Top

Published in:

01-12-2014 | Pediatric Rheumatology (S Ozen, Section Editor)

The Presentation, Assessment, Pathogenesis, and Treatment of Calcinosis in Juvenile Dermatomyositis

Authors: Mark F. Hoeltzel, Edward J. Oberle, Angela Byun Robinson, Arunima Agarwal, Lisa G. Rider

Published in: Current Rheumatology Reports | Issue 12/2014

Abstract

Calcinosis is one of the hallmark sequelae of juvenile dermatomyositis (JDM), and despite recent progress in the therapy of JDM, dystrophic calcification still occurs in approximately one third of patients. This review discusses our current, albeit limited, understanding of risk factors for the development of calcinosis in JDM, as well as approaches to assessment, and current views on its pathogenesis. Anecdotal approaches to treating calcinosis associated with JDM, including both anti-inflammatory therapies and agents aimed at inhibiting the deposition of calcium hydroxyapatite, are reviewed. An improved understanding of the pathogenesis of calcinosis, the establishment of standardized measurement tools to assess calcinosis, and randomized controlled trials employing more sensitive outcome measures are needed to develop efficacious therapies for this often disabling complication.

Rider LG, Lindsley C, Miller FW. Chapter 26: juvenile dermatomyositis. In Textbook of pediatric rheumatology, 6th edition, Ed Petty R, Laxer R. Wedderburn L, Lindsley C. Saunders Elsevier. 2014. In press.

Bohan A, Peter JB. Polymyositis and dermatomyositis. N Engl J Med. 1975;292(344–7):403–7.PubMed

Rider LG. Calcinosis in juvenile dermatomyositis: pathogenesis and current therapies. Pediatr Rheumatol Online J. 2003;1:2.

Ramanan AV, Feldman BM. Clinical features and outcomes of juvenile dermatomyositis and other childhood onset myositis syndromes. Rheum Dis Clin N Am. 2002;28(4):833–58.

Fisler RE, Liang MG, Fuhlbrigge RC, et al. Aggressive management of juvenile dermatomyositis results in improved outcome and decreased incidence of calcinosis. J Am Acad Dermatol. 2002;47(4):505–11.PubMed

Sanner H, Gran JT, Sjaastad I, Flato B. Cumulative organ damage and prognostic factors in juvenile dermatomyositis: a cross-sectional study median 16.8 years after symptom onset. Rheumatology. 2009;48:1541–7.PubMed

Sato JO, Sallum AM, Ferriani VP, et al. A Brazilian registry of juvenile dermatomyositis: onset features and classification of 189 cases. Clin Exp Rheumatol. 2009;27:1031–8.PubMed

Ravelli A, Trail L, Ferrari C, et al. Long-term outcome and prognostic factors of juvenile dermatomyositis: a multinational, multicenter study of 490 patients. Arthritis Care Res. 2010;62(1):63.

Mathiesen P, Hegaard H, Herlin T, et al. Long-term outcome in patients with juvenile dermatomyositis: a cross-sectional follow-up study. Scand J Rheumatol. 2012;41(1):50–8.PubMed

10.

McCann LJ, Juggins AD, Maillard SM, et al. The Juvenile Dermatomyositis National Registry and Repository (UK and Ireland)—clinical characteristics of children recruited within the first 5 yr. Rheumatology (Oxford). 2006;45(10):1255–60.

11.•

Robinson AB, Hoeltzel MF, Wahezi DM, et al. Clinical characteristics of children with juvenile dermatomyositis: the Childhood Arthritis and Rheumatology Research Alliance Registry. Arthritis Care Res. 2014;66(3):404–10. Description of a cross-section of an ongoing registry that collected a cohort of 384 patients with JDM across 55 pediatric rheumatology centers across the USA over 2 years. Includes demographic data, disease characteristics, and functional and quality of life measures. Provides an important infrastructure for future clinical and translational research in this disease.

12.

Shah M, Mamyrova G, Targoff IN, et al. Childhood Myositis Heterogeneity Collaborative Study Group. The clinical phenotypes of the juvenile idiopathic inflammatory myopathies. Medicine (Baltimore). 2013;92(1):25–41.

13.

Rider LG, Lachenbruch PA, Monroe JB, IMACS Group, et al. Damage extent and predictors in adult and juvenile dermatomyositis and polymyositis as determined with the myositis damage index. Arthritis Rheum. 2009;60(11):3425–35.PubMedCentralPubMed

14.

