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Feist E, Mitrovic S, Fautrel B. Mechanisms, biomarkers and targets for adult-onset Still's disease. Nat Rev Rheumatol 2019; 14:603-618. [PMID: 30218025 PMCID: PMC7097309 DOI: 10.1038/s41584-018-0081-x] [Citation(s) in RCA: 229] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adult-onset Still’s disease (AoSD) is a rare but clinically well-known, polygenic, systemic autoinflammatory disease. Owing to its sporadic appearance in all adult age groups with potentially severe inflammatory onset accompanied by a broad spectrum of disease manifestation and complications, AoSD is an unsolved challenge for clinicians with limited therapeutic options. This Review provides a comprehensive insight into the complex and heterogeneous nature of AoSD, describing biomarkers of the disease and its progression and the cytokine signalling pathways that contribute to disease. The efficacy and safety of biologic therapeutic options are also discussed, and guidance for treatment decisions is provided. Improving the approach to AoSD in the future will require much closer cooperation between paediatric and adult rheumatologists to establish common diagnostic strategies, treatment targets and goals. Adult-onset Still’s disease (AoSD) is not easily diagnosed, and treatment options are limited. This Review provides an overview of the disease and its pathogenesis, clinical trial results, therapeutic options and a plan to diagnose and clinically manage these patients. Similar to systemic-onset juvenile idiopathic arthritis, adult-onset Still’s disease (AoSD) is a rare systemic autoinflammatory disease with potentially severe inflammatory onset accompanied by a broad spectrum of disease manifestation and complications. AoSD should be considered in patients with persistent fever, and the diagnosis is based on the combination of clinical and laboratory findings as well as the exclusion of other inflammatory conditions. Central to the pathogenesis of AoSD is the intense activation of innate immune cells and overproduction of several pro-inflammatory cytokines including IL-1, IL-6 and IL-18. Two IL-1 antagonists have been approved for treatment of AoSD, and growing evidence suggests that other biologic agents are therapeutic options, such as anti-IL-6 and anti-IL-18 therapeutics. As a reliable prediction of response and outcome is not possible, therapeutic decisions have to be made on the basis of clinical, biological or imaging characteristics of disease. A close cooperation between paediatric and adult rheumatologists is required to establish common diagnostic strategies, treatment targets and goals.
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Affiliation(s)
- Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité- Universitätsmedizin, Berlin, Germany.
| | - Stéphane Mitrovic
- Department of Rheumatology, AP-HP, Pitié-Salpêtrière Hospital, AP-HP, Paris, France. .,Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France.
| | - Bruno Fautrel
- Department of Rheumatology, AP-HP, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Sorbonne Université, GRC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
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202
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Affiliation(s)
- Dae Hyun Yoo
- Department of Rheumatology, Hospital for Rheumatic Diseases, College of Medicine, Hanyang University, Seoul, Korea
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203
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Damevska K, França K, Nikolovska S, Gucev F. Adult-onset Still's disease as a cutaneous marker of systemic disease. Clin Dermatol 2019; 37:668-674. [PMID: 31864446 DOI: 10.1016/j.clindermatol.2019.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adult-onset Still's disease (AOSD) is a rare, systemic, inflammatory disorder characterized by spiking fevers, an evanescent eruption, arthritis, and multiorgan involvement. The disease has been recently classified as a polygenic autoinflammatory disorder at the "crossroads" of autoinflammatory and autoimmune diseases. The highly characteristic salmon-colored eruption is a cutaneous manifestation of a generalized inflammatory reaction and an important diagnostic criterion. In addition to the evanescent eruption, there are atypical persistent papules and plaques in many patients with AOSD. Emerging data suggest that AOSD with this typical evanescent eruption has a different clinicopathologic presentation and clinical course than AODS with atypical cutaneous manifestations. It appears that there are two subtypes of AOSD with different immunologic profiles, including (1) a systemic disease with high fever, organ involvement, and elevated levels of ferritin, and (2) a chronic disease course with arthritis as the predominant finding. These observations provide novel insight into the disease pathogenesis, suggesting that the underlying mechanisms might differ between these two forms, partially explaining the reported differences in drug response. Recent advances in the understanding of AOSD are summarized with a focus on the spectrum of cutaneous manifestations and its relationship to systemic inflammation.
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Affiliation(s)
- Katerina Damevska
- University Clinic of Dermatology, Ss Cyril and Methodius University, Skopje, Macedonia.
| | - Katlein França
- Department of Dermatology and Cutaneous Surgery, Department of Psychiatry and Behavioral Sciences, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Suzana Nikolovska
- University Clinic of Dermatology, Ss Cyril and Methodius University, Skopje, Macedonia
| | - Filip Gucev
- Univeristy Clinic of Rheumatology, Ss Cyriland Methodius University, Skopje, Macedonia
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204
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Razzaghdoust A, Mofid B, Zangeneh M. Predicting chemotherapy-induced thrombocytopenia in cancer patients with solid tumors or lymphoma. J Oncol Pharm Pract 2019; 26:587-594. [DOI: 10.1177/1078155219861423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PurposeChemotherapy-induced thrombocytopenia is a serious complication in chemotherapy-treated patients. Identification of patients at risk for chemotherapy-induced thrombocytopenia could have clinical value in personalized management of patients and optimized administration of prophylactic thrombopoietic agents. The aim of this study was to develop a predictive model for chemotherapy-induced thrombocytopenia (platelet count < 100,000/µl) in cancer patients undergoing chemotherapy.MethodsA total of 14 covariates were prospectively assessed as explanatory variables in a cohort of consecutive patients with solid tumors or lymphoma. A multivariable logistic regression model was developed after univariable analysis. A bootstrapping technique was applied for internal validation.ResultsData from 305 patients during 1732 chemotherapy cycles were considered for analysis. Forty-eight patients (15.73%) developed chemotherapy-induced thrombocytopenia during their treatment course. The multivariable model exhibited three final predictors for chemotherapy-induced thrombocytopenia, including high ferritin (odds ratio, 4.41; bootstrap P = 0.001), estimated glomerular filtration rate <60 ml/min/1.73 m2(odds ratio, 3.08; bootstrap P = 0.005), and body mass index <23 kg/m2(odds ratio, 2.23; bootstrap P = 0.044). The main characteristics of the model include sensitivity 75%, specificity 65.4%, positive likelihood ratio 2.16, and negative likelihood ratio 0.382. Moreover, the model was well calibrated (Hosmer–Lemeshow P = 0.713) and the area under the receiver operating characteristic curve was 0.735 (95% confidence interval, 0.654–0.816; P < 0.001).ConclusionsWe developed a predictive model for chemotherapy-induced thrombocytopenia based on readily available and easily assessable clinical and laboratory factors. This study may provide a valuable insight to guide optimized treatment of cancer patients. Further studies with larger sample size are warranted.
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Affiliation(s)
- Abolfazl Razzaghdoust
- Student Research Committee, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahram Mofid
- Department of Oncology, Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Zangeneh
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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205
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Horvat CM, Bell J, Kantawala S, Au AK, Clark RSB, Carcillo JA. C-Reactive Protein and Ferritin Are Associated With Organ Dysfunction and Mortality in Hospitalized Children. Clin Pediatr (Phila) 2019; 58:752-760. [PMID: 30931590 PMCID: PMC7049089 DOI: 10.1177/0009922819837352] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our objective was to determine if C-reactive protein (CRP) and ferritin values alone and in combination are associated with mortality among hospitalized children. All hospitalized patients at our institution with a CRP or ferritin assay in 2015 and 2016 were included. Area under the receiver operating curves (AUROC) were examined, optimal cut-points determined, and patients were stratified into low-, intermediate-, or high-risk groups based on elevation of zero, one, or both biomarkers. A total of 14 928 CRP and 653 ferritin values were obtained, with both obtained for 172 patients. AUROC for maximum CRP value was 0.76 (0.68-0.85) with a cut-point of 7.1 mg/dL for in-hospital mortality and 0.90 (0.83-0.98) for maximum ferritin with a cut-point of 373 ng/mL. Elevation of both ferritin and CRP was associated with the highest inpatient mortality (21.7%) and greatest organ dysfunction, followed by either biomarker alone. Additional prospective study of these biomarkers in combination is warranted.
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Affiliation(s)
- Christopher M. Horvat
- Department of Critical Care Medicine, Division of Pediatric Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Health Informatics for Clinical Effectiveness, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Brain Care Institute, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Jamie Bell
- Division of Critical Care Medicine, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Sajel Kantawala
- Health Informatics for Clinical Effectiveness, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA,Brain Care Institute, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Alicia K. Au
- Department of Critical Care Medicine, Division of Pediatric Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Health Informatics for Clinical Effectiveness, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Brain Care Institute, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Robert S. B. Clark
- Department of Critical Care Medicine, Division of Pediatric Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Health Informatics for Clinical Effectiveness, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Brain Care Institute, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Joseph A. Carcillo
- Department of Critical Care Medicine, Division of Pediatric Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Health Informatics for Clinical Effectiveness, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Brain Care Institute, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
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206
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Prevalence and Outcome of Secondary Hemophagocytic Lymphohistiocytosis Among SIRS Patients: Results from a Prospective Cohort Study. J Clin Med 2019; 8:jcm8040541. [PMID: 31010216 PMCID: PMC6518152 DOI: 10.3390/jcm8040541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 12/16/2022] Open
Abstract
Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening condition clinically presenting as SIRS (Systemic Inflammatory Response Syndrome). However, there is no comprehensive data concerning diagnostic algorithms, prevalence, outcome and biomarker performance in SIRS patients. We conducted a prospective observational cohort study on 451 consecutive patients fulfilling ≥2 SIRS criteria. The Hscore and the HLH-2004 criteria were used to determine the presence of sHLH, and the correlation of the screening-biomarkers ferritin, sCD25, and sCD163 with both scores was assessed. Out of 451 standard-care SIRS patients, five patients had high Hscores (≥169), suggesting incipient or HLH-like disease, and these patients were in urgent need for intensified therapy. However, none of these patients fulfilled five HLH-2004 criteria required for formal diagnosis. From the studied biomarkers, ferritin correlated strongest to both the HLH-2004 criteria and the Hscore (rs = 0.72, 0.41, respectively), and was the best predictor of 30-day survival (HR:1.012 per 100 μg/L, 95% CI: 1.004-1.021), when adjusted for patient's age, sex, bacteremia and malignant underlying-disease. Also, the HLH-2004 (HR per point increase: 1.435, 95% CI: 1.1012-2.086) and the Hscore (HR per point increase:1.011, 95% CI: 1.002-1.020) were independent predictors of 30-day-survival. The Hscore detected patients in hyperinflammatory states requiring urgent therapy escalation. Degrees of hyperinflammation, as assessed by ferritin and both HLH scores, are associated with worse outcomes.
