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Boman R, Penkala S, Chan RHM, Joshua F, Cheung RTH. Ultrasound imaging of the dorsalis pedis artery as an early indicator of the precursory changes for rheumatoid vasculitis: A case series. Australas J Ultrasound Med 2024; 27:42-48. [PMID: 38434542 PMCID: PMC10902827 DOI: 10.1002/ajum.12373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Introduction Clinical verification of rheumatoid vasculitis (RV) persists as a mid-to-late diagnosis with medical imaging or biopsy. Early and subclinical presentations of RV, in particular, can remain underdiagnosed in the absence of adequate diagnostic testing. In this study, the research demonstrated the precursory changes for RV in patients with rheumatoid arthritis (RA) using non-invasive ultrasound imaging of a peripheral vessel. Method Six participants were recruited: three participants with (RA) and three age- and gender-matched healthy controls. All participants completed a Foot Health Survey Questionnaire (FHSQ), and participants with RA completed a Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5). Bilateral B-mode and Doppler ultrasound of the dorsalis pedis artery (DPA) was performed. The degree of inflammation, lumen and artery diameters, lumen diameter-to-artery diameter ratio and peak systolic velocity in the proximal DPA were compared between the two groups. Results The mean RADAI-5 score (5.4 ± 0.8 out of 10) indicated moderate disease activity amongst participants with RA. Inflammation was observed in the DPA wall in all participants with RA, compared to no inflammation observed in the control group (Friedmans two-way analysis: χ2 = 15.733, P = 0.003). Differences between groups for inflammation, lumen diameter and lumen diameter-to-artery diameter ratio were found (P < 0.034), without differences for artery diameter and peak systolic velocity (P > 0.605). DPA wall inflammation did not correlate with FHSQ scores (r = -0.770, P = 0.073). Conclusion Despite moderate RA disease activity, this is the first study to demonstrate the use of ultrasound to observe inflammation in small vessel disease. Our findings suggest ultrasound imaging may be a viable screening tool to demonstrate arterial wall inflammation, indicating the precursory changes of RV.
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Affiliation(s)
- Robyn Boman
- School of Health SciencesWestern Sydney UniversityCampbelltownNew South WalesAustralia
| | - Stefania Penkala
- School of Health SciencesWestern Sydney UniversityCampbelltownNew South WalesAustralia
- Translational Health Research InstituteWestern Sydney UniversityCampbelltownNew South WalesAustralia
| | - Rosa H. M. Chan
- Department of Electrical EngineeringCity University of Hong KongHong KongHong Kong
| | - Fredrick Joshua
- Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Roy Tsz Hei Cheung
- School of Health SciencesWestern Sydney UniversityCampbelltownNew South WalesAustralia
- Translational Health Research InstituteWestern Sydney UniversityCampbelltownNew South WalesAustralia
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Ejma-Multański A, Wajda A, Paradowska-Gorycka A. Cell Cultures as a Versatile Tool in the Research and Treatment of Autoimmune Connective Tissue Diseases. Cells 2023; 12:2489. [PMID: 37887333 PMCID: PMC10605903 DOI: 10.3390/cells12202489] [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: 08/18/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Cell cultures are an important part of the research and treatment of autoimmune connective tissue diseases. By culturing the various cell types involved in ACTDs, researchers are able to broaden the knowledge about these diseases that, in the near future, may lead to finding cures. Fibroblast cultures and chondrocyte cultures allow scientists to study the behavior, physiology and intracellular interactions of these cells. This helps in understanding the underlying mechanisms of ACTDs, including inflammation, immune dysregulation and tissue damage. Through the analysis of gene expression patterns, surface proteins and cytokine profiles in peripheral blood mononuclear cell cultures and endothelial cell cultures researchers can identify potential biomarkers that can help in diagnosing, monitoring disease activity and predicting patient's response to treatment. Moreover, cell culturing of mesenchymal stem cells and skin modelling in ACTD research and treatment help to evaluate the effects of potential drugs or therapeutics on specific cell types relevant to the disease. Culturing cells in 3D allows us to assess safety, efficacy and the mechanisms of action, thereby aiding in the screening of potential drug candidates and the development of novel therapies. Nowadays, personalized medicine is increasingly mentioned as a future way of dealing with complex diseases such as ACTD. By culturing cells from individual patients and studying patient-specific cells, researchers can gain insights into the unique characteristics of the patient's disease, identify personalized treatment targets, and develop tailored therapeutic strategies for better outcomes. Cell culturing can help in the evaluation of the effects of these therapies on patient-specific cell populations, as well as in predicting overall treatment response. By analyzing changes in response or behavior of patient-derived cells to a treatment, researchers can assess the response effectiveness to specific therapies, thus enabling more informed treatment decisions. This literature review was created as a form of guidance for researchers and clinicians, and it was written with the use of the NCBI database.
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Affiliation(s)
- Adam Ejma-Multański
- Department of Molecular Biology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (A.W.); (A.P.-G.)
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Mertz P, Wollenschlaeger C, Chasset F, Dima A, Arnaud L. Rheumatoid vasculitis in 2023: Changes and challenges since the biologics era. Autoimmun Rev 2023; 22:103391. [PMID: 37468085 DOI: 10.1016/j.autrev.2023.103391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Significant changes in the epidemiology and natural history of rheumatoid vasculitis (RV) have occurred with the introduction of biological therapies such as TNF inhibitors (TNFi) and rituximab. PURPOSE This scoping review aims to address the key current challenges and propose updated criteria for RV. This will aid future descriptive observational studies and prospective therapeutic trials. METHODOLOGY The MEDLINE database was searched for eligible articles from inception through December 2022. Articles were selected based on language and publication date after 1998, corresponding to the approval of the first TNFi in rheumatic diseases. RESULTS Sixty articles were included in the review. The mean incidence of RV has decreased since the approval of biologic therapies in RA, from 9.1 (95% CI: 6.8-12.0) per million between 1988 and 2000 to 3.9 (95% CI: 2.3-6.2) between 2001 and 2010, probably due to significant improvement in RA severity and a decrease in smoking habits. Factors associated with an increased risk of RV include smoking at RA diagnosis, longer disease duration, severe RA, immunopositivity, and male gender (regardless of age). Homozygosity for the HLA-DRB104 shared epitope is linked to RV, while the presence of HLA-C3 is a significant predictor of vasculitis in patients without HLA-DRB104. Cutaneous (65-88%), neurologic (35-63%), and cardiac (33%) manifestations are common in RV, often associated with constitutional symptoms (70%). Histologic findings range from small vessel vasculitis to medium-sized necrotizing arteritis, but definite evidence of vasculitis is not required in the 1984 Scott and Bacon diagnostic criteria. Existing data on RV treatment are retrospective, and no formal published guidelines are currently available. CONCLUSION The understanding of RV pathogenesis has improved since its initial diagnostic criteria, with a wider range of clinical manifestations identified. However, a validated and updated criteria that incorporates these advances is currently lacking, impeding the development of descriptive observational studies and prospective therapeutic trials. PRIMARY FUNDING SOURCE This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Affiliation(s)
- Philippe Mertz
- Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, 1 Avenue Molière BP 83049, 67098 Strasbourg Cedex, France; Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA, France.
