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NCBI: db=pubmed; Term=vasculitis AND ((English[lang] OR French[lang]) AND adult[MeSH] AND "last 90 days"[PDat])
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Evaluation of Kawasaki's disease-associated coronary artery aneurysms with 3D CT cinematic rendering.

ven, 26/10/2018 - 04:14
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Evaluation of Kawasaki's disease-associated coronary artery aneurysms with 3D CT cinematic rendering.

Emerg Radiol. 2018 Aug;25(4):449-453

Authors: Rowe SP, Zimmerman SL, Johnson PT, Fishman EK

Abstract
Kawasaki's disease (KD) is a vasculitis that predominantly affects children and can lead to the development of coronary artery aneurysms. These aneurysms can subsequently thrombose and occlude, which may lead to chest pain and other signs and symptoms of acute coronary syndrome in young patients. Coronary CT angiography, including 3D visualization techniques, is a common modality used in the follow-up of KD patients. In this series of three patients, we present the typical coronary artery imaging findings that can appear in these patients, with an emphasis on the use of the novel 3D technique of cinematic rendering (CR). CR utilizes a different lighting model than other 3D methods and is able to produce highly-detailed, photorealistic images. The potential advantages of CR images in understanding the complex mediastinal vascular anatomy and the relationships of coronary artery aneurysms to other anatomic structures are emphasized.

PMID: 29488043 [PubMed - indexed for MEDLINE]

Could be serum uric acid a risk factor for thrombosis and/or uveitis in Behcet's disease?

ven, 26/10/2018 - 04:14
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Could be serum uric acid a risk factor for thrombosis and/or uveitis in Behcet's disease?

Vascular. 2018 Aug;26(4):378-386

Authors: Atıl A, Deniz A

Abstract
Introduction Serum uric acid level increases in many inflammatory conditions. Uric acid triggers the vascular inflammation and artery damage, which causes to an increased risk of endothelial dysfunction and atherosclerosis. It is not clear in the literature whether uric acid contributes to uveitis by similar mechanisms. We investigated whether uric acid level increases in Behcet's disease patients with thrombosis or anterior uveitis. Patients and methods We reviewed the medical records of 914 Behcet's disease. After screening for exclusion criteria, there were 50 Behcet's disease patients with thrombotic complication and as the control group 202 BD patients without any vascular complication were included to the study. In the Anterior uveitis group, there were 53 Behcet's disease patients. The Control group consisted of 39 Behçet's disease patients without eye findings. Results Mean uric acid value was 4.96 ± 1.06 mg/dl in Behcet's disease patients with thrombosis whereas 4.08 ± 0.94 mg/dl in controls, indicating a significant difference ( p < 0.001). There was no significant difference between the mean ages of the patients in both groups. The mean age of the BD group without eye findings was 39.31 ± 10.47 years and that of the Behcet's disease with Anterior Uveitis group was 37.72 ± 9.65 years ( p = 0.453). The mean serum UA in the BD group without eye findings was 4.21 ± 1.21 mg/dl, while in the BD with Anterior Uveitis group it was 4.57 ± 1.37 mg/dl ( p = 0.201). Conclusion The extent of increase in uric acid level was greater in Behcet's disease patients that have a thrombotic complication compared to those without thrombotic complication. Uric acid seems to play a role in the pathogenesis of thrombosis. It is concluded that the elevation of serum uric acid level in patients with anterior uveitis with Behcet's disease is not statistically significant.

PMID: 29360007 [PubMed - indexed for MEDLINE]

Investigation of the arterial intima-media thickness in Behcet's disease patients without vascular complaints.

ven, 26/10/2018 - 04:14
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Investigation of the arterial intima-media thickness in Behcet's disease patients without vascular complaints.

