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Characteristics and outcomes of overlap myositis: a comparative multigroup cohort study in adults from the MyoCite cohort

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Abstract

Overlap myositis (OM), an important subset of idiopathic inflammatory myopathies (IIM), is being increasingly recognized with wider myositis-specific autoantibody (MSA) testing. We studied the differences in clinical characteristics and long-term outcomes of OM with Dermatomyositis (DM), Polymyositis (PM), anti-synthetase syndrome (ASSD), and Cancer-associated IIM (CAM). Data from the MyoCite registry (Dec2017–May2020), a prospective dataset of IIM was extracted for the clinical profile, and MSAs, immunosuppressants received, disease activity (relapses and incomplete response), and treatment-related (drugs ADRs and infections) adverse events (DRAE and TRAE) were collected and analyzed between groups. Of 214 adults (58-OM,89-DM,27-ASSD,33-PM,7-CAM), OM had a greater female preponderance (13.5:1). Raynaud’s and sclerodactyly were the prime distinguishing features of OM. OM could be distinguished from PM by frequent arthritis (OR-3.2) and infrequent dysphagia (OR-0.17); DM with greater nephritis (OR-20), infrequent dysphagia (OR-0.24) and rashes (OR-0.02); and ASSD by infrequent ILD (OR-0.07), and mechanic’s hand (OR-0.05). 50% fulfilled the classification criteria for ASSD in the absence of MSA testing. ANA was positive more often (PM/DM: OR-6.7) and anti-Ro52 (OR-4.5) frequent in OM. Baseline serum creatinine and acute phase reactants were higher. OM received lower glucocorticoids (0 mg/kg, p < 0.001). Overall, 90% and 84% of OM at 12 and 24 months, respectively, achieved remission, with similar DRAE and TRAE as other IIM subsets. OM can be misdiagnosed as ASSD in the absence of MSA testing. Raynaud’s, sclerodactyly, and a positive ANA may identify OM and prevent overtreatment.

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Data availability statement

The data underlying this article will be shared on a reasonable request to the corresponding author.

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Funding

APLAR research grant 2017 awarded to LG.

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Authors and Affiliations

  1. Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India

    R. Naveen, Upendra Rathore, Vikas Agarwal & Latika Gupta

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  1. R. Naveen
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  2. Upendra Rathore
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  3. Vikas Agarwal
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  4. Latika Gupta
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Contributions

RN, UR, and LG collected and analyzed the clinical data. All authors were involved in writing and reviewing the manuscript for critical intellectual inputs.

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Correspondence to Latika Gupta.

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R Naveen: none declared, Latika Gupta: none declared, Upendra Rathore: none declared, and Vikas Agarwal: none declared. The paper has been accepted as live oral presentation in APLAR 2020. Link: https://aplar.delegateconnect.co/talks/127

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Supplementary Table 1.

Comorbidities, MSA/MAA and ANA of adults with IIM (n=214) (DOCX 16 KB)

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Naveen, R., Rathore, U., Agarwal, V. et al. Characteristics and outcomes of overlap myositis: a comparative multigroup cohort study in adults from the MyoCite cohort. Rheumatol Int 41, 551–563 (2021). https://doi.org/10.1007/s00296-020-04779-y

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  • DOI: https://doi.org/10.1007/s00296-020-04779-y

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