Overlap myositis, a distinct entity beyond primary inflammatory myositis: A retrospective analysis of a large cohort from the REMICAM registry.
Inflammatory idiopathic myositis (IIM) comprises a heterogeneous group of systemic muscular diseases that can occur together with other connective tissue diseases (CTD), named overlap myositis (OM). The question of whether OM is a distinct entity still remains controversial.
The present study was conducted to assess the clinical and prognostic differences between patients diagnosed with OM, primary polymyositis (PM) and primary dermatomyositis (DM).
The study consists of a retrospective longitudinal and multicenter series of IIM patients. Patients were classified as OM, PM and DM. Overlap myositis was defined as patients fulfilling criteria for IIM plus criteria for other CTD (namely systemic sclerosis, systemic lupus erythematosus, mixed connective tissue disease, rheumatoid arthritis and primary Sjögren's syndrome).
A total of 342 patients were included (98 OM, 137 PM and 107 DM). Overlap myositis patients, in comparison with PM and DM, showed significant differences, with more extramuscular involvement, particularly more arthritis (66%, 34.6% and 48.1%, respectively), puffy fingers (49.5%, 11.1% and 24.3%), sclerodactyly (45.4%, 2.2% and 2%), dysphagia (41.8%, 18.2% and 26.4%), Raynaud phenomenon (65.3%, 16.9% and 19.8%), leucopenia (28.9%, 2.2% and 8.4%), thrombocytopenia (8.2%, 2.2% and 1.9%), interstitial lung disease (ILD) (48%, 35% and 30.8%), renal manifestations (13.4%, 3.7% and 1.9%), and more severe infections (41.3%, 26.7% and 21%). No significant differences were found in survival between groups in log rank test (P = 0.106). Multivariate adjusted survival analyses revealed a worse prognosis for severe infections, ILD and baseline elevation of acute phase reactants.
Overlap myositis stands out as a distinct entity as compared to PM and DM, featuring more extramuscular involvement and more severe infections. Close monitoring is recommended in this subset for early detection and treatment of possible complications.
Nuño-Nuño L
，Joven BE
，Carreira PE
，Maldonado-Romero V
，Larena-Grijalba C
，Llorente Cubas I
，Tomero E
，Barbadillo-Mateos MC
，García de la Peña Lefebvre P
，Ruiz-Gutiérrez L
，López-Robledillo JC
，Moruno-Cruz H
，Pérez A
，Cobo-Ibáñez T
，Almodóvar R
，Lojo L
，García de Yébenes MJ
，López-Longo FJ
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Nailfold capillaroscopy changes with disease activity in patients with inflammatory myositis including overlap myositis, pure dermatomyositis, and pure polymyositis.
Nailfold capillaroscopy (NFC) is useful in the evaluation of connective tissue diseases. There are few capillaroscopy examinations in patients with idiopathic inflammatory myopathies (IIMs) using the 2017 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification. We evaluated the clinical, laboratory, and NFC in patients with IIMs using 2 classifications.
In this cross-sectional study, 150 patients with IIMs were selected based on the EULAR/ACR classification and the Troyanov and Senécal classification. Nailfold capillaroscopy, laboratory tests, clinical manifestations, and disease activity were evaluated.
The subgroups were as follows: 81 patient with dermatomyositis (DM), 25 with amyopathic dermatomyositis (ADM), 25 with juvenile dermatomyositis (JDM), 19 with polymyositis (PM),53 with pure DM, 11 with pure PM, and 51 with overlap myositis (OM). Eight (42%) patients with PM and 28 (34.5%) patients with DM were categorized as OM. The scleroderma pattern was the dominant capillaroscopy pattern in the DM (72.8%), JDM (72%), ADM (76%), pure DM (75.4%), and OM (78.4%) subgroups, respectively. In the DM, ADM, JDM, and OM subgroups, scleroderma pattern had an association with high skin Visual Analogue Scale (VAS) score (p < 0.05). In OM patients, the association between scleroderma pattern and high global VAS was also detected (p < 0.05).
The scleroderma pattern was the dominant capillaroscopy pattern in all groups except for PM and pure PM. Some of patients with PM could be categorized as OM. In the DM and pure DM subgroups, there was a significant association between global and skin activity and higher NFC score. Adding the NFC to the classification of IIM is probably helpful in more detailed classifications.
Shenavandeh S
，Rashidi F
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