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 or = 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.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Asian People , Blood Sedimentation , Carbon Monoxide/metabolism , Cohort Studies , Dermatomyositis/blood , Disease Progression , Erythrocytes/cytology , Follow-Up Studies , Immunosuppressive Agents/therapeutic use , Lung Diseases, Interstitial/complications , Predictive Value of Tests , Prognosis , Republic of Korea , Respiratory Function Tests , Retrospective Studies , Risk Factors , Survival AnalysisABSTRACT
Pneumatosis cystoides intestinalis (PCI), the presence of air within the bowel wall, could be complicated with connective tissue disease. PCI associated with dermatomyositis has rarely been reported. Here, we report on a case of PCI that occurred in a 60-year-old female patient with dermatomyositis, presenting with epigastric discomfort. PCI with pneumoperitoneum was detected on abdominal computed tomography but improved by conservative management without surgery. Treatment for secondary PCI is associated with underlying disease. Also, identification of serious complication, such as bowel perforation, necrosis, and peritonitis, requiring surgical intervention is important.
Subject(s)
Female , Humans , Middle Aged , Adrenal Cortex Hormones , Connective Tissue Diseases , Dermatomyositis , Necrosis , Peritonitis , Pneumatosis Cystoides Intestinalis , PneumoperitoneumABSTRACT
Nowadays, tumor necrosis factor-alpha (TNF-alpha) blockers are used for treatment of rheumatoid arthritis, inflammatory bowel diseases, ankylosing spondylitis, psoriatic arthritis, and psoriasis. Paradoxically, there are some reports on the appearance of psoriasis after administration of TNF-alpha blockers. Here, we report on a patient with monoarthritis in a knee joint who experienced psoriasis after TNF-alpha blocker therapy (adalimumab and etanercept). Oral medication was not a treatment option due to patient intolerance; thus, we tried ustekinumab, an anti-interleukin (IL)-12/23 monoclonal antibody used for treatment of psoriasis. Following ustekinumab injection, psoriatic skin lesions and joint symptoms were much improved. However, in the following period, joint pain and swelling became aggravated and synovial fluid cytokine levels including IL-6 and IL-17 were elevated. The treatment was changed to tocilizumab, a humanized monoclonal antibody against IL-6 receptor. After injection, knee joint swelling rapidly subsided without worsening of psoriatic skin lesions.
