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Cui Y, Li L, Liu C, Wang Y, Sun M, Jia B, Shen Z, Sheng X, Deng Y. Water-Responsive 3D Electronics for Smart Biological Interfaces. NANO LETTERS 2023; 23:11693-11701. [PMID: 38018768 DOI: 10.1021/acs.nanolett.3c03394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Three-dimensional (3D) electronic systems with their potential for enhanced functionalities often require complex fabrication processes. This paper presents a water-based, stimuli-responsive approach for creating self-assembled 3D electronic systems, particularly suited for biorelated applications. We utilize laser scribing to programmatically shape a water-responsive bilayer, resulting in smart 3D electronic substrates. Control over the deformation direction, actuation time, and surface curvature of rolling structures is achieved by adjusting laser-scribing parameters, as validated through experiments and numerical simulations. Additionally, self-locking structures maintain the integrity of the 3D systems. This methodology enables the implementation of spiral twining electrodes for electrophysiological signal monitoring in plants. Furthermore, the integration of self-rolling electrodes onto peripheral nerves in a rodent model allows for stimulation and recording of in vivo neural activities with excellent biocompatibility. These innovations provide viable paths to next-generation 3D biointegrated electronic systems for life science studies and medical applications.
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Affiliation(s)
- Yuanyuan Cui
- Research Institute for Frontier Science, Beihang University, Beijing 100191, China
- Key Laboratory of Intelligent Sensing Materials and Chip Integration Technology of Zhejiang Province, Hangzhou Innovation Institute of Beihang University, Hangzhou 310051, China
| | - Lizhu Li
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, Institute for Precision Medicine, Center for Flexible Electronics Technology, IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing 100084, China
| | - Changbo Liu
- School of Materials Science and Engineering, Beihang University, Beijing 100191, China
- Key Laboratory of Intelligent Sensing Materials and Chip Integration Technology of Zhejiang Province, Hangzhou Innovation Institute of Beihang University, Hangzhou 310051, China
| | - Yuqi Wang
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, Institute for Precision Medicine, Center for Flexible Electronics Technology, IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing 100084, China
| | - Mengwei Sun
- School of Materials Science and Engineering, Beihang University, Beijing 100191, China
| | - Ben Jia
- School of Materials Science and Engineering, Beihang University, Beijing 100191, China
| | - Zhangming Shen
- Applied Mechanics Laboratory, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, China
- Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
| | - Xing Sheng
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, Institute for Precision Medicine, Center for Flexible Electronics Technology, IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing 100084, China
| | - Yuan Deng
- Research Institute for Frontier Science, Beihang University, Beijing 100191, China
- Key Laboratory of Intelligent Sensing Materials and Chip Integration Technology of Zhejiang Province, Hangzhou Innovation Institute of Beihang University, Hangzhou 310051, China
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Poshattiwar RS, Acharya S, Shukla S, Kumar S. Neurological Manifestations of Connective Tissue Disorders. Cureus 2023; 15:e47108. [PMID: 38022020 PMCID: PMC10646945 DOI: 10.7759/cureus.47108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Connective tissue disorders (CTD) are a group of disorders affecting the connective tissues. Usually the musculoskeletal and the vascular system is impacted. Along with these systems, the nervous system is also involved in CTD, which leads to various neurological manifestations. The pathophysiology of neurological complications of CTD is caused by various factors and is complicated. Disturbed immune complexes, chronic inflammation, and autoimmunity in which the body attacks its cells are considered to be responsible for the neurological complications of CTD. Additionally, the vascular symptoms that lead to decreased blood flow to the brain are also responsible for the neurological manifestations of CTD in diseases like systemic lupus erythematosus (SLE). In SLE, vessel wall integrity is compromised, which may lead to decreased blood flow leading to neurological complications. CTD can manifest a variety of neurological complications. These neurological complications can be classified into symptoms affecting the peripheral nervous system, central nervous system, and the autonomic nervous system. Some of the common neurological complications of CTD are headaches, seizures, ataxia, neuropathies leading to cranial nerve palsies, myelopathies, tremors, encephalitis, and cerebral infarction. Cranial nerve palsies can disturb sensations, vision, hearing, and mastication. Neuropsychiatric symptoms are also commonly observed in CTD. Cognitive dysfunction can be caused due to neuropsychiatric problems. Some of the cognitive dysfunctions are lack of concentration, memory loss, confusion, and coma. In this review, we will address various neurological manifestations of CTD.
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Affiliation(s)
- Riddhi S Poshattiwar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Mitrović J, Hrkač S, Tečer J, Golob M, Ljilja Posavec A, Kolar Mitrović H, Grgurević L. Pathogenesis of Extraarticular Manifestations in Rheumatoid Arthritis-A Comprehensive Review. Biomedicines 2023; 11:biomedicines11051262. [PMID: 37238933 DOI: 10.3390/biomedicines11051262] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Rheumatoid arthritis (RA) is among the most prevalent and debilitating autoimmune inflammatory chronic diseases. Although it is primarily characterized by destructive peripheral arthritis, it is a systemic disease, and RA-related extraarticular manifestations (EAMs) can affect almost every organ, exhibit a multitude of clinical presentations, and can even be asymptomatic. Importantly, EAMs largely contribute to the quality of life and mortality of RA patients, particularly substantially increased risk of cardiovascular disease (CVD) which is the leading cause of death in RA patients. In spite of known risk factors related to EAM development, a more in-depth understanding of its pathophysiology is lacking. Improved knowledge of EAMs and their comparison to the pathogenesis of arthritis in RA could lead to a better understanding of RA inflammation overall and its initial phases. Taking into account that RA is a disorder that has many faces and that each person experiences it and responds to treatments differently, gaining a better understanding of the connections between the joint and extra-joint manifestations could help to create new treatments and improve the overall approach to the patient.
