Role of Plasmapheresis in a Treatment of Idiopathic Inflammatory Myopathy

The antifibrotic therapies nintedanib and pirfenidone were first approved by the United States for the treatment of idiopathic pulmonary fibrosis in 2014. In 2020, nintedanib received U.S. Food and Drug Administration (FDA) approval for the treatment of all progressive fibrosing interstitial lung disease (ILD). Given that a major cause of mortality and morbidity in the idiopathic inflammatory myopathies (IIM) is progressive interstitial lung disease and respiratory failure, antifibrotic therapies may be useful as adjuvant to traditional immunosuppression. However, randomized controlled trials of antifibrotic therapies in IIM are lacking. The purpose of this review is to (1) summarize the mechanism of action of nintedanib and pirfenidone in ILD with possible role in IIM-ILD, (2) review the clinical data supporting their use in interstitial lung disease in general, and more specifically in connective tissue disease associated ILD, and (3) discuss the evidence and remaining challenges for using antifibrotic therapies in IIM-ILD.

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Role of Panchakarma in the Management of Masavritavata w.r.t Dermatomyositis - A Case Study

International Journal of Ayurvedic Medicine ◽

10.47552/ijam.v11i4.1666 ◽

2020 ◽

Vol 11 (4) ◽

pp. 780-787

Author(s):

Imtiaz Hossain Md ◽

Mahesh M Parappagoudra ◽

Chimanda L Kamar

Keyword(s):

Immune System ◽

Skeletal Muscles ◽

Inflammatory Myopathy ◽

Signs And Symptoms ◽

Idiopathic Inflammatory Myopathy ◽

Autoimmune Disorder ◽

Muscular Tissue ◽

Small Blood Vessel

Dermatomyositis (DM) is the most frequently occurring Idiopathic Inflammatory Myopathy (IIM) of skeletal muscles causing proximal muscles weakness. The average age at which this disease affects is 40 years and almost twice as many women are affected as men. Its prevalence rate is 2-10 per 1,00,000 in the general population. The actual cause is unknown but the disease has much common with autoimmune disorder in which your immune system mistakenly attacks our body tissue. Small blood vessel in muscular tissue are particularly affected in dermatomyositis. In this disease the ESR and CPK is usually raised. Due to similarity in the signs and symptoms, we can correlate this disease with Mamsavrita-Vata and its treatment can be planned according to it. Here is the case study of 40 years old female patient, diagnosed as Dermatomyositis since 3 months. Patient admitted in Panchakarma ward of Parul Ayurved Hospital, Vadodara. The Panchakarma procedures like Udvartana, Nitya Virechana, Basti Chikitsa, Shasti Shali Pinda Sweda and Shamana Aushadi like Cap Palsineuron and Guduchi Rasayana etc. are given. At the end of the treatment marked improvements were seen in the patient, like reduced ESR and CPK levels. Also the symptoms of the disease reduced significantly.

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Faculty Opinions recommendation of Non-invasive differentiation of idiopathic inflammatory myopathy with cardiac involvement from acute viral myocarditis using cardiovascular magnetic resonance imaging T1 and T2 mapping.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732668604.793548509 ◽

2018 ◽

Author(s):

Matthias Friedrich

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiovascular Magnetic Resonance ◽

Cardiovascular Magnetic Resonance Imaging ◽

Cardiac Involvement ◽

T2 Mapping ◽

Inflammatory Myopathy ◽

Viral Myocarditis ◽

Idiopathic Inflammatory Myopathy ◽

Resonance Imaging ◽

Non Invasive

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Faculty Opinions recommendation of Histological heterogeneity in a large clinical cohort of juvenile idiopathic inflammatory myopathy: analysis by myositis autoantibody and pathological features.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734414936.793567613 ◽

2019 ◽

Author(s):

Manabu Fujimoto ◽

Naoko Okiyama

Keyword(s):

Inflammatory Myopathy ◽

Idiopathic Inflammatory Myopathy ◽

Pathological Features ◽

Clinical Cohort ◽

Histological Heterogeneity

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Molecular detection of cattle Sarcocystis spp. in North-West Italy highlights their association with bovine eosinophilic myositis

Parasites & Vectors ◽

10.1186/s13071-021-04722-5 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Selene Rubiola ◽

Tiziana Civera ◽

Felice Panebianco ◽

Davide Vercellino ◽

Francesco Chiesa

Keyword(s):

