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Inclusion body myopathy in Primary Sjögren's syndrome: clinical and histopathological features in relation to sporadic inclusion body myositis
Linköping University, Department of Neuroscience and Locomotion, Neurology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002.3555-7162
Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Inclusion body myositis (IBM) is a chronic, acquired inflammatory myopathy with typical clinical symptoms and characteristic histopathological features in muscle biopsy. However, there are still uncertainties in diagnostic criteria, implying that disorders of potentially different origin may be classified as IBM. In particular, muscle biopsy findings of vacuolar myopathy in Sjögren's syndrome have indicated an association with IBM, and so far vacuolar Sjögren myopathy is included in the IBM entity.

We therefore compared clinical and histopathological features in a group of patients with sporadic-IBM (s-IBM, n=11) with a group of patients with primary Sjögren's syndrome (pSS) with IBM-like findings in their muscle biopsies (n=10). Biopsies from s-IBM but not from Sjögren patients stained for Congo-red, whereas no other obvious differences were fonnd concerning morphological or biochemical fmdings of vacuolar content (hyperphosphorylated tau-protein: SMI 31 and SMI 310, ubiquitin, tau-protein, ß-amyloid, ß-amyloid precursor protein). Striking differences were fonnd in the clinical picture, age of onset and gender preponderance (females in pSS and males in s-IBM).

Based on the different clinical features and the difference in Congo-red staining, we suggest that vacuolar myopathy in pSS should be regarded as a separate entity, not to be included in the classical s-IBM group. IBM-like fmdings in muscle biopsy are observed in different types of systemic inflammatory diseases, and could preferably be designated as autoimmune associated IBM (a-IBM).

National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-81623OAI: diva2:553419
Available from: 2012-09-19 Created: 2012-09-19 Last updated: 2013-10-25Bibliographically approved
In thesis
1. Immunohistological studies on muscle biopsies: clinical and pathogenetic aspects on inflammatory myopathies
Open this publication in new window or tab >>Immunohistological studies on muscle biopsies: clinical and pathogenetic aspects on inflammatory myopathies
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Inflammatory myopathies constitute a heterogeneous group of disorders comprising polymyositis (PM), dermatomyositis (DM), inclusion body myositis (IBM), as well as overlap syndromes where inflammatory myopathy is associated with different inflammatory systemic diseases, e.g, Sjögren's syndrome. Immunohistochemical methods are increasingly used in the diagnostic evaluation of muscle biopsies, as well as in the search for pathogenetic mechanisms in neuromuscular diseases. The aim of the present thesis was to evaluate immunological markers in the context of diagnostic use and pathogenetic mechanisms in patients with inflammatory myopathies (IM).

In the first paper, the expression of inflammatory markers was investigated in muscle biopsies from 58 healthy subjects, since no large studies on normal expression have been reported previously. MHC class I stained capillaries but not muscle fibres. No capillary or muscle fibre staining was found of MHC class II, complement activation marker MAC, or the regeneration marker neonatal myosin heavy chain, whereas the adhesion molecule ICAM-I was constitutively expressed on capillary endothelial cells. The expression was similar in morphologically completely normal muscle biopsies obtained from clinical routine, justifying the use of such biopsies as normal reference, although some caution is warranted because of individuals with higher expression of inflammatory markers.

Adhesion molecules regulate cell to cell interactions, e.g. they are involved in recruiting cells into inflammatory lesions in muscles. In a group of consecutive patients (n=22) with inflammatory infiltrates pairs of adhesion molecules were examined on infiltrating cells and vascular endothelial cells. VLA-4, known to be important in chronic inflammation, was found to be expressed mostly on infiltrating cells in definite PM, whereas LFA-1 was expressed in all types of IM. These findings suggest a diagnostic potential of the LFA-1/VLA-4 ratio, and a role for VLA-4/VCAM-1 in the pathogenesis of PM.

In a large study of patients (n=48) with primary Sjögren's syndrome (pSS), we described muscle histology and immunohistochemical findings in relation to muscle pain (n=36), a common complaint of patients with pSS. Morphological changes, as perivascular inflammation was common in pSS. A surprisingly high proportion of patients displayed IBM-Iike changes, such as rimmed vacuoles, inflammation and atrophic fibres. Immunohistochemically, MHC class I and MAC showed increased expression, but no single finding showed any relation to muscle pain. MAC expression indicates a role for complement activation in pSS associated myositis.

The finding of IBM-Iike changes in pSS, resulted in a subsequent comparative study of cytoplasmic and vacuolar proteins in classical IBM and pSS. Although more frequently found in IBM, the same vacuolar proteins were found in muscle biopsies from patients with pSS. Clinical symptoms differed between IBM and pSS associated myositis, indicating that these diseases represent different entities. The similarity in histological findings suggests that non-specific mechanisms may operate and lead to the same end result. We therefore propose that vacuolar myositis in pSS should be regarded as a separate entity, different from classical IBM and suggest the term aIBM (autoimmune associated) for patients with IBM-Iike changes and associated autoimmune disease.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2002. 90 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 760
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-26662 (URN)11228 (Local ID)91-7373-200-1 (ISBN)11228 (Archive number)11228 (OAI)
Public defence
2002-12-07, Berzeliussalen, Hälsouniversitet, Linköping, 10:15 (Swedish)


Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-19Bibliographically approved

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