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ID PMID Title PublicationDate abstract
17641898 Successful treatment with rituximab in a patient with mental nerve neuropathy in primary S 2007 Dec We present the case of a 79-year-old female patient with chronic obstructive pulmonary disease on home oxygen therapy who was diagnosed as having Sjögren's syndrome with arthralgias and painful sensory neuropathy. She subsequently developed bilateral numb chin syndrome. Because of refractory and disabling symptoms under high corticosteroids and severe chronic obstructive pulmonary disease, we decided to treat her with rituximab rather than immunosuppressants. This resulted in significant subjective improvement in sicca syndrome while arthalgias, distal and chin paresthesias resolved completely. To our knowledge this is the first description of such a case.
18438852 Inflammatory stimuli accelerate Sjögren's syndrome-like disease in (NZB x NZW)F1 mice. 2008 May OBJECTIVE: This study was undertaken to determine whether induction of systemic inflammation accelerates the development of Sjögren's syndrome (SS) in genetically susceptible mice. METHODS: Female (NZB x NZW)F1 mice were treated with either Freund's incomplete adjuvant (IFA) or phosphate buffered saline (PBS) at monthly intervals. Salivary gland function was monitored by measuring pilocarpine-induced saliva volume. Mice were killed at different time points and examined for sialadenitis and salivary gland-infiltrating cells. Sera were analyzed for autoantibodies to salivary gland antigens, nuclear antigens, and Ro60. RESULTS: While IFA-treated mice had significantly decreased salivary secretion 7 weeks after the initial treatment, salivary secretion did not decrease in PBS-treated controls until 17 weeks. At 7 weeks, the severity of sialadenitis and the number of T and B cells infiltrating the salivary glands did not differ between the 2 groups. However, at this time point IFA-treated mice showed significantly higher frequencies of CD11clow, B220+, Ly6C+, mouse PDCA-1+ dendritic cells (DCs) in the salivary glands. While levels of autoantibodies did not differ between the 2 groups at early time points, by late time points IFA-treated mice had higher levels. The gland dysfunction observed in IFA-treated mice at earlier time points did not correlate with the severity of sialadenitis or levels of autoantibodies. Instead, it was associated with increased frequency of plasmacytoid DCs in the gland. CONCLUSION: Our data suggest that generalized inflammatory stimuli can accelerate the development of SS-like disease in (NZB x NZW)F1 mice, and that gland dysfunction in SS can develop prior to the generation of a robust adaptive autoimmune response.
17522950 A follow-up study of minimally invasive lip biopsy in the diagnosis of Sjögren's syndrome 2007 Jul The aims of this study were to characterize a minimally invasive technique of minor salivary gland biopsy of the lower lip and to present a large patient material undergoing this procedure because of a suspicion of Sjögren's syndrome (SS), as well as to assess the procedure's short-term and long-term value as a diagnostic test and a prognostic factor. The sample consists of consecutive 191 patients undergoing lower lip biopsy in 1987-1990 in Kanta-Hame Central Hospital, Hameenlinna, Finland. The method used was the retrospective chart review. Only three (1.6%) of the biopsies were uninformative, and only one (0.5%) of the patients had a biopsy complication. In 41% of the cases, biopsy was suggestive of SS. Females and elderly patients were more likely to have a positive biopsy result. Surprisingly, a large diversity between pathologists was observed. With the use of focus score instead of older Chisholm classification as an indicator of SS, the specificity of SS diagnostics improved, and the variability between pathologists diminished. Neither SS diagnosis nor positive lip biopsy for SS predicted patients' long-term outcome. In only three patients (1.6%) did the histological diagnosis change due to repeated biopsies. The minimal invasive lower lip biopsy technique presented in this study is a reliable and safe aid in SS diagnostics. The currently recommended histological grading system (focus score > or = 1 suggesting SS) is more specific and reproducible than older Chisholm classification. Repeated biopsy very rarely adds new information.
17435183 Notes on the kidney and its diseases for the neurologist. 2007 May To save their patients from dialysis and transplantation, neurologists need simply remain alert to the possibility of renal failure, particularly in the context of systemic disease, diabetes, sepsis and drugs. Of the numerous territories shared by our respective specialities, we outline a pragmatic approach to the diagnosis and treatment of the vasculitides, underpinned by knowing which questions to ask, equally importantly when to ask them, and in the art of obtaining a tissue diagnosis. We consider the current evolving trial evidence that directs the usage of a growing arsenal of therapies in the induction and maintenance stages of vasculitis treatment, and extend this consideration to Lupus and Sjogren's.
