Coexistence of Multiple Myositis-Specific Antibodies in Patients with Idiopathic Inflammatory Myopathies

Overview

Journal J Clin Med

Specialty General Medicine

Date 2022 Dec 11

PMID 36498547

Authors

Hung-Ling Huang

Wen-Chih Lin

Wei-Lun Tsai

Chia-Tse Weng

Meng-Yu Weng

Chun-Hsin Wu

Yuan-Ting Sun

Affiliations

Soon will be listed here.

Abstract

The mutual exclusivity of myositis-specific antibodies (MSAs) has been reported before, but the coexistence of 2 or more MSAs was still found in a few case reports. This study aims to confirm the existence and prevalence of double MSAs in patients with idiopathic inflammatory myopathy (IIM) and to clarify the clinical features of these patients. One hundred fifty-one patients with IIM diagnosed from 1 July 2018 to 31 July 2022, at National Cheng Kung University Hospital, Taiwan, were enrolled and divided into two groups, patients with ≤1 MSA ( = 128, 84.8%) and those with ≥2 MSAs ( = 23, 15.2%) according to the initial serology results. After being re-examined by ANA-IIF assay, 8 out of 23 patients were confirmed to have ≥2 MSAs. The demographic data and clinical features were presented. The prevalence of double-positive MSAs among IIM was 5.3% in this cohort. The coexistence of two MSAs in an IIM patient does exist but is rare. Patients with two MSAs belonging to two distinct IIM subtypes presented clinical features skewed to one subtype instead of "mixed phenotypes". No apparent difference in clinical severity was found between patients with ≥2 MSAs and ≤1 MSA. Longer follow-ups and more studies are required to characterize the patients of IIM with ≥2 MSAs.

Citing Articles

Clinical Features of Dermatomyositis Associated with Myositis-Specific Antibodies in Moroccan Patients.

Chihi M, Barakat L, Benhayoun F, Allaoui A, Housbane S, Moudatir M Clin Pract. 2025; 15(2).

PMID: 39996701 PMC: 11853990. DOI: 10.3390/clinpract15020031.

Recognition of Idiopathic Inflammatory Myopathies Underlying Interstitial Lung Diseases.

Morina G, Sambataro D, Libra A, Palmucci S, Colaci M, La Rocca G Diagnostics (Basel). 2025; 15(3).

PMID: 39941205 PMC: 11817385. DOI: 10.3390/diagnostics15030275.

Increased Risk of Myositis-Specific and Myositis-Associated Autoantibodies After COVID-19 Pandemic and Vaccination: A Spanish Multicenter Collaborative Study.

Garcia-Bravo L, Prada A, Gutierrez Larranaga M, Espinosa Ros E, Almeida Gonzalez D, Martin Martinez D Biomedicines. 2025; 12(12.

PMID: 39767707 PMC: 11673751. DOI: 10.3390/biomedicines12122800.

An update on autoantibodies in the idiopathic inflammatory myopathies.

Allameen N, Ramos-Lisbona A, Wedderburn L, Lundberg I, Isenberg D Nat Rev Rheumatol. 2024; 21(1):46-62.

PMID: 39609638 DOI: 10.1038/s41584-024-01188-4.

Clinicopathological and imaging differences between pediatric and adult patients with anti-hydroxy-3-methyl-glutaryl-coenzyme A reductase necrotizing myopathy.

Yang M, Wang Y, Zhao Y, Yuan J, Zheng Y, Hao H Clin Rheumatol. 2024; 44(1):43-52.

PMID: 39562394 DOI: 10.1007/s10067-024-07240-8.

References

Leclair V, Lundberg I . New Myositis Classification Criteria-What We Have Learned Since Bohan and Peter. Curr Rheumatol Rep. 2018; 20(4):18. PMC: 5857275. DOI: 10.1007/s11926-018-0726-4. View

Damoiseaux J, Andrade L, Carballo O, Conrad K, Francescantonio P, Fritzler M . Clinical relevance of HEp-2 indirect immunofluorescent patterns: the International Consensus on ANA patterns (ICAP) perspective. Ann Rheum Dis. 2019; 78(7):879-889. PMC: 6585284. DOI: 10.1136/annrheumdis-2018-214436. View

Rietveld A, Lim J, de Visser M, van Engelen B, Pruijn G, Benveniste O . Autoantibody testing in idiopathic inflammatory myopathies. Pract Neurol. 2019; 19(4):284-294. DOI: 10.1136/practneurol-2017-001742. View

Melguizo Madrid E, Fernandez Riejos P, Toyos Saenz de Miera F, Fernandez Perez B, Gonzalez Rodriguez C . Coexistence of anti-Jo1 and anti-signal recognition particle antibodies in a polymyositis patient. Reumatol Clin (Engl Ed). 2018; 15(6):e111-e113. DOI: 10.1016/j.reuma.2017.12.003. View

