Autoimmune Polymyositis

Drugs can cause a wide variety of other autoimmune reactions. One example is myasthenia gravis, which is characterized by muscle weakness and is mediated by antibodies against the acetylcholine receptor at the neuromuscular junction. It has been reported in association with penicillamine [66], gold salts [67], and procainamide [68]. Another form of drug-induced autoimmunity is polymyositis, which is an autoimmune disease... 

Hepatotoxicity Penicillamine has been associated with a mild elevation of hepatic enzymes that usually returns to normal even with continuation of the drug. Autoimmune syndromes Autoimmune syndromes that may be caused by penicillamine include polymyositis, diffuse alveolitis and dermatomyositis, Goodpasture s syndrome, myasthenic syndrome, pemphigus, and obliterative bronchiolitis. 

The autoimmune rheumatic diseases consists of Rheumatoid Arthritis (RA), Spondylarthritis (SpA), Systemic Lupus Erythematosus (SLE), Polymyositis, Dermatomyositis, Polymyalgia Rheumatica, Acute Temporal Arteritis, Giant Cell Arteritis, Behcet s Disease, Sjorgren s Syndrome, Felty s Syndrome and Mixed Connective Tissue Disease (MCTD). Spondylarthritis (SpA) can be subdivided in Reactive Arthritis (ReA), Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), Arthritis associated with the inflammatory bowel diseases are Crohn s disease and Ulcerative Colitis (IBD), Undifferentiated SpA (UspA) and Sacro-ilitis, Juvenile SpA and Acute Anterior Uveitis (AAU). 

Immune system (allergic rhinitis, polymyositis, autoimmune diseases [systemic lupus erythmatosus], graft vs. host disease)... 

Autoimmune responses seem to be the underlying basis for a number of diseases, including rheumatoid arthritis, diabetes mellitus, myasthenia gravis, systemic lupus erythematosus, scleroderma, polymyositis/der-matomyositis, and several other disorders.25,27,44 As indicated previously, it is not exactly clear what factors cause autoimmune responses, as well as why certain individuals are more prone to autoimmune-related diseases. Nonetheless, drugs that suppress the immune system can limit damage to various other tissues, and these drugs may produce dramatic improvements in patients with diseases that are caused by an autoimmune response. 

Polymyositis has very rarely been associated with interferon alfa, but has been reported together with autoimmune thyroiditis in a 48-year-old woman after treatment for 5 months for malignant melanoma (349). 

Hypersensitivity reactions are frequent early in a course of penicillamine, with urticarial or maculopapular rashes, fever, and lymphadenopathy. Cross-allergy to penicillin can occur. In addition, the use of penicillamine can be complicated by a unique variety of often serious autoimmune reactions, involving the skin, kidneys, liver, lungs, muscles, or other organs. Proteinuria is found in more than 10% of patients and sometimes develops into the nephrotic syndrome. Pemphigus, myasthenia gravis, polymyositis, or a lupus-like syndrome occur in smaller percentages. 

In addition, several autoimmune reactions to penicillamine can secondarily affect pulmonary function. PeniciUamine-induced polymyositis (56) or myasthenia gravis can cause respiratory failure, even requiring ventilatory support (57). The diagnosis and management of lupus-induced pleurisy have been reviewed (58). 

Penicillamine can cause other serious autoimmune reactions involving the muscles dermatomyositis, with its characteristic facial rash (354), and polymyositis (56,95,96,321,355-366). 

A characteristic of some autoimmune disorders is the strong geographical variation. There seems to be a clear latitude gradient in incidence of autoimmune diseases, also indicating the effect of sun exposure. This is well known for multiple sclerosis but has now also been described for diabetes mellitus type 1 and polymyositis. A similar gradient is seen both north and south of the equator (Staples et al., 2003), with the incidence of these diseases rising as one moves away from the equator. In this situation, ultraviolet radiation would be protective against some autoimmune disorders (McMichael Hall, 1997 Ponsonby et al., 2005). 

Connective tissue diseases. Systemic autoimmune rheumatic diseases, including systemic lupus erythematosus, Sjogren syndrome, systemic sclerosis (scleroderma), autoimmune myositis (polymyositis, dermatomyositis), mixed connective tissue disease, and other overlapping syndromes. 

D-Penicillamine. A drug that is able to induce a variety of autoantibodies and autoimmune diseases (e.g. myasthenia gravis, polymyositis). Disease usually remits within one year after the medication is stopped. 

Mixed connective tissue disease (MCTD). Systemic autoimmune disease with features of systemic lupus erythematosus, systemic sclerosis, and dermatomyositis/polymyositis and high-titred autoantibodies against Ul-RNP specific proteins. See also myositis, autoimmune. 

Myositis, autoimmune. Rare systemic inflammatory myopathies, including primary polymyositis, primary dermatomyositis, myositis associated with malignancy, childhood dermatomyositis, and myositis with multisystem autoimmune disease (e.g. mixed connective tissue disease, systemic sclerosis). Autoantibodies against aminoacyl-tRNA synthetases (e.g. anti-Jo-1), signal recognition particle (e.g. anti-SRP54), nuclear helicase (anti-Mi-2), tRNA and tRNA-protein complexes (e.g. anti-Mas), and translation factor (anti-KJ) have been described as myositis specific. 

Raynaud phenomenon. Vasospastic condition characterized by acral circulatory disorders affecting the hands and feet. The symptoms can be triggered by cold, dampness, or emotional stress. Characteristic feature of systemic autoimmune diseases. Occurs in all or virtually all patients with systemic sclerosis, mixed connective tissue disease, and polymyositis/scleroderma overlap syndrome. 

Monzani et al, 1999). Fibromyalgia is known to be associated with hypothyroidism. Polymyositis-like syndrome has also been reported, but without the true autoimmune syndrome (Madariaga et al, 2002). Ocular disorder and neck extensor weakness have been reported, but are very rare indeed (Lo et al., 2003 Askmark et al, 2000). 

A case of autoimmune hepatitis was reported in a 57-year-old woman with a history of polymyositis, diabetes, high blood pressure, and obstructive sleep apnea. Medications being taken were labetalol, fosinopril, verapra-mil, metformin, insulin, aspirin, and aminosalicylic acid. The woman had been taking black cohosh (product and dose unspecified) for approximately 1 week (Cohen et al. 2004). 

Takada K, Nagasaka K, Miyasaka N. Polymyositis/dermatomyositis and interstitial lung disease a new therapeutic approach with T-ceU-specific immunosuppressants. Autoimmunity 2005 38 383-392. 

Unhke dermatomyositis and polymyositis, s-IBM is not usually associated with other systemic features such as interstitial lung disease or myocardial involvement. However, some s-IBM patients have another associated autoimmune disease such as Sjogren syndrome, systemic lupus erythematosus, scleroderma, rheumatoid arthritis, or thrombocytopenic purpura [17], and there are also rare reports of s-IBM developing in patients who have previously had dermatomyositis [18]. s-IBM has also been reported to be associated with HIV or human T-cell... 

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