Echocardiographic Abnormalities in New-onset Polymyositis/dermatomyositis

Peter, Anca; Balogh, Agnès; Szilágyi, Szabolcs; Faludi, Réka; Nagy‐Vincze, Melinda; Édes, István; Dankó, Katalin

doi:10.3899/jrheum.140626

Cited by 27 publications

(27 citation statements)

References 34 publications

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“…Oppenheim and colleagues first reported cardiac involvement in dermatomyositis in 1899 [168]. The prevalence of cardiac involvement in dermatomyositis/polymyositis varies between 9% and 72% according to the series and method of detection [169][170][171][172][173].…”

Section: Cardiac Involvementmentioning

confidence: 99%

“…Clinically significant heart involvement is found in 10-15% of patients [174,175]. Congestive heart failure, left ventricular diastolic dysfunction, coronary artery disease and arrhythmias may contribute to dyspnoea [167,168,176]. Pulmonary oedema due to myocarditis and/or cardiomyopathy usually occurs together with active muscular disease.…”

Section: Cardiac Involvementmentioning

confidence: 99%

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Idiopathic inflammatory myopathies and the lung

et al. 2015

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Idiopathic inflammatory myositis (IIM) is a group of rare connective tissue diseases (CTDs) characterised by muscular and extramuscular signs, in which lung involvement is a challenging issue. Interstitial lung disease (ILD) is the hallmark of pulmonary involvement in IIM, and causes morbidity and mortality, resulting in an estimated excess mortality of 50% in some series. Except for inclusion body myositis, these extrapulmonary disorders are associated with the general and visceral involvement frequently found in other CTDs including fever, Raynaud's phenomenon, arthralgia, nonspecific cutaneous modifications and ILD, for which the prevalence is estimated to be up to 65%. Substantial heterogeneity exists within the spectrum of IIMs, and each condition is associated with various frequencies and subtypes of pulmonary involvement. This heterogeneity is partly related to the presence of various autoantibodies encompassing anti-synthetase, anti-MDA5 and anti-PM/Scl. ILD is present in all subsets of IIM including juvenile myositis, but is more frequent in dermatomyositis and overlap myositis. IIM can also be associated with other presentations of respiratory involvement, namely pulmonary arterial hypertension, pleural disease, infections, drug-induced toxicity, malignancy and respiratory muscle weakness. Here, we critically review the current knowledge about adult and juvenile myositis-associated lung disease with a detailed description of therapeutics for chronic and rapidly progressive ILD. @ERSpublications Interstitial lung disease is a leading cause of morbidity in dermatomyositis/polymyositis

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Section: Cardiac Involvementmentioning

confidence: 99%

Section: Cardiac Involvementmentioning

confidence: 99%

Idiopathic inflammatory myopathies and the lung

et al. 2015

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“…121,122 The clinical presentation includes left ventricular diastolic dysfunction, coronary artery disease, conductive disorders or arrhythmias, and congestive heart failure. 120,123,124 Myocarditis with pulmonary edema usually occurs in the context of uncontrolled muscular disease. The incidence of pericardial effusion is 15%.…”

Section: Cardiac Involvementmentioning

confidence: 99%

Lung Diseases in Inflammatory Myopathies

Barba

Mainbourg

Nasser

et al. 2019

Semin Respir Crit Care Med

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Lung involvement is the leading cause of mortality in inflammatory myopathy. A careful assessment of clinical and serologic manifestations especially myositis-associated autoantibodies allows precise classification of the different phenotypes of inflammatory myopathy and stratification of the risk of lung involvement. About three out of four patients with inflammatory myopathy develop interstitial lung disease (ILD), which represents the main cause of morbidity and mortality. In patients with a confirmed diagnosis of inflammatory myopathy, the approach to the diagnosis of ILD includes assessment of clinical and functional severity, evaluation of the high-resolution computed tomography pattern of disease, which often suggests nonspecific interstitial pneumonia or organizing pneumonia. Bronchoalveolar lavage to rule out infection is often performed; however, video-assisted thoracoscopic lung biopsy is now generally discouraged, unless malignancy is suspected. The so-called antisynthetase syndrome characterized by the combination of mechanics' hands, Raynaud' phenomenon, myositis often mild or absent, and presence of one of the anti-tRNA synthetase antibodies is associated with a 70% risk of ILD, especially in subjects with antibodies other than anti-Jo1 antibodies (i.e., anti-PL7 or -PL12 antibodies). Treatment depends on both severity and progression of ILD, often including a combination of corticosteroids and immunosuppressive therapy. Rituximab-based regimen has showed promising results in retrospective studies for the management of refractory or rapidly progressive forms of ILD. Clinical trials are ongoing to evaluate the actual efficacy of this strategy on mortality related to lung disease. Secondary pulmonary complications of inflammatory myopathy include opportunistic infections, aspiration pneumonia, pneumomediastinum, ventilatory failure due to diaphragmatic muscular weakness, drug-induced pneumonitis, and rarely pulmonary hypertension.

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“…As risk of cardiac complications are more common than general population26 27 and the most common cause of death among DM patients,23 they should be evaluated for cardiac comorbidity at the time of diagnosis of myositis 28. Application of newer non-invasive technologies such as specific biomarkers, cardiac MRI,29 newer echocardiographic indices30 31 are warranted to detect and predict the subclinical cardiac involvement 23. Although normal coronary angiography nearly ruled out the HF secondary to myocardial infarction due to obstructive coronary arteries, possibility of myocardial infarction with non-obstructive coronary arteries could not be ruled out.…”

Section: Discussionmentioning

confidence: 99%

Dermatomyositis presenting as heart failure revealed a concealed cervical malignancy: an infrequent clinical nexus

et al. 2020

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Dermatomyositis (DM) belongs to the spectrum of inflammatory myopathies which are a heterogeneous group of acquired disorders in which dysregulated immune system is thought to play a major pathologic role. Patients with DM generally present with characteristic skin manifestations with or without muscle weakness and pain. Although subclinical myocardial involvement in DM is well reported in literature, heart failure (HF) as its principal manifestation is extremely rare. Recognition of DM, a known paraneoplastic syndrome, should prompt clinicians to search for underlying malignancy. While gynaecological malignancies are common in association with DM, cervical cancer has rarely been heard of as an aetiology of paraneoplastic DM. We are reporting a case of DM in a postmenopausal woman presenting with advanced decompensated congestive HF with hidden squamous cell carcinoma of cervix.

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Echocardiographic Abnormalities in New-onset Polymyositis/dermatomyositis

Cited by 27 publications

References 34 publications

Idiopathic inflammatory myopathies and the lung

Idiopathic inflammatory myopathies and the lung

Lung Diseases in Inflammatory Myopathies

Dermatomyositis presenting as heart failure revealed a concealed cervical malignancy: an infrequent clinical nexus

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