Interstitial lung disease common in dermatomyositis

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Rheumawire

Mar 25, 2004

Interstitial lung disease common in dermatomyositis

Stockholm, Sweden - Swedish researchers have found that 65% of patients

with newly diagnosed polymyositis and dermatomyositis have interstitial

lung disease (ILD), often without any clinical symptoms.

It is important to know that ILD is present, because this will influence

the choice of immunosuppressive treatment, say Dr am Fathi

(Karolinska Hospital, Stockholm, Sweden) and colleagues in their paper

in the March 2004 issue of ls of the Rheumatic Diseases [1].

Polymyositis and dermatomyositis are systemic inflammatory disorders

with unknown etiology and pathogenesis. They mainly affect striated

muscles, resulting in proximal muscle weakness. But other organ systems,

including the lungs, may be affected, and pulmonary complications are

associated with high morbidity and mortality, say Fathi et al.

They conducted a prospective study in which they identified 26 new cases

of poly- or dermatomyositis between 1998 and 2000. Of these, 17 patients

were included in the study and were given chest x-rays, high-resolution

computed tomography (HRCT), and pulmonary-function tests. A second

objective was to compare the clinical presentation and biochemical

findings in patients with and without ILD to evaluate methods for

detection of patients at risk of developing ILD in the course of poly-

or dermatomyositis.

ILDdefined as radiological signs on chest x-ray/HRCT or restrictive

ventilatory defectwas found in 11 (65%) of patients and was more common

in men than in women. Arthritis and occurrence of anti-Jo-1 antibodies

were also found more often in patients with ILD than in those without.

" To our knowledge, this is the first report in which newly diagnosed

patients with poly- or dermatomyositis were investigated for the

presence of ILD regardless of clinical symptoms that might indicate lung

disease, " the researchers say. " We observed radiological signs or

restrictive ventilatory defects compatible with ILD in 65% of the

patients, which is a higher prevalence than previously reported. "

Although the majority of patients with ILD experience respiratory

symptoms, such as cough or dyspnea, ILD was present in 4 of the 6

patients without any clinical signs of pulmonary disease, the

researchers note. So, " neither cough nor dyspnea is a valid indicator of

pulmonary involvement in myositis and cannot be used for selection of

patients who should undergo radiological and lung-function assessments, "

they note.

They add that the incidence of subclinical ILD in their study group was

18%, and " it is unclear whether this group of patients will eventually

develop clinically significant ILD. Long-term prospective follow-up

studies are needed to evaluate the relevance of subclinical ILD in

patients with myositis, " they add.

In conclusion, " chest x-rays, HRCT, pulmonary-function tests, and

analysis of anti-Jo-1 antibodies should be included in the initial

investigation of patients with myositis, regardless of respiratory

symptoms, " they say.

Nainggolan

Source

1. Fathi M, Dastmalchi M, Rasmussen E, Lundberg IE, Tornling G.

Interstitial lung disease, a common manifestation of newly diagnosed

polymyositis and dermatomyositis. Ann Rheum Dis 2004 Mar; 63(3):297-301.

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