Cutaneous ulceration in dermatomyositis: association with anti-melanoma differentiation-associated gene 5 antibodies and interstitial lung disease.
Cutaneous ulceration in dermatomyositis: association with anti-melanoma differentiation-associated gene 5 antibodies and interstitial lung disease.
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DOI：
10.1002/acr.22498
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发表时间：
2015-05
影响因子：
4.7
通讯作者：
Fiorentino, David F.
中科院分区：
文献类型：
--
作者：
Narang, Neera S.;Casciola-Rosen, Livia;Li, Shufeng;Chung, Lorinda;Fiorentino, David F.
确定皮肌炎（DM）皮肤溃疡的临床和血清学相关性。我们回顾性研究了152例糖尿病患者的队列。我们使用卡方检验或Fisher精确检验比较溃疡患者与无溃疡患者的特征，并使用单变量和多变量logistic回归模型评估溃疡与恶性肿瘤、间质性肺病（ILD）和无肌病等临床特征之间的相关性。43例患者（28%）有皮肤溃疡。近一半的患者溃疡出现在1个以上的位置：24例（56%）溃疡位于关节伸肌表面，18例（42%）位于指腹或甲周区域，25例（58%）溃疡位于其他部位。在单变量分析中，溃疡与亚洲人种相关，但与其他临床和人口统计学特征（包括恶性肿瘤或ILD）无关。在多变量分析中，溃疡与抗黑色素瘤分化基因5（抗MDA 5）抗体显著相关（比值比10.14，95%置信区间1.95-52.78，P = 0.0059），这在位于指髓的溃疡中最大。在皮肤溃疡患者中，ILD风险仅在抗MDA 5+抗体患者中特异性增加。我们证实了抗MDA 5抗体与皮肤溃疡之间的强相关性，新发现皮肤溃疡与ILD的相关性取决于抗MDA 5抗体的存在。显示这种皮肤表型的DM患者应接受适当的ILD评估。
To identify clinical and serologic correlates of cutaneous ulcers in dermatomyositis (DM). We retrospectively examined a cohort of 152 DM patients. We compared the features of patients with ulcers to those without ulcers using chi-square or Fisher’s exact tests and used univariate and multivariate logistic regression models to assess the association between ulcers and clinical features such as malignancy, interstitial lung disease (ILD), and amyopathic disease. Forty-three patients (28%) had cutaneous ulcers. Nearly half the patients had ulcers present in more than 1 location: 24 (56%) had ulcers over the extensor surfaces of joints, 18 (42%) at the digital pulp or periungual areas, and 25 (58%) had ulcers located elsewhere. In univariate analysis ulcers were associated with Asian race, but not with other clinical and demographic features, including malignancy or ILD. In multivariate analysis ulcers were significantly associated with anti–melanoma differentiation gene 5 (anti-MDA5) antibodies (odds ratio 10.14, 95% confidence interval 1.95–52.78, P = 0.0059) and this was greatest for ulcers located at the digital pulp. In patients with cutaneous ulcers, ILD risk was specifically increased only in patients with anti-MDA5+ antibodies. We confirmed the strong association between anti-MDA5 antibodies and cutaneous ulcers, with the novel finding that the association of cutaneous ulcers with ILD depends upon the presence of anti-MDA5 antibodies. DM patients who display this cutaneous phenotype should undergo appropriate evaluation for ILD.
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