| | - Clara Wollenschlaeger
- Dermatology Clinic, Hôpitaux Universitaires et Université de Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - François Chasset
- Sorbonne Université, Faculté de Médecine, Service de dermatologie et Allergologie, AP-HP, hôpital Tenon, et INSERM U1135, CIMI, Paris
| | - Alina Dima
- Department of Rheumatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Laurent Arnaud
- Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, 1 Avenue Molière BP 83049, 67098 Strasbourg Cedex, France; Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA, France
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Mishima K, Aoki K, Shirai Y, Aritomo H, Iwasaka M, Katsura M, Tatsutani T, Ikeuchi H, Oryoji K, Mizuki S. Elderly onset atypical Lemierre's syndrome concurrent with a rheumatoid vasculitis sacral ulcer infection: a case report. BMC Infect Dis 2023; 23:145. [PMID: 36890459 PMCID: PMC9993631 DOI: 10.1186/s12879-023-08089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Typical Lemierre's syndrome is usually secondary to an oropharyngeal infection. Recently, several cases following a primary infection site other than the oropharynx have been reported as atypical Lemierre's syndrome; although, these primary lesions are limited to the head and neck. This is the first case potentially sequential to infectious foci outside the head and neck. CASE PRESENTATION We describe an atypical Lemierre's syndrome in a 72-year-old woman with rheumatoid arthritis, which occurred during the treatment of Streptococcus anginosus bacteremia acquired from a sacral ulcer infection related to rheumatoid vasculitis. At first, the symptoms resolved after the initial administration of vancomycin for the bacteremia caused by methicillin-resistant Staphylococcus aureus and Streptococcus anginosus that entered via a sacral ulcer. On the 8th day, the patient developed a fever of 40 °C and unexpectedly required 10 L of oxygen due to rapid deterioration of oxygenation temporarily. Immediately contrast-enhanced computed tomography was performed to investigate systemic thrombosis including pulmonary embolism. Afterward, the newly formed thrombi at the right external jugular vein, bilateral internal jugular veins, and the right small saphenous vein were detected, and apixaban was started. On the 9th day, the patient again had an intermittent fever of 39.7 °C, and continuous Streptococcus anginosus bacteremia was revealed; subsequently, clindamycin was administered. On the 10th day, she developed a left hemothorax; consequently, apixaban was discontinued, and a thoracic drain was inserted. She repeatedly had an intermittent fever of 40.3 °C, and contrast-enhanced computed tomography detected an abscess formation at the left parotid gland, pterygoid muscle group, and masseter muscle. After Lemierre's syndrome was diagnosed in combination with the abovementioned jugular vein thrombus, clindamycin was replaced with meropenem, and vancomycin was increased. Swelling of the lower part of the left ear became prominent with delay and peaked at approximately the 16th day. The subsequent treatment course was favorable, and she was discharged on the 41st day. CONCLUSION Clinicians should consider Lemierre's syndrome as the differential diagnosis of internal jugular vein thrombosis occurring during sepsis, even though an antibiotic is administered or a primary infection site is anything besides the oropharynx.
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Affiliation(s)
- Koji Mishima
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan.
| | - Kazunobu Aoki
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Yusuke Shirai
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan.,Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, Miyagi Prefecture, Ishinomaki City, Japan
| | - Hiroshi Aritomo
- Department of Otorhinolaryngology, Matsuyama Red Cross Hospital, Matsuyama City, Ehime Prefecture, Japan
| | - Maiko Iwasaka
- Division of Dermatology, Matsuyama Red Cross Hospital, Matsuyama City, Ehime Prefecture, Japan
| | - Masakazu Katsura
- Department of Thoracic Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Ehime Prefecture, Japan
| | - Tomofumi Tatsutani
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Hiroko Ikeuchi
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Kensuke Oryoji
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Shinichi Mizuki
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
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Zarama Valenzuela AG, Valencia Camacho DP. Mononeuropatía múltiple en fase avanzada como manifestación de rhupus:. UNIVERSITAS MÉDICA 2023. [DOI: 10.11144/javeriana.umed64-1.mono] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introducción: El rhupus es una enfermedad reumatológica rara que se define como la superposición de artritis reumatoide y lupus eritematoso sistémico. En esta población de pacientes, las manifestaciones neurológicas severas son inusuales y de difícil abordaje diagnóstico, con pocos casos reportados hasta el momento en la literatura. Presentación del caso: Hombre latino de 64 años de edad, quien se presentó al servicio de urgencias con pérdida de peso, trastorno de la deglución y la marcha. Inicialmente, se descartó una afectación neoplásica y se documentó la presencia de mononeuritis múltiple en fase avanzada, mediante la realización de electromiografía y neuroconducciones. Dentro de los estudios etiológicos cumplió criterios para rhupus y tuvo una respuesta satisfactoria al tratamiento con esteroides y terapias de rehabilitación a los seis meses de seguimiento. Conclusión: La afectación del sistema nervioso periférico debe reconocerse como una manifestación de las enfermedades autoinmunes para facilitar un diagnóstico rápido e intervenciones oportunas.
