Clinical and histopathological features of myositis in systemic lupus erythematosus
The objectives of this study were to compare the clinical features of patients with SLE with and without myopathy and to describe the muscle biopsy features of patients with SLE myopathy. This nested case-control study included all subjects enrolled in the Hopkins Lupus Cohort database from May 1987...
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| Published in | Lupus science & medicine Vol. 9; no. 1; p. e000635 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
BMJ Publishing Group LTD
01.03.2022
BMJ Publishing Group |
| Series | Original research |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2053-8790 2053-8790 |
| DOI | 10.1136/lupus-2021-000635 |
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| Abstract | The objectives of this study were to compare the clinical features of patients with SLE with and without myopathy and to describe the muscle biopsy features of patients with SLE myopathy.
This nested case-control study included all subjects enrolled in the Hopkins Lupus Cohort database from May 1987 to June 2016. Subjects with elevated creatine kinase along with evidence of muscle oedema on MRI, myopathic electromyography and/or myopathic muscle biopsy features were defined as having SLE myopathy. Demographic, serological and clinical features were compared between patients with SLE with and without myopathy. Muscle biopsies were histologically classified as polymyositis, dermatomyositis, necrotising myopathy or non-specific myositis.
From among 2437 patients with SLE, 179 (7.3%) had myopathy. African American patients were more likely to develop myositis than Caucasian patients (p<0.0001). Compared with those without myopathy, patients with SLE myopathy were more likely to have malar rash (OR 1.67, 1.22-2.29), photosensitivity (OR 1.43, 1.04-1.96), arthritis (OR 1.81, 1.21-2.69), pleurisy (OR 1.77, 1.3-2.42), pericarditis (OR 1.49, 1.06-2.08), acute confusional state (OR 2.07, 1.09-3.94), lymphopaenia (OR 1.64, 1.2-2.24), anti-double-stranded DNA antibodies (OR 1.52, 1.09-2.13), lupus anticoagulant (OR 1.42, 1-2), cognitive impairment (OR 1.87, 1.12-3.13), cataract (OR 1.5, 1.04-2.18), pulmonary hypertension (OR 1.98, 1.13-3.47), pleural fibrosis (OR 2.01, 1.27-3.18), premature gonadal failure (OR 1.9, 1.05-3.43), diabetes (OR 1.92, 1.22-3.02) or hypertension (OR 1.45, 1.06-2). Among 16 muscle biopsies available for review, the most common histological classifications were necrotising myositis (50%) and dermatomyositis (38%).
Patients with SLE myopathy have a higher prevalence of numerous SLE disease manifestations. Necrotising myopathy and dermatomyositis are the most prevalent histopathological features in SLE myopathy. |
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| AbstractList | ObjectiveThe objectives of this study were to compare the clinical features of patients with SLE with and without myopathy and to describe the muscle biopsy features of patients with SLE myopathy.MethodsThis nested case–control study included all subjects enrolled in the Hopkins Lupus Cohort database from May 1987 to June 2016. Subjects with elevated creatine kinase along with evidence of muscle oedema on MRI, myopathic electromyography and/or myopathic muscle biopsy features were defined as having SLE myopathy. Demographic, serological and clinical features were compared between patients with SLE with and without myopathy. Muscle biopsies were histologically classified as polymyositis, dermatomyositis, necrotising myopathy or non-specific myositis.ResultsFrom among 2437 patients with SLE, 179 (7.3%) had myopathy. African