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Abacar K, Kaymaz-Tahra S, Bayındır Ö, İnce B, Kutu ME, Yazıcı A, Ediboğlu ED, Demirci-Yıldırım T, Ademoğlu Z, Omma A, Yaşar-Bilge NŞ, Kimyon G, Kaşifoğlu T, Emmungil H, Önen F, Akar S, Cefle A, Alpay-Kanıtez N, Çelik S, İnanç M, Aksu K, Keser G, Direskeneli H, Alibaz-Öner F. Frequency and the effects of spondyloarthritis-spectrum disorders on the clinical course and management of Takayasu arteritis: an observational retrospective study. Clin Rheumatol 2024; 43:1571-1578. [PMID: 38563865 DOI: 10.1007/s10067-024-06939-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Extravascular findings of Takayasu arteritis (TAK) often share features with the spondyloarthritis (SpA) spectrum of disorders. However, the characteristics of this overlap and its effect on the vascular manifestations of TAK are not fully known. Therefore, we aimed to investigate the frequency of SpA-related features in TAK patients. MATERIAL AND METHODS In this observational retrospective study, 350 patients with TAK classified according to ACR 1990 criteria, from 12 tertiary rheumatology clinics, were included and evaluated for the presence of axSpA, IBD, or psoriasis. Demographic, clinical features, angiographic involvement patterns, disease activity, and treatments of TAK patients with or without SpA were analyzed. RESULTS Mean age was 45.5 ± 13.6 years and mean follow-up period was 76.1 ± 65.9 months. Among 350 patients, 31 (8.8%) had at least one additional disease from the SpA spectrum, 8 had IBD, 8 had psoriasis, and 20 had features of axSpA. In the TAK-SpA group, TAK had significantly earlier disease onset, compared to TAK-without-SpA (p = 0.041). SpA-related symptoms generally preceded TAK symptoms. Biological treatments, mostly for active vasculitis, were higher in the TAK-SpA group (70.9%) compared to TAK-without-SpA (27.9%) (p < 0.001). Vascular involvements were similar in both. CONCLUSION Our study confirmed that diseases in the SpA spectrum are not rare in TAK. Vascular symptoms appeared earlier in such patients, and more aggressive therapy with biological agents was required in the TAK-SpA group, suggesting an association between TAK and SpA spectrum. Key Points • The pathogenesis of Takayasu arteritis is mediated by an MHC class I alelle (HLA-B*52), similar to spondyloarthritis-disorders. • Extravascular findings of Takayasu arteritis are in the spectrum of spondyloarthritis disease. • This frequent coexistence between Takayasu arteritis and spondyloarthritic disorders suggests a relationship rather than a coincidence.
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Affiliation(s)
- Kerem Abacar
- Internal Medicine, Rheumatology, Marmara University, Istanbul, Turkey.
| | - Sema Kaymaz-Tahra
- Internal Medicine, Rheumatology, Sancaktepe Prof. Dr. İlhan Varank Hospital, Istanbul, Turkey
| | - Özün Bayındır
- Internal Medicine, Rheumatology, Ege University, Izmir, Turkey
| | - Burak İnce
- Istanbul Faculty of Medicine, Internal Medicine, Rheumatology, Istanbul University, Istanbul, Turkey
| | - Muhammet Emin Kutu
- Internal Medicine, Rheumatology, Bakırköy Sadi Konuk Hospital, Istanbul, Turkey
| | - Ayten Yazıcı
- Internal Medicine, Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Elif Durak Ediboğlu
- Internal Medicine, Rheumatology, İzmir Katip Çelebi University, Izmir, Turkey
| | | | - Zeliha Ademoğlu
- Internal Medicine, Rheumatology, Trakya University, Edirne, Turkey
| | - Ahmet Omma
- Internal Medicine, Rheumatology, Ankara Sehir Hospital, Ankara, Turkey
| | | | - Gezmiş Kimyon
- Internal Medicine, Rheumatology, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Timuçin Kaşifoğlu
- Internal Medicine, Rheumatology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Hakan Emmungil
- Internal Medicine, Rheumatology, Trakya University, Edirne, Turkey
| | - Fatoş Önen
- Internal Medicine, Rheumatology, Dokuz Eylül University, Izmir, Turkey
| | - Servet Akar
- Internal Medicine, Rheumatology, İzmir Katip Çelebi University, Izmir, Turkey
| | - Ayşe Cefle
- Internal Medicine, Rheumatology, Kocaeli University, Kocaeli, Turkey
| | | | - Selda Çelik
- Internal Medicine, Rheumatology, Bakırköy Sadi Konuk Hospital, Istanbul, Turkey
| | - Murat İnanç
