Cytokines in juvenile dermatomyositis pathophysiology: potential and challenge

Curr Opin Rheumatol. 2003 Nov;15(6):691-7. doi: 10.1097/00002281-200311000-00003.


Purpose of review: Cytokines are criticalmediators of the immune response. This review focuses on cytokine-specific information from children with juvenile dermatomyositis, and includes pertinent data from adults with polymyositis and dermatomyositis.

Recent findings: Much of the new data concern the role of possible antigens and the definition of genetic control of the immune response in juvenile dermatomyositis. Gene expression profile data of DQA1*0501 (present in 85% of patients) compared with age-matched control subjects show that the initial immune response is an interferon-alpha/beta-induced cascade with secondary stimulation of interferon-gamma. Specific epitopes of group A beta-hemolytic streptococcal M protein, with sequence homology for myosin, elicit both cell-mediated cytotoxicity and tumor necrosis factor-alpha production when incubated with mononuclear cells from children with active juvenile dermatomyositis. Tumor necrosis factor-alpha synthesis is increased in juvenile dermatomyositis patients with the tumor necrosis factor-alpha-308A allele, and is associated with increased thrombospondin-1 (an antiangiogenic agent) production and small vessel occlusion in untreated juvenile dermatomyositis. Studies in adults with polymyositis and dermatomyositis implicate interleukin-1alpha, transforming growth factor-beta, and endothelial cell perturbation early in the disease course. Cultured myoblasts were found to produce interleukin-15, which impacts local T-cell activation and proliferation.

Summary: The limited data suggest that a possible viral/microbial antigen may elicit an interferon-alpha/beta-induced response, and that antigenic epitopes may be shared. Increased synthesis of tumor necrosis factor-alpha, more common in juvenile dermatomyositis with the tumor necrosis factor-alpha-308A polymorphism, may augment this response and is associated with a wide range of pathologic consequences, as well as disease chronicity and calcifications. The muscle fibers themselves can regulate local inflammation by production of tumor necrosis factor-alpha, interleukin-15 and interleukin-1alpha, and transforming growth factor-beta.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Biomarkers / analysis
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cytokines / analysis
  • Cytokines / metabolism*
  • Dermatomyositis / etiology*
  • Dermatomyositis / physiopathology*
  • Female
  • Gene Expression
  • Humans
  • Interferon-alpha / genetics*
  • Interleukins / analysis
  • Male
  • Prognosis
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Tumor Necrosis Factor-alpha / analysis


  • Biomarkers
  • Cytokines
  • Interferon-alpha
  • Interleukins
  • Tumor Necrosis Factor-alpha