Lundberg I, Tjarnlund A, Bottai M, Werth V, Pilkington C, de Visser M . 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis. 2017; 76(12):1955-1964. PMC: 5736307. DOI: 10.1136/annrheumdis-2017-211468. View

Selva-OCallaghan A, Martinez-Gomez X, Trallero-Araguas E, Pinal-Fernandez I . The diagnostic work-up of cancer-associated myositis. Curr Opin Rheumatol. 2018; 30(6):630-636. PMC: 11611047. DOI: 10.1097/BOR.0000000000000535. View

Cavagna L, Nuno L, Scire C, Govoni M, Lopez Longo F, Franceschini F . Serum Jo-1 Autoantibody and Isolated Arthritis in the Antisynthetase Syndrome: Review of the Literature and Report of the Experience of AENEAS Collaborative Group. Clin Rev Allergy Immunol. 2016; 52(1):71-80. DOI: 10.1007/s12016-016-8528-9. View

Wu M, Liao W, Lin P, Sun Y . Muscle Biopsy: A Requirement for Precision Medicine in Adult-Onset Myopathy. J Clin Med. 2022; 11(6). PMC: 8951002. DOI: 10.3390/jcm11061580. View

Betteridge Z, Tansley S, Shaddick G, Chinoy H, Cooper R, New R . Frequency, mutual exclusivity and clinical associations of myositis autoantibodies in a combined European cohort of idiopathic inflammatory myopathy patients. J Autoimmun. 2019; 101:48-55. PMC: 6580360. DOI: 10.1016/j.jaut.2019.04.001. View

10.

Stuhlmuller B, Schneider U, Gonzalez-Gonzalez J, Feist E . Disease Specific Autoantibodies in Idiopathic Inflammatory Myopathies. Front Neurol. 2019; 10:438. PMC: 6519140. DOI: 10.3389/fneur.2019.00438. View

11.

Palterer B, Vitiello G, Carraresi A, Giudizi M, Cammelli D, Parronchi P . Bench to bedside review of myositis autoantibodies. Clin Mol Allergy. 2018; 16:5. PMC: 5840827. DOI: 10.1186/s12948-018-0084-9. View

12.

Akintayo R, Agbola O, Adeyemo A, Adelowo O . Hyperacute muscle weakness in an unusual coexistence of antisignal recognition particle and anti-Mi-2 antibodies. BMJ Case Rep. 2017; 2017. PMC: 5534859. DOI: 10.1136/bcr-2017-219221. View

13.

Bodoki L, Nagy-Vincze M, Griger Z, Betteridge Z, Szollosi L, Jobanputra R . Rare myositis-specific autoantibody associations among Hungarian patients with idiopathic inflammatory myopathy. Acta Reumatol Port. 2016; 40(4):337-47. View

14.

Huang H, Lin W, Lin P, Weng M, Sun Y . The significance of myositis autoantibodies in idiopathic inflammatory myopathy concomitant with interstitial lung disease. Neurol Sci. 2020; 42(7):2855-2864. DOI: 10.1007/s10072-020-04911-7. View

15.

Nombel A, Fabien N, Coutant F . Dermatomyositis With Anti-MDA5 Antibodies: Bioclinical Features, Pathogenesis and Emerging Therapies. Front Immunol. 2021; 12:773352. PMC: 8564476. DOI: 10.3389/fimmu.2021.773352. View

16.

Hida A, Yamashita T, Hosono Y, Inoue M, Kaida K, Kadoya M . Anti-TIF1-γ antibody and cancer-associated myositis: A clinicohistopathologic study. Neurology. 2016; 87(3):299-308. DOI: 10.1212/WNL.0000000000002863. View

17.

Sugie K, Tonomura Y, Ueno S . Characterization of dermatomyositis with coexistence of anti-Jo-1 and anti-SRP antibodies. Intern Med. 2012; 51(7):799-802. DOI: 10.2169/internalmedicine.51.6566. View

18.

Nakajima A, Yoshino K, Soejima M, Kawaguchi Y, Satoh T, Kuwana M . High frequencies and co-existing of myositis-specific autoantibodies in patients with idiopathic inflammatory myopathies overlapped to rheumatoid arthritis. Rheumatol Int. 2011; 32(7):2057-61. DOI: 10.1007/s00296-011-1931-x. View

19.

Li Z, Gill E, Mo F, Reyes C . Double anti-PL-7 and anti-MDA-5 positive Amyopathic Dermatomyositis with rapidly progressive interstitial lung disease in a Hispanic patient. BMC Pulm Med. 2020; 20(1):220. PMC: 7429127. DOI: 10.1186/s12890-020-01256-x. View

20.

Schmidt J . Current Classification and Management of Inflammatory Myopathies. J Neuromuscul Dis. 2018; 5(2):109-129. PMC: 6004913. DOI: 10.3233/JND-180308. View