Polymyositis and dermatomyositis laboratory findings: Difference between revisions

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==Laboratory Findings==
==Laboratory Findings==
*Different laboratory tests may be used to diagnose polymyositis and dermatomyositis and exclude other myopathies which include:<ref name="pmid29579414">{{cite journal |vauthors=Adler BL, Christopher-Stine L |title=Triggers of inflammatory myopathy: insights into pathogenesis |journal=Discov Med |volume=25 |issue=136 |pages=75–83 |date=February 2018 |pmid=29579414 |doi= |url=}}</ref><ref name="pmid25182203">{{cite journal |vauthors=Bodoki L, Nagy-Vincze M, Griger Z, Betteridge Z, Szöllősi L, Dankó K |title=Four dermatomyositis-specific autoantibodies-anti-TIF1γ, anti-NXP2, anti-SAE and anti-MDA5-in adult and juvenile patients with idiopathic inflammatory myopathies in a Hungarian cohort |journal=Autoimmun Rev |volume=13 |issue=12 |pages=1211–9 |date=December 2014 |pmid=25182203 |doi=10.1016/j.autrev.2014.08.011 |url=}}</ref><ref name="KhanChristopher-Stine2011">{{cite journal|last1=Khan|first1=Sabiha|last2=Christopher-Stine|first2=Lisa|title=Polymyositis, Dermatomyositis, and Autoimmune Necrotizing Myopathy: Clinical Features|journal=Rheumatic Disease Clinics of North America|volume=37|issue=2|year=2011|pages=143–158|issn=0889857X|doi=10.1016/j.rdc.2011.01.001}}</ref><ref name="DoblougGaren2015">{{cite journal|last1=Dobloug|first1=Cecilie|last2=Garen|first2=Torhild|last3=Bitter|first3=Helle|last4=Stjärne|first4=Johan|last5=Stenseth|first5=Guri|last6=Grøvle|first6=Lars|last7=Sem|first7=Marthe|last8=Gran|first8=Jan Tore|last9=Molberg|first9=Øyvind|title=Prevalence and clinical characteristics of adult polymyositis and dermatomyositis; data from a large and unselected Norwegian cohort|journal=Annals of the Rheumatic Diseases|volume=74|issue=8|year=2015|pages=1551–1556|issn=0003-4967|doi=10.1136/annrheumdis-2013-205127}}</ref><ref name="ChinoyFertig2007">{{cite journal|last1=Chinoy|first1=H.|last2=Fertig|first2=N.|last3=Oddis|first3=C. V|last4=Ollier|first4=W. E R|last5=Cooper|first5=R. G|title=The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis|journal=Annals of the Rheumatic Diseases|volume=66|issue=10|year=2007|pages=1345–1349|issn=0003-4967|doi=10.1136/ard.2006.068502}}</ref><ref name="DalakasHohlfeld2003">{{cite journal|last1=Dalakas|first1=Marinos C|last2=Hohlfeld|first2=Reinhard|title=Polymyositis and dermatomyositis|journal=The Lancet|volume=362|issue=9388|year=2003|pages=971–982|issn=01406736|doi=10.1016/S0140-6736(03)14368-1}}</ref><ref name="DouglasTazelaar2001">{{cite journal|last1=Douglas|first1=William W.|last2=Tazelaar|first2=Henry D.|last3=Hartman|first3=Thomas E.|last4=Hartman|first4=Robert P.|last5=Decker|first5=Paul A.|last6=Schroeder|first6=Darrell R.|last7=Ryu|first7=Jay H.|title=Polymyositis–Dermatomyositis-associated Interstitial Lung Disease|journal=American Journal of Respiratory and Critical Care Medicine|volume=164|issue=7|year=2001|pages=1182–1185|issn=1073-449X|doi=10.1164/ajrccm.164.7.2103110}}</ref><ref name="Miller1993">{{cite journal|last1=Miller|first1=Frederick W.|title=Myositis-Specific Autoantibodies|journal=JAMA|volume=270|issue=15|year=1993|pages=1846|issn=0098-7484|doi=10.1001/jama.1993.03510150080034}}</ref>
*Different laboratory tests may be used to diagnose polymyositis and dermatomyositis and exclude other myopathies which include:<ref name="pmid29579414">{{cite journal |vauthors=Adler BL, Christopher-Stine L |title=Triggers of inflammatory myopathy: insights into pathogenesis |journal=Discov Med |volume=25 |issue=136 |pages=75–83 |date=February 2018 |pmid=29579414 |doi= |url=}}</ref><ref name="pmid25182203">{{cite journal |vauthors=Bodoki L, Nagy-Vincze M, Griger Z, Betteridge Z, Szöllősi L, Dankó K |title=Four dermatomyositis-specific autoantibodies-anti-TIF1γ, anti-NXP2, anti-SAE and anti-MDA5-in adult and juvenile patients with idiopathic inflammatory myopathies in a Hungarian cohort |journal=Autoimmun Rev |volume=13 |issue=12 |pages=1211–9 |date=December 2014 |pmid=25182203 |doi=10.1016/j.autrev.2014.08.011 |url=}}</ref><ref name="KhanChristopher-Stine2011">{{cite journal|last1=Khan|first1=Sabiha|last2=Christopher-Stine|first2=Lisa|title=Polymyositis, Dermatomyositis, and Autoimmune Necrotizing Myopathy: Clinical Features|journal=Rheumatic Disease Clinics of North America|volume=37|issue=2|year=2011|pages=143–158|issn=0889857X|doi=10.1016/j.rdc.2011.01.001}}</ref><ref name="DoblougGaren2015">{{cite journal|last1=Dobloug|first1=Cecilie|last2=Garen|first2=Torhild|last3=Bitter|first3=Helle|last4=Stjärne|first4=Johan|last5=Stenseth|first5=Guri|last6=Grøvle|first6=Lars|last7=Sem|first7=Marthe|last8=Gran|first8=Jan Tore|last9=Molberg|first9=Øyvind|title=Prevalence and clinical characteristics of adult polymyositis and dermatomyositis; data from a large and unselected Norwegian cohort|journal=Annals of the Rheumatic Diseases|volume=74|issue=8|year=2015|pages=1551–1556|issn=0003-4967|doi=10.1136/annrheumdis-2013-205127}}</ref><ref name="ChinoyFertig2007">{{cite journal|last1=Chinoy|first1=H.