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McCallum C, Campbell M, Vines J, Rapley T, Ellis J, Deary V, Hackett K. A Smartphone App to Support Self-Management for People Living With Sjögren's Syndrome: Qualitative Co-Design Workshops. JMIR Hum Factors 2024; 11:e54172. [PMID: 38630530 PMCID: PMC11063884 DOI: 10.2196/54172] [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: 11/01/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Sjögren's syndrome (SS) is the second most common autoimmune rheumatic disease, and the range of symptoms includes fatigue, dryness, sleep disturbances, and pain. Smartphone apps may help deliver a variety of cognitive and behavioral techniques to support self-management in SS. However, app-based interventions must be carefully designed to promote engagement and motivate behavior change. OBJECTIVE We aimed to explore self-management approaches and challenges experienced by people living with SS and produce a corresponding set of design recommendations that inform the design of an engaging, motivating, and evidence-based self-management app for those living with SS. METHODS We conducted a series of 8 co-design workshops and an additional 3 interviews with participants who were unable to attend a workshop. These were audio recorded, transcribed, and initially thematically analyzed using an inductive approach. Then, the themes were mapped to the Self-Determination Theory domains of competency, autonomy, and relatedness. RESULTS Participants experienced a considerable demand in the daily work required in self-managing their SS. The condition demanded unrelenting, fluctuating, and unpredictable mental, physical, and social efforts. Participants used a wide variety of techniques to self-manage their symptoms; however, their sense of competency was undermined by the complexity and interconnected nature of their symptoms and affected by interactions with others. The daily contexts in which this labor was occurring revealed ample opportunities to use digital health aids. The lived experience of participants showed that the constructs of competency, autonomy, and relatedness existed in a complex equilibrium with each other. Sometimes, they were disrupted by tensions, whereas on other occasions, they worked together harmoniously. CONCLUSIONS An SS self-management app needs to recognize the complexity and overlap of symptoms and the complexities of managing the condition in daily life. Identifying techniques that target several symptoms simultaneously may prevent users from becoming overwhelmed. Including techniques that support assertiveness and communication with others about the condition, its symptoms, and users' limitations may support users in their interactions with others and improve engagement in symptom management strategies. For digital health aids (such as self-management apps) to provide meaningful support, they should be designed according to human needs such as competence, autonomy, and relatedness. However, the complexities among the 3 Self-Determination Theory constructs should be carefully considered, as they present both design difficulties and opportunities.
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Affiliation(s)
- Claire McCallum
- Faculty of Engineering, University of Bristol, Bristol, United Kingdom
| | - Miglena Campbell
- Institute for Collective Place Leadership, Teesside University, Middlesbrough, United Kingdom
| | - John Vines
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Jason Ellis
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Vincent Deary
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Katie Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
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Berry J, Tarn J, Lendrem D, Casement J, Ng WF. What can patients tell us in Sjögren's syndrome? RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2024; 5:34-41. [PMID: 38571930 PMCID: PMC10985711 DOI: 10.1515/rir-2024-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 10/04/2023] [Indexed: 04/05/2024]
Abstract
In Sjögren's Syndrome (SS), clinical heterogeneity and discordance between disease activity measures and patient experience are key obstacles to effective therapeutic development. Patient reported outcome measures (PROMs) are useful tools for understanding the unmet needs from the patients' perspective and therefore they are key for the development of patient centric healthcare systems. Initial concern about the subjectivity of PROMs has given way to methodological rigour and clear guidance for the development of PROMs. To date, several studies of patient stratification using PROMs have identified similar symptom-based subgroups. There is evidence to suggest that these subgroups may represent different disease endotypes with differing responses to therapeutic interventions. Stratified medicine approaches, alongside sensitive outcome measures, have the potential to improve our understanding of SS pathobiology and therapeutic development. The inclusion of PROMs is important for the success of such approaches. In this review we discuss the opportunities of using PROMs in understanding the pathogenesis of and therapeutic development for SS.
