Inflammatory myopathies: Issues in diagnosis and management

Olsen, Nancy J.; Park, Jane H.

doi:10.1002/art.1790100308

Cited by 20 publications

(11 citation statements)

References 39 publications

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“…However, in the present study we found that, unlike MHC-I, there was a significant association between MHC-II expression and the presence of inflammatory infiltrates in the IIM group. It is also well known that there is a poor correlation between clinical symptoms and the presence of inflammatory infiltrates in patients with myositis [15,43,50] Text 17 although clearance of infiltrates may correlate with clinical improvement after commencement of corticosteroid therapy [47]. The expression of cytokines such as IL-1α has also been shown to be independent of inflammatory infiltrates or the state of evolution of the disease [15,49].…”

Section: Text 14mentioning

confidence: 99%

An analysis of the sensitivity and specificity of MHC-I and MHC-II immunohistochemical staining in muscle biopsies for the diagnosis of inflammatory myopathies

Cruz

Luo

Miller

et al. 2014

Neuromuscular Disorders

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MURDOCH RESEARCH REPOSITORYThis is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Abstract 1 Abstract 3 AbstractAlthough there have been several previous reports of immunohistochemical staining for MHC antigens in muscle biopsies, there appears to be a lack of consensus about its routine use in the diagnostic evaluation of biopsies from patients with suspected inflammatory myopathy. Positive MHC-I staining is nonspecific but is widely used as a marker for inflammatory myopathy, while the role of MHC-II staining is not clearly defined. We investigated the sensitivity and specificity of MHC-I and II immunostaining for the diagnosis of inflammatory myopathy in a large group of biopsies from a single reference laboratory. Positive staining for MHC-I was found to have a high sensitivity in biopsies from patients with inflammatory myopathy but a very low specificity, as it was also common in other non-inflammatory myopathies and neurogenic disorders.On the other hand, MHC-II positivity had a much higher specificity in all major subgroups of inflammatory myopathy, especially inclusion body myositis. The findings indicate that the combination of MHC-I and MHC-II staining results in a higher degree of specificity for the diagnosis of inflammatory myopathy and that in biopsies with inflammation, positive MHC-II staining strongly supports the diagnosis of an immunemediated myopathy. We recommend that immunohistochemical staining for both MHC-I and MHC-II should be included routinely in the diagnostic evaluation of muscle biopsies from patients with suspected inflammatory myopathy. However, as the sensitivity and interpretation of MHC staining may depend on the technique used, further studies are needed to compare procedures in different centres and develop standardised protocols.Abstract 4

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Section: Text 14mentioning

confidence: 99%

An analysis of the sensitivity and specificity of MHC-I and MHC-II immunohistochemical staining in muscle biopsies for the diagnosis of inflammatory myopathies

Cruz

Luo

Miller

et al. 2014

Neuromuscular Disorders

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“…Both of these often have a patchy distribution, and the degree of histopathologic change in muscle biopsy specimens does not always correspond to the degree of clinical muscle impairment or the patient-reported degree of muscle symptoms (1)(2)(3). In addition to these changes, metabolic disturbances within the affected muscles have been suggested as possible explanations for their impairment, based on ATP and phosphocreatine levels as well as increased urinary secretion of phosphocreatine as determined by magnetic resonance spectroscopy (MRS) (1,(4)(5)(6). Although data are limited, they suggest that metabolic status according to P-31 MRS correlated with clinical outcome measurements (7).…”

Section: Polymyositis (Pm) and Dermatomyositis (Dm)mentioning

confidence: 99%

Vascular endothelial growth factor is highly expressed in muscle tissue of patients with polymyositis and patients with dermatomyositis

Grundtman¹,

Tham²,

Ulfgren³

et al. 2008

Arthritis & Rheumatism

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Objective. To investigate the expression of vascular endothelial growth factor (VEGF) in muscle biopsy specimens and serum from patients with polymyositis and patients with dermatomyositis compared with that in healthy control subjects.Methods. Muscle biopsy specimens from 33 patients with polymyositis or dermatomyositis and 15 healthy control subjects and serum samples from 56 patients and 56 healthy control subjects were analyzed. Patients were categorized into 3 groups, depending on disease duration and the presence or absence of inflammatory infiltrates. The expression of VEGF and the vessel marker CD31 in muscle was analyzed by immunohistochemistry, the expression of VEGF messenger RNA (mRNA) was analyzed by in situ hybridization, and serum levels of VEGF were determined by enzymelinked immunosorbent assay.Results. Patients with polymyositis or dermatomyositis in the early or chronic phase without inflammatory infiltrates had a decreased total number of capillaries compared with healthy individuals. In patients with early disease without inflammatory infil-

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“…However, there is a lack of correlation between the clinical symptoms and the degree of inflammatory infiltrates in patients with myositis. [1][2][3][4] Other phenotypic changes that have been related to muscle weakness include immune function-related molecules produced locally in muscle tissue, such as major histocompatibility complex (MHC) class I and II antigens and interleukin (IL)1a expressed on muscle fibres and microvessels. MHC class I antigen, which normally is not expressed on muscle fibres, is expressed on muscle fibres independent of inflammatory cell infiltrates in patients with myositis and muscle weakness.…”

mentioning

confidence: 99%

Signs of inflammation in both symptomatic and asymptomatic muscles from patients with polymyositis and dermatomyositis

Dorph

Englund

Nennesmo

et al. 2006

Annals of the Rheumatic Diseases

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Objectives: To determine whether muscle weakness is correlated with inflammation, expression of interleukin 1a (IL1a) and major histocompatibility complex (MHC) class I and II antigens on muscle fibres. Methods: Biopsy specimens from clinically symptomatic (proximal muscles) and asymptomatic (all distal but two proximal) muscles in eight patients with polymyositis, three patients with dermatomyositis and six healthy controls were analysed by immunohistochemistry for the presence of T cells and macrophages, and expression of IL1a and of MHC class I and II antigens. Results were evaluated by conventional light microscopy and by computerised image analysis. Results: Inflammatory infiltrates with T cells and macrophages were observed to an equal degree in both symptomatic and asymptomatic muscle. The numbers of capillaries with IL1a expression were significantly higher (p,0.05) in the symptomatic and asymptomatic muscles of patients than in controls. The total IL1a expression per tissue section assessed by computerised image analysis was significantly higher in symptomatic muscles but not in asymptomatic muscles compared with that in controls. Neither the number of IL1a-positive capillaries nor the total IL1a expression differed significantly between symptomatic and asymptomatic muscles. Expression of MHC class I and II antigens on muscle fibres was detected in both symptomatic and asymptomatic muscles but rarely in healthy controls. Conclusions: Presence of inflammatory infiltrates, T cells and macrophages, and expression of MHC class I and II antigens and of IL1a on muscle fibres were independent of clinical symptoms, and were present to an equal degree in both proximal and distal muscles. Thus, other factors seem to determine the development of clinical symptoms. One such factor could be variations in physical demands.

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Inflammatory myopathies: Issues in diagnosis and management

Cited by 20 publications

References 39 publications

An analysis of the sensitivity and specificity of MHC-I and MHC-II immunohistochemical staining in muscle biopsies for the diagnosis of inflammatory myopathies

An analysis of the sensitivity and specificity of MHC-I and MHC-II immunohistochemical staining in muscle biopsies for the diagnosis of inflammatory myopathies

Vascular endothelial growth factor is highly expressed in muscle tissue of patients with polymyositis and patients with dermatomyositis

Signs of inflammation in both symptomatic and asymptomatic muscles from patients with polymyositis and dermatomyositis

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