Abstract
This study aims to report the concomitant diseases observed and damage outcome in a cohort of patients with adult idiopathic inflammatory myositis (IIM) during long-term follow-up. All patients with IIM were identified from a single centre (follow-up between 1979 and 2006) and fulfilled at least three of the four Bohan and Peter criteria. Patients with inclusion body myositis, juvenile-onset myositis and overt overlap syndromes were excluded. Medical notes were retrospectively reviewed. Concomitant diseases identified were divided into 12 different organ systems (bone, cardiac, respiratory, gastrointestinal, renal, central nervous, malignancy, infection, endocrine, eyes, dermatological and haematological). Patient damage index was calculated using the Myositis Damage Index tool. Fifty-five patients (31 polymyositis, 24 dermatomyositis) were identified. The most prevalent organ system involved was lung with 40 events per 1,000 patient years follow-up. There was significant steroid-related complications with 17/18 patients with bone involvement having osteopenia/osteoporosis. Sjogren's syndrome (n = 3) was the most frequent concomitant auto-immune disease observed. Patients with a higher number of organ systems involved had a significantly higher damage index (r = 0.48, p = 0.001). White patients showed a significant trend to develop more than three other organ system involvement (p < 0.0001) and myositis-related lung disease (p < 0.0001) compared to other races. There is significant steroid-related morbidity in adult IIM patients under long-term follow-up. The prevalence of another concomitant auto-immune disease unlike patients with lupus or Sjogren's syndrome is low.
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Ehrenstein MR, Snaith ML, Isenberg DA (1992) Idiopathic myositis: a rheumatological view. Ann Rheum Dis 51(1):41–44
Sultan SM, Ioannou Y, Moss K, Isenberg DA (2002) Outcome in patients with idiopathic inflammatory myositis: morbidity and mortality. Rheumatology (Oxford) 41(1):22–26
Marie I, Hachulla E, Hatron PY et al (2001) Polymyositis and dermatomyositis: short term and long term outcome, and predictive factors of prognosis. J Rheumatol 28(10):2230–2237
Ponyi A, Borgulya G, Constantin T, Vancsa A, Gergely L, Danko K (2005) Functional outcome and quality of life in adult patients with idiopathic inflammatory myositis. Rheumatology (Oxford) 44(1):83–88
Airio A, Kautiainen H, Hakala M (2006) Prognosis and mortality of polymyositis and dermatomyositis patients. Clin Rheumatol 25(2):234–239
Torres C, Belmonte R, Carmona L et al (2006) Survival, mortality and causes of death in inflammatory myopathies. Autoimmunity 39(3):205–215
Maugars YM, Berthelot JM, Abbas AA, Mussini JM, Nguyen JM, Prost AM (1996) Long-term prognosis of 69 patients with dermatomyositis or polymyositis. Clin Exp Rheumatol 14(3):263–274
Tymms KE, Webb J (1985) Dermatopolymyositis and other connective tissue diseases: a review of 105 cases. J Rheumatol 12(6):1140–1148
Rios G (2005) Retrospective review of the clinical manifestations and outcomes in Puerto Ricans with idiopathic inflammatory myopathies. J Clin Rheumatol 11(3):153–156
Uthman I, Vázquez-Abad D, Senécal JL (1996) Distinctive features of idiopathic inflammatory myopathies in French Canadians. Semin Arthritis Rheum 26(1):447–458
McDonagh JE, Isenberg DA (2000) Development of additional autoimmune diseases in a population of patients with systemic lupus erythematosus. Ann Rheum Dis 59(3):230–232
Chambers SA, Charman SC, Rahman A, Isenberg DA (2007) Development of additional autoimmune diseases in a multiethnic cohort of patients with systemic lupus erythematosus with reference to damage and mortality. Ann Rheum Dis 66(9):1173–1177
Lazarus MN, Isenberg DA (2005) Development of additional autoimmune diseases in a population of patients with primary Sjogren's syndrome. Ann Rheum Dis 64(7):1062–1064
Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (first of two parts). N Engl J Med 292(7):344–347
Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (second of two parts). N Engl J Med 292(8):403–407
Vitali C, Bombardieri S, Moutsopoulos HM et al (1993) Preliminary criteria for the classification of Sjögren's syndrome. Results of a prospective concerted action supported by the European Community. Arthritis Rheum 36(3):340–347
Clarke AE, Bloch DA, Medsger TA Jr, Oddis CV (1995) A longitudinal study of functional disability in a national cohort of patients with polymyositis/dermatomyositis. Arthritis Rheum 38(9):1218–1224
