Environmental Factors Associated With Disease Flare In Juvenile and Adult Dermatomyositis

Gulnara Mamyrova¹, Lisa G. Rider², Olcay Jones³, Alison Ehrlich⁴, Lauren M. Pachman⁵, Robert Nickeson⁶, Lisa G. Criscione-Schreiber⁷, Frederick W. Miller², Lawrence K. Jung⁸ and James D. Katz¹, ¹Rheumatology, George Washington University, Washington, DC, ²Environmental Autoimmunity Group, NIEHS, NIH, Bethesda, MD, ³Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, ⁴Dermatology, The George Washington University, Washington, DC, ⁵Division of Pediatric Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, ⁶Pediatrics, All Children's Hospital, St Petersburg, FL, ⁷Dept of Med/Rheum Div, Duke University School of Medicine, Durham, NC, ⁸Pediatric Rheumatology, Children's National Medical Center, Washington, DC

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: dermatomyositis, Disease Activity, environmental factors and juvenile dermatomyositis

Session Information

Title: Muscle Biology, Myositis and Myopathies: Advances in the Epidemiology, Immunology and Therapy of Myositis

Session Type: Abstract Submissions (ACR)

Background/Purpose: To assess environmental factors in relationship to increased disease activity (flare) in juvenile and adult dermatomyositis (DM).

Methods: An online survey was conducted for juvenile and adult DM patients from the US and Canada who were ≥1 year from diagnosis. Patients were recruited through myositis clinics and by a patient support group. The survey examined: exposures during the 6 months prior to disease flare, if the patient experienced a flare within the past 2 years, or in the past 6 months, if the patient did not have a flare. Exposures assessed included smoking, sun exposure, infections, medications, vaccines, stressful life events, and sport activities. Differences were evaluated by Chi-square and Fisher’s exact tests.

Results: Of 210 participants meeting probable or definite Bohan and Peter criteria (164 juvenile and 46 adult DM patients), 134 (63.8%) (103 juvenile and 31 adult DM) experienced a flare and 76 (36.2%) (61 juvenile and 15 adult DM) participants did not experience a disease flare within the past 2 years. For those reporting a disease flare, the mean duration to flare was 13 months for JDM and 10 months for DM. Eighty percent of patients with a flare were female vs. 70% of those without flare; 85% were Caucasian. Patients with flare were less often 0-5 years of age compared to those who did not flare (2.2% vs. 15.8%, p=0.0004). Patients with a disease flare more often reported that their myositis worsened after sun exposure (44.4% vs. 28.6%, p=0.03, OR=1.99, 95% CI: 1.1-3.7), but the use of photoprotective measures was similar between both groups. Infections were more frequently recorded in the preceding 6 months in those who flared vs. those who did not, including UTI (10.2% vs. 0.0%, p= 0.005, OR=16.4, CI: 0.96-280.2) and gastroenteritis (16.5% vs. 5.8%, p=0.04, OR=3.2, CI: 1.1-9.8). Patients who flared more frequently used NSAIDs (63.4% vs. 36.8%; p=0.0003, OR=3.0, CI: 1.7-5.3) or blood pressure medicines (12.7% vs. 3.9%, p=0.049, OR=3.5, CI: 1.0-12.5). HPV vaccine was more frequent in those who flared vs. those who did not (8.2% vs. 0.0%, p=0.032, OR=10.0, CI: 0.6-175.5). Patients who flared tended to experience more frequent serious financial difficulties compared to those who did not (17.2% vs. 7.9%, p=0.06, OR=2.4, CI: 0.9-6.2), but other stressful life events did not differ. Patients with a flare more often exercised 1-5 times a week (74.7% vs. 57.7%, p=0.06, OR=2.2, CI: 1.02-4.6). There was no difference in smoking exposure between the two groups.

Conclusion: Sun exposure, certain infections, medications, and vaccines, which have been associated with illness onset, may also play a role in disease flares in patients with adult and juvenile DM.

Disclosure:

G. Mamyrova,

CureJM,

L. G. Rider,
None;

O. Jones,
None;

A. Ehrlich,
None;

L. M. Pachman,
None;

R. Nickeson,
None;

L. G. Criscione-Schreiber,
None;

F. W. Miller,
None;

L. K. Jung,
None;

J. D. Katz,

CureJM,

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