17273177 A controlled release pilocarpine buccal insert in the treatment of Sjögren's syndrome. 2007 Apr 14 OBJECTIVES: To assess the efficacy of a novel hydrogel polymer buccal insert containing 5 mg pilocarpine in releasing the pilocarpine in a controlled fashion over a three hour period, and to assess the effects of this on quantitative tear and saliva production and the acceptability of the insert to the patient. DESIGN: This was an open, uncontrolled pilot study for which Ethics Committee approval was obtained prior to starting. Hydrogel buccal inserts containing 5 mg pilocarpine were used three times a day for seven days. SETTING: The Department of Oral Medicine, Glasgow Dental Hospital & School. SUBJECTS: Eight patients with Sjögren's syndrome. MAIN OUTCOME MEASURES: Changes over baseline in (1) Schirmer test, (2) whole saliva flow rate, (3) oral comfort score (VAS), (4) ocular comfort score (VAS), (5) patient acceptability. RESULTS: The buccal inserts successfully released in excess of 85% of their 5 mg pilocarpine load over three hours. There was a general improvement in oral and ocular comfort scores assessed by visual linear analogue scale, and saliva and tear production generally increased. The inserts were well tolerated by all patients except one (who wore dentures). Adverse events were few and none was serious. CONCLUSION: This novel form of buccal pilocarpine delivery demonstrated potential for use in treating patients with Sjögren's syndrome.
16548837 Middle lobe syndrome as the pulmonary manifestation of primary Sjögren's syndrome. 2006 Mar 20 Middle lobe syndrome - recurrent atelectasis and/or bronchiectasis involving the right middle lobe and/or lingula - has, up to now, not been reported as the pulmonary manifestation of primary Sjögren's syndrome. We describe a patient in whom lymphocytic bronchiolitis in the atelectatic lobes was proved histologically from two separate transbronchial biopsies. The atelectasis responded well to glucocorticoid treatment, suggesting that the peribronchiolar lymphocytic infiltrates may have played an important role in the development of middle lobe syndrome in this patient.
16431948 Conjunctival surface changes in patients with Sjogren's syndrome: a transmission electron 2006 Feb PURPOSE: To demonstrate the ultrastructural appearance of the conjunctival surface epithelium in patients with Sjögren's syndrome (SS) compared with normal subjects. METHODS: Conjunctival tissue specimens from seven normal subjects and eight patients with SS were obtained by bulbar conjunctival biopsy and examined by transmission electron microscopy. RESULTS: The average number of microvilli per 8.3 microm epithelial length was significantly lower in the SS group than that in the control group (19.6 +/- 2.5 vs. 28.0 +/- 3.4, P < 0.0001). The microvillus height (0.539 +/- 0.151 microm) and height-width ratio (1.825 +/- 0.549) in the conjunctival epithelium in the SS group were significantly lower than those (height: 0.946 +/- 0.117 microm, P < 0.001; and height-width ratio: 3.717 +/- 0.696, P < 0.0001) in normal individuals. The microvilli in the SS group were wider than those in the control group (P = 0.003). Furthermore, the average number of secretory vesicles (per 8.3 microm epithelial length) in the apical conjunctival epithelial cell was significantly reduced in the SS group (16.4 +/- 6.8 vesicles), compared with the control group (34.7 +/- 1.2 vesicles, P = 0.003). In addition, although the ocular surface glycocalyx (OSG) was always present in control subjects, it was not detectable in all but one of the SS conjunctival specimens. CONCLUSIONS: The ultrastructural morphology of the apical conjunctival epithelium is altered in patients with SS. The findings suggest that an intact OSG may play a key role in the maintenance of a healthy ocular surface, possibly by preventing abrasive influences on the apical epithelial cells.
