Polymyositis mit Anti-Jo-1-Antikörpern - 2 Kasuistiken zur erfolgeichen Therapie mit Leflunomid und ein aktueller Überblick

Zusammenfassung

Die idiopathischen Myositiden (IM), wie die Dermatomyositis (DM) und die Polymyositis (PM), sind wichtige Vertreter erworbener entzündlicher Muskelerkrankungen mit unbekannter Ätiologie. Antisynthetase-Antikörper wie Anti-Jo-1 sind hierbei hochspezifische myositisassoziierte Antikörper. Patienten mit Antisynthestase-Antikörper haben häufig eine Mitbeteiligung innerer Organe wie eine interstitielle Lungenerkrankung, Fieber, Polyarthritis, Myositis, Raynaud-Syndrom und „mechanic’s hands”. In der Therapie werden Immunsuppressiva eingesetzt. Geschildert werden zwei Fälle mit Polymyositis und Nachweis von Anti-Jo-1-Antikörper, die mit Leflunomid erfolgreich therapiert wurden. Zudem wird eine aktuelle Übersicht gegeben.

Abstract

Idiopathic inflammatory myopathies (IM), including dermatomyositis (DM) and polymyositis (PM), are a group of systemic rheumatological diseases of unknown etiology, characterized by a chronic inflammatory myositis. Antisynthetase antibodies like anti-Jo-1 antibody are known to be highly specific for inflammatory myopathies. Patients with this antibody often exhibit the combination of symptoms, including interstitial lung disease, fever, polyarthritis, inflammatory myositis, Raynaud’s phenomenon and “mechanic’s hands”. In the management of polymyositis with anti-Jo-1 antibody, immunosuppressive agents are used to control the disease. However, in treatment-resistant cases our experience with drug therapy is very limited. We now report on two female patients with polymyositis and anti-Jo-1 antibody who were successfully treated with leflunomide, and present a current overview of the literature.

