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Published in: Journal of Translational Medicine 1/2019

Open Access 01-12-2019 | Systemic Lupus Erythematosus | Research

Correlation of PMN elastase and PMN elastase-to-neutrophil ratio with disease activity in patients with myositis

Authors: Siyu Wu, Wanchan Peng, Yunli Zhang, Jingjing Guo, Jinfang Fu, Wei Wang

Published in: Journal of Translational Medicine | Issue 1/2019

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Abstract

Background

Polymorphonuclear (PMN) elastase plays an important role in a variety of inflammatory disorders. Our aim was to analyse PMN elastase in idiopathic inflammatory myopathies (IIMs) and its association with disease activity.

Methods

PMN elastase levels were measured using enzyme-linked immunosorbent assay in serum samples obtained from 74 patients with myositis (58 with dermatomyositis [DM] and 16 with polymyositis [PM]) and 22 healthy controls. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminant capacity of PMN elastase level and PMN elastase-to-neutrophil ratio (ENR) in patients with active and remission myositis. The association of serum PMN elastase level and ENR with disease variables was evaluated in patients with IIMs. The disease specificity of PMN elastase level and ENR was further examined in 60 patients with other systemic autoimmune diseases.

Results

PMN elastase level and ENR were significantly higher in patients with active IIMs, DM, and PM than in patients with remission. ROC curve analysis revealed that PMN elastase level and ENR both outperformed creatine kinase (CK), the currently used laboratory marker, and strongly discriminated patients with active disease and those with remission of IIMs, DM, and PM (area under the ROC curve [AUC] 0.9, 0.9, and 0.88 for PMN elastase; AUC 0.96, 0.96, and 1.0 for ENR; AUC 0.72, 0.70, and 0.80 for CK, respectively). PMN elastase level and ENR were positively correlated with myositis disease activity assessment, CK, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, and erythrocyte sedimentation rate. PMN elastase level and ENR were higher in the anti-PM-Scl positive myositis group than those in the anti-PM-Scl negative myositis group. Nevertheless, PMN elastase was not a specific disease marker for IIMs when compared with other autoimmune diseases.