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Vadher A, Yeruva K, Vora C, Gangu K, Baraiya S. Vasculitis Leading to Gangrene: An Early Presentation in a Rheumatoid Arthritis Patient. Cureus 2023; 15:e34438. [PMID: 36874716 PMCID: PMC9979587 DOI: 10.7759/cureus.34438] [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] [Accepted: 01/31/2023] [Indexed: 02/01/2023] Open
Abstract
Vasculitis is a late complication in rheumatoid arthritis (RA) and is seen in RA patients with long-standing disease. Rheumatoid vasculitis affects small-to-medium-sized vessels. In a few patients, vasculitis develops early in the course of the disease. Here, we report the case of a 32-year-old female who presented with gangrene in the second and third digits of the right foot and gangrene in the second digit of the left foot. She was on hydroxychloroquine and methotrexate for one year since the diagnosis of RA. The patient then developed Raynaud's phenomenon and blackish discoloration of toes. She was started on pulse methylprednisolone, aspirin, nifedipine, and pentoxifylline. As no improvement was seen, intravenous cyclophosphamide was started. There was no improvement even after starting cyclophosphamide, and the gangrene further worsened. Eventually, after consulting the surgical team, it was decided to amputate the digits. The second digits in both feet were subsequently amputated. Hence, a physician should always be careful in checking for signs of vasculitis in RA patients early in the course of the disease as well.
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Affiliation(s)
| | - Karthik Yeruva
- Internal Medicine, Merit Health River Region Hospital, Vicksburg, USA
| | - Chitralekha Vora
- Internal Medicine, B. J. Medical and Civil Hospital, Ahmedabad, IND
| | - Karthik Gangu
- Internal Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Swati Baraiya
- Family Medicine, Bombay Hospital and Medical Research Center, Mumbai, IND
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Rafik ST, Zeitoun TM, Shalaby TI, Barakat MK, Ismail CA. Methotrexate conjugated gold nanoparticles improve rheumatoid vascular dysfunction in rat adjuvant-induced arthritis: gold revival. Inflammopharmacology 2023; 31:321-335. [PMID: 36482036 PMCID: PMC9958144 DOI: 10.1007/s10787-022-01104-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
Endothelial vasomotor dysfunction and accelerated atherosclerosis encompass the features of rheumatoid vascular dysfunction (RVD), increasing cardiovascular morbidity and mortality among rheumatoid arthritis (RA) patients. Methotrexate, among DMARDs, effectively reduces cardiovascular events, but its non-selectivity together with its pharmacokinetic variability often limit drug adherence and contribute to its potential toxicity. Thus, methotrexate was conjugated to gold nanoparticles (MTX/AuNPs) and its effect on RVD in rats' adjuvant-induced arthritis was evaluated. A comparative study between MTX/AuNPs, free MTX, and AuNPs treatments on joint inflammation, vascular reactivity and architecture, smooth muscle phenotype, systemic inflammation, and atherogenic profile was done. Since MTX/AuNPs effect was superior, it appears that conjugation of MTX to AuNPs demonstrated a synergistic action. MTX immunomodulatory action combined with AuNPs anti-atherogenic potential yielded prompt control of whole features of RVD. These findings highlight the usefulness of nanoparticles-targeted drug-delivery system in refining rheumatoid-induced vascular dysfunction treatment and reviving gold use in RA.
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Affiliation(s)
- Salma T. Rafik
- Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Teshreen M. Zeitoun
- Department of Histology and Cell Biology, Faculty of Medicine, El-Moassat Medical Hospital, Alexandria University, Alexandria, Egypt
| | - Thanaa I. Shalaby
- Department of Medical Biophysics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mervat K. Barakat
- Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Cherine A. Ismail
- Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Muacevic A, Adler JR, Horinishi Y, Sano C, Ohta R. A Case of Capillary Leak Syndrome and Intestinal Ischemia Caused by Rheumatoid Vasculitis. Cureus 2023; 15:e33404. [PMID: 36751197 PMCID: PMC9899103 DOI: 10.7759/cureus.33404] [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] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
Rheumatoid vasculitis (RV) is a rare disease associated with rheumatoid arthritis (RA). The incidence of RV has decreased with the development of treatment for RA. However, some patients still develop RV in rural areas, where medical care for autoimmune diseases is inadequate. In this report, we describe a case of RV complicated by an acute exacerbation of generalized ulcerative lesions and capillary leak syndrome in an 86-year-old woman with a severe joint deformity due to RA. RV is a systemic vasculitis characterized by various symptoms. When a patient with RA is diagnosed with poorly controlled joint deformities, general physicians should consider the possibility of RV. Urgent investigation and intensive treatment should be initiated for vasculitis to support the lives of older patients with advanced RA.
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Kim YE, Ahn SM, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. Clinical significance of tocilizumab-related neutropenia in patients with rheumatoid arthritis. Joint Bone Spine 2022; 90:105510. [PMID: 36526232 DOI: 10.1016/j.jbspin.2022.105510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the risks and clinical significance of tocilizumab (TCZ)-related neutropenia, in real-world settings, for patients with rheumatoid arthritis (RA). METHODS Medical records of RA patients treated with TCZ at a tertiary referral hospital in South Korea were collected. Infectious complications were defined as cases confirmed by clinical diagnosis and treated with antibiotics. RESULTS A total of 277 RA patients with TCZ treatment (intravenous: 152 [54.9%], subcutaneous: 125 [45.1%]) were included in our study. During the observational period, 22 (7%) patients experienced grade 3 neutropenia. No patients discontinued TCZ due to neutropenia, while the dosage of conventional synthetic DMARD (csDMARD) was either reduced or discontinued for 8 patients. Patients, who experienced neutropenia while using csDMARD, had a higher risk for grade 3/4 neutropenia during TCZ treatment (hazard ratio [HR]: 3.120, 95% CI: 1.189-8.189, P=0.021). Among infections, pulmonary infections were the most common (10.35 per 100 patient-years). Age over 60 years (HR: 2.133, 95% CI: 1.118-4.071, P=0.022) and the presence of extra-articular manifestations (adjusted HR: 11.096, 95% CI: 5.353-22.999, P<0.001), but not neutropenia (adjusted HR: 1.263, 95% CI: 0.269-5.945, P=0.77), were risk factors for infections during TCZ treatment. CONCLUSION Approximately 7% of RA patients treated with TCZ developed grade 3 neutropenia. The previous history of neutropenia during csDMARD was a risk factor for TCZ-related neutropenia. Age and extra-articular manifestations, but not neutropenia, were risk factors for infection during TCZ treatment, suggesting that TCZ treatment can be maintained in the presence of neutropenia unless infection occurs.
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Affiliation(s)
- Young-Eun Kim
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Soo Min Ahn
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Ji Seon Oh
- Information Medicine, Big Data Research Center, Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Gil Kim
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Chang-Keun Lee
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Bin Yoo
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Seokchan Hong
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea.
