Biomarkers in Adult Dermatomyositis: Tools to Help the Diagnosis and Predict the Clinical Outcome

Abstract

Dermatomyositis pathophysiology is complex. In recent years, medical research has identified molecules associated with disease activity. Besides providing insights into the driving mechanisms of dermatomyositis, these findings could provide potential biomarkers. Activity markers can be used to monitor disease activity in clinical trials and may also be useful in daily practice. This article reviews molecules that could be used as biomarkers for diagnosis and monitoring dermatomyositis disease activity.

A report of seronegative clinically amyopathic dermatomyositis

“…When evaluating for specific autoantibodies, it is important to recognize the plethora of autoantibodies associated in the spectrum of dermatomyositis including but not limited to, anti-HMG-CoA, anti-JO-1, anti-PL7, anti-PL12, anti-EJ anti-MDA5, anti-Mi2, anti-NXP2, anti-P155, anti-Pm/Scl, anti-SAE, anti-SRP, and antisynthetases. 7 More specific autoantibodies with respect to CADM include anti-CADM-140 autoantibodies that target melanoma differentiation-associated gene 5 (MDA5) and anti-P155 autoantibodies that target transcription intermediary factor 1-c (TIF1-c) protein. 7 However, autoimmune panel analysis was negative in this report which highlights the challenges of using serology to help assist in diagnosis of CADM.…”

“…7 More specific autoantibodies with respect to CADM include anti-CADM-140 autoantibodies that target melanoma differentiation-associated gene 5 (MDA5) and anti-P155 autoantibodies that target transcription intermediary factor 1-c (TIF1-c) protein. 7 However, autoimmune panel analysis was negative in this report which highlights the challenges of using serology to help assist in diagnosis of CADM. The only additional diagnostic clue was the presence of disproportionate episodes of shortness of breath with exercise which may highlight the involvement of the lungs typically seen in dermatomyositis.…”

“…8 It has been suggested that anti-TIF1-gamma (TIF1-γ) or anti-NXP2 autoantibodies are associated with increased risk of malignancy. 7 Therefore, in addition to age appropriate cancer screening protocols, all newly diagnosed CADM patients require comprehensive screening evaluation for malignancy. In men, associated cancers typically include nasopharyngeal, bladder, colorectal, lung, and prostate cancers whereas in women CADM is commonly associated with breast, ovary, cervix, and uterine cancers.…”

Remission of recalcitrant dermatomyositis following a chiropractic adjustment

“…Cutaneous manifestations play an important role in the DM diagnosis. [24] According to the 2017 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria, patients with pathognomonic skin rashes (heliotrope rash, Gottron's papules and/or Gottron's sign) of DM are accurately classified without including muscle biopsy data. A muscle biopsy is recommended for the patient without these skin manifestations.…”

“…Cytokines such as interleukin (IL-1β, IL-6, IL-18) and tumor necrosis factor (TNF-α) are associated with global disease activity in DM. [4] An association with other connective tissue disorders and malignancy makes this diagnosis particularly important to primary care physicians. [13] The mainstay goal of treatment for DM has been aimed at suppressing, or modifying the immune system.…”