17419198 [Short-term effect of rotating hinge knee prosthesis]. 2007 Mar OBJECTIVE: To discuss short-term effect of rotating hinge knee prosthesis. METHODS: From July 2002 to April 2005, 17 cases of severe knee joint deformity and instability received rotating hinge knee prosthesis for total knee arthroplasty. There were 8 males and 9 females, aging from 4l to 79 years. The left joints were involved in 10 cases and right joint in 7 cases. All patients were admitted because of pain. The course of disease was from 1 to 7 years. There were 10 cases of osteoarthritis, 5 cases of rheumatoid arthritis, 1 case of traumatic arthritis after operation of left femur fracture,and 1 case of traumatic arthritis with injury of anterior cruciate ligament, meniscus medialis and medial collateral ligament after operation of left fracture of tibial plateau. According to HSS (hospital for special surgery) scoring system, the preoperative score was 36 to 58 with an average of 48.6. The preoperative flexed motion range of articulation was 21 degrees to 80 degrees with an average of 57.4 degrees. RESULTS: All patients were followed up from 7 months to 3 years with an average of 23. 6 months. There were no complications of thrombogenesis of veins of lower extremity, pulmonary embolism, palsy of peroneal nerve, fracture, and breakage of extended knee structure. Infection occurred in 1 case at 3 months postoperatively, the prosthesis was dislodged, antibiotic-impregnated cement was filled with knee joint, two-stage arthroplasty was expected. At the last follow-up, the HSS score was 78 to 98 with an average of 91.1 in 16 patients. The flexed motion range of articulation was 75 degrees to 100 degrees with an average of 85.2 degrees at 2 weeks postoperatively. The flexed motion range of articular was 85 degrees to 123 degrees with an average of 108.3 degrees at the last follow-up. There were significant differences in HSS score and motion range of articular between preoperation and the last follow-up (P < 0.05). CONCLUSION: The short-term outcome of rotating hinge knee prosthesis is good and a long term follow-up is necessary.
17437176 Successful treatment of a patient with refractory adult Still's disease by tacrolimus. 2007 Adult Still's disease (ASD) is a systemic rheumatic disease characterized by high spiking fever, erythema, polyarthritis, and increased levels of C-reactive protein, ferritin, and interleukin (IL)-18. Recently, biological agents targeting proinflammatory cytokines such as tumor necrosis factor (TNF) alpha, IL-1, and IL-6 have been described as effective treatments for refractory ASD. Herein, we present a patient with ASD, who was successfully treated by tacrolimus concomitant with corticosteroid, while infliximab and etanercept were not effective. Tacrolimus may be one of the drugs for the ASD patients refractory to the conventional treatments including TNF inhibitors.
20641231 [(99m)Tc]Anti-CD3 monoclonal antibody. 2004 A characteristic feature of rheumatoid arthritis (RA) is progressive inflammation and proliferation of the synovium in the joints, but the disease may also have extra-articular manifestations (1, 2). The inflammatory response observed during RA is believed to be caused by the presence of CD4(+) and CD8(+) T lymphocytes in the RA-inflamed tissue, which indicates that these cells may play an important role in the pathogenesis of this disease (3). Although radiography, scintigraphy, ultrasonography, and magnetic resonance imaging with examination both before and after contrast administration are used for detecting early arthritis, none of these imaging procedures can adequately measure the state of or detect the early signs of arthritis in the tissue (4). The use of radiopharmaceuticals to detect RA has also been explored, but these bone-seeking agents accumulate nonspecifically in the arthritic joint, depicting bone metabolism rather than inflammation of the synovium (5, 6). Because T cells are known to accumulate in the inflamed tissue during RA, the possible use of monoclonal antibodies (mAb) directed against membrane-surface molecules on T cells to detect, evaluate, and monitor the disease has been explored (7-10). Among these mAbs, the anti-CD3 antibody is directed against the CD3 antigen present on the T cells and is widely used as an immunosuppressive drug in organ transplant patients (11). This mAb is approved by the United States Food and Drug Administration for the reversal of acute renal, cardiac, or hepatic allograft rejections and is in clinical trials for the treatment of a variety of conditions involving T cells; it is available commercially. Investigators have evaluated the use of a metastable technetium ((99m)Tc)-labeled anti-CD3 mAb ([(99m)Tc]anti-CD3 mAb or [(99m)Tc]OKT3) for the detection of acute renal rejection in transplant patients and also for monitoring RA synovitis (7, 9, 10).
19142449 Pyoderma gangrenosum and ulcerative colitis in the tropics. 2008 Nov Pyoderma gangrenosum is a rare inflammatory skin condition, characterized by progressive and recurrent skin ulceration. There may be rapidly enlarging, painful ulcers with undermined edges and a necrotic, hemorrhagic base. Disorders classically associated with pyoderma gangrenosum include rheumatoid arthritis, inflammatory bowel disease, paraproteinemia and myeloproliferative disorders. There have been some reports of the occurrence of pyoderma gangrenosum in Africa, and in Nigeria, but only one specifically reported pyoderma gangrenosum in association with ulcerative colitis. We report on a 45-year-old man who presented with pyoderma gangrenosum associated with ulcerative colitis; the second report in Nigeria. The skin lesions were managed with daily honey wound dressings. Oral dapsone and prednisolone were started. The frequency of the bloody diarrhea decreased, and was completely resolved by the second week after admission. The ulcers also showed accelerated healing. The goal of therapy is directed towards the associated systemic disorder, if present.