Clemente G, Piotto DG, Barbosa C, et al. High frequency of calcinosis in juvenile dermatomyositis: a risk factor study. Rev Bras Reumatol. 2012;52(4):549–53.PubMed

15.

Walsh JS, Fairley JA. Calcifying disorders of the skin. J Am Acad Dermatol. 1995;33(5Pt 1):693–706.PubMed

16.••

Balin SJ, Wetter DA, Andersen LK, Davis MD. Calcinosis cutis occurring in association with autoimmune connective tissue disease: the Mayo Clinic experience with 78 patients, 1996–2009. Arch Dermatol. 2012;148(4):455–62. Large series of calcinosis associated with a number of systemic autoimmune diseases, including description of the locations and subtypes of lesions. Also discusses treatment responses, finding diltiazem and surgical resection to be most successful in this series of patients.PubMed

17.

Guseinova D, Consolaro A, Trail L, et al. Comparison of clinical features and drug therapies among European and Latin American patients with juvenile dermatomyositis. Clin Exp Rheumatol. 2011;29(1):117–24.PubMed

18.

Efthimiou P, Kukar M, Kagen LJ. Images in rheumatology. Severe adult-onset calcinosis in a patient with a history of juvenile dermatomyositis. J Rheumatol. 2010;37(1):194.PubMed

19.

Blane CE, White SJ, Braunstein EM, Bowyer SL, Sullivan DB. Patterns of calcification in childhood dermatomyositis. Am J Roentgenol. 1984;142(2):397–400.

20.

Douvoyiannis M, Litman N, Dulau A, Ilowite NT. Panniculitis, infection, and dermatomyositis: case and literature review. Clin Rheumatol. 2009;28 Suppl 1:S57–63.PubMed

21.

Marie I, Menard JF, Hachulla E, et al. Infectious complications in polymyositis and dermatomyositis: a series of 279 patients. Semin Arthritis Rheum. 2011;41(1):48–60.PubMed

22.

Miyamae T, Mori M, Inamo Y, et al. Multi-center analysis of calcinosis in children with juvenile dermatomyositis. Ryumachi. 2003;43(3):538–43.PubMed

23.

Pachman LM, Hayford JR, Chung A, et al. Juvenile dermatomyositis at diagnosis: clinical characteristics of 79 children. J Rheumatol. 1998;25(6):1198–204.PubMed

24.

Mathiesen PR, Zak M, Herlin T, Nielsen SM. Clinical features and outcome in a Danish cohort of juvenile dermatomyositis patients. Clin Exp Rheumatol. 2010;28(5):782–9.PubMed

25.

Sallum AM, Pivato FC, Doria-Filho U, et al. Risk factors associated with calcinosis of juvenile dermatomyositis. J Pediatr (Rio J). 2008;84(1):68–74.

26.•

Ceribelli A, Fredi M, Taraborelli M, et al. Anti-MJ/NXP-2 autoantibody specificity in a cohort of adult Italian patients with polymyositis/dermatomyositis. Arthritis Res Ther. 2012;14(2):R97. Italian adult DM/PM cohort that describes the prevalence of anti-MJ autoantibodies to be 20 % in adult DM and 8 % in adult PM. Anti-MJ autoantibodies are associated with calcinosis in 30 % of patients and also associated with younger age of onset, heliotrope rash (i.e., DM), and less frequent interstitial lung disease.PubMedCentralPubMed

27.

Gunawardena H, Wedderburn LR, Chinoy H, et al. Juvenile Dermatomyositis Research Group, UK and Ireland. Autoantibodies to a 140-kd protein in juvenile dermatomyositis are associated with calcinosis. Arthritis Rheum. 2009;60(6):1807–14.PubMedCentralPubMed

28.

Sugiura K, Muro Y, Akiyama M. Autoantibodies to nuclear matrix protein 2/MJ in adult-onset dermatomyositis with severe calcinosis. J Am Acad Dermatol. 2012;67(4):e167–8.PubMed

29.•

Tansley SL, Betteridge ZE, Shaddick G, et al; on behalf of the Juvenile Dermatomyositis Research Group. Calcinosis in juvenile dermatomyositis is influenced by both anti-NXP2 autoantibody status and age at disease onset. Rheumatology. 2014 Jul 1. Study from large UK JDM cohort that now defines younger age of disease onset and anti-NXP-2 autoantibodies in all age groups to be independently associated with the development of calcinosis in JDM.