- Istanbul Faculty of Medicine, Internal Medicine, Rheumatology, Istanbul University, Istanbul, Turkey
| | - Kenan Aksu
- Internal Medicine, Rheumatology, Ege University, Izmir, Turkey
| | - Gökhan Keser
- Internal Medicine, Rheumatology, Ege University, Izmir, Turkey
| | - Haner Direskeneli
- Internal Medicine, Rheumatology, Marmara University, Istanbul, Turkey
| | - Fatma Alibaz-Öner
- Internal Medicine, Rheumatology, Marmara University, Istanbul, Turkey
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Hintenberger R, Affenzeller B, Vladychuk V, Pieringer H. Cardiovascular risk in axial spondyloarthritis-a systematic review. Clin Rheumatol 2023; 42:2621-2633. [PMID: 37418034 PMCID: PMC10497445 DOI: 10.1007/s10067-023-06655-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 07/08/2023]
Abstract
Cardiovascular manifestations are common in patients suffering axial spondyloarthritis and can result in substantial morbidity and disease burden. To give an overview of this important aspect of axial spondyloarthritis, we conducted a systematic literature search of all articles published between January 2000 and 25 May 2023 on cardiovascular manifestations. Using PubMed and SCOPUS, 123 out of 6792 articles were identified and included in this review. Non-radiographic axial spondyloarthritis seems to be underrepresented in studies; thus, more evidence for ankylosing spondylitis exists. All in all, we found some traditional risk factors that led to higher cardiovascular disease burden or major cardiovascular events. These specific risk factors seem to be more aggressive in patients with spondyloarthropathies and have a strong connection to high or long-standing disease activity. Since disease activity is a major driver of morbidity, diagnostic, therapeutic, and lifestyle interventions are crucial for better outcomes. Key Points • Several studies on axial spondyloarthritis and associated cardiovascular diseases have been conducted in the last few years addressing risk stratification of these patients including artificial intelligence. • Recent data suggest distinct manifestations of cardiovascular disease entities among men and women which the treating physician needs to be aware of. • Rheumatologists need to screen axial spondyloarthritis patients for emerging cardiovascular disease and should aim at reducing traditional risk factors like hyperlipidemia, hypertension, and smoking as well as disease activity.
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Affiliation(s)
- Rainer Hintenberger
- Department for Internal Medicine II, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstraße 9, 4020 Linz and Altenbergerstraße 69, 4040, Linz, Austria.
| | - Barbara Affenzeller
- Department for Internal Medicine II, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstraße 9, 4020 Linz and Altenbergerstraße 69, 4040, Linz, Austria
| | - Valeriia Vladychuk
- Department for Internal Medicine II, Kepler University Hospital GmbH, Krankenhausstraße 9, 4020, Linz, Austria
| | - Herwig Pieringer
- Diakonissen Hospital Linz, Linz, Austria and Paracelsus Private Medical University Salzburg, Salzburg, Austria
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Takayasu's arteritis occurring under TNF blockers in a patient with spondyloarthritis: is it an association or a paradoxical effect? Reumatologia 2021; 59:111-114. [PMID: 33976465 PMCID: PMC8103412 DOI: 10.5114/reum.2021.103394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/20/2021] [Indexed: 11/21/2022] Open
Abstract
Coexistence of spondyloarthritis (SpA) and Takayasu’s arteritis is not a common finding, but such cases have been discussed, particularly in the context of choice of therapy. Inhibition of inflammation by tumor necrosis factor inhibitors (TNFi) is a key aspect of the treatment of SpA and also positive effects of such treatment in concomitant large vessel vasculitis have been reported. However, TNFi is also associated with the possibility of initiating vasculitis. The present article based on a case study and the available literature is an attempt to discuss coexistence of these two diseases and the impact of treatment with biological drugs from the anti-TNF group in the course of SpA with Takayasu’s arteritis.