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Moore CM, Loichle A, Tavakolian K, Odak M, Nightingale S, Patel SV. A Rare Case of Superior Vena Cava Syndrome in a Patient With Rheumatoid Arthritis and IgA Nephropathy. Cureus 2022; 14:e28198. [PMID: 36003344 PMCID: PMC9392423 DOI: 10.7759/cureus.28198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2022] [Indexed: 11/05/2022] Open
Abstract
Superior vena cava syndrome (SVCS) is a vascular condition resulting from an impaired venous return to the right atrium. The majority of SVCS cases are caused by mass effect in which extrinsic compression of the vessel leads to obstruction of blood flow. In less common cases of SVCS, thrombus formation and luminal narrowing can result in poor return through the SVC. Inflammatory causes of SVCS are even rarer and poorly documented. IgA nephropathy and rheumatoid arthritis (RA) are two autoimmune diseases with the potential to cause vasculitis, thus increasing the likelihood of intraluminal vessel occlusion. We report a rare case of SVCS in a 65-year-old female with a past medical history significant for atrial fibrillation, IgA nephropathy, chronic kidney disease stage IIIA, and RA who presented with headache, dizziness, and neck pain and swelling extending down the left upper extremity for three days. Inflammatory SVCS is uncommon and cases of SVCS secondary to RA and IgA nephropathy are underreported in the literature thus far. Our hope in presenting this case is to encourage a greater degree of suspicion for vascular complications, such as SVCS, in patients with autoimmune and inflammatory conditions.
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11
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Saha BK, Bonnier A, Saha S, Saha BN, Milman NT. The Spectrum of Autoantibodies in Adult Patients With Idiopathic Pulmonary Hemosiderosis: A Brief Review of the Literature. Cureus 2022; 14:e24169. [PMID: 35586354 PMCID: PMC9108010 DOI: 10.7759/cureus.24169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Abstract
While autoimmune antibodies or autoantibodies have been reported sporadically in adult patients with idiopathic pulmonary hemosiderosis (IPH), their true prevalence is unknown. The question as to whether any difference exists between antibody-positive and negative patients has not been explored. The primary objective of this paper was to assess the spectrum of autoantibody testing and its positivity rate. The other objectives included a comparative analysis of demographics, symptom onset, clinical manifestations, and differences in clinical outcomes between antibody-positive (cohort A) and negative (cohort B) patients. To that end, we conducted a retrospective review of the relevant published literature. Multiple databases were searched to retrieve studies published between 1990 and 2022. A total of 35 studies, involving 38 patients, were identified. Five of these patients had a positive autoantibody. Patients in cohort A were older and more likely to be male. The frequencies of testing for these antibodies were as follows: antineutrophil cytoplasmic antibody (ANCA): 37/38 (97.4%), antinuclear antibody (ANA): 31/38 (81.6%), and anti-glomerular basement membrane antibody (anti-GBM): 30/38 (78.9%); 5/38 (13.2%) patients tested positive for an autoantibody, and two of these patients were positive for ANA, two for antithyroid antibody, and one patient tested positive for ANCA, rheumatoid factor (RF), and granulocyte monocyte-colony stimulating factor (GM-CSF) antibody. There was no difference between the cohorts regarding their clinical presentations, recurrence risks, and survival. The occurrence of autoantibodies is uncommon in adult IPH patients. This is in contrast with the pediatric IPH patient population, where the prevalence is much higher (26.4% vs. 13.2%), and the antibodies are more diverse. Unlike pediatric patients, adult patients with autoantibodies do not necessarily have worse outcomes.
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Meling MT, Minagawa A, Miyake T, Ashida A, Okuyama R. Certolizumab pegol treatment for leg ulcers due to rheumatoid vasculitis. JAAD Case Rep 2021; 18:12-14. [PMID: 34786446 PMCID: PMC8577500 DOI: 10.1016/j.jdcr.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Maureen Tania Meling
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akane Minagawa
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tomomi Miyake
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsuko Ashida
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryuhei Okuyama
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
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Groner LK, Green DB, Weisman SV, Legasto AC, Toy D, Gruden JF, Escalon JG. Thoracic Manifestations of Rheumatoid Arthritis. Radiographics 2021; 41:32-55. [PMID: 33411607 DOI: 10.1148/rg.2021200091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Rheumatoid arthritis (RA) is one of the most common chronic systemic inflammatory diseases and the most common chronic inflammatory arthritis. Classically a progressive symmetric polyarthritis, RA is characterized by inflammation, erosions, bone loss, and joint destruction. Up to half of patients with RA exhibit extra-articular manifestations (EAMs), which may precede articular disease and are more common in patients with seropositive RA (patients with detectable serum levels of rheumatoid factor and/or anticitrullinated peptide antibodies). Cardiovascular and pulmonary EAMs are the largest contributors to morbidity and mortality in RA and may be especially devastating. Imaging has a significant role in diagnosing these EAMs and assessing response to treatment. Although treatment with disease-modifying antirheumatic drugs has redefined the natural history of RA and helped many patients achieve low disease activity, patients are at risk for treatment-related complications, as well as infections. The clinical features of drug-induced lung disease and infection can overlap considerably with those of EAMs, presenting a diagnostic challenge. Radiologists, by recognizing the imaging characteristics and evolution of these various processes, are essential in diagnosing and distinguishing among EAMs, treatment-related complications, and unrelated processes and formulating an appropriate differential diagnosis. Moreover, recognizing these disease processes at imaging and contextualizing imaging findings with clinical information and laboratory and pathologic findings can facilitate definitive diagnosis and proper treatment. The authors review the articular and extra-articular thoracic imaging manifestations of RA, including cardiovascular, respiratory, and pleural diseases, as well as treatment-related complications and common infections. ©RSNA, 2021.
