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Original Article

Utility of anti-MDA5 antibody measurement in identifying patients with dermatomyositis and a high risk for developing rapidly progressive interstitial lung disease: A review of the literature and a meta-analysis†‡

  1. Zhiyong Chen1,
  2. Mengshu Cao1,2,
  3. Maria Nieves Plana3,
  4. Jun Liang1,
  5. Hourong Cai2,
  6. Masataka Kuwana4,§,*,
  7. Lingyun Sun1,*

DOI: 10.1002/acr.21985

Additional Information

Author Information

  1. 1

    Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China

  2. 2

    Department of Respirology, the Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China

  3. 3

    Clinical Biostatistics Unit. Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain

  4. 4

    Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

  1. §

    Tel:86-25-8310-5209 Fax:86-25-8310-5209

*Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China

  1. †

    These authors equally contributed to this work

  2. ‡

    Competing interests: None declared

  3. §

    Tel:86-25-8310-5209 Fax:86-25-8310-5209

Publication History

  1. Accepted manuscript online: 22 FEB 2013 10:50AM EST
  2. Manuscript Accepted: 12 FEB 2013
  3. Manuscript Revised: 22 JAN 2013
  4. Manuscript Received: 19 JUL 2012

Funded by

  • Nanjing Medical Science and Technique Development Foundation (Z.C.)
  • National Natural Science Foundation of China. Grant Number: 81200049
  • Jiangsu Province Kejiao Xingwei Program Foundation

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Abstract

Objective.

To assess the utility of anti-MDA5 antibody measurement for predicting a risk for developing rapidly progressive interstitial lung disease (RP-ILD) in patients with polymyositis/dermatomyositis (PM/DM).

Methods.

A single-center cohort of 64 consecutive Chinese patients with PM/DM was examined. Serum anti-MDA5 antibody was measured by enzyme-linked immunosorbent assay. For meta-analysis, we searched PubMed and Institute for Scientific Information Web of Knowledge (ISI WoK) for original studies that measured anti-MDA5 antibodies in patients with PM/DM. We calculated pooled sensitivity, specificity, diagnostic odds ratio (DOR), and the summary receiver operating characteristic (sROC) curve.

Results.

In Chinese patients, anti-MDA5 antibodies were detected in 26 patients with classic DM or clinically amyopathic DM (CADM). Compared with anti-MDA5-negative patients, anti-MDA5-positive patients showed a higher prevalence of RP-ILD (P = 0.001). In a total of 233 patients with anti-MDA5 antibody, derived from 16 studies, a higher frequency of CADM was found in Japanese than in non-Japanese patients (74.7% vs. 39.2%, P = 1.2×10-7). Meta-analysis revealed that the pooled sensitivity and specificity of anti-MDA5 antibody for RP-ILD were 77% (95% CI 64-87%) and 86% (95% CI 79-90%), respectively. The pooled diagnostic OR was 20.41 (95% CI 9.02-46.20) with a favorable area under the sROC curve 0.89 (95% CI 0.63-0.98).

Conclusions.

Detection of anti-MDA5 antibody is a valuable tool for identifying DM patients with a high risk for developing RP-ILD, but the distribution of classic DM and CADM in patients with this antibody varies among ethnic groups. © 2013 by the American College of Rheumatology

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