Gender differences in patients with anti-MDA5-positive dermatomyositis: a cohort study of 251 cases
Objective To investigate the impact of sex differences on the clinical characteristics and prognosis of patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis (MDA5 + DM). Methods We retrospectively analyzed a cohort of 251 patients with MDA5 + DM, including 71 in the...
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| Veröffentlicht in: | Clinical rheumatology 2024, Vol.43 (1), p.339-347 |
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| creator | Cheng, Lu Xu, Lingxiao Xu, Yan Yuan, Fenghong Li, Ju Wu, Min Da, Zhanyun Wei, Hua Zhou, Lei Yin, Songlou Wu, Jian Lu, Yan Su, Dinglei Liu, Zhichun Liu, Lin Ma, Longxin Xu, Xiaoyan Liu, Huijie Ren, Tianli Zang, Yinshan |
| description | Objective
To investigate the impact of sex differences on the clinical characteristics and prognosis of patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis (MDA5
+
DM).
Methods
We retrospectively analyzed a cohort of 251 patients with MDA5
+
DM, including 71 in the male group and 180 in the female group. A multivariate logistic regression model was built to analyze independent risk factors for RPILD in each group. An ROC curve was drawn to evaluate the predictive value of independent risk factors. Kaplan‒Meier analysis was used to compare the cumulative survival rates, while the log-rank test was used to test for significant differences between the two groups.
Results
Patients in the male group had a significantly higher prevalence of heliotrope rash, V sign, severe interstitial lung disease (ILD), and rapidly progressive interstitial lung disease (RPILD) than those in the female group. Anti-Ro52 positivity, high CRP level and short disease were identified as independent risk factors for RPILD in both male and female groups by multivariate logistic regression analysis. The mortality rates of males and females were 33.8% and 22.0%, respectively, and the survival time of patients in the male group was shorter than that in the female group.
Conclusion
Male patients with MDA5
+
DM exhibit an increased risk of RPILD, elevated mortality rates and reduced overall survival time compared to their female counterparts, and anti-Ro52 positivity may be an unfavorable prognostic factor for these patients.
Key Points
•
The prevalence of solar rash, V sign, severe interstitial lung disease (ILD) and rapidly progressive interstitial lung disease (RPILD) in anti-MDA5-positive female patients was significantly lower than that in male patients.
•
Positive Anti-Ro52, high CRP level, and short course of disease were independent risk factors for RPILD in both men and women.
•
Female patients exhibited a lower mortality rate than male patients (22.0% vs 33.8%) and demonstrated longer survival time. |
| doi_str_mv | 10.1007/s10067-023-06816-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2892272474</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3153563627</sourcerecordid><originalsourceid>FETCH-LOGICAL-c408t-694db2e2546e17c7e3a62f060cbc11ee795d49ad4a2b00dc9fe12119aa1588f93</originalsourceid><addsrcrecordid>eNqFkU1vFSEUhonR2Gv1D7gwJG7coBw-B3dN1WpS40bXhMucsTR3hiswNfffi71VExe6gQSe9z2Bh5CnwF8C5_ZV7auxjAvJuBnAMH6PbEBJxZxT7j7ZcGs5k-CGE_Ko1mvOuRgcPCQn0rpBayk3JF7gMmKhY5omLLhErDQtdB9awqVV-j21KxqWltjHN2ea7XNNLd0g7Zk5tDwfbg_qaxpozFe5NFrbOh5onqjQQGOoWB-TB1PYVXxyt5-SL-_efj5_zy4_XXw4P7tkUfGhMePUuBUotDIINlqUwYiJGx63EQDROj0qF0YVxJbzMboJQQC4EEAPw-TkKXlx7N2X_G3F2vycasTdLiyY1-olaKmNNML-F-3_JIQVyqqOPv8Lvc5rWfpDvHAARgmwplPiSMWSay04-X1JcygHD9z_tOWPtny35W9ted5Dz-6q1-2M4-_ILz0dkEeg9qvlK5Y_s_9R-wPN3Z5U</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2911642176</pqid></control><display><type>article</type><title>Gender