American patients were more likely to develop myositis than Caucasian patients (p<0.0001). Compared with those without myopathy, patients with SLE myopathy were more likely to have malar rash (OR 1.67, 1.22–2.29), photosensitivity (OR 1.43, 1.04–1.96), arthritis (OR 1.81, 1.21–2.69), pleurisy (OR 1.77, 1.3–2.42), pericarditis (OR 1.49, 1.06–2.08), acute confusional state (OR 2.07, 1.09–3.94), lymphopaenia (OR 1.64, 1.2–2.24), anti-double-stranded DNA antibodies (OR 1.52, 1.09–2.13), lupus anticoagulant (OR 1.42, 1–2), cognitive impairment (OR 1.87, 1.12–3.13), cataract (OR 1.5, 1.04–2.18), pulmonary hypertension (OR 1.98, 1.13–3.47), pleural fibrosis (OR 2.01, 1.27–3.18), premature gonadal failure (OR 1.9, 1.05–3.43), diabetes (OR 1.92, 1.22–3.02) or hypertension (OR 1.45, 1.06–2). Among 16 muscle biopsies available for review, the most common histological classifications were necrotising myositis (50%) and dermatomyositis (38%).ConclusionsPatients with SLE myopathy have a higher prevalence of numerous SLE disease manifestations. Necrotising myopathy and dermatomyositis are the most prevalent histopathological features in SLE myopathy. The objectives of this study were to compare the clinical features of patients with SLE with and without myopathy and to describe the muscle biopsy features of patients with SLE myopathy.OBJECTIVEThe objectives of this study were to compare the clinical features of patients with SLE with and without myopathy and to describe the muscle biopsy features of patients with SLE myopathy.This nested case-control study included all subjects enrolled in the Hopkins Lupus Cohort database from May 1987 to June 2016. Subjects with elevated creatine kinase along with evidence of muscle oedema on MRI, myopathic electromyography and/or myopathic muscle biopsy features were defined as having SLE myopathy. Demographic, serological and clinical features were compared between patients with SLE with and without myopathy. Muscle biopsies were histologically classified as polymyositis, dermatomyositis, necrotising myopathy or non-specific myositis.METHODSThis nested case-control study included all subjects enrolled in the Hopkins Lupus Cohort database from May 1987 to June 2016. Subjects with elevated creatine kinase along with evidence of muscle oedema on MRI, myopathic electromyography and/or myopathic muscle biopsy features were defined as having SLE myopathy. Demographic, serological and clinical features were compared between patients with SLE with and without myopathy. Muscle biopsies were histologically classified as polymyositis, dermatomyositis, necrotising myopathy or non-specific myositis.From among 2437 patients with SLE, 179 (7.3%) had myopathy. African American patients were more likely to develop myositis than Caucasian patients (p<0.0001). Compared with those without myopathy, patients with SLE myopathy were more likely to have malar rash (OR 1.67, 1.22-2.29), photosensitivity (OR 1.43, 1.04-1.96), arthritis (OR 1.81, 1.21-2.69), pleurisy (OR 1.77, 1.3-2.42), pericarditis (OR 1.49, 1.06-2.08), acute confusional state (OR 2.07, 1.09-3.94), lymphopaenia (OR 1.64, 1.2-2.24), anti-double-stranded DNA antibodies (OR 1.52, 1.09-2.13), lupus anticoagulant (OR 1.42, 1-2), cognitive impairment (OR 1.87, 1.12-3.13), cataract (OR 1.5, 1.04-2.18), pulmonary hypertension (OR 1.98, 1.13-3.47), pleural fibrosis (OR 2.01, 1.27-3.18), premature gonadal failure (OR 1.9, 1.05-3.43), diabetes (OR 1.92, 1.22-3.02) or hypertension (OR 1.45, 1.06-2). Among 16 muscle biopsies available for review, the most common histological classifications were necrotising myositis (50%) and dermatomyositis (38%).RESULTSFrom among 