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Jessie Aouizerate, Marie De Antonio, Brigitte Bader-Meunier, Christine Barnerias, Christine Bodemer, Arnaud Isapof, Pierre Quartier, Isabelle Melki, Jean-Luc Charuel, Guillaume Bassez, Isabelle Desguerre, Romain K Gherardi, François-Jérôme Authier, Cyril Gitiaux, Muscle ischaemia associated with NXP2 autoantibodies: a severe subtype of juvenile dermatomyositis, Rheumatology, Volume 57, Issue 5, May 2018, Pages 873–879, https://doi.org/10.1093/rheumatology/kex516
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Abstract
Myositis-specific autoantibodies (MSAs) are increasingly used to delineate distinct subgroups of JDM. The aim of our study was to explore without a priori hypotheses whether MSAs are associated with distinct clinical–pathological changes and severity in a monocentric JDM cohort.
Clinical, biological and histological findings from 23 JDM patients were assessed. Twenty-six histopathological parameters were subjected to multivariate analysis.
Autoantibodies included anti-NXP2 (9/23), anti-TIF1γ (4/23), anti-MDA5 (2/23), no MSAs (8/23). Multivariate analysis yielded two histopathological clusters. Cluster 1 (n = 11) showed a more severe and ischaemic pattern than cluster 2 (n = 12) assessed by: total score severity ⩾ 20 (100.0% vs 25.0%); visual analogic score ⩾6 (100.0% vs 25.0%); the vascular domain score >1 (100.0% vs 41.7%); microinfarcts (100% vs 58.3%); ischaemic myofibrillary loss (focal punched-out vacuoles) (90.9 vs 25%); and obvious capillary loss (81.8% vs 16.7). Compared with cluster 2, patients in cluster 1 had strikingly more often anti-NXP2 antibodies (7/11 vs 2/12), more pronounced muscle weakness, more gastrointestinal involvement and required more aggressive treatment. Furthermore, patients with anti-NXP2 antibodies, mostly assigned in the first cluster, also displayed more severe muscular disease, requiring more aggressive treatment and having a lower remission rate during the follow-up period.
Marked muscle ischaemic involvement and the presence of anti-NXP2 autoantibodies are associated with more severe forms of JDM.
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