Aswin M Nair1, John Mathew1, Ruchika Goel1, Pramod Chebbi1, Ashish Jacob Mathew1, G Arvind1, Bijesh Yadav2, Grace Rebekah2, John A J Prakash3, Debashish Danda4. 1. Department of Clinical Immunology and Rheumatology, Christian Medical College and Hospital (CMCH), Vellore, Tamil Nadu, 632002, India. 2. Department of Bio-statistics, CMCH, Vellore, Tamil Nadu, 632002, India. 3. Department of Microbiology, CMCH, Vellore, Tamil Nadu, 632002, India. 4. Department of Clinical Immunology and Rheumatology, Christian Medical College and Hospital (CMCH), Vellore, Tamil Nadu, 632002, India. debashisdandacmc@hotmail.com.
Abstract
BACKGROUND: Consensus on treatment of idiopathic inflammatory myositis (IIM), particularly with regard to flares and interstitial lung disease (ILD), does not exist. We studied the long-term outcome and treatment response in our large, retrospective cohort of adult South-Asian patients exclusively with IIM. METHODOLOGY: Electronic records of IIM patients satisfying inclusion and exclusion criteria were studied longitudinally at presentation, at 3, 6, 12, 18 and 24 months and thereafter yearly till their last follow up (F/u) visit. Depending on clinical, imaging, and muscle enzyme profile during the F/u period, patients were categorised as complete (CR) and partial responders (PRs). Parameters favouring CR were assessed using multivariate logistic regression analysis. Outcome parameters and flares on immunosuppressants (IS) were then assessed in patients with/without ILD. RESULTS: Two hundred thirty-two patients with median F/u duration of 44.5 months (25-80.25) were included. ILD was seen in 40.1%. Patients with non-Jo1 anti-synthetase antibodies (n=26) were numerically more than those with Jo-1 antibody (n=24). CR status was attained by 50.9% patients. Absence of pericardial effusion (p=0.042, OR 4.223, 95% CI: 1.05-16.9) and presence of Gottron's rash (p=0.044, OR 1.78, 95% CI 1.017-3.121) at baseline predicted CR by multivariate regression. Majority received mycophenolate during the entire F/u period. Discontinuation of steroids was feasible in 51.7% after a median duration of 24 months (18-42). After excluding patients with ILD, flares were numerically lesser in patients only on mycophenolate compared with those only on methotrexate (p=0.06). Further flares were curtailed when switched from other agents to mycophenolate. CONCLUSION: Mycophenolate is an effective treatment option in IIM patients with and without co-existing ILD. Presence of Gottron's rash and absence of pericardial effusion were found to be predictors of favourable clinical outcome in this largest single-centre study.
BACKGROUND: Consensus on treatment of idiopathic inflammatory myositis (IIM), particularly with regard to flares and interstitial lung disease (ILD), does not exist. We studied the long-term outcome and treatment response in our large, retrospective cohort of adult South-Asian patients exclusively with IIM. METHODOLOGY: Electronic records of IIM patients satisfying inclusion and exclusion criteria were studied longitudinally at presentation, at 3, 6, 12, 18 and 24 months and thereafter yearly till their last follow up (F/u) visit. Depending on clinical, imaging, and muscle enzyme profile during the F/u period, patients were categorised as complete (CR) and partial responders (PRs). Parameters favouring CR were assessed using multivariate logistic regression analysis. Outcome parameters and flares on immunosuppressants (IS) were then assessed in patients with/without ILD. RESULTS: Two hundred thirty-two patients with median F/u duration of 44.5 months (25-80.25) were included. ILD was seen in 40.1%. Patients with non-Jo1 anti-synthetase antibodies (n=26) were numerically more than those with Jo-1 antibody (n=24). CR status was attained by 50.9% patients. Absence of pericardial effusion (p=0.042, OR 4.223, 95% CI: 1.05-16.9) and presence of Gottron's rash (p=0.044, OR 1.78, 95% CI 1.017-3.121) at baseline predicted CR by multivariate regression. Majority received mycophenolate during the entire F/u period. Discontinuation of steroids was feasible in 51.7% after a median duration of 24 months (18-42). After excluding patients with ILD, flares were numerically lesser in patients only on mycophenolate compared with those only on methotrexate (p=0.06). Further flares were curtailed when switched from other agents to mycophenolate. CONCLUSION:Mycophenolate is an effective treatment option in IIM patients with and without co-existing ILD. Presence of Gottron's rash and absence of pericardial effusion were found to be predictors of favourable clinical outcome in this largest single-centre study.
Authors: I M Bronner; M F G van der Meulen; M de Visser; S Kalmijn; W J van Venrooij; A E Voskuyl; H J Dinant; W H J P Linssen; J H J Wokke; J E Hoogendijk Journal: Ann Rheum Dis Date: 2006-04-10 Impact factor: 19.103
Authors: Ingrid E Lundberg; Anna Tjärnlund; Matteo Bottai; Victoria P Werth; Clarissa Pilkington; Marianne de Visser; Lars Alfredsson; Anthony A Amato; Richard J Barohn; Matthew H Liang; Jasvinder A Singh; Rohit Aggarwal; Snjolaug Arnardottir; Hector Chinoy; Robert G Cooper; Katalin Dankó; Mazen M Dimachkie; Brian M Feldman; Ignacio Garcia-De La Torre; Patrick Gordon; Taichi Hayashi; James D Katz; Hitoshi Kohsaka; Peter A Lachenbruch; Bianca A Lang; Yuhui Li; Chester V Oddis; Marzena Olesinska; Ann M Reed; Lidia Rutkowska-Sak; Helga Sanner; Albert Selva-O'Callaghan; Yeong-Wook Song; Jiri Vencovsky; Steven R Ytterberg; Frederick W Miller; Lisa G Rider Journal: Ann Rheum Dis Date: 2017-10-27 Impact factor: 19.103