Polymyositis - Anti-Jo-1-Antikörper - Leflunomid

Polymyositis - anti-Jo-1 antibody - leflunomide

Literatur

• 1 Walton J N, Adams R D. (Hrsg) .Polymyositis. Baltimore; Williams & Wilkins 1958
• 2 Kagen L J. Polymyositis/dermatomyositis. McCarty DJ Arthritis and allied conditions Philadelphia; Lea and Febiger 1989: 1092-1117
• 3 Bohan A, Peter J B. Polymyositis and dermatomyositis.  N Engl J Med. 1975;  292 344-347, 403 - 407
• 4 Jerusalem F, Baumgartner R, Wyler R. Virus ähnliche Einschlüsse bei chronischen neuromuskulären Processen.  Arch Psychiatr Nervenkr. 1972;  215 148-166
• 5 Medsger T A, Dawson W N, Masi A T. The epidemiology of polymyositis.  Am J Med. 1970;  48 715-723
• 6 Oddis C V, Conte C G, Steen D V. et al . Incidence of MP-DM: A 20-year study of hospital diagnosed cases in Allegheny Country, PA 1963 - 1982.  J Rheumatol. 1980;  17 1329-1334
• 7 DeVere R, Bradley W G. Polymoositis. Its presentation, morbidity, and mortality.  Brain. 1976;  98 637-666
• 8 Friedmann J M. et al . Immunogenetic studies of juvenile dermatomyositis: HLA-DR antigen frequencies.  Arthritis Rheum. 1983;  26 214-216
• 9 Arnett F C. et al . The Jo-1 antibody system in myositis: relationship to clinical features and HLA.  J Rheumatol. 1981;  8 925-930
• 10 Price P, Santoso L, Mastaglia F. et al . Two major histocompatibility complex haplotypes influence susceptibility to sporadic inclusion body myositis: critical evaluation of an association with HLA-DR3.  Tissue Antigens. 2004;  64 575-580
• 11 Walker E J, Jeffrey P D. Polymyositis and molecular mimicry, a mechanism of autoimmunity.  Lancet. 1986;  2 605-607
• 12 Arahata K, Engel A G. Monoclonal antibody analysis of mononuclear cells in myopathies. Quantitation of subsets according to diagnosis and sites of accumulation and demonstration and counts of muscle fibers invaded by T cells.  Ann Neurol. 1984;  16 193-208
• 13 Miller F W, Love L A, Barbieri S A. et al . Lymphocyte activation markers in idiopathic myositis: Changes with disease activity and differences among clinical and autoantibody subgroups.  Clin Exp Immuno. 1990;  181 373-379
• 14 Behan W MH. et al . Abnormalities of lymphocyte subsets in polymyositis.  Br Med J. 1983;  287 181-182
• 15 Joffe M M, Love L A, Leff R L. et al . Drug therapy of the idiopathic inflammatory myopathies: predictors of response to prednisone, azathioprine, and methotrexate and a comparison of their efficacy.  Am J Med. 1993;  94 379-387
• 16 Love L A, Leff R L, Fraser D D. et al . A new approach to the classification of idiopathic inflammatory myopathy: myositis-specific autoantibodies define useful homogeneous patient groups.  Medicine (Baltimore). 1991;  70 360-374
• 17 Love L A, Leff R L, Fraser D D. et al . A new approach to the classification of idiopathic inflammatory myopathy: myositis-specific autoantibodies define useful homogeneous patient groups.  Medicine (Baltimore). 1991;  70 360-374
• 18 Csuka M E, McCarty D J. A rapid method for measurement of lower extremity muscle strength.  Am J Med. 1985;  78 77-81
• 19 Haupt H M, Hutchins G M. The heart an cardiac conducting system in polymyositis-dermatomyositis.  Am J Cardiol. 1982;  50 998-1006
• 20 Stern R, Goodbold H J, Chess Q. et al . ECG abnormalities in polymyositis.  Arch Intern Med. 1984;  44 2185-2189
• 21 Dyck R F, Katz A, Gordon D A. et al . Glomerulonephritis with polymyositis.  J Rheumatol. 1979;  6 336-344
• 22 Osvaldo F, Valenzuel R, Porush J. Idiopathic polymyositis and glomerulonephritis.  Nephrol. 2001;  14 120-124
• 23 Schumacher H R, Schimmer B, Gordon G V. et al . Articular manifestations of polymyositis and dermatomyositis.  Am J Med. 1979;  67 287-292
• 24 Euwer R L, Sontheimer R D. Amyopathic dermatomyositis (dermatomyositis sine myositis): Presentation of six new cases and review of the literature.  J Am Acad Dermatol. 1991;  24 959-966
• 25 Sontheimer R D. Skin manifestations of systemic autoimmune connective tissue disease: diagnostics and therapeutics.  Best Pract Res Clin Rheumatol. 2004;  18 429-462
• 26 Santmyire-Rosenberger B, Dugan E M. Skin involvement in dermatomyositis.  Curr Opin Rheumatol. 2003;  15 714-722