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Liu G, Ma Y, Yang Q, Deng S. Modulation of inflammatory response and gut microbiota in ankylosing spondylitis mouse model by bioactive peptide IQW. J Appl Microbiol 2020; 128:1669-1677. [PMID: 31977125 DOI: 10.1111/jam.14588] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/03/2019] [Accepted: 01/17/2020] [Indexed: 12/12/2022]
Abstract
AIMS Ankylosing spondylitis (AS) is a widespread and chronic inflammatory autoimmune disease of unknown provenance. Naturally occurring peptides and proteins have shown significant promise as modulators of immune responses. Thus, the aims of this study were to assess the protective effects of the bioactive peptide IQW (Ile-Gln-Trp) with respect to inflammatory indicators, gut microbiota and oxidative stress, and to examine the potential mechanisms of these effects. METHODS AND RESULTS A mouse model was prepared by four injections of human proteoglycan extract (2 mg) in dimethyldioctadecylammonium solution (2 mg) over an interval of 2 weeks. Enzyme-linked immunosorbent assay results for the markers of oxidative stress and inflammation in the AS mice revealed increased concentrations of malondialdehyde, IL-6, IL-1β and TNF-α, along with decreased concentrations of catalase (CAT), glutathione peroxidase (GSH-PX) and superoxide dismutase (SOD). Treatment with IQW was found to decrease the concentrations of IL-6, IL-1β and TNF-α, and increase the concentrations of CAT, GSH-PX and SOD. Moreover the quantification of the microbiota via 16s rRNA sequencing revealed a reduced microbial diversity in the AS mice, while a significantly increased microbial diversity was displayed by those treated with IQW. Whereas, there was a significant reduction in the relative abundance of Bacteroidetes and an increased relative abundance of Verrucomicrobia in AS mice, this was reversed following the IQW treatment. CONCLUSIONS The results demonstrated that IQW exerts a beneficial influence in AS by delaying progression of the disease, reducing the arthritic grade of intervertebral joints, altering the concentrations of cytokines and modulating the microbial diversity and composition. SIGNIFICANCE AND IMPACT OF THE STUDY Oral IQW treatment might represent a new approach to mitigate the onset and development of AS.
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Affiliation(s)
- G Liu
- Tianjin Hospital, Tianjin, China
| | - Y Ma
- Tianjin Hospital, Tianjin, China
| | - Q Yang
- Tianjin Hospital, Tianjin, China
| | - S Deng
- Tianjin Hospital, Tianjin, China
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Li F, Si D, Guo X, Guo N, Li D, Zhang L, Jian X, Ma J. Aberrant expression of miR‑130a‑3p in ankylosing spondylitis and its role in regulating T‑cell survival. Mol Med Rep 2019; 20:3388-3394. [PMID: 31432140 DOI: 10.3892/mmr.2019.10573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 03/06/2019] [Indexed: 11/09/2022] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. MicroRNAs (miRNAs) are a group of endogenous small non‑coding RNAs that regulate target genes, and play a critical role in many biological processes. However, the underlying mechanism of specific miRNA, miR‑130a‑3p, in AS remains largely unknown. Therefore, the present study aimed to explore the underlying mechanism of miR‑130a‑3p in the development of AS. In the present study, it was revealed that miR‑130a‑3p was downregulated in T cells from HLA‑B27‑positive AS patients compared with the HLA‑B27‑negative healthy controls. Next, bioinformatics software TargetScan 7.2 was used to predict the target genes of miR‑130a‑3p, and a luciferase reporter assay indicated that HOXB1 was the direct target gene of miR‑130a‑3p. Furthermore, it was determined that HOXB1 expression was upregulated in T cells from HLA‑B27‑positive AS patients. In addition, the results of the present study indicated that miR‑130a‑3p inhibitor significantly inhibited cell proliferation ability and induced cell apoptosis of Jurkat T cells, while the miR‑130a‑3p mimic promoted proliferation ability and inhibited cell apoptosis of Jurkat T cells. Notably, all the effects of the miR‑130a‑3p mimic on Jurkat T cells were reversed by HOXB1‑plasmid. Collectively, our data indicated that miR‑130a‑3p was decreased in T cells from AS patients and it could regulate T‑cell survival by targeting HOXB1.