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Affiliation(s)
- Joško Mitrović
- Division of Clinical Immunology, Rheumatology and Allergology, Department of Internal Medicine, Dubrava University Hospital, School of Medicine and Faculty of Pharmacy and Biochemistry, University of Zagreb, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Stela Hrkač
- Division of Clinical Immunology, Rheumatology and Allergology, Department of Internal Medicine, Dubrava University Hospital, School of Medicine and Faculty of Pharmacy and Biochemistry, University of Zagreb, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Josip Tečer
- Division of Clinical Immunology, Rheumatology and Allergology, Department of Internal Medicine, Dubrava University Hospital, School of Medicine and Faculty of Pharmacy and Biochemistry, University of Zagreb, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Majda Golob
- Division of Clinical Immunology, Rheumatology and Allergology, Department of Internal Medicine, Dubrava University Hospital, School of Medicine and Faculty of Pharmacy and Biochemistry, University of Zagreb, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Anja Ljilja Posavec
- Polyclinic for the Respiratory Tract Diseases, Prilaz Baruna Filipovića 11, 10000 Zagreb, Croatia
| | - Helena Kolar Mitrović
- Department of Rheumatology and Rehabilitation, Zagreb University Hospital Center, University of Zagreb School of Medicine, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Lovorka Grgurević
- Center for Translational and Clinical Research, Department of Proteomics, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Anatomy, "Drago Perovic", School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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El Hasbani G, El Ouweini H, Dabdoub F, Hourani R, Jawad AS, Uthman I. Rheumatoid Cerebral Vasculitis in a Patient in Remission. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2022; 15:11795476221083114. [PMID: 35283656 PMCID: PMC8915229 DOI: 10.1177/11795476221083114] [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] [Received: 12/02/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022]
Abstract
Cerebral vasculitis is a very rare extra-articular complication of rheumatoid arthritis (RA) that is often challenging to diagnose. Elevated titers of rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), and antinuclear antibodies (ANA) have been linked with severe complications. The absence of highly elevated titers of RF, anti-CCP, and ANA can complicate the diagnosis of RA-associated cerebral vasculitis. We report the case of a 59-year-old woman with long-standing arthritis maintained on rituximab and leflunomide who developed sudden headaches and altered level of consciousness. Laboratory work-up revealed normal lymphocyte count and mildly elevated total serum protein and anti-CCP with negative RF and ANA and no evidence for viral or bacterial infections. Cerebrospinal fluid analysis (CSF) showed slightly elevated anti-CCP with normal levels of CXCL-13 and interleukin 6 (IL-6). Brain magnetic resonance imaging (MRI) showed ill-defined lesion of high T2 signal. Using MR angiogram, MR perfusion, and MR spectroscopy, the diagnosis of rheumatoid cerebral vasculitis was confirmed. The patient was treated with intravenous methyl-prednisolone with fast complete improvement. We conclude that adequate immunosuppression in RA might not be able to prevent rare extra-articular manifestations such as rheumatoid cerebral vasculitis.
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Affiliation(s)
- Georges El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala El Ouweini
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fatema Dabdoub
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Roula Hourani
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Gender-Related Differences in BMP Expression and Adult Hippocampal Neurogenesis within Joint-Hippocampal Axis in a Rat Model of Rheumatoid Arthritis. Int J Mol Sci 2021; 22:ijms222212163. [PMID: 34830044 PMCID: PMC8620092 DOI: 10.3390/ijms222212163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 11/16/2022] Open
Abstract
BMPs regulate synovial quiescence and adult neurogenesis in the hippocampus in non-stress conditions. However, changes in BMP expression that are induced by inflammation during rheumatoid arthritis (RA) have not yet been reported. Here, we show that signalling with synovial BMPs (BMP-4 and -7) mediates the effect of systemic inflammation on adult neurogenesis in the hippocampus during pristane-induced arthritis (PIA) in Dark Agouti (DA) rats, an animal model of RA. Moreover, we show gender differences in BMP expressions and their antagonists (Noggin and Gremlin) during PIA and their correlations with the clinical course and IL-17A and TNF-α levels in serum. Our results indicate gender differences in the clinical course, where male rats showed earlier onset and earlier recovery but a worse clinical course in the first two phases of the disease (onset and peak), which correlates with the initial increase of serum IL-17A level. The clinical course of the female rats worsened in remission. Their prolonged symptoms could be a reflection of an increased TNF-α level in serum during remission. Synovial inflammation was greater in females in PIA-remission with greater synovial BMP and antagonist expressions. More significant correlations between serum cytokines (IL-17A and TNF-α), and synovial BMPs and their antagonists were found in females than in males. On the other hand, males showed an increase in hippocampal BMP-4 expression during the acute phase, but both genders showed a decrease in antagonist expressions during PIA in general. Both genders showed a decrease in the number of Ki-67+ and SOX-2+ and DCX+ cells and in the ratio of DCX+ to Ki67+ cells in the dentate gyrus during PIA. However, in PIA remission, females showed a faster increase in the number of Ki67+, SOX-2+, and DCX+ cells and a faster increase in the DCX/Ki67 ratio than males. Both genders showed an increase of hippocampal BMP-7 expression during remission, although males constantly showed greater BMP-7 expression at all time points. Our data show that gender differences exist in the BMP expressions in the periphery-hippocampus axis and in the IL-17A and TNF-α levels in serum, which could imply differences in the mechanisms for the onset and progression of the disease, the clinical course severity, and adult neurogenesis with subsequent neurological complications between genders.
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Wiegmann S, Armbrecht G, Borucki D, Buehring B, Buttgereit F, Detzer C, Schaumburg D, Zeiner KN, Dietzel R. Association between sarcopenia, physical performance and falls in patients with rheumatoid arthritis: a 1-year prospective study. BMC Musculoskelet Disord 2021; 22:885. [PMID: 34663280 PMCID: PMC8524907 DOI: 10.1186/s12891-021-04605-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/05/2021] [Indexed: 01/07/2023] Open
Abstract
Background Patients with rheumatoid arthritis (RA) are at increased risk of falls and fractures. Sarcopenia occurs more frequently in RA patients due to the inflammatory processes. Early diagnosis and prevention programmes are essential to avoid serious complications. The present study aims to identify risk factors for falls related to sarcopenia and physical performance. Methods In a 1-year prospective study, a total of 289 patients with RA, ages 24–85 years, were followed using quarterly fall diaries to report falls. At the baseline, medical data such as RA disease duration and Disease Activity Score (DAS28CRP) were collected. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ). Appendicular skeletal mass was determined by Dual X-ray-Absorptiometry (DXA). Physical performance was evaluated by handgrip strength, gait speed, chair rise test, Short Physical Performance Battery, and FICSIT-4. Muscle mechanography was measured with the Leonardo Mechanograph®. Sarcopenia was assessed according to established definitions by the European Working Group on Sarcopenia in Older People (EWGSOP2) and The Foundation for the National Institutes of Health (FNIH). Univariate and multiple logistic regression analysis were used to explore associations with falling. Receiver-operating characteristics (ROC) were performed, and the area under the curve is reported. Results A total of 238 subjects with RA completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. No association was found between sarcopenia and prospective falls. Age (OR = 1.04, CI 1.01–1.07), HAQ (OR = 1.62, 1.1–2.38), and low FICSIT-4 score (OR = 2.38, 1.13–5.0) showed significant associations with falls. Conclusions In clinical practice, a fall assessment including age, self-reported activities of daily life and a physical performance measure can identify RA patients at risk of falling. Trial registration The study has been registered at the German Clinical Trials Register and the WHO International Clinical Trials Registry Platform (ICTRP) since 16 March 2017 (DRKS00011873).
