Anti-SAE autoantibody in dermatomyositis: original comparative study and review of the literature

Author:

Demortier Juliette1ORCID,Vautier Mathieu2,Chosidow Olivier3ORCID,Gallay Laure4ORCID,Bessis Didier5ORCID,Berezne Alice6,Cordel Nadège7ORCID,Schmidt Jean8,Smail Amar8,Duffau Pierre9,Jachiet Marie10,Begon Edouard11,Gottlieb Jeremy12,Chasset François13,Graveleau Julie14,Marque Myriam15,Cesbron Elise16,Forestier Amandine17,Josse Séverine18,Kluger Nicolas19,Beauchêne Caroline20,Le Corre Yannick20,Pagis Valentine21,Rigolet Aude2,Guillaume-Jugnot Perrine2,Authier François-Jérôme22ORCID,Guilain Nelly23,Streichenberger Nathalie24,Leonard-Louis Sarah25,Boussouar Samia26,Landon-Cardinal Océane27,Benveniste Olivier2,Allenbach Yves2

Affiliation:

1. Department of Dermatology, Henri Mondor University Hospital, AP-HP , Créteil, France

2. Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP , Paris, France

3. Department of Dermatology, Henri Mondor University Hospital, Université Paris-Est Créteil, AP-HP , Créteil, France

4. Department of Internal Medicine and Clinical Immunology, Edouard Herriot University Hospital, Claude Bernard University Lyon1 , Lyon, France

5. Department of Dermatology, University Hospital Center of Montpellier , Montpellier, France

6. Department of Internal Medicine, CHR Annecy-Genevois , Annecy, France

7. Department of Dermatology and Clinical Immunology, Guadeloupe University Hospital, Pointe-à-Pitre, Guadeloupe and Normandie University, UNIROUEN, IRIB, Inserm, U1234 , Rouen, France

8. Department of Internal Medicine and Clinical Immunology, Amiens-Picardie Nord University Hospital , Amiens, France

9. Department of Internal Medicine, Saint André, Bordeaux University Hospital , Bordeaux, France

10. Department of Dermatology, Saint-Louis Hospital, AP-HP , Paris, France

11. Department of Dermatology, René Dubos Hospital , Pontoise, France

12. Department of Internal Medicine and Clinical Immunology, Bicêtre Hospital, Université Paris-Sud, AP-HP , Le Kremlin-Bicêtre Cedex, France

13. Department of Dermatology, Tenon Hospital, Sorbonne Université, AP-HP , Paris, France

14. Department of Internal Medicine, CH de St Nazaire , St Nazaire, France

15. Department of Dermatology, Caremeau Hospital, Nîmes University Hospital , Nîmes, France

16. Department of Dermatology, Le Mans Hospital Center , Le Mans, France

17. Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Mutualiste , Grenoble, France

18. Department of Internal Medicine and Clinical Immunology, Dieppe Hospital , Dieppe, France

19. Department of Dermatology, Helsinki University Hospital , Helsinki, Finland

20. Department of Dermatology, Angers University Hospital , Angers, France

21. Department of Internal Medicine and Clinical Immunology, Beaujon Hospital, AP-HP , Paris, France

22. Department of Pathology, Henri-Mondor University Hospital, Institut Mondor de Recherche Biomédicale, INSERM, Centre de Reference pour les Maladies Neuromusculaires of Nord-Est-Île de France, Université Paris-Est Créteil, AP-HP , Créteil, France

23. Department of Pathology, Amiens Picardie University Hospital , Amiens, France

24. Neuropathology Department, Hospices Civils Lyon, Claude Bernard University Lyon1 , Lyon, France

25. Neuropathology Department, Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP , Paris, France

26. ICT Cardiothoracic Imaging Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université , Paris, France

27. Division of Rheumatology, Centre Hospitalier de l’Université de Montréal (CHUM), CHUM Research Center, Department of Medicine, Université de Montréal , Montréal, Québec, Canada

Abstract

Abstract Objective Among specific autoantibodies in DM, the anti–small ubiquitin-like modifier activating enzyme (SAE) antibody is rare. We aim to describe the clinical characteristics, cancer prevalence, and muscle pathology of anti-SAE–positive DM. Methods Patients with a diagnosis of DM and sera positive for the anti-SAE antibody were recruited from 19 centres in this retrospective observational study. The available muscular biopsies were reviewed. We conducted a comparison with anti-SAE–negative DM and a review of the literature. Results Of the patients in the study (n = 49), 84% were women. Skin involvement was typical in 96% of patients, with 10% having calcinosis, 18% ulceration and 12% necrosis; 35% presented with a widespread skin rash. Muscular disease affected 84% of patients, with mild weakness [Medical Research Council (MRC) scale 4 (3, 5)], although 39% of patients had dysphagia. Muscular biopsies showed typical DM lesions. Interstitial lung disease was found in 21% of patients, mainly with organizing pneumonia pattern, and 26% of patients showed dyspnoea. Cancer-associated myositis was diagnosed in 16% of patients and was responsible for the majority of deaths, its prevalence being five times that of the general population. IVIG therapy was administered to 51% of the patients during the course of the disease. Comparison with anti-SAE–negative DM (n = 85) showed less and milder muscle weakness (P = 0.02 and P = 0.006, respectively), lower creatinine kinase levels (P < 0.0001) and less dyspnoea (P = 0.003). Conclusion Anti-SAE positive DM is a rare subgroup associated with typical skin features but a potentially diffuse rash, a mild myopathy. Interstitial lung disease defines an organizing pneumonia pattern. Cancer associated DM prevalence is five times that of the general population. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT04637672.

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Rheumatology

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