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Affiliation(s)
- Joe Berry
- Translational and Clinical Research Institute, Newcastle University, Newcastle uponTyne, UK
| | - Jessica Tarn
- Translational and Clinical Research Institute, Newcastle University, Newcastle uponTyne, UK
| | - Dennis Lendrem
- Translational and Clinical Research Institute, Newcastle University, Newcastle uponTyne, UK
| | - John Casement
- Translational and Clinical Research Institute, Newcastle University, Newcastle uponTyne, UK
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University, Newcastle uponTyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre& NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle uponTyne, UK
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Barcelos F, Brás-Geraldes C, Martins C, Papoila AL, Monteiro R, Cardigos J, Madeira N, Alves N, Vaz-Patto J, Cunha-Branco J, Borrego LM. Added value of lymphocyte subpopulations in the classification of Sjögren's syndrome. Sci Rep 2023; 13:6872. [PMID: 37106029 PMCID: PMC10140065 DOI: 10.1038/s41598-023-31782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/17/2023] [Indexed: 04/29/2023] Open
Abstract
Sjögren's Syndrome (SjS) is a chronic systemic immune-mediated inflammatory disease characterized by lymphocytic infiltration and consequent lesion of exocrine glands. SjS diagnosis and classification remains a challenge, especially at SjS onset, when patients may have milder phenotypes of the disease or uncommon presentations. New biomarkers are needed for the classification of SjS, thus, we aimed to evaluate the added-value of lymphocyte subpopulations in discriminating SjS and non-Sjögren Sicca patients. Lymphocyte subsets from 62 SjS and 63 Sicca patients were characterized by flow cytometry. The 2002 AECG and the 2016 ACR/EULAR SjS classification criteria were compared with clinical diagnosis. The added discriminative ability of joining lymphocytic populations to classification criteria was assessed by the area under the Receiver-Operating-Characteristic Curve (AUC). Considering clinical diagnosis as the gold-standard, we obtained an AUC = 0.952 (95% CI: 0.916-0.989) for AECG and an AUC = 0.921 (95% CI: 0.875-0.966) for ACR/EULAR criteria. Adding Tfh and Bm1 subsets to AECG criteria, performance increased, attaining an AUC = 0.985 (95% CI: 0.968-1.000) (p = 0.021). Th1/Breg-like CD24hiCD27+ and switched-memory B-cells maximized the AUC of ACR/EULAR criteria to 0.953 (95% CI: 0.916-0.990) (p = 0.043). Our exploratory study supports the potential use of lymphocyte subpopulations, such as unswitched memory B cells, to improve the performance of classification criteria, since their discriminative ability increases when specific subsets are added to the criteria.
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Affiliation(s)
- Filipe Barcelos
- Comprehensive Health Research Centre, CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School, Universidade Nova de Lisboa, Campo Dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal.
- Rheumatology Department, Instituto Português de Reumatologia, Lisbon, Portugal.
- Rheumatology Department, Hospital CUF Descobertas, Lisbon, Portugal.
