Autoantibodies, Cancer, and Dermatomyositis
Autoantibodies, Cancer, and Dermatomyositis
Clinicians are regularly confronted with the issue of how to identify patients with DM who have cancer, and those who do not. The current standard of care is to perform age-appropriate screening for cancer in patients presenting with DM, although this approach may miss cancers in certain patients and other, more aggressive approaches, such as extensive imaging or testing for blood-based markers of cancer (eg, carcinoembryonic antigen) are not well studied.
Along with other published data, these findings provide additional evidence that certain antibodies may help distinguish patients with cancer-associated DM. Furthermore, methodologic advances in the ability to detect these antibodies accurately is of great importance to moving the field forward.
However, additional work needs to be done to make testing for these antibodies clinically actionable, including development of clear diagnostic accuracy for these tests. Also, although a small study did not find an association between anti-NXP-2 and specific clinical phenotypes of DM, it would be of interest in larger studies with more robust antibody testing methodology to evaluate how these antibodies relate to such findings as skin necrosis and periungual erythema, which have been associated in some studies with an increased risk for cancer. Additional work is also needed to identify specific mechanisms by which these antibodies are associated with cancer in DM, and in particular to discover the role that antibodies to these antigens may play in the initiation of DM.
Nevertheless, these findings should be of great interest to the rheumatic disease community, and we look forward to future work in this area. It may also be that these findings shed light on how other rheumatic diseases may develop.
Abstract
Viewpoint
Clinicians are regularly confronted with the issue of how to identify patients with DM who have cancer, and those who do not. The current standard of care is to perform age-appropriate screening for cancer in patients presenting with DM, although this approach may miss cancers in certain patients and other, more aggressive approaches, such as extensive imaging or testing for blood-based markers of cancer (eg, carcinoembryonic antigen) are not well studied.
Along with other published data, these findings provide additional evidence that certain antibodies may help distinguish patients with cancer-associated DM. Furthermore, methodologic advances in the ability to detect these antibodies accurately is of great importance to moving the field forward.
However, additional work needs to be done to make testing for these antibodies clinically actionable, including development of clear diagnostic accuracy for these tests. Also, although a small study did not find an association between anti-NXP-2 and specific clinical phenotypes of DM, it would be of interest in larger studies with more robust antibody testing methodology to evaluate how these antibodies relate to such findings as skin necrosis and periungual erythema, which have been associated in some studies with an increased risk for cancer. Additional work is also needed to identify specific mechanisms by which these antibodies are associated with cancer in DM, and in particular to discover the role that antibodies to these antigens may play in the initiation of DM.
Nevertheless, these findings should be of great interest to the rheumatic disease community, and we look forward to future work in this area. It may also be that these findings shed light on how other rheumatic diseases may develop.
Abstract
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