Vascular. 2018 Aug;26(4):356-361

Authors: Kankilic N, Aslan A, Karahan O, Demirtas S, Caliskan A, Yavuz C

Abstract
Objectives Behcet's disease is a multisystemic, inflammatory disease. Various factors have been implicated in the disease, including genetics, infections, immunoglobulins, immune complexes, antibodies, and oxidative stress. However, the underlying etiopathogenesis remains unclear. Behcet's disease can occur with or without vascular involvement. This prospective study investigated the relationship between the intima-media thickness of the major arteries, in addition to other factors affecting the disease process, in Behcet's disease without vascular involvement. Methods Twenty-four patients (average age: 38.50 ± 10.931) without vascular involvement or any vascular complaints who were diagnosed with Behcet's disease were included in the study. Sixteen healthy subjects (average age: 39.75 ± 7.793) were included as a control group. Demographic information and medical histories were recorded, and routine blood tests were performed in both groups. The intima-media thickness of the subclavian, axillary, femoral, and carotid arteries of all the participants were recorded using Doppler ultrasonography. The data were then subjected to intergroup statistical and correlation analyses. Results There were no significant differences between the arterial intima-media thickness values of the Behcet's disease patients and those of the control group ( p > 0.05). However, there was a significant difference between the neutrophil-lymphocyte ratio ( p = 0.004), low-density lipoprotein ( p = 0.007), and triglyceride ( p = 0042) levels of the two groups. Significant correlations were found between intima-media thickness and neutrophil-lymphocyte ratio levels ( p = 0.012) and the disease duration ( p = 0.030). There was also a significant correlation between the intima-media thickness of the femoral artery and disease duration ( p = 0.014). Conclusions The results showed that the duration of illness had a significant effect on arterial intima-media thickness in Behcet's disease. Blood neutrophil-lymphocyte ratio levels were also associated with increased intima-media thickness.

PMID: 29182089 [PubMed - indexed for MEDLINE]

Persistent Inflammatory Activity in Blood Cells and Artery Tissue from Patients with Previous Bare Metal Stent.

mar, 23/10/2018 - 02:15
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Persistent Inflammatory Activity in Blood Cells and Artery Tissue from Patients with Previous Bare Metal Stent.

Arq Bras Cardiol. 2018 Aug;111(2):134-141

Authors: Farsky PS, Hirata MH, Arnoni RT, Almeida AFS, Issa M, Lima PHO, Higuchi ML, Lin-Wang HT

Abstract
BACKGROUND: Studies have pointed out a higher mortality after coronary artery bypass surgery (CABG) in patients with stent.
OBJECTIVE: To evaluate inflammatory markers in peripheral blood cells and in coronary artery tissue samples obtained during CABG in patients with stent compared to controls.
METHODS: The case series consisted of two groups, one with previous stent implantation (n = 41) and one control (n = 26). The expression of the LIGHT, IL-6, ICAM, VCAM, CD40, NFKB, TNF, IFNG genes was analyzed in peripheral blood cells collected preoperatively. The coronary artery was evaluated for: interleukin-6, ICAM, VCAM, CD40, NFKB, TNF-alpha and IFN-gamma by immunohistochemistry. A total of 176 tissue samples were grouped for analysis in: A1- arteries with stent (n = 38); A2- native arteries from patients with stent in another artery (n = 68); and A3- arteries without stent from controls undergoing routinely CABG surgery (n = 70). A significance level of 0.05 was adopted.
RESULTS: Patients with stent showed higher TNF (p = 0.03) and lower CD40 gene expression (p = 0.01) in peripheral blood cells than controls without stent. In coronary artery samples, the TNF-alpha protein staining was higher in the group A1, not only in the intima-media layer (5.16 ± 5.05 vs 1.90 ± 2.27; p = 0.02), but also in the adipose tissue (6.69 ± 3.87 vs 2.27 ± 4.00; p < 0.001). Furthermore, group A1 had a higher interleukin-6 protein staining in adipose tissue than group A3 (p = 0.04).
CONCLUSION: We observed a persistently higher systemic TNF expression associated with exacerbated TNF-alpha and interleukin-6 local production in patients with stents. This finding may contribute to a worse clinical outcome.

PMID: 30020327 [PubMed - indexed for MEDLINE]

Unusual Clinical Sequelae of Kawasaki Disease-Symptomatic Extracranial Internal Carotid Stenosis in Young Adult.

ven, 19/10/2018 - 23:25
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Unusual Clinical Sequelae of Kawasaki Disease-Symptomatic Extracranial Internal Carotid Stenosis in Young Adult.