| | - Carlos Brás-Geraldes
- ISEL-Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Centro de Estatística E Aplicações, CEAUL, Universidade de Lisboa, Lisbon, Portugal
| | - Catarina Martins
- Comprehensive Health Research Centre, CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School, Universidade Nova de Lisboa, Campo Dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana-Luísa Papoila
- Centro de Estatística E Aplicações, CEAUL, Universidade de Lisboa, Lisbon, Portugal
- NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ricardo Monteiro
- Comprehensive Health Research Centre, CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School, Universidade Nova de Lisboa, Campo Dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Joana Cardigos
- Ophthalmology Department, Centro Hospitalar de Lisboa Central, Hospital de Santo António Dos Capuchos, Lisbon, Portugal
| | - Nathalie Madeira
- Rheumatology Department, Instituto Português de Reumatologia, Lisbon, Portugal
| | - Nuno Alves
- Ophthalmology Department, Centro Hospitalar de Lisboa Central, Hospital de Santo António Dos Capuchos, Lisbon, Portugal
- Ophthalmology Department, Hospital CUF Descobertas, Lisbon, Portugal
| | - José Vaz-Patto
- Rheumatology Department, Instituto Português de Reumatologia, Lisbon, Portugal
| | - Jaime Cunha-Branco
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital CUF Descobertas, Lisbon, Portugal
- Chronic Diseases Research Center, NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- Rheumatology Department, Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisbon, Portugal
| | - Luís-Miguel Borrego
- Comprehensive Health Research Centre, CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School, Universidade Nova de Lisboa, Campo Dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- Immunoalergy Department, Hospital da Luz Lisboa, Lisbon, Portugal
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Desvaux E, Aussy A, Hubert S, Keime-Guibert F, Blesius A, Soret P, Guedj M, Pers JO, Laigle L, Moingeon P. Model-based computational precision medicine to develop combination therapies for autoimmune diseases. Expert Rev Clin Immunol 2021; 18:47-56. [PMID: 34842494 DOI: 10.1080/1744666x.2022.2012452] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The complex pathophysiology of autoimmune diseases (AIDs) is being progressively deciphered, providing evidence for a multiplicity of pro-inflammatory pathways underlying heterogeneous clinical phenotypes and disease evolution. AREAS COVERED Treatment strategies involving drug combinations are emerging as a preferred option to achieve remission in a vast majority of patients affected by systemic AIDs. The design of appropriate drug combinations can benefit from AID modeling following a comprehensive multi-omics molecular profiling of patients combined with Artificial Intelligence (AI)-powered computational analyses. Such disease models support patient stratification in homogeneous subgroups, shed light on dysregulated pro-inflammatory pathways and yield hypotheses regarding potential therapeutic targets and candidate biomarkers to stratify and monitor patients during treatment. AID models inform the rational design of combination therapies interfering with independent pro-inflammatory pathways related to either one of five prominent immune compartments contributing to the pathophysiology of AIDs, i.e. pro-inflammatory signals originating from tissues, innate immune mechanisms, T lymphocyte activation, autoantibodies and B cell activation, as well as soluble mediators involved in immune cross-talk. EXPERT OPINION The optimal management of AIDs in the future will rely upon rationally designed combination therapies, as a modality of a model-based Computational Precision Medicine taking into account the patients' biological and clinical specificities.
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Affiliation(s)
- Emiko Desvaux
- Servier, Research and Development, Suresnes Cedex, France.,U1227 -Laboratoire d'Immunologie, Univ Brest, CHRU Morvan, Brest Cedex, France
| | - Audrey Aussy
- Servier, Research and Development, Suresnes Cedex, France
| | - Sandra Hubert
- Servier, Research and Development, Suresnes Cedex, France
| | | | - Alexia Blesius
- Servier, Research and Development, Suresnes Cedex, France
| | - Perrine Soret
- Servier, Research and Development, Suresnes Cedex, France
| | - Mickaël Guedj
- Servier, Research and Development, Suresnes Cedex, France
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Targeted Therapy for Primary Sjögren's Syndrome: Where are We Now? BioDrugs 2021; 35:593-610. [PMID: 34731460 DOI: 10.1007/s40259-021-00505-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune exocrinopathy characterized by dryness symptoms. This review briefly describes recent advances in the targeted therapies for pSS. Biologics evaluated for pSS treatment mainly include B cell-depleting agents, inhibitors of B cell activation, and agents that target co-signaling molecules or proinflammatory cytokines. Small molecule inhibitors that target signaling pathways have also been evaluated. However, current evidence for the efficacy of targeted therapies in pSS is still sparse. Although ianalumab (an anti-B cell-activating factor [BAFF]-receptor antibody) and iscalimab (an anti-CD40 antibody) are promising biologics for pSS, their efficacy still needs to be evaluated in larger clinical trials. For other biologics, clinical trials have found no differences versus placebo in the change from baseline in European League Against Rheumatism Sjögren's Syndrome Disease Activity Index (ESSDAI) score and fatigue score. Possible causes of the disappointing outcomes mainly include the inefficacy of those evaluated biologics in treating pSS, the high heterogeneous nature of pSS, irreversible exocrine glandular failure at advanced disease stages, inappropriate recruitment strategy in clinical trials, and outcome measures. Early diagnosis and glandular function-centered outcome measures may help to improve the current situation in the systemic therapy of pSS.
