A importância dos novos autoanticorpos específicos da dermatomiosite

  • Joana Calvão Interna de Dermatologia nos Hospitais da Universidade de Coimbra, Coimbra, Portugal
  • Alexandre Rafael Isidoro Azeiteiro Aluno da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
  • Margarida Gonçalo 3Assistente Hospitalar Sénior de Dermatologia nos Hospitais da Universidade de Coimbra, e Professora Auxiliar convidada de Dermatologia da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
Palavras-chave: Autoanticorpos, Dermatomiosite

Resumo

A dermatomiosite é uma miopatia inflamatória idiopática, rara, com manifestações cutâneas e sistémicas variadas. Mais de 70% dos doentes apresentam autoanticorpos específicos da doença, que se correlacionam com manifestações clínicas distintas. Além dos anticorpos anti-sintetase, nos últimos anos foram descobertos vários anticorpos associados à dermatomiosite e que parecem ter um papel importante na orientação diagnóstica e prognóstica da doença, incluindo os autoanticorpos contra melanoma differentiation antigen 5 (MDA5), transcriptional intermediary factor 1 (TIF1), nuclear matrix protein 2 (NXP2), small ubiquitin-like modifier activating enzyme (SAE) e os anti-Mi2. O autoanticorpo anti-MDA5 está associado a dermatomiosite amiopática e doença intersticial pulmonar rapidamente progressiva e potencialmente fatal, além de caraterísticas mucocutâneas distintas, como ulceração cutânea. Há uma forte correlação entre a positividade para os autoanticorpos anti-TIF-1γ e malignidade, pelo menos na dermatomiosite do adulto. Na dermatomiosite juvenil, estes autoanticorpos têm sido associados a doença cutânea mais extensa, mas não a malignidade. A positividade para anti-NXP2 está associada a calcinose cutânea e envolvimento muscular severos. Na dermatomiosite com autoanticorpos anti-SAE há frequentemente envolvimento cutâneo e disfagia severos, mas com boa resposta à terapêutica imunossupressora e bom prognóstico. Os anticorpos anti-Mi2 associam- -se igualmente a um bom prognóstico.

Downloads

Não há dados estatísticos.

Biografia Autor

Margarida Gonçalo, 3Assistente Hospitalar Sénior de Dermatologia nos Hospitais da Universidade de Coimbra, e Professora Auxiliar convidada de Dermatologia da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal

Assistente Hospitalar Sénior de Dermatologia nos Hospitais da Universidade de Coimbra, e Professora Auxiliar convidada de Dermatologia da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal

Referências

Iaccarino L, Ghirardello A, Bettio S, Zen M, Gatto M,

Punzi L, et al. The clinical features, diagnosis and classification

of dermatomyositis. J Autoimmun. 2014;48-

:122-7. doi:10.1016/j.jaut.2013.11.005.

Mainetti C, Terziroli Beretta-Piccoli B, Selmi C. Cutaneous

manifestations of dermatomyositis: a comprehensive

review. Clin Rev Allergy Immunol. 2017;53:337-56.

doi:10.1007/s12016-017-8652-1.

Palterer B, Vitiello G, Carraresi A, Giudizi MG, Cammelli

D, Parronchi P. Bench to bedside review of myositis

autoantibodies. Clin Mol Allergy. 2018;16:1-17.

doi:10.1186/s12948-018-0084-9.

Parkes JE, Rothwell S, Oldroyd A, Chinoy H, Lamb JA.

Genetic background may contribute to the latitude-dependent

prevalence of dermatomyositis and anti-TIF1-γ

autoantibodies in adult patients with myositis. Arthritis Res

Ther. 2018;20:1-5. doi:10.1186/s13075-018-1617-9.

Troyanov Y, Targoff IN, Payette MP, Raynauld JP, Chartier

S, Goulet JR, et al. Redefining dermatomyositis: A

description of new diagnostic criteria that differentiate

pure dermatomyositis from overlap myositis with dermatomyositis

features. Medicine. 2014;93:318-32.

doi:10.1097/MD.0000000000000222.

Findlay AR, Goyal NA, Mozaffar T. An overview of

polymyositis and dermatomyositis. Muscle Nerve.

;51:638-56. doi:10.1002/mus.24566.

Muro Y, Sugiura K, Akiyama M. Cutaneous manifestations

in dermatomyositis: key clinical and serological

features - a comprehensive review. Clin Rev Allergy Immunol.

; 51:293-302. doi:10.1007/s12016-015-

-5.

Cavazzana I, Fredi M, Selmi C, Tincani A, Franceschini

F. The clinical and histological spectrum of idiopathic

inflammatory myopathies. Clin Rev Allergy Immunol.

; 52:88-98. doi: 10.1007/s12016-015-8517-4.

Cox JT, Gullotti DM, Mecoli CA, Lahouti AH, Albayda

J, Paik J, et al. "Hiker’s feet": a novel cutaneous finding

in the inflammatory myopathies. Clin Rheumatol.

