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Boleto G, Avouac J, Allanore Y. Response to comments on "The phenotype of mixed connective tissue disease patients having associated interstitial lung disease" by Chevalier K et al. and Shih PC. Semin Arthritis Rheum 2024; 64:152333. [PMID: 38087755 DOI: 10.1016/j.semarthrit.2023.152333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Gonçalo Boleto
- Department of Rheumatology, Université Paris Cité, Cochin Hospital, Paris, France; Instituto Português de Reumatologia, Lisboa, Portugal
| | - Jérôme Avouac
- Department of Rheumatology, Université Paris Cité, Cochin Hospital, Paris, France; INSERM U1016, Institut Cochin, CNRS UMR8104, Paris, France
| | - Yannick Allanore
- Department of Rheumatology, Université Paris Cité, Cochin Hospital, Paris, France; INSERM U1016, Institut Cochin, CNRS UMR8104, Paris, France.
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2
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Wang C, Erick Elkowitz D, Esposito MJ, Shah RD, Tannous H, Barilla-Labarca ML, Seetharamu N. A multidisciplinary approach to treating a unique case of recurrent metastatic thymic carcinoma: case report. THERAPEUTIC ADVANCES IN RARE DISEASE 2023; 4:26330040231190661. [PMID: 37576433 PMCID: PMC10422886 DOI: 10.1177/26330040231190661] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023]
Abstract
Thymic carcinoma (TC) is a rare and aggressive malignancy of the thymus associated with less than 25% 5 years survivability. Our case report showcases the successful treatment of advanced metastatic TC using a multidisciplinary approach and the utility of checkpoint inhibitors in treatment of recurrent TC. A 50-year-old man presented with Raynaud's phenomenon and was found to have a stage IVb TC (T3N2M0). Eight months after management with neoadjuvant chemotherapy, surgical resection and adjuvant chemoradiotherapy, patient was diagnosed with metastasis of TC to the liver and a concurrent stage III (T2N1M0) primary sigmoid colon adenocarcinoma. Following complete resection of the colon adenocarcinoma, the patient started palliative-intent treatment for TC with pembrolizumab given PD-L1 tumor proportionate score of 100%. This resulted in a sustained complete response for 38 months. Our patient did have immune-related adverse events involving multiple organs but was able to continue pembrolizumab for a standard treatment duration of 2 years with multidisciplinary care. When recurrent disease was noted in a portocaval lymph node, pembrolizumab was reinitiated and a second complete response was achieved. The patient has maintained that complete response while maintaining an acceptable quality of life, showing that treatment with pembrolizumab is effective in patients after discontinuation with prior immunotherapy.
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Affiliation(s)
- Carol Wang
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd., Hempstead, NY 11549, USA
| | - David Erick Elkowitz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michael John Esposito
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Rakesh Dinesh Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | | | - Nagashree Seetharamu
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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3
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Bollow M. [Atypical arthritis of the hands : Collagenosis-part 2]. Radiologe 2021; 61:470-482. [PMID: 33792744 DOI: 10.1007/s00117-021-00842-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Progressive systemic scleroderma (PSS) and mixed connective tissue disease (MCTD) represent vasculitic autoimmune diseases from the group of collagenoses with manifestations in various organ systems such as the skin, the internal organs and the joints. OBJECTIVE To present the atypical arthritis patterns of the hands in PSS and MCTD that differ from those in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in the context of clinical and serologic findings and in consideration of the classification of PSS and MCTD. MATERIALS AND METHODS Narrative review based on the current literature on the subject from the radiological and rheumatological point of view. RESULTS In PSS, combinations of acral soft tissue atrophy, nonreactive acro-osteolysis, and interstitial calcifications can be visualized by projection radiography, which in the final stage can lead to a scleroderma claw hand. Digital pharmacoangiography of the hands can be used to reliably diagnose manifest vascular occlusions of the digital arteries. MCTD is characterized by various overlapping symptoms of at least two systemic autoimmune diseases and most frequently presents in the hand with symmetrical involvement of the PIP (proximal interphalangeal), MCP (metacarpophalangeal) and wrist joints with the manifestation of so-called "puffy fingers". CONCLUSIONS The presented morphological atypical arthritis patterns of the hands in PSS and MCTD differ considerably from the typical patterns in the hands in RA and PsA. MRI is useful to diagnose early stages and pharmacoangiography can be used to differentiate between temporary and manifest digital vascular occlusions.
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Affiliation(s)
- Matthias Bollow
- Klinik für diagnostische und interventionelle Radiologie, Augusta-Kranken-Anstalt Bochum, Bergstraße 26, 44791, Bochum, Deutschland. .,Ruhr-Universität Bochum, Bochum, Deutschland.