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Duguet F, Ortega-Ferreira C, Fould B, Darville H, Berger S, Chomel A, Leclerc G, Kisand K, Haljasmägi L, Hayday AC, Desvaux E, Nony E, Moingeon P, De Ceuninck F. S95021, a novel selective and pan-neutralizing anti interferon alpha (IFN-α) monoclonal antibody as a candidate treatment for selected autoimmune rheumatic diseases. J Transl Autoimmun 2021; 4:100093. [PMID: 33748735 PMCID: PMC7972961 DOI: 10.1016/j.jtauto.2021.100093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 12/31/2022] Open
Abstract
Increased interferon-α (IFN-α) production is a critical component in the pathophysiology of systemic lupus erythematosus (SLE) and other rheumatic autoimmune diseases. Herein, we report the characterization of S95021, a fully human IgG1 anti-IFN-α monoclonal antibody (mAb) as a novel therapeutic candidate for targeted patient populations. S95021 was expressed in CHOZN GS-/- cells, purified by chromatography and characterized by using electrophoresis, size exclusion chromatography and liquid chromatography-mass spectrometry. High purity S95021 was obtained as a monomeric entity comprising different charge variants mainly due to N-glycosylation. Surface plasmon resonance kinetics experiments showed strong association rates with all IFN-α subtypes and estimated KDs below picomolar values. Pan-IFN-α-binding properties were confirmed by immunoprecipitation assays and neutralization capacity with reporter HEK-Blue IFN-α/β cells. S95021 was IFN-α-selective and exhibited superior potency and broader neutralization profile when compared with the benchmark anti-IFN-α mAbs rontalizumab and sifalimumab. STAT-1 phosphorylation and the type I IFN gene signature induced in human peripheral blood mononuclear cells by recombinant IFN-α subtypes or plasmas from selected autoimmune patients were efficiently reduced by S95021 in a dose-dependent manner. Together, our results show that S95021 is a new potent, selective and pan IFN-α-neutralizing mAb. It is currently further evaluated as a valid therapeutic candidate in selected autoimmune diseases in which the IFN-α pro-inflammatory pathway is dysregulated.
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Affiliation(s)
- Fanny Duguet
- Center for Therapeutic Innovation, Immuno-inflammatory Disease, Institut de Recherches Servier, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
| | - Céline Ortega-Ferreira
- Center of Biotechnological Expertise, Institut de Recherches Servier, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
| | - Benjamin Fould
- Center of Biotechnological Expertise, Institut de Recherches Servier, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
| | - Hélène Darville
- Center of Biotechnological Expertise, Institut de Recherches Servier, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
| | - Sylvie Berger
- Center of Biotechnological Expertise, Institut de Recherches Servier, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
| | - Agnès Chomel
- Center of Biotechnological Expertise, Institut de Recherches Servier, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
| | - Grégory Leclerc
- Center of Biotechnological Expertise, Institut de Recherches Servier, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
| | - Kai Kisand
- Molecular Pathology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila 19, Tartu, 50411, Estonia
- ImmunoQure AG, Königsallee 90, 2012, Düsseldorf, Germany
| | - Liis Haljasmägi
- Molecular Pathology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila 19, Tartu, 50411, Estonia
| | - Adrian C. Hayday
- ImmunoQure AG, Königsallee 90, 2012, Düsseldorf, Germany
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King’s College London, The Francis Crick Institute, London, UK
| | - Emiko Desvaux
- Center for Therapeutic Innovation, Immuno-inflammatory Disease, Institut de Recherches Servier, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
| | - Emmanuel Nony
- Center of Biotechnological Expertise, Institut de Recherches Servier, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
| | - Philippe Moingeon
- Center for Therapeutic Innovation, Immuno-inflammatory Disease, Institut de Recherches Servier, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