2437 patients with SLE, 179 (7.3%) had myopathy. African American patients were more likely to develop myositis than Caucasian patients (p<0.0001). Compared with those without myopathy, patients with SLE myopathy were more likely to have malar rash (OR 1.67, 1.22-2.29), photosensitivity (OR 1.43, 1.04-1.96), arthritis (OR 1.81, 1.21-2.69), pleurisy (OR 1.77, 1.3-2.42), pericarditis (OR 1.49, 1.06-2.08), acute confusional state (OR 2.07, 1.09-3.94), lymphopaenia (OR 1.64, 1.2-2.24), anti-double-stranded DNA antibodies (OR 1.52, 1.09-2.13), lupus anticoagulant (OR 1.42, 1-2), cognitive impairment (OR 1.87, 1.12-3.13), cataract (OR 1.5, 1.04-2.18), pulmonary hypertension (OR 1.98, 1.13-3.47), pleural fibrosis (OR 2.01, 1.27-3.18), premature gonadal failure (OR 1.9, 1.05-3.43), diabetes (OR 1.92, 1.22-3.02) or hypertension (OR 1.45, 1.06-2). Among 16 muscle biopsies available for review, the most common histological classifications were necrotising myositis (50%) and dermatomyositis (38%).Patients with SLE myopathy have a higher prevalence of numerous SLE disease manifestations. Necrotising myopathy and dermatomyositis are the most prevalent histopathological features in SLE myopathy.CONCLUSIONSPatients with SLE myopathy have a higher prevalence of numerous SLE disease manifestations. Necrotising myopathy and dermatomyositis are the most prevalent histopathological features in SLE myopathy. The objectives of this study were to compare the clinical features of patients with SLE with and without myopathy and to describe the muscle biopsy features of patients with SLE myopathy. This nested case-control study included all subjects enrolled in the Hopkins Lupus Cohort database from May 1987 to June 2016. Subjects with elevated creatine kinase along with evidence of muscle oedema on MRI, myopathic electromyography and/or myopathic muscle biopsy features were defined as having SLE myopathy. Demographic, serological and clinical features were compared between patients with SLE with and without myopathy. Muscle biopsies were histologically classified as polymyositis, dermatomyositis, necrotising myopathy or non-specific myositis. From among 2437 patients with SLE, 179 (7.3%) had myopathy. African American patients were more likely to develop myositis than Caucasian patients (p<0.0001). Compared with those without myopathy, patients with SLE myopathy were more likely to have malar rash (OR 1.67, 1.22-2.29), photosensitivity (OR 1.43, 1.04-1.96), arthritis (OR 1.81, 1.21-2.69), pleurisy (OR 1.77, 1.3-2.42), pericarditis (OR 1.49, 1.06-2.08), acute confusional state (OR 2.07, 1.09-3.94), lymphopaenia (OR 1.64, 1.2-2.24), anti-double-stranded DNA antibodies (OR 1.52, 1.09-2.13), lupus anticoagulant (OR 1.42, 1-2), cognitive impairment (OR 1.87, 1.12-3.13), cataract (OR 1.5, 1.04-2.18), pulmonary hypertension (OR 1.98, 1.13-3.47), pleural fibrosis (OR 2.01, 1.27-3.18), premature gonadal failure (OR 1.9, 1.05-3.43), diabetes (OR 1.92, 1.22-3.02) or hypertension (OR 1.45, 1.06-2). Among 16 muscle biopsies available for review, the most common histological classifications were necrotising myositis (50%) and dermatomyositis (38%). Patients with SLE myopathy have a higher prevalence of numerous SLE disease manifestations. Necrotising myopathy and dermatomyositis are the most prevalent histopathological features in SLE myopathy. Objective The objectives of this study were to compare the clinical features of patients with SLE with and without myopathy and to describe the muscle biopsy features of patients with SLE myopathy.Methods This nested case–control study included all subjects enrolled in the Hopkins Lupus Cohort database from May 1987 