Pulmonary Complications of Polymyositis and Dermatomyositis

 

 Buy Article Permissions and Reprints

ABSTRACT

Polymyositis and dermatomyositis are systemic inflammatory diseases with unknown etiology and prognosis. Pulmonary involvement is increasingly recognized to be a major complication and a common cause of morbidity and mortality in these diseases. Thus a thorough pulmonary evaluation is necessary to permit appropriate management. There are three categories of pulmonary complications in myositis: aspiration pneumonia, hypoventilation, and interstitial lung disease (ILD). ILD is a frequent pulmonary complication in patients with myositis, and respiratory symptoms are not reliable signs for diagnosis. The strongest predictive factor for ILD in patients with myositis is the presence of antihistidyl transfer ribonucleic acid (tRNA) synthetase antibodies (anti-Jo-1), but ILD may also be present in patients without these autoantibodies. Therefore, all patients with polymyositis or dermatomyositis should be investigated with chest radiography, high-resolution computed tomography, and lung function tests.

REFERENCES

• 1 Dalakas M C. Polymyositis, dermatomyositis and inclusion-body myositis.  N Engl J Med. 1991;  325 1487-1498
  PubMedGoogle Scholar
• 2 Plotz P H, Rider L G, Targoff I N, Raben N, O'Hanlon T P, Miller F W. NIH conference. Myositis: immunologic contributions to understanding cause, pathogenesis, and therapy.  Ann Intern Med. 1995;  122 715-724
  PubMedGoogle Scholar
• 3 Weitoft T. Occurrence of polymyositis in the county of Gavleborg, Sweden.  Scand J Rheumatol. 1997;  26 104-106
  CrossrefPubMedGoogle Scholar
• 4 Hengstman G J, van Venrooij W J, Vencovsky J, Moutsopoulos H M, van Engelen B G. The relative prevalence of dermatomyositis and polymyositis in Europe exhibits a latitudinal gradient.  Ann Rheum Dis. 2000;  59 141-142
  CrossrefPubMedGoogle Scholar
• 5 Oddis C V, Conte C G, Steen V D, Medsger Jr T A. Incidence of polymyositis-dermatomyositis: a 20-year study of hospital diagnosed cases in Allegheny County, PA 1963-1982.  J Rheumatol. 1990;  17 1329-1334
  PubMedGoogle Scholar
• 6 Kaipiainen-Seppanen O, Aho K. Incidence of rare systemic rheumatic and connective tissue diseases in Finland.  J Intern Med. 1996;  240 81-84
  CrossrefPubMedGoogle Scholar
• 7 Medsger Jr T A, Robinson H, Masi A T. Factors affecting survivorship in polymyositis: a life-table study of 124 patients.  Arthritis Rheum. 1971;  14 249-258
  CrossrefPubMedGoogle Scholar
• 8 Hochberg M C. Epidemiology of polymyositis/dermatomyositis.  Mt Sinai J Med. 1988;  55 447-452
  PubMedGoogle Scholar
• 9 Arahata K, Engel A G. Monoclonal antibody analysis of mononuclear cells in myopathies, I: Quantitation of subsets according to diagnosis and sites of accumulation and demonstration and counts of muscle fibers invaded by T cells.  Ann Neurol. 1984;  16 193-208
  CrossrefPubMedGoogle Scholar
• 10 Engel A G, Arahata K. Monoclonal antibody analysis of mononuclear cells in myopathies, II: Phenotypes of autoinvasive cells in polymyositis and inclusion body myositis.  Ann Neurol. 1984;  16 209-215
  CrossrefPubMedGoogle Scholar
• 11 Nyberg P, Wikman A L, Nennesmo I, Lundberg I. Increased expression of interleukin 1 alpha and MHC class I in muscle tissue of patients with chronic, inactive polymyositis and dermatomyositis.  J Rheumatol. 2000;  27 940-948
  PubMedGoogle Scholar
• 12 Love L A, Leff R L, Fraser D D et al.. A new approach to the classification of idiopathic inflammatory myopathy: myositis-specific autoantibodies define useful homogeneous patient groups.  Medicine (Baltimore). 1991;  70 360-374