Conclusions

PMN elastase, particularly ENR, were significantly correlated with disease activity and could serve as useful biochemical markers for evaluating the disease activity of patients with IIMs. Thus, they are potentially helpful in monitoring disease progression and guiding treatment.
Literature
1.
go back to reference Dalakas MC, Sivakumar K. The immunopathologic and inflammatory differences between dermatomyositis, polymyositis and sporadic inclusion body myositis. Curr Opin Neurol. 1996;9(3):235–9.PubMedCrossRef Dalakas MC, Sivakumar K. The immunopathologic and inflammatory differences between dermatomyositis, polymyositis and sporadic inclusion body myositis. Curr Opin Neurol. 1996;9(3):235–9.PubMedCrossRef
2.
go back to reference Rayavarapu S, Coley W, Kinder TB, Nagaraju K. Idiopathic inflammatory myopathies: pathogenic mechanisms of muscle weakness. Skelet Muscle. 2013;3(1):13.PubMedPubMedCentralCrossRef Rayavarapu S, Coley W, Kinder TB, Nagaraju K. Idiopathic inflammatory myopathies: pathogenic mechanisms of muscle weakness. Skelet Muscle. 2013;3(1):13.PubMedPubMedCentralCrossRef
3.
go back to reference Luo YB, Mastaglia FL. Dermatomyositis, polymyositis and immune-mediated necrotising myopathies. Biochim Biophys Acta. 2015;1852(4):622–32.PubMedCrossRef Luo YB, Mastaglia FL. Dermatomyositis, polymyositis and immune-mediated necrotising myopathies. Biochim Biophys Acta. 2015;1852(4):622–32.PubMedCrossRef
4.
go back to reference Gao S, Luo H, Zhang H, Zuo X, Wang L, Zhu H. Using multi-omics methods to understand dermatomyositis/polymyositis. Autoimmun Rev. 2017;16(10):1044–8.PubMedCrossRef Gao S, Luo H, Zhang H, Zuo X, Wang L, Zhu H. Using multi-omics methods to understand dermatomyositis/polymyositis. Autoimmun Rev. 2017;16(10):1044–8.PubMedCrossRef
5.
go back to reference Rider LG. Assessment of disease activity and its sequelae in children and adults with myositis. Curr Opin Rheumatol. 1996;8(6):495–506.PubMedCrossRef Rider LG. Assessment of disease activity and its sequelae in children and adults with myositis. Curr Opin Rheumatol. 1996;8(6):495–506.PubMedCrossRef
6.
go back to reference Volochayev R, Csako G, Wesley R, Rider LG, Miller FW. Laboratory test abnormalities are common in polymyositis and dermatomyositis and differ among clinical and demographic groups. Open Rheumatol J. 2012;6:54–63.PubMedPubMedCentralCrossRef Volochayev R, Csako G, Wesley R, Rider LG, Miller FW. Laboratory test abnormalities are common in polymyositis and dermatomyositis and differ among clinical and demographic groups. Open Rheumatol J. 2012;6:54–63.PubMedPubMedCentralCrossRef
7.
go back to reference Rider LG, Werth VP, Huber AM, Alexanderson H, Rao AP, Ruperto N, Herbelin L, Barohn R, Isenberg D, Miller FW. Measures of adult and juvenile dermatomyositis, polymyositis, and inclusion body myositis: physician and Patient/Parent Global Activity, Manual Muscle Testing (MMT), Health Assessment Questionnaire (HAQ)/Childhood Health Assessment Questionnaire (C-HAQ), Childhood Myositis Assessment Scale (CMAS), Myositis Disease Activity Assessment Tool (MDAAT), Disease Activity Score (DAS), Short Form 36 (SF-36), Child Health Questionnaire (CHQ), physician global damage, Myositis Damage Index (MDI), Quantitative Muscle Testing (QMT), Myositis Functional Index-2 (FI-2), Myositis Activities Profile (MAP), Inclusion Body Myositis Functional Rating Scale (IBMFRS), Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI), Cutaneous Assessment Tool (CAT), Dermatomyositis Skin Severity Index (DSSI), Skindex, and Dermatology Life Quality Index (DLQI). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S118–57.PubMedPubMedCentralCrossRef Rider LG, Werth VP, Huber AM, Alexanderson H, Rao AP, Ruperto N, Herbelin L, Barohn R, Isenberg D, Miller FW. Measures of adult and juvenile dermatomyositis, polymyositis, and inclusion body myositis: physician and Patient/Parent Global Activity, Manual Muscle Testing (MMT), Health Assessment Questionnaire (HAQ)/Childhood Health Assessment Questionnaire (C-HAQ), Childhood Myositis Assessment Scale (CMAS), Myositis Disease Activity Assessment Tool (MDAAT), Disease Activity Score (DAS), Short Form 36 (SF-36), Child Health Questionnaire (CHQ), physician global damage, Myositis Damage Index (MDI), Quantitative Muscle Testing (QMT), Myositis Functional Index-2 (FI-2), Myositis Activities Profile (MAP), Inclusion Body Myositis Functional Rating Scale (IBMFRS), Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI), Cutaneous Assessment Tool (CAT), Dermatomyositis Skin Severity Index (DSSI), Skindex, and Dermatology Life Quality Index (DLQI). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S118–57.PubMedPubMedCentralCrossRef