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Affiliation(s)
- Fengju Li
- Department of Rheumatism and Immunology, Puyang Oilfield General Hospital, Puyang, Henan 457001, P.R. China
| | - Dingran Si
- Department of Cardiovascular Medicine, Puyang Oilfield General Hospital, Puyang, Henan 457001, P.R. China
| | - Xuejun Guo
- Department of Hematology, Puyang Oilfield General Hospital, Puyang, Henan 457001, P.R. China
| | - Ningru Guo
- Department of Rheumatism and Immunology, Puyang Oilfield General Hospital, Puyang, Henan 457001, P.R. China
| | - Dandan Li
- Department of Rheumatism and Immunology, Puyang Oilfield General Hospital, Puyang, Henan 457001, P.R. China
| | - Liujing Zhang
- Department of Rheumatism and Immunology, Puyang Oilfield General Hospital, Puyang, Henan 457001, P.R. China
| | - Xianan Jian
- Department of Rheumatism and Immunology, Puyang Oilfield General Hospital, Puyang, Henan 457001, P.R. China
| | - Jiasheng Ma
- Department of Rheumatism and Immunology, Puyang Oilfield General Hospital, Puyang, Henan 457001, P.R. China
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Increased incidence of spondyloarthropathies in patients with Takayasu arteritis: a systematic clinical survey. Joint Bone Spine 2019; 86:497-501. [DOI: 10.1016/j.jbspin.2019.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/03/2019] [Accepted: 01/30/2019] [Indexed: 11/17/2022]
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Kwon OC, Lee SW, Park YB, Oh JS, Lee SH, Hong S, Lee CK, Yoo B, Kim YG. Extravascular manifestations of Takayasu arteritis: focusing on the features shared with spondyloarthritis. Arthritis Res Ther 2018; 20:142. [PMID: 29996949 PMCID: PMC6042334 DOI: 10.1186/s13075-018-1643-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/12/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Takayasu arteritis (TAK) is a systemic disease characterized by large vessel involvement. Although the vascular characteristics of TAK are well characterized, there is no well-organized study demonstrating the extravascular manifestations of TAK. We aimed to evaluate the characteristics of extravascular manifestations of TAK, and to identify the association between vascular and extravascular manifestations of TAK. METHODS TAK patients from two independent cohorts between January 2012 and October 2017 were included in the study. Patient characteristics were retrospectively collected from the electronic dataset. The computed tomography scans of all subjects were reviewed to evaluate the pattern of vascular involvement and presence of sacroiliitis. Clinical findings including uveitis, skin lesions, oral ulcers, arthritis, and inflammatory bowel disease (IBD) were reviewed. Logistic regression analysis was performed to evaluate the association between vascular and extravascular manifestations. RESULTS For the 268 TAK patients, the mean age at diagnosis was 41.2 ± 14.2 years and 88.1% were female. The extravascular manifestation of TAK was observed in 19.0% of patients, the most common being arthritis including sacroiliitis (11.9%) followed by recurrent oral ulcers (8.6%) and IBD (2.6%). A multivariate logistic regression analysis revealed type IIB vascular involvement (adjusted odds ratio (OR) 2.956, 95% confidence interval (CI) 1.337-6.537, p = 0.007) and the erythrocyte sedimentation rate (ESR) (adjusted OR 1.014, 95% CI 1.003-1.025, p = 0.012) as significantly associated with the presence of axial and peripheral arthritis. CONCLUSIONS Extravascular manifestations of TAK were observed in up to one-fifth of patients. The most common extravascular manifestation was arthritis, which was associated with a type IIB vascular involvement pattern and a high ESR.
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Affiliation(s)
- Oh Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Seon Oh
- Clinical Research Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang Hoon Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
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Dong B. Protective Effects of Sinomenine Against Ankylosing Spondylitis and the Underlying Molecular Mechanisms. Med Sci Monit 2018; 24:3631-3636. [PMID: 29849019 PMCID: PMC6007288 DOI: 10.12659/msm.907589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effect and underlying molecular mechanism of sinomenine (SIN) on ankylosing spondylitis (AS). MATERIAL AND METHODS To study the potential role of SIN in the pathogenesis of AS, an AS mouse model was established and mice were treated with different concentrations of SIN (10, 30, and 50 mg/kg, administered intraperitoneally). Markers of inflammation and oxidative stress were determined by ELISA assay. Western blot analysis and qRT-PCR were used to quantify the levels of related proteins and gene mRNA expression. RESULTS The results suggest that AS mice has higher levels of TNF-α, IL-1β, and IL-6 (p<0.01 for all), and lower levels of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-PX) (p<0.01 for all). SIN treatment reduced the level of TNF-α, IL-1β, and IL-6 in a dose-dependent manner, and the levels of SOD, CAT, and GSH-PX were dose-dependently increased (p<0.05 for all). The results also revealed that NF-κBp65 expression decreased, while the level of IkB increased, in a dose-dependent manner, after SIN treatment in AS mice (p<0.05 for all). The level of p-p38 was dose-dependently reduced in AS mice by SIN treatment (p<0.05). Moreover, SIN inhibited Cox-2 expression in AS mice in a dose-dependent manner (p<0.05). CONCLUSIONS SIN has a beneficial role in AS through suppressing inflammatory mediators and by down-regulating oxidative stress via inhibiting the MAPKp38/NF-kB pathway and Cox-2 expression.
