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ID PMID Title PublicationDate abstract
21358442 Peripheral neuropathies associated with primary Sjögren syndrome: immunologic profiles of 2011 Mar We conducted this study to characterize the relationship between primary Sjögren syndrome (pSS)-associated peripheral neuropathy (PN) and markers of B-cell monoclonal proliferation and chronic activation. The cohort included 120 consecutive patients presenting with definite pSS according to the American-European Consensus Group criteria. Serum markers of chronic B-cell activation included autoantibodies and hypergammaglobulinemia. Markers of monoclonal B-cell proliferation included mixed cryoglobulin, monoclonal gammopathy, abnormal κ/λ free light chain (FLC) ratio, and B-cell non-Hodgkin lymphoma (B-NHL). Definite PN was present in 30 patients (25%) including 7 patients (23%) with sensorimotor neuropathy, 3 patients (10%) with ataxic sensory neuropathy, and 20 patients (67%) with nonataxic sensory neuropathy. Patients with a sensorimotor neuropathy differed from those without PN by higher rates of monoclonal B-cell proliferation markers, that is, mixed cryoglobulin (57% vs. 11%; p = 0.008), monoclonal gammopathy (71% vs. 17%; p = 0.004), higher FLC ratio (2.7 ± 1.5 vs. 1.7 ± 1.8; p = 0.024), and B-NHL (57% vs. 3%; p < 0.001). Patients with nonataxic sensory neuropathy were characterized by a higher age (57.5 ± 10.7 vs. 48.7 ± 14.3 years; p = 0.007), more frequent central nervous system (CNS) involvement (15% vs. 2%; p = 0.04) and a lower prevalence of chronic B-cell activation serum markers, that is, antinuclear antibodies (ANA) (60% vs. 90%; p = 0.003), anti-SSA (Ro) (40% vs. 72%; p = 0.009), anti-SSB (La) (15% vs. 41%; p = 0.039), rheumatoid factor (37% vs. 67%; p = 0.02), and hypergammaglobulinemia (35% vs. 64%; p = 0.023). In multivariate analysis, sensorimotor neuropathy was associated with the presence of B-NHL (odds ratio [OR], 39.0; p < 0.001), whereas nonataxic sensory neuropathy was associated with the presence of CNS involvement (OR, 17.0; p = 0.025) and ANA (OR, 0.07; p < 0.001). In conclusion, we found that up to 25% of pSS patients presented with PN, predominantly sensory neuropathy. Distinctive immunologic profiles were found according to the type of SS-associated neuropathy: nonataxic sensory neuropathy was marked by a low prevalence of B-cell activation markers, and sensorimotor neuropathy was marked by a high prevalence of B-cell monoclonal proliferation markers.
22480545 The effects of lingual intervention in a patient with inclusion body myositis and Sjögren 2012 Aug OBJECTIVE: To report the 5-year course of a patient's swallowing disorder in the context of progressive neuromuscular disease and the effectiveness of a lingual strengthening treatment program. DESIGN: This is a case report that describes a lingual treatment protocol that was repeated 3 times over a 5-year period with and without maintenance periods. SETTING: The study was completed in 2 settings-an outpatient swallowing clinic at an acute care hospital and the patient's home. PARTICIPANT: The subject was a 77-year-old woman who was diagnosed with inclusion body myositis and Sjögren's syndrome. INTERVENTION: The patient participated in an intensive 8-week lingual strengthening protocol 3 times (at years 1, 4, and 5) and a subsequent maintenance program twice (at years 4 and 5). MAIN OUTCOME MEASURES: Three outcome measures were collected during the study: (1) lingual manometric pressures at the anterior and posterior tongue, measured by using a lingual manometric device, (2) airway invasion measured by using an 8-point Penetration-Aspiration Scale, and (3) clearance of the bolus measured by using a 3-point residue scale. RESULTS: Isometric lingual strengthening was effective in maintaining posterior tongue lingual pressure and Penetration-Aspiration Scale scores during the treatment periods. Residue scale scores did not significantly change during treatment. CONCLUSIONS: We conclude that, in this patient, lingual strengthening slowed the progression of disease-related lingual strength loss and extended functional swallowing performance. Thus, this type of intervention may hold promise as an effective swallowing treatment option for patients with neurodegenerative inflammatory diseases such as inclusion body myositis and Sjögren's syndrome.