8.
go back to reference Aggarwal R, Rider LG, Ruperto N, Bayat N, Erman B, Feldman BM, Oddis CV, Amato AA, Chinoy H, Cooper RG, et al. 2016 American College of Rheumatology/European League Against Rheumatism Criteria for Minimal, Moderate, and Major Clinical Response in Adult Dermatomyositis and Polymyositis: an International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatol. 2017;69(5):898–910.PubMedPubMedCentralCrossRef Aggarwal R, Rider LG, Ruperto N, Bayat N, Erman B, Feldman BM, Oddis CV, Amato AA, Chinoy H, Cooper RG, et al. 2016 American College of Rheumatology/European League Against Rheumatism Criteria for Minimal, Moderate, and Major Clinical Response in Adult Dermatomyositis and Polymyositis: an International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatol. 2017;69(5):898–910.PubMedPubMedCentralCrossRef
9.
go back to reference Bellutti Enders F, van Wijk F, Scholman R, Hofer M, Prakken BJ, van Royen-Kerkhof A, de Jager W. Correlation of CXCL10, tumor necrosis factor receptor type II, and galectin 9 with disease activity in juvenile dermatomyositis. Arthritis Rheumatol. 2014;66(8):2281–9.PubMedCrossRef Bellutti Enders F, van Wijk F, Scholman R, Hofer M, Prakken BJ, van Royen-Kerkhof A, de Jager W. Correlation of CXCL10, tumor necrosis factor receptor type II, and galectin 9 with disease activity in juvenile dermatomyositis. Arthritis Rheumatol. 2014;66(8):2281–9.PubMedCrossRef
10.
go back to reference Wienke J, Bellutti Enders F, Lim J, Mertens JS, van den Hoogen LL, Wijngaarde CA, Yeo JG, Meyer A, Otten HG, Fritsch-Stork RDE, et al. Galectin-9 and CXCL10 as biomarkers for disease activity in juvenile dermatomyositis: a longitudinal cohort study and multicohort validation. Arthritis Rheumatol. 2019;71(8):1377–90.PubMedCrossRef Wienke J, Bellutti Enders F, Lim J, Mertens JS, van den Hoogen LL, Wijngaarde CA, Yeo JG, Meyer A, Otten HG, Fritsch-Stork RDE, et al. Galectin-9 and CXCL10 as biomarkers for disease activity in juvenile dermatomyositis: a longitudinal cohort study and multicohort validation. Arthritis Rheumatol. 2019;71(8):1377–90.PubMedCrossRef
11.
go back to reference Andres Cerezo L, Hulejova H, Sumova B, Kropackova T, Krystufkova O, Klein M, Mann HF, Zamecnik J, Pecha O, Pavelka K, et al. Pro-inflammatory S100A11 is elevated in inflammatory myopathies and reflects disease activity and extramuscular manifestations in myositis. Cytokine. 2019;116:13–20.PubMedCrossRef Andres Cerezo L, Hulejova H, Sumova B, Kropackova T, Krystufkova O, Klein M, Mann HF, Zamecnik J, Pecha O, Pavelka K, et al. Pro-inflammatory S100A11 is elevated in inflammatory myopathies and reflects disease activity and extramuscular manifestations in myositis. Cytokine. 2019;116:13–20.PubMedCrossRef
12.
go back to reference Zhou H, Wang Y, Bi K, Qi H, Song S, Zhou M, Chen L, Wang G, Duan T. Serum-soluble TRAIL: a potential biomarker for disease activity in myositis patients. Clin Rheumatol. 2019;38(5):1425–31.PubMedCrossRef Zhou H, Wang Y, Bi K, Qi H, Song S, Zhou M, Chen L, Wang G, Duan T. Serum-soluble TRAIL: a potential biomarker for disease activity in myositis patients. Clin Rheumatol. 2019;38(5):1425–31.PubMedCrossRef
13.
go back to reference Gao MZ, Wei YY, Xu QW, Ji R, Han ZJ, Jiang TW. Elevated serum YKL-40 correlates with clinical characteristics in patients with polymyositis or dermatomyositis. Ann Clin Biochem. 2019;56(1):95–9.PubMedCrossRef Gao MZ, Wei YY, Xu QW, Ji R, Han ZJ, Jiang TW. Elevated serum YKL-40 correlates with clinical characteristics in patients with polymyositis or dermatomyositis. Ann Clin Biochem. 2019;56(1):95–9.PubMedCrossRef
14.