;36:1683-6. doi: 10.1007/s10067-017-3598-5.

Strowd LC, Jorizzo JL. Review of dermatomyositis:

establishing the diagnosis and treatment algorithm.

J Dermatol Treat. 2013;24:418-21. doi:

3109/09546634.2012.697540.

Bohan A, Peter JB. Polymyositis and dermatomyositis

(first of two parts). N Engl J Med. 1975;292:344-7.

doi:10.1056/NEJM197502132920706.

Bohan A, Peter JB. Polymyositis and dermatomyositis

(second of two parts). N Engl J Med. 1975;292:403-7.

doi:10.1056/NEJM197502202920807.

Sato S, Hirakata M, Kuwana M, Suwa A, Inada S, Mimori

T, et al. Autoantibodies to a 140-kd polypeptide, CADM-

, in Japanese patients with clinically amyopathic

dermatomyositis. Arthritis Rheum. 2005;52:1571-6.

doi:10.1002/art.21023.

Sato S, Hoshino K, Satoh T, Fujita T, Kawakami Y, Fujita

T, et al. RNA helicase encoded by melanoma differentiation-

associated gene 5 is a major autoantigen in patients

with clinically amyopathic dermatomyositis: Association

with rapidly progressive interstitial lung disease. Arthritis

Rheum. 2009;60:2193-200. doi:10.1002/art.24621.

Nakashima R, Imura Y, Kobayashi S, Yukawa N, Yoshifuji

H, Nojima T, et al. The RIG-I-like receptor IFIH1/

MDA5 is a dermatomyositis-specific autoantigen identified

by the anti-CADM-140 antibody. Rheumatology.

;49:433-40. doi:10.1093/rheumatology/kep375.

Kurtzman DJB, Vleugels RA. Anti-melanoma differentiation–

associated gene 5 (MDA5) dermatomyositis:

A concise review with an emphasis on distinctive clinical

features. J Am Acad Dermatol. 2018;78):776-85.

doi:10.1016/j.jaad.2017.12.010.

González-Moreno J, Raya-Cruz M, Losada-Lopez I, Cacheda

AP, Oliver C, Colom B. Rapidly progressive interstitial

lung disease due to anti-MDA5 antibodies without

skin involvement: a case report and literature review.

Rheumatol Int. 2018;38:1293-6. doi:10.1007/s00296-

-3991-7.

Alqatari S, Riddell P, Harney S, Henry M, Murphy G.

MDA-5 associated rapidly progressive interstitial lung

disease with recurrent pneumothoraces: A case report.

BMC Pulm Med. 2018;18:1-5. doi:10.1186/s12890-

-0622-8.

Narang NS, Casciola-Rosen L, Li S, Chung L, Fiorentino

DF. Cutaneous ulceration in dermatomyositis: association

with anti–melanoma differentiation–associated

gene 5 antibodies and interstitial lung disease. Arthritis

Care Res . 2015;67:667–72. doi: 10.1002/acr.22498.

Fujimoto M, Watanabe R, Ishitsuka Y, Okiyama N. Recent

advances in dermatomyositis-specific autoantibodies.

Curr Opin Rheumatol. 2016;28:636-44. doi:10.1097/

BOR.0000000000000329.

Hattori Y, Matsuyama K, Takahashi T, Shu E, Kanoh

H, Seishima M. Anti-MDA5 antibody-positive dermatomyositis

presenting with cellulitis-like erythema on the

mandible as an initial symptom. Case Rep Dermatol.

;10:110-4. doi:10.1159/000488077.

Chen Z, Cao M, Plana MN, Liang J, Cai H, Kuwana M, et

al. Utility of anti-MDA5 antibody measurement in identifying

patients with dermatomyositis and a high risk for

developing rapidly progressive interstitial lung disease:

a review of the literature and a meta-analysis. Arthritis

Care Res. 2013;65:1316-24. doi: 10.1002/acr.21985.

Gono T, Sato S, Kawaguchi Y, Kuwana M, Hanaoka M,

Katsumata Y, et al. Anti-MDA5 antibody, ferritin and IL-18

are useful for the evaluation of response to treatment in

interstitial lung disease with anti-MDA5 antibody-positive

dermatomyositis. Rheumatology. 2012;51:1563-70.

doi:10.1093/rheumatology/kes102.

Jordan M, Ghoreschi K. Anti-melanoma differentiation-

-associated protein 5 autoantibodies as a marker for

dermatomyositis-associated interstitial lung disease. Br

J Dermatol. 2017;176:294-5. doi:10.1111/bjd.15257.

Abe Y, Matsushita M, Tada K, Yamaji K, Takasaki Y, Tamura

N. Clinical characteristics and change in the antibody

titres of patients with anti-MDA5 antibody-positive

inflammatory myositis. Rheumatology. 2017;56:1492-

doi:10.1093/rheumatology/kex188.

