Abstract
Auto-antibodies against aminoacyl-tRNA-synthetases (anti-ARS Abs) represent the hallmark of the anti-synthetase syndrome that is defined as the clinical association of fever, Raynaud’s phenomenon, myositis, interstitial lung disease (ILD), arthritis and mechanic’s hands. Recently, differences in clinical features depending on specific anti-ARS Abs have been reported. We describe three cases of anti-EJ (anti-glycyl) antibody-positive patients presenting with ILD as a common feature, but with heterogeneous histopathological and radiographic patterns and with different responses to treatment. Relapsing-remittent fever, refractory muscle involvement and seronegative arthritis were also striking clinical manifestations.
Similar content being viewed by others
References
Gunawardena H, Betteridge ZE, McHugh NJ (2009) Myositis-specific autoantibodies: their clinical and pathogenic significance in disease expression. Rheumatology 48:607–612. doi:10.1093/rheumatology/kep078
Connors GR, Christopher-Stine L, Oddis CV, Danoff SK (2010) Interstitial lung disease associated with the idiopathic inflammatory miopathies: what progress has been made in the past 35 years? Chest 138(6):1464–1474. doi:10.1378/chest.10-0180
Mahler M, Miller FW, Fritzler MJ (2014) Idiopathic inflammatory myopathies and the anti-synthetase syndrome: a comprehensive review. Autoimmun Rev 13(4–5):367–371. doi:10.1016/j.autrev.2014.01.022, Review. PubMed PMID: 24424190; PubMed Central PMCID: PMC3970575
Targoff IN (1992) Autoantibodies in polymyositis. Rheum Dis Clin N Am 18:455–482
Hamaguchi Y, Fujimoto M, Matsushita T, Kaji K, Komura K, Hasegawa M et al (2013) Common and distinct clinical features in adult patients with anti-aminoacyl-tRNA synthetase antibodies: heterogeneity within the syndrome. PLoS One 8(4):e60442. doi:10.1371/journal.pone.0060442
Hirakata M, Suwa A, Takada T, Sato S, Nagai S, Genth E et al (2007) Clinical and immunogenetic features of patients with autoantibodies to asparaginyl-transfer RNA synthetase. Arthritis Rheum 56:1295–1303. doi:10.1002/art.22506
Sato S, Kuwana M, Hirakata M (2007) Clinical characteristics of Japanese patients with anti-OJ (anti-isoleucyl-tRNA synthetase) autoantibodies. Rheumatology 46:842–845. doi:10.1093/rheumatology/kel435
Targoff IN, Arnett FC (1990) Clinical manifestations in patients with antibody to PL-12 antigen (alanyl-tRNA synthetase). Am J Med 88:241–251. doi:10.1016/0002-9343(90)90149-8
Ghirardello A, Bassi N, Palma L, Borella E, Domeneghetti M, Punzi L et al (2013) Autoantibodies in polymyositis and dermatomyositis. Curr Rheumatol Rep 15:335. doi:10.1007/s11926-013-0335-1
Mehndiratta P, Mehta S, Manjila SV, Kammer GM, Cohen ML, Preston DC (2012) Isolated necrotizing myopathy associated with ANTI-PL12 antibody. Muscle Nerve 46:282–286. doi:10.1002/mus.23383
Targoff IN, Trieu EP, Plotz PH, Miller FW (1992) Antibodies to glycyl-transfer RNA synthetase in patients with myositis and interstitial lung disease. Arthritis Rheum 35(7):821–830
Schneider F, Yousem SA, Bi D, Gibson KF, Oddis CV, Aggarwal R (2014) Pulmonary pathologic manifestations of anti-glycyl-tRNA synthetase (anti-EJ)-related inflammatory myopathy. J Clin Pathol 67:678–683. doi:10.1136/jclinpath-2014-202367
Koreeda Y, Higashimoto I, Yamamoto M, Takahashi M, Kaji K, Fujimoto M et al (2010) Clinical and pathological findings of interstitial lung disease patients with anti-aminoacyl- tRNA synthetase autoantibodies. Intern Med 49(5):361–369
Watanabe K, Handa T, Tanizawa K, Hosono Y, Taguchi Y, Satoshi N et al (2011) Detection of antisynthetase syndrome in patients with idiopathic interstitial pneumonias. Respir Med 105(8):1238–1247. doi:10.1016/j.rmed.2011.03.022