19022053 Chapter 1. Inflammation, angiogenesis, and lymphangiogenesis. 2008 The growth of blood and lymphatic vessels, namely angiogenesis and lymphangiogenesis, is well known to be of importance for tumor growth and metastatic spread. In fact, several therapeutic strategies are currently being pursued in the clinic to interfere with these processes. By contrast, vascular remodeling associated with chronic inflammatory disorders, such as psoriasis, rheumatoid arthritis or inflammatory bowel disease, is only now emerging as a potential new target to treat these conditions. Animal models of inflammation, which mimic the inflammatory and the vascular phenotype of the disease, are important tools for studying inflammation and the accompanying (lymph)angiogenic response in vivo. This review provides a brief summary of our current knowledge of inflammation-induced angiogenesis and lymphangiogenesis and of selected mouse models that can be used to analyze these processes in vivo. It also provides a detailed description of methods, such as immunofluorescence or fluorescence-activated cell sorting (FACS) that can be used to visualize and quantitate vascular remodeling in inflamed tissues.
18953975 Musculoskeletal injections: a review of the evidence. 2008 Oct 15 Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection.
17611852 Knee arthrodesis with the Sheffield external ring fixator: fusion in 6 of 10 consecutive p 2007 Jun BACKGROUND: Knee arthrodesis with external fixation (XF) is a possible salvage procedure for infected total knee arthroplasties (TKA). We report the outcome in 10 patients who underwent arthrodesis with the Sheffield Ring Fixator. PATIENTS AND METHODS: The patients had primary arthrosis in 8 cases; 2 cases were due to rheumatoid arthritis and sclerodermia. The mean time between the primary TKA and arthrodesis was 6 (0.5-14) years. The average age at arthrodesis was 69 years. The average follow-up period was 10 months. RESULTS: Stable fusion was obtained in 6 patients after a mean XF time of 3.6 (2-4) months. 1 patient was referred to another hospital because of nonunion. This patient showed fusion with intramedullary nailing after 7 months. 3 nonunion patients required permanent bracing. 7 patients had pin tract infections. Infections healed in all patients. INTERPRETATION: The Sheffield Ring Fixator gives an acceptable fusion rate for arthrodesis in the infected TKA, with limited complications.
17569208 Modulation of transcription factors by curcumin. 2007 Curcumin is the active ingredient of turmeric that has been consumed as a dietary spice for ages. Turmeric is widely used in traditional Indian medicine to cure biliary disorders, anorexia, cough, diabetic wounds, hepatic disorders, rheumatism, and sinusitis. Extensive investigation over the last five decades has indicated that curcumin reduces blood cholesterol, prevents low-density lipoprotein oxidation, inhibits platelet aggregation, suppresses thrombosis and myocardial infarction, suppresses symptoms associated with type II diabetes, rheumatoid arthritis, multiple sclerosis, and Alzheimer's disease, inhibits HIV replication, enhances wound healing, protects from liver injury, increases bile secretion, protects from cataract formation, and protects from pulmonary toxicity and fibrosis. Evidence indicates that the divergent effects of curcumin are dependent on its pleiotropic molecular effects. These include the regulation of signal transduction pathways and direct modulation of several enzymatic activities. Most of these signaling cascades lead to the activation of transcription factors. Curcumin has been found to modulate the activity of several key transcription factors and, in turn, the cellular expression profiles. Curcumin has been shown to elicit vital cellular responses such as cell cycle arrest, apoptosis, and differentiation by activating a cascade of molecular events. In this chapter, we briefly review the effects of curcumin on transcription factors NF-KB, AP-1, Egr-1, STATs, PPAR-gamma, beta-catenin, nrf2, EpRE, p53, CBP, and androgen receptor (AR) and AR-related cofactors giving major emphasis to the molecular mechanisms of its action.