Chen YJ, Wu CY, Shen JL. Predicting factors of malignancy

in dermatomyositis and polymyositis: a case-control

study. Br J Dermatol. 2001; 144:825-31.

Pelle MT, Callen JP, Bigby M. Adverse cutaneous reactions

to hydroxychloroquine are more common in patients

with dermatomyositis than in patients with cutaneous

lupus erythematosus. Arch Dermatol. 2002;138:1231-

doi:10.1001/archderm.138.9.1231.

Wolstencroft PW, Casciola-Rosen L, Fiorentino DF. Association

between autoantibody phenotype and cutaneous

adverse reactions to hydroxychloroquine in

dermatomyositis. JAMA Dermatol. 2018;154:1199-

doi:10.1001/jamadermatol.2018.2549.

Schiffmann ML, Warneke VS, Ehrchen J. Amyopathic

dermatomyositis with anti-TIF1 gamma antibodies. J Ger

Soc Dermatol. 2018;16:76-8. doi:10.1111/ddg.13394.

Fiorentino DF, Chung LS, Christopher-Stine L, Zaba L,

Li S, Mammen AL, et al. Most patients with cancer-associated

dermatomyositis have antibodies to nuclear

matrix protein NXP-2 or transcription intermediary factor

γ. Arthritis Rheum. 2013;65:2954-62. doi:10.1002/

art.38093.

Merlo G, Clapasson A, Cozzani E, Sanna L, Pesce

G, Bagnasco M, et al. Specific autoantibodies in dermatomyositis:

a helpful tool to classify different clinical

subsets. Arch Dermatol Res. 2017;309:87-95.

doi:10.1007/s00403-016-1704-1

Satoh M, Tanaka S, Ceribelli A, Calise SJ, Chan EKL. A

comprehensive overview on myositis-specific antibodies:

new and old biomarkers in idiopathic inflammatory

myopathy. Clin Rev Allergy Immunol. 2017; 52:1-19.

doi: 10.1007/s12016-015-8510-y.

Wolstencroft PW, Fiorentino DF. Dermatomyositis clinical

and pathological phenotypes associated with

myositis-specific autoantibodies. Curr Rheumatol Rep.

;20:28. doi:10.1007/s11926-018-0733-5.

Fiorentino DF, Kuo K, Chung L, Zaba L, Li S, Casciola-

-Rosen L. Distinctive cutaneous and systemic features

associated with antitranscriptional intermediary factor-

γ antibodies in adults with dermatomyositis. J Am

Acad Dermatol. 2015; 72:449-55. doi: 10.1016/j.

jaad.2014.12.009.

Didier K, Bolko L, Giusti D, Toquet S, Robbins A,

Antonicelli F, et al. Autoantibodies associated with

connective tissue diseases: What meaning for clinicians?

Front Immunol. 2018;9:541. doi:10.3389/

fimmu.2018.00541.

Albayda J, Pinal-Fernandez I, Huang W, Parks C, Paik

J, Casciola-Rosen L, et al. Antinuclear matrix protein 2

autoantibodies and edema, muscle disease, and malignancy

risk in dermatomyositis patients. Arthritis Care

Res. 2017;69:1771-6. doi: 10.1002/acr.23188.

Ghirardello A, Borella E, Beggio M, Franceschini F,

Fredi M, Doria A. Myositis autoantibodies and clinical

phenotypes. Auto Immun Highlights. 2014;5:69-75.

doi:10.1007/s13317-014-0060-4.

Ge Y, Lu X, Shu X, Peng Q, Wang G. Clinical characteristics

of anti-SAE antibodies in Chinese patients with

dermatomyositis in comparison with different patient cohorts.

Sci Rep. 2017;7:1-8. doi:10.1038/s41598-017-

-6.

Cruellas M, Viana V, Levy-Neto M, Souza F, Shinjo S.

Myositis-specific and myositis-associated autoantibody

profiles and their clinical associations in a large series of

patients with polymyositis and dermatomyositis. Clinics.

;68:909-14. doi:10.6061/clinics/2013(07)04.

Ghirardello A, Zampieri S, Iaccarino L, Tarricone E, Bendo

R, Gambari PF, et al. Anti-Mi-2 antibodies. Autoimmunity.

;38:79-83. doi:10.1080/08916930400022681.

Petri MH, Satoh M, Martin-Marquez BT, Vargas-Ramírez

R, Jara LJ, Saavedra MA, et al. Implications in the difference

of anti-Mi-2 and -p155/140 autoantibody prevalence

in two dermatomyositis cohorts from Mexico

City and Guadalajara. Arthritis Res Ther. 2013;15:R48.

doi:10.1186/ar4207.

Publicado
2019-03-26
Como Citar
Calvão, J., Azeiteiro, A. R. I., & Gonçalo, M. (2019). A importância dos novos autoanticorpos específicos da dermatomiosite. Revista Da Sociedade Portuguesa De Dermatologia E Venereologia, 77(1), 15-24. https://doi.org/10.29021/spdv.77.1.1021
Secção
Educação Médica Contínua