22549247 Topical and systemic medications for the treatment of primary Sjögren's syndrome. 2012 May 1 The treatment of primary Sjögren's syndrome (SS) is based principally on the management of sicca features and systemic manifestations. Sicca manifestations are treated symptomatically through administration of topical therapies, such as saliva substitutes and artificial tears; in patients with residual salivary gland function, stimulation of salivary flow with a sialogogue is the therapy of choice. The management of extraglandular features must be tailored to the specific organ or organs involved; however, limited data have been obtained from controlled trials in SS to guide the treatment of systemic symptoms using therapies including antimalarials, glucocorticoids, immunosuppressive drugs and biologic agents. Nevertheless, randomised controlled trials of biologic agents that target molecules and receptors involved in the aetiopathogenesis of primary SS have initiated a new era in the therapeutic management of the disease, although the potential risks and benefits of these agents must be carefully considered. In this Review, we analyse the evidence regarding the efficacy of the therapeutic agents currently available to treat the manifestations of SS. On the basis of this evidence, we provide guidance on the use of these agents in different clinical scenarios.
23020902 Classification and characterisation of peripheral neuropathies in 102 patients with primar 2013 Jan OBJECTIVES: This paper aims to analyse the etiology, characterisation and outcomes of the different types of peripheral neuropathy in patients with primary Sjögren's syndrome (SS) and their association with clinical and immunological disease expression. METHODS: A total of 563 consecutive patients diagnosed with primary SS were evaluated. We retrospectively assessed the results of nerve conduction studies carried out in patients with suspected peripheral nervous system involvement. Peripheral neuropathies were classified into mononeuropathy, mononeuropathy multiplex, polyneuropathy and neuronopathy according to the patterns evidenced by electrodiagnostic studies. RESULTS: Nerve conduction studies were carried out in 158/563 (28%) SS patients. The results were normal in 49 and abnormal in 109 patients, in whom peripheral neuropathy was diagnosed in 102. After excluding patients with neuropathy associated with other diseases and patients with entrapment mononeuropathies, 55/563 (10%) patients were classified as having SS-related peripheral neuropathy, including axonal sensorimotor polyneuropathy (n=24), pure sensory neuronopathy (n=15), mononeuropathy multiplex (n=15) and demyelinating polyradiculoneuropathy (n=1). In spite of therapy, clinical progression measured by the MOHS scale was observed in 12% of patients with axonal polyneuropathy, 13% of those with mononeuropathy multiplex and 47% of those with neuronopathy. Survival was significantly reduced in patients with peripheral neuropathy (especially in those with mononeuropathy multiplex and axonal polyneuropathy) in comparison with the control group (log rank =0.001). CONCLUSIONS: We found a prevalence of SS-related peripheral neuropathy of 10%. Classification of neuropathy according to the clinical presentation and electrodiagnostic tests may be useful in determining the functional outcome, therapeutic response and survival.
22693999 Hereditary systemic amyloidosis due to Asp76Asn variant β2-microglobulin. 2012 Jun 14 We describe a kindred with slowly progressive gastrointestinal symptoms and autonomic neuropathy caused by autosomal dominant, hereditary systemic amyloidosis. The amyloid consists of Asp76Asn variant β(2)-microglobulin. Unlike patients with dialysis-related amyloidosis caused by sustained high plasma concentrations of wild-type β(2)-microglobulin, the affected members of this kindred had normal renal function and normal circulating β(2)-microglobulin values. The Asp76Asn β(2)-microglobulin variant was thermodynamically unstable and remarkably fibrillogenic in vitro under physiological conditions. Previous studies of β(2)-microglobulin aggregation have not shown such amyloidogenicity for single-residue substitutions. Comprehensive biophysical characterization of the β(2)-microglobulin variant, including its 1.40-Å, three-dimensional structure, should allow further elucidation of fibrillogenesis and protein misfolding.