|last2=Fertig|first2=N.|last3=Oddis|first3=C. V|last4=Ollier|first4=W. E R|last5=Cooper|first5=R. G|title=The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis|journal=Annals of the Rheumatic Diseases|volume=66|issue=10|year=2007|pages=1345–1349|issn=0003-4967|doi=10.1136/ard.2006.068502}}</ref><ref name="DalakasHohlfeld2003">{{cite journal|last1=Dalakas|first1=Marinos C|last2=Hohlfeld|first2=Reinhard|title=Polymyositis and dermatomyositis|journal=The Lancet|volume=362|issue=9388|year=2003|pages=971–982|issn=01406736|doi=10.1016/S0140-6736(03)14368-1}}</ref><ref name="DouglasTazelaar2001">{{cite journal|last1=Douglas|first1=William W.|last2=Tazelaar|first2=Henry D.|last3=Hartman|first3=Thomas E.|last4=Hartman|first4=Robert P.|last5=Decker|first5=Paul A.|last6=Schroeder|first6=Darrell R.|last7=Ryu|first7=Jay H.|title=Polymyositis–Dermatomyositis-associated Interstitial Lung Disease|journal=American Journal of Respiratory and Critical Care Medicine|volume=164|issue=7|year=2001|pages=1182–1185|issn=1073-449X|doi=10.1164/ajrccm.164.7.2103110}}</ref><ref name="Miller1993">{{cite journal|last1=Miller|first1=Frederick W.|title=Myositis-Specific Autoantibodies|journal=JAMA|volume=270|issue=15|year=1993|pages=1846|issn=0098-7484|doi=10.1001/jama.1993.03510150080034}}</ref>
**Routine tests<ref name="Volochayev2012">{{cite journal|last1=Volochayev|first1=Rita|title=Laboratory Test Abnormalities are Common in Polymyositis and Dermatomyositis and Differ Among Clinical and Demographic Groups|journal=The Open Rheumatology Journal|volume=6|issue=1|year=2012|pages=54–63|issn=18743129|doi=10.2174/1874312901206010054}}</ref>
**Sarcoplasmic enzymes
**Sarcoplasmic enzymes
**Myositis-specific autoantibodies<ref name="Targoff2006">{{cite journal|last1=Targoff|first1=Ira N.|title=Myositis specific autoantibodies|journal=Current Rheumatology Reports|volume=8|issue=3|year=2006|pages=196–203|issn=1523-3774|doi=10.1007/s11926-996-0025-3}}</ref><ref name="GunawardenaBetteridge2009">{{cite journal|last1=Gunawardena|first1=H.|last2=Betteridge|first2=Z. E.|last3=McHugh|first3=N. J.|title=Myositis-specific autoantibodies: their clinical and pathogenic significance in disease expression|journal=Rheumatology|volume=48|issue=6|year=2009|pages=607–612|issn=1462-0324|doi=10.1093/rheumatology/kep078}}</ref>
**Myositis-specific autoantibodies<ref name="Targoff2006">{{cite journal|last1=Targoff|first1=Ira N.|title=Myositis specific autoantibodies|journal=Current Rheumatology Reports|volume=8|issue=3|year=2006|pages=196–203|issn=1523-3774|doi=10.1007/s11926-996-0025-3}}</ref><ref name="GunawardenaBetteridge2009">{{cite journal|last1=Gunawardena|first1=H.|last2=Betteridge|first2=Z. E.|last3=McHugh|first3=N. J.|title=Myositis-specific autoantibodies: their clinical and pathogenic significance in disease expression|journal=Rheumatology|volume=48|issue=6|year=2009|pages=607–612|issn=1462-0324|doi=10.1093/rheumatology/kep078}}</ref>
=== Routine test ===
* Abnormal test results include:
** CBC
*** High white blood cell counts
*** Low lymphocyte counts
*** Low hematocrit levels
** Low albumin levels
** High erythrocyte sedimentation rates
** High IgM and IgG levels
=== Sarcoplasmic enzymes ===
=== Sarcoplasmic enzymes ===
* Sarcoplasmic enzymes consistent with the diagnosis of polymyositis and dermatomyositis include:<ref name="BohanPeter1975">{{cite journal|last1=Bohan|first1=Anthony|last2=Peter|first2=James B.|title=Polymyositis and Dermatomyositis|journal=New England Journal of Medicine|volume=292|issue=8|year=1975|pages=403–407|issn=0028-4793|doi=10.1056/NEJM197502202920807}}</ref>
* Sarcoplasmic enzymes consistent with the diagnosis of polymyositis and dermatomyositis include:<ref name="BohanPeter1975">{{cite journal|last1=Bohan|first1=Anthony|last2=Peter|first2=James B.|title=Polymyositis and Dermatomyositis|journal=New England Journal of Medicine|volume=292|issue=8|year=1975|pages=403–407|issn=0028-4793|doi=10.1056/NEJM197502202920807}}</ref>