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Affiliation(s)
- Bo Dong
- Department of Orthopedics, No. 2 Ward of Traditional Chinese Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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Matsushita M, Kobayashi S, Tada K, Hayashi E, Yamaji K, Amano A, Tamura N. A case of ankylosing spondylitis with concurrent Takayasu arteritis. J Int Med Res 2018; 46:2486-2494. [PMID: 29690806 PMCID: PMC6023039 DOI: 10.1177/0300060518769548] [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] [Indexed: 12/02/2022] Open
Abstract
We herein report a case involving a 56-year-old man who had experienced neck and lower back pain since the age of 23 years. Ankylosing spondylitis (AS) was diagnosed at 41 years of age, and treatment with sulfasalazine was initiated. At 44 years of age, the patient developed respiratory distress on exertion and chest pain. Aortic regurgitation (AR) was diagnosed via echocardiography, and the patient presented to our hospital for close examination and treatment. Coronary computed tomography angiography revealed no lesions in the coronary artery; however, magnetic resonance angiography revealed stenotic lesions in the left common carotid artery and left subclavian artery. Based on the findings of a physical examination, fundus examination, and blood tests, the patient was diagnosed with AS with concurrent Takayasu arteritis (TA). Upon administration of steroids to alleviate inflammation caused by an autoimmune mechanism, the patient’s chest symptoms and inflammatory findings improved. AR was treated with aortic valve replacement and prosthetic blood vessel replacement, after which the patient progressed well. Intraoperative aortic biopsy revealed findings pathologically consistent with TA. Although AS with concurrent AR is well described, AS with concurrent TA, as in the present case, is rare.
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Affiliation(s)
- Masakazu Matsushita
- 1 Department of Internal Medicine and Rheumatology, Juntendo University, School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shigeto Kobayashi
- 2 Department of Internal Medicine, Juntendo Koshigaya Hospital, 560 Fukuroyama, Koshigaya city, Saitama, Japan
| | - Kurisu Tada
- 1 Department of Internal Medicine and Rheumatology, Juntendo University, School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Eri Hayashi
- 1 Department of Internal Medicine and Rheumatology, Juntendo University, School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ken Yamaji
- 1 Department of Internal Medicine and Rheumatology, Juntendo University, School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Atsushi Amano
- 3 Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Naoto Tamura
- 1 Department of Internal Medicine and Rheumatology, Juntendo University, School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
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Clemente G, Silva CA, Sacchetti SB, Ferriani VPL, Oliveira SK, Sztajnbok F, Bica BERG, Cavalcanti A, Robazzi T, Bandeira M, Terreri MT. Takayasu arteritis in childhood: misdiagnoses at disease onset and associated diseases. Rheumatol Int 2018; 38:1089-1094. [PMID: 29687155 DOI: 10.1007/s00296-018-4030-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/12/2018] [Indexed: 11/24/2022]
Abstract
Juvenile-Takayasu arteritis (j-TA) is a difficult diagnosis and some patients develop uncommon manifestations and associated diseases that may contribute to the delayed diagnosis. Our aim was to identify the misdiagnoses, the associated diseases and the atypical manifestations observed in a j-TA Brazilian multicentre study. 71 children and adolescents who met the classification criteria for j-TA were included. The misdiagnoses, the associated diseases and the atypical manifestations were evaluated. 19 (26.8%) patients had misdiagnoses. The most common of them was aortic coarctation in six (8.4%) patients, followed by rheumatic fever in five (7.0%) and one patient presented with both former diagnoses. Limb pain (two patients), spondyloarthropathy, juvenile idiopathic arthritis (JIA), spinal arteriovenous malformation, polyarteritis nodosa (PAN) and fever of unknown origin (FUO) were other misdiagnoses. Patients who had misdiagnoses previously to j-TA diagnosis presented a trend to have a longer diagnosis delay. 11 (15.5%) patients had 14 TA-associated diseases, such as pulmonary tuberculosis (5 patients), rheumatic fever (2 patients), spondyloarthropathy, polyarticular JIA, Crohn's disease, Prader-Willi disease, diabetes mellitus, Moyamoya and primary immunodeficiency. 7 (9.9%) patients presented 10 atypical manifestations, such as pyoderma gangrenosum, erythema nodosum, myositis, chorea, enthesitis, episcleritis, uveitis, hepatomegaly, splenomegaly and necrosis of extremities. Our study emphasizes the main misdiagnoses, associated diseases and atypical manifestations that occur in patients with j-TA and warns of the features that may alert paediatricians to this diagnosis, such as constitutional symptoms and elevated inflammatory markers.
