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ID PMID Title PublicationDate abstract
21051205 Autoimmune or auto-inflammatory syndrome induced by adjuvants (ASIA): old truths and a new 2011 Feb There has been considerable interest in the role of environmental factors and the induction of autoimmunity and the ways by which they facilitate loss of tolerance. Clearly both genetic and environmental factors are incriminated, as evidenced by the lack of concordance in identical twins and the relatively recent identification of the shared epitope in rheumatoid arthritis. In this issue a new syndrome called 'Asia'-autoimmune/auto-inflammatory syndrome induced by adjuvants has been proposed. It is an intriguing issue and one that is likely to be provocative and lead to further biologic and molecular investigations.
27265498 Primary autoimmune myelofibrosis: a report of three cases and review of the literature. 2009 Sep 5 Myelofibrosis in association with autoimmune disorders has been consistently recognized in sporadic case reports over a number of years. Autoimmune myelofibrosis has been described most commonly in association with systemic lupus erythematosus (SLE). In addition, myelofibrosis presenting as cytopenias and showing clinical response to immunosuppressant drugs, notably steroids, has been reported with a wide range of immune-mediated disorders, including Sjögren's syndrome, polyarteritis nodosa, rheumatoid arthritis, ulcerative colitis, and primary biliary cirrhosis. Attempts have been made to define a syndrome of primary autoimmune myelofibrosis (PAIMF), as a distinct steroid-responsive clinicopathologic entity with excellent prognosis. Herein, we describe three cases of autoimmune myelofibrosis with a review of the literature.
19107112 RADIATE: more treatment options for patients with an inadequate response to tumor necrosis 2009 Feb Over the last decade, the use of tumor necrosis factor (TNF) inhibitors has improved the prognosis of patients with rheumatoid arthritis. Although these agents are more efficacious than traditional DMARDs, a substantial proportion of patients discontinue anti-TNF therapy because of adverse effects or lack of efficacy. Therapeutic options for these patients include dose increases, switching to an alternative TNF antagonist, or switching to a biologic of a different class, such as rituximab or abatacept. The recently published results of the RADIATE study by Emery et al. suggest that the interleukin-6 inhibitor tocilizumab is a safe and effective alternative for patients who fail to respond to anti-TNF therapy. Randomized controlled trials and the study of biomarkers are needed to help clinicians select the most suitable of these options for their patients.
20052957 Helpful tips for performing musculoskeletal injections. 2010 Jan 1 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.
19557143 Review of teriflunomide and its potential in the treatment of multiple sclerosis. 2009 In the light of new cases of progressive multifocal leukoencephalopathy and induced autoimmunity in multiple sclerosis (MS) patients who received treatment with upcoming disease-modifying immunosuppressant drugs with a highly specific mode of action such as natalizumab, rituximab, or alemtuzumab, alternative oral treatment options for a subgroup of less severely affected MS patients are a major focus of drug development. These agents are currently investigated in phase III clinical trials and some of them are characterized by a favorable safety profile. With an emphasis on teriflunomide, the active metabolite of an immunosuppressant approved for the treatment of rheumatoid arthritis since 1998, a number of oral treatment options for patients with MS are discussed.
20184248 [Two cases of Mycobacterium avium complex pleuritis]. 2010 Feb We encountered 2 cases of Mycobacterium avium complex pleuritis. One case was a 68-year-old woman suffering from rheumatoid arthritis, treated with steroids. She presented to our hospital with dyspnea, which improved after a chest tube insertion and the administration of rifampicin, ethambutol, clarithromycin, and streptomycin. In the other case, a 71-year-old man suffering from nephritic syndrome and who had been treated with steroids presented to our hospital with low-grade fever and dyspnea. He improved after therapeutic thoracentesis and clarithromycin administration. Only 6 cases of Mycobacterium avium complex pleuritis have been reported; because it is rare, the characteristics and prognosis of the disease remain unknown. We report 2 cases and review 6 previous reports of Mycobacterium avium complex pleuritis.
19747142 Functional variants of the interleukin-23 receptor gene in non-gastrointestinal autoimmune 2009 Variants of the gene of the interleukin-23 receptor (IL23R) were first identified as susceptibility factors in association with inflammatory bowel diseases. Since then it became clear that different variants of the gene play also role in a number of other autoimmune diseases like psoriasis, rheumatoid arthritis, ankylosing spondylitis and multiple sclerosis while in others, like systemic sclerosis, systemic lupus erythematosus or Sjögren syndrome the same effect could not be seen. However, the results are very controversial both in terms of the various polymorphisms and also in population specificity. The aim of the current paper is to overview all available reports on IL23R gene polymorphisms in various autoimmune and inflammatory diseases and to try to give an explanation on the possible effect of the examined variants.