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4
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Koulouri V, Nezos A, Marketos N, Argyriou E, Boki K, Ioakimidis D, Koutsilieris M, Mavragani CP. The Role of Novel Autoantibodies in the Diagnostic Approach and Prognosis of Patients with Raynaud's Phenomenon. Mediterr J Rheumatol 2021; 31:427-429. [PMID: 33521578 PMCID: PMC7841088 DOI: 10.31138/mjr.31.4.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/14/2020] [Accepted: 06/30/2020] [Indexed: 11/04/2022] Open
Abstract
Raynaud's phenomenon (RP) is a condition characterised by distinct colour changes of the digits upon exposure to sympathomimetic conditions, such as cold temperature. It can be either primary or secondary, depending on whether it presents alone or as part of an underlying disorder. One of the most common causes of secondary RP are systemic autoimmune rheumatic diseases (SARDs), in which RP may precede the onset of other autoimmune features by many years. Thus, timely and accurate recognition of secondary RP is of great importance as it alters patient management and prognosis. An important step in the diagnostic approach of RP is the detection of antinuclear antibodies (ANAs) by indirect immunofluorescence. However, identification of specific autoantibodies is not yet common practice, though many of them have shown important clinical associations. Moreover, the role of some autoantibodies has not yet been elucidated, given their relatively recent discovery and low reported prevalence rates in autoimmune population. The goal of this study is to reveal clinical associations of these novel autoantibodies in SARDs through the application of an extended serology workup in patients presenting with RP.
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Affiliation(s)
- Vasiliki Koulouri
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Adrianos Nezos
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Marketos
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Rheumatology Outpatient Department, Henry Dunant Hospital Centre, Athens, Greece
| | - Evangelia Argyriou
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Rheumatology Unit, Sismanogleio General Hospital, Athens, Greece
| | - Kyriaki Boki
- Rheumatology Unit, Sismanogleio General Hospital, Athens, Greece
| | - Dimitrios Ioakimidis
- Rheumatology Outpatient Department, Henry Dunant Hospital Centre, Athens, Greece
| | - Michalis Koutsilieris
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Clio P Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Rheumatology Outpatient Unit, Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
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5
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Heger LA, Kerber M, Hortmann M, Robinson S, Mauler M, Stallmann D, Duerschmied D, Bode C, Hehrlein C, Ahrens I. Expression of the oxygen-sensitive transcription factor subunit HIF-1α in patients suffering from secondary Raynaud syndrome. Acta Pharmacol Sin 2019; 40:500-506. [PMID: 29991707 DOI: 10.1038/s41401-018-0055-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 05/30/2018] [Indexed: 12/14/2022] Open
Abstract
Anti-ischemic therapy remains a challenge due to the complexity of hypoxia response pathways. Hypoxia-inducible factor (HIF)-1 is a heterodimer transcription factor consisting of 2 subunits, HIF-1α and HIF-1β. Hypoxia-dependent activation of HIF-1α regulates cellular O2 homeostasis. Raynaud syndrome (RS), as a comorbidity of the autoimmune disease systemic sclerosis (SS), is characterized by vasospasms that limit blood flow to the limbs, resulting in hypoxia. A single-center randomized study was conducted to compare prostaglandin E1 (PgE1) therapy with a treatment combining PgE1 and an endothelin-1 blocker, bosentan. A total of 30 patients suffering from SS with RS were enrolled. We examined the regulation of HIF-1α, its target heme oxygenase-1 (HMOX-1), and the serum levels of the HIF-1α protein in a subset of patients as well as in ten healthy individuals. The expression of HIF-1α and HMOX-1 in monocytes was measured using absolute plasmid-based quantitative real-time PCR, whereas serum HIF-1α levels were measured with ELISA. Samples were taken at the time of randomization and after 24 weeks. We found that HIF-1α and HMOX-1 mRNA expression in monocytes and serum HIF-1α protein levels were significantly higher in the SS/RS patients compared to the healthy control group. Single-drug therapy significantly increased HIF-1α and HMOX-1 mRNA expression in monocytes and serum HIF-1α protein levels in the SS/RS patients compared to those at the time of randomization, whereas combining PgE1 with an endothelin-1 blocker prevented the further increases in HIF-1α and HMOX-1 expression. We propose HIF-1α and HMOX-1 as novel markers for anti-ischemic therapy in RS.
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Shoji K, Yanishi K, Yoshimi R, Hamada N, Kondo K, Fujimoto K, Nakajima H, Kuwahara K, Higashi Y, Fukumoto Y, Murohara T, Matoba S. Impact of Therapeutic Angiogenesis Using Autologous Bone Marrow-Derived Mononuclear Cells Implantation in Critical Limb Ischemia With Scleroderma ― Subanalysis of the Long-Term Clinical Outcomes Survey ―. Circ J 2019; 83:662-671. [DOI: 10.1253/circj.cj-18-1044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Keisuke Shoji
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Kenji Yanishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine
| | - Naoki Hamada
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine
| | - Kazuhisa Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kazuteru Fujimoto
- Department of Cardiology, National Hospital Organization Kumamoto Medical Center
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Yoshihiro Fukumoto
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
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7
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Fábián B, Fábián AK, Bugán A, Csiki Z. Comparison of mental and physical health between patients with primary and secondary Raynaud's phenomenon Category: Article. J Psychosom Res 2019; 116:6-9. [PMID: 30654995 DOI: 10.1016/j.jpsychores.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/03/2018] [Accepted: 11/04/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare anxiety, depression, physical health and quality of life in patients with primary Raynaud's phenomenon (PRP) and patients with secondary Raynaud's phenomenon (SRP). METHOD Adult patients with Raynaud's phenomenon (RP) were assessed for the severity of anxiety and depressive symptoms, physical health and quality of life by using the General Anxiety Disorder Scale (GAD-7), the Beck Depression Inventory (BDI), the 12-item Short Form Health Survey: Physical Component Scale (PCS-12), and the Raynaud Specific Quality of Life Questionnaire (RQLQ), respectively. Patients with PRP and SRP were recruited for comparison at a single clinical center in Debrecen, Hungary from September to December 2017. RESULTS In total, 60 primary and 41 secondary patients with RP were studied. Gender distribution, family status, employment status and smoking were similar in the two groups. Significantly more patients with SRP had anxiety and depressive symptoms than patients with PRP. Patients with SRP had significantly higher GAD-7 and BDI; and lower overall PCS-12 and RQLQ scores than patients with PRP. CONCLUSION Anxiety and depression is more common in patients with SRP than in patients with PRP. Patients with SRP have a lower physical health condition and RP specific quality of life than patients with PRP. Anxiety, depression and quality of life impairments should be taken into account when managing all patients with RP. Further study is needed to assess whether appropriately designed interventions have the potential to reduce the mental and physical health burdens of RP on quality of life (QOL), especially in patients with SRP.
