Response to: 'Comment on: 'Idiopathic inflammatory myopathies and antisynthetase syndrome: contribution of antisynthetase antibodies to improve current classification criteria' by Greco et al' by Knitza et al

Tjärnlund, Anna; Lundberg, Ingrid E.

doi:10.1136/annrheumdis-2019-215515

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…[11] This should be carefully evaluated in future studies as these autoantibodies become more widely available. [12] Also, the existence of PM remains debatable. In a recent study of 37 patients from a UK tertiary myositis clinic classified as PM according to both sets of criteria, only 9 (24.3%) remained classified as PM after thorough review and physician’s consensus decisions.…”

Section: Discussionmentioning

confidence: 99%

Performance of the 2017 EULAR/ACR criteria for idiopathic inflammatory myopathies in a cohort of patients from Latin America

Valenzuela¹,

Torres

DEVÉS

2022

Medicine

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We aimed to determine the performance of the 2017 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for idiopathic inflammatory myopathies (IIMs) in a cohort of Chilean patients. This single-center retrospective study included 151 patients with a clinical diagnosis of IIM. Patients were classified according to the 2017 EULAR/ ACR classification criteria for IIM, and its performance was compared to the Bohan & Peter (B&P) classification criteria. A total of 135 patients (89.4%) met the EULAR/ACR criteria, and 140 (92.7%) patients met the B&P criteria. A total of 130 patients had IIM according to both the criteria; concordance rate was 29.2% for definite IIM, 6.2% for probable IIM, and 1.5% for possible IIM. The kappa coefficient of agreement was weak between the 2 classification criteria (κ = 0.39, SD 0.15-0.64). Against gold standard expert physician's diagnosis, sensitivity, and specificity of EULAR/ACR criteria was 0.86 and 0.85 to diagnose dermatomyositis, respectively, and 0.73 and 0.87 to diagnose polymyositis. The EULAR/ACR criteria showed good sensitivity and identified more patients with probable or definite IIM than the B&P criteria in a single-center cohort of patients with IIM in South America. The sensitivity of the EULAR/ACR criteria was slightly higher in patients with dermatomyositis, but lower in patients with polymyositis, than that of the B&P criteria.

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Section: Discussionmentioning

confidence: 99%

Performance of the 2017 EULAR/ACR criteria for idiopathic inflammatory myopathies in a cohort of patients from Latin America

Valenzuela¹,

Torres

DEVÉS

2022

Medicine

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“…Updated diagnostic criteria for IIM were published in 2017 by EULAR/ACR [19]. Due to the low frequency of most MSAs, the EULAR/ACR criteria did not include MSAs other than anti-Jo-1, despite the strong association of four other MSAs (anti-Mi-2, anti-SRP, anti-PL-7, anti-PL-12) with IIM [19,30]. Furthermore, these criteria failed to recognise ILD as a common manifestation of IIM, leaving the classification of patients with amyopathic, non-Jo-1 antisynthetase syndrome-associated ILD and IPAF-MSA unclear.…”

Section: Discussionmentioning

confidence: 99%

“…While some have argued that the IPAF research classification has filled a vacuum left by the absence of a diagnostic classification for antisynthetase syndrome [29], IPAF represents a highly heterogeneous classification without a clear natural history or defined treatment approaches [14]. Despite significant progress in the characterisation of MSAs, the commercially available assays used for their identification are not standardised, lack harmonisation between manufactures and can suffer from low specificity [30][31][32]. These issues have led to concerns around cost and clinical interpretation as MSA testing has been gradually adopted by the scientific community [31,33].…”

Section: Discussionmentioning

confidence: 99%

Myositis-specific antibodies identify a distinct interstitial pneumonia with autoimmune features phenotype

et al. 2020

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Interstitial pneumonia with autoimmune features (IPAF) characterises individuals with interstitial lung disease (ILD) and features of connective tissue disease (CTD) who fail to satisfy CTD criteria. Inclusion of myositis-specific antibodies (MSAs) in the IPAF criteria has generated controversy, as these patients also meet proposed criteria for an anti-synthetase syndrome. Whether MSAs and myositis associated antibodies (MAA) identify phenotypically distinct IPAF subgroups remains unclear.A multi-center, retrospective investigation was conducted to assess clinical features and outcomes in patients meeting IPAF criteria stratified by the presence of MSAs and MAAs. IPAF subgroups were compared to cohorts of patients with idiopathic inflammatory myopathy-ILD (IIM-ILD), idiopathic pulmonary fibrosis (IPF) and non-IIM CTD-ILDs. The primary endpoint assessed was three-year transplant-free survival. Two hundred sixty-nine patients met IPAF criteria, including 35 (13%) with MSAs and 65 (24.2%) with MAAs. Survival was highest among patients with IPAF-MSA and closely approximated those with IIM-ILD. Survival did not differ between IPAF-MAA and IPAF without MSA/MAA cohorts. Usual interstitial pneumonia (UIP) morphology was associated with differential outcome risk, with IPAF patients with non-UIP morphology approximating survival observed in non-IIM CTD-ILDs. MSAs, but not MAAs identified a unique IPAF phenotype characterised by clinical features and outcomes similar to IIM-ILD. UIP morphology was a strong predictor of outcome in others meeting IPAF criteria. Because IPAF is a research classification without clear treatment approach, these findings suggest MSAs should be removed from the IPAF criteria and such patients should be managed as an IIM-ILD.

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“…The 2017 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups do not acknowledge ASyS as a distinct entity, and anti-Jo1 antibody was the only myositis-specific antibody included in the final classification criteria due to the underrepresentation of other antibodies ( 7 ). It has been shown that the inclusion of the other antisynthetase antibodies in the EULAR/ACR classification criteria improves sensitivity for ASyS ( 8 ), but there are concerns that this may compromise specificity ( 9 , 10 ).…”

Section: Classification and Epidemiologymentioning

confidence: 99%

A multidisciplinary approach to the diagnosis of antisynthetase syndrome

et al. 2022

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Antisynthetase syndrome is a subtype of idiopathic inflammatory myopathy, strongly associated with the presence of interstitial lung disease. Diagnosis is made by identifying myositis-specific antibodies directed against aminoacyl tRNA synthetase, and relevant clinical and radiologic features. Given the multisystem nature of the disease, diagnosis requires the careful synthesis of subtle clinical and radiological features with the interpretation of specialized autoimmune serological testing. This is provided in a multidisciplinary environment with input from rheumatologists, respiratory physicians, and radiologists. Differentiation from other idiopathic interstitial lung diseases is key; treatment and prognosis differ between patients with antisynthetase syndrome and idiopathic interstitial lung disease. In this review article, we look at the role of the multidisciplinary team and its individual members in the initial diagnosis of the antisynthetase syndrome, including the role of physicians, radiologists, and the wider team.

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Response to: 'Comment on: 'Idiopathic inflammatory myopathies and antisynthetase syndrome: contribution of antisynthetase antibodies to improve current classification criteria' by Greco et al' by Knitza et al

Cited by 5 publications

References 5 publications

Performance of the 2017 EULAR/ACR criteria for idiopathic inflammatory myopathies in a cohort of patients from Latin America

Performance of the 2017 EULAR/ACR criteria for idiopathic inflammatory myopathies in a cohort of patients from Latin America

Myositis-specific antibodies identify a distinct interstitial pneumonia with autoimmune features phenotype

A multidisciplinary approach to the diagnosis of antisynthetase syndrome

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