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Gender differences in patients with anti-MDA5-positive dermatomyositis: a cohort study of 251 cases

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Abstract

Objective

To investigate the impact of sex differences on the clinical characteristics and prognosis of patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis (MDA5+ DM).

Methods

We retrospectively analyzed a cohort of 251 patients with MDA5+ DM, including 71 in the male group and 180 in the female group. A multivariate logistic regression model was built to analyze independent risk factors for RPILD in each group. An ROC curve was drawn to evaluate the predictive value of independent risk factors. Kaplan‒Meier analysis was used to compare the cumulative survival rates, while the log-rank test was used to test for significant differences between the two groups.

Results

Patients in the male group had a significantly higher prevalence of heliotrope rash, V sign, severe interstitial lung disease (ILD), and rapidly progressive interstitial lung disease (RPILD) than those in the female group. Anti-Ro52 positivity, high CRP level and short disease were identified as independent risk factors for RPILD in both male and female groups by multivariate logistic regression analysis. The mortality rates of males and females were 33.8% and 22.0%, respectively, and the survival time of patients in the male group was shorter than that in the female group.

Conclusion

Male patients with MDA5+ DM exhibit an increased risk of RPILD, elevated mortality rates and reduced overall survival time compared to their female counterparts, and anti-Ro52 positivity may be an unfavorable prognostic factor for these patients.

Key Points

• The prevalence of solar rash, V sign, severe interstitial lung disease (ILD) and rapidly progressive interstitial lung disease (RPILD) in anti-MDA5-positive female patients was significantly lower than that in male patients.

• Positive Anti-Ro52, high CRP level, and short course of disease were independent risk factors for RPILD in both men and women.

• Female patients exhibited a lower mortality rate than male patients (22.0% vs 33.8%) and demonstrated longer survival time.

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Acknowledgements

We thank all authors for their continued and outstanding support of patient data collection, data analysis, statistical analysis, and valuable suggestions made to the article. Final approval of the version to be submitted: all authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.

Funding

Dr. Lingxiao Xu was supported by the National Natural Science Foundation of China (NSFC): 82271844 and Supported by Suqian Sci & Tech Program (Grant No: KY202201).

Author information

Authors and Affiliations

  1. Department of Rheumatology and Immunology, The Affiliated Suqian First People’s Hospital of Nanjing Medical University, Suqian, Jiangsu, China

    Lu Cheng, Lingxiao Xu, Yan Xu & Yinshan Zang

  2. Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China

    Lingxiao Xu

  3. Department of Rheumatology and Immunology, Wuxi People’s Hospital, Wuxi, Jiangsu, China

    Fenghong Yuan

  4. Department of Rheumatology and Immunology, Huai’an First People’s Hospital, Huai’an, Jiangsu, China

    Ju Li

  5. Department of Rheumatology and Immunology, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China

    Min Wu

  6. Department of Rheumatology and Immunology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China

    Zhanyun Da

  7. Department of Rheumatology and Immunology, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, China

    Hua Wei

  8. Department of Rheumatology and Immunology, Changzhou No.2 People’s Hospital, Changzhou, Jiangsu, China

    Lei Zhou

  9. Department of Rheumatology and Immunology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Songlou Yin

  10. Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

    Jian Wu

  11. Department of Rheumatology and Immunology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China

    Yan Lu

  12. Department of Rheumatology and Immunology, Nanjing First Hospital, Nanjing, Jiangsu, China

    Dinglei Su

  13. Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

    Zhichun Liu

  14. Department of Rheumatology and Immunology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China

    Lin Liu

  15. Department of Rheumatology and Immunology, Yancheng No.1 People’s Hospital, Yancheng, Jiangsu, China

    Longxin Ma

  16. Department of Rheumatology and Immunology, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China

    Xiaoyan Xu

  17. Department of Rheumatology and Immunology, The First People’s Hospital of Lianyungang, Lianyungang, Jiangsu, China

    Huijie Liu

  18. Department of Rheumatology and Immunology, Wuxi No.2 People’s Hospital, Wuxi, Jiangsu, China

    Tianli Ren

Authors
  1. Lu Cheng
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  2. Lingxiao Xu
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  3. Yan Xu
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  4. Fenghong Yuan
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  5. Ju Li
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  6. Min Wu
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  7. Zhanyun Da
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  8. Hua Wei
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  9. Lei Zhou
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  10. Songlou Yin
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  11. Jian Wu
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  12. Yan Lu
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  13. Dinglei Su
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  14. Zhichun Liu
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  15. Lin Liu
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  16. Longxin Ma
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  17. Xiaoyan Xu
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  18. Huijie Liu
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  19. Tianli Ren
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  20. Yinshan Zang
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Corresponding author

Correspondence to Yinshan Zang.

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Conflicts of interest

The authors have declared no conflicts of interest.

Ethical approval

This study was approved by the Ethical Committee of the First Affiliated Hospital of Nanjing Medical University: 2020-SR-265. Patient consent for publication was not needed.

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Lu Cheng and Lingxiao Xu are joint first authors and contributed equally to this work.

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Cheng, L., Xu, L., Xu, Y. et al. Gender differences in patients with anti-MDA5-positive dermatomyositis: a cohort study of 251 cases. Clin Rheumatol 43, 339–347 (2024). https://doi.org/10.1007/s10067-023-06816-0

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