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Affiliation(s)
- Gleice Clemente
- Pediatrics Rheumatoloy Unit, Department of Pediatrics, São Paulo Federal University, São Paulo, SP, Brazil.
| | - Clovis A Silva
- Pediatrics Rheumatology Unit, Children's Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Silvana B Sacchetti
- Pediatrics Rheumatology Unit, Pediatric Department of Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Virginia P L Ferriani
- Pediatrics Rheumatology Division, Department of Pediatrics, Ribeirao Preto Medical School, Sao Paulo University, Ribeirao Preto, SP, Brazil
| | - Sheila K Oliveira
- Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, RJ, Brazil
| | - Flavio Sztajnbok
- Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, RJ, Brazil
| | - Blanca E R G Bica
- Hospital Universitário Clementino Fraga Filho-Rheumatology Division-Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
| | - André Cavalcanti
- Pediatrics Rheumatology Unit, Department of Materno-Infantil, Federal University of Pernambuco, Recife, PE, Brazil
| | - Teresa Robazzi
- Pediatrics Rheumatology Unit, Bahia Federal University, Salvador, BA, Brazil
| | | | - Maria Teresa Terreri
- Pediatrics Rheumatoloy Unit, Department of Pediatrics, São Paulo Federal University, São Paulo, SP, Brazil
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Mielnik P, Hjelle AM, Nordeide JL. Coexistence of Takayasu’s arteritis and ankylosing spondylitis may not be accidental – Is there a need for a new subgroup in the spondyloarthritis family? Mod Rheumatol 2017; 28:313-318. [DOI: 10.1080/14397595.2017.1341592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Pawel Mielnik
- Section for Rheumatology, Department for Neurology, Rheumatology and Physical Medicine, Helse Førde, Førde, Norway
| | - Anja Myhre Hjelle
- Section for Rheumatology, Department for Neurology, Rheumatology and Physical Medicine, Helse Førde, Førde, Norway
| | - Jan Leidulv Nordeide
- Section for Rheumatology, Department for Neurology, Rheumatology and Physical Medicine, Helse Førde, Førde, Norway
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Rivière E, Arnaud L, Ebbo M, Allanore Y, Claudepierre P, Dernis E, Ziza JM, Miceli-Richard C, Philippe P, Richez C, Soubrier M, Belkhir R, Seror R, Mariette X, Pavy S. Takayasu Arteritis and Spondyloarthritis: Coincidence or Association? A Study of 14 Cases. J Rheumatol 2017; 44:1011-1017. [DOI: 10.3899/jrheum.160762] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 11/22/2022]
Abstract
Objective.Spondyloarthritis (SpA) and Takayasu arteritis (TA) are 2 chronic inflammatory diseases; their coexistence in a single patient is uncommon. The aims of our study were to describe clinical features of patients having SpA associated with TA and to identify some characteristics of the types of patients with SpA associated with TA. We also analyzed treatments used in this context.Methods.This French multicenter retrospective survey called for observations on behalf of the Club Rhumatismes et Inflammations, with a standardized questionnaire established by the investigators.Results.We included 14 patients (women: 10/14; median age at SpA diagnosis: 43.5 yrs, ranging from 19 to 63). Subtypes of SpA were ankylosing spondylitis (n = 11), psoriatic arthritis (n = 2), and synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome (n = 1). HLA-B27 was positive in 3 cases, negative in 9, and unknown in 2. SpA was diagnosed before TA in 13 cases. Imaging findings compatible with the diagnosis of TA were found with computed tomography (11/14) and/or Doppler ultrasound (10/14). Laboratory tests showed increased acute-phase reactants in all cases (C-reactive protein ≥ 25 mg/l in 71% of the cases). All patients except 1 received corticosteroids and 7 were treated with anti–tumor necrosis factor (anti-TNF).Conclusion.Association of SpA and TA is rare but probably not coincidental. Peripheral pulse palpation and vascular auscultation should be systematic and are the first indicators of TA in patients with SpA. Moreover, increased acute-phase reactants during SpA followup should lead to search for TA. Finally, there are therapeutic implications because anti-TNF are efficient in SpA and might be efficient in TA.
