Association of various myositis-specific autoantibodies with dermatomyositis and polymyositis triggered by pregnancy

Akiyama, Chikaho; Shirai, Toshikazu; Sato, Hiroko; Fujii, Hiroshi; Ishii, Tomonori; Harigae, Hideo

doi:10.1007/s00296-021-04851-1

Cited by 17 publications

(14 citation statements)

References 31 publications

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“…In our study, a total of 16.1% of DM/PM cases worsened or appeared during the postpartum period, including 25 new‐onset cases of DM/PM immediately after delivery or abortion, commonly at 1–2 months. Previous researchers have proposed that the hormonal milieu, alteration of the immune system during the peripartum period, or exposure to fetal antigens may induce DM/PM occurrence 11,28–30 . Recently, Oya found that anti‐TIF‐1γ antibody‐positive DM is potentially triggered by pregnancy 31 .…”

Section: Discussionmentioning

confidence: 99%

“…Previous researchers have proposed that the hormonal milieu, alteration of the immune system during the peripartum period, or exposure to fetal antigens may induce DM/PM occurrence. 11,[28][29][30] Recently, Oya found that anti-TIF-1γ antibody-positive DM is potentially triggered by pregnancy. 31 However, the claim of pregnancy as a trigger of myositis is not solidly supported by our data.…”

Section: Discussionmentioning

confidence: 99%

“…found a prominent risk of spontaneous abortion and preterm birth in post‐IIM pregnancies with active disease (OR: 435.35) 12 . Akiyama found that active disease with systemic involvement, including myositis and interstitial lung disease rather than skin disease alone, negatively affects fetal outcomes 30 . On the basis of these findings, reproductive counseling before conception is important to choose an appropriate period with low activity.…”

Section: Discussionmentioning

confidence: 99%

“…12 Akiyama found that active disease with systemic involvement, including myositis and interstitial lung disease rather than skin disease alone, negatively affects fetal outcomes. 30 On the basis of these findings, reproductive counseling before conception is important to choose an appropriate period with low activity. Disease control during pregnancy is also critical in optimizing pregnancy outcomes among women with DM/PM.…”

Section: Discussionmentioning

confidence: 99%

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Pregnancy in adult‐onset dermatomyositis/polymyositis: A systematic review

Tang

Zhou

Lan

et al. 2022

American J Rep Immunol

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Background: Idiopathic inflammatory myopathy (IIM) in pregnancy is uncommon but may result in complications for both mother and the fetus. Aim:In this systematic review, we summarized the current literature investigating outcomes of pregnancy related to the dermatomyositis/polymyositis (DM/PM) process. Content:We searched PubMed, Embase, Cochrane Library, and Web of Science databases and included 61 studies reporting the disease course, pregnancy outcomes, and management of both pregnancy and DM/PM in the final analysis.The specific information of 221 pregnancies was extracted and these pregnancies were divided into three distinct forms: pregnancies after disease onset (n = 159), pregnancies with new disease onset (n = 37), and pregnancies followed by postpartum onset (n = 25). In most cases, DM/PM disease activity remained stable or improved throughout pregnancy (80.2%) and the postpartum period (83.9%). Active DM/PM during pregnancy significantly increased the risk of stillbirth or neonatal death (12% vs. 1%, P = .005) and preterm birth (34.7% vs. 11%, P < .001). The rates of other poor outcomes (total fetal loss, low birth weight, and intrauterine growth retardation) were also increased in pregnancies with active disease. Mainstay treatments for active DM/PM during pregnancy are glucocorticoids and intravenous immunoglobins. Implications:The present results underline the importance of good control of myopathy in optimizing the pregnancy outcomes of women with DM/PM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pregnancy in adult‐onset dermatomyositis/polymyositis: A systematic review

Tang

Zhou

Lan

et al. 2022

American J Rep Immunol

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“…A systematic review of RTX in anti-MDA5 Ab-positive DM showed an efficacy of 71.43% in the literature (3). Their study included patients who were successfully treated with IIT (7,8). Moreover, reporting bias should be considered when analysing case reports.…”

Section: Discussionmentioning

confidence: 99%

Intensive induction therapy combining tofacitinib, rituximab and plasma exchange in severe anti-melanoma differentiation-associatedprotein-5 antibody-positive dermatomyositis

Shirai

Machiyama

Sato

et al. 2022

Clinical and Experimental Rheumatology

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ObjectivesAnti-melanoma differentiation-associated protein-5 (MDA5) autoantibodies (Abs) are associated with rapidly progressive interstitial lung disease (RP-ILD) in dermatomyositis (DM). Because the addition of plasma exchange (PE) and rituximab (RTX) to triple therapy is inadequate in severe cases, we treat such cases with intensive induction therapy (IIT) combining all these options with tofacitinib (TOF). In this study, we investigated the poor prognostic factors and the efficacy and safety of IIT. Methods Thirty-three patients diagnosed with anti-MDA5 Ab-positive DM in our institution between 2014 and 2021 were included.The clinical characteristics of poor prognosis were retrospectively analysed using principal component analysis (PCA), and the outcomes of IIT were analysed in terms of survival, assessed using the Kaplan-Meier test, and adverse events. ResultsAlthough triple therapy with RTX, PE, or intravenous immunoglobulin was administered before the introduction of IIT, eight of 12 RP-ILD cases with a ferritin level >400 ng/mL (mean, 2,342) died within a median of 2.5 months. PCA revealed distinct clusters for prognosis, and age and serum ferritin were leading predictors of the prognosis. IIT, consisting of combinations of triple therapy with higher doses of methylprednisolone, PE, RTX, and TOF, was applied to eight patients (mean ferritin, 3,558). Although two patients died even with these regimens, a significant improvement in survival was documented. Several IIT-related adverse events were observed, including viral and fungal infections and cytopenia. ConclusionIIT significantly improved the survival of patients with severe anti-MDA5 Ab-positive RP-ILD. Although infections are noted, their benefits outweigh the risks in younger patients with high serum ferritin levels.

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Rheumatologische Krankheiten und Schwangerschaft: Systemischer Lupus erythematodes, Antiphospholipidsyndrom, rheumatoide Arthritis, Spondyloarthritis, systemische Sklerose, entzündliche Myopathien und Vaskulitis

Förger

Mayer-Pickel

2022

Die Geburtshilfe

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Association of various myositis-specific autoantibodies with dermatomyositis and polymyositis triggered by pregnancy

Cited by 17 publications

References 31 publications

Pregnancy in adult‐onset dermatomyositis/polymyositis: A systematic review

Pregnancy in adult‐onset dermatomyositis/polymyositis: A systematic review

Intensive induction therapy combining tofacitinib, rituximab and plasma exchange in severe anti-melanoma differentiation-associatedprotein-5 antibody-positive dermatomyositis

Rheumatologische Krankheiten und Schwangerschaft: Systemischer Lupus erythematodes, Antiphospholipidsyndrom, rheumatoide Arthritis, Spondyloarthritis, systemische Sklerose, entzündliche Myopathien und Vaskulitis

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