Información del artículo
Resumen
Se reporta el caso de un paciente que presentó un síndrome antisintetasa en el cual la miopatía fue precedida por EPID grave de instalación rápida y buena respuesta al manejo inmunosupresor con corticosteroides, ciclofosfamida y azatioprina. El cuadro clínico inicial con fiebre, infiltrados pulmonares, SDRA y ausencia de miopatía fue muy sugestivo de infección.
Palabras clave:
miopatía inflamatoria
enfermedad pulmonar intersticial
síndrome antisintetasa
Summary
We report a patient with antisintetase síndrome with rapid and progressive interstitial difuse pulmonary disease preceding the muscular weakness. The patient was successfully treated with steroids, cyclophosphamide and azathioprine. The initial compromise: fever, dispnoea and pulmonary infiltrates without miopathy was misdiagnosed as pneumonia.
Key words:
inflamatory miopathy
interstitial pulmonary disease
antisintetase syndrome
El Texto completo está disponible en PDF
Referencias
[1.]
M.C. Dalakas, R. Hohlfeld.
Polymyositis and dermatomyositis.
Lancet, 362 (2003), pp. 971-982
[2.]
A.A. Amato, R.J. Barohn.
Inclusion body myositis: old and new concepts.
J Neurol Neurosurg Psychiatry, 80 (2009), pp. 1186-1193
[3.]
M.C. Dalakas, et al.
Polymyositis, Dermatomyositis and Inclusion Body Myositis.
Harrison's Principles of Internal Medicine, 17, pp. 2696-2703
[4.]
A. Imbert-Masseau, M. Hamidou, C. Agard, J.Y. GRolleau, P. Chérin.
Antisynthetase Syndrome.
Joint Bone Spine, 70 (2003), pp. 161-168
[5.]
S. Sato, M. Hirataka, M. Kuwana.
Autoantibodies to a 140 KD polypeptides, CDAM 140, in japanese patient with clinically amyipathic dermatomyositis.
Arth Rheum, 52 (2005), pp. 1571-1576
[6.]
I.N. Targoff.
Autoantibodies and their significance in myositis.
Current Rheumatology Rep, 10 (2008), pp. 333-340
[7.]
H. Gunawardena, Z.E. Betteridge, N. McHugh.
Myositisspecific autoantibodies: their clinical and pathogenic significance in disease expression.
Rheumatology, 48 (2009), pp. 607-612
[8.]
G.J. Hengstman, L. ter, H.B. Wang, Y. Zhang.
Mi2, an autoantigen for Dermatomyositis is an ATP-depending nucleosoma remodelling factor.
Nucleic Acid Res, 29 (2001), pp. 2517-2521
[9.]
H.B. Wang, Y. Zhang.
Mi2, an autoantigen for Dermatomyositis is an ATP-depending nucleosoma remodelling factor.
Nucleic Acid Res, 29 (2001), pp. 2517-2521
[10.]
H. Gunawardena, J. North, L. Weddernburn.
Clinical association of antiP155/140 in adult and juvenile Dermatomyositis (Abstract).
Ann Rheum Dis, 66 (2007), pp. S68
[11.]
H. Chinoy, N. Fertig, C.V. addis, W.E. Ollier, R.D. Cooper.
The diagnostic utility of myositis autoantibodies testing for predicting the risk of cancer associated myositis.
Ann Rheum Dis, 66 (2007), pp. 1345-1349
[12.]
I.N. Targoff, E.P. Trieu, M. Levy-Neto, N. Fertig, C.V. Oddis.
Sera with autoantibodies to the MJ antigen reacts with NPX-2.
Arthritis Rheum, 56 (2007), pp. S787
[13.]
S.M. Levine, N. Raven, D. Xie.
Novel conformation of histidyl-RNA transfer syntetase in the lung; a target tissue in Jo1-associated myositis.
Arth Rheum, 56 (2007), pp. 2729-2739
[14.]
K.B. Stone, C.V. Oddis, N. Ferting, Y. Katsumata, M. Lucas, M. Vogt, et al.
Anti-Jo-1 antibody levels correlate with disease activity in idiopathic inflammatory myophaty.
Arthritis Rheum, 56 (2007), pp. 3125-3131
[15.]
D.P. Ascherman, T.B. Oriss, C.V. Oddis, T.M. Wright.
Critical requirement for professional APCs in eliciting T cell responses to novel fragments of histidyl-tRNA synthetase (Jo-1) in Jo-1 antibody-positive polymyositis.
J Immunol, 169 (2002), pp. 7127-7134
[16.]
T. Mimori, Y. Imura, R. Nakashima, H. Yoshifuji.
Autoantibodies in idiopathic inflammatory myopathy: an update on clinical and pathophysiological significance.
Curr Opin Rheumatol, 19 (2007), pp. 523-529
[17.]
N.E. Bowles, V. Dubowitz, C.A. Sewry, L.C. Archard.
Dermatomyositis, polymyositis, and Coxsackie-B-virus infection.
Lancet, 1 (1987), pp. 1004-1007
[18.]
M. Fathi, I.E. Lundberg.
Interstitial lung disease in polymyositis and dermatomyositis.
Curr Opin Rheumatol, 17 (2005), pp. 701-706
[19.]
S.M. Levine, N. Raven, D. Xie.
Novel conformation of histidyl-RNA transfer syntetase in the lung; a target tissue in Jo1-associated myositis.
Arth Rheum, 56 (2007), pp. 2729-2739
[20.]
N.E. Bowles, V. Dubowitz, C.A. Sewry, L.C. Archard.
Dermatomyositis, polymyositis, and Coxsackie-B-virus infection.