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207
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Carubbi F, Alunno A, Cipriani P, Bistoni O, Scipioni R, Liakouli V, Ruscitti P, Berardicurti O, Di Bartolomeo S, Gerli R, Giacomelli R. Laboratory Assessment of Patients with Suspected Rheumatic Musculoskeletal Diseases: Challenges and Pitfalls. Curr Rheumatol Rev 2019; 15:27-43. [PMID: 29557752 DOI: 10.2174/1573397114666180320113603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 11/22/2022]
Abstract
Current patient care in rheumatology relies primarily on a combination of traditional clinical assessment and standard laboratory tests. Investigators seek to discover new biomarkers and novel technologies to boost the research in this field. Mechanistic biomarkers such as cytokines, cell types, antibodies, signaling molecules, are rooted in the mechanism underlying the disease and can guide the clinical management of the disease. Conversely, descriptive biomarkers are byproducts of the disease process, depict the state of a disease but are not involved in its pathogenesis. In this article, we reviewed the field of common laboratory biomarkers in rheumatology, highlighting both their descriptive or mechanistic value as well as their role in clinical practice.
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Affiliation(s)
- Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy.,Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, AQ, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, PG, Italy
| | - Paola Cipriani
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
| | - Onelia Bistoni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, PG, Italy
| | - Rosa Scipioni
- Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, AQ, Italy
| | - Valiki Liakouli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
| | - Onorina Berardicurti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
| | - Salvatore Di Bartolomeo
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, PG, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
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208
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Karakike E, Giamarellos-Bourboulis EJ. Macrophage Activation-Like Syndrome: A Distinct Entity Leading to Early Death in Sepsis. Front Immunol 2019; 10:55. [PMID: 30766533 PMCID: PMC6365431 DOI: 10.3389/fimmu.2019.00055] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/10/2019] [Indexed: 12/13/2022] Open
Abstract
Hemophagocytic lymphohistocytosis (HLH) is characterized by fulminant cytokine storm leading to multiple organ dysfunction and high mortality. HLH is classified into familial (fHLH) and into secondary (sHLH). fHLH is rare and it is due to mutations of genes encoding for perforin or excretory granules of natural killer (NK) cells of CD8-lymphocytes. sHLH is also known as macrophage activation syndrome (MAS). Macrophage activation syndrome (MAS) in adults is poorly studied. Main features are fever, hepatosplenomegaly, hepatobiliary dysfunction (HBD), coagulopathy, cytopenia of two to three cell lineages, increased triglycerides and hemophagocytosis in the bone marrow. sHLH/MAS complicates hematologic malignancies, autoimmune disorders and infections mainly of viral origin. Pathogenesis is poorly understood and it is associated with increased activation of macrophages and NK cells. An autocrine loop of interleukin (IL)-1β over-secretion leads to cytokine storm of IL-6, IL-18, ferritin, and interferon-gamma; soluble CD163 is highly increased from macrophages. The true incidence of sHLH/MAS among patients with sepsis has only been studied in the cohort of the Hellenic Sepsis Study Group. Patients meeting the Sepsis-3 criteria and who had positive HSscore or co-presence of HBD and disseminated intravascular coagulation (DIC) were classified as patients with macrophage activation-like syndrome (MALS). The frequency of MALS ranged between 3 and 4% and it was an independent entity associated with early mortality after 10 days. Ferritin was proposed as a diagnostic and surrogate biomarker. Concentrations >4,420 ng/ml were associated with diagnosis of MALS with 97.1% specificity and 98% negative predictive value. Increased ferritin was also associated with increased IL-6, IL-18, IFNγ, and sCD163 and by decreased IL-10/TNFα ratio. A drop of ferritin by 15% the first 48 h was a surrogate finding of favorable outcome. There are 10 on-going trials in adults with sHLH; two for the development of biomarkers and eight for management. Only one of them is focusing in sepsis. The acronym of the trial is PROVIDE (ClinicalTrials.gov NCT03332225) and it is a double-blind randomized clinical trial aiming to deliver to patients with septic shock treatment targeting their precise immune state. Patients diagnosed with MALS are receiving randomized treatment with placebo or the IL-1β blocker anakinra.
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Affiliation(s)
- Eleni Karakike
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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209
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Hu Q, Gong W, Gu J, Geng G, Li T, Tian R, Yang Z, Zhang H, Shao L, Liu T, Wan L, Jia J, Yang C, Shi Y, Shi H. Plasma microRNA Profiles as a Potential Biomarker in Differentiating Adult-Onset Still's Disease From Sepsis. Front Immunol 2019; 9:3099. [PMID: 30687316 PMCID: PMC6338094 DOI: 10.3389/fimmu.2018.03099] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/14/2018] [Indexed: 12/14/2022] Open
Abstract
Adult-onset Still's disease (AOSD) is a systemic inflammatory disease characterized by cytokine storm. However, a diagnostic test for AOSD in clinical use is yet to be validated. The aim of our study was to identify non-invasive biomarkers with high specificity and sensitivity to diagnosis of AOSD. MicroRNA (miRNA) profiles in PBMC from new-onset AOSD patients without any treatment and healthy controls (HCs) were analyzed by miRNA deep sequencing. Plasma samples from 100 AOSD patients and 60 HCs were used to validated the expression levels of miRNA by qRT-PCR. The correlations between expression levels of miRNAs and clinical manifestations were analyzed using advanced statistical models. We found that plasma samples from AOSD patients showed a distinct miRNA expression profile. Five miRNAs (miR-142-5p, miR-101-3p, miR-29a-3p, miR-29c-3p, and miR-141-3p) were significantly upregulated in plasma of AOSD patients compared with HCs both in training and validation sets. We discovered a panel including 3 miRNAs (miR-142-5p, miR-101-3p, and miR-29a-3p) that can predict the probability of AOSD with an area under the receiver operating characteristic (ROC) curve of 0.8250 in training and validation sets. Moreover, the expression levels of 5 miRNAs were significantly higher in active AOSD patients compared with those in inactive patients. In addition, elevated level of miR-101-3p was found in AOSD patients with fever, sore throat and arthralgia symptoms; the miR-101-3p was also positively correlated with the levels of IL-6 and TNF-α in serum. Furthermore, five miRNAs (miR-142-5p, miR-101-3p, miR-29c-3p, miR-29a-3p, and miR-141-3p) expressed in plasma were significantly higher in AOSD patients than in sepsis patients (P < 0.05). The AUC value of 4-miRNA panel (miR-142-5p, miR-101-3p, miR-29c-3p, and miR-141-3p) for AOSD diagnosis from sepsis was 0.8448, revealing the potentially diagnostic value to distinguish AOSD patients from sepsis patients. Our results have identified a specific plasma miRNA signature that may serve as a potential non-invasive biomarker for diagnosis of AOSD and monitoring disease activity.
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Affiliation(s)
- Qiongyi Hu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Gong
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Rheumatology and Immunology, The First People's Hospital of Yancheng Affiliated with Nantong University, Yancheng, China
| | - Jieyu Gu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guannan Geng
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Li
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Tian
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhitao Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haocheng Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Lingyun Shao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Tingting Liu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liyan Wan
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinchao Jia
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Shi
- Key Laboratory of Systems Biomedicine (Ministry of Education) and Collaborative Innovation Center of Systems Biomedicine, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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210
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Enomoto N, Oyama Y, Enomoto Y, Mikamo M, Karayama M, Hozumi H, Suzuki Y, Kono M, Furuhashi K, Fujisawa T, Inui N, Nakamura Y, Suda T. Prognostic evaluation of serum ferritin in acute exacerbation of idiopathic pulmonary fibrosis. CLINICAL RESPIRATORY JOURNAL 2018; 12:2378-2389. [PMID: 29873202 DOI: 10.1111/crj.12918] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/13/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has an extremely poor prognosis. The role of ferritin in the pathogenesis of AE-IPF is not well known while serum ferritin is a key prognostic indicator for patients with clinically amyopathic dermatomyositis with rapidly progressive interstitial pneumonia. OBJECTIVE To elucidate the clinical importance of serum ferritin in patients with AE-IPF. METHODS Thirty-seven patients (48 episodes), who were diagnosed with AE-IPF and treated at our hospital between 1997 and 2015, were retrospectively studied. RESULTS Patients with AE-IPF had significantly higher levels of serum ferritin than baseline levels at the first diagnosis of IPF (P = 0.0017). Receiver operating characteristic analysis showed the cut-off value 174 ng/mL for the separation of AE (area under the curve, 0.700). No patients with AE-IPF were positive for anti- melanoma differentiation-associated gene 5 antibody. Patients with AE-IPF and higher ferritin (≥174 ng/mL) had lower %FVC and %DLCO before AE, and those with much higher ferritin (≥500 ng/mL) had significantly worse prognosis than those with lower ferritin (log-rank, P = 0.024). Immunohistochemical staining in autopsy specimens showed alveolar macrophages that were producing ferritin. Finally, in multivariate Cox proportional hazards analyses, serum ferritin level of ≥500 ng/mL was a significant worse prognostic factor (hazard ratio 5.280, P = 0.046). CONCLUSION Higher serum ferritin may be related to a worse prognosis in patients with AE-IPF.
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Affiliation(s)
- Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Health Administration Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshiyuki Oyama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasunori Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masashi Mikamo
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Kono
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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211
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Abstract
Neurotoxicity is an important and common complication of chimeric antigen receptor-T cell therapies. Acute neurologic signs and/or symptoms occur in a significant proportion of patients treated with CD19-directed chimeric antigen receptor-T cells for B-cell malignancies. Clinical manifestations include headache, confusion, delirium, language disturbance, seizures and rarely, acute cerebral edema. Neurotoxicity is associated with cytokine release syndrome, which occurs in the setting of in-vivo chimeric antigen receptor-T cell activation and proliferation. The mechanisms that lead to neurotoxicity remain unknown, but data from patients and animal models suggest there is compromise of the blood-brain barrier, associated with high levels of cytokines in the blood and cerebrospinal fluid, as well as endothelial activation. Corticosteroids, interleukin-6-targeted therapies, and supportive care are frequently used to manage patients with neurotoxicity, but high-quality evidence of their efficacy is lacking.
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Affiliation(s)
- Juliane Gust
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, USA,Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, WA, USA
| | - Agne Taraseviciute
- Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Cameron J. Turtle
- Clinical Research Division and Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA,Department of Medicine, University of Washington, Seattle, WA, USA
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Fatal Septic Shock in a Patient with Hemophagocytic Lymphohistiocytosis Associated with an Infectious Mononucleosis. Case Rep Crit Care 2018; 2018:9756050. [PMID: 30356381 PMCID: PMC6176343 DOI: 10.1155/2018/9756050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/09/2018] [Indexed: 11/24/2022] Open
Abstract
The authors describe the case of a young woman who developed a clinical pictures resembling a septic shock-related multiple organ dysfunction syndrome a couple of months after having been diagnosed suffering from a hemophagocytic lymphohistiocytosis associated with an infectious mononucleosis. Despite the aggressive treatment, which included antibiotics, vasopressors, IV immunoglobulins, and the use of an extracorporeal device aimed to remove mediators released both during sepsis and the cytokine storm determined by the hemophagocytic lymphohistiocytosis, the patient died. At the autopsy, an extremely uncommon aggressive lymphoma of Epstein-Barr virus-positive T-lymphocytes with systemic involvement was discovered.
