Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Reply to: Current classification criteria underestimate the incidence of idiopathic inflammatory myopathies by ignoring subgroups

Nature Reviews Rheumatology volume 20, pages 313–314 (2024)Cite this article

Subjects

Access through your institution
Buy or subscribe

We thank Giannini et al.1 for their response (Giannini, M. et al. Current classification criteria underestimate the incidence of idiopathic inflammatory myopathies by ignoring subgroups. Nat. Rev. Rheumatol. https://doi.org/10.1038/s41584-024-01105-9 (2024)) to our Review article (Epidemiology of the idiopathic inflammatory myopathies, Nat. Rev. Rheumatol. 19, 695–712 (2023))2, in which they make several observations of interest. As highlighted in our Review, accurate assessment of the epidemiology of idiopathic inflammatory myopathies (IIMs) is challenging, and is influenced by disease awareness, classification criteria and access to serological and/or histopathological testing2.

We concur with Giannini et al.1 that some IIM subgroups lack classification criteria. One such clinical subgroup is overlap myositis, which shares clinical features or autoantibodies with a further autoimmune connective tissue disease (CTD). In established cohorts, up to 27% of patients with IIM have been retrospectively reported to have overlap myositis3. The lack of cohorts dedicated to overlap myositis, and its absence from healthcare record diagnostic coding, such as the International Classification of Diseases (ICD), limits the assessment of the true epidemiology of this heterogeneous subgroup.

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Giannini, M. et al. Current classification criteria underestimate the incidence of idiopathic inflammatory myopathies by ignoring subgroups. Nat. Rev. Rheumatol. https://doi.org/10.1038/s41584-024-01105-9 (2024).

    Article  PubMed  Google Scholar 

  2. Khoo, T. et al. Epidemiology of the idiopathic inflammatory myopathies. Nat. Rev. Rheumatol. 19, 695–712 (2023).

    Article  PubMed  Google Scholar 

  3. Naveen, R., Rathore, U., Agarwal, V. & Gupta, L. Characteristics and outcomes of overlap myositis: a comparative multigroup cohort study in adults from the MyoCite cohort. Rheumatol. Int. 41, 551–563 (2021).

    Article  CAS  PubMed  Google Scholar 

  4. Dyball, S. et al. OP0013 Applying standard classificaton criteria excludes up to a half of all patients from connective tissue diseases (CTD) clinical trials. Ann. Rheum. Dis. 82, 9 (2023).

    Google Scholar 

  5. Lundberg, I. E. et al. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Arthritis Rheumatol. 69, 2271–2282 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zanframundo, G. et al. Defining anti-synthetase syndrome: a systematic literature review. Clin. Exp. Rheumatol. 40, 309–319 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Saygin, D. et al. Current myositis clinical trials and tribulations. Ann. Rheum. Dis. https://doi.org/10.1136/ard-2023-224652 (2024).

    Article  PubMed  Google Scholar 

  8. Hum, R. M. et al. Comparison of clinical features between patients with anti-synthetase syndrome and dermatomyositis: results from the MYONET registry. Rheumatology https://doi.org/10.1093/rheumatology/kead481 (2023).

    Article  PubMed  Google Scholar 

  9. Debrut, L. et al. Refining incidence and characteristics of inflammatory myopathies: a quadruple-source capture-recapture survey using the 2017 European League Against Rheumatism/American College of Rheumatology classification criteria. Arthritis Rheumatol 75, 1850–1855 (2023).

    Article  PubMed  Google Scholar 

  10. Tilling, K. Capture-recapture methods—useful or misleading? Int. J. Epidemiol. 30, 12–14 (2001).

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK

    Thomas Khoo, James B. Lilleker & Hector Chinoy

  2. School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia

    Thomas Khoo

  3. Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK

    Thomas Khoo & Hector Chinoy

  4. Manchester Centre for Clinical Neuroscience, Manchester Academic Health Science Centre, Salford Royal Hospital, Northern Care Alliance, NHS Foundation Trust, Salford, UK

    James B. Lilleker

  5. Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore

    Bernard Yu-Hor Thong

  6. Department of Medicine, Division of Rheumatology, McGill University, Montreal, Quebec, Canada

    Valérie Leclair

  7. Epidemiology and Public Health Group, School of Health Sciences, The University of Manchester, Manchester, UK

    Janine A. Lamb

Authors
  1. Thomas Khoo
    View author publications

    Search author on:PubMed Google Scholar

  2. James B. Lilleker
    View author publications

    Search author on:PubMed Google Scholar

  3. Bernard Yu-Hor Thong
    View author publications

    Search author on:PubMed Google Scholar

  4. Valérie Leclair
    View author publications

    Search author on:PubMed Google Scholar

  5. Janine A. Lamb
    View author publications

    Search author on:PubMed Google Scholar

  6. Hector Chinoy
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Hector Chinoy.

Ethics declarations

Competing interests

The authors declare no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khoo, T., Lilleker, J.B., Thong, B.YH. et al. Reply to: Current classification criteria underestimate the incidence of idiopathic inflammatory myopathies by ignoring subgroups. Nat Rev Rheumatol 20, 313–314 (2024). https://doi.org/10.1038/s41584-024-01106-8

Download citation

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41584-024-01106-8

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing