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ID PMID Title PublicationDate abstract
17968930 Salivary proteomic and genomic biomarkers for primary Sjögren's syndrome. 2007 Nov OBJECTIVE: To identify a panel of protein and messenger RNA (mRNA) biomarkers in human whole saliva (WS) that may be used in the detection of primary Sjögren's syndrome (SS). METHODS: Mass spectrometry and expression microarray profiling were used to identify candidate protein and mRNA biomarkers of primary SS in WS samples. Validation of the discovered mRNA and protein biomarkers was also demonstrated using real-time quantitative polymerase chain reaction and immunoblotting techniques. RESULTS: Sixteen WS proteins were found to be down-regulated and 25 WS proteins were found to be up-regulated in primary SS patients compared with matched healthy control subjects. These proteins reflected the damage of glandular cells and inflammation of the oral cavity system in patients with primary SS. In addition, 16 WS peptides (10 up-regulated and 6 down-regulated in primary SS) were found at significantly different levels (P < 0.05) in primary SS patients and controls. Using stringent criteria (3-fold change; P < 0.0005), 27 mRNA in saliva samples were found to be significantly up-regulated in the primary SS patients. Strikingly, 19 of 27 genes that were found to be overexpressed were interferon-inducible or were related to lymphocyte filtration and antigen presentation known to be involved in the pathogenesis of primary SS. CONCLUSION: Our preliminary study has indicated that WS from patients with primary SS contains molecular signatures that reflect damaged glandular cells and an activated immune response in this autoimmune disease. These candidate proteomic and genomic biomarkers may improve the clinical detection of primary SS once they have been further validated. We also found that WS contains more informative proteins, peptides, and mRNA, as compared with gland-specific saliva, that can be used in generating candidate biomarkers for the detection of primary SS.
18778838 A rare cause of reversible unilateral third nerve palsy. 2008 Dec 15 CASE REPORT: A 59-year-old Chinese male presented in January 2007 with acute left retro-orbital headache, diplopia and left partial ptosis. Isolated left third nerve palsy was diagnosed. Imaging studies and cerebral angiography excluded a posterior communicating artery aneurysm. Anti-nuclear (titre 1/800, speckled pattern), anti-PR3, anti-Ro and anti-La antibodies were present. Sjogren's syndrome (SS) was considered in view of positive anti-Ro and La antibodies, and was confirmed with focal lymphocytic infiltrates on labial salivary gland biopsy and a positive Schirmer's test (6 mm of tear flow over 5 min). Immunosuppressive therapy was started 2 months after his initial presentation and within 2 weeks, the patient experienced an almost complete recovery of both ptosis and diplopia. He has been on tapering doses of prednisolone since and his condition remains stable. CONCLUSION: This patient has cranial neuropathy secondary to Sjogren's syndrome. The rapid reversibility of the oculomotor nerve palsy with immunosuppression suggests lymphocytic infiltration or autoantibodies as the cause rather than a vasculitic process, which would have led to irreversible or slowly, partially reversible ischaemic damage.
17599741 Sjögren's Syndrome Disease Damage Index and disease activity index: scoring systems for t 2007 Jul OBJECTIVE: To develop valid instruments for the assessment of disease-related damage and disease activity in Sjögren's syndrome (SS). METHODS: Data on 206 patients with primary SS were collected in 12 Italian centers. Each patient was scored by 1 investigator, on the basis of a global assessment of the degree of disease damage and disease activity. Patients judged to have active disease at the time of enrollment underwent a second evaluation after 3 months. Univariate and multivariate analyses were performed to select the clinical and serologic variables that were the best predictors of damage and of disease activity, and these variables were used to construct the Sjögren's Syndrome Disease Damage Index (SSDDI) and the Sjögren's Syndrome Disease Activity Index (SSDAI). The weight of each variable in the index was determined by the beta coefficients in multivariate regression models. Scores obtained using the SSDDI and the SSDAI were compared with scores initially given by the investigators. Finally, a receiver operating characteristic (ROC) curve was used to determine the cutoff value in the SSDAI with the highest level of accuracy in identifying patients with a significant level of disease activity. RESULTS: A multivariate model with 9 variables was the best predictor of investigator scores of damage. The scores obtained using the SSDDI were closely correlated with investigator ratings (R = 0.760, P < 0.0001). A model composed of 11 variables was the best predictor of investigator scores of disease activity. The scores obtained using the SSDAI were strongly correlated with the investigator ratings both at the time of enrollment and 3 months after enrollment (R = 0.872, P < 0.0001, and R = 0.817, P < 0.0001, respectively). The differences between scores given by investigators at study enrollment and after 3 months, a measure of variation of disease activity over time, were also closely correlated with the differences calculated using the SSDAI (R = 0.683, P < 0.0001). The ROC curve analysis showed that patients with the highest level of disease activity could be identified on the basis of an SSDAI score of >or=5. CONCLUSION: Our findings indicate that the SSDDI is an adequate instrument to objectively measure damage in patients with SS, and that the SSDAI is a valid tool to measure disease activity when used either as a single-state index or as a transition index.
