Venous Thromboembolic Events in Idiopathic Inflammatory Myopathy: Occurrence and Relation to Disease Onset.

To assess the incidence of venous thromboembolic events (VTEs) in patients with idiopathic inflammatory myopathies (IIMs), to compare the incidence of VTEs in IIM to the incidence in the general population, and to identify patient categories at high risk and investigate the development of risk in relation to a diagnosis of IIM. Using nationwide registers, we identified a cohort of 440 individuals with newly diagnosed IIM and 4,459 individuals from the general population. Patients with IIM were diagnosed between 2005 and 2011. The start of follow-up was the date of IIM diagnosis and the corresponding date in the general population. VTE was defined as hospital care with an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code indicating VTE, with a filled prescription for anticoagulant medication. Incidence rates including 95% confidence intervals (95% CIs) were calculated, and Cox proportional hazards models were used to compare the risk of VTE in patients with IIM to the risk in the general population. The incidence of VTEs was higher in patients with IIM than in the general population and was highest in patients who previously had cancer, who were ages >71 years when diagnosed with IIM, or who had dermatomyositis. The overall hazard ratio (HR) of VTE comparing the IIM cohort to the general population was 7.81 (95% CI 4.74, 12.85). The HR was highest the first year after IIM diagnosis, with HR 26.6 (95% CI 10.4, 68.0). Patients with IIM are at increased risk of VTE compared to the general population, especially during the first year after the diagnosis. Preventive measures should be focused on patients who previously have had cancer, who are ages >71 years when diagnosed, or who have dermatomyositis.

Antovic A ，Notarnicola A ，Svensson J ，Lundberg IE ，Holmqvist M ... -  《-》

Acute Coronary Syndrome in Idiopathic Inflammatory Myopathies: A Population-based Study.

Leclair V ，Svensson J ，Lundberg IE ，Holmqvist M ... -  《-》

The Risk of Ischemic and Hemorrhagic Stroke in Patients With Idiopathic Inflammatory Myopathies: A Swedish Population-Based Cohort Study.

To study the occurrence of ischemic stroke and hemorrhagic stroke in patients with idiopathic inflammatory myopathies (IIMs) compared to that in the general population and to investigate how it varies by sex, age, clinical subdiagnosis, and time since IIM diagnosis. All patients in Sweden with newly diagnosed IIM were identified from the National Patient Register, and general population comparators were identified from the Total Population Register. The study population was followed prospectively until death, emigration, December 2013, or first incident stroke. Incidence rates, rate differences, and hazard ratios (HRs) comparing patients with IIMs to the general population were estimated and stratified by age, sex, type of IIM, and time since diagnosis. To account for the competing risk of death, the subdistribution HR was estimated using Fine and Gray models. We observed 34 and 229 stroke events in 663 IIM patients and 6,673 comparators, respectively. The HR was elevated for ischemic stroke (HR 2.1 [95% confidence interval (95% CI) 1.4, 3.0]). Few hemorrhagic stroke events were identified, but an increased risk was observed (HR 1.9 (95% CI 0.7, 5.5]). The association remained elevated for both outcomes when taking the competing risk of death into account. For ischemic stroke, the rate difference was highest in the oldest age group (≥68 years), while the HR was highest in the youngest age group (<56 years). Our findings indicate that the risk of both ischemic stroke and hemorrhagic stroke is increased in patients with IIMs, but it should be kept in mind that stroke is a rare event. Focus on prevention should be directed toward groups with the highest absolute risk, especially older patients.

Moshtaghi-Svensson J ，Lundberg IE ，Von Euler M ，Arkema EV ，Holmqvist M ... -  《-》

Mortality in idiopathic inflammatory myopathy: results from a Swedish nationwide population-based cohort study.

Patients with idiopathic inflammatory myopathies (IIMs) suffer an increased burden of comorbidities, but data on mortality in recently diagnosed IIM are conflicting. Also, little is known when, if ever, in relation to IIM diagnosis, mortality is increased. A population-based IIM cohort of patients diagnosed between 2002 and 2011 and general population comparators were identified using healthcare registers. They were linked to the cause of death register for follow-up. 224 (31%) of the 716 patients with IIM and 870 (12%) of the 7100 general population died during follow-up. This corresponded to a mortality rate of 60/1000 person-years in IIM and 20/1000 person-years in the general population. The cumulative mortality at 1 year after diagnosis was 9% in IIM and 1% in the general population, and increased in both IIM and the general population with time. The overall hazard ratio (HR) 95%CI of death comparing IIM with the general population was 3.7 (3.2 to 4.4). When we stratified on time since diagnosis, we noted an increase in mortality already within the first year of diagnosis compared with the general population, HR 9.6 (95% CI 6.9 to 13.5). This HR then plateaued around 2 after >10 years with the disease, although the estimates were not statistically significant. Malignancies, diseases of the circulatory and respiratory system were common causes of death. Mortality is increased in patients with contemporary IIM. The increased mortality was noted within a year of diagnosis, which calls for extra vigilance during the first year of IIM diagnosis.

Dobloug GC ，Svensson J ，Lundberg IE ，Holmqvist M ... -  《-》

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

To examine the association between idiopathic inflammatory myopathy (IIM) and cancer before and after IIM diagnosis. We used prospectively collected nationwide register data to design a case-control study to investigate the occurrence of cancer before IIM, and a cohort study to investigate the occurrence of cancer after IIM. Patients diagnosed with IIM between 2002 and 2016 in Sweden, were compared to the general population. The association between cancer and IIM was estimated before and after IIM diagnosis via logistic regression and Cox regression models, respectively. We included 1419 patients with IIM and 7045 individuals from the general population. The overall odds of cancer before IIM diagnosis were increased in IIM compared to the general population, adjusted odds ratio (AOR) 1.5, 95% confidence interval (CI) 1.3-1.8. This association was also noted after IIM diagnosis, adjusted hazard ratio (AHR) 1.7 (95% CI 1.4-2.0), or one additional cancer in every 125 IIM patients per year. Colorectal (AOR 2.1), lung (AOR 5.4) and ovarian (AOR 7.0) cancers were associated with IIM before diagnosis. Oropharyngeal (AHR 9.1) and cervical (AHR 3.8) cancers, malignant melanoma (AHR 3.2) and non-melanoma skin cancer (AHR 3.1) were associated with IIM after diagnosis. Adenocarcinomas were associated with dermatomyositis before diagnosis and squamous cell cancers after IIM diagnosis. Lymphatic hematopoietic cancers were associated with IIM both before and after diagnosis. The cancer types that occur before IIM diagnosis differ from the ones that occur after diagnosis. This may have an impact on screening decisions for IIM.

Dani L ，Ian Che W ，Lundberg IE ，Hellgren K ，Holmqvist M ... -  《-》