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Affiliation(s)
- Lauren K Groner
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Daniel B Green
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Stacey V Weisman
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Alan C Legasto
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Dennis Toy
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - James F Gruden
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Joanna G Escalon
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
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de Cerqueira DPA, Pedreira ALS, de Cerqueira MG, Santiago MB. Biological therapy in rheumatoid vasculitis: a systematic review. Clin Rheumatol 2020; 40:1717-1724. [PMID: 33058033 DOI: 10.1007/s10067-020-05459-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 01/16/2023]
Abstract
Rheumatoid vasculitis (RV) is one of the most severe extra-articular manifestations of rheumatoid arthritis, with significant morbidity and mortality, requiring aggressive treatment with corticosteroids and/or immunosuppressants. Recently, biological drugs were included in its therapeutic armamentarium. The objective of this study was to perform a systematic review on the use of biological drugs in the treatment of RV. A systematic literature review was performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations and searching articles in MEDLINE/PubMed, Cochrane, SciELO, Scopus, and Virtual Health Library electronic databases. Secondary references were also evaluated. The methodological quality of the selected studies was evaluated by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Altogether, five articles, assessing the use of biological drugs, were included. Globally, 35 patients participated in the studies, of which 21 were treated with rituximab (RTX) in cycles of 1000 mg every 2 weeks; 9 used infliximab 5 mg/kg; 3 used infliximab 3 mg/kg; and 2 used etanercept 25 mg twice/week. In general, an improvement in clinical picture, reduction of the mean daily dose of corticosteroids, and improvement in the Birmingham Vasculitis Activity Score was achieved by the end of the treatment. Complete remission occurred in almost 70% of the cases. The adverse effect rate was 34%, mainly due to infections. There were two deaths, one due to sepsis and the other due to uncontrolled vasculitis, after the biological drug withdrawal, following the development of sepsis. Based on the results of the present review, we believe that the use of biological therapy such as RTX and anti-tumor necrosis factor α can be beneficial in treating this complication.
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Affiliation(s)
| | - Ana Luisa Souza Pedreira
- Escola Bahiana de Medicina e Saúde Pública, Av Dom João VI, 275 - Brotas, Salvador, BA, 40290-000, Brazil.
- Universidade Federal da Bahia, Salvador, BA, Brazil.
| | | | - Mittermayer Barreto Santiago
- Escola Bahiana de Medicina e Saúde Pública, Av Dom João VI, 275 - Brotas, Salvador, BA, 40290-000, Brazil
- Universidade Federal da Bahia, Salvador, BA, Brazil
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15
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Salata K, Almaghlouth I, Hussain MA, de Mestral C, Greco E, Aljabri BA, Mamdani M, Forbes TL, Verma S, Al-Omran M. Outcomes of abdominal aortic aneurysm repair among patients with rheumatoid arthritis. J Vasc Surg 2020; 73:1261-1268.e5. [PMID: 32950628 DOI: 10.1016/j.jvs.2020.08.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/15/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In the present study, we compared the outcomes of elective abdominal aortic aneurysm (AAA) repair in patients with and without rheumatoid arthritis (RA) stratified by the type of surgery. METHODS A retrospective population-based cohort study was conducted from 2003 to 2016. Linked administrative health data from Ontario, Canada were used to identify all patients aged ≥65 years who had undergone elective open or endovascular AAA repair during the study period. Patients were identified using validated procedure and billing codes and matching using propensity scores. The primary outcome was survival. The secondary outcomes were major adverse cardiovascular events (MACE)-free survival (defined as freedom from death, myocardial infarction, and stroke), reintervention, and secondary rupture. RESULTS Of 14,816 patients undergoing elective AAA repair, a diagnosis of RA was present for 309 (2.0%). The propensity-matched cohort included 234 pairs of RA and control patients. The matched cohort was followed up for a mean ± standard deviation of 4.93 ± 3.35 years, and the median survival was 6.76 and 7.31 years for the RA and control groups, respectively. Cox regression analysis demonstrated no statistically significant differences in the hazards for death, MACE, reintervention, or secondary rupture. Analysis of the differences in outcomes stratified by repair approach also showed no statistically significant differences in the hazards for death, MACE, reintervention, or secondary rupture. CONCLUSIONS We found no statistically significant differences in survival, MACE, reintervention, or secondary rupture among patients with RA undergoing elective AAA repair compared with controls. Further studies are required to evaluate the impact of comorbidities and antirheumatic medications on the outcomes of elective AAA repair.
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Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ibrahim Almaghlouth
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; College of Medicine Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohamad A Hussain
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Elisa Greco
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Badr A Aljabri
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Hogan C, Vakros G, Jones R, Bhalla S, McVeigh K. More Than Meets the Eye: A Rare Case of Posterior Scleritis Masquerading as Orbital Cellulitis. Cureus 2020; 12:e8177. [PMID: 32566418 PMCID: PMC7301425 DOI: 10.7759/cureus.8177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Posterior scleritis is a rare sight-threatening condition that typically presents with an acutely painful eye, often with associated reduced visual acuity. Diagnosis can be challenging and requires specialist ophthalmological assessment. Consequences of delayed treatment include permanent loss of vision. We present a case of posterior scleritis initially managed as periorbital cellulitis. We highlight the importance of broad differential diagnoses when assessing painful periorbital swelling, and present a review of current management strategies for posterior scleritis.
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Affiliation(s)
| | - George Vakros
- Vitreoretinal Surgery/Comprehensive Ophthalmology, Moorfields Eye Hospital, London, GBR
| | - Rebecca Jones
- Ophthalmology, Cheltenham General Hospital, London, GBR
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17
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Olivé A, Riveros A, Juárez P, Morales-Ivorra I, Holgado S, Narváez J. Rheumatoid vasculitis: study of 41 cases. Med Clin (Barc) 2020; 155:126-129. [PMID: 32147187 DOI: 10.1016/j.medcli.2020.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/21/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
AIM To describe the clinical manifestations, evolution and treatment of patients with rheumatoid vasculitis. METHODS Retrospective study (1975-2017) of all patients diagnosed with rheumatoid vasculitis in 2 Rheumatology Services. RESULTS A total of 41 patients were included, 17 (41.5%) males and 24 (58.5%) females; mean age at diagnosis: 67 ± 9 years; duration of rheumatoid arthritis: 10 ± 8.3 years. Most patients had erosive disease, 33 (80%). Rheumatoid factor and anticitrullinated antibodies were positive in all patients. Constitutional symptoms were present in 30 (73%) patients and extra-articular manifestations in 17 (41%) patients. The clinical manifestations of rheumatoid vasculitis were mainly: cutaneous 28 (68%), and polyneuritis 26 (63%). All patients were treated with glucocorticoids. An immunosuppressant was associated in 24 (58.5%) patients. Five (12%) patients were treated with the association of glucocorticoids and a biologic treatment. The mortality after 2years of follow-up was 33%, the most common causes being infection and progression of the vasculitis. The frequency of rheumatoid vasculitis has decreased over the last decade. CONCLUSION The clinical manifestations of rheumatoid vasculitis were similar to previous studies. The frequency of rheumatoid vasculitis seems to decrease. However, the clinical picture and severity remains invariable.