Revision as of 19:18, 12 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Laboratory Findings

  • Different laboratory tests may be used to diagnose polymyositis and dermatomyositis and exclude other myopathies which include:[1][2][3][4][5][6][7][8]
    • Routine tests[9]
    • Sarcoplasmic enzymes
    • Myositis-specific autoantibodies[10][11]

Routine test

  • Abnormal test results include:
    • CBC
      • High white blood cell counts
      • Low lymphocyte counts
      • Low hematocrit levels
    • Low albumin levels
    • High erythrocyte sedimentation rates
    • High IgM and IgG levels

Sarcoplasmic enzymes

  • Sarcoplasmic enzymes consistent with the diagnosis of polymyositis and dermatomyositis include:[12]
    • Creatine phosphokinase
    • Aldolase
    • Transaminases
      • Alanine aminotransferase
      • Aspartate aminotransferase 
    • Lactic dehydrogenase
    • Myoglobin

Myositis-specific autoantibodies

Autoantibody Antigen Features Frequency
Antisynthetase Anti-Jo-1 Histidyl-tRNA synthetase
  • Antisynthetase syndrome
    • Arthritis
    • Interstitial lung disease
    • Fever
    • Mechanic's hands
    • Raynaud's phenomenon
  • Flare up in spring
  • Moderate response to treatment
  • Poor prognosis
  • Associated with epstein-Barr virus (EBV), adenovirus, and influenza infection
 20-25%
Anti-PL-7 Threonyl-tRNA synthetase
  • Myositis, mechanic's hands, Gottron's papules, arthritis
 5-10%
Anti PL-12 Alanyl-tRNA synthetase
  • Fever, Raynaud's phenomenon, high frequency of ILD
  • Epstein-Barr virus (EBV), adenovirus, and influenza infection
 <5%
Alanyl-tRNA
Anti-EJ Glycyl-tRNA synthetase  5-10%
Anti-OJ Isoleucyl-tRNA synthetase <5%
Anti-KS Asparaginyl-tRNA synthetase <5%
Anti-Ha Tyrosyl-tRNA synthetase <1%
Anti-Zo Phenylalanyl-tRNA synthetase <1%
Anti Mi-2 Chromodomain helicase DNA binding protein 4
  • Dermatomyositis rash without significant lung involvement
  • Acute but mild onset
  • Good prognosis
 5-10%
Anti-SRP Signal recognition particle
  • Cardiac involvement
  • Necrotizing myopathy
  • Flare up in fall
  • Very acute and severe onset
  • Poor response to treatment
  • Very poor prognosis
 <5%
Anti-p155/140 Transcriptional intermediary factor 1-gamma
  • Cancer-associated myositis
  • Juvenile dermatomyositis
  • Severe cutaneous disease
 13-21% in IIM