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213
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Ruscitti P, Giacomelli R. Pathogenesis of adult onset still’s disease: current understanding and new insights. Expert Rev Clin Immunol 2018; 14:965-976. [DOI: 10.1080/1744666x.2018.1533403] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Piero Ruscitti
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Roberto Giacomelli
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
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214
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Remy S, Gossez M, Belot A, Hayman J, Portefaix A, Venet F, Javouhey E, Monneret G. Massive increase in monocyte HLA-DR expression can be used to discriminate between septic shock and hemophagocytic lymphohistiocytosis-induced shock. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:213. [PMID: 30205835 PMCID: PMC6131803 DOI: 10.1186/s13054-018-2146-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/30/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Solenn Remy
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Mother and Children University Hospital, 59 Boulevard Pinel, 69500, Bron, France
| | - Morgane Gossez
- Hospices Civils de Lyon, Immunology Laboratory, E. Herriot Hospital, 69003, Lyon, France.,EA 7426, Pathophysiology of injury-induced immunosuppression (University Claude Bernard Lyon 1, BioMérieux, Hospices Civils de Lyon), E. Herriot Hospital, 69003, Lyon, France
| | - Alexandre Belot
- Hospices Civils de Lyon, Paediatric Nephrology, Rheumatology, Dermatology Unit, National Referee Centre for pediatric-onset Rheumatism and autoimmune diseases (RAISE), Mother and Children University Hospital, 59 Boulevard Pinel, 69500, Bron, France.,Université de Lyon, INSERM U1111, CIRI, Lyon, France
| | - Jack Hayman
- Hospices Civils de Lyon, Immunology Laboratory, E. Herriot Hospital, 69003, Lyon, France
| | - Aurelie Portefaix
- EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, CHU-Lyon, Bron, France
| | - Fabienne Venet
- Hospices Civils de Lyon, Immunology Laboratory, E. Herriot Hospital, 69003, Lyon, France.,EA 7426, Pathophysiology of injury-induced immunosuppression (University Claude Bernard Lyon 1, BioMérieux, Hospices Civils de Lyon), E. Herriot Hospital, 69003, Lyon, France
| | - Etienne Javouhey
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Mother and Children University Hospital, 59 Boulevard Pinel, 69500, Bron, France
| | - Guillaume Monneret
- Hospices Civils de Lyon, Immunology Laboratory, E. Herriot Hospital, 69003, Lyon, France. .,EA 7426, Pathophysiology of injury-induced immunosuppression (University Claude Bernard Lyon 1, BioMérieux, Hospices Civils de Lyon), E. Herriot Hospital, 69003, Lyon, France. .,Cellular Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, France Pavillon E - 5 place d'Arsonval, 69437, Lyon, Cedex 03, France.
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215
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Giacomelli R, Ruscitti P, Shoenfeld Y. A comprehensive review on adult onset Still's disease. J Autoimmun 2018; 93:24-36. [PMID: 30077425 DOI: 10.1016/j.jaut.2018.07.018] [Citation(s) in RCA: 239] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 02/06/2023]
Abstract
Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology usually affecting young adults; spiking fever, arthritis and evanescent rash are commonly observed during the disease. Other frequently observed clinical features include sore throat, hepatomegaly, splenomegaly, lymphadenopathy and serositis. Furthermore, AOSD patients may experience different life-threating complications. Macrophage activation syndrome (MAS) has been reported up to 15% of AOSD patients and it is considered to be the most severe complication of the disease being characterised by high mortality rate. During AOSD, laboratory tests reflect the systemic inflammatory process showing high levels of erythrocyte sedimentation rate and C-reactive protein. In addition, the ferritin levels are typically higher than those observed in other autoimmune, inflammatory, infectious, or neoplastic diseases. Analysing AOSD disease course, 3 different clinical patterns of AOSD have been identified: i. monocyclic pattern, characterised by a systemic single episode; ii. polycyclic pattern, characterised by multiple, ≤ 1 year lasting, flares, alternating with remissions; iii. chronic pattern, related to a persistently active disease with associated polyarthritis. At present, AOSD therapeutic strategy is aimed at targeting pro-inflammatory signs and symptoms, preventing organ damage and life-threating complications and minimising adverse effects of treatment. However, the treatment of AOSD remains largely empirical, lacking controlled clinical trials. High dosages of corticosteroids are usually the first line therapy when the systemic symptoms predominate. Despite this treatment, a large percentage of patients experiences several flares with an evolution toward the chronic disease course and up to 16% of patients die during the follow up, due to AOSD-related complications. On these bases, in the last years, biological agents have been successfully used in refractory cases. Finally, multiple recent lines of evidence have suggested new insights in AOSD pathogenesis unmasking further therapeutic targets. In fact, small molecules, used in experimental MAS models, might represent new therapeutic options.
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Affiliation(s)
- Roberto Giacomelli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Piero Ruscitti
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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216
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The diagnosis and clinical management of the catastrophic antiphospholipid syndrome: A comprehensive review. J Autoimmun 2018; 92:1-11. [DOI: 10.1016/j.jaut.2018.05.007] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/10/2018] [Indexed: 01/13/2023]
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217
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Golchin N, Sharifzadeh M, Fransawy Alkomos M, Sachmechi I. Adult-onset Still's Disease in a Female Patient with Schizophrenia: A Case Report and Literature Review. Cureus 2018; 10:e3019. [PMID: 30254808 PMCID: PMC6150749 DOI: 10.7759/cureus.3019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adult-onset Still’s disease (AOSD) is a rare diagnosis. In small percentage of cases, AOSD is associated with other autoimmune diseases including schizophrenia. Despite the lack of sufficient studies, both conditions may share similar autoimmune pathogenic pathways. Herein we describe a 36-year-old woman with the past medical history of schizophrenia who presented with spiking fevers, arthralgia, evanescent rash and pleural chest pain. She reported developing these symptoms a while after poor compliance with her antipsychotic medication. On admission, physical examination was remarkable for high-grade fever, maculopapular rash, oligo arthralgia, hepatomegaly and lymphadenopathy. Laboratory investigation revealed leukocytosis with neutrophilia and markedly elevated ferritin. The patient met four out of four major, and three out of five minor Yamaguchi criteria for AOSD. The patient started on therapy with corticosteroid. Soon after, her symptoms resolved and most of her biochemical markers went back to normal. We review the literature on co-existence of AOSD with other autoimmune diseases, we also discuss that there may be a correlation between ceasing antipsychotic medication (with known immunomodulatory effect) in a schizophrenic patient and triggering an auto-inflammatory process such as AOSD in a susceptible host. In addition, we discussed the possible similar autoimmune pathway of schizophrenia to pathogenesis of AOSD.
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Affiliation(s)
- Nasim Golchin
- Endocrinology, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
| | - Mohaddeseh Sharifzadeh
- Internal Medicine, Icahn School of Medicine at Mount Sinai Queen Hospital Center, New York, USA
| | - Mina Fransawy Alkomos
- Research, California Institute of Behavioral Neurosciences & Psychology, Sacramento, USA
| | - Issac Sachmechi
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
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218
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Rymarz A, Niemczyk S. The complex treatment including rituximab in the Management of Catastrophic Antiphospholid Syndrome with renal involvement. BMC Nephrol 2018; 19:132. [PMID: 29884138 PMCID: PMC5994130 DOI: 10.1186/s12882-018-0928-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 05/24/2018] [Indexed: 11/16/2022] Open
Abstract
Background Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening form of antiphospholipid syndrome (APS) involving many organs and leading to their insufficiency. The pathogenesis of CAPS is associated with the presence of antiphospholipid antibodies (aPL). Typical therapy includes anticoagulation, glucocorticoids, therapeutic plasma exchanges and/or intravenous immunoglobulin. Despite this aggressive treatment, the mortality rate of 37% is still high. Novel therapeutic agents are required. Rituximab (RTX) is the most studied drug in APS also used in CAPS. Because of the rarity of CAPS occurrence it is impossible to plan a controlled, randomized study exploring its efficacy in CAPS. Therefore, case reports of its usage can be a source of our knowledge in this matter. Case presentation A 35-year-old woman who displayed dyspnoea and peripheral edema was admitted to the Nephrology Clinic because of rapidly progressive renal insufficiency. Her history included autoimmune hemolytic anemia anemia, two miscarriages and the diagnosis of APS with the treatment of heparin and acetylosalicylic acid during her next pregnancy. In spite of this treatment, she gave birth to a dead fetus in 22 Hbd. She then developed CAPS with involvement of the kidneys, brain, skin, peripheral veins and central retinal artery. Lupus anticoagulant and β2−glicoprotein-I antibodies were positive. Immediately upon admission to the nephrology clinic, she received anticoagulation and corticosteroids along with therapeutic plasma exchanges. As a supportive treatment hemodialysis sessions were necessary. Under this treatment the amelioration of the general state was observed but renal failure persisted, therefore intravenous immunoglobulin was added. Afterwards, the kidney function recovered and the renal replacement therapy could be stopped. After this therapy, aPL became negative. Four weeks later lupus anticoagulant began to increase. Taking into account the risk factors of the relapse and the life-threatening course of the disease, rituximab was introduced. After administration of 2 g of RTX in three separate doses, we observed no new thrombotic events, the further amelioration of renal function and the negative profile of aPL. Conclusions CAPS is a life-threatening condition and a prompt, complex treatment is necessary. Rituximab together with conventional therapy can be an additional option in case of the risk of relapse.
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Affiliation(s)
- Aleksandra Rymarz
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw, Poland.
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw, Poland
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219
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Mitrovic S, Fautrel B. New Markers for Adult-Onset Still's Disease. Joint Bone Spine 2018; 85:285-293. [DOI: 10.1016/j.jbspin.2017.05.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/03/2017] [Indexed: 01/02/2023]
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220
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Cullis JO, Fitzsimons EJ, Griffiths WJ, Tsochatzis E, Thomas DW. Investigation and management of a raised serum ferritin. Br J Haematol 2018; 181:331-340. [PMID: 29672840 DOI: 10.1111/bjh.15166] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Serum ferritin level is one of the most commonly requested investigations in both primary and secondary care. Whilst low serum ferritin levels invariably indicate reduced iron stores, raised serum ferritin levels can be due to multiple different aetiologies, including iron overload, inflammation, liver or renal disease, malignancy, and the recently described metabolic syndrome. A key test in the further investigation of an unexpected raised serum ferritin is the serum transferrin saturation. This guideline reviews the investigation and management of a raised serum ferritin level. The investigation and management of genetic haemochromatosis is not dealt with however and is the subject of a separate guideline.
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Affiliation(s)
- Jonathan O Cullis
- Department of Haematology, Salisbury NHS Foundation Trust, Salisbury, UK
| | | | - William Jh Griffiths
- Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emmanouil Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free London NHS Foundation Trust and University College, London, UK
| | - D Wayne Thomas
- Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, UK
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221
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Ruscitti P, Iacono D, Ciccia F, Emmi G, Cipriani P, Grembiale RD, Perosa F, Emmi L, Triolo G, Giacomelli R, Valentini G. Macrophage Activation Syndrome in Patients Affected by Adult-onset Still Disease: Analysis of Survival Rates and Predictive Factors in the Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale Cohort. J Rheumatol 2018; 45:864-872. [PMID: 29657144 DOI: 10.3899/jrheum.170955] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Macrophage activation syndrome (MAS) is a reactive form of hemophagocytic lymphohistiocytosis, which can complicate adult-onset Still disease (AOSD). We investigated AOSD clinical features at the time of diagnosis, to assess predictors of MAS occurrence. Further, we analyzed the outcomes of patients with AOSD who experience MAS. METHODS Patients with AOSD admitted to any Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale center were retrospectively analyzed for features typical of AOSD, MAS occurrence, and their survival rate. RESULTS Of 119 patients with AOSD, 17 experienced MAS (12 at admission and 5 during followup). Twelve patients with MAS at first admission differed from the remaining 107 in prevalence of lymphadenopathy and liver involvement at the time of diagnosis. In addition, serum ferritin levels and systemic score values were significantly higher in the patients presenting with MAS. At the time of diagnosis, the 5 patients who developed MAS differed from the remaining 102 in the prevalence of abdominal pain, and they showed increased systemic score values. In the multivariate analysis, lymphadenopathy (OR 7.22, 95% CI 1.49-34.97, p = 0.014) and abdominal pain (OR 4.36, 95% CI 1.24-15.39, p = 0.022) were predictive of MAS occurrence. Finally, MAS occurrence significantly reduced the survival rate of patients with AOSD (p < 0.0001). CONCLUSION MAS occurrence significantly reduced the survival rate in patients with AOSD. Patients with MAS at baseline presented an increased prevalence of lymphadenopathy and liver involvement, as well as high serum ferritin levels and systemic score values. The presence of lymphadenopathy and abdominal pain was associated with MAS occurrence.
