BRAIN and NERVE－神経研究の進歩76巻5号

2024年05月発行

増大特集 末梢神経・筋肉の自己免疫性・炎症性疾患ハンドブック

第2章　疾患各論

ARS抗体症候群

著者： 笹井(中嶋)蘭¹

所属機関： ¹京都大学大学院医学研究科臨床免疫学

ページ範囲：P.655 - P.659

文献概要

アミノアシルtRNA合成酵素（ARS）抗体は特発性炎症性筋疾患で最も高頻度な自己抗体で，合成酵素抗体症候群（ASyS）と呼ばれる臨床特徴（関節痛，筋炎，間質性肺疾患，発熱，レイノー減少，機械工の手）を呈しやすい。治療はステロイドに反応しやすいが，減量とともに再燃しやすく，慢性進行型の経過をたどる。治療にはステロイドを中心に，早期から免疫抑制薬を併用し継続する重要性が示唆されている。

参考文献

1）Nakashima R, Imura Y, Hosono Y, Seto M, Murakami A, et al: The multicenter study of a new assay for simultaneous detection of multiple anti-aminoacyl-tRNA synthetases in myositis and interstitial pneumonia. PLOS ONE 9: e85062, 2014［doi: 10.1371/journal.pone.0085062］

2）Betteridge Z, Gunawardena H, North J, Slinn J, McHugh N: Anti-synthetase syndrome: a new autoantibody to phenylalanyl transfer RNA synthetase (anti-Zo) associated with polymyositis and interstitial pneumonia. Rheumatology (Oxford) 46: 1005-1008, 2007

3）Hashish L, Trieu EP, Sadanandan P, Targoff IN: Identification of autoantibodies to tyrosyl-tRNA synthetase in dermatomyositis with features consistent with antisynthetase syndrome (abstract]. Arthritis Rheum 52: S312, 2005

4）Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, et al; International Myositis Classification Criteria Project consortium, The Euromyositis register and The Juvenile Dermatomyositis Cohort Biomarker Study and Repository (JDRG) (UK and Ireland): 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis 76: 1955-1964, 2017

5）Tanimoto K, Nakano K, Kano S, Mori S, Ueki H, et al: Classification criteria for polymyositis and dermatomyositis. J Rheumatol 22: 668-674, 1995

6）Hamaguchi Y, Fujimoto M, Matsushita T, Kaji K, Komura K, et al: Common and distinct clinical features in adult patients with anti-aminoacyl-tRNA synthetase antibodies: heterogeneity within the syndrome. PLOS ONE 8: e60442, 2013［doi: 10.1371/journal.pone.0060442］

7）Yoshifuji H, Fujii T, Kobayashi S, Imura Y, Fujita Y, et al: Anti-aminoacyl-tRNA synthetase antibodies in clinical course prediction of interstitial lung disease complicated with idiopathic inflammatory myopathies. Autoimmunity 39: 233-241, 2006

8）Connors GR, Christopher-Stine L, Oddis CV, Danoff SK: Interstitial lung disease associated with the idiopathic inflammatory myopathies: what progress has been made in the past 35 years? Chest 138: 1464-1474, 2010

9）Solomon J, Swigris JJ, Brown KK: Myositis-related interstitial lung disease and antisynthetase syndrome. J Bras Pneumol 37: 100-109, 2011

10）Huang K, Aggarwal R: Antisynthetase syndrome: a distinct disease spectrum. J Scleroderma Relat Disord 5: 178-191, 2020

11）Cavagna L, Nuño L, Scirè CA, Govoni M, Longo FJ, et al; AENEAS (American and European NEtwork of Antisynthetase Syndrome) Collaborative Group: Serum Jo-1 autoantibody and isolated arthritis in the antisynthetase syndrome: review of the literature and report of the experience of AENEAS Collaborative Group. Clin Rev Allergy Immunol 52: 71-80, 2017

