Simultaneously developed polymyositis and autoimmune hepatitis

Hounoki, Hiroyuki; Shinoda, Koichiro; Ogawa, Reina; Taki, Hirofumi; Tsuneyama, Koichi; Tobe, Kazuyuki

doi:10.1136/bcr.09.2011.4763

Cited by 8 publications

(5 citation statements)

References 9 publications

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“…Detecting muscle phosphocreatine levels in AIH patients may further confirm this postulation. In addition, the codevelopment of AIH and polymyositis, dermatomyositis, and other inflammatory myopathies that are closely related to creatine metabolism may occur. , The observed elevation of plasma creatine levels in the AIH patients needs further clarification in relationship to coexisting myopathic diseases.…”

Section: Discussionmentioning

confidence: 99%

Metabolomic Profiling of Autoimmune Hepatitis: The Diagnostic Utility of Nuclear Magnetic Resonance Spectroscopy

Wang

Sun

et al. 2014

J. Proteome Res.

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Autoimmune hepatitis (AIH) is often confused with other liver diseases because of their shared nonspecific symptoms and serological and histological overlap. This study compared the plasma metabolomic profiles of patients with AIH, primary biliary cirrhosis (PBC), PBC/AIH overlap syndrome (OS), and drug-induced liver injury (DILI) with those of healthy subjects to identify potential biomarkers of AIH. Metabolomic profiling and biomarker screening were performed using proton nuclear magnetic resonance spectroscopy (H NMR) coupled with a partial least-squares discriminant analysis. Compared with the levels in healthy volunteers and other liver disease patients, AIH patients exhibited relatively high levels of plasma pyruvate, lactate, acetate, acetoacetate, and glucose. Such metabolites are typically related to energy metabolism alterations and may be a sign of metabolic conversion to the aerobic glycolysis phenotype of excessive immune activation. Increased aromatic amino acids and decreased branched-chain amino acids were found in the plasma of AIH patients. The whole NMR profiles were stepwise-reduced, and nine metabolomic biomarkers having the greatest significance in the discriminant analysis were obtained. The diagnostic utility of the selected metabolites was assessed, and these biomarkers achieved good sensitivity, specificity, and accuracy (all above 93%) in distinguishing AIH from PBC, DILI, and OS. This report is the first to present the metabolic phenotype of AIH and the potential utility ofH NMR metabolomics in the diagnosis of AIH.

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Section: Discussionmentioning

confidence: 99%

Metabolomic Profiling of Autoimmune Hepatitis: The Diagnostic Utility of Nuclear Magnetic Resonance Spectroscopy

Wang

Sun

et al. 2014

J. Proteome Res.

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“…It is important to emphasize that LDH and ADL are present in other tissues (liver and brain), and are useful markers to analyze liver function, being elevated in patients in serum of patients with hepatic injury 37 . Also, elevated levels of LDH might be considered in patients with inflammatory connective diseases, such as RA and under treatment with anti-inflammatory drugs 38 . As aforementioned, CQ/HCQ can also accumulate in liver and cardiac cells, causing hepatotoxicity 15 and cardiomyotoxicity 10 , 21 .…”