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Affiliation(s)
- Balázs Fábián
- Department of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
| | - Anna Klaudia Fábián
- Department of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Antal Bugán
- Department of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Zoltán Csiki
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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8
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Ciang NCO, Pereira N, Isenberg DA. Mixed connective tissue disease-enigma variations? Rheumatology (Oxford) 2017; 56:326-333. [PMID: 27436003 DOI: 10.1093/rheumatology/kew265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Indexed: 01/14/2023] Open
Abstract
In 1972, Sharp et al. described a new autoimmune rheumatic disease that they called MCTD, characterized by overlapping features of SSc, SLE, PM/DM, high levels of anti-U1snRNP and low steroid requirements with good prognosis. MCTD was proposed as a distinct disease. However, soon after the original description, questions about the existence of such a syndrome as well as disputes over the features initially described began to surface. The conundrum of whether MCTD is a distinct disease entity remains controversial. We undertook a literature review, focusing on the articles reporting new data about MCTD published in the last decade, to determine whether any new observations help to answer the conundrum of MCTD. After reviewing recent data, we question whether the term MCTD is appropriately retained, preferring to use the term undifferentiated autoimmune rheumatic disease.
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Affiliation(s)
- Natalia C O Ciang
- Division of Rheumatology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Nídia Pereira
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - David A Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
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9
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de Holanda Mafaldo Diógenes A, Bonfá E, Fuller R, Correia Caleiro MT. Capillaroscopy is a dynamic process in mixed connective tissue disease. Lupus 2016; 16:254-8. [PMID: 17439931 DOI: 10.1177/0961203307076517] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To determine the clinical relevance of `scleroderma-pattern' (SD-pattern) in mixed connective tissue disease (MCTD), 63 (MCTD) patients (Kasukawa's criteria) were consecutively selected. The main inclusion criterion was availability of previous nailfold capillaroscopy (NC) five years before inclusion. At entry, organ involvement and autoantibody evaluation were performed. The mean age and disease duration were 45.3 ± 10 and 8.45 ± 5.42 years, respectively. SD-pattern was observed in 41 patients at entry (65%) and in 45 at previous NC (71.5%), P = 0.20. Ten patients (16%) changed NC, seven normalized, and three developed SD-pattern. Disease duration, number and frequency of organ involvement were similar in patients with and without SD-pattern. In contrast, analysis of each SD-pattern parameter revealed a significantly lower frequency of moderate/severe avascular areas (AA) at entry compared to previous examination (26.5 versus 53%, P = 0.013). Moreover, 76% of patients with interstitial lung disease (HRCT) had AA at entry, whereas only 24% of patients with this alteration did not have this NC finding ( P = 0.017). Furthermore, reduced capillary density was more frequently observed in patients taking immunosuppressive therapy than in those without this medication (66.7 versus 33.3%, P = 0.001). NC in MCTD is a dynamic process and analysis of each SD-pattern parameter seems to be a good indicator of lung involvement and disease severity. Lupus (2007) 16, 254—258.
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Gunnarsson R, Hetlevik SO, Lilleby V, Molberg Ø. Mixed connective tissue disease. Best Pract Res Clin Rheumatol 2016; 30:95-111. [DOI: 10.1016/j.berh.2016.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Reiseter S, Molberg Ø, Gunnarsson R, Lund MB, Aalokken TM, Aukrust P, Ueland T, Garen T, Brunborg C, Michelsen A, Abraityte A, Hoffmann-Vold AM. Associations between circulating endostatin levels and vascular organ damage in systemic sclerosis and mixed connective tissue disease: an observational study. Arthritis Res Ther 2015; 17:231. [PMID: 26315510 PMCID: PMC4551562 DOI: 10.1186/s13075-015-0756-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/12/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Systemic sclerosis (SSc) and mixed connective tissue disease (MCTD) are chronic immune-mediated disorders complicated by vascular organ damage. The aim of this study was to examine the serum levels of the markers of neoangiogenesis: endostatin and vascular endothelial growth factor (VEGF), in our unselected cohorts of SSc and MCTD. Methods Sera of SSc patients (N = 298) and MCTD patients (N = 162) from two longitudinal Norwegian cohorts were included. Blood donors were included as controls (N = 100). Circulating VEGF and endostatin were analyzed by enzyme immunoassay. Results Mean endostatin levels were increased in SSc patients 93.7 (37) ng/ml (P < .001) and MCTD patients 83.2 (25) ng/ml (P < .001) compared to controls 65.1 (12) ng/ml. Median VEGF levels were elevated in SSc patients 209.0 (202) pg/ml compared to MCTD patients 181.3 (175) pg/ml (P = .017) and controls 150.0 (145) pg/ml (P < .001). Multivariable analysis of SSc subsets showed that pulmonary arterial hypertension (coefficient 15.7, 95 % CI: 2.2–29.2, P = .023) and scleroderma renal crisis (coefficient 77.6, 95 % CI: 59.3–100.0, P < .001) were associated with elevated endostatin levels. Multivariable analyses of MCTD subsets showed that digital ulcers were associated with elevated endostatin levels (coefficient 10.5, 95 % CI: 3.2–17.8, P = .005). The risk of death increased by 1.6 per SD endostatin increase (95 % CI: 1.2–2.1, P = .001) in the SSc cohort and by 1.6 per SD endostatin increase (95 % CI: 1.0–2.4, P = .041) in the MCTD cohort after adjustments to known risk factors. Conclusions Endostatin levels were elevated in patients with SSc and MCTD, particularly SSc patients with pulmonary arterial hypertension and scleroderma renal crisis, and MCTD patients with digital ulcers. Elevated endostatin levels were also associated with increased all-cause mortality during follow-up in both groups of patients. We propose that endostatin might indicate the degree of vascular injury in SSc and MCTD patients. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0756-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Silje Reiseter
- Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway.