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Affiliation(s)
- Piero Ruscitti
- From the Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila; Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples; Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo; Department of Experimental and Clinical Medicine, University of Florence, Florence; Department of Health Sciences, University of Catanzaro "Magna Graecia," Catanzaro; Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy. .,P. Ruscitti, MD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; D. Iacono, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples; F. Ciccia, MD, PhD, Rheumatology Section, Department of Internal Medicine, University of Palermo; G. Emmi, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence; P. Cipriani, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; R.D. Grembiale, MD, Department of Health Sciences, University of Catanzaro "Magna Graecia"; F. Perosa, MD, PhD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; L. Emmi, MD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; G. Triolo, MD, Rheumatology Section, Department of Internal Medicine, University of Palermo; R. Giacomelli, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; G. Valentini, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples.
| | - Daniela Iacono
- From the Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila; Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples; Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo; Department of Experimental and Clinical Medicine, University of Florence, Florence; Department of Health Sciences, University of Catanzaro "Magna Graecia," Catanzaro; Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.,P. Ruscitti, MD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; D. Iacono, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples; F. Ciccia, MD, PhD, Rheumatology Section, Department of Internal Medicine, University of Palermo; G. Emmi, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence; P. Cipriani, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; R.D. Grembiale, MD, Department of Health Sciences, University of Catanzaro "Magna Graecia"; F. Perosa, MD, PhD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; L. Emmi, MD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; G. Triolo, MD, Rheumatology Section, Department of Internal Medicine, University of Palermo; R. Giacomelli, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; G. Valentini, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples
| | - Francesco Ciccia
- From the Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila; Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples; Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo; Department of Experimental and Clinical Medicine, University of Florence, Florence; Department of Health Sciences, University of Catanzaro "Magna Graecia," Catanzaro; Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.,P. Ruscitti, MD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; D. Iacono, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples; F. Ciccia, MD, PhD, Rheumatology Section, Department of Internal Medicine, University of Palermo; G. Emmi, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence; P. Cipriani, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; R.D. Grembiale, MD, Department of Health Sciences, University of Catanzaro "Magna Graecia"; F. Perosa, MD, PhD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; L. Emmi, MD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; G. Triolo, MD, Rheumatology Section, Department of Internal Medicine, University of Palermo; R. Giacomelli, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; G. Valentini, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples
| | - Giacomo Emmi
- From the Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila; Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples; Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo; Department of Experimental and Clinical Medicine, University of Florence, Florence; Department of Health Sciences, University of Catanzaro "Magna Graecia," Catanzaro; Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.,P. Ruscitti, MD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; D. Iacono, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples; F. Ciccia, MD, PhD, Rheumatology Section, Department of Internal Medicine, University of Palermo; G. Emmi, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence; P. Cipriani, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; R.D. Grembiale, MD, Department of Health Sciences, University of Catanzaro "Magna Graecia"; F. Perosa, MD, PhD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; L. Emmi, MD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; G. Triolo, MD, Rheumatology Section, Department of Internal Medicine, University of Palermo; R. Giacomelli, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; G. Valentini, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples
| | - Paola Cipriani
- From the Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila; Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples; Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo; Department of Experimental and Clinical Medicine, University of Florence, Florence; Department of Health Sciences, University of Catanzaro "Magna Graecia," Catanzaro; Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.,P. Ruscitti, MD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; D. Iacono, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples; F. Ciccia, MD, PhD, Rheumatology Section, Department of Internal Medicine, University of Palermo; G. Emmi, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence; P. Cipriani, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; R.D. Grembiale, MD, Department of Health Sciences, University of Catanzaro "Magna Graecia"; F. Perosa, MD, PhD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; L. Emmi, MD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; G. Triolo, MD, Rheumatology Section, Department of Internal Medicine, University of Palermo; R. Giacomelli, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; G. Valentini, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples
| | - Rosa Daniela Grembiale
- From the Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila; Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples; Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo; Department of Experimental and Clinical Medicine, University of Florence, Florence; Department of Health Sciences, University of Catanzaro "Magna Graecia," Catanzaro; Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.,P. Ruscitti, MD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; D. Iacono, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples; F. Ciccia, MD, PhD, Rheumatology Section, Department of Internal Medicine, University of Palermo; G. Emmi, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence; P. Cipriani, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; R.D. Grembiale, MD, Department of Health Sciences, University of Catanzaro "Magna Graecia"; F. Perosa, MD, PhD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; L. Emmi, MD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; G. Triolo, MD, Rheumatology Section, Department of Internal Medicine, University of Palermo; R. Giacomelli, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; G. Valentini, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples
| | - Federico Perosa
- From the Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila; Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples; Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo; Department of Experimental and Clinical Medicine, University of Florence, Florence; Department of Health Sciences, University of Catanzaro "Magna Graecia," Catanzaro; Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.,P. Ruscitti, MD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; D. Iacono, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples; F. Ciccia, MD, PhD, Rheumatology Section, Department of Internal Medicine, University of Palermo; G. Emmi, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence; P. Cipriani, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; R.D. Grembiale, MD, Department of Health Sciences, University of Catanzaro "Magna Graecia"; F. Perosa, MD, PhD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; L. Emmi, MD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; G. Triolo, MD, Rheumatology Section, Department of Internal Medicine, University of Palermo; R. Giacomelli, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; G. Valentini, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples
| | - Lorenzo Emmi
- From the Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila; Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples; Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo; Department of Experimental and Clinical Medicine, University of Florence, Florence; Department of Health Sciences, University of Catanzaro "Magna Graecia," Catanzaro; Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.,P. Ruscitti, MD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; D. Iacono, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples; F. Ciccia, MD, PhD, Rheumatology Section, Department of Internal Medicine, University of Palermo; G. Emmi, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence; P. Cipriani, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; R.D. Grembiale, MD, Department of Health Sciences, University of Catanzaro "Magna Graecia"; F. Perosa, MD, PhD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; L. Emmi, MD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; G. Triolo, MD, Rheumatology Section, Department of Internal Medicine, University of Palermo; R. Giacomelli, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; G. Valentini, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples
| | - Giovanni Triolo
- From the Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila; Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples; Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo; Department of Experimental and Clinical Medicine, University of Florence, Florence; Department of Health Sciences, University of Catanzaro "Magna Graecia," Catanzaro; Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.,P. Ruscitti, MD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; D. Iacono, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples; F. Ciccia, MD, PhD, Rheumatology Section, Department of Internal Medicine, University of Palermo; G. Emmi, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence; P. Cipriani, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; R.D. Grembiale, MD, Department of Health Sciences, University of Catanzaro "Magna Graecia"; F. Perosa, MD, PhD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; L. Emmi, MD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; G. Triolo, MD, Rheumatology Section, Department of Internal Medicine, University of Palermo; R. Giacomelli, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; G. Valentini, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples
| | - Roberto Giacomelli
- From the Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila; Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples; Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo; Department of Experimental and Clinical Medicine, University of Florence, Florence; Department of Health Sciences, University of Catanzaro "Magna Graecia," Catanzaro; Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.,P. Ruscitti, MD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; D. Iacono, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples; F. Ciccia, MD, PhD, Rheumatology Section, Department of Internal Medicine, University of Palermo; G. Emmi, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence; P. Cipriani, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; R.D. Grembiale, MD, Department of Health Sciences, University of Catanzaro "Magna Graecia"; F. Perosa, MD, PhD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; L. Emmi, MD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; G. Triolo, MD, Rheumatology Section, Department of Internal Medicine, University of Palermo; R. Giacomelli, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; G. Valentini, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples
| | - Gabriele Valentini
- From the Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila; Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples; Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo; Department of Experimental and Clinical Medicine, University of Florence, Florence; Department of Health Sciences, University of Catanzaro "Magna Graecia," Catanzaro; Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.,P. Ruscitti, MD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; D. Iacono, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples; F. Ciccia, MD, PhD, Rheumatology Section, Department of Internal Medicine, University of Palermo; G. Emmi, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence; P. Cipriani, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; R.D. Grembiale, MD, Department of Health Sciences, University of Catanzaro "Magna Graecia"; F. Perosa, MD, PhD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; L. Emmi, MD, Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School; G. Triolo, MD, Rheumatology Section, Department of Internal Medicine, University of Palermo; R. Giacomelli, MD, PhD, Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila; G. Valentini, MD, Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples
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Kawasumi H, Katsumata Y, Nishino A, Hirahara S, Kawaguchi Y, Kuwana M, Yamanaka H. Association of Serum Soluble CD163 with Polymyositis and Dermatomyositis, Especially in Anti-MDA5 Antibody–positive Cases. J Rheumatol 2018; 45:947-955. [DOI: 10.3899/jrheum.170997] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 01/24/2023]
Abstract
Objective.We elucidated the association of serum soluble CD163 (sCD163) with rapidly progressive interstitial lung disease (RP-ILD), autoantibody profiles, and serum ferritin in patients with polymyositis (PM), classic dermatomyositis (DM), and clinical amyopathic dermatomyositis (CADM).Methods.Serum sCD163 levels were retrospectively measured by ELISA in patients with PM, classic DM, and CADM, as well as in healthy controls (HC). Repeat sera samples were obtained posttreatment from available patients. The associations between serum sCD163 levels and clinical information were analyzed.Results.Serum sCD163 levels in patients with PM/classic DM/CADM were significantly higher than those in HC (n = 72, 56, 34, and 68, respectively; p < 0.001 for all comparisons). No significant difference was observed between serum sCD163 levels in patients with and without ILD (p = 0.16) or between those with RP-ILD and chronic ILD (p = 0.21). Serum sCD163 levels were significantly higher in patients with anti-MDA5 antibodies (n = 27) than in those without (p = 0.001). Serum sCD163 levels were weakly correlated with serum ferritin levels in the patients with PM, classic DM, and CADM (r = 0.21). Serum sCD163 levels decreased significantly following treatment in all patient groups (p = 0.003).Conclusion.The present results suggest an association of serum sCD163 with PM, classic DM, and CADM, especially in anti-MDA5 antibody–positive cases. However, serum sCD163 levels were not specifically associated with ILD or RP-ILD.
