Clinical characteristics of patients with anti-aminoacyl-tRNA synthetase antibody positive idiopathic interstitial pneumonia. (November 2017)

• Record Type: Journal Article
• Authors: Yura, Hirokazu; Sakamoto, Noriho; Satoh, Minoru; Ishimoto, Hiroshi; Hanaka, Tetsuya; Ito, Chiyo; Hasegawa, Tomoko; Tanaka, Shin; Miyamura, Takuto; Nakashima, Shota; Hara, Atsuko; Kakugawa, Tomoyuki; Oda, Keishi; Kido, Takashi; Obase, Yasushi; Ishimatsu, Yuji; Yatera, Kazuhiro; Kawakami, Atsushi; Mukae, Hiroshi
• Is Part Of: Respiratory medicine. Volume 132(2017)
• Page Start: 189
• Page End: 194
• Publication Date: 2017-11
• Subjects: Anti-synthetase syndrome -- Idiopathic interstitial pneumonia -- Dermatomyositis -- Polymyositis; ALD aldolase -- ARS anti-aminoacyl-tRNA synthetase -- ARS(−) anti-ARS antibody negative -- ARS(+) anti-ARS antibody positive -- ASS anti-synthetase syndrome -- BALF bronchoalveolar lavage fluid -- CADM clinically amyopathic dermatomyositis -- CK creatine kinase -- CT computed tomography -- CTD connective tissue diseases -- DAD diffuse alveolar damage -- HRCT high-resolution computed tomography -- IIP idiopathic interstitial pneumonia -- ILD interstitial lung disease -- IPF idiopathic pulmonary fibrosis -- KL-6 Krebs von den Lungen 6 -- NSIP nonspecific interstitial pneumonia -- OP organizing pneumonia -- PM/DM polymyositis/dermatomyositis -- UIP usual interstitial pneumonia -- %VC percentage of the vital capacity; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2017.10.020
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Anti-aminoacyl-tRNA synthetase (ARS) antibodies have been detected in patients with polymyositis/dermatomyositis (PM/DM) and are especially correlated with interstitial lung disease (ILD). The aim of this study was to clarify the clinical features of patients with anti-ARS antibody positive idiopathic interstitial pneumonias (IIPs). Methods: Patients were classified into three groups: 1) IIP with anti-ARS antibodies (ARS(+)IIP), 2) IIP without anti-ARS antibodies (ARS(−)IIP), and 3) PM/DM-associated ILD with anti-ARS antibodies (ARS(+)PM/DM-ILD). Clinical characteristics were compared retrospectively between the ARS(+)IIP group and the ARS(−)IIP group or ARS(+)PM/DM-ILD group. Results: Eighteen ARS(+)IIP, 284 ARS(−)IIP, and 20 ARS(+)PM/DM-ILD patients were enrolled. The ARS(+)IIP group was significantly older and the male sex was predominant, had a lower prevalence of signs of connective tissue disease, differences in HRCT findings and patterns, and higher KL-6 levels compared to the ARS(+)PM/DM-ILD group. The findings in the bronchoalveolar lavage fluid (BALF) showing lymphocytosis and a lower CD4/CD8 ratio were similar between the two groups. However, the ARS(+)IIP group had significantly lower percentage of sputum, higher prevalence of mechanic's hand, higher KL-6 levels, lower percentage of vital capacity in the pulmonary function test, and lower CD4/CD8 ratio in BALF, compared to the ARS(−)IIP group. Conclusions: The present study demonstrated that features of pulmonary involvement were similar to those in the ARS(+)PM/DM-ILD group; however, some differences including HRCT findings and higher KL-6 levels suggest that ARS(+)IIP has severe ILD compared with ARS(+)PM/DM-ILD. Further prospective studies with a larger number of patients will elucidate the exact role of anti-ARS antibodies in IIPs. Highlights: Anti-ARS Ab were positive in 6.0% of patients with IIP. Characteristics of ILD and BALF findings in ARS(+)IIP was similar vs. ARS(+)PM/DM-ILD. ARS(+)IIP may have more severe ILD vs ARS(+)PM/DM-ILD, based on HRCT findings and higher KL-6 levels. ARS(+)IIP has higher percentage of Mechanic's hand and NSIP pattern in HRCT vs. ARS(−)IIP.