Spontaneous pneumomediastinum in anti-MDA5-positive dermatomyositis: Prevalence, risk factors, and prognosis
Authors' conclusion
Nearly one-tenth of patients with anti-MDA5+ DM develop SPM. Both CMV and fungal infections are risk factors for SPM occurrence. The development of SPM does not worsen the prognosis of anti-MDA5+ DM patients, and the intensification of IST does harm to the SPM prognosis.
Study context
- Population
- Patients with idiopathic inflammatory myopathy (IIM), including anti-MDA5+ DM patients384 anti-MDA5+ DM
- Participants
- 1,352 patients
- Exposure
- Anti-MDA5+ DM with spontaneous pneumomediastinum (SPM) vs without SPM
- SPMn = 36
- Outcome
- Prevalence of SPM in anti-MDA5+ DM
Main finding
As reported in the abstract
SPM
9.4 %
36
- Significantly higher than non-anti-MDA5+ DM and other IIM subtypes
- P all <0.001
Observational data: associations, not effects.
Further findings
- Time from anti-MDA5+ DM onset to SPM
- 5.5 · median · IQR 3.0–12.0 · months
- Short-term and long-term survival · comparable survival
- P = 0.236
Fever, dyspnea and pulmonary infection (incl. viral and fungal)
- Significantly higher frequency in SPM vs non-SPM
- P all < 0.05
Risk factors for SPM development
- Cytomegalovirus (CMV) and fungal infections independent risk factors for SPM
Mortality in SPM (non-survivors vs survivors)
- Non-survivors: lower peripheral lymphocyte count, higher LDH, more frequent intensification of IST
- Elevated LDH and intensification of IST independent risk factors for increased mortality
Original publication
Spontaneous pneumomediastinum in anti-MDA5-positive dermatomyositis: Prevalence, risk factors, and prognosis. Semin Arthritis Rheum. Published 3 January 2024. doi:10.
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