Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Myositis is a rare systemic autoimmune disease with suspected environmental and genetic risk factors, but little is known about specific infections and medications that might be triggers.
Methods: Myositis patients (362 dermatomyositis [DM], 250 polymyositis [PM], 256 inclusion body myositis [IBM] enrolled in MYOVISION, diagnosed after January 1, 2002, and who met Bohan and Peter or Griggs criteria were included. Infections and medications received within the 12 months prior to diagnosis were queried. Significant univariable results were examined in multivariable logistic regression. Odds ratio point estimates with 95% confidence intervals and p-values were reported for each subtype pairwise comparison, after adjusting for age, gender, race, and year of diagnosis. Interactions of the effects between any infection and any medication, antibiotics, or NSAIDS were tested, after adjusting for age gender, race, and year of diagnosis.
Results: Overall, infections in the 12 months prior to diagnosis were reported more frequently in DM (OR 1.86: 95% CI 1.19-2.92, p ≤0.01) and PM (OR 1.61: 95% CI 1.01-2.55, p ≤0.05) than in IBM. Similar relationships were seen for gastroenteritis (OR 3.45:1.44-8.25 DM vs. IBM, OR 3.39:1.40-8.20 PM vs. IBM, p ≤0.01), respiratory infections, including upper respiratory infections (OR 1.76:1.07-2.89 DM vs. IBM, OR 1.82: 1.10-3.02 PM vs. IBM, p ≤0.05), and febrile illnesses (OR 3.18: 1.26-8.05 DM vs. IBM, OR 3.49: 1.37-8.90, PM vs. IBM, p≤0.05). The same infections were increased in the year prior to diagnosis in patients with an anti-synthetase phenotype with lung disease and arthritis or fever compared to those without. In addition, pneumonia (OR 5.31: 95% CI 2.67-10.6, p≤0.0001) was increased only in patients with an anti-synthetase phenotype. Hepatitis, urinary tract and skin infections were reported in ≤10% of patients in each subgroup and did not differ among subgroups. Among medications, statins were used more frequently in DM and PM than IBM (OR 2.22: 95%CI 1.33-3.70 DM vs. IBM, OR 2.13: 1.26-3.58 PM vs. IBM, p ≤0.005) in the year prior to diagnosis. Diabetes medications (OR 3.35: 95%CI 1.36-8.23, p =0.008) and levothyroxine (OR 2.20: 1.03-4.71, p=0.042) were also used more frequently in PM than IBM. Antibiotics (OR 1.76: 95% CI 1.18-2.63, p≤0.01) and NSAIDs (OR 1.73: 1.17-2.57, p≤0.01) were used more frequently in patients with the anti-synthetase phenotype. Use of blood pressure medicines, other lipid lowering agents, and oral contraceptives did not differ by subgroup. In examining the interaction of any infection with antibiotics, no interaction was detected by clinical subgroups (p=0.14 – 0.84), or within the anti-synthetase phenotype (p=0.45).
Conclusion: Variations among myositis subgroups in reported infections and medications received within the 12 months prior to diagnosis suggest possible risk factors for myositis phenotypes. Certain infections, particularly gastrointestinal and respiratory, are increased in DM and PM patients relative to IBM. A history of pneumonia and antibiotic usage are increased in patients with lung disease. Controlled studies examining these factors may be helpful in elucidating their role in disease development.
To cite this abstract in AMA style:
Rider LG, Noroozi Farhadi P, Bayat N, Wilkerson J, Faiq A, McGrath J, Brunner HI, Goldberg B, Miller FW. Infections and Medications Associated with Onset of Myositis in Myovision, a National Myositis Patient Registry [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/infections-and-medications-associated-with-onset-of-myositis-in-myovision-a-national-myositis-patient-registry/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/infections-and-medications-associated-with-onset-of-myositis-in-myovision-a-national-myositis-patient-registry/