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You are here: Home / Articles / Autoantibodies in Autoimmune Myopathy

Autoantibodies in Autoimmune Myopathy

September 18, 2017 • By Ruth Jessen Hickman, MD

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The new myositis classification guidelines include various clinical characteristics, muscle biopsy findings and autoantibody results. The criteria utilize a scoring system to aid myositis classification. Dr. Aggarwal notes that having myositis autoantibodies gives half the points needed to achieve diagnosis of IIM under the new classification criteria.

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The new criteria include only the auto­antibody Jo-1, not other MSAs. Dr. Aggarwal explains that much more information was available on Jo-1 than for other autoantibodies when these classification criteria were being developed. “That’s why you will see Jo-1 as a representative of myositis autoantibodies in the new classification criteria, but not other autoanti­bodies.” He notes, “In the future, we hope that Jo-1 will be replaced by any myositis-specific antibody in the classification criteria.”

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Ordering MSA & MAA Tests

Although access may be limited in certain clinical settings, tests for MSAs and MAAs are becoming more readily available. Quest Diagnostics provides an MSA autoantibody panel with eight myositis autoantibodies. Dr. Aggarwal also recommends myositis autoantibody panels available through RDL Reference Laboratory, which provide a more extensive selection of autoantibodies. RDL also provides additional myositis tests, which are not included as part of its standard myositis panels. Additionally, some of the most recently discovered autoantibodies may be available only through research centers.

Dr. Aggarwal advises his colleagues to order one of these comprehensive myositis panels if they suspect myositis, even though these panels do not test all MSAs and MAAs. If these tests come back negative, additional autoantibody testing may be warranted if a clinician suspects an autoantibody based on clinical symptoms.

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For example, these panels don’t usually include the anti-HMGCR antibody, which is seen in patients who have been exposed to statins and have developed severe muscle weakness. “If you have that kind of phenotype, which is not getting better even after stopping a statin, there may be value in ordering the anti-HMGCR antibody [test] specifically,” says Dr. Aggarwal. He adds, “As another example, if you have a patient with severe cutaneous rashes with ulceration and palmar rash and ischemic digits, that may be another reason to order another specific anti-MDA5 antibody [test].”

The extended myositis autoantibody panels are beginning to enter standard practice, but many centers do not yet use them routinely. One recent retrospective study looked at the outcomes of 22 patients who had been ordered such a panel. The panel had coverage for 23 autoantibodies. It was diagnostic in 27% of patients who had not received definitive diagnosis through other means. It also helped two patients avoid an invasive muscle biopsy procedure. Because of the results, clinicians initiated increased cancer surveillance in a patient with an anti-TIF1-γ autoantibody, and two patients with antisynthetase syndrome received further lung evaluation via high-resolution CT and pulmonary function tests.16

Future Directions

“If you look at the history of myositis-specific autoantibodies, every two to four years, we are able to discover an autoantibody that was not previously defined. Therefore, I am pretty sure we are missing several

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Filed Under: Conditions, Systemic Inflammatory Syndromes Tagged With: autoantibodies, Autoimmune disease, Classification, connective tissue disease, dermatomyositis, Diagnosis, idiopathic inflammatory myopathies, myositis, patient care, polymyositis, prognosis, Research, rheumatologist, rheumatology, Systemic sclerosis, Test, TreatmentIssue: September 2017

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About Ruth Jessen Hickman, MD

Ruth Jessen Hickman, MD, was born and raised in eastern Kentucky, where she first cultivated her love of literature, writing and personal narratives. She attended Kenyon college, where she received a Bachelor of Arts in philosophy, summa cum laude. She worked with individuals with psychiatric conditions and later in a neuroscience lab at the University of Illinois, Chicago, before graduating from Indiana University Medical School in 2011. Instead of pursuing clinical medicine, Ruth opted to build on her strength of clearly explaining medical topics though a career as a freelance medical writer, writing both for lay people and for health professionals. She writes across the biomedical sciences, but holds strong interests in rheumatology, neurology, autoimmune diseases, genetics, and the intersection of broader social, cultural and emotional contexts with biomedical topics. Ruth now lives in Bloomington, Ind., with her husband, son and cat. She can be contacted via her website at ruthjessenhickman.com.

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