23-29% in JDM

Anti-MJ Nuclear matrix protein (NXP-2)
  • Cancer-associated myositis
  • Juvenile dermatomyositis
 23% in JDM
Anti-SAE Small ubiquitin-like modifier activating enzyme
  • Cancer-associated myositis
 5%
Anti-caDM-140 Intracytoplasmic MDA5
  • Dermatomyositis and rapidly progressive ILD
 50% (C-ADM)
Anti-PMS1 DNA mismatch repair enzyme 7.5%
Anti-HMGCR 3-hydroxy-3-methylglutaryl-coenzyme A reductase
  • Statin-associated necrotizing autoimmune myopathy (SANAM)
 6%
Others Anti-FER Elongation factor 1 alpha
Anti-KJ Unidentified cytoplasmic protein 
Anti-MAS Unidentified cytoplasmic RNA
Anti–PM-Scl
  • Overlap of polymyositis and Scleroderma
 25%

References

  1. ↑ Adler BL, Christopher-Stine L (February 2018). "Triggers of inflammatory myopathy: insights into pathogenesis". Discov Med. 25 (136): 75–83. PMID 29579414.
  2. ↑ Bodoki L, Nagy-Vincze M, Griger Z, Betteridge Z, Szöllősi L, Dankó K (December 2014). "Four dermatomyositis-specific autoantibodies-anti-TIF1γ, anti-NXP2, anti-SAE and anti-MDA5-in adult and juvenile patients with idiopathic inflammatory myopathies in a Hungarian cohort". Autoimmun Rev. 13 (12): 1211–9. doi:10.1016/j.autrev.2014.08.011. PMID 25182203.
  3. ↑ Khan, Sabiha; Christopher-Stine, Lisa (2011). "Polymyositis, Dermatomyositis, and Autoimmune Necrotizing Myopathy: Clinical Features". Rheumatic Disease Clinics of North America. 37 (2): 143–158. doi:10.1016/j.rdc.2011.01.001. ISSN 0889-857X.
  4. ↑ Dobloug, Cecilie; Garen, Torhild; Bitter, Helle; Stjärne, Johan; Stenseth, Guri; Grøvle, Lars; Sem, Marthe; Gran, Jan Tore; Molberg, Øyvind (2015). "Prevalence and clinical characteristics of adult polymyositis and dermatomyositis; data from a large and unselected Norwegian cohort". Annals of the Rheumatic Diseases. 74 (8): 1551–1556. doi:10.1136/annrheumdis-2013-205127. ISSN 0003-4967.
  5. ↑ Chinoy, H.; Fertig, N.; Oddis, C. V; Ollier, W. E R; Cooper, R. G (2007). "The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis". Annals of the Rheumatic Diseases. 66 (10): 1345–1349. doi:10.1136/ard.2006.068502. ISSN 0003-4967.
  6. ↑ Dalakas, Marinos C; Hohlfeld, Reinhard (2003). "Polymyositis and dermatomyositis". The Lancet. 362 (9388): 971–982. doi:10.1016/S0140-6736(03)14368-1. ISSN 0140-6736.
  7. ↑ Douglas, William W.; Tazelaar, Henry D.; Hartman, Thomas E.; Hartman, Robert P.; Decker, Paul A.; Schroeder, Darrell R.; Ryu, Jay H. (2001). "Polymyositis–Dermatomyositis-associated Interstitial Lung Disease". American Journal of Respiratory and Critical Care Medicine. 164 (7): 1182–1185. doi:10.1164/ajrccm.164.7.2103110. ISSN 1073-449X.
  8. ↑ Miller, Frederick W. (1993). "Myositis-Specific Autoantibodies". JAMA. 270 (15): 1846. doi:10.1001/jama.1993.03510150080034. ISSN 0098-7484.
  9. ↑ Volochayev, Rita (2012). "Laboratory Test Abnormalities are Common in Polymyositis and Dermatomyositis and Differ Among Clinical and Demographic Groups". The Open Rheumatology Journal. 6 (1): 54–63. doi:10.2174/1874312901206010054. ISSN 1874-3129.
  10. ↑ Targoff, Ira N. (2006). "Myositis specific autoantibodies". Current Rheumatology Reports. 8 (3): 196–203. doi:10.1007/s11926-996-0025-3. ISSN 1523-3774.
  11. ↑ Gunawardena, H.; Betteridge, Z. E.; McHugh, N. J. (2009). "Myositis-specific autoantibodies: their clinical and pathogenic significance in disease expression". Rheumatology. 48 (6): 607–612. doi:10.1093/rheumatology/kep078. ISSN 1462-0324.
  12. ↑ Bohan, Anthony; Peter, James B. (1975). "Polymyositis and Dermatomyositis". New England Journal of Medicine. 292 (8): 403–407. doi:10.1056/NEJM197502202920807. ISSN 0028-4793.
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