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Dermatomyositis, Negative ANA, and Malignancy Risk

J Am Acad Dermatol; ePub 2018 Nov 17; Hoesly, et al

In patients with adult-onset dermatomyositis (DM), negative antinuclear antibody (ANA) is associated with increased likelihood of developing malignancy within 3 years of DM diagnosis, according to a recent retrospective cohort study of patients. Therefore, particularly close follow-up and frequent malignancy screening may be warranted in ANA-negative individuals with DM. Researchers compared the incidence of amyopathic disease, risk of malignancy, and clinical findings in ANA-positive and ANA-negative patients with adult-onset DM. They found:

  • Of 231 patients, 140 (61%) were ANA-positive and 91 (39%) were ANA-negative.
  • Compared to ANA-negative patients, ANA-positive patients had a lower frequency of dysphagia (15% vs 26%) and heliotrope rash (38% vs 53%).
  • 54 patients (23%) developed malignancy within 3 years of DM diagnosis.
  • 11% of ANA-positive patients developed malignancy vs 43% of ANA-negative patients.
  • There was a strong association between ANA positivity and lower likelihood of malignancy in multivariable analysis (OR: 0.16).
  • Conversely, ANA positivity was not associated with amyopathic disease (OR: 0.94).

Hoesly PM, Sluzevich JC, Jambusaria-Pahlajani A, Lesser ER, Heckman MG, Abril A. Association of antinuclear antibody status with clinical features and malignancy risk in adult-onset dermatomyositis. [Published online ahead of print November 17, 2018]. J Am Acad Dermatol. doi:10.1016/j.jaad.2018.11.023.