  PubMedGoogle Scholar
• 13 Selva-O'Callaghan A, Labrador-Horrillo M, Solans-Laque R, Simeon-Aznar C P, Martínez-Gómez X, Vilardell-Tarrés X. Myositis-specific and myositis-associated antibodies in a series of eighty-eight Mediterranean patients with idiopathic inflammatory myopathy.  Arthritis Rheum. 2006;  55 791-798
  CrossrefPubMedGoogle Scholar
• 14 Hausmanowa-Petrusewicz I, Kowalska-Oledzka E, Miller F W et al.. Clinical, serologic, and immunogenetic features in Polish patients with idiopathic inflammatory myopathies.  Arthritis Rheum. 1997;  40 1257-1266
  PubMedGoogle Scholar
• 15 Rutjes S A, Vree Egberts W T, Jongen P, Van Den Hoogen F, Pruijn G J, Van Venrooij W J. Anti-Ro52 antibodies frequently co-occur with anti-Jo-1 antibodies in sera from patients with idiopathic inflammatory myopathy.  Clin Exp Immunol. 1997;  109 32-40
  CrossrefPubMedGoogle Scholar
• 16 Lundberg I, Ulfgren A K, Nyberg P, Andersson U, Klareskog L. Cytokine production in muscle tissue of patients with idiopathic inflammatory myopathies.  Arthritis Rheum. 1997;  40 865-874
  CrossrefPubMedGoogle Scholar
• 17 Tateyama M, Nagano I, Yoshioka M, Chida K, Nakamura S, Itoyama Y. Expression of tumor necrosis factor-alpha in muscles of polymyositis.  J Neurol Sci. 1997;  146 45-51
  CrossrefPubMedGoogle Scholar
• 18 Ulfgren A K, Grundtman C, Borg K et al.. Down-regulation of the aberrant expression of the inflammation mediator high mobility group box chromosomal protein 1 in muscle tissue of patients with polymyositis and dermatomyositis treated with corticosteroids.  Arthritis Rheum. 2004;  50 1586-1594
  CrossrefPubMedGoogle Scholar
• 19 Fox S A, Ward B K, Robbins P D, Mastaglia F L, Swanson N R. Inclusion body myositis: investigation of the mumps virus hypothesis by polymerase chain reaction.  Muscle Nerve. 1996;  19 23-28
  PubMedGoogle Scholar
• 20 Leff R L, Love L A, Miller F W et al.. Viruses in idiopathic inflammatory myopathies: absence of candidate viral genomes in muscle.  Lancet. 1992;  339 1192-1195
  CrossrefPubMedGoogle Scholar
• 21 Friedman J M, Pachman L M, Maryjowski M L et al.. Immunogenetic studies of juvenile dermatomyositis: HLA-DR antigen frequencies.  Arthritis Rheum. 1983;  26 214-216
  PubMedGoogle Scholar
• 22 O`Hanlon T P, Carrick D M, Arnett F C et al.. Immunogenetic risk and protective factors for the idiopathic inflammatory myopathies: distinct HLA-A, -B, -DRB1 allelic profiles and motifs define clinicopathologic groups in Caucasians.  Medicine. 2005;  84 338-349
  CrossrefPubMedGoogle Scholar
• 23 Chinoy H, Salway F, Fertig N The UK Adult Onset Myositis Immunogenetic Collaboration (AOMIC) et al. In adult onset myositis, the presence of interstitial lung disease and myositis specific/associated antibodies are governed by HLA class II haplotype, rather than by myositis subtype.  Arthritis Res Ther. 2006;  8 R13
  CrossrefPubMedGoogle Scholar
• 24 Bohan A, Peter J B. Polymyositis and dermatomyositis.  N Engl J Med. 1975;  292 344-347
  CrossrefPubMedGoogle Scholar
• 25 Bohan A, Peter J B. Polymyositis and dermatomyositis.  N Engl J Med. 1975;  292 403-407
  CrossrefPubMedGoogle Scholar
• 26 Targoff I N, Miller F W, Medsger Jr T A, Oddis C V. Classification criteria for the idiopathic inflammatory myopathies.  Curr Opin Rheumatol. 1997;  9 527-535
  CrossrefPubMedGoogle Scholar