| | - Øyvind Molberg
- Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway. .,Department of Rheumatology, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway.
| | - Ragnar Gunnarsson
- Department of Rheumatology, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway.
| | - May Brit Lund
- Department of Respiratory Medicine, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway.
| | - Trond Mogens Aalokken
- Department of Radiology, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway.
| | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway. .,Department of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway. .,Research Institute of Clinical Medicine, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway. .,K. G. Jebsen Inflammation Research Centre, Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway. .,K. G. Jebsen Thrombosis Research and Expertise Centre, The Arctic University of Norway, Langnes, 9037, Tromsø, Norway.
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway. .,Research Institute of Clinical Medicine, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway. .,K. G. Jebsen Inflammation Research Centre, Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway. .,K. G. Jebsen Thrombosis Research and Expertise Centre, The Arctic University of Norway, Langnes, 9037, Tromsø, Norway.
| | - Torhild Garen
- Department of Rheumatology, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway.
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Ullevål, 0424, Oslo, Norway.
| | - Annika Michelsen
- Research Institute of Clinical Medicine, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway. .,K. G. Jebsen Thrombosis Research and Expertise Centre, The Arctic University of Norway, Langnes, 9037, Tromsø, Norway.
| | - Aurelija Abraityte
- Research Institute of Clinical Medicine, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway. .,K. G. Jebsen Thrombosis Research and Expertise Centre, The Arctic University of Norway, Langnes, 9037, Tromsø, Norway.
| | - Anna-Maria Hoffmann-Vold
- Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway. .,Department of Rheumatology, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway.
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12
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Yang L, Fujimoto M, Murota H, Serada S, Fujimoto M, Honda H, Yamada K, Suzuki K, Nishikawa A, Hosono Y, Yoneda Y, Takehara K, Imura Y, Mimori T, Takeuchi T, Katayama I, Naka T. Proteomic identification of heterogeneous nuclear ribonucleoprotein K as a novel cold-associated autoantigen in patients with secondary Raynaud's phenomenon. Rheumatology (Oxford) 2014; 54:349-58. [PMID: 25172934 DOI: 10.1093/rheumatology/keu325] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of this study was to identify cold-associated autoantibodies in patients with RP secondary to CTDs. METHODS Indirect immunofluorescence staining was performed on non-permeabilized cold-stimulated normal human dermal microvascular endothelial cells (dHMVECs), using patients' sera. Cold-induced alterations in cell surface proteomes were analysed by isobaric tag for relative and absolute quantitation (iTRAQ) analysis. Serological proteome analysis (SERPA) was applied to screen cold-associated autoantigens. The prevalence of the candidate autoantibody was determined by ELISA in 290 patients with RP secondary to CTDs (SSc, SLE or MCTD), 10 patients with primary RP and 27 healthy controls. RESULTS Enhanced cell surface immunoreactivity was detected in cold-stimulated dHMVECs when incubated with sera from patients with secondary RP. By iTRAQ analysis, many proteins, including heterogeneous nuclear ribonucleoprotein K (hnRNP-K), were found to be increased on the cell surface of dHMVECs after cold stimulation. By the SERPA approach, hnRNP-K was identified as a candidate autoantigen in patients with secondary RP. Cold-induced translocation of hnRNP-K to the cell surface was confirmed by immunoblotting and flow cytometry. By ELISA analysis, patients with secondary RP show a significantly higher prevalence of anti-hnRNP-K autoantibody (30.0%, 61/203) than patients without RP (9.2%, 8/87, P = 0.0001), patients with primary RP (0%, 0/10, P = 0.0314) or healthy controls (0%, 0/27, P = 0.0001). CONCLUSION By comprehensive proteomics, we identified hnRNP-K as a novel cold-associated autoantigen in patients with secondary RP. Anti-hnRNP-K autoantibody may potentially serve as a biomarker for RP secondary to various CTDs.
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Affiliation(s)
- Lingli Yang
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan. Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Minoru Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Satoshi Serada
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Hiromi Honda
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Kohji Yamada
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan. Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Katsuya Suzuki
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Ayumi Nishikawa
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Yuji Hosono
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Yoshihiro Yoneda
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Kazuhiko Takehara
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Yoshitaka Imura
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Tsuneyo Mimori
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Tsutomu Takeuchi
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Ichiro Katayama
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Tetsuji Naka
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan.