Hernandez-Prera J, Beasley MB (2013) Novel patterns of interstitial lung disease. Diagn Histopathol 19:276–281
Sauter JL, Butnor KJ (2014) Expanding the spectrum of pulmonary histopathological manifestations of anti-synthetase syndrome: anti-EJ-associated acute fibrinous and organizing pneumonia. Histopathology 65(4):581–582. doi:10.1111/his.12420
Schwarz MI, Sutarik JM, Nick JA, Leff JA, Emlen JW, Tuder RM (1995) Pulmonary capillaritis and diffuse alveolar hemorrhage. A primary manifestation of polymyositis. Am J Respir Crit Care Med 151(6):2037–2040
Helmers Barbasso S, Englund P, Engstrom M, Ahlin E, Fathi M et al (2009) Sera from anti-JO1-positive patients with polymyositis and interstitial lung disease induce expression of intercellular adhesion molecule 1 in human lung endothelial cells. Arthritis Rheum 60(8):2524–2530. doi:10.1002/art.24683
Moghadam-Kia S, Oddis CV, Sato S, Kuwana M, Aggarwal R (2015) Anti-MDA5 is associated with rapidly progressive lung disease and poor survival in U.S. patients with amyopathic and myopathic dermatomyositis. Arthritis Care Res (Hoboken). doi:10.1002/acr.22728
Koga T, Fujikawa K, Horai Y, Okada A, Kawashiri SY, Iwamoto N et al (2012) The diagnostic utility of anti-melanoma differentiation-associated gene 5 antibody testing for predicting the prognosis of Japanese patients with DM. Rheumatology (Oxford) 51(7):1278–1284. doi:10.1093/rheumatology/ker518
Chatterjee S, Prayson R, Farver C (2013) Antisynthetase syndrome: not just an inflammatory myopathy. Cleve Clin J Med 80:655–666. doi:10.3949/ccjm.80a.12171
de Souza FHC, Cruellas MGP, Levy-Neto M, Shinjo SK (2013) Anti-synthetase syndrome: anti-PL-7, anti-PL-12 and anti-EJ. Rev Bras Reumatol 53:352–357
Tomioka H, Kaneko M, Kogata Y, Katsuyama E, Ishikawa S, Fujii T (2012) A case of interstitial lung disease with anti-EJ and anti-CCP antibodies preceding rheumatoid arthritis. Respir Investig 50:66–69. doi:10.1016/j.resinv.2012.04.003
Hervier B, Devilliers H, Stanciu R, Meyer A, Uzunhan Y, Masseau A et al (2012) Hierarchical cluster and survival analyses of antisynthetase syndrome: phenotype and outcome are correlated with anti-tRNA synthetase autoantibody specificity. Autoimmun Rev 12(2):210–217. doi:10.1016/j.autrev.2012.06.006
Cavagna L, Nuño L, Scirè CA, Govoni M, Javier Lopez Longo F, Franceschini F et al (2015) Clinical spectrum time course in anti-JO1 positive antisynthetase syndrome: results from an international retrospective multicenter study. Medicine (Baltimore) 4(32):1144. doi:10.1097/MD.0000000000001144
Aggarwal R, Cassidy E, Fertig N, Koontz DC, Lucas M, Ascherman DP et al (2014) Patients with non-Jo1 anti-tRNA synthetase autoantibodies have worse survival than Jo1 positive patients. Ann Rheum Dis 73(1):227–232. doi:10.1136/annrheumdis-2012-201800
Song JS, Hwang J, Cha H-S, Jeong B-H, Suh GY, Chung MP et al (2015) Significance of myositis autoantibody in patients with idiopathic interstitial lung disease. Yonsei Med J 56(3):676–683. doi:10.3349/ymj.2015.56.3.676
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
None.
Additional information
Margherita Giannini and Antonella Notarnicola contributed equally to this work.
Rights and permissions
About this article
Cite this article
Giannini, M., Notarnicola, A., Dastmalchi, M. et al. Heterogeneous clinical spectrum of interstitial lung disease in patients with anti-EJ anti-synthetase syndrome: a case series. Clin Rheumatol 35, 2363–2367 (2016). https://doi.org/10.1007/s10067-016-3258-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-016-3258-1