Cancer and immune-mediated necrotizing myopathy: a longitudinal referral case-controlled outcomes evaluation

To investigate immune-mediated necrotizing myopathy (IMNM) association with cancer and its clinical implications. IMNM cases were identified 1 January 2000 to 31 December 2020 matching sex and age controls (4:1). A total of 152 patients with IMNM were identified and among serologically tested, 60% (...

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Published in:Rheumatology (Oxford, England) England), 2022-12, Vol.62 (1), p.281-289
Main Authors: Shelly, Shahar, Beecher, Grayson, Milone, Margherita, Liewluck, Teerin, Ernste, Floranne, Triplett, James, Naddaf, Elie, Zekeridou, Anastasia, McKeon, Andrew, Pittock, Sean J, Dubey, Divyanshu, Mills, John R, Mandrekar, Jay, Klein, Christopher J
Format: Article
Language:English
Subjects:
Autoantibodies
Autoimmune Diseases - complications
Autoimmune Diseases - diagnostic imaging
Autoimmune Diseases - epidemiology
Fluorodeoxyglucose F18
Humans
Immunoglobulin G
Muscle, Skeletal
Muscular Diseases - complications
Muscular Diseases - diagnostic imaging
Muscular Diseases - epidemiology
Myositis - diagnostic imaging
Myositis - epidemiology
Necrosis
Neoplasms - complications
Neoplasms - diagnostic imaging
Neoplasms - epidemiology
Positron Emission Tomography Computed Tomography
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Summary:To investigate immune-mediated necrotizing myopathy (IMNM) association with cancer and its clinical implications. IMNM cases were identified 1 January 2000 to 31 December 2020 matching sex and age controls (4:1). A total of 152 patients with IMNM were identified and among serologically tested, 60% (83/140) were HMGCR-IgG+, 14% (20/140) were SRP-IgG+ and 26% (37/140) were seronegative. Cancer rates were not significantly different between serological subgroups; 18.1% (15/83) HMGCR-IgG+, 25% (5/20) SRP-IgG+ and 30% (11/37) seronegative (P = 0.34). Cancer screening was performed within 12 months from IMNM diagnosis in 88% (134/152) (whole-body CT plus FDG-PET CT in 53, CT alone in 72 and FDG-PET alone in 9). FDG-PET/CT was positive in 73% (25/34) of cancers. Increasing age was the only risk associated with cancer (P = 0.02). The odds of developing cancer at ±3 or ±5 years from IMNM diagnosis was not higher than controls (OR = 0.49; CI: 0.325-0.76). Lifetime IMNM diagnosis of cancer was less compared with controls (OR = 0.5 CI: 0.33-0.78, P = 0.002). Most patients responded to treatment (137/147, P 
ISSN:1462-0324
1462-0332
DOI:10.1093/rheumatology/keac144