Bronner IM, van der Meulen MF, de Visser M et al (2006) Long-term outcome in polymyositis and dermatomyositis. Ann Rheum Dis 65(11):1456–1461
Marie I, Hachulla E, Cherin P et al (2002) Interstitial lung disease in polymyositis and dermatomyositis. Arthritis Rheum 47(6):614–622
Selva-O'Callaghan A, Labrador-Horrillo M, Munoz-Gall X et al (2005) Polymyositis/dermatomyositis-associated lung disease: analysis of a series of 81 patients. Lupus 14(7):534–542
Yaqub S, Moder KG, Lacy MQ (2004) Severe, reversible pulmonary hypertension in a patient with monoclonal gammopathy and features of dermatomyositis. Mayo Clin Proc 79(5):687–689
Grateau G, Roux ME, Franck N et al (1993) Pulmonary hypertension in a case of dermatomyositis. J Rheumatol 20(8):1452–1453
Kissel JT, Mendell JR, Rammohan KW (1986) Microvascular deposition of complement membrane attack complex in dermatomyositis. N Engl J Med 314(6):329–334
Wakata N, Kurihara T, Saito E, Kinoshita M (2002) Polymyositis and dermatomyositis associated with malignancy: a 30-year retrospective study. Int J Dermatol 41(11):729–734
Hill CL, Zhang Y, Sigurgeirsson B et al (2001) Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet 357(9250):96–100
Sigurgeirsson B, Lindelof B, Edhag O, Allander E (1992) Risk of cancer in patients with dermatomyositis or polymyositis. A population-based study. N Engl J Med 326(6):363–367
Bernatsky S, Boivin JF, Joseph L et al (2005) An international cohort study of cancer in systemic lupus erythematosus. Arthritis Rheum 52(5):1481–1490
Bernatsky S, Clarke AE, Suissa S (2008) Haematologic malignant neoplasms after drug exposure in rheumatoid arthritis. Arch Intern Med 168(4):378–381
Biro E, Szekanecz Z, Czirjak L et al (2006) Association of systemic and thyroid autoimmune diseases. Clin Rheumatol 25(2):240–245
Koh ET, Seow A, Ong B, Ratnagopal P, Tjia H, Chng HH (1993) Adult onset polymyositis/dermatomyositis: clinical and laboratory features and treatment response in 75 patients. Ann Rheum Dis 52(12):857–861
Shamim EA, Miller FW (2000) Familial autoimmunity and the idiopathic inflammatory myopathies. Curr Rheumatol Rep 2(3):201–211
Marie I, Hachulla E, Cherin P et al (2005) Opportunistic infections in polymyositis and dermatomyositis. Arthritis Rheum 53(2):155–165
Viguier M, Fouere S, de la Salmoniere P et al (2003) Peripheral blood lymphocyte subset counts in patients with dermatomyositis: clinical correlations and changes following therapy. Medicine (Baltimore) 82(2):82–86
Ishida Y, Utikoshi M, Kurosaki M et al (1998) Hepatic veno-occlusive disease in a case of polymyositis associated with thrombotic thrombocytopenic purpura/hemolytic uremic syndrome. Intern Med 37(8):694–699
Miller FW, Rider LG, Chung YL et al (2001) International Myositis Outcome Assessment Collaborative Study Group. Proposed preliminary core set measures for disease outcome assessment in adult and juvenile idiopathic inflammatory myopathies. Rheumatology (Oxford) 40(11):1262–1273
Isenberg DA, Allen E, Farewell V et al (2004) International Myositis and Clinical Studies Group (IMACS). International consensus outcome measures for patients with idiopathic inflammatory myopathies. Development and initial validation of myositis activity and damage indices in patients with adult onset disease. Rheumatology (Oxford) 43(1):49–54
Sultan SM, Allen E, Oddis CV et al (2008) Reliability and validity of the myositis disease activity assessment tool. Arthritis Rheum 58(11):3593–3599
Shamim EA, Rider LG, Pandey JP et al (2002) Differences in idiopathic inflammatory myopathy phenotypes and genotypes between Mesoamerican mestizos and North American Caucasians: ethnogeographic influences in the genetics and clinical expression of myositis. Arthritis Rheum 46(7):1885–1893
O'Hanlon TP, Rider LG, Mamyrova G et al (2006) HLA polymorphisms in African Americans with idiopathic inflammatory myopathy: allelic profiles distinguish patients with different clinical phenotypes and myositis autoantibodies. Arthritis Rheum 54(11):3670–3681
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Dr. Kristine P. Ng is a recipient of the New Zealand Rose Hellaby medical scholarship.
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Ng, K.P., Ramos, F., Sultan, S.M. et al. Concomitant diseases in a cohort of patients with idiopathic myositis during long-term follow-up. Clin Rheumatol 28, 947–953 (2009). https://doi.org/10.1007/s10067-009-1181-4
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DOI: https://doi.org/10.1007/s10067-009-1181-4