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Affiliation(s)
- Sabine Wiegmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Klinik für Radiologie, Zentrum für Muskel- und Knochenforschung, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Gabriele Armbrecht
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Klinik für Radiologie, Zentrum für Muskel- und Knochenforschung, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Diana Borucki
- Deutsche Rheuma-Liga Bundesverband e.V, Welschnonnenstraße 7, 53111, Bonn, Germany
| | - Bjoern Buehring
- Rheumazentrum Ruhrgebiet, Ruhr-Universität-Bochum, Claudiusstr. 45, 44649, Herne, Germany
| | - Frank Buttgereit
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie u. Klinische Immunologie, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian Detzer
- Deutsche Rheuma-Liga Bundesverband e.V, Welschnonnenstraße 7, 53111, Bonn, Germany
| | - Désirée Schaumburg
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie u. Klinische Immunologie, Charitéplatz 1, 10117, Berlin, Germany
| | - Kim Nikola Zeiner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie u. Klinische Immunologie, Charitéplatz 1, 10117, Berlin, Germany.,Department of Dermatology, Venereology and Allergology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Roswitha Dietzel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Klinik für Radiologie, Zentrum für Muskel- und Knochenforschung, Hindenburgdamm 30, 12200, Berlin, Germany
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Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A. Rheumatoid arthritis: Extra-articular manifestations and comorbidities. Autoimmun Rev 2021; 20:102776. [PMID: 33609792 DOI: 10.1016/j.autrev.2021.102776] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 12/20/2022]
Abstract
Although synovitis is the pathological hallmark of rheumatoid arthritis (RA), many extra-articular manifestations (EMs) and comorbidities likely occur due to the complex, chronic, inflammatory, and autoimmune features of RA. Cardiovascular (CV) disease is the most common cause of death in patients with RA. Compared to the general population, patients with RA have twice the risk of myocardial infarction and up to 50% increased CV mortality risk. Severe and prolonged disease activity, genetics, and inflammation (e.g. CRP, ACPA, cytokines, matrix-degrading enzymes) play important roles in CV disease and atheroscleroticdamage. The second major cause of death in patients with RA is respiratory disease, which occurs in 30-40% of patients. RA may affect the lung interstitium, airways, and pleurae, while pulmonary vascular involvement is less frequent. Central and peripheral nervous system involvement is usually due to small vessel vasculitis, joint damage, or drug toxicity. There is also evidence that microvascular cerebral damage caused by systemic inflammation is associated with the development of Alzheimer's disease and vascular dementia. Some observational studies have hinted how Disease Modified Anti-Rheumatic Drugs and biologics could reduce the incidence of dementia. Primary gastrointestinal and renal involvements are rare and often relate to drug therapy. To minimize morbidity and mortality, physicians must manage RA disease activity (treat-to-target) and monitor risk factors and concomitant conditions (e.g. smoking cessation; weight regulation; monitoring blood pressure, lipids, thyroid hormone, folic acid and homocysteine; screening for depression, anxiety, atlantoaxial instability, and atherosclerosis). This article aims to provide an overview of the most prevalent and important EMs and comorbidities associated with RA.
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Affiliation(s)
- Fabiana Assunta Figus
- Academic Rheumatology Centre, MFRU and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Matteo Piga
- Rheumatology Unit, University Clinic and AOU of Cagliari, Monserrato, Italy
| | - Irene Azzolin
- Academic Rheumatology Centre, MFRU and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | | | - Annamaria Iagnocco
- Academic Rheumatology Centre, MFRU and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy.
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Curtis JR, Weinblatt M, Saag K, Bykerk VP, Furst DE, Fiore S, St John G, Kimura T, Zheng S, Bingham CO, Wright G, Bergman M, Nola K, Charles-Schoeman C, Shadick N. Data-Driven Patient Clustering and Differential Clinical Outcomes in the Brigham and Women's Rheumatoid Arthritis Sequential Study Registry. Arthritis Care Res (Hoboken) 2020; 73:471-480. [PMID: 33002337 PMCID: PMC8048846 DOI: 10.1002/acr.24471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/24/2020] [Indexed: 12/30/2022]
Abstract
Objective To use unbiased, data‐driven, principal component (PC) and cluster analysis to identify patient phenotypes of rheumatoid arthritis (RA) that might exhibit distinct trajectories of disease progression, response to treatment, and risk for adverse events. Methods Patient demographic, socioeconomic, health, and disease characteristics recorded at entry into a large, single‐center, prospective observational registry cohort, the Brigham and Women’s Rheumatoid Arthritis Sequential Study (BRASS), were harmonized using PC analysis to reduce dimensionality and collinearity. The number of PCs was established by eigenvalue >1, cumulative variance, and interpretability. The resulting PCs were used to cluster patients using a K‐means approach. Longitudinal clinical outcomes were compared between the clusters over 2 years. Results Analysis of 142 variables from 1,443 patients identified 41 PCs that accounted for 77% of the cumulative variance in the data set. Cluster analysis distinguished 5 patient clusters: 1) less RA disease activity/multimorbidity, shorter RA duration, lower incidence of comorbidities; 2) less RA disease activity/multimorbidity, longer RA duration, more infections, psychiatric comorbidities, health care utilization; 3) moderate RA disease activity/multimorbidity, more neurologic comorbidity; 4) more RA disease activity/multimorbidity, shorter RA duration, more metabolic comorbidity, higher body mass index; 5) more RA disease activity/multimorbidity, longer RA duration, more hepatic, orthopedic comorbidity and RA‐related surgeries. The clusters exhibited differences in clinical outcomes over 2 years of follow‐up. Conclusion Data‐driven analysis of the BRASS registry identified 5 distinct phenotypes of RA. These results illustrate the potential of data‐driven patient profiling as a tool to support personalized medicine in RA. Validation in an independent data set is ongoing.
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Affiliation(s)
| | | | | | | | - Daniel E Furst
- University of California, Los Angeles, University of Washington, Seattle, and University of Florence, Florence, Italy
| | | | | | | | | | | | | | - Martin Bergman
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kamala Nola
- Lipscomb University College of Pharmacy and Health Sciences, Nashville, Tennessee
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Trabelsi M, Romand X, Gilson M, Vaillant M, Guerne PA, Hayem G, Bertolini E, Baillet A, Gaudin P. Rheumatoid Meningitis a Rare Extra-Articular Manifestation of Rheumatoid Arthritis: Report of 6 Cases and Literature Review. J Clin Med 2020; 9:jcm9061625. [PMID: 32471260 PMCID: PMC7356493 DOI: 10.3390/jcm9061625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives. Central neurological manifestations of rheumatoid arthritis (RA) like rheumatoid meningitis (RM) are rare, little known and have a high rate of morbi-mortality. METHODS. We described six cases of RM that were directly related to RA activity after exhaustive assessment. RESULTS. They were mainly women, aged of 50 to 69. All were positive for anti-cyclic citrullinated peptide antibodies and half for rheumatoid factors. RA activity, duration, and treatments were heterogeneous including oral steroids, conventional synthetic disease modifying anti-rheumatic drugs (DMARDs) and biologic DMARDs. Symptoms were various, with acute or progressive beginning; main were: generalized or focal seizure (4/6), fever (3/6), headaches (3/6), and frontal syndrome (2/6). Imaging lesions were four leptomeningitis, one pachymeningitis, and one association of both. MRI usually showed hypersignal in various territories in T2-FLAIR (fluid attenuated inversion recovery) mode, and enhancement in T1-weighted mode after gadolinium injection. All patients had lumbar puncture that found sterile cerebrospinal fluid, no neoplasic cell, elevated cell count in 5/6 cases and elevated proteins concentration in 3/6 cases. Cerebral biopsy was possible for three patients, and definitively confirmed the diagnosis of aseptic lepto- or pachymenintis, excluding vasculitis and lymphoma. Different treatments were used like intravenous high dose steroids, immunoglobulins or biologic DMARDs, with variable clinical and imaging outcome: one death, one complete recovery, and four recoveries with sequelae. Conclusions. Clinical symptoms, imaging, lumbar puncture, and serological studies are often nonspecific, only histologic examination can confirm the diagnosis of RM. Any central neurological manifestation in RA patients, even in quiescent and ancient RA, should warn the physician.
