title: Vascular pathology in dermatomyositis and anatomic relations to myopathology.
abstract: The causes of perifascicular myofiber atrophy and capillary pathology in dermatomyositis are incompletely understood. We studied 11 dermatomyositis muscles by histochemistry, immunohistochemistry, and ultrastructure. We found that endomysial capillaries within regions of perifascicular atrophy are not entirely lost, but they have reduced size, endothelial loss, C5b9 complement deposits, and relatively preserved connective tissue molecules and pericytes. In all muscles, the perimysium varies regionally. Some areas contain intermediate-sized vessels. Others are avascular. In dermatomyositis, vascular perimysium contains abnormal vessel fragments, perivascular inflammation, and increased PECAM-1. Perifascicular myofiber atrophy and capillary pathology are concentrated near the avascular perimysium. We conclude that both perimysial intermediate-sized vessels and endomysial capillaries within regions of perifascicular myofiber atrophy are abnormal in dermatomyositis. Capillary damage and myofiber atrophy are concentrated in regions distant from intermediate-sized perimysial vessels. Chronic immune vascular damage and insufficiency in dermatomyositis may cause ischemia, myofiber atrophy, and capillary damage in "watershed" regions of muscle near the avascular perimysium.
authors.affiliation: Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Box 8111, St. Louis, Missouri 63110, USA. pestronka@neuro.wustl.edu
authors.forename: Alan
authors.initials: A
authors.lastname: Pestronk
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schmidt
authors.forename: Rati
authors.initials: R
authors.lastname: Choksi
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D001808:Blood Vessels / Q000473:pathology*; D002196:Capillaries / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D024141:Collagen Type IV / Q000378:metabolism; D015938:Complement Membrane Attack Complex / Q000378:metabolism; D003882:Dermatomyositis / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000473:pathology*; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D020797:Receptor, Platelet-Derived Growth Factor beta / Q000378:metabolism
chemical_list: D024141:Collagen Type IV; D015938:Complement Membrane Attack Complex; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D020797:Receptor, Platelet-Derived Growth Factor beta