19647148 Pharmacotherapy of fibromyalgia. 2009 May Advances have occurred in the pharmacotherapy of fibromyalgia (FM) and the methodology of clinical trial design in FM in parallel with improved understanding of the underlying pathophysiologic mechanisms. Several medications have been approved for the management of FM based on their clinically meaningful and durable effect on pain in monotherapy trials and their beneficial effect on patients'global impression of change, function, and other key symptom domains such as fatigue, sleep disturbance, and cognition. Adjunctive therapy with medicines targeted to specific symptom domains such as sleep as well as treatments aimed toward common comorbid conditions such as irritable bowel syndrome or disease states such as rheumatoid arthritis should be considered for the purpose of reducing the patient's overall symptom burden.
19402023 Complete 1H and 13C NMR assignments of four new oligosaccharides and two new glycosides fr 2009 Aug Four new oligosaccharides (1-4), one new pregnane glycoside (5), and one new cardiac glycoside (6) were isolated from the roots of Periploca forrestii Schltr. (Asclepiadaceae), a traditional Chinese medicine used for the treatment of rheumatoid arthritis and wounds. Their structures were characterized on the basis of extensive analysis of NMR (1H, 13C NMR, 1H-1H COSY, HSQC, HMBC, TOCSY and ROESY) spectra.
19371791 IL-17 and Th17 cells in human inflammatory diseases. 2009 Apr IL-17 was discovered in 1995/96 as a T cell derived cytokine with effects on inflammation and neutrophil activation. In 2006, the precise cell source of IL-17 was identified in the mouse, and these cells were named Th17 cells. They play a role in various human diseases associated with inflammation and destruction such as rheumatoid arthritis, psoriasis, Crohn's disease, multiple sclerosis, where IL-17 can be seen as a therapeutic target.
21062299 The crossover of bisphosphonates to cancer therapy. 2010 Nov Bisphosphonates form a class of drugs commonly used to treat disorders of osteoclastic bone resorption, including osteoporosis, Paget's disease of the bone, rheumatoid arthritis, and bone metastases. Although long established as the therapy of choice to treat such disorders, bisphosphonates' potential in treating cancer is garnering interest. Bisphosphonates have been demonstrated to inhibit tumor growth and metastasis, induce apoptosis in tumor cells, and encourage immune reactions against tumor cells. Current applications of bisphosphonates in cancer treatment include their use to treat skeletal metastases and as an adjuvant to endocrine therapy. This review explores bisphosphonates' current clinical utility and potential as a crossover cancer therapy.
20686957 Hypoxic tumors and their effect on immune cells and cancer therapy. 2010 The abnormal decrease or the lack of oxygen supply to cells and tissues is called hypoxia. This condition is commonly seen in various diseases such as rheumatoid arthritis and atherosclerosis, also in solid cancers. Pre-clinical and clinical studies have shown that hypoxic cancers are extremely aggressive, resistant to standard therapies (chemotherapy and radiotherapy), and thus very difficult to eradicate. Hypoxia affects both the tumor and the immune cells via various pathways. This review summarizes the most common effects of hypoxia on immune cells that play a key role in the anti-tumor response, the limitation of current therapies, and the potential solutions that were developed for hypoxic malignancies.
21794642 [Management of difficult situations in patients with RA: Cancer]. 2009 Apr Rheumatoid arthritis (RA) patients have a higher risk of developing some types of cancer, such as lymphoma or lung cancer. The severity of the disease is associated with a higher risk of developing lymphoma. Anti-TNF-α agents do not increase the incidence of neoplasm, but could trigger the onset of lymphoma in a subgroup of RA patients. Anti-TNF-α agents have been associated with a higher frequency of non-melanoma skin cancer. Although methotrexate does not increase the overall incidence of lymphoma or solid neoplasm, its use is sporadically associated with the development of lymphoma. These methotrexate-induced lymphomas occasionally disappear after withdrawal of the drug.
21103242 Gastric Outlet Obstruction due to Cytomegalovirus Infection in an Immunocompromised Patien 2009 Sep 12 A case of gastric outlet obstruction accompanied by diffuse gastritis and gastric ulcer due to cytomegalovirus infection is presented. The patient, a woman aged 67 years with a long history of rheumatoid arthritis under immunosuppressive treatment (methotrexate), was admitted to our department complaining mostly of abdominal pain located in the epigastrium and the right abdomen. Upper gastrointestinal endoscopy revealed the presence of gastritis accompanied by ulcer in the prepyloric area and gastric outlet obstruction due to cytomegalovirus infection which was confirmed histologically. The patient responded well - although after many weeks - to specific treatment with antiviral treatment (ganciclovir). It is concluded that gastric outlet obstruction caused by cytomegalovirus infection can be observed in immunocompromised patients. The clinician must search for possible cytomegalovirus infection in all immunocompromised patients presenting with a clinical picture of gastric outlet obstruction by obtaining enough biopsies and by asking the histopathologist to specifically stain the specimen for the presence of cytomegalovirus, especially if infection by Helicobacter pylori is not present.
21044101 Effect of omega-3 and vitamin E supplementation on dry mouth in patients with Sjögren's s 2010 Nov To determine whether omega-3 (n-3) increases saliva production in patients with Sjögren's syndrome, 61 patients with Sjögren's received either wheat germ oil (n = 23) or n-3 supplement (TheraTears Nutrition®) (n = 38) in a prospective, randomized, double-masked trial. The outcomes assessed were salivary secretion and markers for oral inflammation. The differences between the n-3 group and wheat germ oil group were not statistically significant for either unstimulated (US) or stimulated (SS) salivary secretion (p= 0.38 and p= 0.346, respectively) nor for the number of sites with probing depth (PD) ≥ 4 mm (p= 0.834). In this pilot study, supplementation with n-3 was not found to be significantly better than wheat germ oil in stimulating saliva production in patients with Sjögren's syndrome.
21035563 Bone marrow-derived cells: A potential approach for the treatment of xerostomia. 2011 Jan Transplantations of bone marrow-derived cells (BMDCs) are traditionally used for hematologic diseases, but there are increasing numbers of clinical trials using BMDC treatments for non-hematologic disorders, including autoimmune diseases. BMDCs are recently reported to improve organ functions. This paper will review available reports supporting the role of BMDCs in reducing xerostomia (i.e. re-establishing salivary gland functions) due to head and neck irradiation for cancer therapies and in Sjögren's syndrome. There are reports that BMDCs provide a beneficial effect on the saliva production. BMDCs positively affect blood vessels stability and regeneration in irradiated salivary glands. Also, BMDCs provide an immunomodulatory activity in mice with Sjögren's-like disease. While the exact mechanisms by which BMDCs improve organ functions remain controversial, there is preliminary evidence that a combination of them (such as cell transdifferentiation, vasculogenesis, and paracrine effect) occur in salivary glands.
20308122 Sleepiness or fatigue? Can we detect treatable causes of tiredness in primary Sjögren's s 2010 Jun OBJECTIVE: To study the prevalence of fatigue and daytime sleepiness in primary SS (pSS) and analyse predicting sleep disturbing factors and other potential determinants of fatigue and sleepiness. METHOD: Seventy-two consecutive pSS patients and 59 age-matched healthy controls were compared. Assessment instruments were profile of fatigue (ProF), visual analogue scale fatigue, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, restless legs syndrome (RLS) Diagnostic Criteria and Lund University Sleep Questionnaire. In addition, markers of immune disturbance, inflammation and disease activity using the European League Against Rheumatism SS Disease Activity Index were analysed in patients. RESULTS: Fatigue, especially somatic fatigue, is the main problem for pSS patients. Sleepiness is a minor problem. Patients had significantly more often anxiety, nocturia and woke up more frequently during the night than controls. The factors that predicted daytime fatigue in pSS patients were anxiety and nightly awakenings due to pain. Nocturia was frequent but was not associated with fatigue or sleepiness. RLS, depression and sicca symptoms contributed to fatigue in the univariate regression analysis only. CONCLUSIONS: This is the first study demonstrating not only the presence of disturbed sleep, but also that nightly musculoskeletal pain and other sleep disturbing factors and anxiety significantly influence fatigue. Management strategies aimed at these aspects should therefore be included in future trials for treatment of fatigue in pSS.