World Neurosurg. 2018 Sep;117:162-164

Authors: Yokoya S, Tamura A, Hino A, Bamba M, Kato T, Takezawa H, Goto Y, Oka H, Fujii A, Hashimoto Y

Abstract
BACKGROUND: Kawasaki disease (KD) is an acute systemic vasculitis that primarily affects the coronary artery, but it does not commonly affect the carotid artery. Cerebral infarction (CI) with internal carotid artery stenosis (ICS) in patients with KD has not been reported until now. We report a patient with CI as a remote-phase complication of KD.
CASE PRESENTATION: A 32-year-old man presented with impaired consciousness. Magnetic resonance imaging and digital subtraction angiography confirmed CI and ICS. He successfully underwent carotid endarterectomy. The resected plaque had pathologic findings of KD, which suggested that the internal carotid artery suffered from chronic inflammation.
CONCLUSION: KD in childhood may cause symptomatic ICS as a sequela of a remote phase.

PMID: 29920397 [PubMed - indexed for MEDLINE]

Takayasu's arteritis: a rare disease in Poland.

mar, 16/10/2018 - 20:38
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Takayasu's arteritis: a rare disease in Poland.

Ann Agric Environ Med. 2018 Sep 25;25(3):469-472

Authors: Kanecki K, Nitsch-Osuch A, Tyszko PZ, Goryński P, Smolarczyk R, Suchta K

Abstract
INTRODUCTION: Takayasu's arteritis (TA) is a rare and potentially life-threatening granulomatous large-vessel vasculitis that involves mostly in the aorta and its proximal branches, and occurs most commonly in young females. This study measures the incidence and prevalence of TA, and assesses the gender distribution and territorial differences in the occurrences of this disease in Poland over a five-year period. To the best of our knowledge, this is the first evaluation of this rare disease in Poland based on a hospital morbidity database.
MATERIAL AND METHODS: Analyses were performed with population-based administrative data obtained from a national hospital morbidity study carried out between January 2011 - December 2015 by the Polish National Institute of Public Health. Yearly incidence rates and prevalence of TA were calculated using the number of TA patients and corresponding census data for the overall Polish population.
RESULTS: Data included 660 hospitalization records. The final study sample comprised 177 patients: 154 female (87%) and 23 male (13%) with first-time hospitalization for TA. The mean age was 45.4years (95% CI: 42.9-47.8; SD 16.8; range 4-81 years), median 47. The incidence rate of TA was estimated at 0.92 per million per year (95% CI: 0.68-1.16). Five-year TA prevalence was estimated to be 4,6 per million. Incidence rates of TA did not vary significantly between more urban and more rural regions.
CONCLUSIONS: The incidence of TA in Poland was similar or lower to data reported by other European countries. The study provides epidemiological data on TA in Poland that may be useful while comparing it with other geographical regions.

PMID: 30260188 [PubMed - indexed for MEDLINE]

Unusual and Diffuse Hypermetabolism in Routine 18F-FDG PET/CT of the Supra-aortic Vessels in Biopsy-Positive Giant Cell Arteritis.

mar, 16/10/2018 - 20:38
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Unusual and Diffuse Hypermetabolism in Routine 18F-FDG PET/CT of the Supra-aortic Vessels in Biopsy-Positive Giant Cell Arteritis.

Clin Nucl Med. 2018 Sep;43(9):e336-e337

Authors: Flaus A, Granjon D, Habouzit V, Gaultier JB, Prevot-Bitot N

Abstract
F-FDG PET-CT used to lack of resolution to detect vasculitis in the superficial cranial and cervical arteries. Very few cases, for which some of these arteries were visualized, are published, and the images were acquired using a dedicated PET protocol. We present a case, acquired using a routine whole-body protocol, with increased tracer uptake detected in vertebral arteries, internal and external carotid arteries, superficial temporal arteries, occipital arteries, maxillary arteries, facial arteries, and lingual arteries. It underlines the potential for newer-generation PET-CT system to assess vasculitis. F-FDG PET-CT may have an important role to detect and follow vasculitis in the future.

PMID: 30015661 [PubMed - indexed for MEDLINE]

Comparison between visual and numerical metrics for the evaluation of patients with Takayasu arteritis with 18F-FDG-PET.

mar, 16/10/2018 - 20:38
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Comparison between visual and numerical metrics for the evaluation of patients with Takayasu arteritis with 18F-FDG-PET.