22370999 A case of chronic active Epstein-Barr virus infection mimicking adult-onset Still's diseas 2013 Jan An 83-year-old man was diagnosed with adult-onset Still's disease (AOSD) based on clinical and laboratory findings. However, glucocorticoid had little effect. Epstein-Barr virus (EBV)-DNA was detected in peripheral blood, and autopsy findings confirmed a diagnosis of chronic active EBV infection (CAEBV). CAEBV mimics AOSD, and the presence of articular involvement and leukocytosis does not exclude the possibility of CAEBV. CAEBV should be included in the differential diagnosis of AOSD, and measurement of EBV-DNA is essential.
22349278 Saliva: a potential media for disease diagnostics and monitoring. 2012 Jul Within the past 10 years, the use of saliva as a diagnostic tool has gained considerable attention and become a well-accepted method. As a diagnostic fluid, saliva offers superiority over serum due to both a noninvasive collection method by specially trained persons and a cost-effective approach for screening of large populations. Collection of saliva offers a reduced risk of infection compared to the collection of serum. Moreover, obtaining saliva samples from infant, disabled or anxious patients, is much easier than obtaining other samples. There is a lot of useful components-changing information in saliva when a person is in sick. Therefore, we define these changing components as "biomarkers". The utilization of biomarkers as early predictors for clinical disease not only contributes to the effective prevention and treatment of diseases, but also enhances the assessment of potential health risks. In this article, we have reviewed the properties of saliva, the salivary analysis method for biomarker discovery, and the diagnostic potentials of salivary biomarkers in monitoring and detecting periodontal disease, Oral and Breast cancers, and Sjögren's syndrome. We also discussed some barriers of applications of saliva as a diagnostic media as well as recent improvements. We also prospected the future processing directions of using biomarkers in disease diagnosis and draw a conclusion that saliva is indeed an effective media in various disease monitoring and diagnosis.
22309679 Significant association of past parvovirus B19 infection with cytopenia in both adult-onse 2012 May 18 BACKGROUND: Human parvovirus B19 (B19) infection has been reported as a possible cause of autoimmune diseases. The association of B19 infection with adult-onset Still's diseases (AOSD) remains unclear. METHODS: IgM and IgG against B19-VP1/2 were determined using ELISA in 86 patients with AOSD, 58 patients with systemic lupus erythematosus (SLE) and 64 healthy controls. Anti-B19-VP1-unique region (VP1u) and anti-B19-nonstructural protein-1(NS1) antibodies were assessed by Western blot. B19 DNA was detected by nested PCR. RESULTS: Forty-three (50.0%) of 86 AOSD patients, 27 (46.6%) of 58 SLE patients and 30 (46.9%) of 64 controls had positivity for anti-B19-VP1/2-IgG in the absence of anti-B19-VP1/2-IgM, indicating past infection. None of enrolled subjects had detectable circulating B19 DNA. Significantly higher positivity rates for anti-B19-VP1u and anti-B19-NS1 IgG were observed in AOSD patients (39.5% and 46.5% respectively) and SLE patients (34.5% and 36.2% respectively) than in healthy controls (14.1%, p<0.005 for AOSD and p<0.05 for SLE, and 15.6%, p<0.001 for AOSD and p<0.05 for SLE; respectively). AOSD patients and SLE patients with seropositive results for anti-B19-VP1/2 IgG, anti-B19-VP1u or anti-B19-NS1 antibodies had a higher frequency of leucopenia and thrombocytopenia when compared to those with seronegative results. AOSD patients with anti-B19-VP1u or anti-B19-NS1 antibodies were more likely to have arthritis in comparison with those without these antibodies. CONCLUSIONS: Higher seroreactivity for anti-B19-VP1u and anti-B19-NS1 IgG were associated with cytopenia in both AOSD and SLE patients with unique correlation to arthritis in the AOSD. Further studies are necessary to determine if these responses correlate with a common genetic risk in patients with AOSD and SLE.