18S Rdna ◽

Inflammatory Myopathy ◽

Molecular Techniques ◽

Diaphragm Muscle ◽

Economic Losses ◽

Intermediate Hosts ◽

Slaughter Cattle ◽

Significant Difference ◽

Pcr Targeting

Abstract Background Cattle are intermediate hosts of six Sarcocystis species, among which Sarcocystis hominis and Sarcocystis heydorni can infect humans through the consumption of raw or undercooked meat. In addition to the zoonotic potential, there is increasing interest in these protozoa because of the evidence supporting the role of Sarcocystis spp. in the occurrence of bovine eosinophilic myositis (BEM), a specific inflammatory myopathy which leads to carcass condemnation and considerable economic losses. Actually, all the prevalence studies carried out on cattle in Italy have been based on either morphological or 18S rDNA-based molecular techniques, most likely leading to misidentification of closely related species. Therefore, there is a strong need for new data on the prevalence of the different Sarcocystis spp. in cattle in Italy and their association with bovine eosinophilic myositis. Methods To reach our aim, individual striated muscle samples from BEM condemned carcasses (N = 54) and diaphragm muscle samples from randomly sampled carcasses (N = 59) were obtained from Northwest Italy slaughterhouses. Genomic DNA was extracted and analyzed by multiplex-PCR targeting 18S rDNA and cox1 genes. PCR products amplified using the genus-specific primer set in absence of the specific fragment for S. hirsuta, S. cruzi, S. hominis or S. bovifelis were sequenced to achieve species identification. Results Sarcocystis DNA was detected in 67.8% of the samples from slaughter cattle and in 90.7% of the samples from BEM condemned carcasses. S. cruzi was identified as the most prevalent species in slaughter cattle (61%), followed by S. bovifelis (10.2%), S. hominis (8.5%) and S. hirsuta (1.7%). Notably, among the different Sarcocystis spp. detected, the presence of S. bovifelis and S. hominis was significantly higher in samples isolated from BEM condemned carcasses (46.3% and 40.7% respectively), while there was no statistically significant difference between the presence of S. cruzi or S. hirsuta in BEM condemned carcasses (42.6% and 1.8%, respectively) and randomly sampled carcasses. Furthermore, DNA sequence analysis revealed the presence of a putative new species in two carcasses. Conclusions Our study contributes to updating the data on the prevalence of the different Sarcocystis spp. in cattle in Italy, highlighting the presence of three Sarcocystis spp., S. cruzi, S. hominis and S. bovifelis, in BEM lesions and allowing us to speculate on the possible role of S. hominis and S. bovifelis as the major sarcosporidian species involved in bovine eosinophilic myositis. Graphic Abstract

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T1 mapping-derived signature of myocardial involvement in idiopathic inflammatory myopathy compared to acute viral myocarditis: a texture-based analysis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.314 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

E Bollache ◽

AT Huber ◽

J Lamy ◽

E Afari ◽

TM Bacoyannis ◽

...

Keyword(s):

Contrast Agent ◽

Texture Analysis ◽

T1 Mapping ◽

Inflammatory Myopathy ◽

Viral Myocarditis ◽

Texture Features ◽

Idiopathic Inflammatory Myopathy ◽

Post Contrast ◽

Myocardial T1 ◽

Myocardial Involvement

Abstract Funding Acknowledgements Type of funding sources: None. Background. Recent studies revealed the ability of MRI T1 mapping to characterize myocardial involvement in both idiopathic inflammatory myopathy (IIM) and acute viral myocarditis (AVM), as compared to healthy controls. However, neither myocardial T1 nor T2 maps were able to discriminate between IIM and AVM patients, when considering conventional myocardial mean values and derived indices such as lambda and extracellular volume. Purpose. To investigate the ability of T1 mapping-derived texture analysis to differentiate IIM from AVM. Methods. Forty patients, 20 with IIM (51 ± 17 years, 9 men) and 20 with AVM (34 ± 13 years, 16 men) underwent 1.5T MRI T1 mapping using a modified Look-Locker inversion-recovery sequence before and 15 minutes after injection of a gadolinium contrast agent. After manual delineation of endocardial and epicardial borders and co-registration of all inversion time images, native and post-contrast T1 maps were estimated. Myocardial texture analysis was performed on native T1 maps. Textural features such as: autocorrelation, contrast, dissimilarity, energy and sum entropy were used to build a least squares-based linear regression model. Finally, receiver operating characteristic (ROC) analysis was used to investigate the ability of such texture features score to classify IIM vs. AVM patients, compared to the performance of mean myocardial T1. A Wilcoxon rank-sum test was also used to test difference significance between groups. Results. Both native and post-contrast mean myocardial T1 values were comparable between IIM (native: 1022 ± 43 ms; post-contrast: 319 ± 44 ms) and AVM (1056 ± 59 ms, p = 0.07; 318 ± 35 ms, p = 0.90, respectively) groups. Results of ROC analyses are provided in the Table, indicating that a better discrimination between IIM and AVM patients was obtained when using texture features, with higher AUC and accuracy than mean T1 values (Figure). Conclusion. Texture analysis derived from MRI T1 maps without contrast agent injection was able to discriminate between IIM and AVM with higher accuracy, sensitivity and specificity than conventional T1 indices. Such analysis could provide a useful myocardial signature to help diagnose and manage cardiac alterations associated with IIM in patients presenting with myocarditis and primarily suspected of AVM. Table Area under curve (AUC) Accuracy Sensitivity Specificity Native T1 0.67 0.70 0.65 0.75 Post-contrast T1 0.49 0.60 0.25 0.95 Texture features score 0.85 0.82 0.90 0.75 ROC analyses for classification between IIM and AVM patients Abstract Figure

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