodies are present in the majority of patients with IIM and identify distinct clinical subsets. Furthermore, MSAs are nearly always mutually exclusive endorsing their credentials as valuable disease biomarkers. Myositis specific autoantibodies very rarely coexist in the one individual allowing endotypes to be more precisely defined. The association of anti-TIF1 and cancer-associated myositis is confirmed with a cut-off age of over 58 years. In a large combined European myositis cohort associations of anti-SRP with carditis and anti-Mi-2 with cancer have emerged. Myositis associated autoantibodies are strongly associated with having myositis in association with another connective tissue disease.
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Affiliation(s)
- Z Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - S Tansley
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - G Shaddick
- Department of Mathematics, University of Exeter, Exeter, UK
| | - H Chinoy
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute of Health Research Manchester Biomedical Research Centre, Manchester University Foundation Trust.UK; Salford Royal NHS Foundation Trust, Manchester, UK
| | - R G Cooper
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - R P New
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - J B Lilleker
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Salford Royal NHS Foundation Trust, Manchester, UK
| | - J Vencovsky
- Institute of Rheumatology and Department of Rheumatology, 1stMedical Faculty, Charles University, Prague, Czech Republic
| | - L Chazarain
- Institute of Rheumatology and Department of Rheumatology, 1stMedical Faculty, Charles University, Prague, Czech Republic
| | - K Danko
- Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - M Nagy-Vincze
- Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - L Bodoki
- Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - M Dastmalchi
- Division of Rheumatology, Department of Medicine, Solna Karolinska Institutet, And Karolinska University Hospital, Stockholm, Sweden
| | - L Ekholm
- Division of Rheumatology, Department of Medicine, Solna Karolinska Institutet, And Karolinska University Hospital, Stockholm, Sweden
| | - I E Lundberg
- Division of Rheumatology, Department of Medicine, Solna Karolinska Institutet, And Karolinska University Hospital, Stockholm, Sweden
| | - N McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
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New JP, Aung T, Baker PG, Yongsheng G, Pylypczuk R, Houghton J, Rudenski A, New RP, Hegarty J, Gibson JM, O'Donoghue DJ, Buchan IE. The high prevalence of unrecognized anaemia in patients with diabetes and chronic kidney disease: a population-based study. Diabet Med 2008; 25:564-9. [PMID: 18445169 DOI: 10.1111/j.1464-5491.2008.02424.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anaemia occurs early in the course of diabetes-related chronic kidney disease (CKD). There is little evidence about the prevalence of anaemia in people with diabetes. The aim of this study was to assess the prevalence of anaemia, by stage of CKD, in the general diabetic population. METHODS Haemoglobin (Hb) was measured on all glycated haemoglobin (HbA1c) samples and the most recent (< 4 months) estimated glomerular filtration rate (eGFR) was obtained. Anaemia (at treatment level) was defined as Hb < 110 g/l or the use of erythropoetic stimulating agents (ESA). RESULTS Twelve per cent (10-14%) of people had Hb < 110 g/l. The prevalence of anaemia increased progressively with worsening CKD. People with CKD stage 3 accounted for the largest number of people with anaemia; 18% (95% CI 13-24%) had Hb < 110 g/l. Those with eGFR < 60 ml/min/1.73 m2 and not on ESA or dialysis were four (2-7) times more likely than patients with better renal function to have Hb < 110 g/l. The relation between Hb and eGFR became approximately linear below an eGFR of 83 ml/min/1.73 m2, where, for every 1 ml/min/1.73 m2 fall in eGFR, there was a 0.4 (0.3-0.5) g/l fall in haemoglobin. CONCLUSIONS This study demonstrates that anaemia, at levels where treatment is indicated, occurs commonly in people with diabetes and CKD stage 3 or worse. The screening for anaemia in current diabetes management should be extended.
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Affiliation(s)
- J P New
- Department of Vascular Medicine, Hope Hospital, Salford, UK.
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