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Smichowski AM, Caputo VD, Romeo C, Rivero E, Morales NS, Casado G. Ocular cicatricial pemphigoid: Methotrexate as an initial treatment? REUMATOLOGIA CLINICA 2022; 18:30-32. [PMID: 34088654 DOI: 10.1016/j.reumae.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To analyse the clinical/epidemiological data, the management and the treatments established in patients with Ocular Cicatricial Pemphigoid (OCP) in a Rheumatology Service. MATERIAL AND METHODS Review of clinical histories of patients with OCP referred by ophthalmology between 2008 and 2019. RESULTS In our series of 27 patients, 67% were diagnosed and referred in the last 2 years. Most in Foster stage 1. Of the patients, 18.5% presented associated Sjogren's syndrome, with poor progression: 88.8% received Methotrexate, 74% used it as monotherapy and 66% continued with said treatment up to the end. Eighteen point five percent had to combine or rotate therapies, the drugs used were mycophenolate, azathioprine, cyclophosphamide, sirolimus, etanercept, rituximab: 29% used steroids. Only in 2 eyes was stage progression observed. There were no serious adverse events, and 37% had mild adverse events. CONCLUSION Starting immunosuppressive therapy early is essential, methotrexate being a good initial alternative in our experience, and treatment must be escalated in line with disease progression.
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Affiliation(s)
- Andrea María Smichowski
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina.
| | - Victor Daniel Caputo
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Cecilia Romeo
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Estela Rivero
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Natalia Soledad Morales
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Gustavo Casado
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
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Schmidt E, Rashid H, Marzano A, Lamberts A, Di Zenzo G, Diercks G, Alberti‐Violetti S, Barry R, Borradori L, Caproni M, Carey B, Carrozzo M, Cianchini G, Corrà A, Dikkers F, Feliciani C, Geerling G, Genovese G, Hertl M, Joly P, Meijer J, Mercadante V, Murrell D, Ormond M, Pas H, Patsatsi A, Rauz S, van Rhijn B, Roth M, Setterfield J, Zillikens D, C.Prost, Zambruno G, Horváth B, Caux F. European Guidelines (S3) on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology - Part II. J Eur Acad Dermatol Venereol 2021; 35:1926-1948. [PMID: 34309078 PMCID: PMC8518905 DOI: 10.1111/jdv.17395] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/24/2021] [Indexed: 01/21/2023]
Abstract
This guideline has been initiated by the task force Autoimmune Blistering Diseases of the European Academy of Dermatology and Venereology, including physicians from all relevant disciplines and patient organizations. It is a S3 consensus-based guideline that systematically reviewed the literature on mucous membrane pemphigoid (MMP) in the MEDLINE and EMBASE databases until June 2019, with no limitations on language. While the first part of this guideline addressed methodology, as well as epidemiology, terminology, aetiology, clinical presentation and outcome measures in MMP, the second part presents the diagnostics and management of MMP. MMP should be suspected in cases with predominant mucosal lesions. Direct immunofluorescence microscopy to detect tissue-bound IgG, IgA and/or complement C3, combined with serological testing for circulating autoantibodies are recommended. In most patients, serum autoantibodies are present only in low levels and in variable proportions, depending on the clinical sites involved. Circulating autoantibodies are determined by indirect IF assays using tissue substrates, or ELISA using different recombinant forms of the target antigens or immunoblotting using different substrates. The major target antigen in MMP is type XVII collagen (BP180), although in 10-25% of patients laminin 332 is recognized. In 25-30% of MMP patients with anti-laminin 332 reactivity, malignancies have been associated. As first-line treatment of mild/moderate MMP, dapsone, methotrexate or tetracyclines and/or topical corticosteroids are recommended. For severe MMP, dapsone and oral or intravenous cyclophosphamide and/or oral corticosteroids are recommended as first-line regimens. Additional recommendations are given, tailored to treatment of single-site MMP such as oral, ocular, laryngeal, oesophageal and genital MMP, as well as the diagnosis of ocular MMP. Treatment recommendations are limited by the complete lack of high-quality randomized controlled trials.
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Shimizu E, Yazu H, Aketa N, Yokoiwa R, Sato S, Katayama T, Hanyuda A, Sato Y, Ogawa Y, Tsubota K. Smart Eye Camera: A Validation Study for Evaluating the Tear Film Breakup Time in Human Subjects. Transl Vis Sci Technol 2021; 10:28. [PMID: 34004005 PMCID: PMC8083120 DOI: 10.1167/tvst.10.4.28] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/13/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to demonstrate the efficacy of a "Smart Eye Camera (SEC)" in comparison with the efficacy of the conventional slit-lamp microscope by evaluating their diagnostic functionality for dry eye disease (DED) in clinical cases. Methods This retrospective study included 106 eyes from 53 adult Japanese patients who visited the Ophthalmology outpatient clinics in Keio University Hospital from June 2019 to March 2020. Tear film breakup time (TFBUT) and corneal fluorescence score (CFS) measurements for the diagnosis of DED were compared between the conventional slit-lamp microscope and SEC. Results The objective findings of DED showed that there was a strong correlation between the conventional slit-lamp microscope and SEC with respect to TFBUT and CFS results (Spearman's r = 0.887, 95% confidence interval [CI] = 0.838-0.922, and r = 0.920, 95% CI = 0.884-0.945, respectively). The interobserver reliability between the conventional slit-lamp microscope and SEC showed a moderate agreement (weighted Kappa κ = 0.527, 95% CI = 0.517-0.537 and κ = 0.550, 95% CI = 0.539-0.561 for TFBUT and CFS, respectively). The diagnostic performance of the SEC for Asia Dry Eye Society diagnostic criteria showed a sensitivity of 0.957 (95% CI = 0.841-0.992), specificity of 0.900 (95% CI = 0.811-0.927), positive predictive value of 0.880 (95% CI = 0.774-0.912), and negative predictive value of 0.964 (95% CI = 0.869-0.993). Moreover, the area under the receiver operating characteristic curve was 0.928 (95% CI = 0.849-1.000). Conclusions Compared with the conventional slit-lamp microscope, SEC has sufficient validity and reliability for diagnosing DED in the clinical setting. Translational Relevance The SEC can portably evaluate TFBUT in both basic research and clinical care.