• 27 Wedderburn L R, Li C K. Paediatric idiopathic inflammatory muscle disease.  Best Pract Res Clin Rheumatol. 2004;  18 345-358
• 28 Marie I, Hatron P Y, Hachulla E. et al . Pulmonary involvement in polymyositis and in dermatomyositis.  J Rheumatol. 1998;  25 1336-1134
• 29 Tubery M, Lauque D, Murris M. et al . Course of interstitial lung diseases associated with inflammatory myopathies. Apropos of 5 cases.  Ann Med Interne (Paris). 1997;  148 2-10
• 30 Maeda K, Kimura R, Komuta K. et al . Cyclosporine treatment for polymyositis/dermatomyositis: is it possible to rescue the deteriorating cases with interstitial pneumonitis?.  Scand J Rheumatol. 1997;  26 24-29
• 31 Flammang d ’Ortho MP, Cadranel J, Milleron B. et al . Interstitial pulmonary involvement of polymyositis and dermatomyositis. Apropos of 3 cases. Review of the literature.  Rev Pneumol Clin. 1991;  47 29-36
• 32 Targoff I N. Autoantibodies in polymyositis.  Rheum Dis Clin North Am. 1992;  18 455-482
• 33 Lundberg I E, Dastmalchi M. Possible pathogenic mechanisms in inflammatory myopathies.  Rheum Dis Clin North Am. 2002;  28 799-822
• 34 Englund P, Nennesmo I, Klareskog L. et al . Interleukin-1alpha expression in capillaries and major histocompatibility complex class I expression in type II muscle fibers from polymyositis and dermatomyositis patients: important pathogenic features independent of inflammatory cell clusters in muscle tissue.  Arthritis Rheum. 2002;  46 1044-1055
• 35 Nishikai M, Reichlin M. Heterogenety of precipating antibodies in polymyositis. Characterization of the Jo-1 antibody system.  Arthritis Rheum. 1980;  23 881-888
• 36 Beese M S, Winkler G, Nicolas V. et al . The diagnosis of inflammatory muscular and vascular diseases using MRT with STIR sequences.  Fortschr Röntgenstr. 1993;  158 542-549
• 37 Emslie-Smith A M, Engel A G. Microvascular changes in early and advanced dermatomyositis: A quantitative study.  Ann Neurol. 1990;  27 343-356
• 38 Genth E. Entzündliche Muskelkrankheiten aus internistischer Sicht.  Internist. 2000;  41 445-454
• 39 Mino M, Noma S, Taguchi Y. et al . Pulmonary involvement in polymyositis and dermatomyositis: sequential evaluation with CT.  AJR Am J Roentgenol. 1997;  169 83-87
• 40 Ikezoe J, Johkoh T, Kohno N. et al . High-resolution CT findings of lung disease in patients with polymyositis and dermatomyositis.  J Thorac Imaging. 1996;  11 250-259
• 41 Targoff I N. Immune manifestations of inflammatory muscle disease.  Rheum Dis Clin North Am. 1994;  20 857-880
• 42 Schmidt W A, Wetzel W, Friedländer R. et al . Clinical and serological aspects of patients with anti-Jo-1 antibodies an evolving spectrum of disease manifestations.  Clin Rheumatol. 2000;  19 371-376
• 43 Grau J M, Miro O, Pedrol E. et al . Interstitial lung disease related to dermatomyositis. Comparative study with patients without lung involvement.  J Rheumatol. 1996;  23 1921-1926
• 44 Marie I, Hatron P Y, Hachulla E. et al . Pulmonary involvement in polymyositis and in dermatomyositis.  J Rheumatol. 1998;  25 1336-1343
• 45 Friedman A W, Targoff I N, Arnett F C. Interstitial lung disease with autoantibodies against aminoacyl-tRNA synthetases in the absence of clinically apparent myositis.  Semin Arthritis Rheum. 1996;  26 459-467
• 46 Dalakas M C. Polymyositis, dermatomyositis, and inclusion body myositis.  N Engl J Med. 1991;  325 1487-1498
• 47 Derk C T, Vivino F B, Kenyon L. et al . Inclusion body myositis in connective tissue disorders: case report and review of the literature.  Clin Rheumatol. 2003;  22 324-328
• 48 Christopher-Stine L, Plotz P H. Adult inflammatory myopathies.  Best Pract Res Clin Rheumatol. 2004;  18 331-344
• 49 Sontheimer R D. Cutaneous features of classic dermatomyositis and amyopathic dermatomyositis.  Curr Opin Rheumatol. 1999;  11 475-482
• 50 Serratrice G, Schiano A, Pellissier J F. et al . Anatornoclinical expressions of polymyositis in the child: 23 cases.  Ann Pediatr (Paris). 1989;  36 237-243
• 51 Sherry D D, Haas J E, Milstein J M. Childhood polymyositis as a paraneoplastic phenomenon.  Pediatric Neurol. 1993;  9 155-156