Nucl Med Commun. 2018 Aug;39(8):779-788

Authors: Emsen B, Benali K, Mahida B, Larivière D, Le Guludec D, Papo T, Sacre K, Hyafil F

Abstract
INTRODUCTION: The choice of metrics for defining active Takayasu arteritis (TAK) using fluorine-18-fluorodeoxyglucose (F-FDG)-PET remains controversial.
OBJECTIVE: The aim of this study was to compare in the same patients the diagnostic performance for the detection of active TAK of different metrics applied for the quantification of vascular F-FDG uptake with PET.
PATIENTS AND METHODS: Overall, 62 PET acquisitions were performed 90 min after F-FDG injection in 15 patients with TAK and analyzed retrospectively. The intensity of vascular F-FDG uptake was graded visually in comparison with the liver signal and with the numerical metrics, including maximum standard uptake value (SUV), maximum target to background ratio (TBR, ratio of SUVmax in the vessel wall and SUVmean of blood), most-diseased segment (MDS)-TBR (average of TBR from all active lesions), and global TBR (average TBR along the aorta and carotid arteries). The gold standard was disease activity identified using the National Institute of Health score for TAK.
RESULTS: Using visual analysis, the definition of F-FDG-PET as positive in presence of at least one vascular lesion with a signal more than liver provided the best diagnostic performance for detecting active TAK with a specificity of 98%, a sensitivity of 62% and an accuracy of 89%. Using numerical metrics, SUVmax [SUVmax >3.3; area under the curve (AUC)=0.84] and TBRmax (TBRmax >2.3; AUC=0.84) offered the best diagnostic performance for the detection of active TAK in comparison with MDS-TBR (MDS-TBR>1.7; AUC=0.70) and global TBR (global TBR >1.4; AUC=0.51).
CONCLUSION: In this study, we found that the analysis of the vascular region with the highest F-FDG uptake using either visual or numerical metrics provided the best diagnostic performance for the detection of active TAK with PET.

PMID: 29889690 [PubMed - indexed for MEDLINE]

Infliximab as an alternative therapy for refractory adult onset Kawasaki disease: A case report.

sam, 13/10/2018 - 17:57
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Infliximab as an alternative therapy for refractory adult onset Kawasaki disease: A case report.

Medicine (Baltimore). 2018 Oct;97(40):e12720

Authors: Kawaguchi T, Rikitake Y, Tsuruda T, Kawata C, Rikitake M, Iwao K, Aizawa A, Kariya Y, Matsuda M, Miyauchi S, Umekita K, Takajo I, Okayama A

Abstract
RATIONALE: Kawasaki disease (KD) is an acute febrile illness predominantly affecting children less than 5 years of age and characterized by systemic inflammation in all medium-sized arteries. Adult-onset KD (AKD) is rare with only 105 case reports published. Recently, the efficacy of infliximab (IFX) for patients with refractory KD has been demonstrated.
PATIENT CONCERNS: A previously healthy 24-year-old man was admitted because of a persistent fever, and elevated serum level of AST, ALT, LDH, and CRP.
DIAGNOSIS: The patients met the diagnostic criteria for KD based on the findings of persistent fever, polymorphous exanthema, unilateral cervical lymphadenopathy, non-purulent palpebral conjunctivitis and membranous desquamation. Echocardiogram revealed the dilatation at the proximal sites of the right coronary artery (7.9 mm) and left anterior descending artery (5 mm). The patient was treated with high-dose intravenous immunoglobulin (1 g/kg/day for 2 days) and ASA (100 mg daily). However, his fever and arthralgia persisted.
INTERVENTIONS: He was administered single 5 mg/kg doses of IFX.
OUTCOMES: He became afebrile the next day and his arthralgia improved.
LESSONS: We report the first case of administration of IFX in a patient with AKD refractory to intravenous immunoglobulin (IVIG), and successful reduction of systemic inflammation. However, the effectiveness of IFX in the regression of coronary artery aneurysm remains to be determined.

PMID: 30290679 [PubMed - indexed for MEDLINE]

Extensive Gastrointestinal Manifestations as the Main Relapsing Disease in Granulomatosis with Polyangiitis.

mer, 10/10/2018 - 17:00
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Extensive Gastrointestinal Manifestations as the Main Relapsing Disease in Granulomatosis with Polyangiitis.