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13
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Sen S, Sinhamahapatra P, Choudhury S, Gangopadhyay A, Bala S, Sircar G, Chatterjee G, Ghosh A. Cutaneous manifestations of mixed connective tissue disease: study from a tertiary care hospital in eastern India. Indian J Dermatol 2014; 59:35-40. [PMID: 24470658 PMCID: PMC3884926 DOI: 10.4103/0019-5154.123491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Context: Mixed connective tissue disorder is an uncommon disease. Some scientists are reluctant to recognize it as a separate entity. Some others have defined this ailment. Cutaneous features of this condition are unique. Researchers from India have described these features to relate to those described in the studies from other parts of the globe. Aims: This study aims to delineate the skin manifestations of clearly defined mixed connective tissue disease (MCTD) patients, to compare them with those established as overlap syndrome, and to relate them with studies from other parts of the globe. Settings and Design: Successive patients who fulfilled the specific criteria for MCTD presenting in the skin outpatient department of a tertiary care hospital in eastern India were clinically examined from 2009 for 3 years. Materials and Methods: The number of participants was 23 and the dermatological features of these were compared with 22 patients with overlap syndrome. The antibody to uridine-rich U1 ribonucleoprotein was measured for all patients. Statistical Analysis Used: SPSS (Version 17) and MedCalc (Version 11.6). Results: The Male: Female ratio among the MCTD patients was 1:6.67 and that of the overlap syndrome was 1:10. Twenty patients of the MCTD group presented with synovitis as against only seven in the overlap group. Raynaud's phenomenon was present in some of the subjects. Puffy fingers were rare in our study. Facial numbness was reported by four of those suffering from MCTD. Antinuclear antibody (ANA) was essentially of a speckled pattern in this disease Conclusions: Cutaneous indicators of MCTD are distinct from overlap syndrome. Knowledge of these manifestations prevalent in a region may lead to early diagnosis of the disease.
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Affiliation(s)
- Sumit Sen
- Department of Dermatology, Venereology and Leprosy, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Pradyot Sinhamahapatra
- Department of Rheumatology, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Supriyo Choudhury
- Department of Pharmacology, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Anusree Gangopadhyay
- Department of Dermatology, Venereology and Leprosy, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Sanchaita Bala
- Department of Dermatology, Venereology and Leprosy, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Geetabali Sircar
- Department of Rheumatology, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Gobinda Chatterjee
- Department of Dermatology, Venereology and Leprosy, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Alakendu Ghosh
- Department of Rheumatology, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
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14
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Prete M, Fatone MC, Favoino E, Perosa F. Raynaud's phenomenon: from molecular pathogenesis to therapy. Autoimmun Rev 2014; 13:655-67. [PMID: 24418302 DOI: 10.1016/j.autrev.2013.12.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/24/2013] [Indexed: 01/01/2023]
Abstract
Raynaud's phenomenon (RP) is a well defined clinical syndrome characterized by recurrent episodes of digital vasospasm triggered by exposure to physical/chemical or emotional stress. RP has been classified as primary or secondary, depending on whether it occurs as an isolated condition (pRP) or is associated to an underlying disease, mainly a connective tissue disease (CTD-RP). In both cases, it manifests with unique "triple" (pallor, cyanosis and erythema), or "double" color changes. pRP is usually a benign condition, while sRP can evolve and be complicated by acral digital ulcers and gangrene, which may require surgical treatment. The pathogenesis of RP has not yet been entirely clarified, nor is it known whether autoantibodies have a role in RP. Even so, recent advances in our understanding of the pathophysiology have highlighted novel potential therapeutic targets. The aim of this review is to discuss the etiology, epidemiology, risk factors, clinical manifestations, recently disclosed pathogenic mechanisms underlying RP and their correlation with the available therapeutic options, focusing primarily on pRP and CTD-RP.
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Affiliation(s)
- Marcella Prete
- Internal Medicine, University of Bari Medical School, I-70124 Bari, Italy
| | | | - Elvira Favoino
- Rheumatological and Autoimmune Systemic Diseases Units, University of Bari Medical School, I-70124 Bari, Italy
| | - Federico Perosa
- Rheumatological and Autoimmune Systemic Diseases Units, University of Bari Medical School, I-70124 Bari, Italy.
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15
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Then C, von Einem JC, Müller D, Flaig MJ, Huber RM, Reincke M. Toxic epidermal necrolysis after pemetrexed and cisplatin for non-small cell lung cancer in a patient with sharp syndrome. ACTA ACUST UNITED AC 2012. [PMID: 23207626 DOI: 10.1159/000345109] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pemetrexed is an antifolate drug approved for maintenance and second-line therapy, and, in combination with cisplatin, for first-line treatment of advanced nonsquamous non-small cell lung cancer. The side-effect profile includes fatigue, hematological and gastrointestinal toxicity, an increase in hepatic enzymes, sensory neuropathy, and pulmonary and cutaneous toxicity in various degrees. CASE REPORT We present the case of a 58-year-old woman with history of Sharp's syndrome and adenocarcinoma of the lung, who developed toxic epidermal necrolysis after the first cycle of pemetrexed, including erythema, bullae, extensive skin denudation, subsequent systemic inflammation and severe deterioration in general condition. The generalized skin lesions occurred primarily in the previous radiation field and responded to immunosuppressive treatment with prednisone. CONCLUSION Although skin toxicity is a well-known side effect of pemetrexed, severe skin reactions after pemetrexed administration are rare. Caution should be applied in cases in which pemetrexed is given subsequent to radiation therapy, especially in patients with pre-existing skin diseases.