• 52 Rider L G, Miller F W, Targoff I N. et al . A broadened spectrum of juvenile myositis. Myositis-specific autoantibodies in children.  Arthritis Rheum. 1994;  37 1534-1538
• 53 Barnes B E. Dermatomyositis and malignancy. A reviev of the literature.  Ann Intern Med. 1976;  84 68-76
• 54 Manchul L A, Jim A, Pritchard K L. et al . The frequency of malignant neoplasms in patients with polymyositis- dermatomyositis.  Arch Intern Med. 1985;  145 1835-1939
• 55 Lakhanpal S, Bunch T W, Ilstrup D M. et al . Polymyositis- dermatomyositis and malignant lesions: does an association exist?.  Mayo Clin Proc. 1986;  61 645-653
• 56 Serratrice G, Schiano A, Pellissier J F. et al . 135 cases of polymyositis.  Rev Neurol (Paris). 1986;  142 906-917
• 57 Lawrence J. Kagen Rheumatic Disease Clinics of North America.  1994;  11 814-815
• 58 Lundber, Chung Y L. Treatment and investigation of idiopathic inflammatory myopathies.  Rheumatology. 2000;  39 7-17
• 59 Oddis C V, Medsger T A. Relationship between serum creatine kinase level and corticosteroid therapy in polymyositis-dermatomyositis.  J Rheumatol. 1988;  15 807-811
• 60 Hicks J E. Comprehensive rehabilitative management of patients with polymyositis and dermatomyositis. Dalakas MC Polymyositis and Dermatomyositis Boston; Butterworths 1988: 293-318
• 61 Laxer R M, Stein L D, Petty R E. et al . Intravenous pulse methylprednisolone treatment of juvenile dennatomyositis.  Arthritis Rheum. 1987;  30 328-334
• 62 Metzger A L, Bohan A, Goldberg I S. et al . Polymyositis and dermatomyositis: Combined methotrexate and corticosteroid therapy.  Ann Intern Med. 1974;  81 182-189
• 63 Sokoloff M C, Goldberg L S, Pearson C M. Treatment of corticosteroid-resistant polymyositis with methotrexate.  Lancet. 1971;  1 14-16
• 64 Bunch T W. Prednisone and azathioprine for polymyositis.  Arthritis Rheum. 1981;  24 45-48
• 65 Mehregan D R, Su W PD. Cyclosporine treatment for dermatomyositis/polymyositis.  Cutis. 1993;  51 59-61
• 66 Lueck C J, Trend P, Swash M. Cyclosporin in the management of polymyositis and dermatomyositis.  J Neurol Neurosurg Psychiatry. 1991;  54 1007-1008
• 67 Sinoway P A, Callen J P. Chlorambucil: An effective corticosteroid-sparing agent for patients with recalcitrant dermatomyositis.  Arthritis Rheum. 1993;  36 319-324
• 68 Bombardieri S, Hughes G RV, Neri R. et al . Cyclophosphamide in severe polymyositis.  Lancet. 1988;  1 1138-1139
• 69 Kono D W, Klashman D J, Gilbert R C. Successful IV pulse cyclophosphamide in refractory PM in 3 patients with SLE [letter].  J Rheumatol. 1990;  17 982-983
• 70 Leroy J P, Drosos A A, Yiannopoulos D I. et al . Intravenous pulse cyclophosphamide therapy in myositis and Sjogren’s syndrome.  Arthritis Rheum. 1990;  33 1579-1581
• 71 Villalba L, Hicks J E, Adams E M. et al . Treatment of refractory myositis. A randomised crossover study of two new cytotoxic regimens.  Arthritis Rheum. 1998;  41 392-399
• 72 Cherin P, Herson S, Wechsler B. et al . Efficacy of intravenous gammaglobulin therapy in chronic refractory polymyositis and dermatomyositis: An open study with 20 adult patients.  Am J Med. 1991;  91 162-168
• 73 Dalakas M C. Controlled studies with high-dose intravenous immunoglobulin in the treatment of dermatomyositis, inclusion body myositis, and polymyositis.  Neurology. 1998;  51 537-545
• 74 Cherin P, Pelletier S, Teixeira A. et al . Results and long term follow up of intravenous immunoglobulin infusions in chronic, refractory polymyositis. An open study with thirty five adult patients.  Arthritis Rheum. 2002;  46 467-474
• 75 Fischer-Kahle V, Behler P G, Krieger W. Ungewöhnlicher Verlauf eines Jo-1-Syndroms.  Arthritis + rheuma. 2001;  21 6-8
• 76 Fox R I. Mechanism of action of leflunomide in rheumatoid arthritis.  J Rheumatol Suppl. 1998;  53 20-26
• 77 Elkayam O, Yaron I, Shirazi I. et al . Active leflunomide metabolite inhibits interleukin 1beta, tumour necrosis factor alpha, nitric oxide, and metalloproteinase-3 production in activated human synovial tissue cultures.  Ann Rheum Dis. 2003;  62 440-443
• 78 Genth E. Inflammatory myopathies from internist’s perspective.  Internist. 2000;  41 445-454