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Özgür G, Beyan C. Therapeutic apheresis in the treatment of catastrophic antiphospholipid syndrome. Transfus Apher Sci 2018; 57:13-15. [PMID: 29478799 DOI: 10.1016/j.transci.2018.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Catastrophic thrombotic syndrome is characterized by occurrence of several thromboembolic occlusions which affect a variety of vascular beds over a short period of time. Catastrophic Antiphospholipid syndrome (CAPS) (1%) is regarded as a rare but severe variant of Antiphospholipid Syndrome. Treatment with anticoagulants, steroids and therapeutic plasma exchange has been shown to give the best results. However, to treat CAPS, the best substitute for plasma is still a debatable issue because there are no standard methods.
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Affiliation(s)
- Gökhan Özgür
- Gulhane Training and Research Hospital, Department of Hematology, Ankara, Turkey.
| | - Cengiz Beyan
- TOBB University of Economics and Technology, Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
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224
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Cohen EM, D'Silva K, Kreps D, Son MB, Costenbader KH. Arthritis and use of hydroxychloroquine associated with a decreased risk of macrophage activation syndrome among adult patients hospitalized with systemic lupus erythematosus. Lupus 2018; 27:1065-1071. [PMID: 29451069 DOI: 10.1177/0961203318759428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Macrophage activation syndrome (MAS) is an uncommon but serious complication of systemic lupus erythematosus (SLE). We aimed to identify factors associated with MAS among adult hospitalized SLE patients. Methods Within the Brigham and Women's Hospital (BWH) Lupus Center Registry, we identified adult SLE patients > age 17 who had been hospitalized from 1970 to 2016, with either ferritin > 5000 ng/ml during admission or "macrophage activation syndrome" or "MAS" in discharge summary. We confirmed MAS by physician diagnosis in medical record review. We matched each hospitalized SLE patient with MAS to four SLE patients hospitalized without MAS (by SLE diagnosis date ±1 year). We employed conditional logistic regression models to identify clinical factors associated with MAS among hospitalized SLE patients. Results Among 2094 patients with confirmed SLE, we identified 23 who had a hospitalization with MAS and compared them to 92 hospitalized without MAS. Cases and controls had similar age at SLE diagnosis (29.0 vs. 30.5, p = 0.60), and hospital admission (43.0 vs. 38.3, p = 0.80), proportion female (78% vs. 84%, p = 0.55), and time between SLE diagnosis and hospitalization (1971 vs. 1732 days, p = 0.84). Arthritis (OR 0.04 (95% CI 0.004-0.35)) and hydroxychloroquine use (OR 0.18 (95% CI 0.04-0.72)) on admission were associated with decreased MAS risk. Admission Systemic Lupus Erythematosus Disease Activity Index scores (30 vs. 19, p = 0.002) and lengths of stay (16 days vs. 3 days, p < 0.0001) were much higher among cases. Death during hospitalization was 19% among cases and 3% among controls ( p = 0.03). Conclusions In this case-control study of hospitalized adult SLE patients, arthritis and hydroxychloroquine use at hospital admission were associated with decreased MAS risk. Further studies are needed to validate these factors associated with lowered MAS risk.
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Affiliation(s)
- E M Cohen
- 1 Division of Immunology, 1862 Boston Children's Hospital , Boston, MA, USA
| | - K D'Silva
- 2 Department of Rheumatology, 1861 Brigham and Women's Hospital , Boston, MA, USA
| | - D Kreps
- 2 Department of Rheumatology, 1861 Brigham and Women's Hospital , Boston, MA, USA
| | - M B Son
- 1 Division of Immunology, 1862 Boston Children's Hospital , Boston, MA, USA
| | - K H Costenbader
- 2 Department of Rheumatology, 1861 Brigham and Women's Hospital , Boston, MA, USA
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225
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Wu SJ, Hayden JA. Upfront dilution of ferritin samples to reduce hook effect, improve turnaround time and reduce costs. Biochem Med (Zagreb) 2018; 28:010903. [PMID: 29187801 PMCID: PMC5701779 DOI: 10.11613/bm.2018.010903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/22/2017] [Indexed: 11/12/2022] Open
Abstract
Introduction Sandwich immunoassays offer advantages in the clinical laboratory but can yield erroneously low results due to hook (prozone) effect, especially with analytes whose concentrations span several orders of magnitude such as ferritin. This study investigated a new approach to reduce the likelihood of hook effect in ferritin immunoassays by performing upfront, five-fold dilutions of all samples for ferritin analysis. The impact of this change on turnaround time and costs were also investigated. Materials and methods Ferritin concentrations were analysed in routine clinical practice with and without upfront dilutions on Siemens Centaur® XP (Siemens Healthineers, Erlang, Germany) immunoanalysers. In addition, one month of baseline data (1026 results) were collected prior to implementing upfront dilutions and one month of data (1033 results) were collected after implementation. Results Without upfront dilutions, hook effect was observed in samples with ferritin concentrations as low as 86,028 µg/L. With upfront dilutions, samples with ferritin concentrations as high as 126,050 µg/L yielded values greater than the measurement interval and would have been diluted until an accurate value was obtained. The implementation of upfront dilution of ferritin samples led to a decrease in turnaround time from a median of 2 hours and 3 minutes to 1 hour and 18 minutes (P = 0.002). Conclusions Implementation of upfront dilutions of all ferritin samples reduced the possibility of hook effect, improved turnaround time and saved the cost of performing additional dilutions.
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Affiliation(s)
- Shu Juan Wu
- Central Laboratory, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA
| | - Joshua A Hayden
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
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226
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Chighizola CB, Andreoli L, Gerosa M, Tincani A, Ruffatti A, Meroni PL. The treatment of anti-phospholipid syndrome: A comprehensive clinical approach. J Autoimmun 2018; 90:1-27. [PMID: 29449131 DOI: 10.1016/j.jaut.2018.02.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/06/2018] [Indexed: 01/02/2023]
Abstract
Anti-phospholipid syndrome (APS) is an acquired pro-thrombotic autoimmune disease that predisposes to thrombotic events and/or obstetric complications, in the persistent presence of anti-phospholipid antibodies (aPL). Life long moderate-intensity anticoagulation is the option of choice for aPL-positive patients with a previous thrombosis; critical issues concern the management of those with a history of arterial event due to the high rate of recurrence. Alternatives comprise anti-platelet agents and high-intensity anticoagulation. Low dose aspirin (LDASA) and low molecular weight heparin provide the mainstay of the treatment of obstetric APS, allowing a birth rate in 70% of cases. The management of refractory APS, thrombotic as well as obstetric, is highly debated, but an increasing burden of evidence points towards the beneficial effects of multiple treatments. Similarly, a management envisaging multiple drugs (anticoagulation, steroids, plasma exchange and/or intravenous immunoglobulins) is the most effective approach in catastrophic APS. Asymptomatic aPL carriers are at higher risk of thrombotic and obstetric complications compared to the general population, thus potentially benefitting of a pharmacological intervention. LDASA and hydroxychloroquine can be considered as options, in particular in case of high risk aPL profile, concomitant cardiovascular risk factors or associated autoimmune disease. APS is apparently a simple condition, but its multifaceted nature requires a complex and tailored treatment.
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Affiliation(s)
- Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy; Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy; Allergology, Clinical Immunology and Rheumatology, Piazzale Brescia 20, 20149, Milan, Italy.
| | - Laura Andreoli
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy; Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy; Department of Rheumatology, ASST Istituto Gaetano Pini & CTO, Piazza Cardinal Ferrari, 1 20122, Milan, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Pier Luigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italy
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Kenny LC, Kell DB. Immunological Tolerance, Pregnancy, and Preeclampsia: The Roles of Semen Microbes and the Father. Front Med (Lausanne) 2018; 4:239. [PMID: 29354635 PMCID: PMC5758600 DOI: 10.3389/fmed.2017.00239] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/12/2017] [Indexed: 12/18/2022] Open
Abstract
Although it is widely considered, in many cases, to involve two separable stages (poor placentation followed by oxidative stress/inflammation), the precise originating causes of preeclampsia (PE) remain elusive. We have previously brought together some of the considerable evidence that a (dormant) microbial component is commonly a significant part of its etiology. However, apart from recognizing, consistent with this view, that the many inflammatory markers of PE are also increased in infection, we had little to say about immunity, whether innate or adaptive. In addition, we focused on the gut, oral and female urinary tract microbiomes as the main sources of the infection. We here marshall further evidence for an infectious component in PE, focusing on the immunological tolerance characteristic of pregnancy, and the well-established fact that increased exposure to the father's semen assists this immunological tolerance. As well as these benefits, however, semen is not sterile, microbial tolerance mechanisms may exist, and we also review the evidence that semen may be responsible for inoculating the developing conceptus (and maybe the placenta) with microbes, not all of which are benign. It is suggested that when they are not, this may be a significant cause of PE. A variety of epidemiological and other evidence is entirely consistent with this, not least correlations between semen infection, infertility and PE. Our view also leads to a series of other, testable predictions. Overall, we argue for a significant paternal role in the development of PE through microbial infection of the mother via insemination.
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Affiliation(s)
- Louise C. Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Douglas B. Kell
- School of Chemistry, The University of Manchester, Manchester, United Kingdom
- The Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
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228
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Diagnosis of hyperferritinemia in routine clinical practice. Presse Med 2017; 46:e329-e338. [PMID: 29150231 DOI: 10.1016/j.lpm.2017.09.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/06/2017] [Indexed: 01/29/2023] Open
Abstract
The discovery of hyperferritinemia is often fortuitous, revealed in results from a laboratory screening or follow-up test. The aim of the diagnostic procedure is therefore to identify its cause and to identify or rule out hepatic iron overload, in a three-stage process. In the first step, clinical findings and several simple laboratory tests are sufficient to detect four of the most frequent causes of high ferritin concentrations: alcoholism, inflammatory syndrome, cytolysis, and metabolic syndrome. None of these causes is associated with substantial hepatic iron overload. If transferrin saturation is high (> 50%), hereditary hemochromatosis will be considered in priority. In the second phase, rarer diseases will be sought. Among them, only chronic hematologic diseases (acquired or congenital) and excessive iron intake or infusions (patients on chronic dialysis and high-level athletes) are at risk of iron overload. In the third stage, if a doubt persists about the cause or if the ferritin concentration is very high or continues to rise, it is essential to verify the hepatic iron concentration to rule out overload. The principal examination to guide diagnosis and treatment is hepatic MRI to assess its iron concentration. It is essential to remember that more than 40% of patients with hyperferritinemia have several causes simultaneously present.
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Sharif K, Vieira Borba V, Zandman-Goddard G, Shoenfeld Y. Eppur Si Muove: ferritin is essential in modulating inflammation. Clin Exp Immunol 2017; 191:149-150. [PMID: 29023673 DOI: 10.1111/cei.13069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 12/23/2022] Open
Abstract
Ferritin, which was only discovered in the last century, has stirred a formidable debate. Ferritin has long been appreciated as a non-specific acute-phase reactant. Several years ago, we hypothesized the contributory role of ferritin as a pathogenic molecule rather than being a product of inflammation. The latest emerging evidence provides support to this notion. Such revelation provides a step forward towards the understanding of disease conditions associated with hyperferritinaemia, and hence provide new targets for treatment modalities.