to June 2016. Subjects with elevated creatine kinase along with evidence of muscle oedema on MRI, myopathic electromyography and/or myopathic muscle biopsy features were defined as having SLE myopathy. Demographic, serological and clinical features were compared between patients with SLE with and without myopathy. Muscle biopsies were histologically classified as polymyositis, dermatomyositis, necrotising myopathy or non-specific myositis.Results From among 2437 patients with SLE, 179 (7.3%) had myopathy. African American patients were more likely to develop myositis than Caucasian patients (p<0.0001). Compared with those without myopathy, patients with SLE myopathy were more likely to have malar rash (OR 1.67, 1.22–2.29), photosensitivity (OR 1.43, 1.04–1.96), arthritis (OR 1.81, 1.21–2.69), pleurisy (OR 1.77, 1.3–2.42), pericarditis (OR 1.49, 1.06–2.08), acute confusional state (OR 2.07, 1.09–3.94), lymphopaenia (OR 1.64, 1.2–2.24), anti-double-stranded DNA antibodies (OR 1.52, 1.09–2.13), lupus anticoagulant (OR 1.42, 1–2), cognitive impairment (OR 1.87, 1.12–3.13), cataract (OR 1.5, 1.04–2.18), pulmonary hypertension (OR 1.98, 1.13–3.47), pleural fibrosis (OR 2.01, 1.27–3.18), premature gonadal failure (OR 1.9, 1.05–3.43), diabetes (OR 1.92, 1.22–3.02) or hypertension (OR 1.45, 1.06–2). Among 16 muscle biopsies available for review, the most common histological classifications were necrotising myositis (50%) and dermatomyositis (38%).Conclusions Patients with SLE myopathy have a higher prevalence of numerous SLE disease manifestations. Necrotising myopathy and dermatomyositis are the most prevalent histopathological features in SLE myopathy. |
| Author | Tiniakou, Eleni Corse, Andrea Mammen, Andrew Petri, Michelle A Goldman, Daniel |
| AuthorAffiliation | 4 Division of Rheumatology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA 1 Rheumatology , Johns Hopkins University , Baltimore , Maryland , USA 2 Neurology , Johns Hopkins University , Baltimore , Maryland , USA 3 Muscle Disease Unit , NIAMS , Bethesda , Maryland , USA |
| AuthorAffiliation_xml | – name: 1 Rheumatology , Johns Hopkins University , Baltimore , Maryland , USA – name: 2 Neurology , Johns Hopkins University , Baltimore , Maryland , USA – name: 3 Muscle Disease Unit , NIAMS , Bethesda , Maryland , USA – name: 4 Division of Rheumatology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA |
| Author_xml | – sequence: 1 givenname: Eleni orcidid: 0000-0003-4749-870X surname: Tiniakou fullname: Tiniakou, Eleni organization: Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA – sequence: 2 givenname: Daniel surname: Goldman fullname: Goldman, Daniel organization: Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA – sequence: 3 givenname: Andrea surname: Corse fullname: Corse, Andrea organization: Neurology, Johns Hopkins University, Baltimore, Maryland, USA – sequence: 4 givenname: Andrew surname: Mammen fullname: Mammen, Andrew organization: Neurology, Johns Hopkins University, Baltimore, Maryland, USA, Muscle Disease Unit, NIAMS, Bethesda, Maryland, USA – sequence: 5 givenname: Michelle A orcidid: 0000-0003-1441-5373 surname: Petri fullname: Petri, Michelle A organization: Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35351810$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_14412_1996_7012_2023_4_90_96 crossref_primary_10_3390_ijms25073602 crossref_primary_10_1002_mus_28066 crossref_primary_10_1007_s00401_024_02765_3 crossref_primary_10_1016_j_autrev_2024_103610 crossref_primary_10_1093_rheumatology_kead109 crossref_primary_10_1007_s00401_023_02669_8 crossref_primary_10_1016_j_nmd_2023_03_006 crossref_primary_10_1097_CND_0000000000000523 crossref_primary_10_3899_jrheum_2023_1044 crossref_primary_10_1002_rai2_12146 crossref_primary_10_1111_1756_185X_14894 crossref_primary_10_1016_j_semarthrit_2024_152530 crossref_primary_10_1056_NEJMcps2306879 crossref_primary_10_1080_1744666X_2023_2212162 crossref_primary_10_1016_j_mito_2024_101945 crossref_primary_10_63032_BAYU2491 |
