Overall and site-specific cancer before and after diagnosis of idiopathic inflammatory myopathies: A nationwide study 2002–2016

Dani, Lara; Ian, Weng; Lundberg, Ingrid E.; Hellgren, Karin; Holmqvist, Marie

doi:10.1016/j.semarthrit.2020.12.009

Cited by 23 publications

(19 citation statements)

References 39 publications

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“…These findings confirm those by others, who used as a reference population both IIM patients (26) and the general population (8,27). Our study also highlights an increase in oropharyngeal cancer in IIM patients, as noted previously (28). Because of the small number of oropharyngeal cancers (n = 8) in our study, we were unable to conclude whether this reflects a consequence of long‐term immunosuppression or other risk factors such as alcohol and tobacco exposure.…”

Section: Discussionsupporting

confidence: 91%

Subsets of Idiopathic Inflammatory Myositis Enriched for Contemporaneous Cancer Relative to the General Population

Mecoli

Igusa

Chen

et al. 2023

Arthritis & Rheumatology

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Objective This study investigates cancer risk in idiopathic inflammatory myopathy (IIM) relative to the general population. Methods We conducted a single‐center, retrospective cohort study of IIM patients and malignancy. Myositis‐specific and ‐associated autoantibodies were determined by Euroimmun line blot, enzyme‐linked immunosorbent assay, and immunoprecipitation. We calculated standardized prevalence ratios (SPRs) and adjusted for calendar year, age, sex, race, and ethnicity by comparing observed cancers in IIM patients versus expected cancers in the general population using the Surveillance, Epidemiology, and End Results registry. Results Of 1,172 IIM patients, 203 (17%) patients with a cancer history were studied. Over a median follow‐up of 5.2 years, the observed number of IIM patients diagnosed with cancer was increased 1.43‐fold (SPR 1.43 [95% confidence interval (95% CI) 1.15–1.77]; P = 0.002). Within 3 years of IIM symptom onset, an increased SPR was observed for anti–transcription intermediary factor 1γ (anti‐TIF1γ)–positive patients for ovarian and breast cancer (ovarian SPR 18.39 [95% CI 5.01–47.08], P < 0.001; breast SPR 3.84 [95% CI 1.99–6.71], P < 0.001). As expected, anti‐TIF1γ positivity was associated with a significantly elevated SPR; however, only 55% (36 of 66) of all cancers within 3 years of dermatomyositis onset were observed in anti‐TIF1γ–positive patients. Other myositis‐specific autoantibodies, including anti–Mi‐2, anti–small ubiquitin‐like modifier activating enzyme (SAE), and anti‐nuclear matrix protein 2 (NXP‐2), accounted for 26% (17 of 66) of cancers diagnosed within 3 years of dermatomyositis onset. No cancer association, positive or negative, was observed for patients with antisynthetase, anti–melanoma differentiation–associated protein 5 (anti–MDA‐5), or anti–hydroxymethylglutaryl‐coenzyme A reductase (anti‐HMGCR) antibodies. Conclusion In a tertiary referral center population, anti‐TIF1γ was most strongly associated with breast and ovarian cancer. Patients with antisynthetase, anti–MDA‐5, or anti‐HMGCR antibodies had the same cancer risk as the general population.

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Section: Discussionsupporting

confidence: 91%

Subsets of Idiopathic Inflammatory Myositis Enriched for Contemporaneous Cancer Relative to the General Population

Mecoli

Igusa

Chen

et al. 2023

Arthritis & Rheumatology

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“…Moreover, malignancies that are most commonly associated with IIM (lung, gastrointestinal, and breast cancers and melanoma) are frequently treated with ICI. 48 Myalgia was significantly more common in patients with ICI myositis (84%) than in immune-mediated necrotizing myopathy (40%) and antisynthetase syndrome (29%) in 1 study, but not in another study comparing ICI myositis (54%) to immune-mediated necrotizing myopathy (53%). 9,23 The degree of CK elevation was similar in 1 study between ICI myositis and immune-mediated necrotizing myopathy, whereas it was noted to be significantly lower in ICI myositis in another study.…”

