Elevated Erythrocyte Sedimentation Rate Is Predictive of Interstitial Lung Disease and Mortality in Dermatomyositis: a Korean Retrospective Cohort Study

다국어 초록 (Multilingual Abstract)

Interstitial lung disease (ILD) is a major cause of death in patients with dermatomyositis (DM). This study was aimed to examine the utility of the erythrocyte sedimentation rate (ESR) as a predictor of ILD and prognostic marker of mortality in patients with DM. One hundred-and-fourteen patients with DM were examined, including 28 with clinically amyopathic DM (CADM). A diagnosis of ILD was made based on high resolution computed tomography (HRCT) scans. The association between elevated ESR and pulmonary impairment and mortality was then examined. ILD was diagnosed in 53 (46.5%) of 114 DM patients. Cancer was diagnosed in 2 (3.8%) of 53 DM patients with ILD and in 24 (92.3%) of those without ILD (P < 0.001). The median ESR (50.0 mm/hour) in patients with ILD was significantly higher than that in patients without ILD (29.0 mm/hour; P < 0.001). ESR was inversely correlated with forced vital capacity (Spearman ρ = -0.303; P = 0.007) and carbon monoxide diffusing capacity (ρ = -0.319; P = 0.006). DM patients with baseline ESR ≥ 30 mm/hour had significantly higher mortality than those with ESR < 30 mm/hour (P = 0.002, log-rank test). Patients with a persistently high ESR despite immunosuppressive therapy was associated with higher mortality than those with a normalized ESR (P = 0.039, log-rank test). Elevated ESR is associated with increased mortality in patients with DM due to respiratory failure. Thus, monitoring ESR should be an integral part of the clinical care of DM patients.

참고문헌 (Reference)

1 Sontheimer RD, "Would a new name hasten the acceptance of amyopathic dermatomyositis (dermatomyositis siné myositis) as a distinctive subset within the idiopathic inflammatory dermatomyopathies spectrum of clinical illness?" 46 : 626-636, 2002

2 Becker GJ, "Value of serum C-reactive protein measurement in the investigation of fever in systemic lupus erythematosus" 39 : 50-52, 1980

3 Amerio P, "Usefulness of erythrocyte sedimentation rate as tumor marker in cancer associated dermatomyositis" 12 : 165-169, 2002

4 Walsh RJ, "Type I interferon-inducible gene expression in blood is present and reflects disease activity in dermatomyositis and polymyositis" 56 : 3784-3792, 2007

5 Borawski J, "The hematocrit-corrected erythrocyte sedimentation rate can be useful in diagnosing inflammation in hemodialysis patients" 89 : 381-383, 2001

6 Park JK, "Successful treatment for conventional treatment-resistant dermatomyositis-associated interstitial lung disease with adalimumab" 32 : 3587-3590, 2012

7 Sato S, "RNA helicase encoded by melanoma differentiation-associated gene 5 is a major autoantigen in patients with clinically amyopathic dermatomyositis : Association with rapidly progressive interstitial lung disease" 60 : 2193-2200, 2009

8 Marie I, "Pulmonary involvement in polymyositis and in dermatomyositis" 25 : 1336-1343, 1998

9 Mino M, "Pulmonary involvement in polymyositis and dermatomyositis : sequential evaluation with CT" 169 : 83-87, 1997

10 Park JK, "Pulmonary impairment, not muscle injury, is associated with elevated ESR in the idiopathic inflammatory myopathies" 52 : 1336-1338, 2013

11 Chen YJ, "Predicting factors of malignancy in dermatomyositis and polymyositis : a case-control study" 144 : 825-831, 2001

12 Marie I, "Polymyositis and dermatomyositis: short term and longterm outcome, and predictive factors of prognosis" 28 : 2230-2237, 2001

13 Fathi M, "Interstitial lung disease, a common manifestation of newly diagnosed polymyositis and dermatomyositis" 63 : 297-301, 2004

14 Marie I, "Interstitial lung disease in polymyositis and dermatomyositis" 47 : 614-622, 2002

15 Kang EH, "Interstitial lung disease in patients with polymyositis, dermatomyositis and amyopathic dermatomyositis" 44 : 1282-1286, 2005

16 Sun Y, "Interstitial lung disease in clinically amyopathic dermatomyositis(CADM)patients : a retrospective study of 41 Chinese Han patients" 33 : 1295-1302, 2013

17 So MW, "Idiopathic inflammatory myopathy associated with malignancy : a retrospective cohort of 151 Korean patients with dermatomyositis and polymyositis" 38 : 2432-2435, 2011

18 Ikezoe J, "High-resolution CT findings of lung disease in patients with polymyositis and dermatomyositis" 11 : 250-259, 1996

19 Sun WC, "Dysregulation of the type I interferon system in adult-onset clinically amyopathic dermatomyositis has a potential contribution to the development of interstitial lung disease" 167 : 1236-1244, 2012

20 Moshage H, "Cytokines and the hepatic acute phase response" 181 : 257-266, 1997

21 Gono T, "Cytokine profiles in polymyositis and dermatomyositis complicated by rapidly progressive or chronic interstitial lung disease" 53 : 2196-2203, 2014

22 Nawata Y, "Corticosteroid resistant interstitial pneumonitis in dermatomyositis/polymyositis : prediction and treatment with cyclosporine" 26 : 1527-1533, 1999

23 Mallya RK, "Correlation of clinical parameters of disease activity in rheumatoid arthritis with serum concentration of C-reactive protein and erythrocyte sedimentation rate" 9 : 224-228, 1982

24 Bohan A, "Computer-assisted analysis of 153 patients with polymyositis and dermatomyositis" 56 : 255-286, 1977

25 Brigden ML, "Clinical utility of the erythrocyte sedimentation rate" 60 : 1443-1450, 1999

26 Mukae H, "Clinical differences between interstitial lung disease associated with clinically amyopathic dermatomyositis and classic dermatomyositis" 136 : 1341-1347, 2009

27 Kobayashi N, "Clinical and laboratory features of fatal rapidly progressive interstitial lung disease associated with juvenile dermatomyositis" 54 : 784-791, 2015

28 나상준, "Clinical Characteristics and Outcomes of Juvenile and Adult Dermatomyositis" 대한의학회 24 (24): 715-721, 2009

29 Baechler EC, "An interferon signature in the peripheral blood of dermatomyositis patients is associated with disease activity" 13 : 59-68, 2007

30 Kirou KA, "Activation of the interferon-alpha pathway identifies a subgroup of systemic lupus erythematosus patients with distinct serologic features and active disease" 52 : 1491-1503, 2005

31 Gerami P, "A systematic review of adult-onset clinically amyopathic dermatomyositis(dermatomyositis siné myositis) : a missing link within the spectrum of the idiopathic inflammatory myopathies" 54 : 597-613, 2006

32 Eloranta ML, "A possible mechanism for endogenous activation of the type I interferon system in myositis patients with anti-Jo-1 or anti-Ro 52/anti-Ro 60 autoantibodies" 56 : 3112-3124, 2007