Clinical and Laboratory ObservationsNew insight into calcinosis of juvenile dermatomyositis: A study of composition and treatment☆
Section snippets
Patient 1
This 14-year-old boy had had chronic JDM since the age of 10 years and was steroid-dependent. Remission had been achieved after 2.5 years with cyclosporine treatment (blood levels 150 to 200 mg/mL). Mild calcinosis had developed around the knee, and there was a painful, gradually increasing fluid collection on the left elbow that limited the patient’s movements.
Surgical drainage was required for treatment. There was no cellulitis at the time of the procedure. Twenty milliliters of aseptic fluid
Discussion
Examination of the chemical composition of the calcinosis of JDM showed that the nucleus consists of hydroxyapatite, although other impurities such as calcium oxalate and uric acid may be present in the crystal. The mineral has been identified previously as calcium apatite.4 The presence of macrophages and IL-6, IL-1β, and TNF-α in the milk of calcium, together with the detectable levels of IL-1β in the serum, suggests that activated macrophages play an important role in the calcinosis of JDM.
Acknowledgements
We are grateful for the editorial and secretarial help of Gloria Ginzach and Melanie Kawe.
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Cited by (125)
Calcinosis Biomarkers in Adult and Juvenile Dermatomyositis
2020, Autoimmunity ReviewsCitation Excerpt :The calcium mineral itself may be a chemoattractant for macrophages and monocytes [93]. In different studies analyzing milk of calcium in JDM patients, the fluid collected contained macrophages, tumor necrosis factor alpha (TNFα), Interleukin-1 beta (IL-1β), and other pro-inflammatory cytokines (IL-6, soluble TNF receptors, neopterin, and IL-18) [9,43,94]. Together these findings suggest that activated macrophages play an important role in the calcinosis of DM [43,94].
Juvenile dermatomyositis forty years on: Case report
2018, Neuromuscular DisordersTumor Necrosis Factor Inhibitors in Pediatric Rheumatology
2016, Handbook of Systemic Autoimmune DiseasesCalcinosis in Juvenile Dermatomyositis—Epidemiology, Pathogenesis, Clinical Features, and Treatment: A Systematic Review
2024, Current Rheumatology Reports
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Reprint requests: Masza Mukamel, MD, Pediatric Rheumatology Unit, Schneider Children’s Medical Center of Israel, 14 Kaplan St, Petah Tiqva 49202, Israel.