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Vasculitis and inflammatory arthritis. Best Pract Res Clin Rheumatol 2016; 30:916-931. [PMID: 27964796 DOI: 10.1016/j.berh.2016.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/10/2016] [Accepted: 10/10/2016] [Indexed: 01/28/2023]
Abstract
Vasculitis has been described in most types of inflammatory arthritis. The best described and most widely recognised form is rheumatoid vasculitis. The incidence of systemic rheumatoid vasculitis has declined significantly following the general early use of methotrexate in the 1990s, and it is now a rare form of vasculitis. Treatment of rheumatoid vasculitis is conventionally with glucocorticoids and cyclophosphamide, but there is an increasing role for rituximab similar to that in other types of vasculitis. Despite these developments the mortality of rheumatoid vasculitis remains high. Vasculitis in other types of inflammatory arthritis is less well described and the treatment remains empirical.
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Abstract
Ankylosing spondylitis (AS) is a common and genetically heterozygous inflammatory rheumatic disease characterized by new bone formation, ankylosis and inflammation of hip, sacroiliac joints and spine. Until now, there is no method for early diagnosis of AS and the effective treatment available for AS patients remain largely undefined.We searched articles indexed in PubMed (MEDLINE) database using Medical Subject Heading (MeSH) or Title/Abstract words ("microRNA" and "ankylosing spondylitis") from inception up to November 2015.Genetic polymorphisms of miRNAs and their targets might alter the risk of AS development whereas certain miRNAs exhibit correlation with inflammatory index.Let-7i and miR-124 were upregulated whereas miR-130a was downregulated in circulating immune cells of AS patients. These deregulated miRNAs could modulate key immune cell functions, such as cytokine response and T-cell survival.miRNA deregulation is key to AS pathogenesis. However, clinical utilization of miRNAs for management of AS patients requires further support from future translational studies.
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Affiliation(s)
- Zheng Li
- From the Department of Orthopedics Surgery Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (ZL, JS); State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences and Department of Medicine & Therapeutics (SHW, WKKW); and Department of Anaesthesia and Intensive Care (MTVC), The Chinese University of Hong Kong, Hong Kong, China
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Kanıtez NA, Toz B, Güllüoğlu M, Erer B, Esen BA, Omma A, Şahinkaya Y, İliaz R, Çavuş B, Gül A, İnanç M, Karaca Ç, Kamalı S. Microscopic colitis in patients with Takayasu's arteritis: a potential association between the two disease entities. Clin Rheumatol 2016; 35:2495-9. [PMID: 26742755 DOI: 10.1007/s10067-015-3149-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/06/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023]
Abstract
The association of Takayasu's arteritis (TAK) and inflammatory bowel disease (IBD) has previously been reported in case series. Microscopic colitis (MC) has IBD-like symptoms with regard to clinical and histopathological feature. We aim to assess the presence of MC in TAK patients in this study. We cross-sectionally assessed TAK patients, between the ages of 18-65 years, who were diagnosed according to the American College of Rheumatology (ACR) criteria. Disease activity was evaluated by Kerr's criteria. Age- and sex-matched irritable bowel syndrome (IBS) patients were selected as control group. All patients and controls have been interviewed for IBD and IBS symptoms using the questionnaires of WHO guideline and Rome III criteria, respectively. Lower endoscopic procedure was performed with at least five random biopsies taken from different colonic segments and the terminal ileum. A blinded expert pathologist evaluated the specimens for the features of MC. Thirty TAK patients (29 females and 1 male) with the mean age of 35 ± 11 years (range, 20-59 years) and 15 IBS controls with the mean age of 38 ± 13 years were included in the study. TAK patients all fulfilled the MC criteria (three "complete" and six "incomplete" cases). MC was found to be significantly higher in active TAK patients in comparison to inactive group (67 vs 14 %, p = 0.03, OR = 7.9). Our results show that there is an increased frequency of MC in TAK patients, and this is the first report on the association of TAK and MC.
