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The CC chemokines CCL8, CCL13 and CCL20 are local inflammatory biomarkers of HLA-B27-associated uveitis.

Actualités En Médecine Interne - dim, 23/09/2018 - 14:07
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The CC chemokines CCL8, CCL13 and CCL20 are local inflammatory biomarkers of HLA-B27-associated uveitis.

Acta Ophthalmol. 2018 Sep 21;:

Authors: Abu El-Asrar AM, Berghmans N, Al-Obeidan SA, Gikandi PW, Opdenakker G, Van Damme J, Struyf S

Abstract
PURPOSE: To determine the concentrations of the CC chemokines CCL2, CCL7, CCL8, CCL11, CCL13, CCL20, CCL24 and CCL26 in aqueous humour (AH) samples from patients with specific uveitic entities.
METHODS: Aqueous humour samples from patients with active uveitis associated with Behçet's disease (BD) (n = 13), sarcoidosis (n = 8), HLA-B27-related inflammation (n = 12), Vogt-Koyanagi-Harada (VKH) disease (n = 12) and control patients (n = 9) were assayed with the use of a multiplex assay.
RESULTS: When considering all uveitis patients as one group, all chemokine levels except CCL2 were significantly increased compared to controls. CCL8, CCL13 and CCL20 were the most strongly upregulated, 48-fold, 118-fold and 173-fold, respectively, above control AH levels. CCL8 and CCL13 levels were significantly higher in HLA-B27-associated uveitis than in sarcoidosis and VKH disease. CCL20 levels were significantly higher in HLA-B27-associated uveitis than in BD, sarcoidosis and VKH disease. In addition, CCL20 levels were significantly higher in BD than in VKH disease. In HLA-B27-associated uveitis, CCL8, CCL13 and CCL20 were upregulated 111-fold, 255-fold and 465-fold, respectively, compared with controls. CCL8, CCL13 and CCL20 levels were significantly higher in nongranulomatous uveitis (BD and HLA-B27-associated uveitis) than in granulomatous uveitis (sarcoidosis and VKH disease).
CONCLUSIONS: Immune responses mediated by CCL8, CCL13 and CCL20 appear to be more potent in nongranulomatous uveitis, particularly in HLA-B27-associated uveitis.

PMID: 30242977 [PubMed - as supplied by publisher]

Anti-RNPC3 (U11/U12) antibodies in systemic sclerosis are associated with moderate to severe gastrointestinal dysmotility.

Actualités En Médecine Interne - dim, 23/09/2018 - 14:07
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Anti-RNPC3 (U11/U12) antibodies in systemic sclerosis are associated with moderate to severe gastrointestinal dysmotility.

Arthritis Care Res (Hoboken). 2018 Sep 22;:

Authors: McMahan ZH, Domsic RT, Zhu L, Medsger TA, Casciola-Rosen L, Shah AA

Abstract
OBJECTIVE: We examined the association of anti-RNPC3 antibodies in systemic sclerosis (scleroderma or SSc) patients with selected gastrointestinal (GI) tract complications.
METHODS: Sera from SSc patients with or without severe GI dysfunction (total parenteral nutrition-dependence) from the Johns Hopkins Scleroderma Center were screened for anti-RNPC3 antibodies. We then examined anti-RNPC3-positive cases and negative SSc controls from the University of Pittsburgh and UMPC Scleroderma cohort to confirm our findings and to examine whether specific GI features were associated with anti-RNPC3 antibodies.
RESULTS: In the discovery cohort, SSc patients with severe GI dysfunction (n=37) and without GI dysfunction (n=38) were screened for anti-RNPC3 antibodies. The former were more likely to have anti-RNPC3 antibodies (14% vs. 3%; p=0.11). In the Pittsburgh cohort, moderate to severe GI dysfunction (Medsger GI score ≥2) was present in 36% of anti-RNPC3 positive patients vs. 15% of anti-RNPC3 negative patients (p=<0.01). Anti-RNPC3 positive patients were more likely to be male (31% vs. 15%; p =0.04), black (18% vs. 6%; p =0.02), have esophageal dysmotility (93% vs. 62%; p <0.01), and interstitial lung disease (ILD, 77% vs. 35%; p <0.01). After adjusting for relevant covariates and potential confounders, moderate to severe GI disease was associated with anti-RNPC3 antibodies (OR= 3.8; 95%CI 1.0, 14.3), and ILD trended towards significance (OR= 2.8; 95%CI 1.0, 8.2).
CONCLUSION: Patients with SSc and anti-RNPC3 antibodies are more likely to be male, black and have moderate to severe GI disease and ILD. Further studies on larger patient cohorts may be helpful in further defining subsets of SSc patients at risk for severe GI involvement. This article is protected by copyright. All rights reserved.

