ReviewComparison of long-term outcome between anti-Jo1- and anti-PL7/PL12 positive patients with antisynthetase syndrome
Introduction
Antisynthetase syndrome (ASS) is characterized by polymyositis/dermatomyositis (PM/DM) associated with antisynthetase antibodies, fever, arthritis, Raynaud's phenomenon, mechanic's hands and interstitial lung disease (ILD) [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]. To date, 8 antisynthetase antibodies have been identified in patients with ASS, i.e.: anti-histidyl (anti-Jo1), anti-threonyl (anti-PL7), anti-alanyl (anti-PL12), anti-isoleucyl (anti-OJ), anti-glycyl (anti-EJ), anti-asparaginyl (anti-KS), anti-phenylalanyl (anti-Zo) and anti-tyrosyl-tRNA (anti-YRS) synthetase [12]. Anti-Jo1 antibody is the more common of antisynthetase antibodies, being encountered in 60 to 80% of patients with ASS; on the other hand, anti-PL7 and anti-PL12 antibodies are less frequent, being reported in 10–15% and 5–10%, respectively, of patients with ASS [12], [13]. Among the clinical manifestations, ILD is the most frequent complication of ASS, occurring in 70 to 89% of patients; in patients with ASS, ILD has been found to result in increased morbidity and mortality [12], [13], [14], [15], [16], [17], [18], [19], [20].
However, to date, no series has previously compared the long-term outcome of ASS between anti-Jo1- and anti-PL7/PL12-positive patients. Therefore, the aims of the current study were to compare both the characteristics and long-term outcome between ASS patients with anti-Jo1 antibody and those with anti-PL7/PL12 antibody.
Section snippets
Patients and methods
This retrospective study began with a search of the institutional centers' medical record index, which provides access to the diagnoses of the centers' patients. The first electronic search involved use of the codes PM and DM to identify patients with a diagnosis of PM/DM seen from January 1995 to January 2011 in 6 academic centers (Lille, Paris, Poitiers, Rennes, Rouen, Tours). The diagnosis of PM/DM was based on Bohan and Peter criteria [21], [22]: 1) symmetric muscle weakness, 2) increased
General characteristics of anti-PL7 and anti-PL12 positive patients with ASS
The 20 anti-PL7- (n = 15) and anti-PL12- (n = 5) positive patients comprised 8 men and 12 women with a median age of 59 years [range: 31–79] at ASS diagnosis; only 2 of these 20 patients had DM (10% of cases).
Ten patients had myalgia (50%), and 8 exhibited muscle weakness (40%). The patients experienced ASS-related complications: fever (n = 6), Raynaud's phenomenon (n = 8), mechanic's hands (n = 6), joint impairment (n = 8), esophageal dysfunction (n = 4), gastrointestinal manifestations (n = 3), ILD (n = 18),
Discussion
Patients with ASS auto-antibodies exhibit characteristic features. However, in our review of the Medline database, we found no series comparing both the features and long-term outcome between ASS patients with anti-Jo1 antibody and those with anti-PL7/PL12 antibody. Thus, the current study is, to the best of our knowledge, the first to compare the characteristics between anti-Jo1 and anti-PL7/PL12-positive patients. Our series considered 95 consecutive anti-Jo1 (n = 75) and anti-PL7/PL12- (n = 20)
Take-home messages
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Our study underscores that anti-Jo1 positive patients with ASS share some features with anti-PL7/PL12 antibody with some differences regarding clinical phenotype and long-term outcome.
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Anti-Jo1 positive patients more often developed severe myositis and joint manifestations, including erosive arthritis.
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Anti-Jo1 positive patients more often exhibited cancer. Our findings suggest that these patients require evaluation for cancer, especially digestive and gynecologic cancers which were responsible
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