Epidemiologic study of clinically amyopathic dermatomyositis and anti-melanoma differentiation-associated gene 5 antibodies in central Japan

Abstract

Introduction: Several reports have found the onset or activity of inflammatory myopathies to show spatial clustering and seasonal association. We recently detected autoantibodies against melanoma differentiation-associated gene 5 (MDA-5) in more than 20% of patients with dermatomyositis. Anti-MDA-5 antibodies were associated with the presence of rapidly progressive interstitial lung disease in clinically amyopathic dermatomyositis (CADM). The present study aims to assess the growing prevalence of CADM and the geographical incidence of anti-MDA-5-positive patients.

Methods: We reviewed medical charts and examined the presence of anti-MDA-5 antibodies in 95 patients, including 36 CADM patients. Sera were obtained from 1994 through 2011. Statistical analyses were performed to assess whether CADM development and the presence of anti-MDA-5 antibodies were associated with various parameters, including age at disease onset, season of onset, annual positivity, and population of resident city.

Results: Tertiles based on the year when the sera were collected showed increasing tendencies of CADM and anti-MDA-5-positive patients among all of the dermatomyositis patients. From 1994 to 2010, the relative prevalence of CADM and anti-MDA-5 antibody-positive patients significantly increased. Interestingly, the presence of anti-MDA-5 antibodies in 26 patients was inversely associated with the population of their city of residence.

Conclusions: This is the first study to examine the distribution of anti-MDA-5-positive dermatomyositis phenotypes in Japan. Regional differences in the incidences of these phenotypes would suggest that environmental factors contribute to the production of antibodies against MDA-5, which triggers innate antiviral responses.

Figure 1

Annual prevalence of patients with clinically amyopathic dermatomyositis or anti-melanoma differentiation-associated gene 5 antibodies. The regression equation is shown, in which the year of disease onset is defined as 1994 = 1, 1995 = 2,..., 2010 = 17 on the x axis and the presence or absence of clinically amyopathic dermatomyositis (CADM) or anti-melanoma differentiation-associated gene 5 (anti-MDA-5) antibodies is defined as 1 and 0, respectively, on the y axis (P for linear trend).

Figure 2

Geographic distribution of patients with dermatomyositis. A residential area of 95 patients was plotted. NGY, Nagoya city. Red and white circles show patients with and without anti-melanoma differentiation-associated gene 5 (anti-MDA-5) antibodies, respectively. Blue line shows the Kiso River, which is the biggest in the area.