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Screening for Myositis Antibodies in Idiopathic Interstitial Lung Disease

  • INTERSTITIAL LUNG DISEASE
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Abstract

Purpose

International guidelines recommend screening for connective tissue disease (CTD) with autoantibodies when evaluating patients with idiopathic interstitial lung disease (ILD). Idiopathic inflammatory myositis comprises of a subgroup of CTD diagnosed with myositis antibodies (MA), often presenting with ILD. Our aim was to evaluate the utility of MA screening in patients with idiopathic ILD.

Methods

A retrospective analysis was conducted on patients referred with idiopathic ILD to a tertiary centre ILD clinic who were screened for MA. Patients with known or suspected CTD were excluded. Descriptive statistics, univariate analysis and multivariable logistic regression were used to detect associations between MA and patient characteristics.

Results

Of 360 patients, 165 met inclusion criteria and 44 (26.7%) were identified to have MA. Fourteen patients (8.5%) had a change in diagnosis as a result of MA screening. Multivariable logistic regression identified the presence of MA to be associated with current smoking [OR 6.87 (1.65–28.64), p = 0.008] and a diffusing capacity of < 70% predicted [OR 2.55 (1.09–5.97), p = 0.03]. In patients with a change in diagnosis due to MA screening, 3 (1.8%) underwent a surgical lung biopsy and 2 (1.2%) were previously treated with antifibrotic therapy.

Conclusions

Screening for MA in patients with idiopathic ILD can contribute to a change in patient diagnosis, and may prevent invasive testing and unproven use of antifibrotic therapy. These results support the addition of MA to CTD screening panels during the initial evaluation of idiopathic ILD.

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Abbreviations

ANA:

Antinuclear antibodies

ARS:

Aminoacyl-tRNA synthetase antibodies

aSS:

Antisynthetase syndrome

antiCCP:

Anti-cyclic citrullinated peptide

CT:

Computed tomography

CTD:

Connective tissue disease

DLCO:

Diffusing capacity of the lung for carbon monoxide

FVC:

Forced vital capacity

GER:

Gastroesophageal reflux

IIM:

Idiopathic inflammatory myositis

ILD:

Interstitial lung disease

IPF:

Idiopathic pulmonary fibrosis

MAA:

Myositis-associated antibodies

MA:

Myositis antibodies

MSA:

Myositis-specific antibodies

NSIP:

Non-specific interstitial pneumonia

PFT:

Pulmonary function testing

RF:

Rheumatoid factor

SLB:

Surgical lung biopsy

SRP:

Anti-signal recognition particle

UIP:

Usual interstitial pneumonia

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Funding

Funding for this project was obtained from the Canadian Pulmonary Fibrosis Foundation.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Respirology, University Health Network, University of Toronto, Toronto, Canada

    Lee Fidler, Jolene H. Fisher & Shane Shapera

  2. Department of Medicine, University of Toronto, Toronto, Canada

    Irena Doubelt

  3. Department of Medicine, Department of Radiology, University Health Network, Toronto, Canada

    Sonja Kandel

  4. Division of Rheumatology, University Health Network, Toronto, ON, Canada

    Shikha Mittoo

Authors
  1. Lee Fidler
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  2. Irena Doubelt
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  3. Sonja Kandel
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  4. Jolene H. Fisher
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  5. Shikha Mittoo
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  6. Shane Shapera
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Contributions

LF is the guarantor of this research, and takes responsibility for the integrity of this work. All authors contributed to manuscript revisions, and provided final approval of the version for publication. LF, SS and SM contributed to the study concept and design, statistical analysis, drafting of initial manuscript and study supervision. Other contributions: none.

Corresponding author

Correspondence to Lee Fidler.

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Conflict of interest

SS has participated in speaking engagements and advisory boards for Hoffman-LaRoche Canada, Boehringer-Ingelheim Canada and AstraZeneca Canada. He has participated in clinical trials research for Hoffman-LeRoche Canada, Boehringer-Ingelheim Canada, Prometic Pharmaceuticals, Gilead Pharmaceuticals and Sanofi-Aventis Canada. All others have no conflicts of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required.

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Fidler, L., Doubelt, I., Kandel, S. et al. Screening for Myositis Antibodies in Idiopathic Interstitial Lung Disease. Lung 197, 277–284 (2019). https://doi.org/10.1007/s00408-019-00212-9

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  • DOI: https://doi.org/10.1007/s00408-019-00212-9

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