Division of Immunology, Allergy and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan.
School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan.
Medicine (Baltimore). 2021 Sep 17;100(37):e27230. doi: 10.1097/MD.0000000000027230.
The aim of this study was to evaluate the association between clinical phenotypes of dermatomyositis (DM) and polymyositis (PM) with myositis-specific antibodies (MSAs), and overlap diagnosis of systemic autoimmune diseases.This cross-sectional study was conducted on 67 patients with DM and 27 patients with PM recruited from a regional hospital in southern Taiwan. Clinical phenotypes of DM and PM were assessed and MSAs were measured using a commercial line blot assay. The association of clinical phenotypes of DM and PM with MSAs and overlap diagnosis of systemic autoimmune diseases was performed using univariate and multiple logistic regression analyses.Clinically, patients with DM and PM and overlap diagnosis of systemic sclerosis were associated with a higher risk of interstitial lung diseases (ILDs) (odds ratio [OR] = 6.73; P = .048), Raynaud phenomenon (OR = 7.30; P = .034), and malignancy (OR = 350.77; P = .013). The risk of malignancy was also associated with older age (OR 1.31; P = .012), and male patients were associated with a higher risk of fever. For MSAs, anti-aminoacyl-tRNA synthetase antibodies were associated with ILD, antinuclear antibody were associated with a lower risk of arthritis, anti-transcription intermediary factor 1-gamma antibodies were associated with milder symptoms of muscle weakness, anti-Ku antibodies were associated with overlap diagnosis of systemic lupus erythematosus, and anti-Ro52 antibodies were associated with the development of Raynaud phenomenon and Sjögren syndrome.MSAs and overlap diagnosis of systemic sclerosis were significantly associated with clinical phenotypes of DM and PM. Physicians should be vigilant for malignancy in older DM and PM patients with overlap diagnosis of systeic sclerosis. The possibility of developing ILD in patients with overlap diagnosis of systemic sclerosis or serum positivity of anti-aminoacyl-tRNA synthetase antibodies should be considered.
本研究旨在评估皮肌炎（DM）和多发性肌炎（PM）的临床表型与肌炎特异性抗体（MSA）以及重叠诊断的系统性自身免疫性疾病之间的关系。本横断面研究在台湾南部一家地区医院招募了 67 例 DM 患者和 27 例 PM 患者。评估 DM 和 PM 的临床表型，并使用商业线印迹分析测量 MSA。使用单变量和多变量逻辑回归分析评估 DM 和 PM 的临床表型与 MSA 和重叠诊断的系统性自身免疫性疾病之间的关系。临床方面，DM、PM 和重叠诊断的系统性硬皮病患者发生间质性肺病（ILDs）（比值比[OR] = 6.73；P = .048）、雷诺现象（OR = 7.30；P = .034）和恶性肿瘤（OR = 350.77；P = .013）的风险更高。恶性肿瘤的风险也与年龄较大（OR 1.31；P = .012）相关，男性患者与发热风险较高相关。对于 MSA，抗氨酰-tRNA 合成酶抗体与ILD 相关，抗核抗体与关节炎风险降低相关，抗转录中介因子 1-γ抗体与肌肉无力症状较轻相关，抗 Ku 抗体与重叠诊断的系统性红斑狼疮相关，抗 Ro52 抗体与雷诺现象和干燥综合征的发生相关。MSA 和重叠诊断的系统性硬皮病与 DM 和 PM 的临床表型显著相关。对于重叠诊断的系统性硬皮病的老年 DM 和 PM 患者，医生应警惕恶性肿瘤。对于重叠诊断的系统性硬皮病或血清阳性的抗氨酰-tRNA 合成酶抗体的患者，应考虑发生ILD 的可能性。
