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Comparison of long-term prognosis and relapse of dermatomyositis complicated with interstitial pneumonia according to autoantibodies: anti-aminoacyl tRNA synthetase antibodies versus anti-melanoma differentiation-associated gene 5 antibody

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Abstract

The aim of this study was to investigate long-term prognosis and relapse of dermatomyositis complicated with interstitial pneumonia (DMIP) according to anti-aminoacyl tRNA synthetase (ARS) antibodies and anti-melanoma differentiation-associated gene 5 (MDA5) antibody. This retrospective study comprised 36 patients with DMIP who were divided into the anti-ARS antibody-positive group (ARS+) (n = 12), anti MDA5 antibody-positive group (MDA5+) (n = 11), double-negative group (ARS−/MDA5−) (n = 11), and double-positive group (ARS+/MDA5+) (n = 1). Clinical features, treatment, prognoses, and relapses during the 2 years after initiation of treatment were compared between three groups excluding ARS+/MDA5+ group. Although short-term (24-week) mortality in MDA+ was higher than that in ARS+ or ARS−/MDA5− (P = 0.004), there was no difference in long-term (2-year) mortality between the three groups. Relapse rate in ARS+ was higher than that in MDA5+ and ARS−/MDA5− during the 2 years after initiation of treatment (P = 0.044). There was no difference in serum KL-6 levels at the initiation of treatment between ARS+ and MDA5+, but serum ferritin levels in MDA5+ were significantly higher than those in ARS+ (P = 0.406, 0.042, respectively). Serum KL-6 and ferritin levels at 2 years after initiation of treatment in ARS+ were significantly higher than those in MDA5+ (P = 0.008, 0.034, respectively). We found that in MDA5+ DMIP, acute alveolar inflammation caused a poor prognosis early in the disease course, and in ARS+ DMIP, chronic injury to the alveolar epithelial cells or basement membrane caused long-term recurrence.

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Authors and Affiliations

  1. Department of Rheumatology, Yodogawa Christian Hospital, Osaka, Japan

    Kentaro Isoda, Takao Kiboshi & Takeshi Shoda

  2. Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan

    Takuya Kotani, Tohru Takeuchi, Kenichiro Hata, Takaaki Ishida & Shigeki Makino

  3. Department of Respiratory Medicine, Yodogawa Christian Hospital, Osaka, Japan

    Kenichiro Otani, Takao Kamimori & Hiroshi Fujiwara

  4. 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka, 533-0024, Japan

    Kentaro Isoda

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  1. Kentaro Isoda
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  2. Takuya Kotani
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  3. Tohru Takeuchi
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Correspondence to Kentaro Isoda.

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All Authors declare that they have no conflict of interest.

Ethical approval

This study was conducted in accordance with the 1964 Helsinki declaration and its amendments, and was approved by the Yodogawa Christian Hospital and Faculty of Medicine Ethics Committee and the Osaka Medical College and Faculty of Medicine Ethics Committee.

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Informed consent was obtained from all individual participants included in this study.

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Isoda, K., Kotani, T., Takeuchi, T. et al. Comparison of long-term prognosis and relapse of dermatomyositis complicated with interstitial pneumonia according to autoantibodies: anti-aminoacyl tRNA synthetase antibodies versus anti-melanoma differentiation-associated gene 5 antibody. Rheumatol Int 37, 1335–1340 (2017). https://doi.org/10.1007/s00296-017-3729-y

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  • DOI: https://doi.org/10.1007/s00296-017-3729-y

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