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Affiliation(s)
- Mélanie Trabelsi
- Rheumatology Department, CHU Grenoble Alpes, Hôpital Sud, 38130 Echirolles, France; (X.R.); (M.G.); (A.B.); (P.G.)
- Correspondence:
| | - Xavier Romand
- Rheumatology Department, CHU Grenoble Alpes, Hôpital Sud, 38130 Echirolles, France; (X.R.); (M.G.); (A.B.); (P.G.)
- GREPI TIMC, CNRS UMR 5525, Université Grenoble Alpes, 38000 Grenoble, France
| | - Mélanie Gilson
- Rheumatology Department, CHU Grenoble Alpes, Hôpital Sud, 38130 Echirolles, France; (X.R.); (M.G.); (A.B.); (P.G.)
| | - Mathieu Vaillant
- Neurology Department, CHU Grenoble Alpes, Hôpital Nord, 38000 Grenoble, France;
| | | | - Gilles Hayem
- Rheumatology Department, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France;
| | - Ewa Bertolini
- Rheumatology Department, CH Annecy, 74370 Annecy, France;
| | - Athan Baillet
- Rheumatology Department, CHU Grenoble Alpes, Hôpital Sud, 38130 Echirolles, France; (X.R.); (M.G.); (A.B.); (P.G.)
- GREPI TIMC, CNRS UMR 5525, Université Grenoble Alpes, 38000 Grenoble, France
| | - Philippe Gaudin
- Rheumatology Department, CHU Grenoble Alpes, Hôpital Sud, 38130 Echirolles, France; (X.R.); (M.G.); (A.B.); (P.G.)
- GREPI TIMC, CNRS UMR 5525, Université Grenoble Alpes, 38000 Grenoble, France
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Nakane S, Mukaino A, Higuchi O, Yasuhiro M, Takamatsu K, Yamakawa M, Watari M, Tawara N, Nakahara KI, Kawakami A, Matsuo H, Ando Y. A comprehensive analysis of the clinical characteristics and laboratory features in 179 patients with autoimmune autonomic ganglionopathy. J Autoimmun 2020; 108:102403. [PMID: 31924415 DOI: 10.1016/j.jaut.2020.102403] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/29/2019] [Accepted: 01/01/2020] [Indexed: 12/12/2022]
Abstract
The clinical importance of autoantibodies against the ganglionic acetylcholine receptor (gAChR) remains to be fully elucidated. We aimed to identify the clinical characteristics of autoimmune autonomic ganglionopathy (AAG) in patients with gAChR autoantibodies. For this cohort investigation, serum samples were obtained from patients with AAG between 2012 and 2018 in Japan. We measured the levels of autoantibodies against gAChRα3 and gAChRβ4 and evaluated clinical features, as well as assessing the laboratory investigation results among the included patients. A total of 179 patients tested positive for antibodies, including 116 gAChRα3-positive, 13 gAChRβ4-positive, and 50 double antibody-positive patients. Seropositive AAG patients exhibited widespread autonomic dysfunction. Extra-autonomic manifestations including sensory disturbance, central nervous system involvement, endocrine disorders, autoimmune diseases, and tumours were present in 118 patients (83%). We observed significant differences in the frequencies of several autonomic and extra-autonomic symptoms among the three groups. Our 123I-metaiodobenzylguanidine myocardial scintigraphy analysis of the entire cohort revealed that the heart-to-mediastinum ratio had decreased by 80%. The present study is the first to demonstrate that patients with AAG who are seropositive for anti-gAChRβ4 autoantibodies exhibit unique autonomic and extra-autonomic signs. Decreased cardiac uptake occurred in most cases, indicating that 123I- metaiodobenzylguanidine myocardial scintigraphy may be useful for monitoring AAG. Therefore, our findings indicate that gAChRα3 and gAChRβ4 autoantibodies cause functional changes in postganglionic fibres in the autonomic nervous system and extra-autonomic manifestations in seropositive patients with AAG.
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Affiliation(s)
- Shunya Nakane
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Molecular Neurology and Therapeutics, Kumamoto University Hospital, Kumamoto, Japan.
| | - Akihiro Mukaino
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Molecular Neurology and Therapeutics, Kumamoto University Hospital, Kumamoto, Japan.
| | - Osamu Higuchi
- Department of Clinical Research, National Hospital Organization Nagasaki Kawatana Medical Center, Nagasaki, Japan; Department of Neuroimmunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Maeda Yasuhiro
- Department of Clinical Research, National Hospital Organization Nagasaki Kawatana Medical Center, Nagasaki, Japan; Department of Neuroimmunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Neurology, National Hospital Organization Nagasaki Kawatana Medical Center, Nagasaki, Japan.
| | - Koutaro Takamatsu
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Makoto Yamakawa
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Mari Watari
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Nozomu Tawara
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Kei-Ichi Nakahara
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Hidenori Matsuo
- Department of Clinical Research, National Hospital Organization Nagasaki Kawatana Medical Center, Nagasaki, Japan; Department of Neurology, National Hospital Organization Nagasaki Kawatana Medical Center, Nagasaki, Japan.
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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11
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Scheitel M, Ives ST, Nasr R, Nolan MW. When the plot thickens: a rare complication of rheumatoid arthritis. J Community Hosp Intern Med Perspect 2019; 9:143-146. [PMID: 31044046 PMCID: PMC6484464 DOI: 10.1080/20009666.2019.1593780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/07/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: Rheumatoid arthritis (RA) is a common illness with many extraarticular manifestations. Rheumatoid pachymeningitis is a rare neurologic complication of this common disease. Here in we present a patient with longstanding RA who developed this uncommon complication. Case description: A 75-year-old woman with longstanding RA presented to the clinic with multiple seizure-like spells per day. Upon admission to the hospital, brain MRI showed enhancement of the meninges. After an extensive workup for possible other infectious or inflammatory causes, the patient was diagnosed with rheumatoid pachymeningitis. Conclusion: Rheumatoid pachymeningitis is a rare complication of RA that usually occurs late in the disease course. It may have many neurologic manifestations include mimicking seizure or stroke and must be considered in patients with RA presenting with neurologic symptoms. Pachymeningitis is treated distinctly from articular RA, so early recognition can lead to appropriate treatment.