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| Keywords | Polymyositis Lupus Erythematosus, Systemic Dermatomyositis |
| Language | English |
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| References_xml | – volume: 20 start-page: 837 year: 2002 ident: 2025091515115168000_9.1.e000635.15 article-title: Low values of creatine kinase in systemic lupus erythematosus. clinical significance in 300 patients publication-title: Clin Exp Rheumatol – ident: 2025091515115168000_9.1.e000635.16 doi: 10.1191/0961203302lu186oa – ident: 2025091515115168000_9.1.e000635.11 doi: 10.1056/NEJM197502132920706 – ident: 2025091515115168000_9.1.e000635.1 doi: 10.1002/art.34473 – ident: 2025091515115168000_9.1.e000635.4 doi: 10.1002/mus.880050112 – ident: 2025091515115168000_9.1.e000635.18 doi: 10.1136/ard.53.3.178 – volume: 23 start-page: 2543 year: 2017 ident: 2025091515115168000_9.1.e000635.3 article-title: Associated variables of myositis in systemic lupus erythematosus: a cross-sectional study publication-title: Med Sci Monit doi: 10.12659/MSM.902016 – volume: 18 start-page: 886 year: 2015 ident: 2025091515115168000_9.1.e000635.6 article-title: Sle myopathy: a clinicopathological study publication-title: Int J Rheum Dis doi: 10.1111/1756-185X.12592 – volume: 8 start-page: 917 year: 1981 ident: 2025091515115168000_9.1.e000635.2 article-title: Muscle disease in systemic lupus erythematosus: a study of its nature, frequency and cause publication-title: J Rheumatol – volume: 40 year: 1997 ident: 2025091515115168000_9.1.e000635.8 article-title: Updating the American College of rheumatology revised criteria for the classification of systemic lupus erythematosus publication-title: Arthritis Rheum doi: 10.1002/art.1780400928 – ident: 2025091515115168000_9.1.e000635.10 doi: 10.1001/jama.1981.03320070050025 – ident: 2025091515115168000_9.1.e000635.12 doi: 10.1056/NEJM197502202920807 – ident: 2025091515115168000_9.1.e000635.14 doi: 10.1001/jama.1981.03320170033024 – ident: 2025091515115168000_9.1.e000635.17 doi: 10.1007/s00296-011-1880-4 – volume: 30 start-page: 615 year: 2021 ident: 2025091515115168000_9.1.e000635.13 article-title: Myositis in systemic lupus erythematosus publication-title: Lupus doi: 10.1177/0961203320988587 – ident: 2025091515115168000_9.1.e000635.5 doi: 10.1093/rheumatology/36.10.1067 – volume: 92 start-page: e1416 year: 2019 ident: 2025091515115168000_9.1.e000635.20 article-title: Muscular and extramuscular features of myositis patients with anti-U1-RNP autoantibodies publication-title: Neurology doi: 10.1212/WNL.0000000000007188 – volume: 16 start-page: 689 year: 2020 ident: 2025091515115168000_9.1.e000635.19 article-title: Immune-Mediated necrotizing myopathy: clinical features and pathogenesis publication-title: Nat Rev Rheumatol doi: 10.1038/s41584-020-00515-9 – ident: 2025091515115168000_9.1.e000635.7 doi: 10.1002/art.1780251101 – volume: 67 start-page: 1416 year: 2015 ident: 2025091515115168000_9.1.e000635.9 article-title: Spectrum of muscle histopathologic findings in forty-two scleroderma patients with weakness publication-title: Arthritis Care Res doi: 10.1002/acr.22620 |
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| Title | Clinical and histopathological features of myositis in systemic lupus erythematosus |
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