What are the best treatments for Antisynthetase syndrome?

Treatments for Antisynthetase Syndrome

Antisynthetase syndrome is a rare autoimmune disorder characterized by the presence of specific autoantibodies called antisynthetase antibodies. These antibodies target a group of enzymes called aminoacyl-tRNA synthetases, which are essential for protein synthesis in cells. The syndrome primarily affects the muscles, lungs, and joints, leading to symptoms such as muscle weakness, interstitial lung disease, and arthritis.

While there is no cure for Antisynthetase syndrome, several treatment options are available to manage the symptoms and improve the quality of life for affected individuals. The choice of treatment depends on the severity of the symptoms and the organs involved. A multidisciplinary approach involving rheumatologists, pulmonologists, and other specialists is often necessary to provide comprehensive care.

1. Immunosuppressive Medications

Immunosuppressive medications are commonly prescribed to suppress the overactive immune response in Antisynthetase syndrome. These medications help reduce inflammation and prevent further damage to affected organs. Corticosteroids, such as prednisone, are often the first-line treatment and can provide rapid relief of symptoms. However, long-term use of corticosteroids may lead to significant side effects.

In cases where corticosteroids alone are insufficient, additional immunosuppressive drugs may be prescribed. These include:

• Methotrexate: This medication is commonly used in Antisynthetase syndrome to reduce inflammation and suppress the immune system. It can help control joint and muscle symptoms.


• Azathioprine: Azathioprine is another immunosuppressive drug that can be used as a steroid-sparing agent. It helps reduce the need for high-dose corticosteroids and may be beneficial in managing lung involvement.


• Mycophenolate mofetil: This medication is often used as an alternative to azathioprine and can help control lung and muscle symptoms.


• Rituximab: In more severe cases, where other medications have failed, rituximab may be considered. It is a monoclonal antibody that targets specific immune cells involved in the autoimmune response.

2. Physical Therapy

Physical therapy plays a crucial role in managing Antisynthetase syndrome. A tailored exercise program can help improve muscle strength, flexibility, and overall physical function. Physical therapists can also provide techniques to manage pain and prevent joint deformities. Regular exercise and stretching can help maintain joint mobility and prevent muscle wasting.

3. Pulmonary Rehabilitation

As Antisynthetase syndrome often involves lung inflammation and fibrosis, pulmonary rehabilitation is essential to optimize respiratory function. This program includes breathing exercises, respiratory muscle training, and education on energy conservation techniques. Pulmonary rehabilitation can help improve lung capacity, reduce shortness of breath, and enhance overall respiratory well-being.

4. Treatment of Interstitial Lung Disease

Interstitial lung disease (ILD) is a common manifestation of Antisynthetase syndrome and can significantly impact lung function. Treatment of ILD may involve:

• Immunosuppressive medications: As mentioned earlier, immunosuppressive drugs like methotrexate, azathioprine, or mycophenolate mofetil can help reduce lung inflammation and slow down the progression of ILD.


• Antifibrotic medications: In some cases, antifibrotic medications like pirfenidone or nintedanib may be considered to slow down the scarring process in the lungs.


• Oxygen therapy: Supplemental oxygen may be prescribed to improve oxygen levels in the blood and alleviate symptoms of breathlessness.


• Lung transplantation: In severe cases of ILD that do not respond to other treatments, lung transplantation may be considered as a last resort.

5. Symptomatic Management

Various medications and interventions can be used to manage specific symptoms associated with Antisynthetase syndrome:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs can help relieve joint pain and inflammation.


• Topical creams and ointments: These can be used to alleviate skin rashes and manage dermatological symptoms.


• Pain management: For individuals experiencing chronic pain, medications such as tramadol or gabapentin may be prescribed.


• Occupational therapy: Occupational therapists can provide strategies to manage daily activities and assistive devices to improve independence and quality of life.

It is important for individuals with Antisynthetase syndrome to work closely with their healthcare team to develop an individualized treatment plan. Regular monitoring and follow-up visits are essential to assess treatment response, manage side effects, and adjust medications as needed. Additionally, lifestyle modifications such as smoking cessation and maintaining a healthy weight can contribute to overall well-being.