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Affiliation(s)
- Marianne Scheitel
- Department of Internal Medicine, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Samuel T Ives
- Division of General Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.,Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Rawad Nasr
- Medicine, University of Minnesota, Minneapolis, MN, USA.,Division of Rheumatology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Marc W Nolan
- Division of Rheumatology, HealthPartners, Saint Paul, MN, USA
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12
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Li Y, Jiang L, Zhang Z, Li H, Jiang L, Wang L, Li Z. Clinical characteristics of rheumatoid arthritis patients with peripheral neuropathy and potential related risk factors. Clin Rheumatol 2019; 38:2099-2107. [DOI: 10.1007/s10067-019-04521-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 02/28/2019] [Accepted: 03/14/2019] [Indexed: 12/29/2022]
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13
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Role of miR-9-5p in preventing peripheral neuropathy in patients with rheumatoid arthritis by targeting REST/miR-132 pathway. In Vitro Cell Dev Biol Anim 2018; 55:52-61. [PMID: 30456455 DOI: 10.1007/s11626-018-0310-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/08/2018] [Indexed: 12/27/2022]
Abstract
MicroRNAs (miRNAs) are found to play a key role in neural cell differentiation, peripheral nerve injury, and rheumatoid arthritis (RA). However, no study has yet been conducted highlighting their role in RA-induced peripheral neuropathy. Here, we investigated the role of miRNAs in RA-induced peripheral neuropathy. Levels of six miRNAs were detected in serum collected from 15 patients with RA and peripheral neuropathy and 16 patients with RA. In vitro, Schwann cells were treated with 0.1 ng/mL IL-6 and 20 ng/mL TNF-α. The expression level of miR-9-5p and its association with the repressor element-1 silencing transcription factor (REST) were investigated. The roles of miR-9-5p and REST in Schwann cell injury were examined after transfection of miR-9-5p mimics or REST siRNA. In patients with RA and peripheral neuropathy, serum miR-9-5p was significantly downregulated when compared with RA. In IL-6- and TNF-α-stimulated Schwann cells, apoptosis was induced, while the cell viability and level of miR-9-5p were inhibited. A significantly negative correlation was observed between miR-9-5p and REST. Transfection of miR-9-5p mimics and REST siRNA significantly reversed the inhibition of cell viability and induction of apoptosis caused by IL-6 and TNF-α. In addition, overexpression of miR-9-5p upregulated the expression of miR-132, miRNA targeting E1A binding protein EP300 (EEP300), phosphatase and tensin homolog (PTEN) and forkhead box O3 (FOXO3). These results showed that Schwann cells were protected by miR-9-5p from inflammatory damage by targeting REST/miR-132 pathway, which could provide new targets for treatment of RA-induced peripheral neuropathy.
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14
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Nakane S, Mukaino A, Higuchi O, Watari M, Maeda Y, Yamakawa M, Nakahara K, Takamatsu K, Matsuo H, Ando Y. Autoimmune autonomic ganglionopathy: an update on diagnosis and treatment. Expert Rev Neurother 2018; 18:953-965. [PMID: 30352532 DOI: 10.1080/14737175.2018.1540304] [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: 01/19/2023]
Abstract
INTRODUCTION Autoimmune autonomic ganglionopathy (AAG) is an acquired immune-mediated disorder that leads to autonomic failure. The disorder is associated with autoantibodies to the ganglionic nicotinic acetylcholine receptor (gAChR). We subsequently reported that AAG is associated with an overrepresentation of psychiatric symptoms, sensory disturbance, autoimmune diseases, and endocrine disorders. Area covered: The aim of this review was to describe AAG and highlight its pivotal pathophysiological aspects, clinical features, laboratory examinations, and therapeutic options. Expert commentary: AAG is a complex neuroimmunological disease, these days considered as an autonomic failure with extra-autonomic manifestations (and various limited forms). Further comprehension of the pathophysiology of this disease is required, especially the mechanisms of the extra-autonomic manifestations should be elucidated. There is the possibility that the co-presence of antibodies that were directed against the other subunits in both the central and peripheral nAChRs in the serum of the AAG patients. Some patients improve with immunotherapies such as IVIg and/or corticosteroid and/or plasma exchange. 123I-MIBG myocardial scintigraphy may be a useful tool to monitor the therapeutic effects of immunotherapies.
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Affiliation(s)
- Shunya Nakane
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan.,b Department of Molecular Neurology and Therapeutics , Kumamoto University Hospital , Kumamoto , Japan
| | - Akihiro Mukaino
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan.,b Department of Molecular Neurology and Therapeutics , Kumamoto University Hospital , Kumamoto , Japan
| | - Osamu Higuchi
- c Department of Neurology and Clinical Research , Nagasaki Kawatana Medical Center , Nagasaki , Japan
| | - Mari Watari
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Yasuhiro Maeda
- c Department of Neurology and Clinical Research , Nagasaki Kawatana Medical Center , Nagasaki , Japan
| | - Makoto Yamakawa
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Keiichi Nakahara
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Koutaro Takamatsu
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Hidenori Matsuo
- c Department of Neurology and Clinical Research , Nagasaki Kawatana Medical Center , Nagasaki , Japan
| | - Yukio Ando
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
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15
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Filatova ES, Erdes SF. [Etiopathogenetic factors of peripheral neuropathic pain in rheumatoid arthritis]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 117:67-71. [PMID: 28884720 DOI: 10.17116/jnevro20171178167-71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To determine a neuropathic component of pain and define its causes in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS One hundred and eighty-three patients with confirmed RA, mean age 46,5±11,7 years, RA duration from 3 month to 30 years, were studied. Rheumatology, neurological, using the DN4 questionnaire, examinations and stimulation electromyography were used. Results and сonclusion. Signs of neuropathic pain (NP) assessed with the DN4 were identified in 73 (43%) patients with RA. These patients were older, had longer RA duration as well as higher clinical stage of disease and reduced functional abilities. There were no correlation between NP and disease activity. Peripheral nervous system (PNS) lesions were seen in 96% patients with NP: sensory motor neuropathy (55%), tunnel syndrome (14%), mononeuropathy (19%) and their combinations (4%), cervical myelopathy (4%). PNS lesions is the main etiopathogenetic factor of peripheral NP in RA. This finding opens new perspectives for complex treatment, including group B vitamins, of chronic pain in RA.