30.

Rider LG, Shah M, Mamyrova G, Childhood Myositis Heterogeneity Collaborative Study Group, et al. The myositis autoantibody phenotypes of the juvenile idiopathic inflammatory myopathies. Medicine. 2013;92(4):223–43.PubMedCentralPubMed

31.

Marguerie C, Bunn CC, Copier J, et al. The clinical and immunogenetic features of patients with autoantibodies to the nucleolar antigen PM-Scl. Medicine (Baltimore). 1992;71(6):327–36.

32.•

Shimizu M, Ueno K, Ishikawa S, et al. Role of activated macrophage and inflammatory cytokines in the development of calcinosis in juvenile dermatomyositis. Rheumatology. 2014;53(4):766–7. Case report which finds many macrophages and some T lymphocytes in a surgically resected calcinosis lesion from a patients with JDM. Also detects large amounts of pro-inflammatory cytokines in draining calcinosis fluid.PubMed

33.

Pachman LM, Liotta-Davis MR, Hong DK, et al. TNFalpha-308A allele in juvenile dermatomyositis: association with increased production of tumor necrosis factor alpha, disease duration, and pathologic calcifications. Arthritis Rheum. 2000;43(10):2368–77.PubMed

34.

Mamyrova G, O’Hanlon TP, Sillers L, Childhood Myositis Heterogeneity Collaborative Study Group, et al. Cytokine gene polymorphisms as risk and severity factors for juvenile dermatomyositis. Arthritis Rheum. 2008;58(12):3941–50.PubMedCentralPubMed

35.

Tabarki B, Ponsot G, Prieur AM, Tardieu M. Childhood dermatomyositis: clinical course of 36 patients treated with low doses of corticosteroids. Eur J Pediatr Neurol. 1998;2(4):205–11.

36.

Bingham A, Mamyrova G, Rother KI, Childhood Myositis Heterogeneity Study Group, et al. Cytokine gene polymorphisms as risk and severity factors for juvenile dermatomyositis. Arthritis Rheum. 2008;58(12):3941–50.

37.

Hoeltzel MF, Becker ML, Robinson AB, et al. Race is a risk factor for calcinosis in patients with JDM—early results from the CARRAnet Registry study. Pediatr Rheumatol Online J. 2012;10 Suppl 1:A65.PubMedCentral

38.•

Faller G, Mistry BJ, Tikly M. Juvenile dermatomyositis in South African children is characterised by frequent dystrophic calcification: a cross sectional study. Pediatr Rheumatol Online J. 2014;12(1):2. In a small South African cohort of JDM patients, 29 % presented with calcinosis at the time of diagnosis, but the cumulative frequency of calcinosis was quite high (71 %). Calcinosis was strongly associated with vasculitic skin rashes, lower serum creatine kinase levels, and Staphylococcus aureus skin infections.PubMedCentralPubMed

39.•

Shahi V, Wetter DA, Howe BM, et al. Plain radiography is effective for the detection of calcinosis cutis is occurring in association with autoimmune connective tissue disease. Br J Dermatol. 2014;170(5):1073–9. A study of plain radiography detected calcinosis in all patients examined; thus, plain radiography is recommended for initial screening of calcinosis. Patients were primarily adults and had a number of different autoimmune diseases, including dermatomyositis, scleroderma, and overlap connective tissue disease.PubMed

40.

Bar-Sever Z, Mukamel M, Harel L, Hardoff R. Scintigraphic evaluation of calcinosis in juvenile dermatomyositis with Tc-9m MDP. Clin Nucl Med. 2000;25(12):1013–6.PubMed

41.

Agarwal V, Sachdev A, Dabra AK. Case 104: calcinosis in juvenile dermatomyositis. Radiology. 2007;242(1):307–11.PubMed

42.

Kimball AB, Summers RM, Turner M, et al. Magnetic resonance imaging detection of occult skin and subcutaneous abnormalities in juvenile dermatomyositis. Implications for diagnosis and therapy. Arthritis Rheum. 2000;43(8):1866–73.PubMed

43.