PMID: 30242973 [PubMed - as supplied by publisher]

A retrospective analysis of distinguishing features of chest HRCT and clinical manifestation in primary Sjögren's syndrome-related interstitial lung disease in a Chinese population.

Actualités En Médecine Interne - dim, 23/09/2018 - 14:07
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A retrospective analysis of distinguishing features of chest HRCT and clinical manifestation in primary Sjögren's syndrome-related interstitial lung disease in a Chinese population.

Clin Rheumatol. 2018 Sep 22;:

Authors: Dong X, Zhou J, Guo X, Li Y, Xu Y, Fu Q, Lu Y, Zheng Y

Abstract
To characterize the distinctive chest high-resolution computerized tomography (HRCT) features and clinical manifestations of primary Sjögren syndrome (pSS)-related interstitial lung disease (ILD). The demographic data, clinical manifestations, and laboratory and radiological findings of 527 pSS patients were retrospectively analyzed. ILD was defined based on the presences of pulmonary signs in HRCT. Two hundred six of 527 patients were diagnosed as pSS-ILD, and the prevalence was 39.1%. The three most frequent abnormalities in HRCT were reticular pattern (92.7%), ground-glass attenuation (87.4%), and bronchovascular bundle thickening (82%). One hundred twenty-four cases (60.2%) of the pSS-ILD patients had only a single HRCT pattern, which involved 86 non-specific interstitial pneumonitis (NSIP) cases (41.7%), 22 usual interstitial pneumonia (UIP) cases (10.68%), 8 organizing pneumonia (OP) cases (3.9%), and 8 lymphocytic interstitial pneumonia (LIP) cases (3.9%), respectively. Besides, the more important observation was that 82 cases had no less than two HRCT patterns, and NSIP admixed with OP (43.9%), NSIP admixed with UIP (35.4%), and NSIP admixed with LIP (19.5%) were the most frequent. HRCT of pSS-ILD patients demonstrated bilateral infiltrates (99%), with abnormalities predominantly in the lower lobes (89.3%) and subpleural areas (81.1%), and a few lesions were characterized by hilum distributed (8.7%). Pulmonary function tests (PFTs) revealed impaired diffusion capacity for carbon monoxide and total lung capacity, and the rate of small airway lesions in the pSS-ILD patients was 3.5 times higher in patients of pSS. Logistic regression analysis showed that dry cough (OR 59.05), clubbing (OR 6.26), elevated lactate dehydrogenase (OR 21.38) and positive anti-Ro (OR 7.86) were relevant factors of pSS-ILD. ILD is the common pulmonary involvement of pSS and the prevalence of pSS-ILD is 39.1%. The single pattern of NSIP and UIP in HRCT are the commonest, and about 40% of the pSS-ILD patients possess multiple patterns in HRCT. The classification of idiopathic pulmonary fibrosis cannot completely include the pulmonary imaging features of pSS-ILD.

PMID: 30242640 [PubMed - as supplied by publisher]

Immune checkpoint inhibitor rechallenge in patients with immune-related myositis.

Actualités En Médecine Interne - dim, 23/09/2018 - 14:07
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Immune checkpoint inhibitor rechallenge in patients with immune-related myositis.

Ann Rheum Dis. 2018 Sep 21;:

Authors: Delyon J, Brunet-Possenti F, Leonard-Louis S, Arangalage D, Baudet M, Baroudjian B, Lebbe C, Hervier B

PMID: 30242031 [PubMed - as supplied by publisher]

((((((thrombophlebitis) OR takayasu) OR temporal arteritis) OR sarcoidosis) OR myositis) OR scleroderma) OR sjogren's disease; +17 new citations

Actualités En Médecine Interne - sam, 22/09/2018 - 19:28

17 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

((((((thrombophlebitis) OR takayasu) OR temporal arteritis) OR sarcoidosis) OR myositis) OR scleroderma) OR sjogren's disease

These pubmed results were generated on 2018/09/22

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

((((((thrombophlebitis) OR takayasu) OR temporal arteritis) OR sarcoidosis) OR myositis) OR scleroderma) OR sjogren's disease; +17 new citations

Actualités En Médecine Interne - sam, 22/09/2018 - 12:39

17 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

((((((thrombophlebitis) OR takayasu) OR temporal arteritis) OR sarcoidosis) OR myositis) OR scleroderma) OR sjogren's disease

These pubmed results were generated on 2018/09/22

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

Antineutrophil cytoplasmic antibodies in Chinese patients with tuberculosis.