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Affiliation(s)
- K Sharif
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - V Vieira Borba
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department A of Internal Medicine, Coimbra University Hospital Care, Coimbra, Portugal
| | - G Zandman-Goddard
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Medicine C, Wolfson Medical Center, Tel Aviv, Israel
| | - Y Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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230
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Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. Int Immunol 2017; 29:401-409. [PMID: 28541437 PMCID: PMC5890889 DOI: 10.1093/intimm/dxx031] [Citation(s) in RCA: 328] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/23/2017] [Indexed: 12/18/2022] Open
Abstract
Understanding of ferritin biology has traditionally centered on its role in iron storage and homeostasis, with low ferritin levels indicative of deficiency and high levels indicative of primary or secondary hemochromatosis. However, further work has shown that iron, redox biology and inflammation are inexorably linked. During infection, increased ferritin levels represent an important host defense mechanism that deprives bacterial growth of iron and protects immune cell function. It may also be protective, limiting the production of free radicals and mediating immunomodulation. Additionally, hyperferritinemia is a key acute-phase reactants, used by clinicians as an indication for therapeutic intervention, aimed at controlling inflammation in high-risk patients. One school of thought maintains that hyperferritinemia is an 'innocent bystander' biomarker of uncontrolled inflammation that can be used to gauge effectiveness of intervention. Other schools of thought maintain that ferritin induction could be a protective negative regulatory loop. Others maintain that ferritin is a key mediator of immune dysregulation, especially in extreme hyperferritinemia, via direct immune-suppressive and pro-inflammatory effects. There is a clear need for further investigation of the role of ferritin in uncontrolled inflammatory conditions both as a biomarker and mediator of disease because its occurrence identifies patients with high mortality risk and its resolution predicts their improved survival.
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Affiliation(s)
- Kate F Kernan
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA
| | - Joseph A Carcillo
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA
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231
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Iardino A, Bunin V, Truong LD, Preti HA. Complement activation: an atypical presentation of an atypical syndrome. BMJ Case Rep 2017; 2017:bcr-2017-221798. [PMID: 29084740 DOI: 10.1136/bcr-2017-221798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 42-year-old Hispanic female and long-distance runner was seen for evaluation of fatigue. Her physical examination showed petechiae and ecchymoses in upper extremities, abdominal distension and bilateral ankle oedema. Laboratory workup revealed anaemia, thrombocytopenia, hypoalbuminemia and proteinuria of 1.4 g/24 hours. No schistocytes were found on peripheral blood smear. CT of her abdomen revealed diffuse small lymphadenopathy and hepatomegaly. Bone marrow biopsy demonstrated normal trilineage hematopoiesis with no hemophagocytosis. The patient was started on oral prednisone with no improvement and was subsequently admitted to the hospital for pulsed steroids, intravenous immunoglobulin and rituximab. Her proteinuria became nephrotic range, and a renal biopsy revealed features of thrombotic microangiopathy limited to the glomerular capillaries. ADAMTS13 was low which is >10% of normal, and a diagnosis of atypical haemolytic-uraemic syndrome (aHUS) was made. Eculizumab was started with prompt response. Whole exome sequencing demonstrated mutation in SPTA1, which has been associated with red blood cell membrane diseases but has not been described in patients with aHUS.
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Affiliation(s)
- Alfredo Iardino
- Internal Medicine, Texas Tech University at the Permian Basin, Odessa, Texas, USA
| | - Viviane Bunin
- Rheumatology, Houston Methodist Hospital, Houston, Texas, USA
| | - Luan D Truong
- Department of Pathology, Houston Methodist Hospital, Houston, Texas, USA
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Ferritin is secreted via 2 distinct nonclassical vesicular pathways. Blood 2017; 131:342-352. [PMID: 29074498 DOI: 10.1182/blood-2017-02-768580] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/18/2017] [Indexed: 12/11/2022] Open
Abstract
Ferritin turnover plays a major role in tissue iron homeostasis, and ferritin malfunction is associated with impaired iron homeostasis and neurodegenerative diseases. In most eukaryotes, ferritin is considered an intracellular protein that stores iron in a nontoxic and bioavailable form. In insects, ferritin is a classically secreted protein and plays a major role in systemic iron distribution. Mammalian ferritin lacks the signal peptide for classical endoplasmic reticulum-Golgi secretion but is found in serum and is secreted via a nonclassical lysosomal secretion pathway. This study applied bioinformatics and biochemical tools, alongside a protein trafficking mouse models, to characterize the mechanisms of ferritin secretion. Ferritin trafficking via the classical secretion pathway was ruled out, and a 2:1 distribution of intracellular ferritin between membrane-bound compartments and the cytosol was observed, suggesting a role for ferritin in the vesicular compartments of the cell. Focusing on nonclassical secretion, we analyzed mouse models of impaired endolysosomal trafficking and found that ferritin secretion was decreased by a BLOC-1 mutation but increased by BLOC-2, BLOC-3, and Rab27A mutations of the cellular trafficking machinery, suggesting multiple export routes. A 13-amino-acid motif unique to ferritins that lack the secretion signal peptide was identified on the BC-loop of both subunits and plays a role in the regulation of ferritin secretion. Finally, we provide evidence that secretion of iron-rich ferritin was mediated via the multivesicular body-exosome pathway. These results enhance our understanding of the mechanism of ferritin secretion, which is an important piece in the puzzle of tissue iron homeostasis.
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233
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Sulaiman W, Abdullah AC, Tan Tsen Chuen J, Baba S, Karim N. Refractory Adult Onset Still's Disease. Cureus 2017; 9:e1802. [PMID: 29282446 PMCID: PMC5741270 DOI: 10.7759/cureus.1802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
It is often a challenge and a dilemma for clinicians encountering patients with pyrexia of unknown origin. Numerous tests performed to determine the underlying cause often give inconclusive results. We present a 52-year-old man with undulating fever for more than 10 months with persistent hyperferritinaemia, and negative immunological and serological markers. Despite corticosteroids, disease modifying anti-rheumatic agents and immune-modulator therapy, he succumbed to the illness. A diagnosis of refractory Adult onset Still’s disease complicated by haemophagocytic lymphohistiocytosis was made.
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Affiliation(s)
- Wahinuddin Sulaiman
- Medicine, Faculty of Medicine, Universiti Kuala Lumpur Royal College of Medicine Perak
| | | | | | - Shaffie Baba
- Radiology, Hospital Raja Permaisuri Bainun, Ipoh
| | - Norain Karim
- Pathology, Hospital Raja Permaisuri Bainun, Ipoh
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Ruscitti P, Cipriani P, Di Benedetto P, Liakouli V, Berardicurti O, Carubbi F, Ciccia F, Guggino G, Triolo G, Giacomelli R. H-ferritin and proinflammatory cytokines are increased in the bone marrow of patients affected by macrophage activation syndrome. Clin Exp Immunol 2017; 191:220-228. [PMID: 28960260 DOI: 10.1111/cei.13057] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 12/12/2022] Open
Abstract
Macrophage activation syndrome (MAS) is hyperinflammatory life-threatening syndrome, associated typically with high levels of serum ferritin. This is an iron storage protein including heavy (H) and light (L) subunits, categorized on their molecular weight. The H-/L subunits ratio may be different in tissues, depending on the specific tissue and pathophysiological status. In this study, we analysed the bone marrow (BM) biopsies of adult MAS patients to assess the presence of: (i) H-ferritin and L-ferritin; (ii) CD68+ /H-ferritin+ and CD68+ /L-ferritin+ ; and (iii) interleukin (IL)-1β, tumour necrosis factor (TNF) and interferon (IFN)-γ. We also explored possible correlations of these results with clinical data. H-ferritin, IL-1β, TNF and IFN-γ were increased significantly in MAS. Furthermore, an increased number of CD68+ /H-ferritin+ cells and an infiltrate of cells co-expressing H-ferritin and IL-12, suggesting an infiltrate of M1 macrophages, were observed. H-ferritin levels and CD68+ /H-ferritin+ cells were correlated with haematological involvement of the disease, serum ferritin and C-reactive protein. L-ferritin and CD68+ /L-ferritin+ cells did not correlate with these parameters. In conclusion, during MAS, H-ferritin, CD68+ /H-ferritin+ cells and proinflammatory cytokines were increased significantly in the BM inflammatory infiltrate, pointing out a possible vicious pathogenic loop. To date, H-ferritin and CD68+ /H-ferritin+ were associated significantly with haematological involvement of the disease, suggesting biomarkers assessing severity of clinical picture.
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Affiliation(s)
- P Ruscitti
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Cipriani
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Di Benedetto
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - V Liakouli
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - O Berardicurti
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Carubbi
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Ciccia
- Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - G Guggino
- Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - G Triolo
- Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - R Giacomelli
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Serum Ferritin: A Backstage Weapon in Diagnosis of Dengue Fever. Interdiscip Perspect Infect Dis 2017; 2017:7463489. [PMID: 29098002 PMCID: PMC5643150 DOI: 10.1155/2017/7463489] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/08/2017] [Accepted: 08/23/2017] [Indexed: 11/25/2022] Open
Abstract
Aims This retrospective study evaluates ferritin as a surrogate marker for dengue infection (NS1 and IgM negative stage) as opposed to other febrile illnesses of infective or inflammatory etiology (OFI). Methodology Data of all patients admitted to medical ward and medical ITU during the dengue outbreak were collected. Patients admitted between 5 and 10 days of febrile illness without a diagnosis were included. Patients with NS1 positivity (Days 2–8) and/or positive IgM for dengue (Days 6–10) were considered to be dengue cases and those with other confirmed diagnoses were considered in the OFI group. Ferritin, CRP, TC of WBC, platelet count, SGOT, SGPT, and albumin levels were analysed for both groups. Results We examined 30 cases of clinically and serologically confirmed dengue fever and 22 cases of OFI. Ferritin level in dengue cohort was significantly higher than the OFI group (p < 0.0001). The best cut-off for ferritin level to differentiate dengue from OFI was found to be 1291. The sensitivity at this cut-off is 82.6% and the specificity at this cut-off is 100%. Conclusion Ferritin may serve as a significant marker for differentiating between dengue fever and OFI, in absence of a positive NS1 antigen or a positive IgM antibody for dengue.
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Ruscitti P, Ursini F, Cipriani P, De Sarro G, Giacomelli R. Biologic drugs in adult onset Still's disease: a systematic review and meta-analysis of observational studies. Expert Rev Clin Immunol 2017; 13:1089-1097. [PMID: 28870100 DOI: 10.1080/1744666x.2017.1375853] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Biological drugs, mainly interleukin (IL)-1 and IL-6 antagonists, but also tumor necrosis factor (TNF) inhibitors, have been used in the treatment of adult onset Still's disease patients (AOSD). METHODS We summarised the available evidence for the effectiveness of biologic drugs in AOSD. A systematic review of the literature was performed in order to identify all the available data concerning the effectiveness of biologic drugs in AOSD. The proportion of patients achieving complete remission or any clinical response was calculated. The meta-analysis was thus performed using a random-effects model accounting for the expected high level of heterogeneity. RESULTS Nineteen observational published studies were included in the meta-analysis. The pooled analysis under a random-effects model showed an overall rate of clinical response of 0.85 (95% CI: 0.77-0.91, p < 0.0001) and an overall rate of complete remission of 0.66 (95% CI: 0.54-0.77, p = 0.01). The heterogeneity across studies was high (Q = 59.82 with df = 19.0, p < 0.0001, I2 = 68.23%). CONCLUSIONS Our meta-analysis suggests that AOSD patients may experience a clinical response and/or a complete remission when treated with biologic drugs. Specifically designed and powered studies are needed to fully investigate the role of such medications in the management of AOSD patients.
