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Di Ludovico A, Rinaldi M, Lauriola F, Ciarelli F, La Bella S, Gualdi G, Chiarelli F, Bailey K, Breda L. The Diagnostic Role of Skin Manifestations in Rheumatic Diseases in Children: A Critical Review of Paediatric Vasculitis. Int J Mol Sci 2024; 25:7323. [PMID: 39000430 PMCID: PMC11242831 DOI: 10.3390/ijms25137323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
Skin lesions are frequently observed in children with rheumatic diseases, particularly in conditions such as IgA vasculitis (IgAV) and Kawasaki disease (KD). In paediatric vasculitis, the presence of skin lesions serves as an early indicator, emphasising the importance of timely diagnosis to prevent complications, such as cardiac or renal involvement. Conversely, autoinflammatory disorders like juvenile systemic lupus erythematosus (SLE) and juvenile dermatomyositis (DM) may manifest with cutaneous manifestations either at the onset of disease or during its progression. Identifying these skin lesions prior to the appearance of systemic symptoms offers an opportunity for early diagnosis and treatment, which has a positive influence on the outcomes. Additionally, it is noteworthy that specific rheumatological conditions, such as acute rheumatic fever (ARF) or oligoarticular or polyarticular forms of juvenile idiopathic arthritis (JIA), may exhibit occasional, but significant skin involvement, which is strongly correlated with an unfavourable prognosis. The assessment of skin is important in the holist approach to assessing patients for potentially systemic/multisystem disorder and helps distinguish discrete conditions.
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Affiliation(s)
- Armando Di Ludovico
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Marta Rinaldi
- Paediatric Department, Buckinghamshire Healthcare NHS Trust, Aylesbury-Thames Valley Deanery, Oxford HP21 8AL, UK
| | - Federico Lauriola
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Francesca Ciarelli
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Saverio La Bella
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Giulio Gualdi
- Dermatology Clinic, Department of Medicine and Aging Science, University G D’Annunzio Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Chiarelli
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Kathryn Bailey
- Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Luciana Breda
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
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2
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Hasegawa M, Chasset F, Chong BF, Fiorentino DF, Fujimoto M, Nyberg F, Sato S, Wenzel J, Werth VP. International exchange on the clinical practice and research of rheumatic skin diseases: A report of the 5th International Conference of Cutaneous Lupus Erythematosus. J Dermatol 2024; 51:881-884. [PMID: 38450816 DOI: 10.1111/1346-8138.17153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
The 5th International Conference of Cutaneous Lupus Erythematosus was held in Tokyo, Japan on May 9 and 10, 2023. The latest topics on the pathogenesis, diagnosis, assessment, and treatment of cutaneous lupus erythematosus, dermatomyositis, and scleroderma (systemic sclerosis, morphea) were presented by experts in each field and new developments discussed. In these rheumatic skin diseases, many clinical trials of novel therapies targeting cytokines, signaling molecules, plasmacytoid dendritic cells, B cells, and other molecules are currently underway, and standardization of outcome assessment was discussed. In addition, the selection of the therapeutic agents available for the diversity of each case is becoming more important, together with the ongoing pathophysiological analysis of the diseases. The achievements of this conference will further promote the development of clinical practice and research in rheumatic skin diseases through international exchange among researchers. We hope that by reporting a summary of the conference in this manuscript, we can share its contents with readers.
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Affiliation(s)
- Minoru Hasegawa
- Department of Dermatology, University of Fukui, Fukui, Japan
| | - François Chasset
- Faculté de médecine, Service de dermatologie et allergologie, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David F Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Filippa Nyberg
- Department of Pathology and Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Shinichi Sato
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Joerg Wenzel
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans' Administration Medical Center, Philadelphia, Pennsylvania, USA
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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3
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Aimo C, Mariotti EB, Corrà A, Quintarelli L, Bianchi B, Verdelli A, Ruffo di Calabria V, Caproni M. Lymphedema of the Arm after COVID-19 Vaccination in a Patient with Hidden Breast Cancer and Paraneoplastic Dermatomyositis. Vaccines (Basel) 2022; 10:vaccines10081219. [PMID: 36016107 PMCID: PMC9416749 DOI: 10.3390/vaccines10081219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 12/17/2022] Open
Abstract
The pandemic outbreak of Coronavirus Disease 2019 (COVID-19) led to the development of mRNA vaccines. With the extensive vaccination campaign performed worldwide, many adverse reactions to these drugs have been reported in the literature. Although most of them are mild and self-limiting, they may sometimes cause psychological stress and require efforts to make a differential diagnosis with other conditions. This is the case of lymphadenopathies and lymphedema in patients with a history of cancer. Herein we present a case of lymphedema of the arm developed ten days after a VAXZEVRIA COVID-19 vaccine shot in a patient who had concomitant signs and symptoms compatible with a diagnosis of dermatomyositis. It was later classified as paraneoplastic as instrumental investigation revealed a breast carcinoma contralateral to the site of vaccine injection. With this report we ponder an adverse reaction to COVID-19 vaccination with the aim of bringing new data for clinicians who face similar clinical presentations, particularly controversial for radiologists and oncologists.
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Affiliation(s)
- Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Correspondence:
| | - Elena Biancamaria Mariotti
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Rare Diseases Unit, Azienda USL Toscana Centro, Section of Dermatology, Department of Health Sciences, University of Florence, European Reference Network Skin Member, 50125 Florence, Italy
| | - Beatrice Bianchi
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Alice Verdelli
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Rare Diseases Unit, Azienda USL Toscana Centro, Section of Dermatology, Department of Health Sciences, University of Florence, European Reference Network Skin Member, 50125 Florence, Italy
| | - Valentina Ruffo di Calabria
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Marzia Caproni
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Rare Diseases Unit, Azienda USL Toscana Centro, Section of Dermatology, Department of Health Sciences, University of Florence, European Reference Network Skin Member, 50125 Florence, Italy
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4
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Werth VP, Askanase AD, Lundberg IE. Importance of collaboration of dermatology and rheumatology to advance the field for lupus and dermatomyositis. Int J Womens Dermatol 2021; 7:583-587. [PMID: 35005178 PMCID: PMC8721050 DOI: 10.1016/j.ijwd.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
There have been a number of advances in the clinical and translational understanding of cutaneous lupus and dermatomyositis, which both disproportionately affect women. These advances have involved ongoing collaborations between dermatology and rheumatology that highlight the importance of the skin in these disorders, with improvement in the education of trainees and clinical management of these complex multisystem diseases. In addition, a new disease classification has allowed inclusion of patients with skin-predominant dermatomyositis, frequently associated with systemic findings, in the spectrum of idiopathic inflammatory myopathies. Validated outcome measures allow translational research and facilitate progress toward better and more targeted therapeutics. Clinical trials using disease severity tools, such as the Cutaneous Lupus Erythematosus Area and Severity Index and the Cutaneous Dermatomyositis Disease Area and Severity Index, allow measurement of improvement in the skin. Recent results of phase 2 and 3 trials clearly show that patients will benefit from collaborative interactions and studies between dermatology and rheumatology.
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Affiliation(s)
- Victoria P. Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
- Medical Research, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Anca D. Askanase
- Division of Rheumatology, Columbia University Irving Medical Center, New York, New York
| | - Ingrid E. Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
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5
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Connelly K, Vettivel J, Golder V, Kandane-Rathnayake R, Morand EF. Measurement of specific organ domains in lupus randomised controlled trials: a scoping review. Rheumatology (Oxford) 2021; 61:1341-1353. [PMID: 34664636 DOI: 10.1093/rheumatology/keab777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Randomised controlled trials (RCTs) in systemic lupus erythematosus (SLE, lupus) typically adopt composite responder definitions as primary efficacy endpoints, however outcomes within individual organ domains are also important to understand. The aim of this scoping review was to evaluate how organ-specific disease activity and therapeutic responses have been measured and reported in lupus RCTs. METHODS We searched MEDLINE, EMBASE, Cochrane registry and clinicaltrials.gov. Eligible studies were RCTs investigating efficacy of an immune-directed drug therapy in active SLE, published January 2000-March 2021, excluding studies limited to lupus nephritis. Data were extracted independently in duplicate into a template and summarised descriptively. RESULTS Thirty-four RCTs were included, of which 32 (94%) reported activity and/or responses in at least one organ domain. Study populations had a high, although variable, frequency of baseline musculoskeletal and mucocutaneous activity and low but also variable representation of other domains. Definitions of organ-specific responses were inconsistent, even within individual instruments. Response in most organ domains were evaluated using BILAG and SLEDAI components but meaningful comparison between treatment arms was limited by small subgroups analysed in a post hoc fashion. Specific mucocutaneous and arthritis instruments were also used, including within pre-specified organ-specific endpoints, which discriminated between treatment arms in some studies. CONCLUSION Mucocutaneous and musculoskeletal manifestations predominate in SLE RCTs. Organ-specific outcome measures are commonly reported, but definitions of involvement and response are inconsistent. Research into the development of new outcome measures for key organ domains, and validation and comparison of response definitions using existing instruments, is needed.
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Affiliation(s)
- Kathryn Connelly
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia.,Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
| | - Jeevan Vettivel
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia
| | - Vera Golder
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia.,Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
| | | | - Eric F Morand
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia.,Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
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6
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Chakka S, Krain RL, Concha JSS, Chong BF, Merola JF, Werth VP. The CLASI, a validated tool for the evaluation of skin disease in lupus erythematosus: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:431. [PMID: 33842652 PMCID: PMC8033342 DOI: 10.21037/atm-20-5048] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cutaneous lupus erythematosus (CLE) can present with or without features of systemic lupus erythematosus (SLE), with estimates of the incidence of isolated skin disease almost equaling the incidence of those with systemic disease. However, despite the impact CLE has on a patient’s quality of life (QoL), there has been no US Food and Drug Administration (FDA) approved treatment for the disease in the past 50 years. In addition, patients with skin predominant LE are often excluded from clinical SLE trials. In the rare trials that include patients with skin predominant LE, disease activity and progression in the skin are often difficult to evaluate using multi-organ outcome measures. The need for new therapies for CLE and the lack of focus on skin outcomes has led to the development of the Cutaneous Lupus Disease Area and Severity Index (CLASI), a validated organ-specific outcome measure that is not only responsive to change in disease activity and damage but also correlated to changes in a patient’s QoL. This paper will emphasize the extensive validation studies performed in developing the CLASI, as well as the importance of clinical trials using the CLASI to address the need for improved therapies for patients with lupus skin manifestations.
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Affiliation(s)
- Srita Chakka
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca L Krain
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Josef Symon S Concha
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph F Merola
- Department of Dermatology and Department of Medicine, Division of Rheumatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Victoria P Werth
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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7
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Yang J, Guo Z, Liu X, Liu Q, Wu M, Yao X, Liu Y, Cui C, Li H, Song C, Liu D, Xue L. Cytotoxicity Evaluation of Chloroquine and Hydroxychloroquine in Multiple Cell Lines and Tissues by Dynamic Imaging System and Physiologically Based Pharmacokinetic Model. Front Pharmacol 2020; 11:574720. [PMID: 33658924 PMCID: PMC7919379 DOI: 10.3389/fphar.2020.574720] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/12/2020] [Indexed: 01/15/2023] Open
Abstract
Chloroquine (CQ) and hydroxychloroquine (HCQ) have been challenged in treating COVID-19 patients and still under debate due to the uncertainty regarding the effectiveness and safety, and there is still lack of the systematic study on the toxicity of these two drugs. To further uncover the toxicity profile of CQ and HCQ in different tissues, we evaluated the cytotoxicity of them in eight cell lines and further adopted the physiologically based pharmacokinetic models to predict the tissue risk, respectively. Retina, myocardium, lung, liver, kidney, vascular endothelium, and intestinal epithelium originated cells were included in the toxicity evaluation of CQ and HCQ, respectively. The proliferation pattern was monitored in 0–72 h by IncuCyte S3. CC50 and the ratio of tissue trough concentrations to CC50 (RTTCC) were brought into predicted toxicity profiles. Compared to CQ, HCQ was found to be less toxic in six cell types except Hep3B and Vero cells. In addition, RTTCC was significantly higher in CQ treatment group compared to HCQ group, which indicates relative safety of HCQ. To further simulate the situation of the COVID-19 patients who suffered the dyspnea and hypoxemia, we also tested the cytotoxicity upon hypoxia and normoxia (1, 5 vs. 21% O2). It was found that the cytotoxicity of CQ was more sensitive to hypoxia compared with that of HCQ, particularly in liver originated cells. Both CQ and HCQ showed cytotoxicity in time-dependent manner which indicates the necessity of short period administration clinically.
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Affiliation(s)
- Jianling Yang
- Center of Basic Medicine Research (CBMR), Peking University Third Hospital, Beijing, China
| | - Zhengyang Guo
- Center of Basic Medicine Research (CBMR), Peking University Third Hospital, Beijing, China
| | - Xu Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China.,Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
| | - Qi Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Meng Wu
- Center of Basic Medicine Research (CBMR), Peking University Third Hospital, Beijing, China
| | - Xueting Yao
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Yang Liu
- Center of Basic Medicine Research (CBMR), Peking University Third Hospital, Beijing, China
| | - Cheng Cui
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Haiyan Li
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Chunli Song
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Lixiang Xue
- Center of Basic Medicine Research (CBMR), Peking University Third Hospital, Beijing, China
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8
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Werth VP, Merrill JT. A double-blind, randomized, placebo-controlled, phase II trial of baricitinib for systemic lupus erythematosus: how to optimize lupus trials to examine effects on cutaneous lupus erythematosus. Br J Dermatol 2020; 180:964-965. [PMID: 31025748 DOI: 10.1111/bjd.17344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- V P Werth
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, U.S.A.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, PA, U.S.A
| | - J T Merrill
- Oklahoma Medical Research Foundation, Oklahoma City, OK, U.S.A
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9
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Nemer G, El-Hachem N, Eid E, Hamie L, Bardawil T, Khalil S, El-Rassy I, Safi R, Khalil A, Abbas O, Shimomura Y, Kurban M. A novel TRAF3IP2 variant causing familial scarring alopecia with mixed features of discoid lupus erythematosus and folliculitis decalvans. Clin Genet 2020; 98:116-125. [PMID: 32350852 DOI: 10.1111/cge.13767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/22/2022]
Abstract
Discoid lupus erythematosus (DLE) is an autoimmune disorder with a poorly defined etiology. Despite epidemiologic gender and ethnic biases, a clear genetic basis for DLE remains elusive. In this study, we used exome and RNA sequencing technologies to characterize a consanguineous Lebanese family with four affected individuals who presented with classical scalp DLE and generalized folliculitis. Our results unraveled a novel biallelic variant c.1313C > A leading to a missense substitution p.(Thr438Asn) in TRAF3IP2(NM_147200.3). Expression studies in cultured cells revealed mis-localization of the mutated protein. Functional characterization of the mutated protein showed significant reduction in the physical interaction with the interleukin 17-A receptor (IL17RA), while interaction with TRAF6 was unaffected. By conducting a differential genome-wide transcriptomics analysis between affected and non-affected individuals, we showed that the hair follicle differentiation pathway is drastically suppressed, whereas cytokine and inflammation responses are significantly upregulated. Furthermore, our results were highly concordant with molecular signatures in patients with DLE from a public dataset. In conclusion, this is the first report on a new putative role for TRAF3IP2 in the etiology of DLE. The identified molecular features associated with this gene could pave the way for better DLE-targeted treatment.
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Affiliation(s)
- Georges Nemer
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Nehme El-Hachem
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
- Pillar Genomics Institute of Precision Medicine, American University of Beirut, Beirut, Lebanon
| | - Edward Eid
- Dermatology, American University of Beirut, Beirut, Lebanon
| | - Lamiaa Hamie
- Dermatology, American University of Beirut, Beirut, Lebanon
| | - Tara Bardawil
- Dermatology, American University of Beirut, Beirut, Lebanon
| | - Samar Khalil
- Dermatology, American University of Beirut, Beirut, Lebanon
| | - Inaam El-Rassy
- Pillar Genomics Institute of Precision Medicine, American University of Beirut, Beirut, Lebanon
| | - Remi Safi
- Dermatology, American University of Beirut, Beirut, Lebanon
| | - Athar Khalil
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Ossama Abbas
- Dermatology, American University of Beirut, Beirut, Lebanon
| | - Yutaka Shimomura
- Department of Dermatology, Yamaguchi University, Yamaguchi, Japan
| | - Mazen Kurban
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
- Dermatology, American University of Beirut, Beirut, Lebanon
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10
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Shipman WD, Vernice NA, Demetres M, Jorizzo JL. An update on the use of hydroxychloroquine in cutaneous lupus erythematosus: A systematic review. J Am Acad Dermatol 2020; 82:709-722. [DOI: 10.1016/j.jaad.2019.07.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/10/2019] [Accepted: 07/03/2019] [Indexed: 01/03/2023]
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11
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Yang J, Guo Z, Liu X, Liu Q, Wu M, Yao X, Liu Y, Cui C, Li H, Song C, Liu D, Xue L. Cytotoxicity Evaluation of Chloroquine and Hydroxychloroquine in Multiple Cell Lines and Tissues by Dynamic Imaging System and Physiologically Based Pharmacokinetic Model. Front Pharmacol 2020. [PMID: 33658924 DOI: 10.1101/2020.04.22.056762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Chloroquine (CQ) and hydroxychloroquine (HCQ) have been challenged in treating COVID-19 patients and still under debate due to the uncertainty regarding the effectiveness and safety, and there is still lack of the systematic study on the toxicity of these two drugs. To further uncover the toxicity profile of CQ and HCQ in different tissues, we evaluated the cytotoxicity of them in eight cell lines and further adopted the physiologically based pharmacokinetic models to predict the tissue risk, respectively. Retina, myocardium, lung, liver, kidney, vascular endothelium, and intestinal epithelium originated cells were included in the toxicity evaluation of CQ and HCQ, respectively. The proliferation pattern was monitored in 0-72 h by IncuCyte S3. CC50 and the ratio of tissue trough concentrations to CC50 (RTTCC) were brought into predicted toxicity profiles. Compared to CQ, HCQ was found to be less toxic in six cell types except Hep3B and Vero cells. In addition, RTTCC was significantly higher in CQ treatment group compared to HCQ group, which indicates relative safety of HCQ. To further simulate the situation of the COVID-19 patients who suffered the dyspnea and hypoxemia, we also tested the cytotoxicity upon hypoxia and normoxia (1, 5 vs. 21% O2). It was found that the cytotoxicity of CQ was more sensitive to hypoxia compared with that of HCQ, particularly in liver originated cells. Both CQ and HCQ showed cytotoxicity in time-dependent manner which indicates the necessity of short period administration clinically.
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Affiliation(s)
- Jianling Yang
- Center of Basic Medicine Research (CBMR), Peking University Third Hospital, Beijing, China
| | - Zhengyang Guo
- Center of Basic Medicine Research (CBMR), Peking University Third Hospital, Beijing, China
| | - Xu Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
| | - Qi Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Meng Wu
- Center of Basic Medicine Research (CBMR), Peking University Third Hospital, Beijing, China
| | - Xueting Yao
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Yang Liu
- Center of Basic Medicine Research (CBMR), Peking University Third Hospital, Beijing, China
| | - Cheng Cui
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Haiyan Li
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Chunli Song
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Lixiang Xue
- Center of Basic Medicine Research (CBMR), Peking University Third Hospital, Beijing, China
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12
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Alves F, Gonçalo M. Suspected inflammatory rheumatic diseases in patients presenting with skin rashes. Best Pract Res Clin Rheumatol 2019; 33:101440. [PMID: 31585842 DOI: 10.1016/j.berh.2019.101440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Skin lesions occur, often at very early stages, in many of the most frequent inflammatory rheumatic diseases such as in systemic lupus erythematosus (SLE), dermatomyositis (DM), systemic sclerosis (SSc), Sjögren's syndrome, rheumatoid arthritis (RA), and psoriatic arthritis. It is important to recognize the different specific cutaneous lesions in SLE (e.g., "butterfly" rash in acute, annular or psoriasiform photosensitive lesions in the subacute form, and discoid lesions in the chronic form) for an early diagnosis and to estimate the associated risks of internal disease, whereas nonspecific lesions (exanthema, vasculitis, and alopecia) can be part of SLE flares. Cutaneous lesions in DM (Gottron's papules and sign, heliotrope rash, dystrophic cuticles, and nailfold capillary abnormalities) may occur before any clinically evident muscular or systemic organ involvement and are of utmost importance for early diagnosis. The pattern of cutaneous lesions and associated autoantibodies also allow the distinction of different phenotypes, either more prone to life-threatening interstitial lung disease (MDA-5) or with higher risk for neoplasia (TIF1-γ). Many other skin lesions, although not specific, require further investigation to look for a possible underlying inflammatory rheumatic disease: non-pruritic urticarial lesions in anti-C1q-associated urticarial vasculitis, Still's disease or hereditary auto-inflammatory syndromes, transient macular purpura of vasculitis in Sjögren's syndrome, Behçet's disease, or RA, Raynaud's phenomenon in SSc and mixed connective tissue disease, erythema nodosum or other panniculitis in RA, Behçet's disease and SLE, pustular eruptions in Behçet's disease, psoriasis, and hereditary auto-inflammatory syndromes. After reviewing in detail the cutaneous manifestations of the most frequent inflammatory rheumatic diseases, we describe a topographic and morphological approach to skin rashes, calling attention to facial rashes, hand involvement, scalp, nail, or leg lesions or to some morphological aspects of skin lesions (annular, pustular, urticarial, or exanthematous) that may be the initial manifestations of inflammatory rheumatic diseases. The importance of skin lesions is confirmed by their presence as part of the classification criteria of many inflammatory rheumatic diseases. They also contribute to early diagnosis, to characterize disease phenotypes, to aid in effective patient management, and, ultimately, to impact on disease prognosis.
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Affiliation(s)
- Francisca Alves
- Clinic of Dermatology, University Hospital of Coimbra, Portugal
| | - Margarida Gonçalo
- Clinic of Dermatology, University Hospital of Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
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13
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Concha JSS, Pena S, Gaffney RG, Patel B, Tarazi M, Kushner CJ, Merola JF, Fiorentino D, Dutz JP, Goodfield M, Nyberg F, Volc-Platzer B, Fujimoto M, Ang CC, Werth VP. Developing classification criteria for skin-predominant dermatomyositis: the Delphi process. Br J Dermatol 2019; 182:410-417. [PMID: 31049930 DOI: 10.1111/bjd.18096] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The European League Against Rheumatism/American College of Rheumatology classification criteria for inflammatory myopathies are able to classify patients with skin-predominant dermatomyositis (DM). However, approximately 25% of patients with skin-predominant DM do not meet two of the three hallmark skin signs and fail to meet the criteria. OBJECTIVES To develop a set of skin-focused classification criteria that will distinguish cutaneous DM from mimickers and allow a more inclusive definition of skin-predominant disease. METHODS An extensive literature review was done to generate items for the Delphi process. Items were grouped into categories of distribution, morphology, symptoms, antibodies, histology and contextual factors. Using REDCap™, participants rated these items in terms of appropriateness and distinguishing ability from mimickers. The relevance score ranged from 1 to 100, and the median score determined a rank-ordered list. A prespecified median score cut-off was decided by the steering committee and the participants. There was a pre-Delphi and two rounds of actual Delphi. RESULTS There were 50 participating dermatologists and rheumatologists from North America, South America, Europe and Asia. After a cut-off score of 70 during the first round, 37 of the initial 54 items were retained and carried over to the next round. The cut-off was raised to 80 during round two and a list of 25 items was generated. CONCLUSIONS This project is a key step in the development of prospectively validated classification criteria that will create a more inclusive population of patients with DM for clinical research. What's already known about this topic? Proper classification of patients with skin-predominant dermatomyositis (DM) is indispensable in the appropriate conduct of clinical/translational research in the field. The only validated European League Against Rheumatism/American College of Rheumatology criteria for idiopathic inflammatory myopathies are able to classify skin-predominant DM. However, a quarter of amyopathic patients still fail the criteria and does not meet the disease classification. What does this study add? A list of 25 potential criteria divided into categories of distribution, morphology, symptomatology, pathology and contextual factors has been generated after several rounds of consensus exercise among experts in the field of DM. This Delphi project is a prerequisite to the development of a validated classification criteria set for skin-predominant DM.
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Affiliation(s)
- J S S Concha
- Michael J. Crescenz VAMC, Philadelphia, PA, U.S.A.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - S Pena
- Michael J. Crescenz VAMC, Philadelphia, PA, U.S.A.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - R G Gaffney
- Michael J. Crescenz VAMC, Philadelphia, PA, U.S.A.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - B Patel
- Michael J. Crescenz VAMC, Philadelphia, PA, U.S.A.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - M Tarazi
- Michael J. Crescenz VAMC, Philadelphia, PA, U.S.A.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - C J Kushner
- Michael J. Crescenz VAMC, Philadelphia, PA, U.S.A.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - J F Merola
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| | - D Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, U.S.A
| | - J P Dutz
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - M Goodfield
- Department of Dermatology, Leeds General Infirmary, Leeds, U.K
| | - F Nyberg
- Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - B Volc-Platzer
- Department of Dermatology, Wiener Krankenanstaltenverbund, Vienna, Austria
| | - M Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - C C Ang
- Department of Dermatology, Changi General Hospital, Singapore
| | - V P Werth
- Michael J. Crescenz VAMC, Philadelphia, PA, U.S.A.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
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14
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Chasset F, Francès C. Current Concepts and Future Approaches in the Treatment of Cutaneous Lupus Erythematosus: A Comprehensive Review. Drugs 2019; 79:1199-1215. [DOI: 10.1007/s40265-019-01151-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Krain RL, Chen KL, Werth VP. Management of autoimmune blistering diseases in pregnancy and the neonate. GIORN ITAL DERMAT V 2019; 154:539-549. [PMID: 31195784 DOI: 10.23736/s0392-0488.19.06375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The management of autoimmune blistering diseases (AIBD) is therapeutically challenging, particularly in patients who plan to conceive, or are pregnant or breastfeeding. Not only is a patient's immune system altered by pregnancy-associated hormonal changes, but several medications used for AIBD treatment are not recommended for use in pregnancy or lactation. The data acquired regarding the safety and efficacy of these therapeutic interventions are gathered from studies or case reports from other diseases, as the treatment modalities are similar and randomized controlled trials are typically not performed in the setting of pregnancy. Although some medications for AIBD treatment are considered unsafe for use in pregnancy, many effective and tolerable therapies are able to provide benefit to these patients. In fact, most first-line agents may be used in pregnancy, to a given extent. This article discusses the medications used to treat AIBD prior to conception, during pregnancy, and while breastfeeding, as well as highlights those that are contraindicated. The preferred approach to management in these patients is also discussed. Additionally, we present the available information regarding neonates of mothers with a diagnosis of AIBD, including the likelihood, identification, and management of neonatal blistering and the effects from medication exposure in utero.
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Affiliation(s)
- Rebecca L Krain
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristen L Chen
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria P Werth
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA - .,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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16
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Chen KL, Krain RL, Werth VP. Advancing understanding, diagnosis, and therapies for cutaneous lupus erythematosus within the broader context of systemic lupus erythematosus. F1000Res 2019; 8:F1000 Faculty Rev-332. [PMID: 30984372 PMCID: PMC6436187 DOI: 10.12688/f1000research.17787.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 01/19/2023] Open
Abstract
Cutaneous lupus erythematosus (CLE) is an autoimmune disease that can be associated with systemic lupus erythematosus (SLE) symptoms. The pathogenesis of both CLE and SLE is multifactorial, involving genetic susceptibility, environmental factors, and innate and adaptive immune responses. Despite the efficacy of current medications, many patients remain refractory, highlighting the necessity for new treatment options. Unfortunately, owing to challenges related in part to trial design and disease heterogeneity, only one new biologic in the last 50 years has been approved by the US Food and Drug Administration for the treatment of SLE. Thus, although SLE and CLE have a similar pathogenesis, patients with CLE who do not meet criteria for SLE cannot benefit from this advancement. This article discusses the recent trials and emphasizes the need to include patients with single-organ lupus, such as CLE, in SLE trials.
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Affiliation(s)
- Kristen L. Chen
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
- Department of Dermatology, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Suite 1-330A, Philadelphia, PA 19104, USA
| | - Rebecca L. Krain
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
- Department of Dermatology, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Suite 1-330A, Philadelphia, PA 19104, USA
| | - Victoria P. Werth
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
- Department of Dermatology, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Suite 1-330A, Philadelphia, PA 19104, USA
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