differences in patients with anti-MDA5-positive dermatomyositis: a cohort study of 251 cases</title><source>SpringerNature Complete Journals</source><creator>Cheng, Lu ; Xu, Lingxiao ; Xu, Yan ; Yuan, Fenghong ; Li, Ju ; Wu, Min ; Da, Zhanyun ; Wei, Hua ; Zhou, Lei ; Yin, Songlou ; Wu, Jian ; Lu, Yan ; Su, Dinglei ; Liu, Zhichun ; Liu, Lin ; Ma, Longxin ; Xu, Xiaoyan ; Liu, Huijie ; Ren, Tianli ; Zang, Yinshan</creator><creatorcontrib>Cheng, Lu ; Xu, Lingxiao ; Xu, Yan ; Yuan, Fenghong ; Li, Ju ; Wu, Min ; Da, Zhanyun ; Wei, Hua ; Zhou, Lei ; Yin, Songlou ; Wu, Jian ; Lu, Yan ; Su, Dinglei ; Liu, Zhichun ; Liu, Lin ; Ma, Longxin ; Xu, Xiaoyan ; Liu, Huijie ; Ren, Tianli ; Zang, Yinshan</creatorcontrib><description>Objective
To investigate the impact of sex differences on the clinical characteristics and prognosis of patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis (MDA5
+
DM).
Methods
We retrospectively analyzed a cohort of 251 patients with MDA5
+
DM, including 71 in the male group and 180 in the female group. A multivariate logistic regression model was built to analyze independent risk factors for RPILD in each group. An ROC curve was drawn to evaluate the predictive value of independent risk factors. Kaplan‒Meier analysis was used to compare the cumulative survival rates, while the log-rank test was used to test for significant differences between the two groups.
Results
Patients in the male group had a significantly higher prevalence of heliotrope rash, V sign, severe interstitial lung disease (ILD), and rapidly progressive interstitial lung disease (RPILD) than those in the female group. Anti-Ro52 positivity, high CRP level and short disease were identified as independent risk factors for RPILD in both male and female groups by multivariate logistic regression analysis. The mortality rates of males and females were 33.8% and 22.0%, respectively, and the survival time of patients in the male group was shorter than that in the female group.
Conclusion
Male patients with MDA5
+
DM exhibit an increased risk of RPILD, elevated mortality rates and reduced overall survival time compared to their female counterparts, and anti-Ro52 positivity may be an unfavorable prognostic factor for these patients.
Key Points
•
The prevalence of solar rash, V sign, severe interstitial lung disease (ILD) and rapidly progressive interstitial lung disease (RPILD) in anti-MDA5-positive female patients was significantly lower than that in male patients.
•
Positive Anti-Ro52, high CRP level, and short course of disease were independent risk factors for RPILD in both men and women.
•
Female patients exhibited a lower mortality rate than male patients (22.0% vs 33.8%) and demonstrated longer survival time.</description><identifier>ISSN: 0770-3198</identifier><identifier>EISSN: 1434-9949</identifier><identifier>DOI: 10.1007/s10067-023-06816-0</identifier><identifier>PMID: 37985533</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>cohort studies ; Dermatomyositis ; Exanthema ; Females ; Gender differences ; genes ; Heliotropium arborescens ; Lung diseases ; Males ; Medical prognosis ; Medicine ; Medicine & Public Health ; Melanoma ; Mortality ; Original Article ; prognosis ; Regression analysis ; respiratory tract diseases ; Rheumatology ; risk ; Risk factors ; Sex differences ; Survival</subject><ispartof>Clinical rheumatology, 2024, Vol.43 (1), p.339-347</ispartof><rights>The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR) 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-694db2e2546e17c7e3a62f060cbc11ee795d49ad4a2b00dc9fe12119aa1588f93</citedby><cites>FETCH-LOGICAL-c408t-694db2e2546e17c7e3a62f060cbc11ee795d49ad4a2b00dc9fe12119aa1588f93</cites><orcidid>0000-0001-6812-8930</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10067-023-06816-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10067-023-06816-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37985533$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cheng, Lu</creatorcontrib><creatorcontrib>Xu, Lingxiao</creatorcontrib><creatorcontrib>Xu, Yan</creatorcontrib><creatorcontrib>Yuan, Fenghong</creatorcontrib><creatorcontrib>Li, Ju</creatorcontrib><creatorcontrib>Wu, Min</creatorcontrib><creatorcontrib>Da, Zhanyun</creatorcontrib><creatorcontrib>Wei, Hua</creatorcontrib><creatorcontrib>Zhou, Lei</creatorcontrib><creatorcontrib>Yin, Songlou</creatorcontrib><creatorcontrib>Wu, Jian</creatorcontrib><creatorcontrib>Lu, Yan</creatorcontrib><creatorcontrib>Su, Dinglei</creatorcontrib><creatorcontrib>Liu, Zhichun</creatorcontrib><creatorcontrib>Liu, Lin</creatorcontrib><creatorcontrib>Ma, Longxin</creatorcontrib><creatorcontrib>Xu, Xiaoyan</creatorcontrib><creatorcontrib>Liu, Huijie</creatorcontrib><creatorcontrib>Ren, Tianli</creatorcontrib><creatorcontrib>Zang, Yinshan</creatorcontrib><title>Gender differences in patients with anti-MDA5-positive dermatomyositis: a cohort study of 251 cases</title><title>Clinical rheumatology</title><addtitle>Clin Rheumatol</addtitle><addtitle>Clin Rheumatol</addtitle><description>Objective
To investigate the impact of sex differences on the clinical characteristics and prognosis of patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis (MDA5
+
DM).
Methods
We retrospectively analyzed a cohort of 251 patients with MDA5
+
DM, including 71 in the male group and 180 in the female group. A multivariate logistic regression model was built to analyze independent risk factors for RPILD in each group. An ROC curve was drawn to evaluate the predictive value of independent risk factors. Kaplan‒Meier analysis was used to compare the cumulative survival rates, while the log-rank test was used to test for significant differences between the two groups.
Results
Patients in the male group had a significantly higher prevalence of heliotrope rash, V sign, severe interstitial lung disease (ILD), and rapidly progressive interstitial lung disease (RPILD) than those in the female group. Anti-Ro52 positivity, high CRP level and short disease were identified as independent risk factors for RPILD in both male and female groups by multivariate logistic regression analysis. The mortality rates of males and females were 33.8% and 22.0%, respectively, and the survival time of patients in the male group was shorter than that in the female group.
Conclusion
Male patients with MDA5
+
DM exhibit an increased risk of RPILD, elevated mortality rates and reduced overall survival time compared to their female counterparts, and anti-Ro52 positivity may be an unfavorable prognostic factor for these patients.
Key Points
•
The prevalence of solar rash, V sign, severe interstitial lung disease (ILD) and rapidly progressive interstitial lung disease (RPILD) in anti-MDA5-positive female patients was significantly lower than that in male patients.
•
Positive Anti-Ro52, high CRP level, and short course of disease were independent risk factors for RPILD in both men and women.