21888688 Immunopathologic differences of Sjögren's syndrome versus sicca syndrome in HCV and HIV i 2011 Aug 19 A clinical picture of dry eye and dry mouth with the histological counterpart of focal lymphocytic sialoadenitis, usually detected in minor salivary glands, is considered the hallmark of Sjögren's syndrome. The association of sicca complaints and focal sialoadenitis can be also found in a number of other diseases, including some systemic viral infections. Among these conditions, chronic hepatitis C virus infection, associated with mixed cryoglobulinaemia and extra-hepatic manifestations, and HIV infection, particularly in the phase of diffuse interstitial lymphocytic infiltration, may mimic the clinical and histological aspects of Sjögren's syndrome. However, each disorder is characterised by specific, disease-related immunopathological aspects. Besides sicca complaints, the various disorders may also share a number of systemic extra-glandular features and the possible development of mucosa-associated lymphoid tissue lymphomas. This latter event represents in all of these diseases the final result of an antigen-driven chronic stimulation of B lymphocytes.
21604024 A failure of TNFAIP3 negative regulation maintains sustained NF-κB activation in Sjögren 2011 Jun Sjögren's syndrome (SS) is characterized by the features of systemic autoimmunity and exocrine gland dysfunction and inflammation. Deregulated cytokine production is known to contribute to the etiology of SS but the underlying molecular mechanism is still remains to be unclear. TNF-α-induced protein 3 or TNFAIP3 is involved in the negative feedback regulation of nuclear factor-κB (NF-κB) signaling in response to specific pro-inflammatory stimuli in different cell types. To define the contribution of TNFAIP3 to SS, the levels of TNFAIP3 expression in human salivary gland epithelial cells (SGEC) derived from active primary SS patients were analyzed. Histological analysis was performed on paraffin-embedded human Sjögren's samples and healthy tissues. In separate experiments, immunofluorescence staining, western blot analysis and quantitative real-time PCR for TNFAIP3 was conducted in SGEC from SS and healthy subjects. Our findings clearly demonstrate changes in levels of the protein and gene expression between healthy controls and SS patients, depicting a very weak positivity for TNFAIP3 in SS samples. TNFAIP3 was found down-regulated in SGECs derived from SS patients in comparison with controls, and the cells with down-regulated TNFAIP3 expression exhibited enhanced NF-κB activities. In addition, to investigate the role of TNFAIP3 in the activation of NF-κB, we depleted TNFAIP3 expression by siRNA in healthy SGEC after treatment with or without TNF-α. Intriguingly, the silencing of TNFAIP3 by its siRNA in healthy SGEC increased NF-κB activation that could explain the deregulated cytokines production observed in SS.
21558290 Prognostic factors for the clinical severity of keratoconjunctivitis sicca in patients wit 2012 Feb AIMS: To determine whether prognostic immunological profiles predict the severity of keratoconjunctivitis sicca (KCS) in patients with Sjögren's syndrome (SS). METHODS: 121 patients diagnosed with SS and followed for at least 1 year were enrolled in this study. Patients were allocated to either a mild KCS group (Mi-KCS; n=65) or to a moderate to severe KCS group (MS-KCS; n=56) based on the Oxford scheme and response to treatment. These groups were each sub-divided into two groups based on the clinical severity of KCS and the presence of associated rheumatic disease (primary SS vs secondary SS). Anti-Ro/anti-La antibody, rheumatoid factor and tear interleukin (IL)-17 levels and Schirmer test results were compared between each group. RESULTS: Anti-Ro/SSA antibody and anti-La/SSB antibody concentrations were significantly higher in the MS-KCS group than in the Mi-KCS group for total and primary SS. The presence of anti-La/SSB antibody was significantly higher in the MS-KCS than the Mi-KCS group for total and primary SS. The mean tear IL-17 concentration in the MS-KCS group was significantly higher than in the Mi-KCS group for both total SS and primary SS patients. CONCLUSION: Serum anti-La/SSB antibody, serum anti-Ro/SSA antibody and tear IL-17 are likely to be strongly involved in the clinical severity of KCS in patients with primary SS.
