In addition to the physical consequences of these issues are the mental health implications. Indeed, Dr. Coldiron noted that a key challenge in humanitarian medicine is that many patients have suffered psychological damage. Mental healthcare issues are increasingly recognized as an important part of health as impacted by climate change and violence.
Meet the Experts: Idiopathic Inflammatory Myositis
Changing gears, the next portion of the Global Rheumatology Summit focused on a panel discussion concerning the management of complicated cases of idiopathic inflammatory myositis. This session was moderated by Lesley Jackson, MD, instructor, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, and Rebecca Grainger, MBChB (Dstn), BMedSci (Dstn) MIsntD, CHIA, FRACP, FACHI, PhD, professor, Department of Medicine, University of Otago, Wellington, New Zealand.
The panelists for this session were Guochun Wang, MD, professor of medicine, Department of Rheumatology, China-Japan Friendship Hospital, Beijing, and Ingrid Lundberg, MD, PhD, professor, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. The moderators and panelists led the audience through an expert discussion of several clinical cases in the world of myositis.
Anti-MDA-5 Antibody-Positive Dermatomyositis
The first case discussed focused on the management of severe skin and joint disease in anti-melanoma differentiation-associated gene 5 (MDA-5) antibody-positive dermatomyositis. In discussing this entity in general, Dr. Lundberg noted that anti-MDA-5 antibody positivity is associated with often severe and rapidly progressive interstitial lung disease (ILD). Thus, all of these patients should be evaluated with pulmonary function testing and high-resolution computed tomography (CT) imaging of the chest.
Dr. Lundberg also stated that it is important to carefully evaluate these patients for muscle involvement, which can be subtle. In fact, testing the endurance of muscles may be more sensitive than stress testing (i.e., testing strength for just a few seconds in each muscle group) alone, and the patient may not realize that issues exist with muscle endurance. Dr. Lundberg pointed out that the Myositis Functional Index can be used to test muscle endurance and is a helpful tool for clinicians.
Dr. Wang concurred with Dr. Lundberg in explaining that anti-MDA-5 dermatomyositis is a heterogeneous disease. He argued that it is important to evaluate specific lab parameters, such as white blood cell count, lymphocyte count, C-reactive protein and ferritin, to fully assess the patient and help identify subtypes of the disease. With respect to treatment, corticosteroids are often a significant part of therapy, and steroid-sparing agents may include methotrexate, mycophenolate mofetil and Janus kinase inhibitor therapy. Dr. Lundberg said that cyclophosphamide is an option as well, although it has significant associated toxicity, and that azathioprine can be used but is not particularly effective in this disease.