16979538 Management of patients presenting with Sjogren's syndrome. 2006 Aug Sjogren's syndrome is an autoimmune exocrinopathy that predominantly affects salivary and lachrymal glands, leading to dry eyes and mouth. The most common clinical problems faced by the rheumatologist are those of dry eyes and mouth, parotid swelling, fatigue and extraglandular manifestations. The first stage in management is to make an accurate diagnosis based on the American/European consensus criteria. The most frequent differential diagnoses are dry eyes and mouth symptoms, a variant of chronic fatigue syndrome and fibromyalgia, and sialosis, which causes a non-inflammatory enlargement of the parotid glands. The mainstay of treatment for the sicca symptoms is local therapy, and that for the milder systemic symptoms is hydroxychloroquine. Steroids and immunosuppressive drugs are reserved for more severe extraglandular disease. In spite of intensive research in other systemic treatments including biologic therapies, there is limited evidence to support their use in routine clinical practice.
18652917 Anti-rheumatoid arthritic effect of madecassoside on type II collagen-induced arthritis in 2008 Nov Madecassoside is the highest amount of triterpene constituent in Centella asiatica herbs, a frequently prescribed crude drug in southeastern Asian and China for wound healing and scar management. The present study aimed to investigate the therapeutic potential and underlying mechanisms of madecassoside on collagen II (CII)-induced arthritis (CIA) in mice. Madecassoside (10, 20 and 40mg/kg), orally administered from the day of the antigen challenge for twenty consecutive days, dose-dependently alleviated the severity of the disease based on the reduced clinical scores, and elevated the body weights of mice. Histopathological examination indicated that madecassoside alleviated infiltration of inflammatory cells and synovial hyperplasia as well as protected joint destruction. Moreover, madecassoside reduced the serum level of anti-CII IgG, suppressed the delayed type hypersensitivity against CII in ears, and moderately suppress CII-stimulated proliferation of lymphocytes from popliteal lymph nodes in CIA mice. In vitro, madecassoside was ineffective in the activation of macrophages caused by lipopolysaccharide. It was concluded that madecassoside substantially prevented mouse CIA, and might be the major active constituent of C. asiatica herbs responsible for clinical uses for rheumatoid arthritis. The underlying mechanisms of action may be mainly through regulating the abnormal humoral and cellular immunity as well as protecting joint destruction.
16907920 In the rat, citrullinated autologous fibrinogen is immunogenic but the induced autoimmune 2006 Sep Conversion of arginyl to citrullyl residues (citrullination) is essential for the formation of the epitopes recognized by rheumatoid arthritis (RA)-associated autoantibodies to citrullinated proteins (ACPA). ACPA are secreted by plasma cells of the rheumatoid synovial tissue where their major target, citrullinated fibrin, is abundant. Although numerous arguments suggest that ACPA play an important role in RA, their pathological relevance remains to be established. In the present study, we assessed the immunogenicity and arthritogenicity of complete Freund's adjuvant-emulsified autologous citrullinated (C-rFBG) or non-citrullinated (NC-rFBG) fibrinogen in Lewis (LEW) and Brown-Norway rats, which exhibit drastic differences in their susceptibility to induced autoimmune diseases. NC-rFBG induced no antibody response. In contrast, a single injection of C-rFBG induced an IgG response directed mainly to citrullinated determinants of rFBG. However, all rat strains remained devoid of clinical and histological signs of arthritis up to 3 months after C-rFBG inoculation. Next, in LEW rats, we tested whether autoimmunity to C-rFBG could aggravate acute ankle arthritis triggered by intra-articular injection of incomplete Freund's adjuvant (IFA). However, such arthritis evolved identically in the presence or absence of anti-C-rFBG autoantibodies. However, IFA-injected joints were devoid of citrullinated fibrin deposits. Therefore, citrullination allows breakdown of immunological tolerance but the autoimmune response developed is not spontaneously arthritogenic. Whether or not it can aggravate arthritis with citrullinated fibrin deposits remains to be evaluated.
