Anti-SAE autoantibody in dermatomyositis: original comparative study and review of the literature

Rheumatology (Oxford). 2023 Dec 1;62(12):3932-3939. doi: 10.1093/rheumatology/kead154.


Objective: Among specific autoantibodies in DM, the anti-small ubiquitin-like modifier activating enzyme (SAE) antibody is rare. We aim to describe the clinical characteristics, cancer prevalence, and muscle pathology of anti-SAE-positive DM.

Methods: Patients with a diagnosis of DM and sera positive for the anti-SAE antibody were recruited from 19 centres in this retrospective observational study. The available muscular biopsies were reviewed. We conducted a comparison with anti-SAE-negative DM and a review of the literature.

Results: Of the patients in the study (n = 49), 84% were women. Skin involvement was typical in 96% of patients, with 10% having calcinosis, 18% ulceration and 12% necrosis; 35% presented with a widespread skin rash. Muscular disease affected 84% of patients, with mild weakness [Medical Research Council (MRC) scale 4 (3, 5)], although 39% of patients had dysphagia. Muscular biopsies showed typical DM lesions. Interstitial lung disease was found in 21% of patients, mainly with organizing pneumonia pattern, and 26% of patients showed dyspnoea. Cancer-associated myositis was diagnosed in 16% of patients and was responsible for the majority of deaths, its prevalence being five times that of the general population. IVIG therapy was administered to 51% of the patients during the course of the disease. Comparison with anti-SAE-negative DM (n = 85) showed less and milder muscle weakness (P = 0.02 and P = 0.006, respectively), lower creatinine kinase levels (P < 0.0001) and less dyspnoea (P = 0.003).

Conclusion: Anti-SAE positive DM is a rare subgroup associated with typical skin features but a potentially diffuse rash, a mild myopathy. Interstitial lung disease defines an organizing pneumonia pattern. Cancer associated DM prevalence is five times that of the general population.

Trial registration:,, NCT04637672.

Keywords: DM; cancer; interstitial lung disease; myositis; small ubiquitin-like modifier activating enzyme.

Publication types

  • Review

MeSH terms

  • Autoantibodies
  • Dermatomyositis* / complications
  • Dyspnea
  • Exanthema* / epidemiology
  • Female
  • Humans
  • Lung Diseases, Interstitial* / complications
  • Lung Diseases, Interstitial* / epidemiology
  • Male
  • Myositis* / diagnosis
  • Neoplasms* / complications
  • Neoplasms* / epidemiology
  • Observational Studies as Topic
  • Ubiquitin-Activating Enzymes


  • Autoantibodies
  • Ubiquitin-Activating Enzymes

Associated data