Dig Dis Sci. 2018 10;63(10):2810-2812

Authors: Vergara-Fernández O, Chablé-Montero F, Ruiz N, Mitre-Reyes D, Cerda-Contreras E, Hernández A, Marroquín-Fabián E, Flores-Suárez LF

PMID: 29862483 [PubMed - indexed for MEDLINE]

Choroidal Thickness Indicates Subclinical Ocular and Systemic Inflammation in Eyes with Behçet Disease without Active Inflammation.

jeu, 04/10/2018 - 11:56
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Choroidal Thickness Indicates Subclinical Ocular and Systemic Inflammation in Eyes with Behçet Disease without Active Inflammation.

Korean J Ophthalmol. 2018 08;32(4):290-295

Authors: Chung YR, Cho EH, Jang S, Lee SY, Lee ES, Lee K

Abstract
PURPOSE: To investigate whether subfoveal choroidal thickness, measured using enhanced depth imaging optical coherence tomography (EDI-OCT), is an indicator of subclinical ocular or systemic inflammation in eyes with Behçet disease (BD) without active ocular inflammation.
METHODS: A retrospective analysis was used to examine clinical features of non-uveitic patients with BD (NUBD group), patients with a previous history of Behçet uveitis in an inactive state (IUBD group), and healthy controls were evaluated from October 2014 to September 2015. Subfoveal choroidal thickness was measured using EDI-OCT.
RESULTS: The NUBD group included 46 eyes in 24 patients; the IUBD group included 16 eyes in 11 patients; and the control group included 35 eyes in 23 individuals. The mean subfoveal choroidal thicknesses differed significantly among these groups. Choroidal thickness was significantly greater in the NUBD (310.5 ± 81.0 μm) than in the IUBD (263.1 ± 56.6 μm, p = 0.013) and control (256.9 ± 67.9 μm, p = 0.002) groups. The disease activity score was significantly higher in the NUBD than in the IUBD group (p < 0.001), while the use of cyclosporine was significantly associated with choroidal thickness in eyes with NUBD (p = 0.039).
CONCLUSIONS: Subfoveal choroidal thickness, as measured by EDI-OCT, may be a clinical indicator of subclinical ocular inflammation and systemic inflammation in BD patients without active ocular inflammation.

PMID: 30091307 [PubMed - indexed for MEDLINE]

Asymmetrical Dimethylarginine Levels in Hepatitis B Virus-Positive Patients.

lun, 01/10/2018 - 10:55
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Asymmetrical Dimethylarginine Levels in Hepatitis B Virus-Positive Patients.

Ann Lab Med. 2018 Sep;38(5):446-449

Authors: Karakecili F, Cikman A, Aydin M, Gulhan B

Abstract
BACKGROUND: High asymmetrical dimethylarginine (ADMA) levels have been associated with endothelial dysfunction and contribute to the development of several diseases. However, data on the relationship between hepatitis B virus (HBV) and ADMA are limited. The aim of our study was to explore the relationship between ADMA and HBV by comparing the ADMA levels in patients with chronic active hepatitis B (CHB), inactive HBV carriers (carriers), and healthy volunteers (controls).
METHODS: The participants were divided into three groups: 90 patients with CHB, 90 HBV carriers, and 90 controls. Serum ADMA levels were quantified using an ELISA kit (Cusabio, Wuhan, China). The data were analyzed using an ANOVA or the Kruskal-Wallis test as appropriate, with P<0.05 considered significant.
RESULTS: Serum ADMA levels were significantly higher in patients with CHB (228.35±91.10 ng/mL) than in HBV carriers (207.80±75.80 ng/mL) and controls (207.61±89.10 ng/mL) (P=0.049). The clinical scores of the patients were positively correlated with ADMA levels.
CONCLUSIONS: The elevated serum ADMA levels in patients with CHB confirm that HBV plays a role in vasculitis. Further investigation of the mechanisms contributing to the high levels of ADMA in CHB may contribute toward development of new treatment modalities.

PMID: 29797815 [PubMed - indexed for MEDLINE]

Reduction of Nicardipine-Related Phlebitis in Patients with Acute Stroke by Diluting Its Concentration.

ven, 28/09/2018 - 08:59
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Reduction of Nicardipine-Related Phlebitis in Patients with Acute Stroke by Diluting Its Concentration.

