Composition of calcifications in children with juvenile dermatomyositis: Association with chronic cutaneous inflammation

Pachman, Lauren M.; Veis, Arthur; Stock, Stuart R.; Abbott, Kathy; Vicari, F; Patel, Prakruti; Giczewski, Diana; Webb, Catherine L.; Spevak, Lyudmila; Boskey, Adele L.

doi:10.1002/art.22158

Cited by 70 publications

(53 citation statements)

References 12 publications

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“…In dermatomyositis, dystrophic calcification is a well-recognized complication of inflammation within the skin or muscle, even though the precise precipitants of this condition are not clear. There is a strong consensus that dystrophic calcification is most likely to occur in patients whose dermatomyositis has been aggressive and persistent (13,14). Undertreatment is also considered to play a role in some cases.…”

Section: Discussionmentioning

confidence: 99%

“…Calcification is usually associated with "burnt-out" muscle disease, although there have been reports that calcinosis may be associated with relapse of dermatomyositis (15). The calcified deposit in dermatomyositis contains hydroxyapatite crystal as well as bone proteins (13). It is possible that a nidus of degenerated material in the skin or muscle initiates the pathologic calcification (16).…”

Section: Discussionmentioning

confidence: 99%

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Tumorous swelling on the back

Shrivastava¹,

Khanna²,

Metgud³

et al. 2011

Arthritis Care & Research

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A 29-year-old man with a painless mass on his back. History of the present illnessThe patient had noticed a painless mass over his right midback 2 years earlier. The mass had increased gradually in size. He had no history of fever, weight loss, anorexia, back pain, or similar lesions at any other site on his body. The overlying skin did not appear to be involved, and there was no history of any injury, injection, or surgical procedure on that site. There was no sensory loss or burning or tingling over or around the mass lesion, nor a history of chest pain, cough, hemoptysis, or breathlessness.Examination revealed a well-demarcated mass of moderate firmness that was approximately 7 ϫ 5 cm 2 in dimension. There was no erythema or tenderness to suggest inflammation. There was no spinal tenderness or gibbus, and scapular movements were not restricted. The remainder of the physical examination was unremarkable. Spine radiographs did not reveal any vertebral damage to suggest Pott's spine.Ultrasonography revealed a localized intramuscular abscess on the right scapular area. The patient was subsequently lost to followup for 1 year, during which time he underwent multiple incision and drainage procedures of the presumed abscess at other clinics. However, the lesion did not resolve. Cultures of the pus-like material exuded during abscess drainage were negative on several occasions.When the patient returned to our clinic, the mass had grown significantly in size and now occupied nearly twothirds of the right side of his back and the side of his trunk ( Figures 1A and B). The mass was firm, nontender, and nearly oblong, with few fluctuant areas. It was difficult to determine if the tumor was fixed to underlying structures, but the overlying skin was not tethered. Shoulder girdle movement and chest expansion were nearly normal. There were no enlarged regional lymph nodes. There was no fever and a complete review of systems was otherwise noncontributory. Medical historyThe patient had been diagnosed with dermatomyositis 7 years before presentation with the mass. His dermatomyositis had been characterized by polyarthritis, gradually progressive proximal muscle weakness, and ulcers over both elbows. There was no history of photosensitivity, malar rash, cough, dyspnea, dysphagia, or dysphonia. Examination had revealed a classic Gottron's sign over the dorsal surfaces of his metacarpal, proximal interphalangeal, and distal interphalangeal joints; punched out ulcers over both elbows; and proximal muscle weakness.The patient's muscle enzymes (creatine kinase, lactate dehydrogenase, and aspartate aminotransferase) were elevated more than 4-fold at presentation, accompanied by elevations in the erythrocyte sedimentation rate and C-reactive protein concentration. An enzyme immunoassay for antibodies to the human immunodeficiency virus was negative, as were assays for antinuclear antibodies and antiMi2 antibodies. Electrodiagnostic studies and the result of a muscle biopsy confirmed the diagnosis of dermatomyositis.The patient's elbow...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tumorous swelling on the back

Shrivastava¹,

Khanna²,

Metgud³

et al. 2011

Arthritis Care & Research

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“…The mineral is calcium hydroxyapatite or carbonate apatite, from x-ray diffraction, infrared spectroscopy and X-ray micro-computed tomography studies [60,61]. The properties of the mineral in the calcinosis lesions are closest to that of enamel, and the mineral clearly differs from bone.…”

Section: Pathogenesismentioning

confidence: 99%

The Presentation, Assessment, Pathogenesis, and Treatment of Calcinosis in Juvenile Dermatomyositis

et al. 2014

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Calcinosis is one of the hallmark sequelae of juvenile dermatomyositis (JDM), and despite recent progress in the therapy of JDM, dystrophic calcification still occurs in approximately one-third of patients. This review discusses our current, albeit limited, understanding of risk factors for the development of calcinosis in JDM, as well as approaches to assessment, and current views on its pathogenesis. Anecdotal approaches to treating calcinosis associated with JDM, including both anti-inflammatory therapies and agents aimed at inhibiting the deposition of calcium hydroxyapatite, are reviewed. An improved understanding of the pathogenesis of calcinosis, the establishment of standardized measurement tools to assess calcinosis, and randomized controlled trials employing more sensitive outcome measures are needed to develop efficacious therapies for this often disabling complication.

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“…This point-by-point mapping has been widely applied to the analysis of polymers [7] and to a variety of tissues and individual cells to learn more about spatial variation in tissue and cellular composition [8][9][10][11]. It has also been used to identify pathologic inclusions such as foreign matter [12] and unusual soft tissue calcifications [13]. Data collection using point-by-point FT-IR microspectroscopic mapping was relatively slow and tedious, requiring the sample to be moved a specified distance for each point analyzed.…”

Section: Introductionmentioning

confidence: 99%

FT-IR imaging of native and tissue-engineered bone and cartilage

2007

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Fourier transform Infrared (FT-IR) imaging and microspectroscopy have been extensively applied to the analyses of tissues in health and disease. Spatially resolved mid-infrared data has provided insights into molecular changes that occur in diseases of connective or collagen-based tissues, including osteoarthritis, osteoporosis, osteogenesis imperfecta, osteopetrosis and pathologic calcifications. These techniques have also been used to probe chemical changes associated with load, disuse, and micro-damage in bone, and with degradation and repair in cartilage. This review summarizes the applications of FT-IR microscopy and imaging for analyses of bone and cartilage in healthy and diseased tissues, and illustrates the application of these techniques for the characterization of tissue engineered bone and cartilage.

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Composition of calcifications in children with juvenile dermatomyositis: Association with chronic cutaneous inflammation

Cited by 70 publications

References 12 publications

Tumorous swelling on the back

Tumorous swelling on the back

The Presentation, Assessment, Pathogenesis, and Treatment of Calcinosis in Juvenile Dermatomyositis

FT-IR imaging of native and tissue-engineered bone and cartilage

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