Vascularites - sam, 22/09/2018 - 06:14
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Antineutrophil cytoplasmic antibodies in Chinese patients with tuberculosis.

Rev Soc Bras Med Trop. 2018 Jul-Aug;51(4):475-478

Authors: Huan G, Yang G, Xiao-Yu Q, Jiancheng X, Yan-Qing S

Abstract
INTRODUCTION: Based on reports, infection with Mycobacterium tuberculosis is believed to induce the development of antibodies that are considered to be biological indicators for the diagnosis of some other diseases. However, conflicting results have been published regarding the presence of antineutrophil cytoplasmic antibodies (ANCAs) in patients with tuberculosis. We aim to study the seroprevalence of ANCA in a population of Chinese patients with tuberculosis, which may lead to the misdiagnosis of vasculitic disorders.
METHODS: The study was conducted from January 2016 to May 2017 to evaluate the presence of ANCA in 103 Chinese patients using indirect immunofluorescent assay. An enzyme-linked immunosorbent assay was performed for anti-myeloperoxidase (MPO) and anti-proteinase 3 (PR3) detection.
RESULTS: Perinuclear ANCA (p-ANCA) was detected in 4.8% (5/103) of patients, whereas cytoplasmic ANCA (c-ANCA) was not detected; 1.9% (2/103) of patients with tuberculosis was positive for anti-MPO antibodies, and none had anti-PR3 antibodies. Both anti-MPO-positive patients were diagnosed with ANCA-associated vasculitides.
CONCLUSIONS: ANCA positivity may be more related to vasculitis and immunological disorders than to a M. tuberculosis infection. Therefore, to improve diagnostic accuracy, patients with M. tuberculosis who are ANCA positive should be investigated for concurrent diseases, including the effects of drugs. Therefore, even in tuberculosis epidemic area, ANCA seropositivity, detected by ELISA, is still more suggestive of ANCA-associated vasculitides.

PMID: 30133630 [PubMed - indexed for MEDLINE]

Socio-economic inequalities in occurrence and health care costs in rheumatic and musculoskeletal diseases: results from a Spanish population-based study including 1.9 million persons.

Vascularites - sam, 22/09/2018 - 06:14
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Socio-economic inequalities in occurrence and health care costs in rheumatic and musculoskeletal diseases: results from a Spanish population-based study including 1.9 million persons.

Clin Exp Rheumatol. 2018 Jul-Aug;36(4):589-594

Authors: Putrik P, Ramiro S, Orueta JF, Keszei A, Alonso Moran E, Nuño Solinis R, Boonen A

Abstract
OBJECTIVES: To explore and compare the impact of socio-economic deprivation on the occurrence of the major rheumatic and musculoskeletal diseases (RMDs) and health care costs.
METHODS: Data on diagnoses, socio-demographics and health care costs of the entire adult population of the Basque Country (Spain) was used. Area deprivation index included five categories (1 to 5 (most deprived)). Cost categories included primary and specialist care, emergency room, hospitalisations, and drug prescriptions. Twenty-nine RMDs were grouped into seven groups: Rheumatoid Arthritis, Spondyloarthritis, Crystal Arthropathies, Osteoarthritis, Soft Tissue Diseases, Connective Tissue Diseases, and Vasculitis. The relations between the deprivation and the occurrence of RMD and costs were explored in regression models adjusted for relevant confounders.
RESULTS: Data from 1,923,156 adults were analysed. Mean age was 49.9 (SD18.4) years, 49% were males. Soft tissue diseases were the most prevalent RMD (5.5%, n=105,656), followed by osteoarthritis (2.2%, n=41,924). Socio-economic deprivation was associated with higher likelihood to have any of the 29 RMDs. The strongest socio-economic gradient was seen for the soft tissue diseases (OR 1.82 [95%CI 1.78;1.85], most vs. least deprived), followed by osteoarthritis (OR 1.59 [1.54;1.64]). Deprivation was also associated with higher costs across the majority of the conditions however patterns were more blurred, and inverse relationship was observed for connective tissue diseases, gout, hip osteoarthritis and undifferentiated (poly)arthritis.
CONCLUSIONS: Socio-economic deprivation is associated with increased occurrence of all RMDs, and in most cases more deprived patients incur higher health care costs.

