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Clinical features and prognosis of idiopathic inflammatory myopathies with coexistent multiple myositis-specific antibodies


1, 2, 3, 4, 5, 6, 7, 8, 9

 

  1. Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
  2. Department of Rheumatology and Immunology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China.
  3. Southern Medical University, Guangzhou, China.
  4. Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
  5. Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
  6. Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
  7. Department of Rheumatology and Immunology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China. lidongsheng2456@sina.com
  8. Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, and Department of Traditional Chinese Internal Medicine, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China. lijuan@smu.edu.cn
  9. Department of Rheumatology and Immunology, Nanfang Hospital, and Department of Rheumatology and Immunology, Ganzhou Hospital-Nanfang HospitalSouthern Medical University, Guangzhou, China. jqzhujq@yeah.net

CER17426
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PMID: 38819961 [PubMed]

Received: 29/12/2023
Accepted : 11/03/2024
In Press: 30/05/2024

Abstract

OBJECTIVES:
This study aimed to evaluate the clinical significance of the coexistence of 2 or more myositis-specific antibodies (multiple MSAs) in adult patients with idiopathic inflammatory myopathies (IIM).
METHODS:
We assessed a cohort of 202 consecutive patients with IIM. Clinical features and survival rates were compared between patients with and without multiple MSAs.
RESULTS:
Of those 202 patients, 44 (21.8%) were found to have multiple MSAs. 63.6% of the 44 patients tested positive for anti-aminoacyl-tRNA synthetase antibodies (anti-ARS+) and 52.3% positive for anti-melanoma differentiation-associated protein-5 antibody (anti-MDA5+). The presence of multiple MSAs was associated with less rapidly progressive interstitial lung disease (RP-ILD), fever, rash, periungual erythema, more muscle involvement and dysphagia, higher albumin level, and higher positive rate of ANA antibody in anti-MDA5+ population. In anti-ARS+ population with multiple MSAs, there were more V-neck sign, skin ulcers, dysphagia and peripheral edema. No differences in survival rates were observed between patients with or without multiple MSAs in the overall and anti-ARS+ populations. However, the survival rate in anti-MDA5+ population with multiple MSAs was significantly higher than those without multiple MSAs (p = 0.003). Moreover, multiple MSAs remained an independent protective factor against mortality in multivariable Cox regression analysis of anti-MDA5+ population [HR 0.108 (95% CI 0.013, 0.908), p=0.041].
CONCLUSIONS:
Multiple MSAs coexist in some IIM patients and their existence indicates mixed features from concomitant MSAs in anti-MDA5+ population and anti-ARS+ population. Identifying multiple MSAs could help to discover a more favourable disease phenotype with decreased mortality in anti-MDA5+ population.

DOI: https://doi.org/10.55563/clinexprheumatol/22j41g

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