Recent advances in dermatomyositis-specific autoantibodies

Abstract

'Autoantibody-based classification' of dermatomyositis subsets is now a useful strategy for comprehending the heterogeneous spectrum of dermatomyositis.

Associations between anti‐melanoma differentiation‐associated gene 5 antibody and demographics, clinical characteristics and laboratory results of patients with dermatomyositis: A systematic meta‐analysis

“…The OR, CI and P ‐values of anti‐MDA5 antibody associated with 12 clinical characteristics of DM patients were as follows: muscle weakness from six studies with 308 DM patients (OR = 0.30, 95% CI = 0.10–0.87, P = 0.026), Gottron's sign or papules from 10 studies with 565 DM patients (OR = 1.87, 95% CI = 1.14–3.08, P = 0.013), mechanic's hand from three studies with 216 DM patients (OR = 2.88, 95% CI = 1.30–6.37, P = 0.009), V rash from three studies with 216 DM patients (OR = 2.59, 95% CI = 1.11–6.04, P = 0.028), skin ulcers from seven studies with 412 DM patients (OR = 13.77, 95% CI = 7.01–27.08, P < 0.001), panniculitis from two studies with 194 DM patients (OR = 5.68, 95% CI = 1.93–16.68, P = 0.002), alopecia from two studies with 132 DM patients (OR = 7.29, 95% CI = 2.05–25.90, P = 0.002), arthritis/arthralgia from seven studies with 340 DM patients (OR = 2.54, 95% CI = 1.44–4.50, P = 0.001), pneumomediastinum from two studies with 161 DM patients (OR = 15.79, 95% CI = 3.27–76.38, P = 0.001), RPILD from 14 studies with 822 DM patients (OR = 26.85, 95% CI = 16.36–44.07, P < 0.001), CDM from three studies with 224 patients (OR = 0.10, 95% CI = 0.04–0.25, P < 0.001) and CADM from nine studies with 524 patients (OR = 9.24, 95% CI = 3.98–21.48, P < 0.001). Anti‐MDA5 antibody has a high specificity in DM patients presenting RPILD, particularly in the Asian population, therefore, we analyzed the association in this subgroup between anti‐MDA5 antibody and RPILD according to race. In the Asian population, the pooled OR from 12 studies involving 171 DM patients with anti‐MDA5 antibody and 457 DM patients without anti‐MDA5 antibody was 28.46 (95% CI = 16.44–49.26, P < 0.001), suggesting that anti‐MDA5‐positive Asian DM patients have a high risk of developing RPILD; however, the association between anti‐MDA5 antibody and RPILD in European DM patients was not evaluated because of the lack of studies that would enable a subgroup analysis in this specific population.…”

The IgG2 Isotype of Anti–Transcription Intermediary Factor 1γ Autoantibodies Is a Biomarker of Cancer and Mortality in Adult Dermatomyositis

“…Clinically, anti‐TIF1γ–positive adult DM is associated with severe cutaneous signs, moderate muscular symptoms, and frequent dysphagia, while systemic features are uncommon . Other reported risk factors for cancer in adult DM, i.e., older age, male sex, and cutaneous necrosis, have also been identified in anti‐TIF1γ–positive adult DM . Anti‐TIF1γ autoantibodies are also found in 30–40% of patients with juvenile DM, without any association with cancer .…”

Recent Approaches To Optimize Laboratory Assessment of Antinuclear Antibodies

“…In recent years, testing for specific ANAs has become useful in the evaluation of IIMs (12,13). While the patterns and specificities of ANAs in IIMs are quite diverse (1,3,15), identification of certain autoantibodies is useful both for diagnosing and distinguishing between subtypes of myositis and for predicting or monitoring the development of additional clinical manifestations, including organ involvement, and risks for cancers (12,13). In general, these autoantibodies are categorized as myositisspecific antibodies (MSAs) or myositis-associated antibodies (MAAs).…”

“…The use of HEp-2 cells, of human larynx epithelioma origin, provided increased sensitivities for detecting ANAs, probably due to their ability to divide rapidly in vitro as well as the presence of large nuclei, which allowed optimal detection of patterns associated with specific autoantibodies in SARDs (4,9,10). Although the ANA IFA method continued to be plagued by a number of analytical and diagnostic challenges, increasing recognition of the use of autoantibodies to diagnose and to further stratify SARDs, as well as efforts to harmonize the nomenclatures for testing and reporting, makes this a powerful screening tool (1,(11)(12)(13)(14)(15)(16)(17). Thus, testing for ANAs or ANA-specific autoantibodies has been incorporated in a few guidelines on diagnostic criteria.…”