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Affiliation(s)
- Cornelia Then
- Medizinische Klinik und Poliklinik IV, University Hospital Munich, Germany.
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16
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Multiple Autoantibodies Display Association with Lymphopenia, Proteinuria, and Cellular Casts in a Large, Ethnically Diverse SLE Patient Cohort. Autoimmune Dis 2012; 2012:819634. [PMID: 22988489 PMCID: PMC3439936 DOI: 10.1155/2012/819634] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/13/2012] [Indexed: 01/05/2023] Open
Abstract
Purpose. This study evaluates high-throughput autoantibody screening and determines associated systemic lupus erythematosus (SLE) clinical features in a large lupus cohort. Methods. Clinical and demographic information, along with serum samples, were obtained from each SLE study participant after appropriate informed consent. Serum samples were screened for 10 distinct SLE autoantibody specificities and examined for association with SLE ACR criteria and subcriteria using conditional logistic regression analysis. Results. In European-American SLE patients, autoantibodies against 52 kD Ro and RNP 68 are independently enriched in patients with lymphopenia, anti-La, and anti-ribosomal P are increased in patients with malar rash, and anti-dsDNA and anti-Sm are enriched in patients with proteinuria. In African-American SLE patients, cellular casts associate with autoantibodies against dsDNA, Sm, and Sm/nRNP. Conclusion. Using a high-throughput, bead-based method of autoantibody detection, anti-dsDNA is significantly enriched in patienets with SLE ACR renal criteria as has been previously described. However, lymphopenia is associated with several distinct autoantibody specificities. These findings offer meaningful information to allow clinicians and clinical investigators to understand which autoantibodies correlate with select SLE clinical manifestations across common racial groups using this novel methodology which is expanding in clinical use.
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17
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Hand Angiography in Connective Tissue Disease. J Clin Rheumatol 2012; 18:321. [DOI: 10.1097/rhu.0b013e3182685ccd] [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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18
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Jung SM, Yoo JT, Kim YH, Seo YN, Lee NY, Lee SG, Park SH, Park YE, Baek SH, Kim GT, Kim SI, Lee JW. A Case of Pediatric-onset Mixed Connective Tissue Disease Presenting Raynaud's Phenomenon Affecting Tongue, Hands, and Feet. JOURNAL OF RHEUMATIC DISEASES 2012. [DOI: 10.4078/jrd.2012.19.6.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Soon Myung Jung
- Department of Internal Medicine, Busan St. Mary's Medical Center, Busan, Korea
| | - Jin Taek Yoo
- Department of Internal Medicine, Busan St. Mary's Medical Center, Busan, Korea
| | - Young Hwan Kim
- Department of Internal Medicine, Busan St. Mary's Medical Center, Busan, Korea
| | - Yu Na Seo
- Department of Radiology, Busan St. Mary's Medical Center, Busan, Korea
| | - Na Young Lee
- Department of Pediatrics, Busan St. Mary's Medical Center, Busan, Korea
| | - Seong Geun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seong Hu Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Young Eun Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seung Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Geun Tae Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sung-Il Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Joung Wook Lee
- Department of Internal Medicine, Busan St. Mary's Medical Center, Busan, Korea
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19
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Huisstede BM, Hoogvliet P, Paulis WD, van Middelkoop M, Hausman M, Coert JH, Koes BW. Effectiveness of interventions for secondary Raynaud's phenomenon: a systematic review. Arch Phys Med Rehabil 2011; 92:1166-80. [PMID: 21704799 DOI: 10.1016/j.apmr.2011.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To present an evidence-based overview of the effectiveness of (non)surgical symptomatic interventions to treat secondary Raynaud's phenomenon (RP). DATA SOURCES The Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched for relevant systematic reviews and randomized controlled trials (RCTs). STUDY SELECTION Two reviewers independently applied the inclusion criteria to select potential studies. DATA EXTRACTION Two reviewers independently extracted data and assessed the methodologic quality. DATA SYNTHESIS If pooling of data was not possible, a best-evidence synthesis was used to summarize the results. Of the 5 reviews and 19 RCTs included, 1 RCT studied acupuncture and another RCT reported on percutaneous radiofrequency thoracic sympathectomy. All others concentrated on the effectiveness of drugs (oral or intravenous [IV]). It appeared that calcium channel blockers significantly reduce the frequency and severity of Raynaud attacks, and are therefore effective in the treatment of secondary RP. Iloprost (oral and IV) was also found to be effective. Limited evidence was found for atorvastatin. For other traditional and more recently discovered interventions, no clear favorable effects were found. CONCLUSIONS This review shows that there is clear evidence in favor of calcium channel blockers and iloprost (oral and IV) to treat secondary RP. For all other interventions, only limited, conflicting, or no evidence was found. More high-quality, well-designed RCTs are needed in this field, especially for new interventions based on recent knowledge about the pathophysiology of secondary RP.
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Affiliation(s)
- Bionka M Huisstede
- Department of General Practice, Erasmus MC - University Medical Center Rotterdam, the Netherlands.