PMID: 29465359 [PubMed - indexed for MEDLINE]

Hypoalbuminaemia in antineutrophil cytoplasmic antibody-associated vasculitis: incidence and significance.

Vascularites - sam, 22/09/2018 - 06:14
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Hypoalbuminaemia in antineutrophil cytoplasmic antibody-associated vasculitis: incidence and significance.

Clin Exp Rheumatol. 2018 Jul-Aug;36(4):603-611

Authors: Xu PC, Tong ZY, Chen T, Gao S, Hu SY, Yang XW, Yan TK, Lin S

Abstract
OBJECTIVES: Hypoalbuminaemia has been proved to be a biomarker of poor prognosis in many diseases. The objective of this study was to investigate the significance of hypoalbuminaemia in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).
METHODS: Data of 117 AAV patients were analysed retrospectively. The relationship between hypoalbuminaemia and disease severity were studied. The influence of albumin on the pathogenetic role of ANCA was investigated in vitro.
RESULTS: Among all patients, 52 had light hypoalbuminaemia (30g/L<=albumin<35g/L) and 40 had nephrotic hypoalbuminaemia (albumin <30g/L). Patients with hypoalbuminaemia had higher inflammation levels and more severe kidney injury than patients without hypoalbuminaemia, but no significant difference of the urinary protein levels were found between patients with nephrotic and light hypoalbuminaemia. Multivariate analysis showed serum albumin correlated with age (r=-0.566, p=0.018), C-reactive protein (r=-0.521, p=0.032) and haemoglobin (r=0.512, p=0.036). Patients with nephrotic hypoalbuminaemia had higher incidence of infection, end stage renal disease and all cause mortality during treatment than patients with light hypoalbuminaemia or normal serum albumin. In vitro study indicated albumin could inhibit the binding between ANCA and neutrophils in a concentration dependent manner. Albumin also inhibited the ANCA-induced respiratory burst and neutrophil extracellular traps formation.
CONCLUSIONS: Serum albumin have an inhibitory effect on the binding between ANCA and its antigen. The incidence of hypoalbuminaemia in AAV with kidney involvement is high but is not caused by heavy proteinuria. Hypoalbuminaemia is correlated with the high inflammation level and poor prognosis of AAV. Therapy targeting hypoalbuminaemia might benefit patients with AAV.

PMID: 29352844 [PubMed - indexed for MEDLINE]

((((((thrombophlebitis) OR takayasu) OR temporal arteritis) OR sarcoidosis) OR myositis) OR scleroderma) OR sjogren's disease; +16 new citations

Actualités En Médecine Interne - ven, 21/09/2018 - 13:32

16 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

((((((thrombophlebitis) OR takayasu) OR temporal arteritis) OR sarcoidosis) OR myositis) OR scleroderma) OR sjogren's disease

These pubmed results were generated on 2018/09/21

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

Impact of environmental pollution on the ocular surface of Sjögren's syndrome patients.

Actualités En Médecine Interne - jeu, 20/09/2018 - 14:37
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Impact of environmental pollution on the ocular surface of Sjögren's syndrome patients.

Arq Bras Oftalmol. 2018 Sep 13;:

Authors: Galperín G, Berra M, Marquez MI, Mandaradoni M, Tau J, Berra A

Abstract
PURPOSE: To evaluate the effect of air pollution on the ocular surface of patients with Sjögren's syndrome.
METHODS: We investigated the ocular surfaces of thirty patients with Sjögren's syndrome and thirty healthy volunteers (control group) living in the Metropolitan Area of Buenos Aires. We used nitrogen dioxide as an indicator of exposure to air pollution. An ocular symptoms questionnaire was answered by all subjects, who also underwent a complete ocular surface ophthalmic examination-including an Ocular Surface Disease Index questionnaire, biomicroscopy, tear breakup time, Schirmer 1 test, corneal and conjunctival vital staining with fluorescein and lissamine green, tear lysozyme concentration, and impression cytology.
RESULTS: In almost all ocular surface test findings, we found a positive and significant correlation between higher levels of exposure to air pollution and higher levels of ocular surface damage in both the control group and Sjögren's syndrome patients. In Sjögren's syndrome patients, the Ocular Surface Disease Index questionnaire, tear breakup time, vital staining and impression cytology showed a significant correlation between high levels of air pollution and ocular surface disease. In the control group, the Ocular Surface Disease Index questionnaire, tear breakup time, and impression cytology showed a significant correlation between high levels of air pollution and ocular surface disease.
CONCLUSIONS: Here we demonstrated that in patients with dry eye syndrome associated with Sjögren, abnormalities of the ocular surface and eye irritation related to air pollution are more severe than those in the control group. We believe that measuring air quality should be not only an integral part of the evaluation of ocular surface disease but also a therapeutic consideration.

