Inflammatory myopathy associated with anti-mitochondrial antibodies: A distinct phenotype with cardiac involvement

• Published in: Seminars in arthritis and rheumatism Vol. 47; no. 4; pp. 552 - 556
• Main Authors: Albayda, Jemima, MD, Khan, Aamna, Casciola-Rosen, Livia, PhD, Corse, Andrea M., MD, Paik, Julie J., MD,MHS, Christopher-Stine, Lisa, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2018
• Subjects: Anti-mitochondrial antibodies; Arrhythmia; Autoantibodies - immunology; Cardiomyopathy; Female; Humans; Male; Middle Aged; Mitochondria - immunology; Myocarditis; Myocardium - immunology; Myositis; Myositis - immunology; Phenotype; Retrospective Studies; Rheumatology; Myocarditis; Myositis; Arrhythmia; Cardiomyopathy; Anti-mitochondrial antibodies
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2017.06.004

Abstract Objective In the context of clinical evaluations performed on our prospective myositis cohort, we noted a striking association of severe cardiac disease in myositis patients with anti-mitochondrial antibodies. We sought to review all cases of anti-mitochondrial antibody (AMA) associated myositis in our cohort to describe the clinical features of this disease subset. Methods We identified 7 patients with confirmed anti-mitochondrial antibodies who presented as an inflammatory myopathy. A retrospective chart review was completed to assess their clinical presentation, laboratory, imaging, electrophysiologic and histopathologic features. Results One patient presented with dermatomyositis, and six were classified as polymyositis using Bohan and Peter criteria [1,2]. In all but one patient, a chronic course of muscle involvement was appreciated with an average of 6.5 years of weakness prior to presentation. Muscle atrophy was often noted, as well as atypical findings of scapular winging in 2 of the patients. Muscle biopsies were consistent with immune-mediated necrotizing myopathy in four patients, dermatomyositis in one, polymyositis in one and non-specific or granulomatous myositis in one patient. Cardiac involvement (including myocarditis, atrial and ventricular arrhythmias and cardiomyopathy), was seen in 5 out of 7 (71%) of the patients, and usually preceded the muscle involvement. Coexisting autoimmune conditions were seen in 3/7of the patients and included primary biliary cirrhosis, autoimmune hepatitis, psoriasis, and Hashimoto′s thyroiditis. Conclusions Anti-mitochondrial antibodies identify a distinct inflammatory myopathy phenotype that is frequently associated with chronic skeletal muscle disease and severe cardiac involvement. Early recognition of this rare entity as an immune-mediated process is important due to implications for treatment. We propose that anti-mitochondrial antibody status should be determined in patients with a compatible clinical picture.