• 27 Hoogendijk J E, Amato A A, Lecky B R et al.. 119th ENMC International Workshop: trial design in adult idiopathic inflammatory myopathies, with the exception of inclusion body myositis 10-12 October 2003, Naarden, the Netherlands.  Neuromuscul Disord. 2004;  14 337-345
  CrossrefPubMedGoogle Scholar
• 28 Tanimoto K, Nakano K, Kano S et al.. Classification criteria for polymyositis and dermatomyositis.  J Rheumatol. 1995;  22 668-674
  PubMedGoogle Scholar
• 29 Marie I, Hachulla E, Cherin P et al.. Interstitial lung disease in polymyositis and dermatomyositis.  Arthritis Rheum. 2002;  47 614-622
  CrossrefPubMedGoogle Scholar
• 30 Marie I, Hachulla E, Cherin P et al.. Opportunistic infections in polymyositis and dermatomyositis.  Arthritis Rheum. 2005;  53 155-165
  CrossrefPubMedGoogle Scholar
• 31 Dankó K, Ponyi A, Constantin T, Borgulya G, Szegedi G. Long-term survival of patients with idiopathic inflammatory myopathies according to clinical features: a longitudinal study of 162 cases.  Medicine. 2004;  83 35-42
  CrossrefPubMedGoogle Scholar
• 32 Hepper N G, Ferguson R H, Howard Jr F M. Three types of pulmonary involvement in polymyositis.  Med Clin North Am. 1964;  48 1031-1042
  PubMedGoogle Scholar
• 33 Dickey B F, Myers A R. Pulmonary disease in polymyositis/dermatomyositis.  Semin Arthritis Rheum. 1984;  14 60-76
  CrossrefPubMedGoogle Scholar
• 34 Braun N M, Arora N S, Rochester D F. Respiratory muscle and pulmonary function in polymyositis and other proximal myopathies.  Thorax. 1983;  38 616-623
  PubMedGoogle Scholar
• 35 Benbassat J, Gefel D, Larholt K, Sukenik S, Morgenstern V, Zlotnick A. Prognostic factors in polymyositis/dermatomyositis: a computer-assisted analysis of ninety-two cases.  Arthritis Rheum. 1985;  28 249-255
  CrossrefPubMedGoogle Scholar
• 36 Schwarz M I. The lung in polymyositis.  Clin Chest Med. 1998;  19 701-712 , viii.
  CrossrefPubMedGoogle Scholar
• 37 Takizawa H, Shiga J, Moroi Y et al.. Interstitial lung disease in dermatomyositis: clinicopathological study.  J Rheumatol. 1987;  14 102-107
  PubMedGoogle Scholar
• 38 Fathi M, Dastmalchi M, Rasmussen E, Lundberg I E, Tornling G. Interstitial lung disease, a common manifestation of newly diagnosed polymyositis and dermatomyositis.  Ann Rheum Dis. 2004;  63 297-301
  CrossrefPubMedGoogle Scholar
• 39 Wallaert B, Hatron P Y, Grosbois J M, Tonnel A B, Devulder B, Voisin C. Subclinical pulmonary involvement in collagen-vascular diseases assessed by bronchoalveolar lavage: relationship between alveolitis and subsequent changes in lung function.  Am Rev Respir Dis. 1986;  133 574-580
  PubMedGoogle Scholar
• 40 Remy-Jardin M, Giraud F, Remy J, Copin M C, Gosselin B, Duhamel A. Importance of ground-glass attenuation in chronic diffuse infiltrative lung disease: pathologic-CT correlation.  Radiology. 1993;  189 693-698
  CrossrefPubMedGoogle Scholar
• 41 Aoun N Y, Velez E, Aggarwal A, Hayes G B, Kenney L A. Fatal acute interstitial pneumonitis complicating polymyositis in a 41-year-old man.  Respir Care. 2004;  49 1515-1521
  PubMedGoogle Scholar
• 42 Friedman A W, Targoff I N, Amett F C. Interstitial lung disease with autoantibodies against aminoacyl-tRNA synthetases in the absence of clinically apparent myositis.  Semin Arthritis Rheum. 1996;  26 459-467
  CrossrefPubMedGoogle Scholar
• 43 Yang Y, Fujita J, Tokuda M, Bandoh S, Ishida T. Chronological evaluation of the onset of histologically confirmed interstitial pneumonia associated with polymyositis/dermatomyositis.  Intern Med. 2002;  41 1135-1141
  CrossrefPubMedGoogle Scholar
