Arthritis in idiopathic inflammatory myopathy: clinical features and autoantibody associations.
OBJECTIVE
To determine the prevalence, distribution, and clinical manifestations of arthritis in a cohort of patients with idiopathic inflammatory myopathies (IIM). Associations with autoantibody status and HLA genetic background were also explored.


METHODS
Consecutive patients with IIM treated in a single center were included in this cross-sectional study (n = 106). History of arthritis, 68-joint and 66-joint tender and swollen joint index, clinical features of IIM, and autoantibody profiles were obtained by clinical examination, personal interview, and review of patient records. High-resolution genotyping in HLA-DRB1 and HLA-DQB1 loci was performed in 71 and 73 patients, respectively.


RESULTS
A combination of patients' medical history and cross-sectional physical examination revealed that arthritis at any time during the disease course had occurred in 56 patients (53%). It was present at the beginning of the disease in 39 patients (37%) including 23 cases (22%) with arthritis preceding the onset of muscle weakness. On physical examination, 29% of patients had at least 1 swollen joint. The most frequently affected areas were wrists, and metacarpophalangeal and proximal interphalangeal joints. Twenty-seven out of the 29 anti-Jo1-positive patients had arthritis at any time during the course of their illness; this prevalence was significantly higher compared to patients without the anti-Jo1 autoantibody (p < 0.0001). No association of arthritis with individual HLA alleles was found.


CONCLUSIONS
Our data suggest that arthritis is a common feature of myositis. It is frequently present at the onset of disease and it may even precede muscular manifestations of IIM. The most common presentation is a symmetrical, nonerosive polyarthritis affecting particularly the wrists, shoulders, and small joints of the hands. We have confirmed a strong association of arthritis with the presence of the anti-Jo1 antibody.
From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague.
Martin
M
Klein
From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague.
Heřman
H
Mann
From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague.
Lenka
L
Pleštilová
From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague.
Zoe
Z
Betteridge
From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague.
Neil
N
McHugh
From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague.
Martina
M
Remáková
From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague.
Peter
P
Novota
From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague. vencovsky@revma.cz.
Jiří
J
Vencovský
D000328:Adult; D000368:Aged; D000483:Alleles; D001168:Arthritis / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology; D001323:Autoantibodies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005838:Genotype; D059866:HLA-DQ beta-Chains / Q000235:genetics*; D059811:HLA-DRB1 Chains / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009220:Myositis / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology; D015995:Prevalence
D001323:Autoantibodies; D059866:HLA-DQ beta-Chains; C069051:HLA-DQB1 antigen; D059811:HLA-DRB1 Chains
ARTHRITIS; AUTOANTIBODIES; IDIOPATHIC INFLAMMATORY MYOPATHIES