PMID: 30231159 [PubMed - as supplied by publisher]

Analysis of autoantibody profiles in two asbestiform fiber exposure cohorts.

Actualités En Médecine Interne - jeu, 20/09/2018 - 14:37
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Analysis of autoantibody profiles in two asbestiform fiber exposure cohorts.

J Toxicol Environ Health A. 2018 Sep 19;:1-13

Authors: Pfau JC, Barbour C, Black B, Serve KM, Fritzler MJ

Abstract
An increased risk for Systemic Autoimmune Diseases (SAID) was reported in the population of Libby, Montana, where extensive exposure to asbestiform amphiboles occurred through mining and use of asbestiform fiber-laden vermiculite. High frequencies of antinuclear autoantibodies (ANA) were detected in individuals and mice exposed to Libby Asbestiform Amphiboles (LAA). Among the 6603 individuals who have undergone health screening at the Center for Asbestos Related Diseases (CARD, Libby MT), the frequencies of rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, and systemic sclerosis are significantly higher than expected prevalence in the United States. While these data support the hypothesis that LAA can trigger autoimmune responses, evidence suggests that chrysotile asbestos does not. Serological testing was therefore performed in subjects exposed to LAA or predominantly chrysotile (New York steamfitters) using multiplexed array technologies. Analyses were performed in order to determine a) autoantibody profiles in each cohort, and b) whether the two populations could be distinguished through predictive modeling. Analysis using perMANOVA testing confirmed a significant difference between autoantibody profiles suggesting differential pathways leading to autoantibody formation. ANA were more frequent in the LAA cohort. Specific autoantibodies more highly expressed with LAA-exposure were to histone, ribosomal P protein, Sm/Ribonucleoproteins, and Jo-1 (histidyl tRNA synthetase). Myositis autoantibodies more highly expressed in the LAA cohort were Jo-1, PM100, NXP2, and Mi2a. Predictive modeling demonstrated that anti-histone antibodies were most predictive for LAA exposure, and anti-Sm was predictive for the steamfitters' exposure. This emphasizes the need to consider fiber types when evaluating risk of SAID with asbestos exposure.

PMID: 30230971 [PubMed - as supplied by publisher]

Detection of piscine orthoreoviruses (PRV-1 and PRV-3) in Atlantic salmon and rainbow trout farmed in Germany.

Actualités En Médecine Interne - jeu, 20/09/2018 - 14:37
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Detection of piscine orthoreoviruses (PRV-1 and PRV-3) in Atlantic salmon and rainbow trout farmed in Germany.

Transbound Emerg Dis. 2018 Sep 19;:

Authors: Adamek M, Hellmann J, Flamm A, Teitge F, Vendramin N, Fey D, Riße K, Blakey F, Rimstad E, Steinhagen D

Abstract
Piscine orthoreoviruses (PRVs) are emerging pathogens causing circulatory disorders in salmonids. PRV-1 is the etiological cause of heart and skeletal muscle inflammation (HSMI) in farmed Atlantic salmon (Salmo salar), characterized by epicarditis, inflammation and necrosis of the myocardium, myositis and necrosis of red skeletal muscle. In 2017, two German breeding farms for Atlantic salmon and rainbow trout (Oncorhynchus mykiss), respectively, experienced disease outbreaks with mortalities of 10% and 20%. The main clinical signs were exhaustion and lethargic behavior. During examinations, PRV-1 in the salmon and the PRV-3 in trout were detected for the first time in Germany. Further analyses also indicated the presence of Aeromonas salmonicida in internal tissues of both species. While PRV-1 could be putatively linked with the disease in Atlantic salmon, most of the rainbow trout suffered from an infection with A. salmonicida and not with PRV-3. Interestingly, the sequence analysis suggests that the German PRV-3 isolate is more similar to a Chilean PRV-3 isolate from Coho salmon (Oncorhynchus kisutch) than to PRV-3 from rainbow trout from Norway. This indicates a wide geographic distribution of this virus or dispersal by global trade. These findings indicate that infections with PRVs should be considered when investigating disease outbreaks in salmonids. This article is protected by copyright. All rights reserved.

PMID: 30230250 [PubMed - as supplied by publisher]

Infliximab biosimilar CT-P13 therapy in patients with Takayasu arteritis with low dose of glucocorticoids: a prospective single-arm study.

