Clinical Characteristics of Anti‐Synthetase Syndrome: Analysis From the Classification Criteria for Anti‐Synthetase Syndrome Project
Sara Faghihi‐Kashani, Akira Yoshida, F. Bozán, Giovanni Zanframundo, Davide Rozza, Aravinthan Loganathan, Eduardo Dourado, Gianluca Sambataro, Iazsmin Bauer Ventura, Sangmee Bae, Darosa Lim, Daphne Rivero‐Gallegos, Yasuhiko Yamano, Albert Selva-O’Callaghan, Andrew L. Mammen, Carlo Alberto Scirè, Carlomaurizio Montecucco, Chester V. Oddis, David Fiorentino, Francesco Bonella, Frederick W. Miller, Ingrid E. Lundberg, Jens Schmidt, Jorge Rojas‐Serrano, Marie Hudson, Masataka Kuwana, Miguel Á. González‐Gay, Neil McHugh, Tamera J. Corte, Tracy J. Doyle, Victoria P. Werth, Latika Gupta, Diana Isabel Perez Roman, Laura Bianchessi, Phani Kumar Devarasetti, Samuel Katsuyuki Shinjo, Fabrizio Luppi, Ilaria Cavazzana, Siamak Moghadam‐Kia, Marco Fornaro, Elizabeth R. Volkmann, Matteo Piga, Jesus Loarce‐Martos, Giacomo De Luca, Johannes Knitza, Veronica Wolff‐Cecchi, Marco Sebastiani, Adam Schiffenbauer, Lisa G. Rider, Raquel Campanilho‐Marques, Lucian T. Marts, Elena Bravi, Harsha Gunawardena, Rohit Aggarwal, Lorenzo Cavagna, the Classification Criteria for Anti‐Synthetase Syndrome Project participating investigators
Abstract
OBJECTIVE: Anti-synthetase syndrome (ASSD) is a rare systemic autoimmune rheumatic disease (SARD) with significant heterogeneity and no shared classification criteria. We aimed to identify clinical and serological features associated with ASSD that may be suitable for inclusion in the data-driven classification criteria for ASSD. METHODS: We used a large, international, multicenter "Classification Criteria for Anti-synthetase Syndrome" (CLASS) project database, which includes both patients with ASSD and controls with mimicking conditions, namely, SARDs and/or interstitial lung disease (ILD). The local diagnoses of ASSD and controls were confirmed by project team members. We employed univariable logistic regression and multivariable Ridge regression to evaluate clinical and serological features associated with an ASSD diagnosis in a randomly selected subset of the cohort. RESULTS: Our analysis included 948 patients with ASSD and 1,077 controls. Joint, muscle, lung, skin, and cardiac involvement were more prevalent in patients with ASSD than in controls. Specific variables associated with ASSD included arthritis, diffuse myalgia, muscle weakness, muscle enzyme elevation, ILD, mechanic's hands, secondary pulmonary hypertension due to ILD, Raynaud phenomenon, and unexplained fever. In terms of serological variables, Jo-1 and non-Jo-1 anti-synthetase autoantibodies, antinuclear antibodies with cytoplasmic pattern, and anti-Ro52 autoantibodies were associated with ASSD. In contrast, isolated arthralgia, dysphagia, electromyography/magnetic resonance imaging/muscle biopsy findings suggestive of myopathy, inflammatory rashes, myocarditis, and pulmonary arterial hypertension did not differentiate between patients with ASSD and controls or were inversely associated with ASSD. CONCLUSION: We identified key clinical and serological variables associated with ASSD, which will help clinicians and offer insights into the development of data-driven classification criteria for ASSD.