Yassaee M, Fiorentino D, Okawa J, et al. Modification of the cutaneous dermatomyositis disease area and severity index, an outcome instrument. Br J Dermatol. 2010;162(3):669–73.PubMedCentralPubMed

44.

Reiter N, El-Shabrawi L, Leinweber B, et al. Calcinosis cutis: part I. Diagnostic pathway. J Am Acad Dermatol. 2011;65(1):1–12.PubMed

45.

Robertson LP, Marshall RW, Hickling P. Treatment of cutaneous calcinosis in limited systemic sclerosis with minocycline. Ann Rheum Dis. 2003;62(3):267–9.PubMedCentralPubMed

46.

Chander S, Gordon P. Soft tissue and subcutaneous calcification in connective tissue diseases. Curr Opin Rheumatol. 2012;24(2):158–64.PubMed

47.

Rothe MJ, Grant-Kels JM, Rothfield NF. Extensive calcinosis cutis with systemic lupus erythematosus. Arch Dermatol. 1990;126(8):1060–3.PubMed

48.

Farrow EG, Imel EA, White KE. Hyperphosphatemic familial tumoral calcinosis (FGF23, GALNT3, αKlotho). Best Pract Res Clin Rheumatol. 2011;25(5):735–47.PubMedCentralPubMed

49.

Pignolo RJ, Shore EM, Kaplan FS. Fibrodysplasia ossificans progressiva: diagnosis, management, and therapeutic horizons. Pediatr Endocrinol Rev. 2013;10 Suppl 2:437–48.PubMedCentralPubMed

50.

McCarthy EF, Sundaram M. Heterotopic ossification: a review. Skelet Radiol. 2005;34:609–19.

51.

Collins MT, Boehm M. It ANKH necessarily so. J Clin Endocrinol Metab. 2011;96(1):72–4.PubMedCentralPubMed

52.

Boulman N, Slobodin G, Rozenbaum M, Rosner I. Calcinosis in rheumatic diseases. Semin Arthritis Rheum. 2005;34(6):805–12.PubMed

53.

Mukamel M, Horev G, Mimouni M. New insight into calcinosis of juvenile dermatomyositis: a study of composition and treatment. J Pediatr. 2001;138(5):763–6.PubMed

54.

Miyamae T, Sano F, Ozawa R, et al. Efficacy of thalidomide in a girl with inflammatory calcinosis, a severe complication of juvenile dermatomyositis. Pediatr Rheumatol Online J. 2010;8(1):6.PubMedCentralPubMed

55.

Marhaug G, Shah V, Shroff R, et al. Age-dependent inhibition of ectopic calcification: a possible role for fetuin-A and osteopontin in patients with juvenile dermatomyositis with calcinosis. Rheumatology (Oxford). 2008;47(7):1031–7.

56.

Nielsen AO, Johnson E, Hentzer B, Kobayasi T. Dermatomyositis with calcinosis universalis: a histopathological and electron optic study. J Cutan Pathol. 1979;6(6):486–91.PubMed

57.

Kawakami T, Nakamura C, Hasegawa H, et al. Ultrastructural study of calcinosis universalis with dermatomyositis. J Cutan Pathol. 1986;13(2):135–43.PubMed

58.

Magid D, Fishman EK, Siegelman SS. Dermatomyositis with calcinosis cutis. Case report 317. Skelet Radiol. 1985;14(2):126–31.

59.

Olszak IT, Poznansky MC, Evans RH, et al. Extracellular calcium elicits a chemokinetic response from monocytes in vitro and in vivo. J Clin Invest. 2000;105(9):1299–305.PubMedCentralPubMed

60.

Pachman LM, Veis A, Stock S, et al. Composition of calcifications in children with juvenile dermatomyositis: association with chronic cutaneous inflammation. Arthritis Rheum. 2006;54(10):3345–50.PubMedCentralPubMed

61.

Eidelman N, Boyde A, Bushby AJ, et al. Microstructure and mineral composition of dystrophic calcification associated with the idiopathic inflammatory myopathies. Arthritis Res Ther. 2009;11(5):R159.PubMedCentralPubMed

62.

Urganus AL, Zhao YD, Pachman LM. Juvenile dermatomyositis calcifications selectively displayed markers of bone formation. Arthritis Rheum. 2009;61(4):501–8.PubMedCentralPubMed

63.

van Summeren MJH, Spliet WG, Royen-Kerkhof A, et al. Calcinosis in juvenile dermatomyositis: a possible role for the vitamin K-dependent protein matrix Gla protein. Rheumatology (Oxford). 2008;47(3):267–71.