Actualités En Médecine Interne - jeu, 20/09/2018 - 14:37
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Infliximab biosimilar CT-P13 therapy in patients with Takayasu arteritis with low dose of glucocorticoids: a prospective single-arm study.

Rheumatol Int. 2018 Sep 18;:

Authors: Park EH, Lee EY, Lee YJ, Ha YJ, Yoo WH, Choi BY, Paeng JC, Suh HY, Song YW

Abstract
To evaluate the efficacy and safety of infliximab biosimilar CT-P13 in patients with active Takayasu arteritis (TAK). In this single-center open-label trial, patients with active TAK received CT-P13 at a starting dose of 5 mg/kg at weeks 0, 2, 6, and then every 8 weeks up to week 46. They were followed up until week 54. From week 14 to week 46, patients with inadequate response received increased dose of CT-P13 by 1.5 mg/kg. Concomitant prednisolone was allowed ≤ 10 mg/day. The primary efficacy end point was the achievement of partial or complete remission at week 30. All patients underwent positron emission tomography-computed tomography (PET-CT) at baseline and week 30. Twelve patients with TAK received CT-P13; one patient with protocol violation was excluded from analysis. Nine (81.8%) patients had taken concomitant prednisolone with median dose of 5.0 mg/day. At week 30, three (27.3%) patients achieved complete remission and six (54.5%) patients achieved partial remission. Statistically significant improvements in modified Indian Takayasu Clinical Activity Score (ITAS2010), ITAS-A, and serum levels of erythrocyte sedimentation rate and C-reactive protein were seen at week 30 from baseline. PET parameters were significantly reduced from baseline to week 30, including maximum standardized uptake value, target-to-vein ratio, target-to-liver ratio, and PET Vascular Activity Score. There were no serious adverse events. Treatment with CT-P13 may lead to improvement in clinical, radiographic, and serological activities with lower glucocorticoid requirement in TAK.Trial registration number NCT02457585.

PMID: 30229280 [PubMed - as supplied by publisher]

Urinary and plasma metabolite differences detected by HPLC-ESI-QTOF-MS in systemic sclerosis patients.

Actualités En Médecine Interne - mer, 19/09/2018 - 13:24
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Urinary and plasma metabolite differences detected by HPLC-ESI-QTOF-MS in systemic sclerosis patients.

J Pharm Biomed Anal. 2018 Sep 11;162:82-90

Authors: Fernández-Ochoa Á, Quirantes-Piné R, Borrás-Linares I, Gemperline D, PRECISESADS Clinical Consortium, Alarcón Riquelme ME, Beretta L, Segura-Carretero A

Abstract
Systemic Sclerosis (SSc) is a chronic autoimmune disease whose origin and pathogenesis are not yet well known. Recent studies are allowing a better definition of the disease. However, few studies have been performed based on metabolomics. In this way, this study aims to find altered metabolites in SSc patients in order to improve their diagnosis, prognosis and treatment. For that, 59 SSc patients and 28 healthy volunteers participated in this study. Urine and plasma samples were analysed by a fingerprinting metabolomic approach based on HPLC-ESI-QTOF-MS. We observed larger differences in urine than plasma metabolites. The main deregulated metabolic families in urine were acylcarnitines, acylglycines and metabolites derived from amino acids, specifically from proline, histidine and glutamine. These results indicate perturbations in fatty acid beta oxidation and amino acid pathways in scleroderma patients. On the other hand, the main plasma biomarker candidate was 2-arachidonoylglycerol, which is involved in the endocannabinoid system with potential implications in the induction and propagation of systemic sclerosis and autoimmunity.

PMID: 30227356 [PubMed - as supplied by publisher]

High Prevalence of Comorbid Autoimmune Diseases in Adults with Type 1 Diabetes from the HealthFacts Database.

Actualités En Médecine Interne - mer, 19/09/2018 - 13:24
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High Prevalence of Comorbid Autoimmune Diseases in Adults with Type 1 Diabetes from the HealthFacts Database.