• 44 Schnabel A, Reuter M, Biederer J, Richter C, Gross W L. Interstitial lung disease in polymyositis and dermatomyositis: clinical course and response to treatment.  Semin Arthritis Rheum. 2003;  32 273-284
  CrossrefPubMedGoogle Scholar
• 45 Suda T, Fujisawa T, Enomoto N et al.. Interstitial lung diseases associated with amyopathic dermatomyositis.  Eur Respir J. 2006;  28 1005-1012
  CrossrefPubMedGoogle Scholar
• 46 Sakamoto N, Mukae H, Fujii T et al.. Nonspecific interstitial pneumonia with poor prognosis associated with amyopathic dermatomyositis.  Intern Med. 2004;  43 838-842
  CrossrefPubMedGoogle Scholar
• 47 High W A, Cohen J B, Murphy B A, Costner M I. Fatal interstitial pulmonary fibrosis in anti-Jo-1-negative amyopathic dermatomyositis.  J Am Acad Dermatol. 2003;  49 295-298
  CrossrefPubMedGoogle Scholar
• 48 Frazier A R, Miller R D. Interstitial pneumonitis in association with polymyositis and dermatomyositis.  Chest. 1974;  65 403-407
  CrossrefPubMedGoogle Scholar
• 49 Muller N L, Staples C A, Miller R R, Vedal S, Thurlbeck W M, Ostrow D N. Disease activity in idiopathic pulmonary fibrosis: CT and pathologic correlation.  Radiology. 1987;  165 731-734
  PubMedGoogle Scholar
• 50 Muller N L, Miller R R, Webb W R, Evans K G, Ostrow D N. Fibrosing alveolitis: CT-pathologic correlation.  Radiology. 1986;  160 585-588
  PubMedGoogle Scholar
• 51 Nishimura K, Kitaichi M, Izumi T, Itoh H. Diffuse panbronchiolitis: correlation of high-resolution CT and pathologic findings.  Radiology. 1992;  184 779-785
  PubMedGoogle Scholar
• 52 Lee C S, Chen T L, Tzen C Y et al.. Idiopathic inflammatory myopathy with diffuse alveolar damage.  Clin Rheumatol. 2002;  21 391-396
  CrossrefPubMedGoogle Scholar
• 53 Bonnefoy O, Ferretti G, Calaque O et al.. Serial chest CT findings in interstitial lung disease associated with polymyositis-dermatomyositis.  Eur J Radiol. 2004;  49 235-244
  CrossrefPubMedGoogle Scholar
• 54 Mino M, Noma S, Taguchi Y, Tomii K, Kohri Y, Oida K. Pulmonary involvement in polymyositis and dermatomyositis: sequential evaluation with CT.  AJR Am J Roentgenol. 1997;  169 83-87
  PubMedGoogle Scholar
• 55 Arakawa H, Yamada H, Kurihara Y et al.. Nonspecific interstitial pneumonia associated with polymyositis and dermatomyositis: serial high-resolution CT findings and functional correlation.  Chest. 2003;  123 1096-1103
  CrossrefPubMedGoogle Scholar
• 56 Douglas W W, Tazelaar H D, Hartman T E et al.. Polymyositis-dermatomyositis-associated interstitial lung disease.  Am J Respir Crit Care Med. 2001;  164 1182-1185
  CrossrefPubMedGoogle Scholar
• 57 Tazelaar H D, Viggiano R W, Pickersgill J, Colby T V. Interstitial lung disease in polymyositis and dermatomyositis: clinical features and prognosis as correlated with histologic findings.  Am Rev Respir Dis. 1990;  141 727-733
  CrossrefPubMedGoogle Scholar
• 58 Wells A U, Hansell D M, Corrin B et al.. High-resolution computed tomography as a predictor of lung histology in systemic sclerosis.  Thorax. 1992;  47 738-742
  PubMedGoogle Scholar
• 59 Tansey D, Wells A U, Colby T V et al.. Variations in histological patterns of interstitial pneumonia between connective tissue disorders and their relationship to prognosis.  Histopathology. 2004;  44 585-596
  CrossrefPubMedGoogle Scholar
• 60 Kubo M, Ihn H, Yamane K et al.. Serum KL-6 in adult patients with polymyositis and dermatomyositis.  Rheumatology (Oxford). 2000;  39 632-636
  CrossrefPubMedGoogle Scholar