64.

Robey PG. Vertebrate mineralized matrix proteins: structure and function. Connect Tissue Res. 1996;35(1–4):131–6.PubMed

65.

Boskey AL. Matrix proteins and mineralization: an overview. Connect Tissue Res. 1996;35(1–4):357–63.PubMed

66.

Pachman LM, Boskey AL. Clinical manifestations and pathogenesis of hydroxyapatite crystal deposition in juvenile dermatomyositis. Curr Rheumatol Rep. 2006;8(3):236–43.PubMed

67.

Steitz SA, Speer MY, McKee MD, et al. Osteopontin inhibits mineral deposition and promotes regression of ectopic calcification. Am J Pathol. 2002;161(6):2035–46.PubMedCentralPubMed

68.

Gutierrez Jr A, Wetter DA. Calcinosis cutis in autoimmune connective tissue diseases. Dermatol Ther. 2012;25(2):195–206.PubMed

69.

Dalakas MC. Images in clinical medicine. Calcifications in dermatomyositis. N Engl J Med. 1995;333(15):978.PubMed

70.

Schanz S, Ulmer A, Fierlbeck G. Response of dystrophic calcification to intravenous immunoglobulin. Arch Dermatol. 2008;144(5):585–7.PubMed

71.

Shahani L. Refractory calcinosis in a patient with dermatomyositis: response to intravenous immune globulin. BMJ Case Rep. 2012;published online 20 Aug 2012.

72.

Peñate Y, Guillermo N, Melwani P, et al. Calcinosis cutis associated with amyopathic dermatomyositis: response to intravenous immunoglobulin. J Am Acad Dermatol. 2009;60(6):1076–7.PubMed

73.

Touimy M, Janani S, Rachidi W, et al. Calcinosis universalis complicating juvenile dermatomyositis: improvement after intravenous immunoglobulin therapy. Joint Bone Spine. 2013;80(1):108–9.PubMed

74.

Kalajian AH, Perryman JH, Callen JP. Intravenous immunoglobulin therapy for dystrophic calcinosis cutis: unreliable in our hands. Arch Dermatol. 2009;145(3):334.PubMed

75.

Riley P, McCann LJ, Maillard SM, et al. Effectiveness of infliximab in the treatment of refractory juvenile dermatomyositis with calcinosis. Rheumatology (Oxford). 2008;47(6):877–80.

76.

Boulter EL, Beard L, Ryder C, Pilkington C. Effectiveness of anti-tumor necrosis factor-agents in the treatment of refractory juvenile dermatomyositis. Arthritis Rheum. 2011;63(suppl):S795.

77.•

Arabshahi B, Silverman RA, Jones OY, Rider LG. Abatacept and sodium thiosulfate for treatment of recalcitrant juvenile dermatomyositis complicated by ulceration and calcinosis. J Pediatr. 2012;160(3):520–2. Case report that describes improvement in severe calcinosis in a JDM patient following use of abatacept in combination with topical and intravenous sodium thiosulfate therapy. Cutaneous ulcerations also healed.PubMedCentralPubMed

78.•

Daoussis D, Antonopoulos I, Liossis SN, et al. Treatment of systemic sclerosis-associated calcinosis: a case report of rituximab-induced regression of CREST-related calcinosis and review of the literature. Semin Arthritis Rheum. 2012;41(6):822–9. Case report of improvement in calcinosis associated with systemic sclerosis following rituximab therapy and provides a review of therapies for calcinosis.PubMed

79.

de Paula DR, Klem FB, Lorencetti PG, et al. Rituximab-induced regression of CREST-related calcinosis. Clin Rheumatol. 2013;32(2):281–3.PubMed

80.

Hurabielle C, Allanore Y, Kahan A, Avouac J. Flare of calcinosis despite rituximab therapy. Semin Arthritis Rheum. 2014; Apr 13.

81.

Oddis CV, Reed AM, Aggarwal R, et al. RIM Study Group. Rituximab in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. Arthritis Rheum. 2013;65(2):314–24.PubMedCentralPubMed

82.