Section: Discussionmentioning

confidence: 99%

The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis

Biguetti

Santiago²,

Fiedler

et al. 2021

Sci Rep

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The aim of this systematic review was to perform qualitative and quantitative analysis on the toxic effects of chloroquine (CQ) and hydroxychloroquine (HCQ) on skeletal muscles. We designed the study according to PRISMA guidelines. Studies for qualitative and quantitative analyses were selected according to the following inclusion criteria: English language; size of sample (> 5 patients), adult (> age of 18) patients, treated with CQ/HCQ for inflammatory diseases, and presenting and not presenting with toxic effects on skeletal muscles. We collected data published from 1990 to April 2020 using PubMed, Cochrane Library, EMBASE, and SciELO. Risk of bias for observational studies was assessed regarding the ROBIN-I scale. Studies with less than five patients (case reports) were selected for an additional qualitative analysis. We used the software Comprehensive Meta-Analysis at the confidence level of 0.05. We identified 23 studies for qualitative analysis (17 case-reports), and five studies were eligible for quantitative analysis. From case reports, 21 patients presented muscle weakness and confirmatory biopsy for CQ/HCQ induced myopathy. From observational studies, 37 patients out of 1,367 patients from five studies presented muscle weakness related to the use of CQ/HCQ, and 252 patients presented elevated levels of muscle enzymes (aldolase, creatine phosphokinase, and lactate dehydrogenase). Four studies presented data on 34 patients with confirmatory biopsy for drug-induced myopathy. No study presented randomized samples. The chronic use of CQ/HCQ may be a risk for drug-induced myopathy. There is substantiated need for proper randomized trials and controlled prospective studies needed to assess the clinical and subclinical stages of CQ/HCQ -induced muscle myopathy.

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“…Furthermore, high levels of AST, ALT and LDH, without assessment of CK may lead to a false diagnosis of a liver disease in a patient with PM. On the other hand, elevations of AST, ALT and LDH along with CK in myositis patients may be interpreted to be due to muscle injury and not liver involvement [3]. Therefore, in patients with PBC or especially AIH type 1, awareness of associated autoimmune diseases may lead to prompt diagnosis and better outcome.…”

Section: Discussionmentioning

confidence: 99%

“…24 No 1: 101-104 (LDH), aminotransferases are usually elevated. High levels of aminotransferases and LDH, without assessment of creatine kinase (CK), are often misdiagnosed as hepatic diseases [3]. Conversely, concomitant elevations of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and LDH along with the CK in patients with polymyositis, PM/dermatomyositis, DM may be considered to be due to myopathy itself, even in the case of coexistence with liver injury [3].…”

mentioning

confidence: 99%

Primary Biliary Cirrhosis – Autoimmune Hepatitis Overlap Syndrome Associated with Dermatomyositis, Autoimmune Thyroiditis and Antiphospholipid Syndrome

Pamfil

Candrea

Berki³

et al. 2015

JGLD

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Autoimmune liver diseases may be associated with extrahepatic autoimmune pathology. We report the case of a 52-year old woman who initially presented to the gastroenterology department for extreme fatigue, pale stools, dark urine and pruritus. Laboratory tests showed significant cholestasis and elevation of aminotransferase levels. Immunological tests revealed positive antinuclear (ANA=1:320) and antimitochondrial antibodies (AMA=1:40) with negative anti-smooth muscle and liver kidney microsomal type 1 antibodies. The biopsy was compatible with overlap syndrome type 1. The patient was commenced on immunosuppressive therapy according to standard of care (azathioprine 50mg, ursodeoxycholic acid and prednisone 0.5mg/kg), with moderate biochemical improvement. She subsequently developed proximal symmetrical weakness and cutaneous involvement and was diagnosed with biopsy-proven dermatomyositis. The immunosuppressive regimen was intensified to 150 mg azathioprine. At the three-month follow-up, her symptoms subsided and aminotransferases and muscle enzymes normalized. Upon further investigation the patient was diagnosed with autoimmune thyroiditis and antiphospholipid syndrome. To our knowledge, this is the first case of primary biliary cirrhosis - autoimmune hepatitis overlap syndrome associated with dermatomyositis, autoimmune thyroiditis and antiphospholipid syndrome.

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Simultaneously developed polymyositis and autoimmune hepatitis

Cited by 8 publications

References 9 publications

Metabolomic Profiling of Autoimmune Hepatitis: The Diagnostic Utility of Nuclear Magnetic Resonance Spectroscopy

Metabolomic Profiling of Autoimmune Hepatitis: The Diagnostic Utility of Nuclear Magnetic Resonance Spectroscopy

The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis

Primary Biliary Cirrhosis – Autoimmune Hepatitis Overlap Syndrome Associated with Dermatomyositis, Autoimmune Thyroiditis and Antiphospholipid Syndrome

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