go back to reference Yang Y, Liu Y, Huang L, Wang L, Liu K, Liu M, Luo H, Zuo X, Li Y, Zhang H. Clinical features and cytokine profile in myositis patients with anti-EJ autoantibodies detected by a novel immunoprecipitation assay. Biomed Res Int. 2019;2019:1856180.PubMedPubMedCentral Yang Y, Liu Y, Huang L, Wang L, Liu K, Liu M, Luo H, Zuo X, Li Y, Zhang H. Clinical features and cytokine profile in myositis patients with anti-EJ autoantibodies detected by a novel immunoprecipitation assay. Biomed Res Int. 2019;2019:1856180.PubMedPubMedCentral
15.
go back to reference Korkmaz B, Horwitz MS, Jenne DE, Gauthier F. Neutrophil elastase, proteinase 3, and cathepsin G as therapeutic targets in human diseases. Pharmacol Rev. 2010;62(4):726–59.PubMedPubMedCentralCrossRef Korkmaz B, Horwitz MS, Jenne DE, Gauthier F. Neutrophil elastase, proteinase 3, and cathepsin G as therapeutic targets in human diseases. Pharmacol Rev. 2010;62(4):726–59.PubMedPubMedCentralCrossRef
16.
go back to reference Muley MM, Reid AR, Botz B, Bolcskei K, Helyes Z, McDougall JJ. Neutrophil elastase induces inflammation and pain in mouse knee joints via activation of proteinase-activated receptor-2. Br J Pharmacol. 2016;173(4):766–77.PubMedCrossRef Muley MM, Reid AR, Botz B, Bolcskei K, Helyes Z, McDougall JJ. Neutrophil elastase induces inflammation and pain in mouse knee joints via activation of proteinase-activated receptor-2. Br J Pharmacol. 2016;173(4):766–77.PubMedCrossRef
17.
go back to reference Langhorst J, Elsenbruch S, Koelzer J, Rueffer A, Michalsen A, Dobos GJ. Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol. 2008;103(1):162–9.PubMedCrossRef Langhorst J, Elsenbruch S, Koelzer J, Rueffer A, Michalsen A, Dobos GJ. Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol. 2008;103(1):162–9.PubMedCrossRef
18.
go back to reference Langhorst J, Boone J, Lauche R, Rueffer A, Dobos G. Faecal lactoferrin, calprotectin, PMN-elastase, CRP, and white blood cell count as indicators for mucosal healing and clinical course of disease in patients with mild to moderate ulcerative colitis: post hoc analysis of a prospective clinical trial. J Crohns Colitis. 2016;10(7):786–94.PubMedCrossRef Langhorst J, Boone J, Lauche R, Rueffer A, Dobos G. Faecal lactoferrin, calprotectin, PMN-elastase, CRP, and white blood cell count as indicators for mucosal healing and clinical course of disease in patients with mild to moderate ulcerative colitis: post hoc analysis of a prospective clinical trial. J Crohns Colitis. 2016;10(7):786–94.PubMedCrossRef
19.
go back to reference Kawabata K, Hagio T, Matsuoka S. The role of neutrophil elastase in acute lung injury. Eur J Pharmacol. 2002;451(1):1–10.PubMedCrossRef Kawabata K, Hagio T, Matsuoka S. The role of neutrophil elastase in acute lung injury. Eur J Pharmacol. 2002;451(1):1–10.PubMedCrossRef
20.
go back to reference Orem A, Deger O, Cimsit G, Bahadir S. Plasma polymorphonuclear leukocyte elastase levels and its relation to disease activity in psoriasis. Clin Chim Acta. 1997;264(1):49–56.PubMedCrossRef Orem A, Deger O, Cimsit G, Bahadir S. Plasma polymorphonuclear leukocyte elastase levels and its relation to disease activity in psoriasis. Clin Chim Acta. 1997;264(1):49–56.PubMedCrossRef
21.
go back to reference Shioya Y, Katakura K, Ohira H. Neutrophil elastase inhibitor suppresses IL-17 based inflammation of murine experimental colitis. Fukushima J Med Sci. 2014;60(1):14–21.PubMedCrossRef Shioya Y, Katakura K, Ohira H. Neutrophil elastase inhibitor suppresses IL-17 based inflammation of murine experimental colitis. Fukushima J Med Sci. 2014;60(1):14–21.PubMedCrossRef
22.
go back to reference Ferreira AV, Perelshtein I, Perkas N, Gedanken A, Cunha J, Cavaco-Paulo A. Detection of human neutrophil elastase (HNE) on wound dressings as marker of inflammation. Appl Microbiol Biotechnol. 2017;101(4):1443–54.PubMedCrossRef Ferreira AV, Perelshtein I, Perkas N, Gedanken A, Cunha J, Cavaco-Paulo A. Detection of human neutrophil elastase (HNE) on wound dressings as marker of inflammation. Appl Microbiol Biotechnol. 2017;101(4):1443–54.PubMedCrossRef
23.
go back to reference Gao S, Zuo X, Liu D, Xiao Y, Zhu H, Zhang H, Luo H. The roles of neutrophil serine proteinases in idiopathic inflammatory myopathies. Arthritis Res Ther. 2018;20(1):134.PubMedPubMedCentralCrossRef Gao S, Zuo X, Liu D, Xiao Y, Zhu H, Zhang H, Luo H. The roles of neutrophil serine proteinases in idiopathic inflammatory myopathies. Arthritis Res Ther. 2018;20(1):134.PubMedPubMedCentralCrossRef