Al-Mayouf SM, Alsonbul A, Alismail K. Localized calcinosis in juvenile dermatomyositis: successful treatment with intralesional corticosteroids injection. Int J Rheum Dis. 2010;13(3):e26–8.PubMed

83.

Manukyan G, Petrek M, Tomankova T, et al. Colchicine modulates expression of pro-inflammatory genes in neutrophils from patients with familial Mediterranean fever and healthy subjects. J Biol Regul Homeost Agents. 2013;27(2):329–36.PubMed

84.

Taborn J, Bole GG, Thompson GR. Colchicine suppression of local and systemic inflammation due to calcinosis universalis in chronic dermatomyositis. Ann Intern Med. 1978;8(5 Pt 1):648–9.

85.

Fuchs D, Fruchter L, Fishel B, et al. Colchicine suppression of local inflammation due to calcinosis in dermatomyositis and progressive systemic sclerosis. Clin Rheumatol. 1986;5(4):527–30.PubMed

86.

Terroso G, Bernardes M, Aleixo A, et al. Therapy of calcinosis universalis complicating adult dermatomyositis. Acta Reumatol Port. 2013;38(1):44–8.PubMed

87.

Oliveri MB, Palermo R, Mautalen C, Hubscher O. Regression of calcinosis during diltiazem treatment in juvenile dermatomyositis. J Rheumatol. 1996;23(12):2152–5.PubMed

88.

Vayssairat M, Hidouche D, Abdoucheli-Baudot N, Gaitz JP. Clinical significance of subcutaneous calcinosis in patients with systemic sclerosis. Does diltiazem induce its regression? Ann Rheum Dis. 1998;57(4):252–4.PubMedCentralPubMed

89.

Okamoto M, Yamanaka S, Yoshimoto W, Shigematsu T. Alendronate as an effective treatment for bone loss and vascular calcification in kidney transplant recipients. J Transpl. 2014;2014:269613.

90.

Silverman SL. Bisphosphonate use in conditions other than osteoporosis. Ann N Y Acad Sci. 2011;1218:33–7.PubMed

91.

Shoemaker LR. Expanding role of bisphosphonate therapy in children. J Pediatr. 1999;134(3):264–7.PubMed

92.

Luckman SP, Coxon FP, Ebetino FH, et al. Heterocycle-containing bisphosphonates cause apoptosis and inhibit bone resorption by preventing protein prenylation: evidence from structure-activity relationships in J774 macrophages. J Bone Miner Res. 1998;13(11):1668–78.PubMed

93.

Van Gelder JM, Breuer E, Ornoy A, et al. Anticalcification and antiresorption effects of bisacylphosphonates. Bone. 1995;16(5):511–20.PubMed

94.

Ylitalo R. Bisphosphonates and atherosclerosis. Gen Pharmacol. 2002;35(6):287–96.

95.

Apschner A, Huitema LF, Ponsioen B, et al. Zebrafish enpp1 mutants exhibit pathological mineralization, mimicking features of generalized arterial calcification of infancy (GACI) and pseudoxanthoma elasticum (PXE). Dis Model Mech. 2014;7(7):811–22.PubMedCentralPubMed

96.

Slimani S, Abdessemed A, Haddouche A, Ladjouze-Rezig A. Complete resolution of universal calcinosis in a patient with juvenile dermatomyositis using pamidronate. Joint Bone Spine. 2010;77(1):70–2.PubMed

97.

Marco Puche A, Calvo Penades I, Lopez MB. Effectiveness of the treatment with intravenous pamidronate in calcinosis in juvenile dermatomyositis. Clin Exp Rheumatol. 2010;28(1):135–40.PubMed

98.

Ambler GR, Chaitow J, Rogers M, et al. Rapid improvement of calcinosis in juvenile dermatomyositis with alendronate therapy. J Rheumatol. 2005;32(9):1837–9.PubMed

99.

Van Gelder JM, Breuer E, Schlossman A, et al. In vitro and in vivo effects of tetrakisphosphonates on bone resorption, tumor osteolysis, ectopic calcification, and macrophages. J Pharm Sci. 1997;86(3):283–9.PubMed

100.

Metzger AL, Singer FR, Bluestone R, Pearson CM. Failure of disodium etidronate in calcinosis due to dermatomyositis and scleroderma. N Engl J Med. 1974;291(24):1294–6.PubMed

101.