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20
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Halvorson CR, Kwon SY, Kao GF, Germanas JP. Lipomembranous fat necrosis in a patient with mixed connective tissue disease. J Am Acad Dermatol 2011; 64:1010-1. [PMID: 21496719 DOI: 10.1016/j.jaad.2010.01.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 01/04/2010] [Accepted: 01/27/2010] [Indexed: 11/18/2022]
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21
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Case history of mixed connective tissue disease. КЛИНИЧЕСКАЯ ПРАКТИКА 2011. [DOI: 10.17816/clinpract83846] [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] Open
Abstract
The literary review on mixed connective tissue disease is given according to modern international data. The case history of this pathology is described. The case has been observed in the rheumatological department of the Federal Research Clinical Center FMBA of Russia.
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22
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Vera-Recabarren MA, García-Carrasco M, Ramos-Casals M, Herrero C. Cutaneous lupus erythematosus: clinical and immunological study of 308 patients stratified by gender. Clin Exp Dermatol 2010; 35:729-35. [PMID: 20015282 DOI: 10.1111/j.1365-2230.2009.03764.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Numerous studies involving systemic lupus erythematosus (SLE) have attempted to identify gender differences in patients with lupus erythematosus (LE). However, few reports on cutaneous lupus erythematous (CLE) have identified gender differences. AIM To analyse and compare the prevalence and characteristics of the main clinical and immunological features of male and female patients with CLE. METHODS The medical records of 103 (33.4%) male and 205 (66.6%) female patients with CLE who were treated as inpatients or outpatients between January 1985 and December 2000 were retrospectively studied. All patients were reviewed in detail stratified by a predefined protocol. RESULTS Female patients had a higher prevalence of Raynaud's phenomenon (P < 0.01), chilblain lupus (P = 0.005), arthralgias (P = 0.001) and SLE (P < 0.01). Female patients were also more likely to have an increased erythrocyte sedimentation rate (P < 0.005), higher levels of antinuclear antibodies (P < 0.001) and decreased levels of C3 (P < 0.001), C4 (P < 0.01) and CH50 (P < 0.01). There was a higher prevalence of clinical and laboratory abnormalities in female patients who had both SLE and CLE than in male patients with both conditions. Conclusions. In our series, differences in the expression of CLE existed between male and female patients with respect to the type of lesions, systemic features, and immunological findings.
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Affiliation(s)
- M A Vera-Recabarren
- Department of Dermatology, Hospital Clinic, University of Barcelona, Catalonia, Spain.
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23
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Liang YX, Gu MN, Wang SD, Chu HC. Perianesthesia management of Raynaud's phenomenon--a case report. J Perianesth Nurs 2010; 25:221-5. [PMID: 20656258 DOI: 10.1016/j.jopan.2010.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Revised: 03/25/2010] [Accepted: 05/18/2010] [Indexed: 11/29/2022]
Abstract
This article presents a case report of a 52-year-old female patient with lung cancer presenting with Raynaud's phenomenon during thoracic surgery. Experiences and lessons learned from this case are presented. The classification, pathogenesis, and perianesthesia management of Raynaud's phenomenon are discussed.
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Affiliation(s)
- Yong X Liang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University Medical College, Qingdao 266000, People's Republic of China.
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24
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[Lupus erythematosus. Wide range of symptoms through clinical variation, associated diseases and imitators]. Hautarzt 2010; 61:676-82. [PMID: 20549478 DOI: 10.1007/s00105-010-1939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The typical clinical forms of cutaneous lupus erythematosus (LE) are the butterfly rash, acute, subacute and chronic cutaneous lupus, intermediate lupus (lupus tumidus), chilblain- and bullous lupus, lupus profundus, and ulcerating lesions on the mucous membrane. Besides the typical lupus forms, nonspecific skin lesions are also observed such as dermal mucinosis, acneiform skin lesions, different variants of livedo, necrotizing vasculitis with ulcers, purpura, urticaria vasculitis, neutrophilic dermatosis, hyperpigmentation, hair and nail changes as well as overlap syndromes with erythema multiforme, scleroderma, Sjögren syndrome, Raynaud phenomenon, lichen planus, bullous pemphigoid und psoriasis. There are lupus imitators which create differential diagnostic challenges, such as infections with atypical mycobacteria or subcutaneous T-cell lymphoma both of which are similar to lupus profundus. All these skin lesions can present as maximal pathological findings seen in lupus or be caused by a variety of pathological laboratory findings such as the anti-phospholipid antibodies or a deficiency of complement factors. In the latter situation severe lupus often with complications can be expected.
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Fregene A, Ditmars D, Siddiqui A. Botulinum toxin type A: a treatment option for digital ischemia in patients with Raynaud's phenomenon. J Hand Surg Am 2009; 34:446-52. [PMID: 19258141 DOI: 10.1016/j.jhsa.2008.11.026] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 11/19/2008] [Accepted: 11/24/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE Raynaud's phenomenon is an exaggerated vasospastic response that causes pallor and cyanosis. In the hand, it results in pain, disability, and the need for amputation. Current accepted medical and surgical treatments are not uniformly successful and have their inherent morbidities. Reports in the literature describe the use of botulinum toxin type A (BTX-A) for the treatment of vasospastic ischemia of the digits. We report the results of the treatment of recalcitrant digital ischemia with BTX-A in our institution. METHODS We performed a retrospective chart review between January 2003 and February 2007. All patients presented with a diagnosis of Raynaud's phenomenon with worsening pain, discoloration, or nonhealing wound of the hand. Patients received BTX-A injections into the perineurovascular tissue of the wrist or the distal palm, or along the digit. Outcomes measured included pain rating, digit color and appearance, transcutaneous oxygen saturation, and healing of chronic ulcers. RESULTS Twenty-six patients were treated, with a total of 55 treatment encounters. Patients were observed for an average of 18 months. Statistically significant improvements were noted for pain score and digit transcutaneous oxygen saturation measurements after treatment (p < .05). We found smokers and women were more likely to have improved coloration and appearance after injections. Complications included localized injection-related pain and transient intrinsic muscle weakness. CONCLUSIONS Botulinum toxin type A significantly improves pain and improves healing in Raynaud's patients with few complications. BTX-A was found to be a safe and useful treatment option for vasospastic digital ischemia.
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Affiliation(s)
- Alero Fregene
- Division of Plastic Surgery, Henry Ford Hospital, Detroit, MI, USA
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27
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A case of MCTD overlapped by Takayasu’s arteritis, presenting Raynaud’s phenomenon as the initial manifestation of both diseases. Rheumatol Int 2008; 29:685-8. [DOI: 10.1007/s00296-008-0717-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 09/07/2008] [Indexed: 10/21/2022]
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28
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García-Carrasco M, Jiménez-Hernández M, Escárcega RO, Mendoza-Pinto C, Pardo-Santos R, Levy R, Maldonado CG, Chávez GP, Cervera R. Treatment of Raynaud's phenomenon. Autoimmun Rev 2008; 8:62-8. [DOI: 10.1016/j.autrev.2008.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 07/12/2008] [Indexed: 10/21/2022]
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Behne MJ, Hauswirth U, Menz A, Brüllke N, Müllerleile U, Moll I. [Acral necrosis in metastatic ovarian carcinoma. A single episode of Moschowitz syndrome during gemcitabine chemotherapy]. Hautarzt 2008; 59:917-21. [PMID: 18368377 DOI: 10.1007/s00105-008-1494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
For some time now, there have been reports of acral necrosis as a paraneoplasia that may occur in association with a number of different malignant tumours. There have also been a series of reports about acral necrosis associated with chemotherapy with various cytostatics. The treatment of choice if these lesions occur is plasmapheresis. Ultimately, the occurrence of thrombotic microangiopathy (TMA) can only be prevented by close monitoring through regular laboratory controls before each new cycle of chemotherapy. In the differential diagnosis, Raynaud's syndrome should be considered as a premonitory paraneoplasia, a risk factor for the occurrence of acral necrosis in patients with a malignant tumour undergoing chemotherapy, particularly patients with ovarian carcinoma receiving gemcitabine treatment.
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Affiliation(s)
- M J Behne
- Klinik für Dermatologie und Venerologie, Universitätskrankenhaus Eppendorf, Martinistrasse 52, 20246 Hamburg, Deutschland.
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Aringer M, Smolen JS. Mixed connective tissue disease: what is behind the curtain? Best Pract Res Clin Rheumatol 2008; 21:1037-49. [PMID: 18068860 DOI: 10.1016/j.berh.2007.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although there is still an emotional debate over the existence of mixed connective tissue disease, the evidence from animal models suggests that anti-U1RNP antibodies, similar to other autoantibodies in other connective tissue diseases (such as antisynthetase, anticentromere, and antitopoisomerase), play a pathophysiological role in this disease. Despite an antiendothelial effect of anti-U1RNP antibodies, which is reminiscent of anticentromere antibodies, patients with high-titer autoantibodies to U1RNP in the absence of anti-Sm antibodies do not usually have or develop typical systemic sclerosis. Instead, their severe Raynaud's syndrome is commonly accompanied by arthritis, which can be erosive, and by swollen/puffy hands and myositis. Pulmonary arterial hypertension is the major life-threatening complication in these patients and regular screening for this condition is essential.
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Affiliation(s)
- Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Center Carl Gustav Carus, Technical University of Dresden, Germany.
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Distler M, Distler J, Ciurea A, Kyburz D, Müller-Ladner U, Reich K, Distler O. [Evidence-based therapy of Raynaud's syndrome]. Z Rheumatol 2007; 65:285-9. [PMID: 16804699 DOI: 10.1007/s00393-006-0068-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Raynaud's syndrome has a prevalence of 3-5% in the general population. Despite its high frequency, the majority of available therapies have not been validated in randomized controlled trials. Effective therapies with a high level of evidence include the calcium channel blocker nifedipine. As analyzed by meta-analyses, nifedipine showed improvement of the peripheral circulation, as well as reduction of both the intensity and frequency of attacks in patients with primary and secondary Raynaud's syndrome as compared to placebo. Similar results in a metaanalysis were obtained for intravenous infusions of iloprost in patients with secondary Raynaud's phenomenon associated with systemic sclerosis. In addition, intravenous infusions of iloprost improved healing of fingertip ulcers in patients with systemic sclerosis. Therapies with significant effects in single randomized controlled trials include angiotensin II-receptor type 1 antagonists (losartan), the calcium channel blockers felodipine und amlodipine, serotonin-reuptake-inhibitors (fluoxetine) und phosphodiesterase-V-inhibitors (sildenafil, vardenafil). However, the results for these promising substances have to be confirmed in long-term trials with larger patient numbers.
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Affiliation(s)
- M Distler
- Abt. Dermatologie und Venerologie, Georg-August-Universität Göttingen
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