12）Mescam-Mancini L, Allenbach Y, Hervier B, Devilliers H, Mariampillay K, et al: Anti-Jo-1 antibody-positive patients show a characteristic necrotizing perifascicular myositis. Brain 138: 2485-2492, 2015

13）Aouizerate J, De Antonio M, Bassez G, Gherardi RK, Berenbaum F, et al: Myofiber HLA-DR expression is a distinctive biomarker for antisynthetase-associated myopathy. Acta Neuropathol Commun 2: 154, 2014［doi: 10.1186/s40478-014-0154-2］

14）Rigolet M, Hou C, Baba Amer Y, Aouizerate J, Periou B, et al: Distinct interferon signatures stratify inflammatory and dysimmune myopathies. RMD Open 5: e000811, 2019［doi: 10.1136/rmdopen-2018-000811］

15）Nakazawa M, Kaneko Y, Takeuchi T: Risk factors for the recurrence of interstitial lung disease in patients with polymyositis and dermatomyositis: a retrospective cohort study. Clin Rheumatol 37: 765-771, 2018

16）Cavagna L, Trallero-Araguás E, Meloni F, Cavazzana I, Rojas-Serrano J, et al: Influence of antisynthetase antibodies specificities on antisynthetase syndrome clinical spectrum time course. J Clin Med 8: 2013, 2019［doi: 10.3390/jcm8112013］

17）Tanizawa K, Handa T, Nakashima R, Kubo T, Hosono Y, et al: The long-term outcome of interstitial lung disease with anti-aminoacyl-tRNA synthetase antibodies. Respir Med 127: 57-64, 2017

18）Hozumi H, Fujisawa T, Nakashima R, Yasui H, Suzuki Y, et al: Efficacy of glucocorticoids and calcineurin inhibitors for anti-aminoacyl-tRNA synthetase antibody-positive polymyositis/dermatomyositis-associated interstitial lung disease: a propensity score-matched analysis. J Rheumatol 46: 509-517, 2019

19）Takei R, Yamano Y, Kataoka K, Yokoyama T, Matsuda T, et al: Predictive factors for the recurrence of anti-aminoacyl-tRNA synthetase antibody-associated interstitial lung disease. Respir Investig 58: 83-90, 2020

20）Kohsaka H, Mimori T, Kanda T, Shimizu J, Sunada Y, et al: Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists, neurologists and dermatologists. Mod Rheumatol 29: 1-19, 2019

21）Kondoh Y, Makino S, Ogura T, Suda T, Tomioka H, et al; joint committee of Japanese Respiratory Society and Japan College of Rheumatology: 2020 guide for the diagnosis and treatment of interstitial lung disease associated with connective tissue disease. Respir Investig 59: 709-740, 2021

22）Fujisawa T: Management of myositis-associated interstitial lung disease. Medicina (Kaunas) 57: 347, 2021［doi: 10.3390/medicina57040347］

23）Aggarwal R, Bandos A, Reed AM, Ascherman DP, Barohn RJ, et al: Predictors of clinical improvement in rituximab-treated refractory adult and juvenile dermatomyositis and adult polymyositis. Arthritis Rheumatol 66: 740-749, 2014

24）Müller F, Boeltz S, Knitza J, Aigner M, Völkl S, et al: CD19-targeted CAR T cells in refractory antisynthetase syndrome. Lancet 401: 815-818, 2023

25）Wells AU, Flaherty KR, Brown KK, Inoue Y, Devaraj A, et al; INBUILD trial investigators: Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial. Lancet Respir Med 8: 453-460, 2020

26）Liang J, Cao H, Yang Y, Ke Y, Yu Y, et al: Efficacy and tolerability of nintedanib in idiopathic-inflammatory-myopathy-related interstitial lung disease: a pilot study. Front Med (Lausanne) 8: 626953, 2021［doi: 10.3389/fmed.2021.626953］