20045999 IgA nephropathy in two patients with Sjögren's syndrome: one with concomitant autoimmune 2010 Concurrent glomeruli and liver involvement in patients with Sjögren's syndrome (SS) has seldom been reported. Meanwhile, IgA nephropathy (IgAN) associated with SS is not as common as other types of glomerulonephritis, such as membranoproliferative glomerulonephritis (MPGN) and membranous nephropathy (MN). Two patients with SS and IgAN are presented. Case 1 was diagnosed as SS complicated with IgAN (Haas subclass III) and severe AIH, while case 2 was diagnosed as SS and IgAN (Haas subclass I) with serious tubulointerstitial lesions. The true prevalence of IgAN secondary to SS is certainly underestimated and the crucial pathogenetic factors may be polyclonal hypergammaglobulinemia and hypocomplementemia (especially C4). The frequent presence of multiple immunoglobulin and complement deposition in glomeruli, especially weak deposits of C4 and (or) C1q, is an immunofluorescence staining feature of IgAN secondary to SS and may be associated with disease severity and activity.
19300286 Prevalence of thyroid dysfunction in systemic lupus erythematosus. 2009 Apr OBJECTIVE: To report the prevalence and clinical relevance of autoimmune thyroid disease and thyroid antibodies in 524 patients with SLE. METHODS: The medical charts of SLE patients followed in our rheumatology unit were reviewed to determine the prevalence and clinical associations of autoimmune thyroid disease. These findings were compared with the prevalence of autoimmune thyroid disease in 50 female adults. Chi(2) tests and Fisher exact tests were used in the comparison of the groups for the categorical variables and Mann-Whitney U test for the continuous variables. Spearman rank correlation was used to identify an association between thyroid symptoms and disease activity. RESULTS: Symptomatic autoimmune thyroid disease was observed in 32 of 524 (6.1%) SLE patients and in 1 of 50 controls (P > 0.05), predominantly hypothyroidism (28 SLE patients vs. in 1 control). Subclinical thyroid disease was identified in 60 (11.5%) and positive thyroid autoantibodies in the absence of thyroid disease in 89 of 524 (17%) SLE patients. Thyroid autoantibodies preceded the occurrence of clinical autoimmune thyroid disease in 70% of SLE patients. Sjögren syndrome (P = 0.001) and positive rheumatoid factor (P = 0.04) were more frequently observed in SLE patients with autoimmune thyroid disease when compared with SLE patients without autoimmune thyroid disease. Disease activity of the SLE was correlated with the presence of symptoms of hyperthyroidism (r = 0.4; P = 0.004). CONCLUSION: Our patients with SLE had a high prevalence of symptomatic and significantly more subclinical hypothyroidism and positive thyroid autoantibodies. Thyroid autoantibodies may precede the appearance of clinical autoimmune disease. Sjögren syndrome and positive rheumatoid factors were more frequently observed in SLE patients with autoimmune thyroid disease. We believe that, since symptoms of SLE and thyroid disease can be similar, that SLE patients should routinely been investigated for autoimmune thyroid disease.
20634952 CD40: novel association with Crohn's disease and replication in multiple sclerosis suscept 2010 Jul 12 BACKGROUND: A functional polymorphism located at -1 from the start codon of the CD40 gene, rs1883832, was previously reported to disrupt a Kozak sequence essential for translation. It has been consistently associated with Graves' disease risk in populations of different ethnicity and genetic proxies of this variant evaluated in genome-wide association studies have shown evidence of an effect in rheumatoid arthritis and multiple sclerosis (MS) susceptibility. However, the protective allele associated with Graves' disease or rheumatoid arthritis has shown a risk role in MS, an effect that we aimed to replicate in the present work. We hypothesized that this functional polymorphism might also show an association with other complex autoimmune condition such as inflammatory bowel disease, given the CD40 overexpression previously observed in Crohn's disease (CD) lesions. METHODOLOGY: Genotyping of rs1883832C>T was performed in 1564 MS, 1102 CD and 969 ulcerative colitis (UC) Spanish patients and in 2948 ethnically matched controls by TaqMan chemistry. PRINCIPAL FINDINGS: The observed effect of the minor allele rs1883832T was replicated in our independent Spanish MS cohort [p = 0.025; OR (95% CI) = 1.12 (1.01-1.23)]. The frequency of the minor allele was also significantly higher in CD patients than in controls [p = 0.002; OR (95% CI) = 1.19 (1.06-1.33)]. This increased predisposition was not detected in UC patients [p = 0.5; OR (95% CI) = 1.04 (0.93-1.17)]. CONCLUSION: The impact of CD40 rs1883832 on MS and CD risk points to a common signaling shared by these autoimmune conditions.