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Affiliation(s)
- E S Filatova
- Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Sh F Erdes
- Nasonova Research Institute of Rheumatology, Moscow, Russia
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16
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Systemic autoimmune diseases complicated with hydrocephalus: pathogenesis and management. Neurosurg Rev 2017; 42:255-261. [PMID: 29130124 DOI: 10.1007/s10143-017-0917-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/10/2017] [Accepted: 09/27/2017] [Indexed: 01/17/2023]
Abstract
Systemic autoimmune diseases (SAIDs) represent a group of syndromes involving at least two organ systems. Classical SAIDs include connective tissue diseases, vasculitis, and granulomatous diseases, many of which involve the nervous system and result in different neurological manifestations. Hydrocephalus can be a rare but lethal complication of various SAIDs, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), sarcoidosis, and primary vasculitis. However, the pathogenesis of SAIDs complicated with different types of hydrocephalus is varied and difficult to determine using the existing published data, and various manifestations and expressive forms of the conditions bring a substantial challenge to a timely clinical diagnosis and treatment. The commonly used medical management programs based on the etiology of hydrocephalus are anti-inflammatory or anti-infectious therapies, while surgical management such as ventriculoperitoneal shunts is effective most of the time. Further research should be directed toward improving our understanding of the pathogenesis of these conditions and determining the most effective method for treating this life-threatening condition.
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17
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Tsouni P, Bill O, Truffert A, Liaudat C, Ochsner F, Steck AJ, Kuntzer T. Anti-TNF alpha medications and neuropathy. J Peripher Nerv Syst 2016; 20:397-402. [PMID: 26309233 DOI: 10.1111/jns.12147] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/26/2022]
Abstract
We studied the clinical, electrophysiological, and pathological features, outcome, and frequency of anti-tumor necrosis factor alpha (a-TNF) medications-induced neuropathies (ATIN) in patients with inflammatory disorders. Of 2,017 patients treated with a-TNF medication, 12 patients met our inclusion criteria for a prevalence of 0.60% and an incidence of 0.4 cases per 1,000 person-years. The median time from a-TNF medication treatment to ATIN was 16.8 months (range 2-60 months). Six patients had focal or multifocal peripheral neuropathies. The other six had generalized neuropathies. For all, a-TNF medication was stopped. Seven patients received immunoglobulin infusions. ATIN outcome was favorable in all but one patient. ATINs are rare and heterogeneous neuropathies. In 10 patients, the neuropathy was "inflammatory", suggesting that it could be due to systemic pro-inflammatory effects of a-TNF agents.
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Affiliation(s)
- Pinelopi Tsouni
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Olivier Bill
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - André Truffert
- Division of Neurology, Department of Clinical Neurosciences, University Hospital of Geneva (HUG), Geneva, Switzerland
| | - Christelle Liaudat
- Department of Rheumatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - François Ochsner
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Andreas J Steck
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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18
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El-Hewala AESI, Soliman SG, Labeeb AA, Zytoon AA, El-Shanawany AT. Foot neuropathy in rheumatoid arthritis patients: clinical, electrophysiological, and ultrasound studies. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2016. [DOI: 10.4103/1110-161x.189640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Mukaino A, Nakane S, Higuchi O, Nakamura H, Miyagi T, Shiroma K, Tokashiki T, Fuseya Y, Ochi K, Umeda M, Nakazato T, Akioka S, Maruoka H, Hayashi M, Igarashi SI, Yokoi K, Maeda Y, Sakai W, Matsuo H, Kawakami A. Insights from the ganglionic acetylcholine receptor autoantibodies in patients with Sjögren's syndrome. Mod Rheumatol 2016; 26:708-15. [PMID: 26873295 DOI: 10.3109/14397595.2016.1147404] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE It is not known whether autonomic neuropathy is a feature of Sjögren's syndrome (SS) or whether it is related to circulating antiganglionic acetylcholine receptor (gAChR) antibodies. The goal of the present study was to investigate the autonomic dysfunction in patients with SS and the associations between autonomic dysfunction, anti-gAChR antibodies, and clinical features of SS. METHODS (1) The first observational study tested for the presence of gAChR antibodies in the serum samples from 39 patients with SS (absent information regarding autonomic symptoms) and healthy volunteers. (2) In the second study, serological and clinical data from 10 Japanese patients diagnosed with SS were reviewed. These patients showed autonomic dysfunction, and luciferase immunoprecipitation systems (LIPS) test was conducted to detect anti-α3 and anti-β4 gAChR antibodies. (3) In the final analysis, we combined the data of seropositive SS patients with autonomic symptom from the first study with all of the patients from the second study, and analyzed the clinical features. RESULTS (1) The LIPS assay revealed that anti-gAChRα3 and anti-gAChRβ4 antibodies were detected in the sera from patients with SS (23.1%, 9/39). Five of nine SS patients had autonomic symptoms. (2) Anti-α3 and anti-β4 gAChR antibodies were also detected in 80.0% (8/10) of patients with SS with autonomic symptoms. Six of the ten patients were diagnosed as having SS after neurological symptoms developed. These seropositive patients had predominant and severe autonomic symptoms and were diagnosed with autonomic neuropathy. (3) Thirteen of fifteen SS patients with autonomic symptoms (86.7%) were seropositive for anti-gAChR antibodies, and we confirmed sicca complex, orthostatic hypotension, upper and lower gastrointestinal (GI) symptoms, and bladder dysfunction at high rates. CONCLUSION The present results suggest the possibility of anti-gAChR antibodies aiding the diagnostics of SS with autonomic dysfunction.