| | - Frédéric De Ceuninck
- Center for Therapeutic Innovation, Immuno-inflammatory Disease, Institut de Recherches Servier, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
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Ciurtin C, Cho Y, Al-Obaidi M, Jury EC, Price EJ. Barriers to translational research in Sjögren's syndrome with childhood onset: challenges of recognising and diagnosing an orphan rheumatic disease. THE LANCET. RHEUMATOLOGY 2021; 3:e138-e148. [PMID: 38279369 DOI: 10.1016/s2665-9913(20)30393-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 01/28/2024]
Abstract
Sjögren's syndrome was considered for many years a disease of adulthood, characterised by immune infiltration of exocrine glands, leading to dryness (eg, dry mouth and eyes), which is a cardinal symptom. As of the last 20 years, it became apparent that although the disease is very rare in children, its clinical presentation differs from that of adults, posing substantial challenges to the recognition, diagnosis, and classification of patients with childhood-onset Sjögren's syndrome. This Viewpoint explores comparative classification criteria for children (not validated) and adults with Sjögren's syndrome, as well as differences in the clinical presentation of childhood-onset versus adult-onset Sjögren's syndrome, offering ideas about how we can improve the diagnosis of Sjögren's syndrome in children. A review of the role of medical history and clinical assessment, serology, glandular function assessment, and imaging, as well as salivary and lachrymal gland biopsy in the diagnosis of children with Sjögren's syndrome is included. Additionally, we provide suggestions about further research and registry data collection that is required to address the unmet needs of these patients.
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Affiliation(s)
- Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, London, UK; Department of Rheumatology, University College London Hospital NHS Trust, London, UK.
| | - Youna Cho
- University College London Medical School, University College London, London, UK
| | - Muthana Al-Obaidi
- Department of Paediatric Rheumatology, Great Ormond Hospital for Children NHS Trust, London, UK
| | - Elizabeth C Jury
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
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Abstract
Sjogren's syndrome is an autoimmune connective tissue disease targeting the exocrine glands and frequently affecting the respiratory system. The pulmonary disease is the most important extra-glandular manifestation as it carries most of the morbidity and mortality. Typically, it affects the small airways ranging from mild to severe respiratory symptoms. The upper airways are also commonly involved, predisposing sinusitis to occur more frequently than in the normal population. Lymphocytic interstitial pneumonia was initially thought to be the prevailing parenchymal disease; however, multiple cohorts report non-interstitial pneumonia to be the most frequent subtype of interstitial lung disease. In the review of high-resolution computed tomography scans, cystic lesions are commonly found and associate with both the small airways and parenchymal disease. Under their presence, amyloidosis or lymphomas should be considered in the differential. Overall, Sjogren's syndrome has a higher risk for lymphoma, and in lungs this condition should be thought of, especially when the images reveal pulmonary nodularity, lymphocytic interstitial pneumonia and lymphadenopathy. Although, pulmonary artery hypertension was traditionally and exceptionally linked with Sjogren's syndrome, together with systemic lupus erythematosus, they are now acknowledged to be the most common pulmonary vascular disease in east Asian populations, even over patients with systemic sclerosis. Although there are no controlled prospective trials to treat pulmonary disease in Sjogren's syndrome, the mainstay treatment modality still falls on glucocorticoid therapy (systemic and inhaled), combined with immune modulators or alone. Most of the evidence sustains successful outcomes based on reported cases or case series.