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Affiliation(s)
- Piero Ruscitti
- a Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences , University of L'Aquila , L'Aquila , Italy
| | - Francesco Ursini
- b Department of Health Sciences , University of Catanzaro "Magna Graecia" , Catanzaro , Italy
| | - Paola Cipriani
- a Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences , University of L'Aquila , L'Aquila , Italy
| | - Giovambattista De Sarro
- b Department of Health Sciences , University of Catanzaro "Magna Graecia" , Catanzaro , Italy
| | - Roberto Giacomelli
- a Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences , University of L'Aquila , L'Aquila , Italy
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Hemmati-Dinarvand M, Taher-Aghdam AA, Mota A, Zununi Vahed S, Samadi N. Dysregulation of serum NADPH oxidase1 and ferritin levels provides insights into diagnosis of Parkinson's disease. Clin Biochem 2017; 50:1087-1092. [PMID: 28941592 DOI: 10.1016/j.clinbiochem.2017.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Parkinson's disease (PD) is a common neurodegenerative disease. Oxidative stress is considered as a key modulator in the development of PD. This study aimed to investigate associations between serum NOX1 (NADPH oxidase1), ferritin, selenium (Se), and uric acid (UA) levels and clinical parameters in patients with PD. DESIGN AND METHODS Serum levels of NOX1, ferritin, Se, and UA were measured in 40 PD patients and 40 healthy individuals. Receiver operating characteristic (ROC) analysis was performed to investigate incremental diagnostic value of each factor in the study groups. RESULTS Mean serum NOX1 levels were markedly higher in patient group (22.36±5.80ng/mL) versus healthy individuals (8.89±2.37ng/mL) (p<0.001). Significant differences were also observed in the serum concentrations of ferritin (p=0.005) and Se (p=0.001) between patients with PD and healthy individuals. However, the serum concentrations of UA were not statistically significant between the study groups (p=0.560). ROC analysis revealed a diagnostic ability of serum NOX1 and ferritin levels for PD with an area under ROC curve of ≥0.7 (p<0.05) and relatively high sensitivity and specificity. Combination of serum NOX1 and Se along with ferritin and UA levels increased the sensitivity up to 85%, specificity up to 97% and area under the ROC curve up to 0.94 (95% confidence interval (95% CI): 0.89 to 0.99, p<0.001). CONCLUSION Our findings indicated that serum concentrations of NOX1, ferritin, and Se are significantly higher in the patients with PD. Therefore, these factors can be considered as potential diagnostic biomarkers for diagnosis and monitoring of PD patients. Further studies are required with larger sample size to provide more detailed information about the cognitive profile of participants and the outcome measures.
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Affiliation(s)
- Mohsen Hemmati-Dinarvand
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Clinical Biochemistry and Laboratory Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali-Akbar Taher-Aghdam
- Department of Neurology, Faculty of Medicine, TabrizUniversity of Medical Sciences, Tabriz, Iran
| | - Ali Mota
- Department of Clinical Biochemistry and Laboratory Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Nasser Samadi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Clinical Biochemistry and Laboratory Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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238
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Kyriazopoulou E, Leventogiannis K, Norrby-Teglund A, Dimopoulos G, Pantazi A, Orfanos SE, Rovina N, Tsangaris I, Gkavogianni T, Botsa E, Chassiou E, Kotanidou A, Kontouli C, Chaloulis P, Velissaris D, Savva A, Cullberg JS, Akinosoglou K, Gogos C, Armaganidis A, Giamarellos-Bourboulis EJ. Macrophage activation-like syndrome: an immunological entity associated with rapid progression to death in sepsis. BMC Med 2017; 15:172. [PMID: 28918754 PMCID: PMC5603161 DOI: 10.1186/s12916-017-0930-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/10/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A subanalysis of a randomized clinical trial indicated sepsis survival benefit from interleukin (IL)-1 blockade in patients with features of the macrophage activation-like syndrome (MALS). This study aimed to investigate the frequency of MALS and to develop a biomarker of diagnosis and prognosis. METHODS Patients with infections and systemic inflammatory response syndrome were assigned to one test cohort (n = 3417) and a validation cohort (n = 1704). MALS was diagnosed for patients scoring positive either for the hemophagocytic syndrome score and/or having both hepatobiliary dysfunction and disseminated intravascular coagulation. Logistic regression analysis was used to estimate the predictive value of MALS for 10-day mortality in both cohorts. Ferritin, sCD163, IL-6, IL-10, IL-18, interferon gamma (IFN-γ), and tumor necrosis factor alpha (TNF-α) were measured in the blood the first 24 h; ferritin measurements were repeated in 747 patients on day 3. RESULTS The frequency of MALS was 3.7% and 4.3% in the test and the validation cohort, respectively. In both cohorts, MALS was an independent risk factor for 10-day mortality. A ferritin level above 4420 ng/ml was accompanied by 66.7% and 66% mortality after 28 days, respectively. Ferritin levels above 4420 ng/ml were associated with an increase of IL-6, IL-18, INF-γ, and sCD163 and a decreased IL-10/TNF-α ratio, indicating predominance of pro-inflammatory phenomena. Any less than 15% decrease of ferritin on day 3 was associated with more than 90% sensitivity for unfavorable outcome after 10 days. This high mortality risk was also validated in an independent Swedish cohort (n = 109). CONCLUSIONS MALS is an independent life-threatening entity in sepsis. Ferritin measurements can provide early diagnosis of MALS and may allow for specific treatment.
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Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Konstantinos Leventogiannis
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Anna Norrby-Teglund
- Department for Infectious Diseases and Center for Infectious Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Georgios Dimopoulos
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Pantazi
- 2nd Department of Internal Medicine, Thriasion Elefsis General Hospital, Elefsina, Greece
| | - Stylianos E Orfanos
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoletta Rovina
- 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Iraklis Tsangaris
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Elektra Botsa
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | | | - Anastasia Kotanidou
- 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Kontouli
- Intensive Care Unit, "Agios Dimitrios" General Hospital, Thessaloniki, Greece
| | | | - Dimitrios Velissaris
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
| | - Athina Savva
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Jonas-Sundén Cullberg
- Department for Infectious Diseases and Center for Infectious Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Karolina Akinosoglou
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
| | - Charalambos Gogos
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
| | - Apostolos Armaganidis
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece.
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Ruscitti P, Rago C, Breda L, Cipriani P, Liakouli V, Berardicurti O, Carubbi F, Di Battista C, Verrotti A, Giacomelli R. Macrophage activation syndrome in Still’s disease: analysis of clinical characteristics and survival in paediatric and adult patients. Clin Rheumatol 2017; 36:2839-2845. [DOI: 10.1007/s10067-017-3830-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 01/10/2023]
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Ruscitti P, Cipriani P, Di Benedetto P, Liakouli V, Carubbi F, Berardicurti O, Ciccia F, Guggino G, Triolo G, Giacomelli R. Advances in immunopathogenesis of macrophage activation syndrome during rheumatic inflammatory diseases: toward new therapeutic targets? Expert Rev Clin Immunol 2017; 13:1041-1047. [PMID: 28837367 DOI: 10.1080/1744666x.2017.1372194] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Macrophage activation syndrome (MAS) is a severe, hyperinflammatory life-threatening syndrome, generally complicating different rheumatic diseases. Despite the severity of the disease, little is known about the pathogenic mechanisms and, thus, possible targeted therapies in the management of these patients. Areas covered: In this review, we aimed to update the current pathogenic knowledge of MAS, during rheumatic diseases, focusing mainly on immunologic abnormalities and on new possible therapeutic strategies. Expert commentary: The difficult pathogenic scenario of MAS, in which genetic defects, predisposing diseases, and triggers are mixed together with the high mortality rate, make it difficult to manage these patients. Although most efforts have been focused on investigating the disease in children, in recent years, several studies are trying to elucidate the possible pathogenic mechanism in adult MAS patients. In this context, genetic and immunological studies might lead to advances in the knowledge of pathogenic mechanisms and possible new therapeutic targets. In the future, the results of ongoing clinical trials are awaited in order to improve the management and, thus, the survival of these patients.
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Affiliation(s)
- Piero Ruscitti
- a Division of Rheumatology , University of L'Aquila , L'Aquila , Italy
| | - Paola Cipriani
- a Division of Rheumatology , University of L'Aquila , L'Aquila , Italy
| | | | - Vasiliky Liakouli
- a Division of Rheumatology , University of L'Aquila , L'Aquila , Italy
| | - Francesco Carubbi
- a Division of Rheumatology , University of L'Aquila , L'Aquila , Italy
| | | | - Francesco Ciccia
- b Division of Rheumatology , University of Palermo , Palermo , Italy
| | - Giuliana Guggino
- b Division of Rheumatology , University of Palermo , Palermo , Italy
| | - Giovanni Triolo
- b Division of Rheumatology , University of Palermo , Palermo , Italy
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Govoni M, Bortoluzzi A, Rossi D, Modena V. How I treat patients with adult onset Still's disease in clinical practice. Autoimmun Rev 2017; 16:1016-1023. [PMID: 28778712 DOI: 10.1016/j.autrev.2017.07.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 06/22/2017] [Indexed: 12/27/2022]
Abstract
Adult onset Still's disease (AOSD) is a rare systemic inflammatory disease of unknown etiology characterized by four cardinal signs which are almost always present in patients: high spiking fever, arthralgia (with or without synovitis), maculo-papular salmon-pink evanescent skin rash, striking leukocytosis with neutrophilia. Here, we review the clinical features of AOSD and describe the best practice approaches for its management, reviewing available guidelines and recommendations and providing experts' insights.
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Affiliation(s)
- Marcello Govoni
- Rheumatology Unit, S. Anna Hospital and University of Ferrara, Italy
| | | | - Daniela Rossi
- Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases, Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Vittorio Modena
- Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases, Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy.
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Kucuk H, Varan O, Goker B, Bitik B, Ozturk MA, Haznedaroglu S, Tufan A. Serum ferritin as an activity marker for granulamotosis with polyangiitis. Ren Fail 2017; 39:566-569. [PMID: 28741986 PMCID: PMC6446145 DOI: 10.1080/0886022x.2017.1349675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Serum ferritin correlates well with the activities of systemic lupus erythematosus (SLE) and dermatomyositis, but it has not been previously studied in patients with vasculitis. Methods: Medical records of granulomatosis with polyangiitis (GPA, Wegener’s granulomatosis) patients with at least six months of regular follow-up were evaluated. The activity of GPA was assessed with Birmingham Vasculitis Activity Score for Wegener’s Granulomatosis (BVAS/WG). Serum ferritin and other acute phase markers were measured at initial presentation. Results: Serum ferritin levels were found to be the highest in GPA patients with alveolar hemorrhage, median (IQR) 1041 (1281) μg/L. Patients with renal disease also had high levels of ferritin and it was correlated with concurrent glomerular filtration rate (r = −0.65, p < .001). Serum ferritin is also correlated well with the BVAS/WG scores (r = 0.79, p < .001). Conclusions: Measurement of serum ferritin might help in assessing disease activity of GPA.
