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Extended report
Thigh muscle MRI in immune-mediated necrotising myopathy: extensive oedema, early muscle damage and role of anti-SRP autoantibodies as a marker of severity
  1. Iago Pinal-Fernandez1,
  2. Maria Casal-Dominguez2,
  3. John A Carrino2,
  4. Arash H Lahouti2,
  5. Pari Basharat2,
  6. Jemima Albayda2,
  7. Julie J Paik2,
  8. Shivani Ahlawat2,
  9. Sonye K Danoff2,
  10. Thomas E Lloyd2,
  11. Andrew L Mammen1,2,
  12. Lisa Christopher-Stine2
  1. 1National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
  2. 2Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Iago Pinal-Fernandez or Dr Andrew L Mammen, Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Expression, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 50 South Drive, Room 1141, Building 50, MSC 8024, Bethesda, MD 20892, USA; iagopf{at} and andrew.mammen{at}


Objectives The aims of this study were to define the pattern of muscle involvement in patients with immune-mediated necrotising myopathy (IMNM) relative to those with other inflammatory myopathies and to compare patients with IMNM with different autoantibodies.

Methods All Johns Hopkins Myositis Longitudinal Cohort subjects with a thigh MRI (tMRI) who fulfilled criteria for IMNM, dermatomyositis (DM), polymyositis (PM), inclusion body myositis (IBM) or clinically amyopathic DM (CADM) were included in the study. Muscles were assessed for intramuscular and fascial oedema, atrophy and fatty replacement. Disease subgroups were compared using univariate and multivariate analyses. Patients with IMNM with anti-signal recognition particle (SRP) autoantibodies were compared with those with IMNM with anti-HMG-CoA reductase (HMGCR) autoantibodies.

Results The study included 666 subjects (101 IMNM, 176 PM, 219 DM, 17 CADM and 153 IBM). Compared with DM or PM, IMNM was characterised by a higher proportion of thigh muscles with oedema, atrophy and fatty replacement (p<0.01). Patients with IMNM with anti-SRP had more atrophy (19%, p=0.003) and fatty replacement (18%, p=0.04) than those with anti-HMGCR. In IMNM, muscle abnormalities were especially common in the lateral rotator and gluteal groups. Fascial involvement was most widespread in DM. Fatty replacement of muscle tissue began early during the course of disease in IMNM and the other groups. An optimal combination of tMRI features had only a 55% positive predictive value for diagnosing IMNM.

Conclusions Compared with patients with DM or PM, IMNM is characterised by more widespread muscle involvement. Anti-SRP-positive patients have more severe muscle involvement than anti-HMGCR-positive patients.

  • Autoantibodies
  • Dermatomyositis
  • Polymyositis
  • Magnetic Resonance Imaging

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  • Handling editor Tore K Kvien

  • IP-F, MC-D, ALM and LC-S contributed equally.

  • IP-F and ALM are co-corresponding authors.

  • Correction notice This article has been corrected since it was published Online First. Details of the co-corresponding author have been included.

  • Contributors All authors listed have contributed sufficiently to the project to be included as authors and to take public responsibility for its content, and all those who are qualified to be authors are listed in the author byline.

  • Funding This research was supported in part by the Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health. The Myositis Research Database is supported by the Huayi and Siuling Zhang Discovery Fund.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Ethics approval This study was approved by the Johns Hopkins Institutional Review Board.