Abstract: 【Abstract】 Objective To investigate the relationship of antinuclear antibody （ANA） status with clinical features and malignancy risk in adult patients with dermatomyositis. Methods A retrospective analysis was performed to analyze clinical data from 101 inpatients with dermatomyositis in Department of Dermatology, the First Affiliated Hospital of Soochow University from April 2008 to April 2018. These patients were divided into ANA - positive group and ANA-negative group, and differences in myopathy and malignancy risks as well as other clinical features were analyzed between the 2 groups. A 2-year follow-up was undertaken among 92 patients. Chi-square test was used to analyze and compare clinical features between the 2 groups, and a multivariate regression model was used to analyze the relationship of ANA status with amyopathic dermatomyositis and malignancies. Results Among the 101 patients with dermatomyositis, there were 42 males and 59 females, aged 55.13 ± 14.63 years; 14 patients had amyopathic dermatomyositis, 6 patients had hypomyopathic dermatomyositis, and 81 patients had myopathic dermatomyositis; 42 （41.58%） cases were positive for ANA, and 59 （58.41%） were negative for ANA. Compared with the ANA- negative group, the ANA - positive group showed significantly decreased incidence of cervical erythema （33.33% vs. 59.32%, P = 0.010） and shawl sign （14.28% vs. 35.59%, P = 0.017）. Twenty-eight （27.72%） patients with dermatomyositis were complicated by malignancies. Malignancies were found in 5 （11.9%） of ANA-positive patients, and in 23 （38.98%） of ANA - negative patients. Univariate analysis showed that ANA-negative patients with dermatomyositis had a higher risk of malignancies compared with ANA-positive patients with dermatomyositis, with an odds ratio of 7.52 （95% CI: 1.62 - 13.78, P = 0.003）. In the multivariate regression model, the absence of ANA （OR = 4.34, 95% CI: 1.37 - 13.72, P = 0.012） and cervical erythema （OR = 3.27, 95% CI: 1.20 - 8.91, P = 0.020） were associated with high incidence of malignancies, while the absence of ANA was not significantly correlated with the occurrence of amyopathic dermatomyositis （OR = 0.99, 95% CI: 0.32 - 2.99, P = 0.980）. Conclusions ANA-negative adult dermatomyositis patients with cervical erythema had an increased risk of malignancies. Thus, close follow-up and regular tumor screening are necessary in these patients.

Key words: Dermatomyositis, Antibodies, antinuclear, Neoplasms, V-shaped erythema