Background/Purpose: A subset of patients with dermatomyositis may fail to achieve remission despite treatment.  Nevertheless, the risk factors for failure to achieve remission in dermatomyositis are largely unknown.   

Methods: We conducted a retrospective chart review of patients seen between 2006 and 2011 at John H. Stroger Medical Center of Cook County (Illinois, USA) with a diagnosis of dermatomyositis.  All patients met 1975 Bohan and Peter criteria for “probable” or “definite” dermatomyositis. Remission could occur at any time point during follow-up and was defined as normal strength, creatine kinase < 200 mg/dL, and the absence of active dermatomyositis rash.  Clinical features were defined at baseline within 1 month of presentation. We compared demographics, dermatomyositis-related clinical and serologic parameters, and treatments between those who achieved remission and those who did not. We used Chi square tests to compare categorical variables and Student’s t-tests to compare continuous variables. We then conducted a multivariable logistic regression to examine the outcome of failure to achieve remission. We forced age, sex, race, and follow-up time into the model and included clinical variables based on a p-value of < 0.2 in univariate screen. Treatments were not included in the multivariable model due to inability to adjust for confounding by treatment severity in this small sample.

Results: 65 patients, of whom 92.3 % (60/65) were African-American or Hispanic, were included in this study.  Mean follow-up time for patients who did not achieve remission was 45.9 months vs. 60.7 months for those who did achieve remission (p-=0.253). 33.8% (22/65) of patients failed to achieve remission at any point during follow-up.  Patients who failed to achieve remission were younger (mean age 40.6 years vs. 49.1 years; p=0.025) at first visit than patients who achieved remission.  Patients who failed to achieve remission were more likely to have been treated with intravenous immunoglobulin (27.3% vs. 4.7%; p=0.009) at any point during follow-up.  A multivariable logistic regression with age at presentation, female sex, African-American race, follow-up time, and full strength on presentation as predictors demonstrated that younger age at presentation was an independent risk factor for failure to achieve remission (OR 0.95 [95% CI 0.91-0.99] per 1-year increase in age; p=0.030).   

Conclusion: In this small cohort of largely African-American and Hispanic patients with dermatomyositis seen at a US medical facility largely serving poor and uninsured patients, younger age at presentation was an independent risk factor for failure to achieve remission.  Patients who failed to achieve remission were more likely to have been treated with second-line agents than those who achieved remission. Given that patients who failed to achieve remission were more likely to have normal baseline muscle strength than those who achieved remission, we hypothesize that younger age at presentation may be associated with more treatment-refractory cutaneous disease.  

Descriptive data

Multivariable analysis

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/younger-age-at-presentation-is-a-risk-factor-for-failure-to-achieve-remission-in-adult-dermatomyositis/