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Affiliation(s)
- Alejandro Olivé
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España.
| | - Anne Riveros
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España
| | - Pablo Juárez
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - Isabel Morales-Ivorra
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - Susana Holgado
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España
| | - Javier Narváez
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
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18
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Isobe M, Amano K, Arimura Y, Ishizu A, Ito S, Kaname S, Kobayashi S, Komagata Y, Komuro I, Komori K, Takahashi K, Tanemoto K, Hasegawa H, Harigai M, Fujimoto S, Miyazaki T, Miyata T, Yamada H, Yoshida A, Wada T, Inoue Y, Uchida HA, Ota H, Okazaki T, Onimaru M, Kawakami T, Kinouchi R, Kurata A, Kosuge H, Sada KE, Shigematsu K, Suematsu E, Sueyoshi E, Sugihara T, Sugiyama H, Takeno M, Tamura N, Tsutsumino M, Dobashi H, Nakaoka Y, Nagasaka K, Maejima Y, Yoshifuji H, Watanabe Y, Ozaki S, Kimura T, Shigematsu H, Yamauchi-Takihara K, Murohara T, Momomura SI. JCS 2017 Guideline on Management of Vasculitis Syndrome - Digest Version. Circ J 2020; 84:299-359. [PMID: 31956163 DOI: 10.1253/circj.cj-19-0773] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University
| | - Yoshihiro Arimura
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine.,Internal Medicine, Kichijoji Asahi Hospital
| | - Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | | | - Yoshinori Komagata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology, and Infectious Diseases, Ehime University Graduate School of Medicine
| | - Masayoshi Harigai
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki
| | | | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
| | - Hidehiro Yamada
- Medical Center for Rheumatic Diseases, Seirei Yokohama Hospital
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Graduate School of Medical Sciences, Kanazawa University
| | | | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hideki Ota
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine
| | - Takahiro Okazaki
- Vice-Director, Shizuoka Medical Center, National Hospital Organization
| | - Mitsuho Onimaru
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University
| | - Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University
| | - Reiko Kinouchi
- Medicine and Engineering Combined Research Institute, Asahikawa Medical University.,Department of Ophthalmology, Asahikawa Medical University
| | - Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University
| | | | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Eiichi Suematsu
- Division of Internal Medicine and Rheumatology, National Hospital Organization, Kyushu Medical Center
| | - Eijun Sueyoshi
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
| | | | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine Department of Internal Medicine, Faculty of Medicine, Kagawa University
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Kenji Nagasaka
- Department of Rheumatology, Ome Municipal General Hospital
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | | | - Shoichi Ozaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hiroshi Shigematsu
- Clinical Research Center for Medicine, International University of Health and Welfare
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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19
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Karasawa K, Iwabuchi Y, Kyoda M, Akihisa T, Yamaguchi E, Suzuki S, Ogura S, Takabe T, Miyabe Y, Kamiyama T, Nakano M, Manabe S, Kamiyama M, Akiyama K, Sato M, Uchida K, Nitta K, Moriyama T. Primary IgA Vasculitis with Nephritis in a Patient with Rheumatoid Arthritis Diagnosed by Anti-galactose-deficient IgA1 Immunostaining. Intern Med 2019; 58:2551-2554. [PMID: 31178497 PMCID: PMC6761328 DOI: 10.2169/internalmedicine.2640-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Renal disease is a common complication of rheumatoid arthritis (RA) and can occur secondary to RA or be induced by therapeutic agents. Recently, glomerular deposition of galactose-deficient IgA1 (Gd-IgA1) was identified as a feature of primary IgA vasculitis with nephritis (IgA-VN). We herein report a case of IgA-VN in an RA patient whose disease activity was controlled by treatment with etanercept. To distinguish between primary IgA-VN and secondary IgA-VN caused by RA or etanercept, we performed immunostaining of renal biopsy sections with the Gd-IgA1-specific antibody KM55. Positive KM55 staining confirmed the diagnosis of primary IgA-VN in a patient with RA.
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Affiliation(s)
| | - Yuko Iwabuchi
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Mizuki Kyoda
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Taro Akihisa
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Erika Yamaguchi
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Shunji Suzuki
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Shota Ogura
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Tomo Takabe
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Yoei Miyabe
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | | | - Marie Nakano
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Shun Manabe
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | | | - Kenichi Akiyama
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Masayo Sato
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Keiko Uchida
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University, Japan
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20
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Coffey CM, Richter MD, Crowson CS, Koster MJ, Warrington KJ, Ytterberg SR, Makol A. Rituximab Therapy for Systemic Rheumatoid Vasculitis: Indications, Outcomes, and Adverse Events. J Rheumatol 2019; 47:518-523. [DOI: 10.3899/jrheum.181397] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 11/22/2022]
Abstract
Objective.To characterize the indication, outcomes, and adverse effects of rituximab (RTX) treatment in a large single-center cohort of patients with systemic rheumatoid vasculitis (RV).Methods.We retrospectively reviewed the medical charts of 17 patients treated with RTX for systemic RV from 2000 to 2017. Clinical characteristics, outcomes, and adverse effects were analyzed.Results.At RV diagnosis, mean age was 59 years, 59% were female, 94% were white, and 82% had positive rheumatoid factor. At the time of initiating RTX, median Birmingham Vasculitis Activity Score for rheumatoid arthritis was 4.0 (interquartile range 2.0–7.5). RV presented in the skin in 8 patients (47%), as mononeuritis multiplex in 2 (12%), inflammatory ocular disease in 2 (12%), and affected multiple organ systems in 5 (29%). RTX was used for induction therapy in 8 patients (47%), relapsing RV in 4 (24%), second-line therapy in 2 (12%), and salvage therapy or in combination with another agent in 3 (18%). At 3 months, 2 (13%) of 15 patients with available followup information achieved complete remission (CR), and 10 (67%) achieved partial response (PR). At 6 months, 6 patients (40%) achieved CR, 8 (53%) achieved PR, and one had no response. At 12 months, 8 of 13 patients with available records (62%) had CR and 5 patients (38%) had PR.Conclusion.Systemic RV is difficult to treat effectively. CR of RV was achieved in 62% and PR in 38% of patients within 12 months of RTX use. Further evidence is needed to inform treatment for patients with RV.