• 61 Bandoh S, Fujita J, Ohtsuki Y et al.. Sequential changes of KL-6 in sera of patients with interstitial pneumonia associated with polymyositis/dermatomyositis.  Ann Rheum Dis. 2000;  59 257-262
  CrossrefPubMedGoogle Scholar
• 62 Ihn H, Asano Y, Kubo M et al.. Clinical significance of serum surfactant protein D (SP-D) in patients with polymyositis/dermatomyositis: correlation with interstitial lung disease.  Rheumatology (Oxford). 2002;  41 1268-1272
  CrossrefPubMedGoogle Scholar
• 63 Fujita J, Dobashi N, Tokuda M et al.. Elevation of cytokeratin 19 fragment in patients with interstitial pneumonia associated with polymyositis/dermatomyositis.  J Rheumatol. 1999;  26 2377-2382
  PubMedGoogle Scholar
• 64 Fujisawa T, Suda T, Nakamura Y et al.. Differences in clinical features and prognosis of interstitial lung diseases between polymyositis and dermatomyositis.  J Rheumatol. 2005;  32 58-64
  PubMedGoogle Scholar
• 65 Marguerie C, Bunn C C, Beynon H L et al.. Polymyositis, pulmonary fibrosis and autoantibodies to aminoacyl-tRNA synthetase enzymes.  Q J Med. 1990;  77 1019-1038
  PubMedGoogle Scholar
• 66 Spath M, Schroder M, Schlotter-Weigel B et al.. The long-term outcome of anti-Jo-1-positive inflammatory myopathies.  J Neurol. 2004;  251 859-864
  PubMedGoogle Scholar
• 67 Kashiwabara K, Ota K. Rapidly progressive interstitial lung disease in a dermatomyositis patient with high levels of creatine phosphokinase, severe muscle symptoms and positive anti-Jo-1 antibody.  Intern Med. 2002;  41 584-588
  CrossrefPubMedGoogle Scholar
• 68 Tubery M, Lauque D, Murris M et al.. Course of interstitial lung diseases associated with inflammatory myopathies: apropos of 5 cases.  Ann Med Interne (Paris). 1997;  148 2-10
  PubMedGoogle Scholar
• 69 Tomsic M, Sifrer F. Acute respiratory distress syndrome in a polymyositis patient with the anti-Jo-1 antibody.  Wien Klin Wochenschr. 2000;  112 728-731
  PubMedGoogle Scholar
• 70 Miyake S, Ohtani Y, Sawada M et al.. Usefulness of cyclosporine A on rapidly progressive interstitial pneumonia in dermatomyositis.  Sarcoidosis Vasc Diffuse Lung Dis. 2002;  19 128-133
  PubMedGoogle Scholar
• 71 Selva-O'Callaghan A, Labrador-Horrillo M, Munoz-Gall X et al.. Polymyositis/dermatomyositis-associated lung disease: analysis of a series of 81 patients.  Lupus. 2005;  14 534-542
  CrossrefPubMedGoogle Scholar
• 72 Takada K, Nagasaka K, Miyasaka N. Polymyositis/dermatomyositis and interstitial lung disease: a new therapeutic approach with T-cell-specific immunosuppressants.  Autoimmunity. 2005;  38 383-392
  CrossrefPubMedGoogle Scholar
• 73 Wilkes M R, Sereika S M, Fertig N, Lucas M R, Oddis C V. Treatment of antisynthetase-associated interstitial lung disease with tacrolimus.  Arthritis Rheum. 2005;  52 2439-2446
  CrossrefPubMedGoogle Scholar
• 74 Labioche I, Liozon E, Weschler B, Loustaud-Ratti V, Soria P, Vidal E. Refractory polymyositis responding to infliximab: extended follow-up.  Rheumatology (Oxford). 2004;  43 531-532
  CrossrefPubMedGoogle Scholar
• 75 Efthimiou P. Tumor necrosis factor-alpha in inflammatory myopathies: pathophysiology and therapeutic implications.  Semin Arthritis Rheum. 2006;  36 144-152
  CrossrefPubMedGoogle Scholar
• 76 Hengstman G J, van den Hoogen F H, van Engelen B G. Treatment of dermatomyositis and polymyositis with anti-tumor necrosis factor-alpha: long-term follow-up.  Eur Neurol. 2004;  52 61-63
  CrossrefPubMedGoogle Scholar

Ingrid LundbergM.D. Ph.D. 

Rheumatology Unit, Karolinska University Hospital, Solna, Karolinska Institutet

SE- 171 76 Stockholm, Sweden

Email: ingrid.Lundberg@ki.se