Skip to main content
Log in

Heterogeneous clinical spectrum of interstitial lung disease in patients with anti-EJ anti-synthetase syndrome: a case series

  • Case Based Review
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. 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

    Article  CAS  PubMed  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Targoff IN (1992) Autoantibodies in polymyositis. Rheum Dis Clin N Am 18:455–482

    CAS  Google Scholar 

  5. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. 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

    Article  CAS  PubMed  Google Scholar 

  7. 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

    Article  CAS  PubMed  Google Scholar 

  8. 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

    Article  CAS  PubMed  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. 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

    Article  CAS  PubMed  Google Scholar 

  11. 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

    Article  CAS  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. Hernandez-Prera J, Beasley MB (2013) Novel patterns of interstitial lung disease. Diagn Histopathol 19:276–281

    Article  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    Article  CAS  PubMed  Google Scholar 

  18. 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

    Article  Google Scholar 

  19. 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

    Google Scholar 

  20. 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

    Article  CAS  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  24. 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

    Article  CAS  PubMed  Google Scholar 

  25. 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

    Article  Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. 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

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Florenzo Iannone.

Ethics declarations

Disclosures

None.

Additional information

Margherita Giannini and Antonella Notarnicola contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-016-3258-1

Keywords

Navigation