Malignancies in systemic rheumatic diseases: A mini review

Anti-melanoma differentiation-associated gene 5 (MDA-5) antibody-positive dermatomyositis (MDA5-DM) is known to cause rapidly progressive interstitial lung disease (RP-ILD). Cancer complications in MDA5-DM are less frequently reported compared to other forms of DM, though they do occur. The treatment strategy for DM with aspects of paraneoplastic syndrome is usually to treat the cancer first, if possible. However, surgery is difficult in the setting of respiratory failure and carries the risk of acute exacerbation of interstitial lung disease, as does chemotherapy and radiotherapy. The prognosis of MDA5-DM with RP-ILD has improved with initial immunosuppressive combination therapy, but certain cases remain refractory to treatment. Recently, the efficacy of janus kinase (JAK) inhibitors in refractory MDA5-DM cases has been reported. However, immunosuppressive therapies, including JAK inhibitors, may have negative effect on cancer progression. Here, we report a 48-year-old woman suffering from MDA5-DM with RP-ILD complicated by bilateral breast cancer. Due to respiratory failure, radical breast cancer surgery and chemotherapy could not be performed, so endocrine therapy and combined immunosuppressive therapy were first administered. However, the patient’s condition was refractory to this initial treatment. Therefore, tofacitinib in combination with plasma exchange therapy was initiated, leading to an improvement in ILD, and bilateral mastectomy could be performed. One year later, MDA-5 antibody titers became negative, and glucocorticoid was successfully discontinued after two years. To date, three years have passed without recurrence of either MDA5-DM or breast cancer. To our knowledge, this is the first report of MDA5-DM complicated by breast cancer, as well as the first case of JAK inhibitor use for MDA5-DM with cancer. For curative treatment of MD5-DM with RP-ILD, if comorbid cancers are found, collaboration with oncologists to balance the efficacy and adverse events of MDA5-DM with RP-ILD therapy is essential in determining the appropriate type and timing of treatment, which could lead to a favorable outcome.

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Practical Use of Ultrasound in Modern Rheumatology—From A to Z

Sapundzhieva,

Sapundzhiev,

Batalov

2024

Life

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During the past 20 years, the use of ultrasound (US) in rheumatology has increased tremendously, and has become a valuable tool in rheumatologists’ hands, not only for assessment of musculoskeletal structures like joints and peri-articular tissues, but also for evaluation of nerves, vessels, lungs, and skin, as well as for increasing the accuracy in a number of US-guided aspirations and injections. The US is currently used as the imaging method of choice for establishing an early diagnosis, assessing disease activity, monitoring treatment efficacy, and assessing the remission state of inflammatory joint diseases. It is also used as a complementary tool for the assessment of patients with degenerative joint diseases like osteoarthritis, and in the detection of crystal deposits for establishing the diagnosis of metabolic arthropathies (gout, calcium pyrophosphate deposition disease). The US has an added value in the diagnostic process of polymyalgia rheumatica and giant-cell arteritis, and is currently included in the classification criteria. A novel use of US in the assessment of the skin and lung involvement in connective tissue diseases has the potential to replace more expensive and risky imaging modalities. This narrative review will take a close look at the most recent evidence-based data regarding the use of US in the big spectrum of rheumatic diseases.

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Malignancies in systemic rheumatic diseases: A mini review

Cited by 3 publications

References 98 publications

The risk of cancer in pediatric-onset immune-mediated inflammatory diseases – A nationwide study

The risk of cancer in pediatric-onset immune-mediated inflammatory diseases – A nationwide study

Successful treatment of anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis with rapidly progressive interstitial lung disease complicated by bilateral breast cancer following the additional tofacitinib: A case report

Practical Use of Ultrasound in Modern Rheumatology—From A to Z

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