Lancet, 1 (1987), pp. 1004-1007
[21.]
M. Hirakata, S. Nagai.
Interstitial lung disease in polymyositis and dermatomyositis.
Curr Opin Rheumatol, 12 (2000), pp. 501-508
[22.]
A.R. Frazier, R.D. Miller.
Interstitial pneumonitis in association with polymyositis and dermatomyositis.
Chest, 65 (1974), pp. 403-407
[23.]
M. Hirakata, S. Nagai.
Interstitial lung disease in polymyositis and dermatomyositis.
Curr Opin Rheumatol, 12 (2000), pp. 501-508
[24.]
L.F. Pinto, C.J. Velásquez, J.D. Márquez.
Síndrome antisintetasa en un paciente con dermatomiositis amiopática.
Rev Col Reumatol, 15 (2008), pp. 331
[25.]
M. Al-Janadi, C.D. Smith, J. Karsh.
Cyclophosphamide treatment of interstitial pulmonary fibrosis in polymyositis/dermatomyositis.
J Rheumatol, 16 (1989), pp. 1592-1596
[26.]
U. Costabel, T.E. King.
International consensus statement on idiopathic pulmonary fibrosis.
Eur Respir J, 17 (2001), pp. 163-167
[27.]
C. Bachmeyer, I. Tillie-Leblond, A. Lacert, J. Cadranel, S. Aractingi.
‘Mechanic's hands’: a misleading cutaneous sign of the antisynthetase syndrome.
Br J Dermatol, 156 (2007), pp. 192-194
[28.]
I. Marie, E. Hachulla, P. Chérin, S. Dominique, P.Y. Hatron, M.F. Hellot, et al.
Interstitial lung disease in polymyositis and dermatomyositis.
Arthritis Rheum, 47 (2002), pp. 614-622
[29.]
O. Bonnefoy, G. Ferretti, O. Calaque, M. Coulomb, H. Bequeret, M. Beylot-Barry.
Serial chest CT findings in interstitial lung disease associated with polymyositisdermatomyositis.
Eur J Radiol, 49 (2004), pp. 235-244
[30.]
W.W. Douglas, H.D. Tazelaar, P.A. Hecker, D.R. Schroeder, et al.
Polymyositis–dermatomyositis-associated interstitial lung disease.
Am J Respir Crit Care Med, 164 (2001), pp. 1182-1185
[31.]
D. Tansey, A.U. Wells, T.V. Colby, S. Ip, A. Nikolakopolou, R.M. du Bois, et al.
Variations in histological patterns of interstitial pneumonia between connective tissue disorders and their relationship to prognosis.
Histopathology, 44 (2004), pp. 585-596
[32.]
M. Al-Janadi, C.D. Smith, J. Karsh.
Cyclophosphamide treatment of interstitial pulmonary fibrosis in polymyositis/dermatomyositis.
J Rheumatol, 16 (1989), pp. 1592-1596
[33.]
A. Schnabel, M. Reuter, W.L. Gross.
Intravenous pulse cyclophosphamide in the treatment of interstitial lung disease due to collagen vascular disease.
Arth Rheum, 41 (1998), pp. 1215-1220
[34.]
K.A. Qushmaq, A. Chalmers, J.M. Esdaile.
Cyclosporine A in the treatment of refractory adult polymyositis/dermatomyositis: population based experience in 6 patients and literature review.
J Rheumatol, 27 (2000), pp. 2855-2859
[35.]
T.W. Bunch, J.W. Worthington, J.J. Combs, D.M. Ilstrup, A.G. Engel.
Azathioprine and prednisone for polymyositis: a controlled clinical trial.
Ann Intern Med, 92 (1980), pp. 365-369
[36.]
M.M. Joffe, L.A. Love, R.L. Leff, D.D. Fraser, I.N. Targoff, J.E. Hicks, 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, 94 (1993), pp. 379-387
[37.]
M.R. Wilkes, S.M. Sereika, N. Fertig, M.R. Lucas, C.V. Oddis.
Treatment of Antisynthetase-Associated Interstitial Lung Disease With Tacrolimus.
Arthritis Rheum, 52 (2005), pp. 2439-2446
[38.]
W.W. Douglas, H.D. Tazelaar, P.A. Hecker, D.R. Schroeder, et al.
Polymyositis–dermatomyositis-associated interstitial lung disease.
Am J Respir Crit Care Med, 164 (2001), pp. 1182-1185
[39.]
M. Späth, M. Schröder, B. Sholotter-Weigel, M.C. Walter, H. Hautmann, G. Leinsinger, et al.
The long-term outcome of anti-Jo-1-positive inflammatory myopathies.
J Neurol, 251 (2004), pp. 859-864
[40.]
N. Franzolini, L. Quartuccio, G. De Marchi, S. De Vita.
Efficacy of ab initio immunosuppressive therapy and steroid sparing effect in interstitial lung disease associated to antisynthetase syndrome.
Reumatismo, 59 (2007), pp. 202-208
[41.]
A. Sauty, T. Rochat, O.D. Schoch, J. Hamacher, A.M. Kurt, J.M. Dayer.
Pulmonary fibrosis with predominant CD8 lymphocytic alveolitis and anti-Jo-1 antibodies.
Eur Respir J, 10 (1997), pp. 2907-2912
[42.]
H. Yoshifuji, T. Fuji, S. Kobayashi, Y. Imura, Y. Fujita, D. Kawabata, et al.
Anti-aminoacyl-tRNA synthetase antibodies in clinical course prediction of interstitial lung disease complicated with idiopathic inflammatory myopathies.
Autoimmunity, 39 (2006), pp. 233-241
Copyright © 2010. Asociación Colombiana de Reumatología