21345395 [Alterations in voice, speech and swallowing in patients with Sjögren's syndrome]. 2011 Jul OBJECTIVE: To identify and describe voice, speech and swallowing abnormalities in patients with Sjögren's Syndrome (SS). MATERIALS AND METHODS: This was a prospective cross-sectional descriptive observational study. Patients with SS were interviewed and physically explored. Nasolaryngeal endoscopy, video laryngeal stroboscopy, fiberoptic endoscopic evaluation of swallowing and computerized voice spectrographic analysis (PRAAT® software) of voice and speech were also performed. RESULTS: We included 31 patients (96.7% women). Average time of evolution was 5 years; mean age was 48.4 years. Of these SS cases, 87% were secondary and 13% primary. Symptomatology: 70.9% dysphagia, 41.9% dysphonia, 35.4% dysglossia, 3.2% dysarthria. We found abnormalities principally in: one or more cranial nerves (V, VII, IX, X, XII) (67.7%), nasopharyngolaryngeal mucosa (77.4%), mucosal wave of vocal cords (90%), swallowing mechanism (90.3%), spectrogram of the vowels /e/ (58.06%) and /i/ (51.61%), and rhythm of the trisyllable "pataka" (35.48%). CONCLUSIONS: Patients with SS have voice, speech and swallowing abnormalities, not only associated to xerosis, but perhaps also to neurological abnormalities, probably secondary to the syndrome.
21397583 Prosthodontic rehabilitation in Sjogren's syndrome with a simplified palatal reservoir: tw 2011 Oct PATIENTS: A 45-year-old female patient came to the institute complaining of reduced salivation, pain and food lodgment in multiple teeth, and difficulty in eating. The systemic examination revealed dry eyes, dry mouth, cracking of corners of mouth and lack of appetite. The diagnostic tests were conclusive of Sjogren's syndrome, which is associated with xerostomia, ocular dryness and connective tissue disorders. Major oral problems in such patients include high caries rate, burning of oral mucosa, early tooth loss, increased tooth wear, poor tolerance for dentures and repeated failure of dental restorations. DISCUSSION: Prosthodontic therapy for this unique patient group is challenging and neglected, due to limited choice of abutments, loss of vertical dimension and poor occlusion. Two-year follow up of a patient of Sjogren's syndrome who was rehabilitated by a combination of fixed and removable prostheses, with a simplified palatal salivary reservoir is presented. CONCLUSION: Though the patient felt an improvement in quality of life due to the prosthesis, slurred speech and frequent reservoir refilling remained problems.
22867978 Use of containers with sterilizing filter in autologous serum eyedrops. 2012 Nov OBJECTIVE: To assess the effect of the use of containers with an adapted sterilizing filter on the contamination of autologous serum eyedrops. DESIGN: Prospective, consecutive, comparative, and randomized study. PARTICIPANTS: Thirty patients with Sjögren syndrome. METHODS: One hundred seventy-six autologous serum containers used in home therapy were studied; 48 of them included an adapted filter (Hyabak; Thea, Clermont-Ferrand, France), and the other 128 were conventional containers. Containers equipped with a filter were tested at 7, 14, 21, and 28 days of use, whereas conventional containers were studied after 7 days of use. In addition, testing for contamination was carried out in 14 conventional containers used during in-patient therapy every week for 4 weeks. In all cases, the preparation of the autologous serum was similar. Blood agar and chocolate agar were used as regular culture media for the microbiologic studies, whereas Sabouraud agar with chloramphenicol was the medium for fungal studies. MAIN OUTCOMES MEASURES: Microbiologic contamination of containers with autologous serum eyedrops. RESULTS: Only one of the containers with an adapted sterilizing filter (2.1%) became contaminated with Staphylococcus epidermidis after 1 month of treatment, whereas the contamination rate among conventional containers reached 28.9% after 7 days of treatment. The most frequent germs found in the samples were coagulase-negative Staphylococcus (48.6%). With regard the containers used in the in-patient setting, 2 (14.3%) became contaminated after 2 weeks, 5 (35.7%) became contaminated after 3 weeks, and 5 (50%) became contaminated after 4 weeks, leaving 7 (50%) that did not become contaminated after 1 month of treatment. CONCLUSIONS: Using containers with an adapted filter significantly reduces the contamination rates in autologous serum eyedrops, thus extending the use of such container by the patients for up to 4 weeks with virtually no contamination risks.
