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Recent Treatment of Interstitial Lung Disease with Idiopathic Inflammatory Myopathies.

Kawasumi H, Gono T, Kawaguchi Y, Yamanaka H - Clin Med Insights Circ Respir Pulm Med (2015)

Bottom Line: Anti-melanoma differentiation-associated gene 5 antibody and hyperferritinemia predict the development and severity of rapidly progressive (RP) ILD, particularly in East Asian patients.In contrast, patients with anti-aminoacyl-tRNA synthetase (ARS) show better responses to corticosteroids alone.However, ILDs with anti-ARS often display disease recurrence or become refractory to corticosteroid monotherapy.

View Article: PubMed Central - PubMed

Affiliation: Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.

ABSTRACT
Interstitial lung disease (ILD) is a prognostic factor for poor outcome in polymyositis (PM)/dermatomyositis (DM). The appropriate management of ILD is very important to improve the prognosis of patients with PM/DM. ILD activity and severity depend on the disease subtype. Therefore, clinicians should determine therapeutic strategies according to the disease subtype in each patient with PM/DM. Anti-melanoma differentiation-associated gene 5 antibody and hyperferritinemia predict the development and severity of rapidly progressive (RP) ILD, particularly in East Asian patients. Combination therapy with corticosteroids, intravenous cyclophosphamide pulse, and calcineurin inhibitors should be administered in RP-ILD. In contrast, patients with anti-aminoacyl-tRNA synthetase (ARS) show better responses to corticosteroids alone. However, ILDs with anti-ARS often display disease recurrence or become refractory to corticosteroid monotherapy. Recent studies have demonstrated that the administration of tacrolimus or rituximab in addition to corticosteroids may be considered in ILD patients with anti-ARS. Large-scale, multicenter randomized clinical trials should be conducted in the future to confirm that the aforementioned agents exhibit efficacy in ILD patients with PM/DM. The pathophysiology of ILD with PM/DM should also be elucidated in greater detail to develop effective therapeutic strategies for patients with ILD in PM/DM.

No MeSH data available.


Related in: MedlinePlus

Therapeutic strategy for ILDs associated with PM/DM.Abbreviation: Ab, antibodies.
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Related In: Results  -  Collection


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f1-ccrpm-suppl.1-2015-009: Therapeutic strategy for ILDs associated with PM/DM.Abbreviation: Ab, antibodies.

Mentions: Clinicians should determine when and how patients with ILD should be treated in PM/DM. However, there are no large controlled trials to confirm the efficacy of treatments in ILD with PM/DM patients. Figure 1 provides a flowchart that illustrates the process for determining the optimal therapeutic strategy based on our experiences and the findings described above. The clinical course of ILD shows a less rapid progression in Caucasians than in East Asians. For example, ILD with anti-MDA5 more frequently shows rapid progression in Asian patients than in Westerners. Clinical manifestations and treatment responses for each MSA may depend on race, although MSAs are useful predictors of clinical manifestations and prognoses. Thus, therapeutic strategies should be considered individually in each race.


Recent Treatment of Interstitial Lung Disease with Idiopathic Inflammatory Myopathies.

Kawasumi H, Gono T, Kawaguchi Y, Yamanaka H - Clin Med Insights Circ Respir Pulm Med (2015)

Therapeutic strategy for ILDs associated with PM/DM.Abbreviation: Ab, antibodies.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4514184&req=5

f1-ccrpm-suppl.1-2015-009: Therapeutic strategy for ILDs associated with PM/DM.Abbreviation: Ab, antibodies.
Mentions: Clinicians should determine when and how patients with ILD should be treated in PM/DM. However, there are no large controlled trials to confirm the efficacy of treatments in ILD with PM/DM patients. Figure 1 provides a flowchart that illustrates the process for determining the optimal therapeutic strategy based on our experiences and the findings described above. The clinical course of ILD shows a less rapid progression in Caucasians than in East Asians. For example, ILD with anti-MDA5 more frequently shows rapid progression in Asian patients than in Westerners. Clinical manifestations and treatment responses for each MSA may depend on race, although MSAs are useful predictors of clinical manifestations and prognoses. Thus, therapeutic strategies should be considered individually in each race.

Bottom Line: Anti-melanoma differentiation-associated gene 5 antibody and hyperferritinemia predict the development and severity of rapidly progressive (RP) ILD, particularly in East Asian patients.In contrast, patients with anti-aminoacyl-tRNA synthetase (ARS) show better responses to corticosteroids alone.However, ILDs with anti-ARS often display disease recurrence or become refractory to corticosteroid monotherapy.

View Article: PubMed Central - PubMed

Affiliation: Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.

ABSTRACT
Interstitial lung disease (ILD) is a prognostic factor for poor outcome in polymyositis (PM)/dermatomyositis (DM). The appropriate management of ILD is very important to improve the prognosis of patients with PM/DM. ILD activity and severity depend on the disease subtype. Therefore, clinicians should determine therapeutic strategies according to the disease subtype in each patient with PM/DM. Anti-melanoma differentiation-associated gene 5 antibody and hyperferritinemia predict the development and severity of rapidly progressive (RP) ILD, particularly in East Asian patients. Combination therapy with corticosteroids, intravenous cyclophosphamide pulse, and calcineurin inhibitors should be administered in RP-ILD. In contrast, patients with anti-aminoacyl-tRNA synthetase (ARS) show better responses to corticosteroids alone. However, ILDs with anti-ARS often display disease recurrence or become refractory to corticosteroid monotherapy. Recent studies have demonstrated that the administration of tacrolimus or rituximab in addition to corticosteroids may be considered in ILD patients with anti-ARS. Large-scale, multicenter randomized clinical trials should be conducted in the future to confirm that the aforementioned agents exhibit efficacy in ILD patients with PM/DM. The pathophysiology of ILD with PM/DM should also be elucidated in greater detail to develop effective therapeutic strategies for patients with ILD in PM/DM.

No MeSH data available.


Related in: MedlinePlus