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21
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Kawabe A, Nakano K, Miyata H, Shibuya R, Matsuyama A, Ogoshi T, Tanaka Y. Fatal Chronic Active Epstein-Barr Virus Infection in a Rheumatoid Arthritis Patient Treated with Abatacept. Intern Med 2019; 58:585-591. [PMID: 30210119 PMCID: PMC6421150 DOI: 10.2169/internalmedicine.1280-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Chronic active Epstein-Barr virus (CAEBV) T-cell type infection, systemic form, is characterized by persistent infectious mononucleosis-like symptoms, high Epstein-Barr virus (EBV) DNA levels in the peripheral blood, organ damage, and a poor prognosis. The association between CAEBV and rheumatoid arthritis (RA) is unclear. We report a case of fatal CAEBV T-cell type infection in an RA patient undergoing treatment with cytotoxic T-lymphocyte-associated antigen 4 immunoglobulin fusion protein (abatacept, ABT). CAEBV can rapidly worsen in RA patients receiving ABT. Thus, we should try to establish an early diagnosis in patients with CAEBV infection.
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Affiliation(s)
- Akio Kawabe
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Kazuhisa Nakano
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Hiroko Miyata
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Ryo Shibuya
- The Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Atsuji Matsuyama
- The Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Takaaki Ogoshi
- The Department of Respiratory Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
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Abstract
Vasculitis is an inflammatory condition that targets the blood vessels, which may occur in isolation or as a component of a systemic inflammatory condition. Although many of the vasculitides can directly affect the organs of the gastrointestinal system, some types exhibit a proclivity for certain gastrointestinal and hepatic organs. Often a patient presents with nonspecific symptoms, delaying the diagnosis and treatment of the underlying vasculitis. Vasculitis can also present with severe manifestations, such as upper gastrointestinal bleeds and bowel perforation. It is important to identify the signs and symptoms of vasculitis in gastrointestinal system and institute appropriate treatment.
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Affiliation(s)
- Eric Anderson
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Neel Gakhar
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Courtney Stull
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Liron Caplan
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA.
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23
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A mouse model of the Δ133p53 isoform: roles in cancer progression and inflammation. Mamm Genome 2018; 29:831-842. [PMID: 29992419 DOI: 10.1007/s00335-018-9758-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/05/2018] [Indexed: 01/19/2023]
Abstract
This review paper outlines studies on the Δ122p53 mouse, a model of the human Δ133p53 isoform, together with studies in other model organisms, cell culture, and where available, clinical investigations. In general, these studies imply that, in contrast to the canonical p53 tumor suppressor, Δ133p53 family members have oncogenic capability. Δ122p53 is multi-functional, conferring survival and proliferative advantages on cells, promoting invasion, metastasis and vascularization, as does Δ133p53. Cancers with high levels of Δ133p53 often have poor prognosis. Δ122p53 mediates its effects through the JAK-STAT and RhoA-ROCK signaling pathways. We propose that Δ133p53 isoforms have evolved as inflammatory signaling molecules to deal with the consequent tissue damage of p53 activation. However, if sustained expression of the isoforms occur, pathologies may result.
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Abstract
PURPOSE OF REVIEW Rheumatoid vasculitis (RV) is an unusual complication of long-standing rheumatoid arthritis, which is characterized by the development of necrotizing or leukocytoclastic vasculitis involving small or medium-sized vessels. In this review, we aim to provide an update on the epidemiology, pathogenesis, clinical presentation, and management of this challenging extra-articular manifestation. RECENT FINDINGS RV is heterogenous in its clinical presentation depending on the organ and size of blood vessels involved. The most common organs involved are the skin and peripheral nerve. Based on recent population studies, the incidence has significantly decreased with early recognition and the advent of immunosuppressive drugs and biologics; however, the mortality rates remain high. RV remains a serious extra-articular manifestation of RA that needs to be promptly recognized and treated. No consensus is available on treatment, given the ongoing debate of whether the biologics can trigger or treat RV.
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Affiliation(s)
- Shweta Kishore
- Division of Rheumatology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA.
| | - Lisa Maher
- Division of Rheumatology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA.,G. V. (Sonny) Montgomery VAMC, 1500 E. Woodrow Wilson Drive, Jackson, MS, 39216, USA
| | - Vikas Majithia
- Division of Rheumatology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA.,G. V. (Sonny) Montgomery VAMC, 1500 E. Woodrow Wilson Drive, Jackson, MS, 39216, USA
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Emamifar A, Hangaard J, Jensen Hansen IM. Thyroid disorders in patients with newly diagnosed rheumatoid arthritis is associated with poor initial treatment response evaluated by disease activity score in 28 joints-C-reactive protein (DAS28-CRP): An observational cohort study. Medicine (Baltimore) 2017; 96:e8357. [PMID: 29069018 PMCID: PMC5671851 DOI: 10.1097/md.0000000000008357] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
To determine the prevalence of thyroid disorders among newly diagnosed rheumatoid arthritis (RA) patients and evaluate the association between clinical characteristics of RA and thyroid disorders, and also initial treatment response in the RA patients with thyroid disorders.Newly diagnosed, adult RA patients who were diagnosed according to the new 2010 American College of Rheumatology/European League Against Rheumatism criteria since January 1, 2010, were included. Patients' demographic data, serology results including immunoglobulin M rheumatoid factor (IgM RF), anticyclic citrullinated peptide antibody (anti-CCP), and antinuclear antibody (ANA), and also disease activity score in 28 joints-C-reactive protein at the time of diagnosis and after 4 months (±1-2 months) of treatment initiation were extracted from Danish Danbio Registry. Patients' electronic hospital records for the past 10 years were reviewed to reveal if they had been diagnosed with thyroid disorders or they had abnormal thyroid test.In all, 439 patients were included, female 60.1%, mean age 64.6 ± 15.0 years and disease duration 2.6 ± 1.7 years. Prevalence of thyroid disorders was 69/439 (15.7%) and hypothyroidism was the most frequent disorder (30.4%). The presence of thyroid disorders among RA patients was significantly associated with female sex (P < .001), ANA positivity (P = .04), and anti-CCP ≥100 EU/mL (P = .05). Furthermore, RA patients with thyroid disorders had significantly poorer initial response to RA treatment compared with patients with isolated RA after 4 months of treatment (P = .02). There were no associations between thyroid disorders and age, disease duration, and also IgM RF positivity.Presence of thyroid disorders in RA patients is suggestive of a more aggressive disease and poor outcome, with direct effect on initial treatment response. To diagnose concurrent thyroid disorders at an earlier stage, routine measurement of serum thyroid-stimulating hormone is recommended in all RA patients at the time of diagnosis and with yearly interval thereafter.