Tong PL, Yu LL, Chan JJ. Drug-induced dermatomyositis after zoledronic acid. Australas J Dermatol. 2012;53(4):e73–5.PubMed

102.

Apalla Z, Tzellos T, Lallas A, et al. Possible zoledronic acid-induced dermatomyositis. Clin Exp Dermatol. 2012;37(3):309–11.PubMed

103.

Schlieper G, Brandenburg V, Kettler M, Floege J. Sodium thiosulfate in the treatment of calcific uremic arteriolopathy. Nat Rev Nephrol. 2009;5(9):539–43.PubMed

104.

Raffaella C, Annapaola C, Tullio I, et al. Successful treatment of severe iatrogenic calcinosis cutis with intravenous sodium thiosulfate in a child affected by T-acute lymphoblastic leukemia. Pediatr Dermatol. 2009;26(3):311–5.PubMed

105.

Wolf EK, Smite AC, Layman AE. Topical sodium thiosulfate therapy for leg ulcers with dystrophic calcification. Arch Dermatol. 2008;144:1560–2.PubMed

106.

Amin N, Gonzalez E, Leber M, et al. Successful treatment of calcific uremic arteriolopathy in a pediatric dialysis patient. Pediatr Nephrol. 2010;25(2):357–62.PubMed

107.

Ratsimbazafy V, Bahans C, Guigonis V. Dramatic diminution of a large calcification treated with topical sodium thiosulfate. Arthritis Rheum. 2012;64(11):3826.PubMed

108.

Pagnini L, Simonini G, Giani T, et al. Sodium thiosulfate for the treatment of calcinosis secondary to juvenile dermatomyositis. Clin Exp Rheumatol. 2014;32(3):408–9.PubMed

109.

Aihara Y, Mori M, Ibe M, et al. A case of juvenile dermatomyositis with calcinosis universalis- remarkable improvement with aluminum hydroxide therapy. Ryumachi. 1994;34(5):879–84.PubMed

110.

Nakagawa T, Takaiwa T. Calcinosis cutis in juvenile dermatomyositis responsive to aluminum hydroxide treatment. J Dermatol. 1993;20(9):558–60.PubMed

111.

Wang WJ, Lo WL, Wong CK. Calcinosis cutis in juvenile dermatomyositis: remarkable response to aluminum hydroxide therapy. Arch Dermatol. 1988;124(11):1721–2.PubMed

112.

Nakamura H, Kawakami A, Ida H, et al. Efficacy of probenecid for a patient with juvenile dermatomyositis complicated with calcinosis. J Rheumatol. 2006;33(8):1691–3.PubMed

113.

Harel L, Harel G, Korenreich L, et al. Treatment of calcinosis in juvenile dermatomyositis with probenecid: the role of phosphorus metabolism in the development of calcifications. J Rheumatol. 2001;28(5):1129–32.PubMed

114.

Costello JC, Rosenthal AK, Kurup IV, et al. Parallel regulation of extracellular ATP and inorganic pyrophosphate: roles of growth factors, transduction modulators, and ANK. Connect Tissue Res. 2011;52(2):139–46.PubMed

115.

Vitale A, Delia G, La Torre F, et al. Massive gluteal calcinosis in a 10-year-old girl with juvenile dermatomyositis: successful surgical management. Plast Reconstr Surg. 2009;124(6):e456–8.

116.

Wu JJ, Metz BJ. Calcinosis cutis of juvenile dermatomyositis treated with incision and drainage. Dermatol Surg. 2008;34(4):575–7.PubMed

Title: The Presentation, Assessment, Pathogenesis, and Treatment of Calcinosis in Juvenile Dermatomyositis
Authors: Mark F. Hoeltzel
Edward J. Oberle
Angela Byun Robinson
Arunima Agarwal
Lisa G. Rider
Publication date: 01-12-2014
Publisher: Springer US
Published in: Current Rheumatology Reports / Issue 12/2014
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI: https://doi.org/10.1007/s11926-014-0467-y

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2014

Ongoing Developments in Sporadic Inclusion Body Myositis

Economics of Stratified Medicine in Rheumatoid Arthritis

Myositis Specific and Associated Autoantibodies in the Diagnosis and Management of Juvenile and Adult Idiopathic Inflammatory Myopathies

Amyopathic Dermatomyositis: Definitions, Diagnosis, and Management

Enthesitis-Related Arthritis: Time to Re-define?

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials