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Shalata W, Yakobson A, Cohen AY, Goldstein I, Saleh OA, Dudnik Y, Rouvinov K. Unexpected Adverse Events of Immune Checkpoint Inhibitors. Life (Basel) 2023; 13:1657. [PMID: 37629514 PMCID: PMC10455121 DOI: 10.3390/life13081657] [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: 06/26/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
The introduction of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment standards and significantly enhanced patient prognoses. However, the utilization of these groundbreaking therapies has led to the observation and reporting of various types of adverse events, commonly known as immune-related adverse events (irAEs). In the following article, we present four patients who encountered uncommon toxicities induced by ICIs. The first patient was a 59-year-old female diagnosed with stage 4 lung adenocarcinoma. She received immunotherapy (pembrolizumab) together with chemotherapy and subsequently developed autonomic neuropathy (AN). The next two patients also received chemo-immunotherapy (pembrolizumab) and were both 63-year-old males with stage 4 lung adenocarcinoma. One of the two experienced palmoplantar keratoderma, while the other presented with Reiter's syndrome (urethritis, conjunctivitis and arthritis). The 4th patient, an 80-year-old male with stage 4 squamous cell carcinoma of the lung, received chemo-immunotherapy (pembrolizumab) and developed myasthenia gravis.
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Affiliation(s)
- Walid Shalata
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben-Gurion University, Beer Sheva 84105, Israel
| | - Alexander Yakobson
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben-Gurion University, Beer Sheva 84105, Israel
| | - Aharon Y. Cohen
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben-Gurion University, Beer Sheva 84105, Israel
| | - Iris Goldstein
- Department of Neurology, Faculty of Health Sciences, Soroka Medical Center, Ben-Gurion University, Beer Sheva 84105, Israel
| | - Omar Abu Saleh
- Department of Dermatology and Venereology, The Emek Medical Centre, Afula 18341, Israel
| | - Yulia Dudnik
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben-Gurion University, Beer Sheva 84105, Israel
| | - Keren Rouvinov
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben-Gurion University, Beer Sheva 84105, Israel
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2
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Jhang JJ, Chen SJ, Huang CP, Chen HY, Lin WC, Chen YH, Chen WC. A Case Report of Intratesticular Hematoma in a Patient with Reiter's Syndrome. Diagnostics (Basel) 2023; 13:1993. [PMID: 37370888 DOI: 10.3390/diagnostics13121993] [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] [Received: 04/03/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
We present a case of a 28-year-old male patient with a spontaneous intratesticular hematoma. He had no history of trauma but experienced sudden onset of painful swelling in his right testis. Initially, testicular malignancy was suspected. The tumor marker of testis, including alfa-fetoprotein, lactic dehydrogenase, and β-human chorionic gonadotropin, was within normal range. The patient had been diagnosed with Reiter's syndrome at the age of 20 and had been treated with sulfasalazine, non-steroidal anti-inflammatory drugs, and acetaminophen for eight years. Various imaging techniques before operation planning, including ultrasonography and computed tomography, revealed a hematoma that accounted for 32% of the testicular volume. During the waiting period before the operation, the patient was diagnosed with a hematoma and avoided a possible diagnosis of malignancy. Follow-up imaging with computed tomography and magnetic resonance imaging confirmed the presence of an intratesticular hematoma that had decreased in size. Since no other related factor contributed to this hematoma, and considering the possible hematological side effects of sulfasalazine, we suggest that this may be a rare side effect of sulfasalazine. Although the patient's testis was preserved, further fertility should be observed because animal studies have reported that testicular hematoma may cause fertility changes if the initial volume occupied is over 30% of the testis.
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Affiliation(s)
- Jia-Jyun Jhang
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Szu-Ju Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Huey-Yi Chen
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 404327, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
| | - Wei-Ching Lin
- Department of Medical Imaging, China Medical University Hospital, Taichung 404327, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 404327, Taiwan
| | - Wen-Chi Chen
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
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3
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Zysset-Burri DC, Morandi S, Herzog EL, Berger LE, Zinkernagel MS. The role of the gut microbiome in eye diseases. Prog Retin Eye Res 2023; 92:101117. [PMID: 36075807 DOI: 10.1016/j.preteyeres.2022.101117] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023]
Abstract
The gut microbiome is a complex ecosystem of microorganisms and their genetic entities colonizing the gastrointestinal tract. When in balanced composition, the gut microbiome is in symbiotic interaction with its host and maintains intestinal homeostasis. It is involved in essential functions such as nutrient metabolism, inhibition of pathogens and regulation of immune function. Through translocation of microbes and their metabolites along the epithelial barrier, microbial dysbiosis induces systemic inflammation that may lead to tissue destruction and promote the onset of various diseases. Using whole-metagenome shotgun sequencing, several studies have shown that the composition and associated functional capacities of the gut microbiome are associated with age-related macular degeneration, retinal artery occlusion, central serous chorioretinopathy and uveitis. In this review, we provide an overview of the current knowledge about the gut microbiome in eye diseases, with a focus on interactions between the microbiome, specific microbial-derived metabolites and the immune system. We explain how these interactions may be involved in the pathogenesis of age-related macular degeneration, retinal artery occlusion, central serous chorioretinopathy and uveitis and guide the development of new therapeutic approaches by microbiome-altering interventions for these diseases.
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Affiliation(s)
- Denise C Zysset-Burri
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland; Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008, Bern, Switzerland.
| | - Sophia Morandi
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland; Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008, Bern, Switzerland.
| | - Elio L Herzog
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland; Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Mittelstrasse 43, CH-3012, Bern, Switzerland.
| | - Lieselotte E Berger
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland; Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008, Bern, Switzerland.
| | - Martin S Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland; Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008, Bern, Switzerland.
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4
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Liu Y, He J, Jiang J, Wang Y, Liu T. Reactive Arthritis Triggered by Adalimumab and Leflunomide in a Patient with Ankylosing Spondylitis. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:2601-2605. [DOI: 10.2147/ccid.s390918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022]
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5
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Slouma M, Ben Dhia S, Dhahri R, Litaiem N, Metoui L, Gharsallah I, Louzir B. Cutaneous and rheumatological manifestations of reactive arthritis: A case report. Clin Case Rep 2022; 10:e6542. [PMCID: PMC9637938 DOI: 10.1002/ccr3.6542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/23/2022] [Accepted: 10/15/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Maroua Slouma
- Department of Rheumatology Military Hospital Tunis Tunisia
- Tunis El Manar University Tunis Tunisia
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
| | - Siwar Ben Dhia
- Department of Rheumatology Military Hospital Tunis Tunisia
- Tunis El Manar University Tunis Tunisia
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
| | - Rim Dhahri
- Department of Rheumatology Military Hospital Tunis Tunisia
- Tunis El Manar University Tunis Tunisia
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
| | - Noureddine Litaiem
- Tunis El Manar University Tunis Tunisia
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
- Department of Internal Medicine Military Hospital Tunis Tunisia
| | - Leila Metoui
- Department of Rheumatology Military Hospital Tunis Tunisia
- Tunis El Manar University Tunis Tunisia
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
| | - Imen Gharsallah
- Department of Rheumatology Military Hospital Tunis Tunisia
- Tunis El Manar University Tunis Tunisia
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
| | - Bassem Louzir
- Tunis El Manar University Tunis Tunisia
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
- Department of Internal Medicine Military Hospital Tunis Tunisia
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6
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Shakshouk H, Erickson LA, Johnson EF, Lehman JS. Updates and Proposed Diagnostic Approach to Psoriasiform Dermatoses. Adv Anat Pathol 2022; 29:263-274. [PMID: 35180737 DOI: 10.1097/pap.0000000000000333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psoriasiform dermatoses represent a wide array of skin diseases commonly encountered by clinicians and pathologists. While they may present a diagnostic challenge, thorough observation coupled with proper interpretation of subtle additional clinical or histopathologic features provide clues to the correct diagnosis. In this review, we provide updates on emerging entities and develop a systemic approach to establish the pathologic diagnosis, with emphasis on the importance of clinicopathologic correlation.
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Affiliation(s)
- Hadir Shakshouk
- Departments of Dermatology
- Department of Dermatology, Alexandria University, Alexandria, Egypt
| | - Lori A Erickson
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Emma F Johnson
- Departments of Dermatology
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Julia S Lehman
- Departments of Dermatology
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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7
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Gnesotto L, Mioso G, Alaibac M. Use of granulocyte and monocyte adsorption apheresis in dermatology (Review). Exp Ther Med 2022; 24:536. [PMID: 35837066 PMCID: PMC9257973 DOI: 10.3892/etm.2022.11463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
Adsorptive granulocyte and monocyte apheresis (GMA) is an extracorporeal treatment that selectively removes activated myeloid lineage leukocytes from peripheral blood. This technique consists of a column with cellulose acetate beads as absorptive leukocytapheresis carriers, and was initially used to treat ulcerative colitis. A literature search was conducted to extract recently published studies about the clinical efficacy of GMA in patients with different skin disorders, reporting information on demographics, clinical symptoms, treatment and clinical course. Dermatological diseases, in which GMA has been performed, include generalized pustular psoriasis, pyoderma gangrenosum, palmoplantar pustular psoriasis, Behcet's disease, Sweet's syndrome, adult-onset Still's disease, impetigo herpetiformis, reactive arthritis, acne and hidradenitis suppurativa syndrome, cutaneous allergic vasculitis and systemic lupus erythematosus. In most patients, GMA was started after the failure of conventional therapeutic options and it was helpful in the majority of cases. Based on the information summarized, GMA could be considered a valid non-pharmacological treatment option for patients with several dermatological conditions, which are difficult to treat with other pharmacological preparations.
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Affiliation(s)
- Laura Gnesotto
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
| | - Guido Mioso
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
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8
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Lebowitz E, Kim JS, Magro C. Reactive arthritis following COVID-19 vaccination with BNT162b2. JAAD Case Rep 2022; 24:108-111. [PMID: 35571454 PMCID: PMC9090820 DOI: 10.1016/j.jdcr.2022.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Emily Lebowitz
- Department of Dermatology, Weill Cornell Medicine, New York
| | | | - Cynthia Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York
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9
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Chang CH, Huang YH. A young man with red eye. BMJ 2022; 376:e064287. [PMID: 35264333 DOI: 10.1136/bmj-2021-064287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Chun-Hsiang Chang
- Department of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Hsun Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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10
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Martínez-Ramos S, Rafael-Vidal C, Pego-Reigosa JM, García S. Monocytes and Macrophages in Spondyloarthritis: Functional Roles and Effects of Current Therapies. Cells 2022; 11:cells11030515. [PMID: 35159323 PMCID: PMC8834543 DOI: 10.3390/cells11030515] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 01/27/2023] Open
Abstract
Spondyloarthritis (SpA) is a family of chronic inflammatory diseases, being the most prevalent ankylosing spondylitis (AS) and psoriatic arthritis (PsA). These diseases share genetic, clinical and immunological features, such as the implication of human leukocyte antigen (HLA) class I molecule 27 (HLA-B27), the inflammation of peripheral, spine and sacroiliac joints and the presence of extra-articular manifestations (psoriasis, anterior uveitis, enthesitis and inflammatory bowel disease). Monocytes and macrophages are essential cells of the innate immune system and are the first line of defence against external agents. In rheumatic diseases including SpA, the frequency and phenotypic and functional characteristics of both cell types are deregulated and are involved in the pathogenesis of these diseases. In fact, monocytes and macrophages play key roles in the inflammatory processes characteristics of SpA. The aim of this review is analysing the characteristics and functional roles of monocytes and macrophages in these diseases, as well as the impact of different current therapies on these cell types.
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Affiliation(s)
- Sara Martínez-Ramos
- Rheumatology & Immuno-Mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (S.M.-R.); (C.R.-V.); (J.M.P.-R.)
- Rheumatology Department, University Hospital Complex of Vigo, 36214 Vigo, Spain
| | - Carlos Rafael-Vidal
- Rheumatology & Immuno-Mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (S.M.-R.); (C.R.-V.); (J.M.P.-R.)
- Rheumatology Department, University Hospital Complex of Vigo, 36214 Vigo, Spain
| | - José M. Pego-Reigosa
- Rheumatology & Immuno-Mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (S.M.-R.); (C.R.-V.); (J.M.P.-R.)
- Rheumatology Department, University Hospital Complex of Vigo, 36214 Vigo, Spain
| | - Samuel García
- Rheumatology & Immuno-Mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (S.M.-R.); (C.R.-V.); (J.M.P.-R.)
- Rheumatology Department, University Hospital Complex of Vigo, 36214 Vigo, Spain
- Correspondence: ; Tel.: +34-986-217-463
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11
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Opara NU. Osteomyelitis infection disguised as Reiter's syndrome in a child: A case report. Clin Case Rep 2021; 9:e05219. [PMID: 34963806 PMCID: PMC8677886 DOI: 10.1002/ccr3.5219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022] Open
Abstract
Reiter's syndrome (reactive arthritis) should always prompt a thorough clinical investigation of a potentially more serious disease condition in every pediatric patient and adults. It should always be regarded as a warning sign and not a disease. This is a case of a 16-year-old African boy with osteomyelitis presenting with symptoms of reactive arthritis (Reiter's syndrome).
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Affiliation(s)
- Nnennaya U. Opara
- Department of Emergency MedicineCharleston Area Medical CenterCharlestonWest VirginiaUSA
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12
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Applicability of the Geographic Tongue Area and Severity Index among Healthcare Professionals: A Cross-Sectional Clinical Validation of a Newly Developed Geographic Tongue Scoring System. J Clin Med 2021; 10:jcm10235493. [PMID: 34884195 PMCID: PMC8658609 DOI: 10.3390/jcm10235493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 02/08/2023] Open
Abstract
Geographic tongue (GT) is a chronic condition of unknown aetiology, with no defined parameters to establish the protocol for evidence-based management. Validation of a newly developed and proposed clinical index to assess the severity of GT could assist in its diagnosis, especially in cases associated with systemic dermatological diseases in the form of psoriasis. OBJECTIVE To verify the applicability of the geographic tongue area and severity index (GTASI). This involved healthcare professionals from different specialties to evaluate the usefulness of the GTASI in supporting GT classification, as well as the follow-up process. METHODS One hundred cases of previously diagnosed GT were initially evaluated by three independent, experienced researchers/clinicians to obtain a standardised classification baseline. Subsequently, nine cases of GT were selected, three cases for each category-mild, moderate and severe. These stages were professionally evaluated by 51 healthcare professionals from three groups: 17 dentists (33%), 22 oral medicine specialists (43%) and 12 specialist dermatologists (24%) during a cross-sectional survey. RESULTS The quantitative and qualitative assessment based on experts' opinions in the cross-sectional survey demonstrated an acceptable, similar level of GT clinical diagnosis (p > 0.05), with coherence between the various groups of professionals critically appraising the GTASI. An apparent divergence was observed for the moderate GT category, as well as in the group of less experienced evaluators. CONCLUSION Whilst the validation of GTASI applicability was successfully executed, the general dental practitioners, specialists in oral medicine and dermatologists were equally capable of correct GT diagnosis and appropriately rating its severity. These coherent results were especially replicated among the experienced clinicians. The validation of the newly proposed index confirmed its reliability as a feasible instrument in oral medicine, with the prospect of its wider implementation in clinical practice.
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Abstract
The prevalence of oral ulcers in children is reported to be 9%, however diagnosis of oral lesions can be challenging, being an unspecific symptom of several diseases. Differential diagnosis can range from classic infectious disease of childhood (e.g. herpangina, hand-foot-and-mouth-disease) over nutritional deficiencies, gastrointestinal disorders, inflammations (e.g. pemphigus vulgaris, lichen planus, mucous membrane pemphigoid) to side effects of medications (Stevens-Johnson Syndrome) or chronic dieseases (e.g. sarcoidosis, systemic Lupus erythematodes, familial Mediterrenean fever). Therefore, children with oral ulcers are treated by many different specialists such as dentists, family doctors, paediatricians, rheumatologists, haematologists, gastroenterologists and otorhinolaryngologists.A systematic literature search and a narrative literature review about the potential 48 diseases connected to oral ulcers were performed. According to the duration of symptoms and size of the lesions, a tabular overview was created to support the clinician in making a correct diagnosis, additionally different treatment options are presented.
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Affiliation(s)
- Corinne Légeret
- University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
- University Children’s Hospital Basel, Spitalstrasse 31, 4055 Basel, Switzerland
| | - Raoul Furlano
- University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
- University Children’s Hospital Basel, Spitalstrasse 31, 4055 Basel, Switzerland
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14
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Shokraee K, Moradi S, Eftekhari T, Shajari R, Masoumi M. Reactive arthritis in the right hip following COVID-19 infection: a case report. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2021; 7:18. [PMID: 34130744 PMCID: PMC8204059 DOI: 10.1186/s40794-021-00142-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND SARS-COV-2 usually presents with respiratory symptoms but can have various other manifestations and sequelae. One of the rare complications of COVID-19 infection is Reactive Arthritis. While this complication is more likely to occur following sexually transmitted or gastrointestinal infections, other infections such as COVID-19 can lead to reactive arthritis as well. CASE PRESENTATION Herein, we report a 58 year old woman hospitalized following COVID-19 infection and was discharged after a week. She consequently presented to the clinic ten days after her discharge, complaining of walking difficulties and radiating pain in her right hip. After ultrasound and MRI, she was diagnosed with reactive arthritis inflammation in the hip's neck. Other known microorganisms responsible for reactive arthritis were ruled out before attributing it to the earlier COVID-19 infection. Clinical symptoms were resolved after being treated using a combination of indomethacin and depot methyl-prednisolone for 14 days. CONCLUSION Latest evidence shows that COVID-19 can lead to autoimmune reactions, including reactive arthritis. Further attention should be paid to symptoms occurring after an episode of infection with COVID-19 to expand our understanding of the disease and the symptoms with which it can manifest.
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Affiliation(s)
| | - Soroush Moradi
- Student Research Committee, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Eftekhari
- Clinical Research and Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Beheshti Blvd, Qom, Iran
| | - Rasoul Shajari
- Clinical Research and Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Beheshti Blvd, Qom, Iran
| | - Maryam Masoumi
- Clinical Research and Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Beheshti Blvd, Qom, Iran.
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15
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Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview. ACTA ACUST UNITED AC 2021; 57:medicina57030271. [PMID: 33809659 PMCID: PMC8002330 DOI: 10.3390/medicina57030271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022]
Abstract
Many systemic (infective, genetic, autoimmune, neoplastic) diseases may involve the oral cavity and, more generally, the soft and hard tissues of the head and neck as primary or secondary localization. Primary onset in the oral cavity of both pediatric and adult diseases usually represents a true challenge for clinicians; their precocious detection is often difficult and requires a wide knowledge but surely results in the early diagnosis and therapy onset with an overall better prognosis and clinical outcomes. In the current paper, as for the topic of the current Special Issue, the authors present an overview on the most frequent clinical manifestations at the oral and maxillo-facial district of systemic disease.
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16
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Pepin ME, Chan D. Applying a clinical decision-making model to a patient with severe shoulder pain ultimately diagnosed as neuralgic amyotrophy. Physiother Theory Pract 2020; 38:1078-1089. [PMID: 32892675 DOI: 10.1080/09593985.2020.1815260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE AND PURPOSE Shoulder symptoms are often encountered in physical therapy and a myriad of etiologies can cause these symptoms, either locally or remotely. The purpose of this case report is to describe the physical therapist's differential diagnostic process for a patient with acute and severe onset of shoulder pain. Case Description: The patient was a 37-year-old female with sudden onset of right shoulder pain that awakened her at night. Pain was associated with decreased range of motion and shoulder weakness. Faced with an uncertain diagnosis, the physical therapist followed a systematic approach to clinical decision-making. Outcomes: Neuralgic amyotrophy was the primary diagnostic hypothesis but other causes of shoulder pain could not be ruled out. Conclusion: The clinical decision-making process helped the physical therapist narrow down the differential diagnosis list and make a decision to send the patient for further testing. Magnetic resonance imaging and electromyogram confirmed the diagnosis of neuralgic amyotrophy.
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Affiliation(s)
- Marie-Eve Pepin
- Physical Therapy Program, Wayne State University, Detroit, MI, USA
| | - Derek Chan
- Center for Athletic Medicine, Henry Ford Health Care System, Detroit, MI, USA
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Abstract
Reactive arthritis, also known as Reiter syndrome, is a spondyloarthropathy that typically follows a urogenital or gastrointestinal infection, and is characterized by conjunctivitis, urethritis, and arthritis. The frequency of reactive arthritis in the United States is estimated at 3.5 to 5 patients per 100,000. Physician assistants (PAs) can manage the condition; therefore, they should be familiar with the disease's signs and symptoms, diagnostic criteria, and treatment regimens. Without proper management, reactive arthritis can progress to a chronic destructive arthritis. Prompt recognition of the condition is key to early intervention and a better patient outcome with fewer complications.
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Picciani BLS, Santos LR, Teixeira-Souza T, Dick TNA, Carneiro S, Pinto JMN, Avelleira JCR, Azulay DR, Luiz RR, de Sousa Gonzaga HF. Geographic tongue severity index: A new and clinical scoring system. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:330-338. [PMID: 31974034 DOI: 10.1016/j.oooo.2019.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/03/2019] [Accepted: 12/18/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study was designed to develop a severity index for geographic tongue (GT) based on the Psoriasis Area and Severity Index. STUDY DESIGN This cross-sectional observational study, with a retrospective sample of 100 participants, included 5 photographs of each case (dorsum, right border, left border, apex, and lingual belly), totaling 500 images of GT, which were evaluated by 3 experienced researchers in the area of GT and psoriasis. At the end of the analysis, GT was classified as mild, moderate, or severe. RESULTS Of the 100 patients, white women were most prevalent, accounting for 53% of cases. Of these participants, 34% had psoriasis and 24% reported a burning sensation. The values of the proposed new index obtained at time 1 (0.855) and time 2 (0.819) presented low variability, and intra- and interrater correlations produced satisfactory values ranging from 0.950 to 0.898 and 0.898 to 0.850, respectively. CONCLUSION The new index, Geographic Tongue Area and Severity Index, provides a better characterization of GT by assessing the severity of lesions in an easy and reliable manner, and it is indicated as a first step for interpreting the condition in clinical routines and clinical trials.
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Affiliation(s)
| | - Lílian Rocha Santos
- Graduate Program in Pathology, School of Medicine, Fluminense Federal University, Niterói, RJ, Brazil
| | - Thays Teixeira-Souza
- Graduate Program in Pathology, School of Medicine, Fluminense Federal University, Niterói, RJ, Brazil
| | - Thaylla Núñez Amin Dick
- Graduate Program in Pathology, School of Medicine, Fluminense Federal University, Niterói, RJ, Brazil
| | - Sueli Carneiro
- Sector of Dermatology, Medical Clinic Department, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
| | | | | | - David Rubem Azulay
- Institute of Dermatology, Santa Casa da Misericórdia, Rio de Janeiro, RJ, Brazil
| | - Ronir Raggio Luiz
- Institute of Public Health Studies, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
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Lee EY, Koh MJA, Foong AYW, Teh KL, Arkachaisri T. A penile rash in a child with arthritis. Pediatr Dermatol 2020; 37:202-203. [PMID: 31997443 DOI: 10.1111/pde.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Elis Y Lee
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | | | - Alice Y W Foong
- Dermatology Service, KK Women's & Children's Hospital, Singapore
| | - Kai Liang Teh
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Thaschawee Arkachaisri
- Department of Paediatric Subspecialties, Rheumatology and Immunology Service, KK Women's and Children's Hospital, Singapore
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Thomsen H, Li X, Sundquist K, Sundquist J, Försti A, Hemminki K. Familial risks between Graves disease and Hashimoto thyroiditis and other autoimmune diseases in the population of Sweden. J Transl Autoimmun 2020; 3:100058. [PMID: 32743538 PMCID: PMC7388361 DOI: 10.1016/j.jtauto.2020.100058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 02/08/2023] Open
Abstract
Genetic and family studies have indicated that Graves disease and Hashimoto thyroiditis have a heritable component which appears to be shared to some extend also with some other autoimmune diseases (AIDs). In the present nation-wide study we describe familial risk for Graves disease and Hashimoto thyroiditis identified from the Swedish Hospital Discharge Register (years 1964 through 2012) and the Outpatient Register (2001 through 2012). Family relationships were obtained from the Multigeneration Register and cancers from the Cancer Registry. Familial standardized incidence ratios (SIRs) were calculated for 29,005 offspring with Graves disease and for 25,607 offspring with Hashimoto thyroiditis depending on any of 43 AIDs in parents or siblings. The concordant familial risks for Graves disease and Hashimoto thyroiditis were 3.85 and 4.75, higher for men than for women. The familial risks were very high (11.35, Graves and 22.06, Hashimoto) when both a parent and a sibling were affected. Spousal familial risks were higher for Hashimoto thyroiditis (1.98/1.93) than for Graves disease (1.48/1.50). For Graves disease, 24 discordant AIDs showed a significant association; for Hashimoto thyroiditis, 20 discordant associations were significant. All significant discordant associations were positive for the two thyroid AIDs, with the exception of Hashimoto thyroiditis with Reiter disease. Overall 8 associations were significant only for Graves disease and 6 Hashimoto thyroiditis. The overall high concordant familial risks for Graves disease and Hashimoto thyroiditis suggest a strong genetic contribution to the familial risk. Significant familial associations among more than half of the 43 AIDs attest to the extensive polyautoimmunity among thyroid AIDs.
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Affiliation(s)
- Hauke Thomsen
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- GeneWerk GmbH, 69120, Heidelberg, Germany
- Corresponding author. Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany.
| | - 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 94305-5705, USA
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Hopp Children’s Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany
- Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, 30605, Pilsen, Czech Republic
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Krakowski P, Gerkowicz A, Pietrzak A, Krasowska D, Jurkiewicz A, Gorzelak M, Schwartz RA. Psoriatic arthritis - new perspectives. Arch Med Sci 2019; 15:580-589. [PMID: 31110522 PMCID: PMC6524178 DOI: 10.5114/aoms.2018.77725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/18/2018] [Indexed: 01/04/2023] Open
Abstract
Psoriatic arthritis (PsA) is a seronegative arthropathy with many clinical manifestations, and it may affect nearly a half of patients with psoriasis. PsA should be diagnosed as early as possible to slow down joint damage and progression of disability. To improve the diagnosis of PsA, physicians should look for peripheral inflammatory pain, axial inflammatory pain, dactylitis, and buttock and sciatic pain. In most patients with PsA, pharmacologic treatment with non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and biologic agents is effective. However, when pharmacological treatment fails, patients with PsA may benefit from orthopedic surgery, which can improve both joint function and quality of life. Total hip arthroplasty, total knee arthroplasty, and arthroscopic synovectomy of the knee are the most common surgical procedures offered to patients with PsA. The management of PsA requires the care of a multidisciplinary team, which should include dermatologists, rheumatologists, physiotherapists, and orthopedic surgeons.
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Affiliation(s)
| | - Agnieszka Gerkowicz
- Chair and Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Aldona Pietrzak
- Chair and Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Dorota Krasowska
- Chair and Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Andrzej Jurkiewicz
- Orthopaedic Department, Independent Public District Hospital, Łęczna, Poland
| | - Mieczysław Gorzelak
- Chair and Department of Rehabilitation and Orthopedics, Medical University of Lublin, Lublin, Poland
| | - Robert A. Schwartz
- Dermatology Rutgers New Jersey Medical School Rutgers, The State University of New Jersey, USA
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What's causing this patient's hip pain and eye irritation? JAAPA 2019; 30:55-56. [PMID: 28538433 DOI: 10.1097/01.jaa.0000516359.42244.c7] [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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Bragazzi NL, Damiani G, Martini M. From Rheumatology 1.0 to Rheumatology 4.0 and beyond: the contributions of Big Data to the field of rheumatology. Mediterr J Rheumatol 2019; 30:3-6. [PMID: 31938766 PMCID: PMC6959971 DOI: 10.31138/mjr.30.1.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Nicola Luigi Bragazzi
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Young Dermatologists Italian Network (YDIN), GISED, Bergamo, Italy
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
| | - Mariano Martini
- Department of Health Sciences, Section of Medical History and Ethics, University of Genoa, Italy
- UNESCO CHAIR Anthropology of Health - Biosphere and Healing System, University of Genoa, Italy
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Circinate oral and genital mucositis. JAAD Case Rep 2018; 4:622-624. [PMID: 30094300 PMCID: PMC6077180 DOI: 10.1016/j.jdcr.2018.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Nature versus nurture in the spectrum of rheumatic diseases: Classification of spondyloarthritis as autoimmune or autoinflammatory. Autoimmun Rev 2018; 17:935-941. [PMID: 30005857 DOI: 10.1016/j.autrev.2018.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 02/08/2023]
Abstract
Spondyloarthritides (SpA) include inflammatory joint diseases with various clinical phenotypes that may also include the axial skeleton and/or entheses. SpA include psoriatic arthritis, reactive arthritis, enteropathic arthritis and ankylosing spondylitis; the latter is frequently associated with extra-articular manifestations, such as uveitis, psoriasis, and inflammatory bowel disease. SpA are associated with the HLA-B27 allele and recognize T cells as key pathogenetic players. In contrast to other rheumatic diseases, SpA affect women and men equally and are not associated with detectable serum autoantibodies. In addition, but opposite to rheumatoid arthritis, SpA are responsive to treatment regimens including IL-23 or IL-17-targeting biologics, yet are virtually unresponsive to steroid treatment. Based on these differences with prototypical autoimmune diseases, such as rheumatoid arthritis or connective tissue diseases, SpA may be better classified among autoinflammatory diseases, with a predominant innate immunity involvement. This would rank SpA closer to gouty arthritis and periodic fevers in the spectrum of rheumatic diseases, as opposed to autoimmune-predominant diseases. We herein provide available literature on risk factors associated with SpA in support of this hypothesis with a specific focus on genetic and environmental factors.
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Abstract
Individuals with cutaneous diseases of the external genitalia often initially present to their primary care provider. When present, these conditions may be associated with considerable physical symptoms and psychological distress. Dermatoses affecting the genitals may be of infectious, inflammatory, or neoplastic cause, and can be processes confined to the genitalia or a manifestation of a more widespread dermatologic condition. This article provides a guide to recognizing and managing common genital dermatoses and when to refer for specialist opinion.
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Affiliation(s)
- Emily Yura
- Department of Urology, Northwestern University, Tarry Building Room 16-703, 300 East Superior Street, Chicago, IL 60611, USA
| | - Sarah Flury
- Department of Urology, Northwestern University, Tarry Building Room 16-703, 300 East Superior Street, Chicago, IL 60611, USA.
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27
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Chua-Aguilera CJ, Möller B, Yawalkar N. Skin Manifestations of Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, and Spondyloarthritides. Clin Rev Allergy Immunol 2017; 53:371-393. [DOI: 10.1007/s12016-017-8632-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
During complete inspection of skin a variety of penile skin alterations may be found. Not all dermatological findings have clinical relevance. Pearly papules and heterotopic sebaceous glands are physiological variations. Most penile melanotic macules, angiokeratoma, fibroma and angioma have not to be treated. However, other more severe diseases such as malignant skin lesions (erythroplasia of Queyrat), infectious disease (human papillomavirus-induced penile warts) or systemic skin diseases (psoriasis) may be detected. Since patients are alarmed by genital skin lesions and their sexuality may be affected, the initiation of adequate therapy is an important task for urologists and dermatologists.
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Leone A, Cassar-Pullicino VN, D'Aprile P, Nasuto M, Guglielmi G. Computed Tomography and MR Imaging in Spondyloarthritis. Radiol Clin North Am 2017; 55:1009-1021. [PMID: 28774445 DOI: 10.1016/j.rcl.2017.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article provides an overview of the computed tomography (CT) and MR imaging appearances suggestive of spondyloarthritis, with a specific emphasis on the MR imaging findings of vertebral and sacroiliac involvement, and presents relevant clinical features that assist early diagnosis. CT is a sensitive imaging modality for the assessment of structural bone changes, but its clinical utility is limited. MR imaging is the modality of choice for early diagnosis, because of its ability to depict inflammation long before structural bone damage occurs, for monitoring of disease activity, and for evaluating therapeutic response.
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Affiliation(s)
- Antonio Leone
- Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, Catholic University School of Medicine, Largo A. Gemelli 1, Rome 00168, Italy.
| | - Victor N Cassar-Pullicino
- Department of Diagnostic Imaging, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Gobowen, Oswestry SY10 7AG, UK
| | - Paola D'Aprile
- Department of Radiology, Ospedale San Paolo, Via Caposcardicchio, Bari 70123, Italy
| | - Michelangelo Nasuto
- Department of Radiology, University of Foggia, Viale L. Pinto 1, Foggia 71100, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale L. Pinto 1, Foggia 71100, Italy; Casa Sollievo della Sofferenza, Scientific Institute Hospital, Viale Cappuccini 1, San Giovanni Rotondo, Foggia 71013, Italy
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30
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Köhn FM, Schultheiss D, Krämer-Schultheiss K. [Dermatological diseases of the external male genitalia : Part 1]. Urologe A 2017; 55:829-42. [PMID: 27250104 DOI: 10.1007/s00120-016-0136-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The urological examination of male patients includes an inspection of the external genitalia whereby a variety of dermatological alterations can be found. Not all dermatological findings are of clinical relevance. Pearly penile papules and heterotopic sebaceous glands are examples of normal physiological variations. Most penile melanotic macules, angiokeratomas, fibromas and angiomas do not have to be treated; however, penile skin lesions may also be symptoms of other diseases, such as circinate balanitis in Reiter's syndrome and multiple angiokeratomas in Fabry's disease. A typical manifestation of reactions to various drugs is the fixed drug eruption of penile skin. The differential diagnosis of various forms of balanoposthitis may be difficult and requires histological investigations (e.g. plasma cell balanitis or Zoon's disease). In contrast, the clinical manifestation of lichen sclerosus et atrophicus is easy to recognize. The clinical relevance of this disease is due to phimosis and problems during sexual intercourse.
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Affiliation(s)
- F M Köhn
- Andrologicum München, Burgstr. 7, 80331, München, Deutschland.
| | - D Schultheiss
- Gemeinschaftspraxis für Dermatologie und Urologie, Gießen, Deutschland
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Salas-Cuestas F, Bautista-Molano W, Bello-Gualtero JM, Arias I, Castillo DM, Chila-Moreno L, Valle-Oñate R, Herrera D, Romero-Sánchez C. Higher Levels of Secretory IgA Are Associated with Low Disease Activity Index in Patients with Reactive Arthritis and Undifferentiated Spondyloarthritis. Front Immunol 2017; 8:476. [PMID: 28496443 PMCID: PMC5406393 DOI: 10.3389/fimmu.2017.00476] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/05/2017] [Indexed: 01/31/2023] Open
Abstract
Introduction Both reactive arthritis (ReA) and undifferentiated spondyloarthritis (uSpA) belong to the group of autoinflammatory diseases called spondyloarthritis (SpA). Hypotheses have been proposed about a relationship between the intestinal mucosa and inflammation of joint tissues. The role of immunoglobulin IgA or secretory immunoglobulin A (SIgA) in the inflammatory and/or clinical activity of patients with SpA remains poorly understood. Objective To evaluate the status of total IgA and SIgA, and the association among the levels of SIgA, IgA, IgA anti-Chlamydia trachomatis, and anti-Shigella spp. with the disease activity measures, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, was compared in a cohort of patients with ReA and uSpA and healthy subjects. Methods This was a cross-sectional study. The serum concentrations of SIgA, IgA anti-C. trachomatis, anti-Shigella spp., and total IgA were measured. Disease activity was measured in each patient by means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Statistical analysis did include as bivariate evaluation, comparisons by Student’s t-test, Kruskal–Wallis test, and U Mann–Whitney test, with a multivariate evaluation by principal components analysis (PCA). A correlation analysis was carried out using the Pearson correlation coefficient and a linear regression models. All analysis were made using Stata version 11.2® for Windows, R V3.3.21. Statistical significance was defined a p-value <0.05. Results In all, 46 patients (78.2% men; mean age, 34.8 ± 12.3 years) and 53 controls (41% men; mean age, 32 ± 11.4 years) were included in the study. The mean serum levels of SIgA were higher in SpA patients than in healthy subjects (p < 0.001). Only SIgA levels correlated with disease activity: BASDAI (r = −0.42, p = 0.0046), ASDAS-CRP (r = −0.37, p = 0.014), and ASDAS-ESR (r = −0.45, p = 0.0021). The negative correlation between SIgA and all activity indices was higher in HLA-B27-positive patients (BASDAI r = −0.70, p = 0.0009, ASDAS-CRP r = −0.58, p = 0.0093, and ASDAS-ESR r = −0.57, p = 0.0083). The PCA showed three factors: the first component was constituted by variables referred as clinical activity measures, the second did include the serological activity markers, and the last component was compounded by age and symptoms time. Conclusion Elevated serum levels of SIgA were found to be related with low disease activity in patients with ReA and uSpA.
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Affiliation(s)
| | - Wilson Bautista-Molano
- Faculty of Medicine, Universidad Militar Nueva Granada, Bogotá, Colombia.,Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Juan M Bello-Gualtero
- Faculty of Medicine, Universidad Militar Nueva Granada, Bogotá, Colombia.,Department of Rheumatology and Immunology, Hospital Militar Central, Bogotá, Colombia
| | - Ivonne Arias
- School of Medicine, Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diana Marcela Castillo
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Lorena Chila-Moreno
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Rafael Valle-Oñate
- Faculty of Medicine, Universidad Militar Nueva Granada, Bogotá, Colombia.,Department of Rheumatology and Immunology, Hospital Militar Central, Bogotá, Colombia
| | - Daniel Herrera
- School of Medicine, Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Consuelo Romero-Sánchez
- Faculty of Medicine, Universidad Militar Nueva Granada, Bogotá, Colombia.,Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá, Colombia.,Department of Rheumatology and Immunology, Hospital Militar Central, Bogotá, Colombia
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Reiter's syndrome postintravesical Bacillus Calmette–Guérin instillations. Asian J Surg 2017; 40:163-165. [DOI: 10.1016/j.asjsur.2014.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 12/03/2013] [Accepted: 01/27/2014] [Indexed: 11/17/2022] Open
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Fatahzadeh M, Schwartz RA. Oral Psoriasis: An Overlooked Enigma. Dermatology 2016; 232:319-25. [PMID: 27035486 DOI: 10.1159/000444850] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/19/2016] [Indexed: 11/19/2022] Open
Abstract
Although cutaneous psoriasis is common, the existence of its manifestations in the oral cavity has been questioned. The definitive diagnosis of oral psoriasis can be challenging due to the variability of presentations, and overlapping clinical and histological features with a number of other conditions as well as the lack of consensus. We review oral psoriasis, noting its variable clinical appearance, delineate the differential diagnosis, and discuss management strategies.
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Affiliation(s)
- Mahnaz Fatahzadeh
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, N.J., USA
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Kumar S, Mahajan BB, Ahluwalia RS, Boparai AS. Reiter's disease: Circinate balanitis as alone preceding presentation - Successfully treated with pimecrolimus 1% cream. Indian J Sex Transm Dis AIDS 2015; 36:70-3. [PMID: 26392659 DOI: 10.4103/0253-7184.156733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Circinate balanitis, although a common manifestation of reactive arthritis, is usually an associated finding present along with the triad of arthritis, conjunctivitis, and urethritis. It is rarely seen as the only preceding manifestation of reactive arthritis. We hereby report a case of circinate balanitis as alone preceding presentation of reactive arthritis that was successfully treated with topical pimecrolimus 1% cream.
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Affiliation(s)
- Sumir Kumar
- Department of Dermatology, GGS Medical College, Faridkot, Punjab, India
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Mason E, Wray L, Foster R, Jamil MS, Guy R, McNulty A, Donovan B. Reactive arthritis at the Sydney Sexual Health Centre 1992-2012: declining despite increasing chlamydia diagnoses. Int J STD AIDS 2015; 27:882-9. [PMID: 26378192 DOI: 10.1177/0956462415598251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/01/2015] [Indexed: 01/21/2023]
Abstract
Reactive arthritis is an under-studied complication of genital Chlamydia trachomatis infection (chlamydia). We assessed trends and risk factors for reactive arthritis in a large urban sexual health clinic. Using a case-control design, data on reactive arthritis cases and controls at the Sydney Sexual Health Centre over the period 1992-2012 were extracted and multivariate analyses were performed. Trend analyses were performed on reactive arthritis diagnoses. Over the 1992-2012 study period, 85 reactive arthritis cases were diagnosed at Sydney Sexual Health Centre. The rate of reactive arthritis diagnoses decreased over time (23 in 1992-1996 to one in 2007-2011 and none in 2012), while chlamydia diagnoses increased (770 in 1992-1996 to 2257 in 2007-2011). In multivariate analysis, factors independently associated with a reactive arthritis diagnosis were: being male (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.04-10.32; p = 0.043) or born overseas (aOR 2.69; 95% CI 1.27-5.70; p = 0.010), while a past sexually transmitted infection other than chlamydia or non-gonococcal urethritis was protective (aOR 0.21; 95% CI 0.10-0.45; p < 0.001). Reactive arthritis was not associated with current or recent chlamydia infection (p = 0.184) but was marginally associated with past non-gonococcal urethritis (p = 0.080). This study found a decline in reactive arthritis diagnoses despite an increase in chlamydia diagnoses.
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Affiliation(s)
- E Mason
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
| | - L Wray
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia School of Women's and Children's Health, UNSW Australia, Sydney, NSW, Australia
| | - R Foster
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - M S Jamil
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - R Guy
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - A McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - B Donovan
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
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Generali E, Ceribelli A, Massarotti M, Cantarini L, Selmi C. Seronegative reactive spondyloarthritis and the skin. Clin Dermatol 2015; 33:531-7. [DOI: 10.1016/j.clindermatol.2015.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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40
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Spencer CH, Patwardhan A. Pediatric Rheumatology for the Primary Care Clinicians-Recognizing Patterns of Disease. Curr Probl Pediatr Adolesc Health Care 2015. [PMID: 26205101 DOI: 10.1016/j.cppeds.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This review presents a diagnostic approach to musculoskeletal and rheumatic diseases in children for primary care clinicians. The focus is on juvenile idiopathic arthritis (JIA) as the major arthritis disease in children. It is necessary to know the personalities of these JIA categories. It is also crucial to be able to recognize the common infectious, orthopedic and mechanical, malignant, genetic, other rheumatic diseases, and other miscellaneous syndromes that can mimic JIA. To do so requires recognition of clinical patterns using a thorough musculoskeletal and rheumatic history and repeated complete physical exams with emphasis on the musculoskeletal exam. It also requires targeted and limited laboratory testing with careful follow-up over time.
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Mattsson U, Warfvinge G, Jontell M. Oral psoriasis-a diagnostic dilemma: a report of two cases and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:e183-9. [PMID: 25944682 DOI: 10.1016/j.oooo.2015.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 03/08/2015] [Accepted: 03/12/2015] [Indexed: 12/29/2022]
Abstract
Whether psoriasis can manifest itself in the oral mucosa has been a matter of debate for many years. If an oral version of psoriasis exists, most researchers regard this manifestation as rare. The present report describes two patients who presented with lesions possibly related to cutaneous psoriasis. One patient had patchy erythematous lesions on the gingiva, and one had serpiginous lesions in the hard palate. We discuss these cases in relation to the existing literature, with special emphasis on the clinical and histopathologic criteria for the diagnosis of oral psoriasis.
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Affiliation(s)
- U Mattsson
- Associate Professor, Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - G Warfvinge
- Professor, Department of Oral Pathology, Faculty of Odontology, Malmö University, Sweden
| | - M Jontell
- Professor, Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Sweden
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Rastegar K, Ghalaenovi H, Babashahi A, Shayanfar N, Jafari M, Jalalian M, Fattahi A. Cervical Spine Involvement: A Rare Manifestation of Reiter's Syndrome. Open Rheumatol J 2014; 8:82-8. [PMID: 25360183 PMCID: PMC4212507 DOI: 10.2174/1874312901408010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 08/04/2014] [Accepted: 08/26/2014] [Indexed: 11/22/2022] Open
Abstract
Spine involvement is less common in Reiter's syndrome than in other seronegative spondyloarthropathies. Also, cervical spine involvement rarely occurs in Reiter's syndrome and other spondyloarthropathies. This paper reports a rare case of Reiter's syndrome in which there was cervical spine involvement that presented clinically as an atlanto-axial rotatory subluxation. Reiter's Syndrome (RS) is one of the most common types of seronegative spondyloarthropathies (SSAs) that presents clinically with a triad of symptoms, i.e., conjunctivitis, urethritis, and arthritis. This case highlighted the importance of radiographs of the lateral cervical spine and dynamic cervical imaging for all patients who have Reiter's syndrome with cervical spine symptoms to ensure that this dangerous abnormality is not overlooked.
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Affiliation(s)
- Khodakaram Rastegar
- Neurosurgery ward of Rasool-e-Akram Hospital Complex, Department of Neurosurgery, Iran University of Medical Science, Tehran, Iran
| | - Hossein Ghalaenovi
- Neurosurgery ward of Rasool-e-Akram Hospital Complex, Department of Neurosurgery, Iran University of Medical Science, Tehran, Iran
| | - Ali Babashahi
- Neurosurgery ward of Rasool-e-Akram Hospital Complex, Department of Neurosurgery, Iran University of Medical Science, Tehran, Iran
| | - Nasrin Shayanfar
- Pathology ward of Rasool-e-Akram Hospital Complex, Department of Pathology, Iran University of Medical Science, Tehran, Iran
| | - Mohammad Jafari
- Medical Doctor, Resident of Neurosurgery, Neurosurgery Ward of Rasool-e-Akram Hospital Complex, Department of Neurosurgery, Iran University of Medical Science, Tehran, Iran
| | | | - Arash Fattahi
- Medical Doctor, Resident of Neurosurgery, Neurosurgery Ward of Rasool-e-Akram Hospital Complex, Department of Neurosurgery, Iran University of Medical Science, Tehran, Iran
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Stavropoulos PG, Soura E, Kanelleas A, Katsambas A, Antoniou C. Reactive arthritis. J Eur Acad Dermatol Venereol 2014; 29:415-24. [PMID: 25199646 DOI: 10.1111/jdv.12741] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/08/2014] [Indexed: 01/20/2023]
Abstract
Reactive arthritis (ReA) is an immune-mediated seronegative arthritis that belongs to the group of spondyloarthropathies and develops after a gastrointestinal or genitourinary system infection. The condition is considered to be characterized by a triad of symptoms (conjunctivitis, arthritis and urethritis) although a constellation of other manifestations may also be present. ReA is characterized by psoriasiform dermatological manifestations that may resemble those of pustular psoriasis and, similar to guttate psoriasis, is a post-infectious entity. Also, the articular manifestations of the disorder are similar to those of psoriatic arthritis and both conditions show a correlation with HLA-B27. These facts have led several authors to suggest that there is a connection between ReA and psoriasis, listing ReA among the disorders related to psoriasis. However, the pathogenetic mechanism behind the condition is complex and poorly understood. Bacterial antigenicity, the type of host response (i.e. Th1/Th2 imbalance) and various genetic factors (i.e. HLA-B27 etc.) play an important role in the development of the disorder. It is unknown whether all the aforementioned factors are part of a mechanism that could be similar to, or share basic aspects with known psoriasis pathogenesis mechanisms.
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Affiliation(s)
- P G Stavropoulos
- 1st Department of Dermatology/University Clinic, 'Andreas Syggros' Hospital, Athens, Greece
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44
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The Spectrum of HIV-Associated Infective and Inflammatory Dermatoses in Pigmented Skin. Dermatol Clin 2014; 32:211-25. [DOI: 10.1016/j.det.2013.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bakkour W, Chularojanamontri L, Motta L, Chalmers RJG. Successful use of dapsone for the management of circinate balanitis. Clin Exp Dermatol 2014; 39:333-5. [DOI: 10.1111/ced.12299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2013] [Indexed: 11/27/2022]
Affiliation(s)
- W. Bakkour
- Dermatology Centre; Salford Royal NHS Foundation Trust; Manchester UK
| | - L. Chularojanamontri
- Department of Dermatology; Faculty of Medicine; Siriraj hospital Mahidol University; Bangkok Thailand
| | - L. Motta
- Dermatology Centre; Salford Royal NHS Foundation Trust; Manchester UK
| | - R. J. G. Chalmers
- Dermatology Centre; Salford Royal NHS Foundation Trust; Manchester UK
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Lew PP, Ngai SS, Hamidi R, Cho JK, Birnbaum RA, Peng DH, Varma RK. Imaging of Disorders Affecting the Bone and Skin. Radiographics 2014; 34:197-216. [DOI: 10.1148/rg.341125112] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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DeYoung KH, Riddle MS, May L, Porter CK. A case-control study of incident rheumatological conditions following acute gastroenteritis during military deployment. BMJ Open 2013; 3:e003801. [PMID: 24319273 PMCID: PMC3855532 DOI: 10.1136/bmjopen-2013-003801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the risk of incident rheumatological diagnoses (RD) associated with self-reported diarrhoea and vomiting during a first-time deployment to Iraq or Afghanistan. Such an association would provide evidence that RD in this population may include individuals with reactive arthritis (ReA) from deployment-related infectious gastroenteritis. DESIGN This case-control epidemiological study used univariate and multivariate logistic regression to compare the odds of self-reported diarrhoea/vomiting among deployed US military personnel with incident RD to the odds of diarrhoea/vomiting among a control population. SETTING We analysed health records of personnel deployed to Iraq or Afghanistan, including responses on a postdeployment health assessment and medical follow-up postdeployment. PARTICIPANTS Anonymous data were obtained from 891 US military personnel with at least 6 months of medical follow-up following a first-time deployment to Iraq or Afghanistan in 2008-2009. Cases were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes; controls had an unrelated medical encounter and were representative of the study population. MAIN OUTCOME MEASURES The primary measure was an association between incident RD and self-reported diarrhoea/vomiting during deployment. A secondary measure was the overall incidence of RD in this population. RESULTS We identified 98 cases of new onset RD, with a total incidence of 161/100 000 persons. Of those, two participants had been diagnosed with Reiter's disease (i) (3.3/100 000 persons) and the remainder with non-specific arthritis/arthralgia (157.5/100 000 persons). The OR for acute diarrhoea was 2.67 (p=0.03) after adjusting for important covariates. CONCLUSIONS Incident rheumatological conditions, even those classified as 'non-specific,' are significantly associated with prior severe diarrhoea in previously deployed military personnel, potentially indicating ReA and need for preventive measures to reduce diarrhoeagenic bacterial exposures in military personnel and other travellers to the developing regions.
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Affiliation(s)
- Kathryn H DeYoung
- Denver Public Health, Denver, Colorado, USA
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington DC, USA
| | - Mark S Riddle
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Larissa May
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington DC, USA
- Department of Emergency Medicine, George Washington University, Washington DC, USA
| | - Chad K Porter
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, Maryland, USA
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Nakib S, Han J, Li T, Joshipura K, Qureshi AA. Periodontal disease and risk of psoriasis among nurses in the United States. Acta Odontol Scand 2013; 71:1423-9. [PMID: 23374087 DOI: 10.3109/00016357.2013.766360] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Periodontal disease has been associated with systemic inflammation and may be a risk factor for autoimmune diseases. This study evaluated the association between periodontal disease and the risk of incident psoriasis in a large prospective cohort study. MATERIAL AND METHODS Self-reported history of periodontal bone loss, from 1998-2008, was evaluated as a risk factor for incident psoriasis among 60,457 women in the Nurses' Health Study. Secondary analyses examined associations between history of tooth loss and number of natural teeth and psoriasis risk. Cox proportional hazards models were used to assess multivariate estimates, adjusting for age, cigarette smoking, body mass index, alcohol intake and physical activity. RESULTS An increased multivariate risk of psoriasis was observed for those with mild periodontal bone loss (RR = 1.35, 95% CI = 1.03-1.75) and moderate-to-severe periodontal bone loss (RR = 1.49, 95% CI = 1.08-2.05), as compared to those without periodontal bone loss, after adjusting for age, cigarette smoking, body mass index, alcohol intake, physical activity and tooth loss. Number of natural teeth and tooth loss were not associated with risk of psoriasis in this study. CONCLUSION This study shows that a history of periodontal bone loss may increase risk of subsequent psoriasis. A limitation of this study is that it is based on self-reported measures.
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Affiliation(s)
- Sarah Nakib
- Department of Dermatology, Johns Hopkins Medical Center , Baltimore, MD , USA
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Kluger N, Francès P. [Reactive arthritis]. Presse Med 2013; 43:229-31. [PMID: 23725796 DOI: 10.1016/j.lpm.2013.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 01/15/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- Nicolas Kluger
- Helsinki University Central Hospital, University of Helsinki, Skin and Allergy Hospital, Institute of Clinical Medicine, Departments of Dermatology, Allergology and Venereology, Helsinki, Finlande
| | - Pierre Francès
- Cabinet de médecine générale, 1, rue Saint-Jean-Baptiste, 66650 Banyuls-sur-mer, France.
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Abstract
Syphilis, a sexually transmitted disease caused by the spirochete Treponema pallidum, can affect nearly every organ system in the body. In particular, skin manifestations of secondary syphilis are common but nonspecific and can be a true masquerader of other skin disorders. Concomitant infection with HIV has been increasing and may cause even more unusual skin presentations. We present a patient with the atypical combination of palmoplantar keratoderma and ocular symptoms that closely resembled reactive arthritis (or Reiter's syndrome). When evaluating patients with HIV infection, clinicians should maintain a high level of suspicion for syphilis to accurately diagnose and treat this curable but potentially fatal disease.
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