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Affiliation(s)
- Amir Emamifar
- Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg
- Faculty of Health Sciences, University of Southern Denmark, Odense
| | - Jørgen Hangaard
- Department of Endocrinology, Odense University Hospital, Svendborg Hospital, Svendborg
| | - Inger Marie Jensen Hansen
- Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg
- Faculty of Health Sciences, University of Southern Denmark, Odense
- DANBIO Registry, Copenhagen, Denmark
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Koryem HK, Tayel MY, Eltawab SS, Moftah RF, Elazzay OE. Study of the association between nailfold capillaroscopic changes and serum level of interleukin-17 in rheumatoid: a clue for emerging vaculitis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2016. [DOI: 10.4103/1110-161x.192254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yoshida S, Takeuchi T, Sawaki H, Imai T, Makino S, Hanafusa T. Successful treatment with tocilizumab of pericarditis associated with rheumatoid arthritis. Mod Rheumatol 2014; 24:677-80. [DOI: 10.3109/14397595.2013.874733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shuzo Yoshida
- Internal Medicine, Arisawa General Hospital,
Osaka, Japan
- Department of Internal Medicine (Ι), Osaka Medical College,
Osaka, Japan
| | - Tohru Takeuchi
- Department of Internal Medicine (Ι), Osaka Medical College,
Osaka, Japan
| | - Hideaki Sawaki
- Internal Medicine, Arisawa General Hospital,
Osaka, Japan
| | - Tamaki Imai
- Internal Medicine, Arisawa General Hospital,
Osaka, Japan
| | - Shigeki Makino
- Department of Internal Medicine (Ι), Osaka Medical College,
Osaka, Japan
| | - Toshiaki Hanafusa
- Department of Internal Medicine (Ι), Osaka Medical College,
Osaka, Japan
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30
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Lee SY, Lee SW, Chung WT. Jejunal vasculitis in patient with rheumatoid arthritis: case report and literature review. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0608-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sang Yeob Lee
- Department of Internal Medicine and Rheumatology, Dong-A University Hospital, 3 Ga 1, Dong-daeshin dong, Seo-Gu, Pusan, Korea,
| | - Sung Won Lee
- Department of Internal Medicine and Rheumatology, Dong-A University Hospital, 3 Ga 1, Dong-daeshin dong, Seo-Gu, Pusan, Korea,
| | - Won Tae Chung
- Department of Internal Medicine and Rheumatology, Dong-A University Hospital, 3 Ga 1, Dong-daeshin dong, Seo-Gu, Pusan, Korea,
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31
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Leprosy in a rheumatology setting: a challenging mimic to expose. Clin Rheumatol 2013; 32:1557-63. [PMID: 23645094 PMCID: PMC3778233 DOI: 10.1007/s10067-013-2276-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 04/19/2013] [Indexed: 11/01/2022]
Abstract
Leprosy can manifest arthritis both as a complication and a comorbid disorder and can be a challenging differential diagnosis in rheumatology practice due to several common features. Uncommonly, it may present as acute severe polyarthritis with skin lesions and neurological deficit or a digital vasculitis and gangrene. We demonstrate this profile in a retrospective case series analysis of 33 patients (13 females, median age 55 years) in a community-based clinic setting over the period 1998-2012; an electronic search of case records of 41,000 patients was carried out. Rheumatoid arthritis (RA) coexisted in seven patients (three lepromatous, two tuberculoid, and two polyneuritic). Serological rheumatoid factor and antinuclear antibody were often false positive. Several patients of RA were on long-term supervised methotrexate. Rheumatologists should be aware of this clinical mimic to avoid errors in diagnosis and management.
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32
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Wollina U, Unger L, Haroske G, Heinig B. Classification of vascular disorders in the skin and selected data on new evaluation and treatment. Dermatol Ther 2013; 25:287-96. [PMID: 22950555 DOI: 10.1111/j.1529-8019.2012.01514.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cutaneous vascular disorders are common. They include arteries, veins, and lymphatic vessels, or a mixture of them. In this review, we discuss classification, new developments in understanding and treatment of vascular diseases. We focus on infantile hemangiomas and drug therapy, vasculitides with new vasculitic syndromes, yellow nail syndrome and localized lymphatic malformations. Benign cutaneous vascular lesions may be a sign of severe internal diseases. In many cases multidisciplinary treatment is important. The dermatologist can often act as a pilot for these patients.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.
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Affiliation(s)
- Xavier Puéchal
- Referral Center for Rare Systemic and Autoimmune Diseases, AP-HP, University Paris Descartes, Hôpital Cochin, Department of Internal Medicine, 75014 Paris, France.
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Denniston AK, Gayed M, Carruthers D, Gordon C, Murray PI. Rheumatic Disease. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Yoshida S, Takeuchi T, Sawaki H, Imai T, Makino S, Hanafusa T. Successful treatment with tocilizumab of pericarditis associated with rheumatoid arthritis. Mod Rheumatol 2012. [DOI: 10.1007/s10165-012-0805-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Lee SY, Lee SW, Chung WT. Jejunal vasculitis in patient with rheumatoid arthritis: case report and literature review. Mod Rheumatol 2012; 22:924-7. [PMID: 22350577 DOI: 10.1007/s10165-012-0608-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 01/18/2012] [Indexed: 10/28/2022]
Abstract
A 57-year-old man with rheumatoid arthritis presented severe abdominal pain symptomatic of panperitonitis. Computer tomography findings were consistent with vasculitis on the jejunum. Confirmatory angiography was conducted. Since abdominal vasculitis in rheumatoid arthritis is very rare, early diagnosis and treatment should be done according to clinical manifestation. In this case, high-dose steroid treatment was applied based on clinical manifestation, laboratory findings, and radiologic finding. After therapy, clinical manifestation and flare-up arthritis diminished.
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Affiliation(s)
- Sang Yeob Lee
- Department of Internal Medicine and Rheumatology, Dong-A University Hospital, Pusan, Korea.
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