Malignancy in dermatomyositis and polymyositis
- Marc L Miller, MD
Marc L Miller, MD
- Clinical Assistant Professor of Medicine
- Tufts University School of Medicine
- Section Editors
- Ira N Targoff, MD
Ira N Targoff, MD
- Section Editor — Muscle Disease
- Professor of Medicine, Section of Rheumatology
- University of Oklahoma Health Sciences Center
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
Dermatomyositis (DM) and polymyositis (PM) are idiopathic inflammatory myopathies characterized by proximal skeletal muscle weakness and evidence of muscle inflammation. DM, unlike PM, is characterized by the presence of various cutaneous manifestations. DM and PM may also be associated with inflammatory arthritis, interstitial lung disease, Raynaud phenomenon, and the presence of autoantibodies.
An association between inflammatory myopathy and cancer has been recognized since the report of two cases of PM and gastric cancer in 1916 . The association is stronger for patients with DM than PM. The evidence for an association between cancer and inflammatory myopathy includes:
●Epidemiologic evidence from large population studies
●Temporal relationship between the diagnosis of cancer and myopathy
●The improvement or resolution of myopathy after treatment of the cancerTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Stertz O. Polymyositis. Berl Klin Wochenschr 1916; 53:489.
- Casciola-Rosen L, Nagaraju K, Plotz P, et al. Enhanced autoantigen expression in regenerating muscle cells in idiopathic inflammatory myopathy. J Exp Med 2005; 201:591.
- Levine SM. Cancer and myositis: new insights into an old association. Curr Opin Rheumatol 2006; 18:620.
- Furneaux HM, Rosenblum MK, Dalmau J, et al. Selective expression of Purkinje-cell antigens in tumor tissue from patients with paraneoplastic cerebellar degeneration. N Engl J Med 1990; 322:1844.
- Albert ML, Darnell RB. Paraneoplastic neurological degenerations: keys to tumour immunity. Nat Rev Cancer 2004; 4:36.
- Barnes BE, Mawr B. Dermatomyositis and malignancy. A review of the literature. Ann Intern Med 1976; 84:68.
- Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med 1975; 292:344.
- Sigurgeirsson B, Lindelöf B, Edhag O, Allander E. Risk of cancer in patients with dermatomyositis or polymyositis. A population-based study. N Engl J Med 1992; 326:363.
- Chow WH, Gridley G, Mellemkjaer L, et al. Cancer risk following polymyositis and dermatomyositis: a nationwide cohort study in Denmark. Cancer Causes Control 1995; 6:9.
- Buchbinder R, Forbes A, Hall S, et al. Incidence of malignant disease in biopsy-proven inflammatory myopathy. A population-based cohort study. Ann Intern Med 2001; 134:1087.
- Chen YJ, Wu CY, Huang YL, et al. Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan. Arthritis Res Ther 2010; 12:R70.
- Stockton D, Doherty VR, Brewster DH. Risk of cancer in patients with dermatomyositis or polymyositis, and follow-up implications: a Scottish population-based cohort study. Br J Cancer 2001; 85:41.
- Lakhanpal S, Bunch TW, Ilstrup DM, Melton LJ 3rd. Polymyositis-dermatomyositis and malignant lesions: does an association exist? Mayo Clin Proc 1986; 61:645.
- Yang Z, Lin F, Qin B, et al. Polymyositis/dermatomyositis and malignancy risk: a metaanalysis study. J Rheumatol 2015; 42:282.
- Hill CL, Zhang Y, Sigurgeirsson B, et al. Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet 2001; 357:96.
- Bivalacqua TJ, Alphs H, Aksentijevich I, et al. Paraneoplastic polyarthritis from non-small-cell lung cancer metastatic to the bladder. J Clin Oncol 2007; 25:2621.
- Whitmore SE, Rosenshein NB, Provost TT. Ovarian cancer in patients with dermatomyositis. Medicine (Baltimore) 1994; 73:153.
- Chen YJ, Wu CY, Shen JL. Predicting factors of malignancy in dermatomyositis and polymyositis: a case-control study. Br J Dermatol 2001; 144:825.
- Targoff IN, Mamyrova G, Trieu EP, et al. A novel autoantibody to a 155-kd protein is associated with dermatomyositis. Arthritis Rheum 2006; 54:3682.
- Callen JP. The value of malignancy evaluation in patients with dermatomyositis. J Am Acad Dermatol 1982; 6:253.
- Cox NH, Lawrence CM, Langtry JA, Ive FA. Dermatomyositis. Disease associations and an evaluation of screening investigations for malignancy. Arch Dermatol 1990; 126:61.
- Urbano-Márquez A, Casademont J, Grau JM. Polymyositis/dermatomyositis: the current position. Ann Rheum Dis 1991; 50:191.
- Hunger RE, Dürr C, Brand CU. Cutaneous leukocytoclastic vasculitis in dermatomyositis suggests malignancy. Dermatology 2001; 202:123.
- Wang J, Guo G, Chen G, et al. Meta-analysis of the association of dermatomyositis and polymyositis with cancer. Br J Dermatol 2013; 169:838.
- Douglas WW, Tazelaar HD, Hartman TE, et al. Polymyositis-dermatomyositis-associated interstitial lung disease. Am J Respir Crit Care Med 2001; 164:1182.
- Chinoy H, Fertig N, Oddis CV, et al. The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis. Ann Rheum Dis 2007; 66:1345.
- Kaji K, Fujimoto M, Hasegawa M, et al. Identification of a novel autoantibody reactive with 155 and 140 kDa nuclear proteins in patients with dermatomyositis: an association with malignancy. Rheumatology (Oxford) 2007; 46:25.
- Trallero-Araguás E, Labrador-Horrillo M, Selva-O'Callaghan A, et al. Cancer-associated myositis and anti-p155 autoantibody in a series of 85 patients with idiopathic inflammatory myopathy. Medicine (Baltimore) 2010; 89:47.
- Fiorentino DF, Chung LS, Christopher-Stine L, et al. Most patients with cancer-associated dermatomyositis have antibodies to nuclear matrix protein NXP-2 or transcription intermediary factor 1γ. Arthritis Rheum 2013; 65:2954.
- Lu X, Yang H, Shu X, et al. Factors predicting malignancy in patients with polymyositis and dermatomyostis: a systematic review and meta-analysis. PLoS One 2014; 9:e94128.
- Selva-O'Callaghan A, Grau JM, Gámez-Cenzano C, et al. Conventional cancer screening versus PET/CT in dermatomyositis/polymyositis. Am J Med 2010; 123:558.
- Mahmood S, Rodríguez Martínez de Llano S. 18F-FDG PET detection of unknown primary malignancy in dermatomyositis. Clin Nucl Med 2012; 37:e204.
- Types of malignancies
- Temporal relationship
- RISK FACTORS
- Clinical risk factors
- Serum autoantibodies
- APPROACH TO SCREENING
- Initial screening for malignancy
- Post-treatment surveillance
- IMPACT OF MALIGNANCY ON DISEASE SEVERITY
- SUMMARY AND RECOMMENDATIONS