Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea.
Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
Yonsei Med J. 2021 May;62(5):424-430. doi: 10.3349/ymj.2021.62.5.424.
To investigate correlations between myositis-specific autoantibodies (MSA) or myositis-associated antibodies (MAA) and clinical features, thereby demonstrating the utility of clinicoserologic classification in idiopathic inflammatory myopathies (IIM) patients.
We conducted a multicenter study of 108 adult patients (age ≥18 years) who were diagnosed with IIM by Peter and Bohan criteria or 2004 European Neuromuscular Centre (ENMC) criteria. Clinical data were obtained by medical record review. Immunoblot assay with Euroline strip (EUROIMMUN, Germany) was performed using the sera of dermatomyositis (DM, n=56), polymyositis (PM, n=45), amyopathic DM (n=5), DM sine dermatitis (n=1), and immune mediated necrotizing myopathy (n=1) patients. Patients were classified based on two classifications: 2017 EULAR/ACR and novel clinicoserologic classification.
According to 2017 EULAR/ACR criteria, DM and PM were the most and the second most frequent entities. Overlap myositis was the major entity of IIM, and the frequency of PM was significantly lower when applying clinicoserologic classification criteria. Sixty-nine (63.9%) patients had one or more MSA, and 61 (56.5%) patients had one or more MAA. Interstitial lung disease was closely associated with anti-MDA5 and anti-ARS, and DM-specific skin lesions were frequently observed in patients with anti-TIF1γ, anti-SRP, and anti-MDA5.
The clinicoserologic criteria based on MSA/MAA positivity could reflect more precise clinical features of IIM. Establishment of a laboratory system routinely available to screen for MSA/MAA status will be beneficial to provide precise diagnosis and proper management of IIM patients.
研究肌炎特异性自身抗体（MSA）或肌炎相关自身抗体（MAA）与临床特征之间的相关性，从而证明在特发性炎性肌病（IIM）患者中临床血清学分类的实用性。
我们对 108 名成年患者（年龄≥18 岁）进行了一项多中心研究，这些患者根据彼得和博汉标准或 2004 年欧洲神经肌肉中心（ENMC）标准被诊断为 IIM。临床数据通过病历回顾获得。使用 Euroline 条带（EUROIMMUN，德国）对皮肌炎（DM，n=56）、多发性肌炎（PM，n=45）、无皮肌炎的 DM（n=5）、DM 无皮疹（n=1）和免疫介导性坏死性肌病（n=1）患者的血清进行免疫印迹分析。根据 2017 年 EULAR/ACR 和新型临床血清学分类对患者进行分类。
根据 2017 年 EULAR/ACR 标准，DM 和 PM 是最常见和第二常见的实体。重叠性肌炎是 IIM 的主要实体，当应用临床血清学分类标准时，PM 的频率明显较低。69（63.9%）名患者有一种或多种 MSA，61（56.5%）名患者有一种或多种 MAA。间质性肺病与抗 MDA5 和抗 ARS 密切相关，而抗 TIF1γ、抗 SRP 和抗 MDA5 的患者常出现 DM 特异性皮肤病变。
基于 MSA/MAA 阳性的临床血清学标准可以更准确地反映 IIM 的临床特征。建立一种常规筛选 MSA/MAA 状态的实验室系统将有利于为 IIM 患者提供更准确的诊断和适当的管理。