17957858 The complexity of the differential diagnosis for the inflammatory arthritides. 2006 May Increasing evidence reveals that patients who have inflammatory arthritis experience structural damage early in the course of the disease. To effectively minimize the destruction caused by chronic inflammation, it is necessary to identify these patients soon after the onset of symptoms. However, differential diagnosis is not always straightforward. This article reviews selected underlying issues that complicate the differential diagnosis of the inflammatory arthritides and describes key features of the typical presentations for 3 of the commonly seen forms of inflammatory arthritis--rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.
17983150 Collagen-induced arthritis in rats. 2007 Collagen-Induced Arthritis (CIA) is a complex model of autoimmune-mediated arthritis that is regulated by multiple genetic and environmental factors. CIA is induced in rats by immunization with native type II collagen and develops joint pathology similar to that of rheumatoid arthritis. This chapter details methods for the extraction and purification of native type II collagen from sternal and articular cartilage, an arthritis induction protocol that has resulted in reproducible CIA expression in several rat strains from year to year and criteria for measuring clinical, radiographic and immunological outcome parameters characteristic of CIA.
19354160 Imaging aspects of the lacrimal gland in Sjögren syndrome--case report. 2008 PURPOSE: The study presents a case of bilateral lacrimal gland hypertrophy with secondary glaucoma due to the increased episcleral venous pressure. METHOD: The case was investigated by means of clinical methods associated with ultrasound (A and B-scan, Doppler-ultrasound) and magnetic resonance imaging techniques. RESULTS: The clinical data revealed proptosis, episcleral congestion, and elevated intraocular pressure. An abnormal Schirmer test and xerophthalmia were also present. Ultrasound examination identifies enlarged masses in the bilateral lacrimal fossa, supra-temporal to the globe, mostly on the left side, having a cystic structure. The Doppler ultrasound investigation revealed the vascularisation, and the magnetic resonance imaging completed the dates offered by the ultrasound methods. According to the clinical aspect and the possible visual impairment produced by the secondary glaucoma, the mass lesion was removed on the left side by neurosurgical approach. The histopathological exam confirmed the destruction of the lacrimal gland, and, furthermore, the immunohistochemical study revealed the aspect of Sjögren syndrome lesions. CONCLUSIONS: Sonography is able to provide noninvasively much of the information needed by the clinician. Ultrasound techniques (A-scan, B-scan and color Doppler) and magnetic resonance imaging allow tracking and discrimination of the orbital diseases, such as lacrimal gland lesions. Associated with the clinical features, these methods offer the basis of a correct diagnosis and a proper therapy for lacrimal gland pathology.
17592401 Instability of the rheumatoid wrist: patterns and treatment. 2006 Jun 30 Pathology of the wrist is frequent in rheumatoid arthritis. The proper treatment leading to improvement in function and symptoms relief is of a big importance. The classification based on natural pattern of the disease is presented including three types: ankylotic, arthritic changes with artrodesis and instability leading to wrist collapse. It the third type it is important to add partial or total arthrodesis to the common synovectomy and ulnar head resection.
16344933 Lymphocytic alveolitis: A surprising index of poor prognosis in patients with primary Sjog 2006 Jul Twelve years ago we reported that lymphocytic alveolitis [or bronchoalveolar lavage (BAL) lymphocytosis] correlates with clinical pulmonary involvement in primary Sjogren's syndrome (pSS). Our thesis was based on subtle clinical and functional evidence of interstitial lung disease (ILD) in pSS patients with "high lymphocytic alveolitis" (>15% lymphocytes in BAL). This report is a follow-up study of these patients. Basic clinical and functional re-evaluation of the 22 patients with pSS, studied in 1991, emphasized the differences between those with alveolitis and those without alveolitis. There was no significant functional decline. There were, however, two statistically significant differences between the two groups: (1) only patients with BAL lymphocytosis had to be treated with steroids (5/12 vs. 0/10, P < 0.05) and (2) only patients with BAL lymphocytosis had died in the mean time (6/12 vs. 0/10, P < 0.01). The causes of death were various. On only two occasions were they related to respiratory infections while there were no deaths from respiratory failure secondary to ILD. BAL lymphocytosis appears to be a surprisingly serious index of dismal prognosis in patients with pSS. We offer no unifying pathophysiologic mechanism for it and, therefore, all we propose is that BAL is performed early, in as many patients with pSS as possible. These patients should then be followed up systematically, in order to evaluate if BAL lymphocytosis has any pathophysiologic importance in the development of clinically serious pSS, which is serious enough to lead to death.