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Affiliation(s)
- Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- OUI Inc., Tokyo, Japan
| | - Hiroyuki Yazu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- OUI Inc., Tokyo, Japan
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa, Japan
| | - Naohiko Aketa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- OUI Inc., Tokyo, Japan
| | | | - Shinri Sato
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Taiichiro Katayama
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Hanyuda
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Cifuentes-González C, Amaris-Martínez S, Reyes-Guanes J, Uribe-Reina P, de-la-Torre A. Ocular Cicatricial Pemphigoid, Sjögren's Syndrome, and Hashimoto's Thyroiditis as a Multiple Autoimmune Syndrome: A case report. Eur J Ophthalmol 2021; 32:NP52-NP55. [PMID: 33601905 PMCID: PMC9294440 DOI: 10.1177/1120672121996637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose: To present a rare and novel association of Ocular Cicatricial Pemphigoid,
Sjögren’s Syndrome, and Hashimoto’s Thyroiditis as a Multiple Autoimmune
Syndrome. Case report: A 43-year-old Colombian female, presented with corneal ulcers, associated
with trichiasis. At the ophthalmological examination forniceal shortening OU
and symblepharon OD was found. Conjunctival biopsy was performed, evidencing
linear deposition of IgG and IgA antibodies along the basement membrane of
the conjunctiva, confirming Ocular Cicatricial Pemphigoid diagnosis. After
12 years, the patient presented constitutional symptoms, xerostomia, and
worsening of xerophthalmia. Laboratory tests showed positive Anti-TG,
Anti-TPO, Anti-Ro, and Anti-La antibodies, and salivary gland biopsy was
consistent with Sjögren’s Syndrome. Due to these findings, Hashimoto’s
Thyroiditis and Sjögren’s Syndrome were diagnosed, defining a Multiple
Autoimmune Syndrome. Conclusion: A novel association of Multiple Autoimmune Syndrome is presented in this
case. Ophthalmologists and other specialists involved in the evaluation and
treatment of patients with autoimmune diseases, should be aware of this
clinical presentation. A multidisciplinary approach in this condition is
important for optimum treatment instauration and follow-up, in order to
prevent complications.
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Affiliation(s)
- Carlos Cifuentes-González
- Research Group in Neurosciences NeURos, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Stefania Amaris-Martínez
- Research Group in Neurosciences NeURos, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Escuela Barraquer. Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Pilar Uribe-Reina
- Research Group in Neurosciences NeURos, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.,Escuela Barraquer. Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Research Group in Neurosciences NeURos, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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Smichowski AM, Caputo VD, Romeo C, Rivero E, Morales NS, Casado G. Ocular Cicatricial Pemphigoid: Methotrexate as an Initial Treatment? REUMATOLOGIA CLINICA 2021; 18:S1699-258X(20)30242-4. [PMID: 33454207 DOI: 10.1016/j.reuma.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/21/2020] [Accepted: 10/15/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyse the clinical / epidemiological data, the management and the treatments established in patients with ocular cicatricial pemphigoid in a Rheumatology Service. MATERIAL AND METHODS Review of clinical histories of patients with ocular cicatricial pemphigoid referred by ophthalmology between 2008 and 2019. RESULTS In our series of 27 patients, 67% were diagnosed and referred in the last 2 years. Most in Foster stage 1. Of the patients, 18.5% presented associated Sjogren's syndrome, with poor progression: 88.8% received Methotrexate, 74% used it as monotherapy and 66% continued with said treatment up to the end. Eighteen point five percent had to combine or rotate therapies, the drugs used were mycophenolate, azathioprine, cyclophosphamide, sirolimus, etanercept, rituximab: 29% used steroids. Only in 2 eyes was stage progression observed. There were no serious adverse events, and 37% had mild adverse events. CONCLUSION Starting immunosuppressive therapy early is essential, methotrexate being a good initial alternative in our experience, and treatment must be escalated in line with disease progression.
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Affiliation(s)
- Andrea María Smichowski
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina.
| | - Victor Daniel Caputo
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Cecilia Romeo
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Estela Rivero
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Natalia Soledad Morales
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Gustavo Casado
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
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Taurone S, Spoletini M, Ralli M, Gobbi P, Artico M, Imre L, Czakò C, Kovàcs I, Greco A, Micera A. Ocular mucous membrane pemphigoid: a review. Immunol Res 2019; 67:280-289. [DOI: 10.1007/s12026-019-09087-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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