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Affiliation(s)
- Hamit Kucuk
- a Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine , Gazi University , Ankara , Turkey
| | - Ozkan Varan
- a Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine , Gazi University , Ankara , Turkey
| | - Berna Goker
- a Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine , Gazi University , Ankara , Turkey
| | - Berivan Bitik
- a Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine , Gazi University , Ankara , Turkey
| | - Mehmet Akif Ozturk
- a Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine , Gazi University , Ankara , Turkey
| | - Seminur Haznedaroglu
- a Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine , Gazi University , Ankara , Turkey
| | - Abdurrahman Tufan
- a Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine , Gazi University , Ankara , Turkey
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Abstract
Adult-onset Still’s disease (AOSD) is a multi-systemic inflammatory disorder of unknown etiology. To date, no single diagnostic test is available for AOSD. Herein, we investigated the pathogenic role of microRNAs in AOSD. MicroRNA profiles in plasma from AOSD patients and healthy controls were analyzed by microarray analysis, followed by quantitative reverse transcription PCR validation. The biological functions of microRNAs were evaluated using in vitro cell-based assay. Among the differentially expressed microRNAs, microRNA-134 (miR-134) expression was positively correlated with AOSD activity scores and significantly decreased after effective treatment. An increased miR-134 level is significantly associated with the activation of Toll-like receptor 3 (TLR3). The reporter assay identified IL-18 binding protein (IL-18BP) as the target of miR-134. A negative correlation between miR-134 expression and IL-18BP mRNA levels were detected in peripheral blood cells following TLR3 ligand treatment. Lower plasma IL-18BP levels and higher IL-18 levels were also observed in active AOSD patients who had higher miR-134 expression than inactive patients. Upregulation of circulating miR-134 was associated with elevated IL-18 levels by targeting IL-18BP in AOSD patients and was positively correlated with disease activity, suggesting its involvement in AOSD pathogenesis. MiR-134 may be a novel activity indicator or potential prognostic biomarker in AOSD.
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Bereikienė S, Rascon J. Hemofagocitinė limfohistiocitozė: literatūros apžvalga. Acta Med Litu 2017. [PMID: 28630593 PMCID: PMC5467963 DOI: 10.6001/actamedica.v24i1.3463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS A LITERATURE REVIEW Hemophagocytic lymphohistiocytosis is an immune dysregulatory syndrome that is associated with alteration in the immune response activation and inhibition balance. There are two basic forms of the syndrome: primary (genetic or familial) determined by genes mutations involved in immune cell interactions, and secondary or sporadic developing as a result of an infectious process. The exact genetic background of the secondary form is still unknown. These forms are characterized by same combination of specific hyperinflammatory reactions and clinical signs and symptoms. Discrimination between primary and secondary forms is often challenging due to the rarity of the pathology, a wide spectrum of clinical signs, and limited availability of specific tests. Etiopathogenetic treatment of the primary form is an urgent allogeneic hematopoietic stem cell transplantation, otherwise a fatal outcome is inevitable. Meanwhile, the approach to the secondary form depends on the clinical manifestation and the type of the infectious trigger. To rescue the patient, a timely diagnosis is crucial for prompt administration of appropriate treatment. Treatment of hemophagocytic lymphohistiocytosis is complicated by the high incidence of treatment-related mortality and the propensity to relapse. Keywords: hemophagocytis lymphohistiocytosis, immunodeficiency, diagnostic criteria.
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Affiliation(s)
| | - Jelena Rascon
- Vilniaus universiteto Medicinos fakulteto Vaikų ligų klinika.,Vaikų ligoninė, VšĮ Vilniaus universiteto ligoninės Santariškių klinikų filialas, Vaikų onkohematologijos centras
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Graft Versus Host Disease After Liver Transplantation in Adults: A Case series, Review of Literature, and an Approach to Management. Transplantation 2017; 100:2661-2670. [PMID: 27495762 DOI: 10.1097/tp.0000000000001406] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Graft-versus-host-disease (GVHD) after liver transplantation (LT) is a deadly complication with very limited data on risk factors, diagnosis and management. We report a case series and a comprehensive review of the literature. METHODS Data were systematically extracted from reports of GVHD after LT, and from the United Network for Organ Sharing database. Group comparisons were performed. RESULTS One hundred fifty-six adult patients with GVHD after LT have been reported. Median time to GVHD onset was 28 days. Clinical features were skin rash (92%), pancytopenia (78%), and diarrhea (65%). Six-month mortality with GVHD after LT was 73%. Sepsis was the most common cause of death (60%). Enterobacter bacteremia, invasive aspergillosis, and disseminated Candida infections were frequently reported. Recipient age over 50 years is a risk factor for GVHD after LT. Hepatocellular carcinoma was overrepresented, whereas chronic hepatitis C was underrepresented, in reported United States GVHD cases relative to all United Network for Organ Sharing database LT cases. Mortality rate with treatment of GVHD after LT was 84% with high-dose steroids alone, 75% to 100% with regimens using dose increases of calcineurin inhibitors, and 55% with IL-2 antagonists. Mortality was 25% in small case series using the CD2-blocker alefacept or TNF-α antagonists. CONCLUSIONS Age older than 50 years and hepatocellular carcinoma appear to be risk factors for GVHD. Hepatitis C may be protective. High-dose steroids and calcineurin inhibitors are ineffective in the treatment of GVHD after LT. CD2-blockers and TNF-α antagonists appear promising. We propose a diagnostic algorithm to assist clinicians in managing adults with GVHD after LT.
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Abstract
INTRODUCTION Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology, and approximately 60-70% of patients may develop a chronic polyphasic form of the disease or a chronic polyarthritis. Due to rarity of disease, treatment of AOSD is not based on controlled study, but on case based experiences. Areas covered: Recently, the application of anti-cytokine therapy based on pathophysiology has resulted in significant progress in the treatment of AOSD. Here, we review current knowledge of the pathogenesis, disease progression, currently available biomarkers of disease activity, standard therapeutic agents, utility of biologic agents, future perspectives for treatment and treatment of macrophage activation syndrome. Expert commentary: Accumulated clinical data suggest that chronic disease can be classified into two subsets: dominant systemic disease, and the arthritis subgroup. IL-1 inhibitors may be more efficient for systemic manifestations and IL-6 inhibitor for both joint involvement and systemic manifestations. TNF inhibitors must be reserved for patients with purely chronic articular manifestations. For ideal management of patients, it is very important to measure disease activity accurately during follow up, but no single biomarker has been classified as ideal. New therapeutic agents and composite biomarkers are needed to improve the outcome of patients with AOSD by identifying disease activity properly.
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Affiliation(s)
- Dae Hyun Yoo
- a Department of Rheumatology, College of Medicine , Hanyang University Hospital for Rheumatic Diseases , Seoul , Korea
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Hyperferritinemia in Hemophagocytic Lymphohistiocytosis: A Single Institution Experience in Pediatric Patients. Indian J Clin Biochem 2017; 33:108-112. [PMID: 29371779 DOI: 10.1007/s12291-017-0655-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/26/2017] [Indexed: 12/16/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is an inflammatory condition that may run a rapid fatal course and calls for prompt diagnosis. Early intervention with steroids and other immunosuppressive drugs can contain the disease process and favours positive outcome. Ferritin ≥500 ng/ml is a HLH diagnostic criterion. We evaluated the diagnostic potential of admission ferritin, in children with HLH. Pediatric patients of a referral teaching hospital from Feb 2010-Oct 2013 having been investigated for ferritin on admission were included. HLH was confirmed when patients had clinical features and met 5/8 diagnostic criteria of the revised 2004 HLH guidelines. Ferritin was estimated on Cobas e411 by electrochemiluminiscence, with a measuring range of 0.5-2000 ng/ml. Dilutions were made when linearity exceeded and absolute values were reported. 905 on-admission ferritin investigations were reviewed out of which 346 values ≥500 ng/ml. Hyperferritinemia was seen in HLH/MAS (macrophage activation syndrome) [HLH group, median age 4 year 4 month, 59% male] and in systemic lupus erythematosus, sepsis, juvenile idiopathic arthritis, impending HLH, haemolytic anemias and malignancy [non-HLH group, median age 4 year 6 month, 60% male]. Of 346, 72 cases of hyperferritinemia were diagnosed with secondary HLH while one patient had primary HLH. 13/73 patients expired. The median ferritin level of the HLH group was significantly higher [6556 (2402-11,734) ng/ml] compared to non-HLH group [median 1175 (943-2000) ng/ml] (p < 0.0001). Receiver operator characteristics curve analysis revealed optimal admission ferritin of 3120 ng/ml as the cut-off with sensitivity of 70% and specificity of 88.9% for HLH diagnosis, exceeding the currently prescribed cut-off of 500 ng/ml. Hyperferritinemia below 3120 ng/ml has higher negative predictive value to rule out secondary HLH on admission in the study population of children predominantly diagnosed with infection associated HLH than the prescribed cut-off as per the 2004 guidelines. This may prove to be beneficial to alert physicians for prompt intervention which considerably decreases mortality in this often fatal condition.
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Ahn SS, Yoo BW, Jung SM, Lee SW, Park YB, Song JJ. Application of the 2016 EULAR/ACR/PRINTO Classification Criteria for Macrophage Activation Syndrome in Patients with Adult-onset Still Disease. J Rheumatol 2017; 44:996-1003. [PMID: 28412707 DOI: 10.3899/jrheum.161286] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the clinical significance of the 2016 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR)/Pediatric Rheumatology International Trials Organization (PRINTO) classification criteria for macrophage activation syndrome (MAS) in patients with adult-onset Still disease (AOSD). METHODS We performed a retrospective analysis of patients with AOSD with fever who were admitted to Severance Hospital between 2005 and 2016. The patients with AOSD were evaluated for MAS using the 2016 classification criteria for MAS. Clinical features, laboratory findings, and overall survival were analyzed. Logistic regression analysis was used to evaluate the factors associated with in-hospital mortality. RESULTS Among 64 patients with AOSD, 36 (56.3%) were classified as having MAS. The overall survival rate was significantly lower in patients with MAS than in those without (67% vs 100%, p < 0.001). Multivariate analysis showed that a low erythrocyte sedimentation rate, a low albumin level, an increase in ferritin of over 2 folds, and the development of MAS on admission were significantly associated with mortality in patients with AOSD. CONCLUSION The 2016 EULAR/ACR/PRINTO classification criteria for MAS are potentially useful for the identification of patients with AOSD at high risk for a poor outcome. Febrile patients with AOSD should be monitored with the 2016 classification criteria for MAS in the early diagnosis and proper treatment of MAS.
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Affiliation(s)
- Sung Soo Ahn
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine
| | - Byung-Woo Yoo
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine
| | - Seung Min Jung
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine
| | - Sang-Won Lee
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine
| | - Yong-Beom Park
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine
| | - Jason Jungsik Song
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea. .,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine.
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Carmi O, Berla M, Shoenfeld Y, Levy Y. Diagnosis and management of catastrophic antiphospholipid syndrome. Expert Rev Hematol 2017; 10:365-374. [DOI: 10.1080/17474086.2017.1300522] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Or Carmi
- Department of Medicine E, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Maya Berla
- Department of Medicine E, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Yair Levy
- Department of Medicine E, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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