24.
go back to reference Gao S, Zhu H, Yang H, Zhang H, Li Q, Luo H. The role and mechanism of cathepsin G in dermatomyositis. Biomed Pharmacother. 2017;94:697–704.PubMedCrossRef Gao S, Zhu H, Yang H, Zhang H, Li Q, Luo H. The role and mechanism of cathepsin G in dermatomyositis. Biomed Pharmacother. 2017;94:697–704.PubMedCrossRef
25.
go back to reference Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975;292(7):344–7.PubMedCrossRef Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975;292(7):344–7.PubMedCrossRef
26.
go back to reference Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med. 1975;292(8):403–7.PubMedCrossRef Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med. 1975;292(8):403–7.PubMedCrossRef
27.
go back to reference Isenberg DA, Allen E, Farewell V, Ehrenstein MR, Hanna MG, Lundberg IE, Oddis C, Pilkington C, Plotz P, Scott D, et al. International consensus outcome measures for patients with idiopathic inflammatory myopathies Development and initial validation of myositis activity and damage indices in patients with adult onset disease. Rheumatology (Oxford). 2004;43(1):49–54.CrossRef Isenberg DA, Allen E, Farewell V, Ehrenstein MR, Hanna MG, Lundberg IE, Oddis C, Pilkington C, Plotz P, Scott D, et al. International consensus outcome measures for patients with idiopathic inflammatory myopathies Development and initial validation of myositis activity and damage indices in patients with adult onset disease. Rheumatology (Oxford). 2004;43(1):49–54.CrossRef
28.
go back to reference Shu XM, Lu X, Xie Y, Wang GC. Clinical characteristics and favorable long-term outcomes for patients with idiopathic inflammatory myopathies: a retrospective single center study in China. BMC Neurol. 2011;11:143.PubMedPubMedCentralCrossRef Shu XM, Lu X, Xie Y, Wang GC. Clinical characteristics and favorable long-term outcomes for patients with idiopathic inflammatory myopathies: a retrospective single center study in China. BMC Neurol. 2011;11:143.PubMedPubMedCentralCrossRef
29.
go back to reference Yee CS, Farewell VT, Isenberg DA, Griffiths B, Teh LS, Bruce IN, Ahmad Y, Rahman A, Prabu A, Akil M, et al. The use of Systemic Lupus Erythematosus Disease Activity Index-2000 to define active disease and minimal clinically meaningful change based on data from a large cohort of systemic lupus erythematosus patients. Rheumatology (Oxford). 2011;50(5):982–8.CrossRef Yee CS, Farewell VT, Isenberg DA, Griffiths B, Teh LS, Bruce IN, Ahmad Y, Rahman A, Prabu A, Akil M, et al. The use of Systemic Lupus Erythematosus Disease Activity Index-2000 to define active disease and minimal clinically meaningful change based on data from a large cohort of systemic lupus erythematosus patients. Rheumatology (Oxford). 2011;50(5):982–8.CrossRef
30.
go back to reference Valentini G, Iudici M, Walker UA, Jaeger VK, Baron M, Carreira P, Czirjak L, Denton CP, Distler O, Hachulla E, et al. The European Scleroderma Trials and Research group (EUSTAR) task force for the development of revised activity criteria for systemic sclerosis: derivation and validation of a preliminarily revised EUSTAR activity index. Ann Rheum Dis. 2017;76(1):270–6.PubMedCrossRef Valentini G, Iudici M, Walker UA, Jaeger VK, Baron M, Carreira P, Czirjak L, Denton CP, Distler O, Hachulla E, et al. The European Scleroderma Trials and Research group (EUSTAR) task force for the development of revised activity criteria for systemic sclerosis: derivation and validation of a preliminarily revised EUSTAR activity index. Ann Rheum Dis. 2017;76(1):270–6.PubMedCrossRef
31.
go back to reference Fleischmann RM, van der Heijde D, Gardiner PV, Szumski A, Marshall L, Bananis E. DAS28-CRP and DAS28-ESR cut-offs for high disease activity in rheumatoid arthritis are not interchangeable. RMD Open. 2017;3(1):e000382.PubMedPubMedCentralCrossRef Fleischmann RM, van der Heijde D, Gardiner PV, Szumski A, Marshall L, Bananis E. DAS28-CRP and DAS28-ESR cut-offs for high disease activity in rheumatoid arthritis are not interchangeable. RMD Open. 2017;3(1):e000382.PubMedPubMedCentralCrossRef