18778028 [The overlap of primary Sjögren's syndrome with antiphospholipid syndrome in man: case re 2007 We describe the case a 63-year-old man with overlap of primary Sjögren syndrome (pSS) and antiphospholipid syndrome (APS). According to literature the presence of antiphospholipid antibodies is observed in about 20% of patients with pSS. The coexistence of pSS and APS should be considered as an infrequent, but not exceptional, event.
17957859 New directions in the standard of care for inflammatory arthritis. 2006 May Inflammatory arthritides are associated with progressive joint destruction early in the course of disease; therefore, early diagnosis and treatment with drugs that offer the potential to slow disease progression or induce remission is crucial. This article discusses the most recent approaches to treatment for 3 common inflammatory arthritic conditions: rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.
16979537 Problems encountered during anti-tumour necrosis factor therapy. 2006 Aug Worldwide, over 400,000 patients have been treated with tumour necrosis factor (TNF)-alpha antagonists for indications that include rheumatoid arthritis, juvenile rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis and ankylosing spondylitis. Since their approval, concerns regarding safety have been raised. There is a risk of re-activation of granulomatous diseases, especially tuberculosis, and measures should be taken for detection and treatment of latent tuberculosis infections. Preliminary data suggest that anti-TNF therapy may be safe in chronic hepatitis C. However, TNF-alpha antagonists have resulted in re-activation of chronic hepatitis B if not given concurrently with antiviral therapy. Solid tumours do not appear to be increased with anti-TNF therapy. Variable rates of increased lymphoma risk have been described with anti-TNF therapy compared with the general population, although no increased risk was found compared with a rheumatoid arthritis population. Large phase II and III trials with TNF-alpha antagonists in advanced heart failure have shown trends towards a worse prognosis, and should therefore be avoided in this population. Both etanercept and infliximab are associated with the formation of autoantibodies, and these autoantibodies are rarely associated with any specific clinical syndrome. Rare cases of aplastic anaemia, pancytopenia, vasculitis and demyelination have been described with anti-TNF therapy. This chapter will discuss the safety profile and adverse events of the three commercially available TNF-alpha antagonists: etanercept, infliximab and adalimumab. The data presented in this review have been collected from published data, individual case reports or series, package inserts, the Food and Drug Administration postmarketing adverse events surveillance system, and abstracts from the American College of Rheumatology and European Congress of Rheumatology meetings for 2005.
17181917 Epidemiology of rheumatoid arthritis, juvenile idiopathic arthritis and gout in two region 2006 Sep OBJECTIVE: To estimate the annual incidence and prevalence of rheumatoid arthritis (RA), juvenile arthritis (JIA) and gout in a population based study in two regions of the Czech Republic with total population of 186,000 inhabitants. METHODS: The study was conducted in the Town of Ceske Budejovice and district of Cheb in the Czech Republic (with a total population of 186,000 inhabitants) in the years 2002 and 2003. Incident cases were registered on condition that the definite diagnosis was confirmed according to existing classification criteria during the study period. Prevalence was studied on the basis of identification of established diagnosis from registers of patients of participating rheumatologists and other specialists. They were asked to report all living patients who had been diagnosed before 1st March 2002. Patients were only included in the study if their permanent address was in the selected study area. RESULTS: Overall, we found 48 incident and 947 prevalent cases of RA among adults (16+ years), 4 incident and 43 prevalent cases of JIA among children (less than 16 years old), and 64 incident and 425 prevalent cases of gout among adults (16+ years). The total annual incidence of RA was 31/100,000 in the adult population aged 16 years and more (95% CI 20 to 42/100,000). The prevalence of RA was 610/100,000 (95% CI 561 to 658/100,000) in the adult population. An annual incidence of gout in adults was 41/100,000 (95% CI 28 to 53/100,000). The prevalence of gout was 300/100,000 (95% CI 266 to 334/100,000). The annual incidence of JIA was 13/100,000 in children less than 16 years old (95%CI 1 to 20/100,000). The prevalence of JIA in children was 140/100,000 (95% CI 117 to 280/100,000). CONCLUSION: This study estimates the annual incidence and prevalence rates of RA, gout and JIA in the first population-based survey in the Czech Republic. The rates of RA and JIA compare well with figures reported from other countries; figures in gout seem to be lower than reported elsewhere.