Section: Inflammatory Myopathiesmentioning

confidence: 87%

“…Immune checkpoint inhibitor–associated myositis can be challenging to differentiate from a de novo (cancer-associated) IIM or unmasking of preexisting subclinical myositis, particularly in the absence of DM-like rash. Moreover, malignancies that are most commonly associated with IIM (lung, gastrointestinal, and breast cancers and melanoma) are frequently treated with ICI 48 . Myalgia was significantly more common in patients with ICI myositis (84%) than in immune-mediated necrotizing myopathy (40%) and antisynthetase syndrome (29%) in 1 study, but not in another study comparing ICI myositis (54%) to immune-mediated necrotizing myopathy (53%) 9,23 .…”

Section: Differential Diagnosismentioning

confidence: 90%

Immune Checkpoint Inhibitor–Associated Myositis

2022

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Research on the relationship between inflammatory myopathy and malignancy has grown considerably within the last century. Now, the burgeoning field of inflammatory myopathy has yet another player in the mix: immune checkpoint inhibitor-associated myositis (ICI myositis). Immune checkpoint inhibitor-associated myositis is indicated by clinical diagnosis of inflammatory myopathy after initiation of immune checkpoint inhibitor for cancer management. Current literature reflects low prevalence but high mortality associated with ICI myositis, especially when involving myasthenia gravis and myocarditis. Immune checkpoint inhibitor-associated myositis tends to have muscle pain along with weakness, infrequent presentation with dermatitis, or interstitial lung disease and is typically seronegative with scattered, endomysial inflammatory infiltrates on biopsy. The differential diagnosis of ICI myositis includes myasthenia gravis and other neurological immune-related adverse events. Therapeutic approach involves high doses of corticosteroids with a choice of steroid-sparing immunomodulating agent(s) that is primarily driven by expert opinion due to lack of robust research to support one agent over another. There is wide variation in the inclusion criteria for ICI myositis used in previous studies. We review previously used inclusion criteria and suggest an expertise-based classification criterion to provide a standardized definition and allow comparability between studies. There is a critical need for prospective translational and clinical studies that elucidate the pathophysiology of ICI myositis in order to improve evaluation and management of these patients.

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“…DM was considered a key for ovarian cancer diagnosis, Field et al reported two cases that shared BRCA mutations [ 18 ]. More importantly, ovarian cancer is one of the three types of cancer that are associated with DM before diagnosis [ 19 ] so more clues are needed to identify the underlying cancer risk. Our observation is that MRI reticular edema signals in the marginal zone of the vastus lateralis have the potential to be an alert for physicians identifying DM patients who need more detailed examinations.…”

Section: Discussionmentioning

confidence: 99%

Thigh Muscle MRI Edema Features of Dermatomyositis Patients With Ovarian Cancer: A Report of Three Cases

Cheng¹,

Fang²

2022

Cureus

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Dermatomyositis (DM) is a rare inflammatory disease with systemic manifestations, including internal malignancy. Ovarian cancer is one of the most commonly found tumor types in DM patients. To date, no study has analyzed the MRI signals of dermatomyositis patients with cancer. Thus, in this report, we describe three cases in which we found ovarian cancer after the diagnosis of DM and observed a symmetrical honeycomb pattern edema signal distributed to the peripheral area of vastus laterals while adductors and posterior thigh compartments were relatively spared. Our report has important implications for clinicians to identify patients with dermatomyositis at potential ovarian cancer risk.

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Overall and site-specific cancer before and after diagnosis of idiopathic inflammatory myopathies: A nationwide study 2002–2016

Cited by 23 publications

References 39 publications

Subsets of Idiopathic Inflammatory Myositis Enriched for Contemporaneous Cancer Relative to the General Population

Subsets of Idiopathic Inflammatory Myositis Enriched for Contemporaneous Cancer Relative to the General Population

Immune Checkpoint Inhibitor–Associated Myositis

Thigh Muscle MRI Edema Features of Dermatomyositis Patients With Ovarian Cancer: A Report of Three Cases

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