32.
go back to reference Owen CA, Campbell EJ. The cell biology of leukocyte-mediated proteolysis. J Leukoc Biol. 1999;65(2):137–50.PubMedCrossRef Owen CA, Campbell EJ. The cell biology of leukocyte-mediated proteolysis. J Leukoc Biol. 1999;65(2):137–50.PubMedCrossRef
33.
go back to reference Momohara S, Kashiwazaki S, Inoue K, Saito S, Nakagawa T. Elastase from polymorphonuclear leukocyte in articular cartilage and synovial fluids of patients with rheumatoid arthritis. Clin Rheumatol. 1997;16(2):133–40.PubMedCrossRef Momohara S, Kashiwazaki S, Inoue K, Saito S, Nakagawa T. Elastase from polymorphonuclear leukocyte in articular cartilage and synovial fluids of patients with rheumatoid arthritis. Clin Rheumatol. 1997;16(2):133–40.PubMedCrossRef
34.
go back to reference Hara T, Ogawa F, Yanaba K, Iwata Y, Muroi E, Komura K, Takenaka M, Shimizu K, Hasegawa M, Fujimoto M, et al. Elevated serum concentrations of polymorphonuclear neutrophilic leukocyte elastase in systemic sclerosis: association with pulmonary fibrosis. J Rheumatol. 2009;36(1):99–105.PubMedCrossRef Hara T, Ogawa F, Yanaba K, Iwata Y, Muroi E, Komura K, Takenaka M, Shimizu K, Hasegawa M, Fujimoto M, et al. Elevated serum concentrations of polymorphonuclear neutrophilic leukocyte elastase in systemic sclerosis: association with pulmonary fibrosis. J Rheumatol. 2009;36(1):99–105.PubMedCrossRef
35.
go back to reference Lundberg IE, Tjarnlund A, Bottai M, Werth VP, Pilkington C, Visser M, Alfredsson L, Amato AA, Barohn RJ, Liang MH, et al. 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. 2017;76(12):1955–64.PubMedPubMedCentralCrossRef Lundberg IE, Tjarnlund A, Bottai M, Werth VP, Pilkington C, Visser M, Alfredsson L, Amato AA, Barohn RJ, Liang MH, et al. 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. 2017;76(12):1955–64.PubMedPubMedCentralCrossRef
36.
go back to reference Zhang L, Wu G, Gao D, Liu G, Pan L, Ni L, Li Z, Wang Q. Factors associated with interstitial lung disease in patients with polymyositis and dermatomyositis: a systematic review and meta-analysis. PLoS ONE. 2016;11(5):e0155381.PubMedPubMedCentralCrossRef Zhang L, Wu G, Gao D, Liu G, Pan L, Ni L, Li Z, Wang Q. Factors associated with interstitial lung disease in patients with polymyositis and dermatomyositis: a systematic review and meta-analysis. PLoS ONE. 2016;11(5):e0155381.PubMedPubMedCentralCrossRef
37.
go back to reference Lazarevic D, Pistorio A, Palmisani E, Miettunen P, Ravelli A, Pilkington C, Wulffraat NM, Malattia C, Garay SM, Hofer M, et al. The PRINTO criteria for clinically inactive disease in juvenile dermatomyositis. Ann Rheum Dis. 2013;72(5):686–93.PubMedCrossRef Lazarevic D, Pistorio A, Palmisani E, Miettunen P, Ravelli A, Pilkington C, Wulffraat NM, Malattia C, Garay SM, Hofer M, et al. The PRINTO criteria for clinically inactive disease in juvenile dermatomyositis. Ann Rheum Dis. 2013;72(5):686–93.PubMedCrossRef
38.
go back to reference Almeida B, Campanilho-Marques R, Arnold K, Pilkington CA, Wedderburn LR, Nistala K. Juvenile dermatomyositis research g analysis of published criteria for clinically inactive disease in a large juvenile dermatomyositis cohort shows that skin disease is underestimated. Arthritis Rheumatol. 2015;67(9):2495–502.PubMedPubMedCentralCrossRef Almeida B, Campanilho-Marques R, Arnold K, Pilkington CA, Wedderburn LR, Nistala K. Juvenile dermatomyositis research g analysis of published criteria for clinically inactive disease in a large juvenile dermatomyositis cohort shows that skin disease is underestimated. Arthritis Rheumatol. 2015;67(9):2495–502.PubMedPubMedCentralCrossRef
39.
go back to reference Needham M, Mastaglia FL. Immunotherapies for immune-mediated myopathies: a current perspective. Neurotherapeutics. 2016;13(1):132–46.PubMedCrossRef Needham M, Mastaglia FL. Immunotherapies for immune-mediated myopathies: a current perspective. Neurotherapeutics. 2016;13(1):132–46.PubMedCrossRef
Metadata
Title
Correlation of PMN elastase and PMN elastase-to-neutrophil ratio with disease activity in patients with myositis
Authors
Siyu Wu
Wanchan Peng
Yunli Zhang
Jingjing Guo
Jinfang Fu
Wei Wang
Publication date
01-12-2019

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