17945384 Palisaded neutrophilic and granulomatous dermatitis associated with limited systemic scler 2008 Apr Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a condition that is characterized histopathologically by a characteristic pattern of granulomatous inflammation in the presence or absence of leukocytoclastic vasculitis. It has been associated with systemic diseases, especially autoimmune conditions such as rheumatoid arthritis and Behçet's disease. A 44-year-old woman with underlying limited systemic sclerosis presented with painful erythematous nodules located on her face and scalp. Histopathologic analysis confirmed a diagnosis of PNGD, which self-resolved within weeks of the biopsy. To our knowledge, this is the first report of a case of PNGD associated with systemic sclerosis. A review of the literature revealed that PNGD is a female-predominant disease that is most commonly associated with rheumatoid arthritis, followed closely by lupus erythematosus. Most patients with PNGD respond to treatment of the underlying systemic disease, although spontaneous resolution is not uncommonly observed.
20477615 Toll-like receptors: a new target in rheumatoid arthritis? 2006 Jul Rheumatoid arthritis (RA) is one of the most prevalent autoimmune diseases. It is characterized by chronic inflammation of the joint leading to its destruction. Although the initiating cause remains elusive, environmental factors and genetic background are known to contribute to the etiology of RA. The role of Toll-like receptors (TLRs) in innate immunity and their ability to recognize microbial products has been well characterized. TLRs are able to recognize endogenous molecules released upon cell damage and necrosis, and are present in RA synovial fluid. Although it appears unlikely that a pathogen underlies the pathogenesis or progression of RA, the release of endogenous TLR ligands during inflammation may activate TLRs and perpetuate the disease. An increasing body of circumstantial evidence implicates TLR signaling in RA, although, at present, their involvement is not defined comprehensively. Targeting individual TLRs or their signaling transducers may provide a more specific therapy without global suppression of the immune system.
23495927 Rheumatoid arthritis diagnosis with antimutated citrullinated vimentin ELISA by Orgentec D 2008 Sep BACKGROUND: There is a need for highly sensitive and specific laboratory tests for the early diagnosis of rheumatoid arthritis (RA). Anticitrullinated protein/peptide antibodies are produced in the sera of RA patients. OBJECTIVE: To assess and discuss the diagnostic value of Orgentec antimutated citrullinated vimentin (anti-MCV) ELISA and to compare this diagnostic to commercially available anticyclic citrullinated peptide (anti-CCP) tests. METHODS: The evaluation is based on our recently published study on the comparison of anti-MCV and anti-CCP2 tests, as well as on published studies. RESULTS/CONCLUSION: In established RA, the anti-MCV ELISA exerts a specificity comparable with anti-CCP2. Numerous recent studies suggest that anti-MCV may have higher sensitivity, however there are also some publications stating the opposite. In early RA, anti-MCV may be a better predictor of disease activity and radiological progression than anti-CCP tests.
18246701 Acneiform eruption following anti-TNF-alpha treatment: a report of three cases. 2008 Jan Tumor necrosis factor-alpha (TNF-alpha) antagonists are used to treat many autoimmune disorders including Crohn's disease, ulcerative colitis, rheumatoid arthritis, and more recently, psoriasis. The adverse effects of the treatment regimen for psoriasis are not as well documented as those for Crohn's disease and rheumatoid arthritis. We report the development of acne vulgaris in 3 patients with psoriasis after initiating anti-TNF-alpha therapy.
18466442 On the choice of linkage statistics. 2007 Three LOD score statistics are often used for genome-wide linkage analysis: the maximum LOD score, the LOD score statistic proposed by Kong and Cox, both based on the allele-sharing between affected sib pairs, and the maximization of the LOD score function of Morton on two genetic models and an heterogeneity parameter.Using only identity-by-descent sharing between affected sibs as linkage information, we studied the behavior of these three statistics under the null hypothesis in the rheumatoid arthritis simulated data (Genetic Analysis Workshop 15 Problem 3 - simulating model known). Distributions under the null hypothesis show that identical values of the statistics correspond to very different genome-wide p-values: comparison and interpretation of several linkage statistics cannot be done on the observed value. The Kong and Cox LOD score statistic had slightly better power to detect the HLA region involved in rheumatoid arthritis compared to the other methods. In a second step, we show that performing the analysis under a greater number of genetic models in the hope of better scanning the space of models, does not increase the power of detection.