J Diabetes. 2018 Sep 18;:

Authors: Bao YK, Weide LG, Ganesan VC, Jakhar I, McGill JB, Sahil S, Cheng AL, Gaddis M, Drees BM

Abstract
BACKGROUND: Patients with type 1 diabetes are at risk for other autoimmune diseases (ie. polyautoimmunity). The prevalence and risk factors of this phenomenon has been under-reported in adults and ethnic minorities, and data is lacking about non-endocrine autoimmune diseases.
METHODS: Study population data was gathered from the HealthFacts, a de-identified patient database from electronic medical records systems in the United States. Patients with an International Classification of Diseases diagnosis code specifying type 1 diabetes were included, and patients with a diagnosis of type 2 diabetes mellitus were excluded.
RESULTS: The cross-sectional study cohort comprised 158,865 adults with type 1 diabetes, mean age 51.4 ± 18.9 years and 52.5% female. The most common autoimmune diseases were thyroid disease (20.1%), systemic rheumatic diseases (3.4%), rheumatoid arthritis specifically (2.0%), and gastrointestinal autoimmune diseases (1.4%). Most of the autoimmune diseases were more common in women (eg. hypothyroidism, hyperthyroidism, celiac disease, rheumatoid arthritis, lupus, and Sjogren's). Caucasians were more likely than other ethnicities to have an additional autoimmune disease. Autoimmune disease prevalence increased with increasing age, significantly in women, such that 38.5% of women over the age of 80 years had an additional autoimmune disease, relative to 17.9% of women age 29 years or younger.
CONCLUSIONS: Additional autoimmunity represents a significant comorbidity in patients with type 1 diabetes. Autoimmune diseases are more common in Caucasians and in women and increase with age. Clinicians treating patients with type 1 diabetes should be aware of the risk factors for additional autoimmune diseases. This article is protected by copyright. All rights reserved.

PMID: 30226016 [PubMed - as supplied by publisher]

Ovarian necrosis due to S. pyogenes septic thrombophlebitis: A case report.

Actualités En Médecine Interne - mer, 19/09/2018 - 13:24
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Ovarian necrosis due to S. pyogenes septic thrombophlebitis: A case report.

Case Rep Womens Health. 2018 Oct;20:e00078

Authors: Guntiñas A, Kirk JL, Blanco MT, Pérez-Pedregosa J, Rodríguez MA

Abstract
The incidence of systemic infection attributed to group A streptococci (GAS) is increasing, mainly in postpartum women. Such infections require multidisciplinary management and prompt treatment, but an atypical presentation can delay diagnosis. We report the case of a 24-year-old woman admitted to the emergency department for evaluation. She had acute abdominal pain and fever 18 h after insertion of a levonorgestrel intrauterine device (IUD). She had a normal vaginal delivery 45 days earlier, and no other significant medical background. In a few hours the symptoms worsened, with rapid progression towards multiorgan failure. Differential diagnoses of late ovarian thrombophlebitis and ovarian torsion were considered. Laparoscopic surgery revealed the absence of ovarian torsion. The microbiologic culture of the IUD showed colonization by GAS. The sudden onset of shock-like symptoms in a postpartum woman with rapid progression towards multiorgan failure should prompt consideration of a diagnosis of GAS infection, so that appropriate treatment can be initiated to avoid the possible fatal consequences of this aggressive infection.

PMID: 30225202 [PubMed]

Efficacy and safety of using topical cyclosporine A for treatment of moderate to severe dry eye disease.

Actualités En Médecine Interne - mer, 19/09/2018 - 13:24
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Efficacy and safety of using topical cyclosporine A for treatment of moderate to severe dry eye disease.

Saudi J Ophthalmol. 2018 Jul-Sep;32(3):217-221

Authors: Othman TM, Mousa A, Gikandi PW, AbdelMabod M, Abdelrahman AM

Abstract
Objective: To investigate and evaluate the efficacy and safety of topical cyclosporine A for treatment of moderate to severe dry eye disease.
Materials and methods: This is a prospective study of patients with moderate to severe dry eye syndrome were recruited. All cases were selected from patients attending the ophthalmic outpatient clinic of Research institute of ophthalmology. Eligible patients were at least 21 years of age with a confirmed diagnosis of keratoconjunctivitis sicca with or without Sjogren's syndrome refractory to conventional management.The medication used in this study were unit dose vials of unpreserved cyclosporine A 0.05% used twice daily.The protocol was composed of a 2-week washout phase, a 12-week treatment phase, and a 4-week post treatment phase. Patients were evaluated at weeks 4, 8, 12 during the treatment phase. During these visits patients were evaluated for changes from base line in Schirmer test, rose Bengal staining, superficial punctuate erosions, BUT, impression cytology, symptoms of ocular discomfort and visual acuity. After completion of the treatment phase, patients were also evaluated at post treatment week 4, during this visit patients were assessed for Schirmer test, rose Bengal staining, superficial punctuate erosion, BUT, impression cytology, symptoms of ocular discomfort and visual acuity.
Results: Thirty two cases in the mean age of 47 (12.9), range [20-67] years; four (13%) male and 28 (87%) female were recruited in the current study. Out of them, 12 (38%) cases had Sjogren syndrome. Visual acuity improved significantly (p = 0.012), BUT (p < 0.0001) for both eyes, Schirmer measurements (p < 0.0001 and p = 0.029 for OD and OS, respectively).
Conclusions: Cyclosporine A ophthalmic emulsion 0.05% has been demonstrated to be effective and safe in human clinical trials. It reduces signs and symptoms of dry eye disease, with the fact that its effect continued to occur significantly within the treatment periods as well as improvement of ocular condition kept on, actually more slowly towards stability, despite the drug has already stopped.

