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Myositis autoantibodies, clinical features, and environmental exposures at illness onset are associated with disease course in juvenile myositis #MMPMID26474155
Habers GEA; Huber AM; Mamyrova G; Targoff IN; O?Hanlon TP; Adams S; Pandey JP; Boonacker C; van Brussel M; Miller FW; van Royen-Kerkhof A; Rider LG
Arthritis Rheumatol 2016[Mar]; 68 (3): 761-8 PMID26474155show ga
Objective: To identify early factors associated with disease course in patients with juvenile idiopathic inflammatory myopathies (JIIM). Methods: Univariable and multivariable multinomial logistic regression analyses were performed in a large JIIM registry (n=365), including demographics, early clinical features, serum muscle enzyme levels, myositis autoantibodies, environmental exposures, and immunogenetic polymorphisms. Results: Multivariable associations with chronic or polycyclic courses compared to monocyclic included myositis-specific autoantibodies (multinomial odds ratio (M-OR) 4.2 and 2.8, respectively), myositis-associated autoantibodies (M-OR 4.8 and 3.5), and a documented infection within six months of illness onset (M-OR 2.5 and 4.7). A higher overall clinical symptom score at diagnosis was associated with chronic or monocyclic courses compared to polycyclic. Furthermore, a severe illness onset was associated with chronic compared to monocyclic or polycyclic courses (M-OR 2.1 and 2.6), while anti-p155/140 autoantibodies were associated with chronic or polycyclic courses compared to monocyclic (M-OR 3.9 and 2.3). Additional univariable associations of chronic compared to monocyclic course included photosensitivity, ?V-sign? or ?Shawl-sign? rashes, and cuticular overgrowth (OR 2.2?3.2). The mean and highest ultraviolet index in the month before diagnosis were associated with a chronic compared to polycyclic course in boys (OR 1.3 and 1.5), while residing in the Northwest was less frequently associated with a chronic course (OR 0.2). Conclusion: Myositis autoantibodies, in particular anti-p155/140, and a number of early clinical features and environmental exposures were associated with a chronic course in patients with JIIM. These findings suggest early factors can be identified that are associated with poorer outcomes in JIIM.