J Stroke Cerebrovasc Dis. 2018 Jul;27(7):1783-1788

Authors: Kawada K, Ohta T, Tanaka K, Miyamoto N

Abstract
BACKGROUND: Nicardipine is frequently used in the treatment of hypertension for patients with acute stroke; however, its dosing is complicated by a high risk of phlebitis. In the present study, we examined whether restricting nicardipine concentration under a specific value could reduce the incidence of nicardipine-related phlebitis in patients with acute stroke.
METHODS: Intravenous nicardipine-related phlebitis was retrospectively analyzed. From July 2015, a simple proposition was made to dilute maximum intravenous nicardipine concentration to lower than 130 µg/mL. The maximum intravenous nicardipine concentration and the incidence of phlebitis were compared between patients treated from July 2014 to June 2015 (preproposition group) and patients treated from July 2015 to June 2016 (postproposition group).
RESULTS: A total of 300 patients (preproposition group, 138; postproposition group, 162) were included. The postproposition group demonstrated significantly lower maximum intravenous nicardipine concentration (in µg/mL, 76.9, 47.6-104.5 versus 130.4, 69.8-230.8; P < .001) and incidence of phlebitis (9.9%, 16/162 vs. 30%, 42/138; P < .001) than the preproposition group. Multivariable logistic regression analysis revealed that the maximum intravenous nicardipine concentration lower than 130 µg/mL (odds ratio [OR] .15; 95% confidence interval [CI] .06-.35; P < .001) and National Institutes of Health Stroke Scale on admission (OR .95; 95% CI .91-.99; P = .007) were the statistically significant independent factors for phlebitis, which indicated the usefulness of the proposition to dilute maximum intravenous nicardipine concentration to lower than 130 µg/mL.
CONCLUSIONS: The simple and appropriate proposition about nicardipine administration lowered maximum nicardipine concentration and reduced the incidence of nicardipine-related phlebitis in patients with acute stroke.

PMID: 29519742 [PubMed - indexed for MEDLINE]

Antineutrophil cytoplasmic antibodies in Chinese patients with tuberculosis.

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.

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.

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]

Ulcerative colitis in an adult patient mimicking Henoch-Schönlein purpura: A case report.

mer, 19/09/2018 - 03:30
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Ulcerative colitis in an adult patient mimicking Henoch-Schönlein purpura: A case report.

Medicine (Baltimore). 2018 Aug;97(35):e12036

Authors: Lu B, Niu LL, Xu XG, Yao SL, Tan XY

Abstract
RATIONALE: Ulcerative colitis (UC) is one of the chronic inflammatory diseases of the intestinal tract. UC being misdiagnosed as Henoch-Schönlein purpura (HSP) in the elderly has seldom been reported about.
PATIENT CONCERNS: A 64-year-old man was admitted to the hospital with petechiae and palpable purpura in lower limbs and abdominal pain for about 1 month.
DIAGNOSES: Colonoscopy demonstrated severe inflammation in the colon, mucosal congestion, and edema, and multiple hemorrhages and ulcerations, with purulent adhesions. A histopathologic examination of the colon biopsies revealed extensive infiltration of immune cells and mucosal ulcerations in the intestine. UC was diagnosed.
INTERVENTIONS: The patient was treated with prednisone (1.0 mg/kg/d) with progressive dose reduction.
OUTCOMES: The skin lesions were healed within 4 weeks, and his abdominal pain was alleviated remarkably. He is currently under follow-up.
LESSONS: As the treatment used for patients with HSP was not effective, it was advised that UC should be taken into consideration.

PMID: 30170414 [PubMed - indexed for MEDLINE]

Rheumatoid Arthritis-Associated Orbital Vasculitis.

mer, 19/09/2018 - 03:30
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Rheumatoid Arthritis-Associated Orbital Vasculitis.