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Affiliation(s)
- Nilüfer Alpay Kanıtez
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Bahtiyar Toz
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Mine Güllüoğlu
- Istanbul Medical Faculty, Department of Pathology, Istanbul University, Istanbul, Turkey
| | - Burak Erer
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Bahar Artım Esen
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Ahmet Omma
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Yasemin Şahinkaya
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Raim İliaz
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul, Turkey
| | - Bilger Çavuş
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul, Turkey
| | - Ahmet Gül
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Murat İnanç
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Çetin Karaca
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul, Turkey
| | - Sevil Kamalı
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey.
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Features of anti-aquaporin 4 antibody-seropositive Chinese patients with neuromyelitis optica spectrum optic neuritis. J Neurol 2015; 262:2293-304. [DOI: 10.1007/s00415-015-7844-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 01/04/2023]
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Li H, Zhang Y, Yi Z, Huang D, Wei S. Frequency of autoantibodies and connective tissue diseases in Chinese patients with optic neuritis. PLoS One 2014; 9:e99323. [PMID: 24950188 PMCID: PMC4064964 DOI: 10.1371/journal.pone.0099323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/13/2014] [Indexed: 12/29/2022] Open
Abstract
Background Optic neuritis (ON) is often associated with other clinical or serological markers of connective tissue diseases (CTDs). To date, the effects of autoantibodies on ON are not clear. Purpose To assess the prevalence, clinical patterns, and short outcomes of autoantibodies and Sjögren’s syndrome (SS) involvement in Chinese ON patients and evaluate the relationship between ON, including their subtypes, and autoantibodies. Methods A total of 190 ON patients were divided into recurrent ON (RON), bilateral ON (BON), and isolated monocular ON (ION). Demographic, clinical, and serum autoantibodies data were compared between them with and without SS involvement. Serum was drawn for antinuclear antibody (ANA), extractable nuclear antigen antibodies (SSA/SSB), rheumatoid factor (RF), anticardiolipin antibodies (ACA), and anti-double-stranded DNA antibody (A-ds DNA), anticardiolipin antibody (ACLs), anti-β2-glycoprotein I (β2-GPI) and Aquaporin-4 antibodies (AQP4-Ab). Spectral-domain optical coherence tomography (SD-OCT) was used to evaluate the atrophy of the optic nerve. Results 68 patients (35.79%) had abnormal autoantibodies, 26(13.68%) patients met diagnostic criteria for CTDs, including 15(7.89%) patients meeting the criteria for SS. Antibodies including SSA/SSB 23 (30.26%) (p1 and p 2<0.001) and AQP4–Ab10 (13.16%) (p1 = 0.044, p2 = 0.01) were significantly different in patients in the RON group when compared with those in the BON (P1 = RON VS ION) and ION (p2 = RON VS ION) groups. SS was more common in RON patients (p1 = 0.04, p2 = 0.028). There was no significant difference between SSA/SSB positive and negative patients in disease characteristics or severity. Similar results were obtained when SS was diagnosed in SSA/SSB positive patients. Conclusion RON and BON were more likely associated with abnormal autoantibodies; furthermore, AQP4 antibody, SSA/SSB and SS were more common in the RON patients. AQP4 antibodydetermination is crucial in RON patients who will develop NMO. However, when compared with other autoantibodies, SSA/SSB detected in patients was not significantly associated with disease characteristics or severity.
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Affiliation(s)
- Hongyang Li
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yan Zhang
- Department of Ophthalmology, The General Hospital of Beijing Military Region, Beijing, China
| | - Zuohuizi Yi
- Department of Ophthalmology, The People’s Hospital Affiliated Wuhan University, Wuhan, China
| | - Dehui Huang
- Department of Neurology, The Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital, Beijing, China
- * E-mail:
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