PMID: 30224886 [PubMed]

Implant-supported Prostheses in Patient with Sjögren's Syndrome: Clinical Report with 3-year Follow-up.

Actualités En Médecine Interne - mer, 19/09/2018 - 13:24
Related Articles

Implant-supported Prostheses in Patient with Sjögren's Syndrome: Clinical Report with 3-year Follow-up.

Bull Tokyo Dent Coll. 2018;59(3):201-206

Authors: Mori G, Kobayashi T, Ito T, Yajima Y

Abstract
Sjögren's syndrome (SS), an autoimmune disorder, affects the exocrine glands, including the lacrimal and salivary glands. It is characterized by symptoms of dry eye and dry mouth. As secretion of saliva decreases, patients with SS experience rampant caries, pain in the oral mucosa, inflammation and hardening of the salivary glands, abnormal taste, dysphagia, and loss of teeth earlier than healthy individuals. A removable partial denture is often used as a prosthesis after tooth loss. Compromised salivary lubrication, however, can produce traumatic ulceration of the mucosa, making use of a removable prosthesis in SS patients painful. In such cases, a dental implant is likely to be requested as an alternative. This report describes dental implant treatment in an SS patient, a 50-year-old woman who presented with the chief complaint of masticatory dysfunction and pain due to a removable partial denture. Eight implants were placed in the maxillary and mandibular first molar tooth and second molar tooth regions. Following a 4-month non-loading period, second-stage surgery and provisional restoration with a screwretained implant temporary crown were performed. Screw-retained superstructures were fitted by means of a customized titanium abutment and zirconia crown as the final restoration. No complications, including inflammation of peri-implant soft tissue or resorption of peri-implant bone, were observed at 3 years following placement of the superstructures.

PMID: 30224614 [PubMed - in process]

Disseminated extrapulmonary Legionella pneumophila infection presenting with panniculitis: case report and literature review.

Actualités En Médecine Interne - mer, 19/09/2018 - 13:24
Related Articles

Disseminated extrapulmonary Legionella pneumophila infection presenting with panniculitis: case report and literature review.

BMC Infect Dis. 2018 Sep 17;18(1):467

Authors: Chitasombat MN, Ratchatanawin N, Visessiri Y

Abstract
BACKGROUND: Legionellosis is a well-known cause of pneumonia. Primary cutaneous and subcutaneous infection caused by Legionella pneumophila is rare and the diagnosis is challenging.
CASE PRESENTATION: A 38-year-old Thai woman with systemic lupus erythematosus and myasthenia gravis treated with prednisolone and azathioprine presented to our hospital with low-grade fever, diarrhea, and indurated skin lesions on both thighs. Initial examination showed plaques on both inner thighs. Magnetic resonance imaging showed myositis and swelling of the skin and subcutaneous tissue. Diagnosis of panniculitis due to L. pneumophila was carried out by histopathology, Gram stain, and 16S rRNA gene sequencing method of tissue biopsy from multiple sites on both thighs. Myocarditis was diagnosed by echocardiography. The final diagnosis was disseminated extrapulmonary legionellosis. Treatment comprised intravenous azithromycin for 3 weeks and the skin lesions, myositis and myocarditis resolved. Oral azithromycin and ciprofloxacin were continued for 3 months to ensure eradication of the organism. The patient's overall condition improved.
CONCLUSIONS: To our knowledge, we report the first case of L. pneumophila infection manifesting with panniculitis, possible myositis, and myocarditis in the absence of pneumonia. The diagnosis of extrapulmonary Legionella infection is difficult, especially in the absence of pneumonia. A high index of suspicion and appropriate culture with special media or molecular testing are required. Initiation of appropriate treatment is critical because delaying therapy was associated with progressive infection in our patient.

PMID: 30223775 [PubMed - in process]

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