•
Female patients exhibited a lower mortality rate than male patients (22.0% vs 33.8%) and demonstrated longer survival time.</description><subject>cohort studies</subject><subject>Dermatomyositis</subject><subject>Exanthema</subject><subject>Females</subject><subject>Gender differences</subject><subject>genes</subject><subject>Heliotropium arborescens</subject><subject>Lung diseases</subject><subject>Males</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Melanoma</subject><subject>Mortality</subject><subject>Original Article</subject><subject>prognosis</subject><subject>Regression analysis</subject><subject>respiratory tract diseases</subject><subject>Rheumatology</subject><subject>risk</subject><subject>Risk factors</subject><subject>Sex differences</subject><subject>Survival</subject><issn>0770-3198</issn><issn>1434-9949</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNqFkU1vFSEUhonR2Gv1D7gwJG7coBw-B3dN1WpS40bXhMucsTR3hiswNfffi71VExe6gQSe9z2Bh5CnwF8C5_ZV7auxjAvJuBnAMH6PbEBJxZxT7j7ZcGs5k-CGE_Ko1mvOuRgcPCQn0rpBayk3JF7gMmKhY5omLLhErDQtdB9awqVV-j21KxqWltjHN2ea7XNNLd0g7Zk5tDwfbg_qaxpozFe5NFrbOh5onqjQQGOoWB-TB1PYVXxyt5-SL-_efj5_zy4_XXw4P7tkUfGhMePUuBUotDIINlqUwYiJGx63EQDROj0qF0YVxJbzMboJQQC4EEAPw-TkKXlx7N2X_G3F2vycasTdLiyY1-olaKmNNML-F-3_JIQVyqqOPv8Lvc5rWfpDvHAARgmwplPiSMWSay04-X1JcygHD9z_tOWPtny35W9ted5Dz-6q1-2M4-_ILz0dkEeg9qvlK5Y_s_9R-wPN3Z5U</recordid><startdate>2024</startdate><enddate>2024</enddate><creator>Cheng, Lu</creator><creator>Xu, Lingxiao</creator><creator>Xu, Yan</creator><creator>Yuan, Fenghong</creator><creator>Li, Ju</creator><creator>Wu, Min</creator><creator>Da, Zhanyun</creator><creator>Wei, Hua</creator><creator>Zhou, Lei</creator><creator>Yin, Songlou</creator><creator>Wu, Jian</creator><creator>Lu, Yan</creator><creator>Su, Dinglei</creator><creator>Liu, Zhichun</creator><creator>Liu, Lin</creator><creator>Ma, Longxin</creator><creator>Xu, Xiaoyan</creator><creator>Liu, Huijie</creator><creator>Ren, Tianli</creator><creator>Zang, Yinshan</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>7S9</scope><scope>L.6</scope><orcidid>https://orcid.org/0000-0001-6812-8930</orcidid></search><sort><creationdate>2024</creationdate><title>Gender differences in patients with anti-MDA5-positive dermatomyositis: a cohort study of 251 cases</title><author>Cheng, Lu ; Xu, Lingxiao ; Xu, Yan ; Yuan, Fenghong ; Li, Ju ; Wu, Min ; Da, Zhanyun ; Wei, Hua ; Zhou, Lei ; Yin, Songlou ; Wu, Jian ; Lu, Yan ; Su, Dinglei ; Liu, Zhichun ; Liu, Lin ; Ma, Longxin ; Xu, Xiaoyan ; Liu, Huijie ; Ren, Tianli ; Zang, Yinshan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-694db2e2546e17c7e3a62f060cbc11ee795d49ad4a2b00dc9fe12119aa1588f93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>cohort studies</topic><topic>Dermatomyositis</topic><topic>Exanthema</topic><topic>Females</topic><topic>Gender differences</topic><topic>genes</topic><topic>Heliotropium arborescens</topic><topic>Lung diseases</topic><topic>Males</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Melanoma</topic><topic>Mortality</topic><topic>Original Article</topic><topic>prognosis</topic><topic>Regression analysis</topic><topic>respiratory tract diseases</topic><topic>Rheumatology</topic><topic>risk</topic><topic>Risk factors</topic><topic>Sex differences</topic><topic>Survival</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cheng, Lu</creatorcontrib><creatorcontrib>Xu, Lingxiao</creatorcontrib><creatorcontrib>Xu, Yan</creatorcontrib><creatorcontrib>Yuan, Fenghong</creatorcontrib><creatorcontrib>Li, Ju</creatorcontrib><creatorcontrib>Wu, Min</creatorcontrib><creatorcontrib>Da, Zhanyun</creatorcontrib><creatorcontrib>Wei, Hua</creatorcontrib><creatorcontrib>Zhou, Lei</creatorcontrib><creatorcontrib>Yin, Songlou</creatorcontrib><creatorcontrib>Wu, Jian</creatorcontrib><creatorcontrib>Lu, Yan</creatorcontrib><creatorcontrib>Su, Dinglei</creatorcontrib><creatorcontrib>Liu, Zhichun</creatorcontrib><creatorcontrib>Liu, Lin</creatorcontrib><creatorcontrib>Ma, Longxin</creatorcontrib><creatorcontrib>Xu, Xiaoyan</creatorcontrib><creatorcontrib>Liu, Huijie</creatorcontrib><creatorcontrib>Ren, Tianli</creatorcontrib><creatorcontrib>Zang, Yinshan</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>AGRICOLA</collection><collection>AGRICOLA - Academic</collection><jtitle>Clinical rheumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cheng, Lu</au><au>Xu, Lingxiao</au><au>Xu, Yan</au><au>Yuan, Fenghong</au><au>Li, Ju</au><au>Wu, Min</au><au>Da, Zhanyun</au><au>Wei, Hua</au><au>Zhou, Lei</au><au>Yin, Songlou</au><au>Wu, Jian</au><au>Lu, Yan</au><au>Su, Dinglei</au><au>Liu, Zhichun</au><au>Liu, Lin</au><au>Ma, Longxin</au><au>Xu, Xiaoyan</au><au>Liu, Huijie</au><au>Ren, Tianli</au><au>Zang, Yinshan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Gender differences in patients with anti-MDA5-positive dermatomyositis: a cohort study of 251 cases</atitle><jtitle>Clinical rheumatology</jtitle><stitle>Clin Rheumatol</stitle><addtitle>Clin Rheumatol</addtitle><date>2024</date><risdate>2024</risdate><volume>43</volume><issue>1</issue><spage>339</spage><epage>347</epage><pages>339-347</pages><issn>0770-3198</issn><eissn>1434-9949</eissn><abstract>Objective
To investigate the impact of sex differences on the clinical characteristics and prognosis of patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis (MDA5
+
DM).
Methods
We retrospectively analyzed a cohort of 251 patients with MDA5
+
DM, including 71 in the male group and 180 in the female group. A multivariate logistic regression model was built to analyze independent risk factors for RPILD in each group. An ROC curve was drawn to evaluate the predictive value of independent risk factors. Kaplan‒Meier analysis was used to compare the cumulative survival rates, while the log-rank test was used to test for significant differences between the two groups.
Results
Patients in the male group had a significantly higher prevalence of heliotrope rash, V sign, severe interstitial lung disease (ILD), and rapidly progressive interstitial lung disease (RPILD) than those in the female group. Anti-Ro52 positivity, high CRP level and short disease were identified as independent risk factors for RPILD in both male and female groups by multivariate logistic regression analysis. The mortality rates of males and females were 33.8% and 22.0%, respectively, and the survival time of patients in the male group was shorter than that in the female group.
Conclusion
Male patients with MDA5
+
DM exhibit an increased risk of RPILD, elevated mortality rates and reduced overall survival time compared to their female counterparts, and anti-Ro52 positivity may be an unfavorable prognostic factor for these patients.
Key Points
•
The prevalence of solar rash, V sign, severe interstitial lung disease (ILD) and rapidly progressive interstitial lung disease (RPILD) in anti-MDA5-positive female patients was significantly lower than that in male patients.
•
Positive Anti-Ro52, high CRP level, and short course of disease were independent risk factors for RPILD in both men and women.
•
Female patients exhibited a lower mortality rate than male patients (22.0% vs 33.8%) and demonstrated longer survival time.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>37985533</pmid><doi>10.1007/s10067-023-06816-0</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-6812-8930</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0770-3198 |
| ispartof | Clinical rheumatology, 2024, Vol.43 (1), p.339-347 |
| issn | 0770-3198 1434-9949 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2892272474 |
| source | SpringerNature Complete Journals |
| subjects | cohort studies Dermatomyositis Exanthema Females Gender differences genes Heliotropium arborescens Lung diseases Males Medical prognosis Medicine Medicine & Public Health Melanoma Mortality Original Article prognosis Regression analysis respiratory tract diseases Rheumatology risk Risk factors Sex differences Survival |
| title | Gender differences in patients with anti-MDA5-positive dermatomyositis: a cohort study of 251 cases |
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