23115602 The Effect of Stopping Smoking on Disease Activity in Rheumatoid Arthritis (RA). Data from 2012 OBJECTIVE: We studied the effect of stopping smoking on disease activity in patients with RA. METHODS: Between 1992 and 2005, 2,800 adult patients were included in the BARFOT early RA study in Sweden. Disease Activity Score 28 joints (DAS28), C-reactive protein (CRP), Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), anti-CCP, general health and pain visual analog scales (VAS), EULAR response and treatment were registered at inclusion and at follow-up 2, 5 and 8 years. In 2010, a self-completion postal questionnaire was sent to 2,102 patients, enquiring about lifestyle factors, including cessation of smoking. RESULTS: A total of 1,460 adult RA patients with disease duration ≤2 years were included in this study. Seventeen percent smoked in 2010. In total, 127 patients stopped smoking after inclusion in the study. Smoking cessation after inclusion in the study was negatively associated with EULAR good outcome at 8 years (OR 0.44, 95% CI 0.22-0.86, p=0.02), controlled for age, disease duration, sex, socioeconomic class, smoking status, RF, and DAS28 at inclusion. CONCLUSION: Seventeen percent of the RA patients smoked in 2010 in this large Swedish RA cohort. Stopping smoking after onset of RA did not change the poor prognosis of smokers with RA, but all RA patients need to stop smoking because of the high risk of cardiovascular mortality and morbidity and the association of smoking with vasculitis and noduli in RA.
23021356 Autoimmunity as a possible predisposing factor for Stenotrophomonas maltophilia endocardit 2012 Jul Only 40 cases of Stenotrophomonas maltophilia (S. maltophilia) endocarditis have been reported to date, and there is no description in patients with underlying autoimmunity. A 23-year-old woman with systemic lupus erythematosus (SLE) overlapping rheumatoid arthritis (RA) and no risk factors for endocarditis was admitted in our hospital because of community-acquired tricuspid valve endocarditis. During hospitalization, she was complicated with pulmonary thromboembolism and pneumonia. Laboratory showed autoimmune diathesis featured by anti-cyclic citrullinated peptide (anti-CCP), anti-Sm, anti-Ro/SSA, anti-cardiolipin, anti-β₂ glycoprotein 1, and antinuclear antibodies, rheumatoid factor (RF), low complement, lymphopenia and C-reactive protein (CRP) of 425mg/L. S. maltophilia grew in serial blood culture sets. Empirical broad-spectrum antimicrobials were ineffective until trimethoprim/sulfamethoxazole (TMP/SMX) was added to therapy. One month after admission, the patient underwent successful surgical replacement of the tricuspid valve and the subsequent course was satisfactory, allowing her to be discharged 14 days after. Nowadays, she remains free of complaints and her cardiac, renal and pulmonary functioning is stable. Noteworthy is that all auto-antibodies have been persistently raised over time. Here, we present a compilation of the available information about S. maltophilia endocarditis, and suggest that autoimmunity could be included as a novel predisposing factor for S. maltophilia endocarditis.
23001748 The Japanese version of the modified ACR preliminary diagnostic criteria for fibromyalgia 2013 Sep PURPOSE: The aim of this study is to investigate the reliability and validity of the Japanese version of the modified American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia (mACR 2010-J) and the Fibromyalgia Symptom Scale (mFS-J). METHODS: According to the ACR 1990 classification criteria, patients with chronic pain were divided into the fibromyalgia group and nonfibromyalgia group (rheumatoid arthritis and osteoarthritis). Patients in both groups were assessed using mACR 2010-J and mFS-J. RESULTS: 294 of 462 (64 %) patients in the fibromyalgia group met mACR 2010-J, whereas 4 % (9/231) of the nonfibromyalgia group did, with sensitivity of 64 %, specificity of 96 %, positive predictive value of 97 %, negative predictive value of 56 %, and positive likelihood ratio of 16.3. Mean total scores on mFS-J significantly differentiated the fibromyalgia from the nonfibromyalgia group. According to the value of the Youden index, the best cutoff score for the mFS-J was 9/10. CONCLUSION: Our findings indicate that mACR 2010-J as a positive test and mFS-J as a quantification scale might be suitable for assessing fibromyalgia among Japanese chronic pain populations.
