Zhejiang University School of Medicine Second Affiliated Hospital, Department of Dermatology, Hangzhou, Zhejiang, PR China.
Zhejiang University School of Medicine, Department of Basic Medicine, Hangzhou, Zhejiang, PR China.
Semin Arthritis Rheum. 2024 Aug;67:152478. doi: 10.1016/j.semarthrit.2024.152478. Epub 2024 May 27.
Drug-induced dermatomyositis (DIDM) is a rare and underestimated variant of dermatomyositis (DM) characterized by muscle damage and skin rash and related to certain drug exposure. The spectrum of drugs causing DIDM has evolved over time, originally implicating hydroxyurea, penicillamine, and statins as causative agents. Tumor necrosis factor α inhibitors and immune checkpoint inhibitors have also been associated with such conditions. To bridge the gap between current literature and clinical practice, and therefore guide clinicians, we conducted a comprehensive review of English literature from Pubmed, EMBASE, and MEDLINE. Our analysis included demographic data, clinical features, laboratory findings, therapeutic outcomes, and extant research pertaining to the probable pathogenesis of DIDM induced by various drugs. Furthermore, we categorized the drugs involved in DIDM cases into biologics and traditional agents for subsequent statistical analysis. Over time, there has been a gradual accumulation of reported DIDM cases. A total of 69 published DIDM cases were documented in our study, among which 33 should be attributed to biologics and the remaining 36 to traditional drugs. Interestingly, 41 of all DIDM cases had a previous history of malignancies. Additionally, DIDM cases exhibited similar cutaneous and muscular manifestations to classic DM, with the exception of cases induced by hydroxyurea, which did not entail muscle damage. Positive antinuclear antibodies and anti-TIF1-γ autoantibodies have been predominantly observed in biologics-induced cases, while positive anti-TIF1-γ antibodies were merely reported in the cases that were primarily diagnosed with malignant diseases and exposed to ICIs afterwards. Anti-TIF1-γ antibodies may potentially serve as a red flag in the identification of co-existing malignant diseases in DM patients. We also provided a comprehensive summary and exploration of potential mechanisms lying behind drug-induced dermatomyositis. In conclusion, our review consolidates the current literature on DIDM, highlighting the evolving spectrum of medications and elucidating the differences in clinical manifestations, laboratory findings, and underlying mechanisms.
药物性皮肌炎（DIDM）是皮肌炎（DM）的一种罕见且被低估的变体，其特征为肌肉损伤和皮疹，并与某些药物暴露有关。引起 DIDM 的药物范围随着时间的推移而演变，最初涉及羟基脲、青霉胺和他汀类药物作为致病剂。肿瘤坏死因子-α抑制剂和免疫检查点抑制剂也与这些情况有关。为了弥合当前文献与临床实践之间的差距，从而为临床医生提供指导，我们对来自 Pubmed、EMBASE 和 MEDLINE 的英文文献进行了全面回顾。我们的分析包括人口统计学数据、临床特征、实验室发现、治疗结果以及与各种药物引起的 DIDM 相关的现有研究。此外，我们将涉及 DIDM 病例的药物分为生物制剂和传统药物，以便进行后续的统计分析。随着时间的推移，报告的 DIDM 病例逐渐增多。我们的研究共记录了 69 例已发表的 DIDM 病例，其中 33 例归因于生物制剂，其余 36 例归因于传统药物。有趣的是，所有 DIDM 病例中有 41 例有先前的恶性肿瘤病史。此外，DIDM 病例表现出与经典 DM 相似的皮肤和肌肉表现，除了由羟基脲引起的病例外，后者不涉及肌肉损伤。生物制剂诱导的病例中主要观察到抗核抗体和抗 TIF1-γ 自身抗体阳性，而主要诊断为恶性疾病并随后暴露于 ICI 的病例中仅报告了抗 TIF1-γ 抗体阳性。抗 TIF1-γ 抗体可能是 DM 患者合并恶性肿瘤的一个标志。我们还对药物性皮肌炎背后的潜在机制进行了全面总结和探讨。总之，我们的综述整合了目前关于 DIDM 的文献，强调了药物范围的演变，并阐明了临床表现、实验室发现和潜在机制的差异。
