Association of antinuclear antibody status with clinical features and malignancy risk in adult-onset dermatomyositis

Publication date: Available online 17 November 2018

Source: Journal of the American Academy of Dermatology

Author(s): Paul M. Hoesly, Jason C. Sluzevich, Anokhi Jambusaria-Pahlajani, Elizabeth R. Lesser, Michael G. Heckman, Andy Abril

Abstract

Background

The clinical significance of antinuclear antibody (ANA) status in adults with dermatomyositis (DM) has yet to be fully defined.

Objective

We compared the incidence of amyopathic disease, risk of malignancy, and clinical findings in ANA-positive and ANA-negative patients with adult-onset DM.

Methods

This was a retrospective cohort study of patients with ANA-positive or ANA-negative adult-onset DM determined by enzyme-linked immunosorbent assay.

Results

Of 231 patients, 140 (61%) were ANA-positive and 91 (39%) were ANA-negative. Compared to ANA-negative patients, ANA-positive patients had a lower frequency of dysphagia (15% vs 26%, P=0.033) and heliotrope rash (38% vs 53%, P=0.026). Fifty-four patients (23%) developed malignancy within 3 years of DM diagnosis. Eleven percent of ANA-positive patients developed malignancy versus 43% of ANA-negative patients (P<0.001). There was a strong association between ANA positivity and lower likelihood of malignancy in multivariable analysis (OR: 0.16, P<0.001). Conversely, ANA positivity was not associated with amyopathic disease (OR: 0.94, P=0.87).

Limitations

The retrospective nature of the study was a limitation.

Conclusion

In patients with adult-onset DM, negative ANA is associated with increased likelihood of developing malignancy within three years of DM diagnosis. Particularly close follow-up and frequent malignancy screening may be warranted in ANA-negative individuals with DM.

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