Ophthalmic Plast Reconstr Surg. 2018 Sep/Oct;34(5):e164-e166

Authors: Weber AC, Shetlar DJ, Yen MT

Abstract
A patient with a history of rheumatoid arthritis presented with bilateral orbital lesions while on abatacept. Biopsy of the lesions yielded pathologic assessment showing vasculitis with a mixed inflammatory infiltrate notable for numerous eosinophils. Despite initial improvement on cyclophosphamide therapy, she developed progression of the orbital lesions and lesions elsewhere on her body. All serologic studies were normal except for increased levels of rheumatoid factor and eosinophilia. The patient underwent a second biopsy, which was consistent with her initial pathology. The patient was started on high-dose mycophenolate mofetil treatment with a good response. After 1 year of treatment, the patient's lesions have nearly completely resolved. This patient illustrates the diagnostic and therapeutic challenges encountered when treating orbital vasculitis. Furthermore, this case shows the importance of not categorizing vasculitis with unclear etiology under the umbrella diagnosis of atypical granulomatosis with polyangiitis. This patient did not exhibit the serologic or pathologic characteristics of granulomatosis with polyangiitis, and she did not respond to treatment as would be expected for granulomatosis with polyangiitis. Maintaining an open approach to diagnosis and treatment was crucial in obtaining a favorable outcome for this patient.

PMID: 30119075 [PubMed - indexed for MEDLINE]

Comparative effectiveness of 18F-FDG PET-CT and contrast-enhanced CT in the diagnosis of suspected large-vessel vasculitis.

dim, 16/09/2018 - 03:07
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Comparative effectiveness of 18F-FDG PET-CT and contrast-enhanced CT in the diagnosis of suspected large-vessel vasculitis.

Br J Radiol. 2018 Sep;91(1089):20180247

Authors: Vaidyanathan S, Chattopadhyay A, Mackie SL, Scarsbrook AF

Abstract
OBJECTIVE: Large-vessel vasculitis (LVV) is a serious illness with potentially life-threatening consequences. (18Fluorine) fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) has emerged as a valuable diagnostic tool in suspected LVV, combining the strengths of functional and structural imaging. This study aimed to compare the accuracy of FDG PET-CT and contrast-enhanced CT (CECT) in the evaluation of patients with LVV.
METHODS: A retrospective database review for LVV patients undergoing CECT and PET-CT between 2011 to 2016 yielded demographics, scan interval and vasculitis type. Qualitative and quantitative PET-CT analyses included aorta:liver FDG uptake, bespoke FDG uptake distribution scores and vascular maximum standardised uptake values (SUVmax). Quantitative CECT data were assessed for wall thickness and mural-lumen ratio. Receiver operating characteristics (ROC) curves were constructed to evaluate comparative diagnostic accuracy and a correlational analysis was conducted between SUVmax and wall thickness.
RESULTS: 36 adults (17 LVV, 19 controls) with a mean age (range) 63 (38-89) years, of which 17 (47%) were males were included. Time interval between CT and PET was mean [standard deviation (SD)] 1.9 (1.2) months. Both SUVmax and wall thickness demonstrated a significant difference between LVV and controls, with a mean difference [95%confidence interval (CI)] for SUVmax 1.6 (1.1, 2.0) and wall thickness 1.25 (0.68, 1.83) mm, respectively. These two parameters were significantly correlated (p < 0.0001, R = 0.62). The area under the curve (AUC) (95% CI) for SUVmax was 0.95 (0.88-1.00), and for mural thickening was 0.83 (0.66-0.99).
CONCLUSION: FDG PET-CT demonstrated excellent accuracy whilst CECT mural thickening showed good accuracy in the diagnosis of LVV. Both parameters showed a highly significant correlation. In hospitals without access to FDG PET-CT or in patients unsuitable for PET-CT (e.g. uncontrolled diabetes) CECT offers a viable alternative for the assessment of LVV. Advances in knowledge: FDG PET-CT is a highly accurate test for the diagnosis of LVV. Aorta:liver SUVmax ratio is the most specific parameter for LVV. In hospitals without PET-CT or in unsuitable patients e.g. diabetics, CECT is a viable alternative.

PMID: 29927635 [PubMed - indexed for MEDLINE]

Chronic Abdominal Pain in a 47-Year-Old Woman.

dim, 16/09/2018 - 03:07
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Chronic Abdominal Pain in a 47-Year-Old Woman.

Gastroenterology. 2018 Sep;155(3):627-628

Authors: Anderson B, Sweetser S

PMID: 29913135 [PubMed - indexed for MEDLINE]

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