22933700 A mechanically powered negative pressure device used in conjunction with a bioengineered c 2012 Sep Pyoderma gangrenosum (PG), an uncommon inflammatory and ulcerative skin disease, typically is treated medically with a combination of immunosuppression and local wound care, but evidence to guide care is limited. PG wounds can be difficult to heal. A 76-year-old male patient presented with a history of rheumatoid arthritis and recalcitrant PG. After 9 months of treatment with local wound care, steroids, and topical tacrolimus, the wound had increased in size from 1.8 cm x 1.5 cm to 7.2 cm x 5.6 cm. At that time, he was started on a regimen of five applications of a bioengineered cell- based product (one application every 2 weeks for a total of five applications) with twice-weekly mechanically powered negative pressure device changes. The latter was started at 75 mm Hg and changed to 125 mm Hg after 4 weeks. Oral corticosteroid therapy was initially started at 40 mg of prednisone, then slowly tapered to 20 mg, but could not be completely discontinued due to a flare in the patient's rheumatoid symptoms. The wound was completely healed after 16 weeks. Research to ascertain the effectiveness of protocols of PG care, including the combination treatment described, is needed to help clinicians provide evidence-based care for these challenging wounds.
23233307 [Anti-inflammatory effects of tea-flavonoids]. 2012 Dec Tea flavonoids belong to the large group of polyphenols and display antioxidative, anti-inflammatory and anti-neoplastic activities. These phytochemicals are xenobiotics and are synthesized by tea plants such as Camellia sinensis and Camomilla recucita. These botanicals exhibit in vivo activities similar to that of biologicals which are widely used for chronic inflammatory diseases (rheumatoid arthritis, chronic inflammatory bowel disease). Epigallocathechin gallate and apigenin from these plants inhibit cytokines, chemokines and activated immune cells in vivo and in vitro. Clinical disorders with induced inflammatory pathways could benefit from flavonoid treatment. Dietary supplementation with specific tea-flavonoids could be used for Crohn's disease, ulcerative colitis and irritable bowel syndrome. Suppression of cytokine production could ultimately lead to inhibition of carcinogenesis. This mechanism could explain why flavonoids are effective in the prevention of intestinal neoplasia. This innovative new form of therapy should be tested in controlled, randomized clinical studies.
23020730 Pleuropulmonary pathology in patients with rheumatic disease. 2012 Oct Thoracic manifestations of rheumatic disease (RD) are increasingly recognized as a significant cause of morbidity and mortality worldwide. Rheumatologic underpinnings have been identified in a significant proportion of patients with interstitial lung disease. The 5 RDs most frequently associated with pleuropulmonary disease are (1) rheumatoid arthritis, (2) systemic lupus erythematosus, (3) progressive systemic sclerosis, (4) polymyositis/dermatomyositis, and (5) Sjögren syndrome. The onset of thoracic involvement in these diseases is variable. In some patients, it precedes the systemic disease or is its only manifestation. Moreover, there is a wide spectrum of clinical presentation ranging from subclinical abnormalities to acute respiratory failure. Histopathologically, the hallmark features of thoracic involvement by RD are inflammatory, targeting one or more lung compartments. The reactions range from acute to chronic, with remodeling by fibrosis being a common result. Although the inflammatory findings are often nonspecific, certain reactions or anatomic distributions may favor one RD over another, and occasionally, a distinctive histopathology may be present (eg, rheumatoid nodules). Three diagnostic dilemmas are encountered in patients with RD who develop diffuse lung disease: 1) opportunistic infection in the immunocompromised host, 2) drug toxicity related to the medications used to treat the systemic disease, and 3) manifestations of the patient's known systemic disease in lung and pleura. To confidently address the latter, the 5 major RDs are presented here, with their most common pleuropulmonary pathologic manifestations, accompanied by brief clinical and radiologic correlations.