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Alunno A, Leone MC, Bartoloni E, Gerli R, Carubbi F. Novel insights on lymphoma and lymphomagenesis in primary Sjögren's Syndrome. Panminerva Med 2020; 63:491-498. [PMID: 33274907 DOI: 10.23736/s0031-0808.20.04079-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Primary Sjögren's Syndrome (pSS) is a systemic autoimmune disease characterized by a chronic inflammatory process mainly affecting the exocrine glands but also burdened by a wide range of extraglandular manifestations. Non-Hodgkin lymphoma (NHL) is the most severe pSS complication worsening disease prognosis. We summarized original articles published between April 2018 and May 2020 on this topic aiming to highlight novelties on lymphoma and lymphomagenesis. Results have been grouped by epidemiology, etiopathogenesis and predictors of lymphoma. NHL is the most severe complication of pSS and occurs in around 5-10% of patients. Over the last two years, several clinical, serological, and histopathological features have been proposed as predictive for lymphoma in pSS patients, allowing early diagnosis and consequently, better management and prognosis. Individual monitoring for disease activity and possible lymphoma development is a central clue in the evaluation of pSS patients.
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Affiliation(s)
- Alessia Alunno
- Unit of Rheumatology, University of Perugia, Perugia, Italy
| | - Maria C Leone
- Unit of Rheumatology, S. Maria Hospital, Terni, Italy
| | | | - Roberto Gerli
- Unit of Rheumatology, University of Perugia, Perugia, Italy
| | - Francesco Carubbi
- Unit of COVID-19 Medicine, Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy -
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Verstappen GM, Kroese FGM, Bootsma H. Stumbles in Sjögren's syndrome drug development: where to look for the next big leap? Expert Rev Clin Immunol 2020; 16:1043-1045. [PMID: 33196342 DOI: 10.1080/1744666x.2021.1831915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Gwenny M Verstappen
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Frans G M Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
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Thomsen H, Li X, Sundquist K, Sundquist J, Försti A, Hemminki K. Familial associations for rheumatoid autoimmune diseases. Rheumatol Adv Pract 2020; 4:rkaa048. [PMID: 33241174 PMCID: PMC7673201 DOI: 10.1093/rap/rkaa048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/17/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Previous studies have shown a familial component in RA and in some other rheumatic autoimmune diseases (RAIDs), but because of the different study designs the risk estimates for familial risks differ extensively. The objective of this study is to identify familial components for RAIDs. METHODS We collected data on patients diagnosed in Swedish hospitals with RA, AS, PM/DM, SS, SLE and SSc (and scleroderma) and calculated familial standardized incidence ratios (SIRs) for each of these (concordant) and between them (discordant). RESULTS The combined number of RAID patients in the offspring population (for whom SIRs were calculated) was 71 544, and in the whole population the number was 152 714, accounting for 19.8% of all autoimmune diseases in Sweden. AS showed the highest concordant familial risk of 18.42, followed by SLE (14.04), SS (8.63), SSc (4.50), PM/DM (4.03) and RA (3.03). There was no sex difference in SIRs. Risks for AS and SLE were 80.28 and 19.53 for persons whose parents and siblings were affected. Discordant risks were far lower than concordant risks, but they were significant for RA with all the other five RAIDs, for SLE and SSc with four RAIDs, for AS and SS with three RAIDs and for PM/DM with two RAIDs, attesting to extensive polyautoimmunity between RAIDs. CONCLUSION The derived familial risks in this nationwide family study on medically diagnosed RAID are compatible with emerging evidence on the polygenic background of these complex diseases. Novel genetic pathways offer new therapeutic targets that alleviate disease onset optimally in high-risk familial patients and others.
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Affiliation(s)
- Hauke Thomsen
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Bioinformatics and Biostatistics Working Section, GeneWerk GmbH, Heidelberg, Germany
- Correspondence to: Hauke Thomsen, GeneWerk GmbH, Im Neuenheimer Feld 582, D-69120 Heidelberg, Germany. E-mail:
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Hopp Children's Cancer Center (KiTZ), German Cancer Research Center (DKFZ)
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK)
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, Pilsen, Czech Republic
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