Lung involvement, cancer ‘two things you should always worry about’ in dermatomyositis
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ORLANDO, Fla. — Malignancies and lung involvement are the two key manifestations of dermatomyositis that require vigilance, according to a presenter at the 2024 Rheumatology Nurses Society annual conference.
“Lungs and cancer — those are the two things you should always worry about with these patients,” Rebekah Garrard, RN, MSN, FNP-C, nurse practitioner at the Lafayette Arthritis and Endocrine Clinic, in Louisiana, told attendees. “Make sure things are being monitored.”
Progressive interstitial lung disease is a complication of dermatomyositis that can in turn lead to secondary pulmonary arterial hypertension. According to Garrard, the most important warning sign of rapidly progressing ILD in dermatomyositis is positivity for anti-MDA5 antibodies.
“If you have a patient with that, you need to screen them regularly,” she said.
Garrard additionally advised being watchful for dry, bilateral crackling in the lungs.
“It’s literally like if you could take Velcro and you pull it apart,” she said. “If you start hearing this, we need to look a little deeper. Make sure that they have their chest X-ray. I’d love a high-resolution CT, because we’re going to really see that honeycombing and that beginning of fibrosis.”
Dermatomyositis also carries a five to seven times greater risk for malignancies — mostly breast, cervical and ovarian cancer among women, and lung cancer among men, Garrard said. For cancer, the red flags to bear in mind are positivity for anti-TIF1-y and anti-NXP2 antibodies, she added.
“Those antibodies should trigger you,” Garrard said. “If you see that, they need to have their yearly scans.”
For screening, she recommended that all patients with dermatomyositis undergo serum protein electrophoresis, urinalysis and liver panels. Those at high risk for malignancy should also have a CT of the neck, thorax, abdomen and pelvis performed, she added. According to Garrard, cancer antigen 125 levels can additionally monitor for ovarian cancer. Important tests for high-risk patients also include the fecal occult blood test and a colonoscopy, she said.
Meanwhile, Garrard cautioned against reliance on plain chest X-ray.
“A lot of times maybe the rheumatologist is reading it, and not the radiologist or a pulmonologist, and so we may not see those fine changes in the beginning,” she said. “If you did a high-resolution CT, you’re really going to see that beginning-stage fibrosis happening.”
Other patients to watch for regarding cancer are those who begin developing cutaneous ulcerations, Garrard said. She added that this manifestation is typically seen in later-progressed cases.
“We want to make sure we’re scanning them regularly and making sure that they’re being checked by their other physicians for cancer,” she said.
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Garrard R. Skin Deep, Muscle Bound: The Dual Challenge of Dermatomyositis. Presented at: Rheumatology Nurses Society annual conference; July 17-20, 2024, in Orlando, Florida (hybrid meeting).
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