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Affiliation(s)
- Akihiro Mukaino
- a Department of Clinical Neuroscience and Neurology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Shunya Nakane
- b Department of Clinical Research and.,c Department of Neurology , Nagasaki Kawatana Medical Center , Nagasaki , Japan
| | | | - Hideki Nakamura
- d Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Tomo Miyagi
- e Department of Cardiovascular Medicine, Nephrology and Neurology , University of the Ryukyu School of Medicine , Okinawa , Japan
| | - Kanako Shiroma
- e Department of Cardiovascular Medicine, Nephrology and Neurology , University of the Ryukyu School of Medicine , Okinawa , Japan
| | - Takashi Tokashiki
- e Department of Cardiovascular Medicine, Nephrology and Neurology , University of the Ryukyu School of Medicine , Okinawa , Japan
| | - Yasuhiro Fuseya
- f Department of Neurology , Kitano Hospital Medical Research Institute , Osaka , Japan
| | - Kazuhide Ochi
- g Department of Neurology , Hiroshima University Hospital , Hiroshima , Japan
| | - Masataka Umeda
- d Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Tetsuya Nakazato
- h Department of Neurology , Sapporo Yamanoue Hospital , Sapporo , Japan
| | - Shinji Akioka
- i Department of Pediatrics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Hiroyuki Maruoka
- j Department of Neurology and Neurological Science, and Predictive and Preventive Medicine , Tokyo Medical and Dental University , Tokyo , Japan
| | | | - Shu-Ichi Igarashi
- l Department of Neurology , Niigata City General Hospital , Niigata , Japan , and
| | - Katsunori Yokoi
- m Department of Neurology , Anjo Kosei Hospital , Aichi , Japan
| | - Yasuhiro Maeda
- c Department of Neurology , Nagasaki Kawatana Medical Center , Nagasaki , Japan
| | - Waka Sakai
- c Department of Neurology , Nagasaki Kawatana Medical Center , Nagasaki , Japan
| | - Hidenori Matsuo
- c Department of Neurology , Nagasaki Kawatana Medical Center , Nagasaki , Japan
| | - Atsushi Kawakami
- d Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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20
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Kampylafka EI, Alexopoulos H, Dalakas MC, Tzioufas AG. Immunotherapies for Neurological Manifestations in the Context of Systemic Autoimmunity. Neurotherapeutics 2016; 13:163-78. [PMID: 26510559 PMCID: PMC4720664 DOI: 10.1007/s13311-015-0393-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Neurological involvement is relatively common in the majority of systemic autoimmune diseases and may lead to severe morbidity and mortality, if not promptly treated. Treatment options vary greatly, depending on the underlying systemic pathophysiology and the associated neurological symptoms. Selecting the appropriate therapeutic scheme is further complicated by the lack of definite therapeutic guidelines, the necessity to differentiate primary neurological syndromes from those related to the underlying systemic disease, and to sort out adverse neurological manifestations caused by immunosuppressants or the biological agents used to treat the primary disease. Immunotherapy is a sine qua non for treating most, if not all, neurological conditions presenting in the context of systemic autoimmunity. Specific agents include classical immune modulators such as corticosteroids, cyclophosphamide, intravenous immunoglobulin, and plasma exchange, as well as numerous biological therapies, for example anti-tumor necrosis factor agents and monoclonal antibodies that target various immune pathways such as B cells, cytokines, and co-stimulatory molecules. However, experience regarding the use of these agents in neurological complications of systemic diseases is mainly empirical or based on small uncontrolled studies and case series. The aim of this review is to present the state-of-the-art therapies applied in various neurological manifestations encountered in the context of systemic autoimmune diseases; evaluate all treatment options on the basis of existing guidelines; and compliment these data with our personal experience derived from a large number of patients.
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Affiliation(s)
- Eleni I Kampylafka
- Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Harry Alexopoulos
- Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Marinos C Dalakas
- Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece.
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21
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Joaquim AF, Appenzeller S. Neuropsychiatric manifestations in rheumatoid arthritis. Autoimmun Rev 2015; 14:1116-22. [PMID: 26238502 DOI: 10.1016/j.autrev.2015.07.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic disease characterized by persistent synovitis, systemic inflammation, and the presence of autoantibodies. Neuropsychiatric manifestations are quite common in RA, including depression, cognitive dysfunction, behavior changes, spinal cord compression and peripheral nerve involvement. Potential causes include systemic inflammatory process, neural compression due to bone and joint destruction, side effects of medications and copying difficulties due to the chronicity of the disease. A high level of suspicious is required for an adequate diagnosis and treatment. In this review, we will discuss topographically the main neuropsychiatric manifestations described in RA patients, in an attempt to help in the management of these complex and multifaceted disease.
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Affiliation(s)
- Andrei F Joaquim
- Department of Neurology, State University of Campinas (UNICAMP), 13083-970 Campinas SP, Brazil.
| | - Simone Appenzeller
- Department of Medicine, State University of Campinas (UNICAMP), 13083-970 Campinas SP, Brazil
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22
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Nakane S, Higuchi O, Koga M, Kanda T, Murata K, Suzuki T, Kurono H, Kunimoto M, Kaida KI, Mukaino A, Sakai W, Maeda Y, Matsuo H. Clinical features of autoimmune autonomic ganglionopathy and the detection of subunit-specific autoantibodies to the ganglionic acetylcholine receptor in Japanese patients. PLoS One 2015; 10:e0118312. [PMID: 25790156 PMCID: PMC4366081 DOI: 10.1371/journal.pone.0118312] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/14/2015] [Indexed: 01/08/2023] Open
Abstract
Autoimmune autonomic ganglionopathy (AAG) is a rare acquired channelopathy that is characterized by pandysautonomia, in which autoantibodies to ganglionic nicotinic acetylcholine receptors (gAChR) may play a central role. Radioimmunoprecipitation (RIP) assays have been used for the sensitive detection of autoantibodies to gAChR in the serum of patients with AAG. Here, we developed luciferase immunoprecipitation systems (LIPS) to diagnose AAG based on IgGs to both the α3 and β4 gAChR subunits in patient serum. We reviewed the serological and clinical data of 50 Japanese patients who were diagnosed with AAG. With the LIPS testing, we detected anti-α3 and -β4 gAChR antibodies in 48% (24/50) of the patients. A gradual mode of onset was more common in the seropositive group than in the seronegative group. Patients with AAG frequently have orthostatic hypotension and upper and lower gastrointestinal tract symptoms, with or without anti-gAChR. The occurrence of autonomic symptoms was not significantly different between the seropositive and seronegative group, with the exception of achalasia in three patients from the seropositive group. In addition, we found a significant overrepresentation of autoimmune diseases in the seropositive group and endocrinological abnormalities as an occasional complication of AAG. Our results demonstrated that the LIPS assay was a useful novel tool for detecting autoantibodies against gAChR in patients with AAG.
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Affiliation(s)
- Shunya Nakane
- Department of Clinical Research, Nagasaki Kawatana Medical Center, Nagasaki, Japan; Department of Neurology, Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Osamu Higuchi
- Department of Clinical Research, Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Michiaki Koga
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kenya Murata
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - Takashi Suzuki
- Department of Neurology, Joetsu General Hospital, Niigata, Japan
| | - Hiroko Kurono
- Department of Neurology, Saiseikai Kanagawa Prefecture Hospital, Kanagawa, Japan
| | - Masanari Kunimoto
- Department of Neurology, Saiseikai Kanagawa Prefecture Hospital, Kanagawa, Japan
| | - Ken-ichi Kaida
- Division of Neurology, Department of Internal Medicine 3, National Defense Medical College, Saitama, Japan
| | - Akihiro Mukaino
- Department of Clinical Neuroscience and Neurology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Waka Sakai
- Department of Neurology, Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Yasuhiro Maeda
- Department of Neurology, Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Hidenori Matsuo
- Department of Neurology, Nagasaki Kawatana Medical Center, Nagasaki, Japan
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Morris G, Berk M, Walder K, Maes M. Central pathways causing fatigue in neuro-inflammatory and autoimmune illnesses. BMC Med 2015; 13:28. [PMID: 25856766 PMCID: PMC4320458 DOI: 10.1186/s12916-014-0259-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/17/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The genesis of severe fatigue and disability in people following acute pathogen invasion involves the activation of Toll-like receptors followed by the upregulation of proinflammatory cytokines and the activation of microglia and astrocytes. Many patients suffering from neuroinflammatory and autoimmune diseases, such as multiple sclerosis, Parkinson's disease and systemic lupus erythematosus, also commonly suffer from severe disabling fatigue. Such patients also present with chronic peripheral immune activation and systemic inflammation in the guise of elevated proinflammtory cytokines, oxidative stress and activated Toll-like receptors. This is also true of many patients presenting with severe, apparently idiopathic, fatigue accompanied by profound levels of physical and cognitive disability often afforded the non-specific diagnosis of chronic fatigue syndrome. DISCUSSION Multiple lines of evidence demonstrate a positive association between the degree of peripheral immune activation, inflammation and oxidative stress, gray matter atrophy, glucose hypometabolism and cerebral hypoperfusion in illness, such as multiple sclerosis, Parkinson's disease and chronic fatigue syndrome. Most, if not all, of these abnormalities can be explained by a reduction in the numbers and function of astrocytes secondary to peripheral immune activation and inflammation. This is also true of the widespread mitochondrial dysfunction seen in otherwise normal tissue in neuroinflammatory, neurodegenerative and autoimmune diseases and in many patients with disabling, apparently idiopathic, fatigue. Given the strong association between peripheral immune activation and neuroinflammation with the genesis of fatigue the latter group of patients should be examined using FLAIR magnetic resonance imaging (MRI) and tested for the presence of peripheral immune activation. SUMMARY It is concluded that peripheral inflammation and immune activation, together with the subsequent activation of glial cells and mitochondrial damage, likely account for the severe levels of intractable fatigue and disability seen in many patients with neuroimmune and autoimmune diseases.This would also appear to be the case for many patients afforded a diagnosis of Chronic Fatigue Syndrome.
