Inflammatory myopathy associated with antimitochondrial antibodies: A distinct phenotype with cardiac involvement

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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 antimitochondrial antibodies. We sought to review all cases of antimitochondrial antibody (AMA) associated myositis in our cohort to describe the clinical features of this disease subset. Methods: We identified 7 patients with confirmed antimitochondrial 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 6 were classified as polymyositis using Bohan and Peter criteria (Tansley and Gunawardena (2014) ; Betteridge and McHugh (2015) ). 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 4 patients, dermatomyositis in 1, polymyositis in 1, and nonspecific or granulomatous myositis in 1 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 3/7 of the patients and included primary biliary cirrhosis, autoimmune hepatitis, psoriasis, and Hashimoto's thyroiditis. Conclusions: Antimitochondrial 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 antimitochondrial antibody status should be determined in patients with a compatible clinical picture.

Original languageEnglish (US)
JournalSeminars in Arthritis and Rheumatism
DOIs
Publication statusAccepted/In press - 2017

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Keywords

  • Antimitochondrial antibodies
  • Arrhythmia
  • Cardiomyopathy
  • Myocarditis
  • Myositis

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

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