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Answer 4
  1. Presence of anti-Jo-1 antibodies. Patients with the antisynthetase syndrome can present with polymyositis or dermatomyositis and can exhibit the nonmyopathic features of interstitial lung disease, nonerosive arthritis, Raynaud’s phenomenon, and fever. Serologically, these patients have antibodies directed against aminoacyl-tRNA synthetase, and the most common antibodies in this group are anti-Jo-1. Patients with antisynthetase syndrome have a more variable response to standard treatment, and as such, may warrant consideration of alternative immunosuppressive agents early in the course of their disease. Although there is increasing evidence supporting the association between dermatomyositis and cancer, the relationship between cancer and myositis is controversial. All patients should have age- and risk-appropriate screening for cancer. Paraneoplastic syndromes are important to consider when evaluating myopathy, but breast cancer is not associated with polymyositis. Although severe fatigue and weight loss can be associated with autoimmune disease, they do not play a role in prognosis of disease or response to treatment. A recent viral infection would not result in a sustained severe elevation of muscle enzymes, and dyesthesia may be a sign of comorbidity (eg, diabetic neuropathy).

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