20477095 Endogenous retroviruses and human disease. 2006 Jan Human endogenous retroviruses (HERVs) constitute up to 8% of the human genome. In general they are highly defective, but complete proviruses have also been described. Over time some transposable elements became inactive, while others retain mobility within the genome. Variably inserting in cellular genes, and differentially within the various allotypes of polymorphic genes, they may have determined inheritable, stable gene modifications. Approximately 40,000 HERV elements have been identified to date, including truncated and solitary long terminal repeats. The latter have powerful transcriptional regulatory properties, therefore they may behave as promoters and enhancers of cellular genes and interact with oncogenes. In some cases, the host has utilized the presence of these ancestrally transmitted foreign genomes to serve physiological functions, and several possible beneficial effects have been reported. On the other hand, links of some human diseases with HERVs are increasingly observed, and this review presents data on possible HERV association to human disease. Reports have shown expression of one or more HERVs in physiological or pathological conditions, in one or more body sites. A key problem is differentiating this expression as cause or effect of a particular disease. Human diseases have been related to HERVs, particularly those characterized by multifactorial etiology or dysregulated immune functions, such as multiple sclerosis, Type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus, psoriasis, schizophrenia, cancer and hematological disorders. Convincing evidence has been found that the HERV-W family has a physiological role in early pregnancy and a role in multiple sclerosis as a cofactor and predictor of disease progression. Data available for HERVs and other diseases are attractive, but further studies are required.
18725317 Interleukin-23: immunological roles and clinical implications. 2009 Apr Increasing evidence has revealed the importance of IL-23, which closely resembles IL-12 both structurally and immunologically, in linking innate and adaptive immunity. IL-23, produced by activated type 1 macrophages and dendritic cells (DC), possesses unique roles in the differentiation and expansion of memory T cells. IL-23 has been associated with several inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease (IBD) and Helicobacter pylori associated gastritis, mainly due to its capacity to induce a strong Th1 type immune response. IL-23 is also associated with Th17 responses and the cytokine produced by the antigen presenting cells (APC), i.e. IL-12 vs IL-23 determines in part if a response is Th1 or Th17. Recent studies have also associated chronic inflammatory diseases such as IBD, psoriasis and myocardial infarction with polymorphisms of the IL-23 receptor complex. The current review focuses on the immunological role of IL-23 and possible therapeutic avenues for inflammatory diseases.
18712523 Infliximab-induced lupus-like syndrome in a patient with ankylosing spondylitis. 2009 Feb Infliximab is a chimerical monoclonal antibody currently used in the treatment of various inflammatory diseases. Lupus-like syndrome is a rarely reported adverse event, and generally observed in rheumatoid arthritis cases. We hereby define and describe a case of a lupus-like syndrome, which developed following the 4th infliximab infusion in a 62-year-old patient with ankylosing spondylitis (AS). As far as we acknowledge, the present case is the third AS case with infliximab-induced lupus.
18647090 Effect of photodynamic therapy on proliferation and apoptosis of 3T3 fibroblasts and HeLa 2008 Aug OBJECTIVE: The aim of the study was to test the effect of photodynamic therapy on fibroblast proliferation in vitro using protoporphyrin IX as a photosensitizer. BACKGROUND DATA: The abnormal proliferation of synovial tissue serves as a propagator of immune response and tissue damage in rheumatoid arthritis. Since the synovial fibroblasts mediate most relevant pathways of joint destruction, they constitute an important target for novel therapeutic approaches. Photodynamic therapy, which is the clinically applied treatment for various tumors, as well as for some non-oncologic diseases, is based on administration of an exogenous photosensitizer which is used to induce cell death of fibroblast cells. MATERIALS AND METHODS: The photosensitizing effects of protoporphyrin IX (PpIX) were studied in the 3T3 cell line that served as a model of fibroblasts and HeLa cells cultured in vitro. RESULTS: The number of fibroblasts and HeLa cells treated with photo-activated PpIX decreased significantly. The compound affects the viability of study cells, causing necrosis of 3T3 cells and apoptosis of HeLa cells. CONCLUSIONS: The light-activated protoporphyrin affected proliferation of both 3T3 and HeLa cells. No effects of the phototherapy were seen in the form of apoptosis of 3T3 cells, whereas the induction of cell death in HeLa cells was detected.
18298078 Bicyclic polyketide lactones from Chinese medicinal ants, Polyrhacis lamellidens. 2008 Apr Two new bicyclic polyketide lactones, polyrhacitides A ( 1) and B ( 2), were isolated from Chinese medicinal ants, Polyrhacis lamellidens, which have been used as an effective therapeutic agent to treat rheumatoid arthritis and hepatitis in China. Their absolute structures were elucidated on the basis of spectroscopic analyses and chemical evidence. The occurrence of polyketides with similar structures in plants of the Lamiaceae, Lauraceae, and Staphyleaceae indicates their significance in the study of chemical ecology.