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Affiliation(s)
- Gerwyn Morris
- Tir Na Nog, Bryn Road seaside 87, Llanelli, SA152LW Wales UK
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Ken Walder
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Michael Maes
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Birnbaum J. The nervous system in rheumatic disease. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00039-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lubahn CL, Lorton D, Schaller JA, Sweeney SJ, Bellinger DL. Targeting α- and β-Adrenergic Receptors Differentially Shifts Th1, Th2, and Inflammatory Cytokine Profiles in Immune Organs to Attenuate Adjuvant Arthritis. Front Immunol 2014; 5:346. [PMID: 25157248 PMCID: PMC4127464 DOI: 10.3389/fimmu.2014.00346] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/07/2014] [Indexed: 12/13/2022] Open
Abstract
The sympathetic nervous system (SNS) regulates host defense responses and restores homeostasis. SNS-immune regulation is altered in rheumatoid arthritis (RA) and rodent models of RA, characterized by nerve remodeling in immune organs and defective adrenergic receptor (AR) signaling to immune cell targets. The SNS typically promotes or suppresses inflammation via α- and β2-AR activation, respectively, and indirectly drives humoral immunity by blocking Th1 cytokine secretion. Here, we investigate how β2-AR stimulation and/or α-AR blockade at disease onset affects disease pathology and cytokine profiles in relevant immune organs from male Lewis rats with adjuvant-induced arthritis (AA). Rats challenged to induce AA were treated with terbutaline (TERB), a β2-AR agonist (600 μg/kg/day) and/or phentolamine (PHEN), an α-AR antagonist (5.0 mg/kg/day) or vehicle from disease onset through severe disease. We report that in spleen, mesenteric (MLN) and draining lymph node (DLN) cells, TERB reduces proliferation, an effect independent of IL-2. TERB also fails to shift T helper (Th) cytokines from a Th1 to Th2 profile in spleen and MLN (no effect on IFN-γ) and DLN (greater IFN-γ) cells. In splenocytes, TERB, PHEN, and co-treatment (PT) promotes an anti-inflammatory profile (greater IL-10) and lowers TNF-α (PT only). In DLN cells, drug treatments do not affect inflammatory profiles, except PT, which raised IL-10. In MLN cells, TERB or PHEN lowers MLN cell secretion of TNF-α or IL-10, respectively. Collectively, our findings indicate disrupted β2-AR, but not α-AR signaling in AA. Aberrant β2-AR signaling consequently derails the sympathetic regulation of lymphocyte expansion, Th cell differentiation, and inflammation in the spleen, DLNs and MLs that is required for immune system homeostasis. Importantly, this study provides potential mechanisms through which reestablished balance between α- and β2-AR function in the immune system ameliorates inflammation and joint destruction in AA.
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Affiliation(s)
- Cheri L Lubahn
- College of Arts and Sciences, Kent State University , Kent, OH , USA
| | - Dianne Lorton
- College of Arts and Sciences, Kent State University , Kent, OH , USA
| | - Jill A Schaller
- College of Arts and Sciences, Kent State University , Kent, OH , USA
| | - Sarah J Sweeney
- College of Arts and Sciences, Kent State University , Kent, OH , USA
| | - Denise L Bellinger
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine , Loma Linda, CA , USA
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Stack RJ, Sahni M, Mallen CD, Raza K. Symptom complexes at the earliest phases of rheumatoid arthritis: a synthesis of the qualitative literature. Arthritis Care Res (Hoboken) 2013; 65:1916-26. [PMID: 23926091 PMCID: PMC4030621 DOI: 10.1002/acr.22097] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 07/30/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Understanding the features and patterns of symptoms that characterize the earliest stages of rheumatoid arthritis (RA) is of considerable importance if patients are to be identified and started on treatment early. However, little is known about the characteristics of symptoms at the onset of a disease that eventually progresses to RA. METHODS A systematic review of qualitative peer-reviewed publications was conducted to identify the earliest symptoms associated with the onset of RA. A total of 1,736 abstracts were searched to identify relevant publications. Twenty-six publications were identified, assessed for quality, and subjected to analysis informed by thematic and grounded theory frameworks. RESULTS Several interacting themes describing the early symptoms of RA were identified, including swelling, pain and tenderness, stiffness, fatigue and weakness, and the emotional impact of symptoms. For each symptom, different and evolving intensities were described; in some cases, patterns of symptom onset and symptom complexes at the onset of RA were highlighted. Importantly, this review has emphasized major deficiencies in the literature. None of the studies reviewed originally aimed to explore symptoms at RA onset (often discussions about symptom onset were secondary to the study's primary aim). Also, many of the articles identified sampled people diagnosed with RA many years previously, making their recollection of symptoms at onset less reliable. CONCLUSION In order for clinicians to fully understand the earliest phases of disease, the nature of symptoms at onset needs to be understood. The current work represents a useful starting point, but this area needs further qualitative investigation, followed by quantitative explorations of symptom clusters and their associated features.
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Affiliation(s)
- Rebecca J Stack
- Sandwell and West Birmingham Hospitals NHS Trust and Centre for Translational Inflammation Research, University of BirminghamBirmingham, UK
| | - Melanie Sahni
- Sandwell and West Birmingham Hospitals NHS TrustBirmingham, UK
| | - Christian D Mallen
- Arthritis Research UK Primary Care Centre, University of KeeleStoke-on-Trent, UK
| | - Karim Raza
- Sandwell and West Birmingham Hospitals NHS Trust and Centre for Translational Inflammation Research, University of BirminghamBirmingham, UK
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