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Efthimiou P, Petryna O, Nakasato P, Kontzias A. New insights on multigenic autoinflammatory diseases. Ther Adv Musculoskelet Dis 2022; 14:1759720X221117880. [PMID: 36081748 PMCID: PMC9445512 DOI: 10.1177/1759720x221117880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Autoinflammatory diseases are disorders of the innate immune system, which can be either monogenic due to a specific genetic mutation or complex multigenic due to the involvement of multiple genes. The aim of this review is to explore and summarize the recent advances in pathogenesis, diagnosis, and management of genetically complex autoinflammatory diseases, such as Schnitzler's syndrome; adult-onset Still's disease; synovitis, acne, pustulosis, hyperostosis, osteitis syndrome/chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis; Adamantiades-Behçet's disease; Yao syndrome; and periodic fever with aphthous stomatitis, pharyngitis, and adenitis syndrome. The PubMed database was screened for relevant articles using free text words and specific search strings. The search was limited to English-language articles, reporting the results of studies in humans, published through March 2021. Evidence from literature suggest that these rare multigenic autoinflammatory diseases can present with different clinical features and the diagnosis of these diseases can be challenging due to a combination of nonspecific manifestations that can be seen in a variety of other conditions. Diagnostic delays and disease complications may occur due to low disease awareness and the lack of pathognomonic markers. The pathogeneses of these diseases are complex and in some cases precise pathogenesis is not clearly understood. Conventional treatments are commonly used for the management of these conditions, but biologics have shown promising results. Biologics targeting proinflammatory cytokines including IL-1, IL-6, TNF-α, IL-17A and IL-18 have been shown to ameliorate signs and symptoms of different multigenic autoinflammatory diseases.
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Affiliation(s)
- Petros Efthimiou
- New York Rheumatology Care, Ross University School of Medicine, New York, USA
| | - Olga Petryna
- NYU Grossman School of Medicine, New York, NY, USA
| | | | - Apostolos Kontzias
- Department of Rheumatology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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Pawar M, Zawar V, Kumavat S. Persistent Pruritic Papules AND Plaques and Flagellate Erythema as Presenting Manifestations of an Adult onset Still's Disease. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Pápulas y placas pruriginosas persistentes y eritema flagelado como manifestaciones de una enfermedad de Still del adulto. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:794-796. [DOI: 10.1016/j.ad.2019.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/10/2019] [Accepted: 01/30/2019] [Indexed: 11/20/2022] Open
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Gabr JB, Liu E, Mian S, Pillittere J, Bonilla E, Banki K, Perl A. Successful treatment of secondary macrophage activation syndrome with emapalumab in a patient with newly diagnosed adult-onset Still's disease: case report and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:887. [PMID: 32793731 DOI: 10.21037/atm-20-3127] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Here, we present a 22-year-old female patient with adult-onset Still's disease (AOSD) who was newly diagnosed in the setting of secondary macrophage activation syndrome (MAS), a rare, life-threatening inflammatory disease with 50% mortality due to multi-organ failure. She met the diagnostic criteria of AOSD and MAS, while genetic testing excluded primary causes of MAS. She had high fevers, anemia, thrombocytopenia, splenomegaly, hematophagocytosis, and elevated serum ferritin (37,950 ng/mL) and CD25 levels (11,870 pg/mL), which remained unresponsive to corticosteroids and anakinra. Her serum interferon gamma (IFN-γ) levels were elevated (7 pg/mL). She was markedly responsive to IFN-γ blockade with emapalumab that eliminated her fevers and all MAS-associated laboratory abnormalities. This report provides initial evidence for therapeutic efficacy for IFN-γ blockade in AOSD and secondary MAS.
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Affiliation(s)
- Jihad Ben Gabr
- Department of Medicine, Upstate Medical University, College of Medicine, Syracuse, NY, USA
| | - Eric Liu
- Department of Medicine, Upstate Medical University, College of Medicine, Syracuse, NY, USA
| | - Sundus Mian
- Department of Medicine, Upstate Medical University, College of Medicine, Syracuse, NY, USA
| | - Julie Pillittere
- Department of Medicine, Upstate Medical University, College of Medicine, Syracuse, NY, USA
| | - Eduardo Bonilla
- Department of Medicine, Upstate Medical University, College of Medicine, Syracuse, NY, USA
| | - Katalin Banki
- Department of Pathology, State University of New York, College of Medicine, Syracuse, NY, USA
| | - Andras Perl
- Department of Medicine, Upstate Medical University, College of Medicine, Syracuse, NY, USA.,Department of Microbiology and Immunology, Upstate Medical University, College of Medicine, Syracuse, NY, USA.,Department of Biochemistry and Molecular Biology, Upstate Medical University, College of Medicine, Syracuse, NY, USA
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Sode T, Uzoma B, Vandergriff T, Hosler GA. Urticaria and a rare mutation: An unusual case of neutrophilic urticarial dermatosis. JAAD Case Rep 2020; 6:543-545. [PMID: 32490121 PMCID: PMC7256433 DOI: 10.1016/j.jdcr.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Titilola Sode
- ProPath Dermatopathology, Dallas, Texas
- Correspondence to: Titilola Sode, MD, ProPath Dermatopathology, 1355 River Bend Drive, Dallas, TX 75247.
| | - Bianca Uzoma
- The University of Texas Medical Branch School of Medicine, Galveston, Texas
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Gregory A. Hosler
- ProPath Dermatopathology, Dallas, Texas
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
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Fernandez-Flores A. La biopsia cutánea en el contexto de la enfermedad sistémica. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:710-727. [DOI: 10.1016/j.ad.2019.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 02/07/2023] Open
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Damevska K, França K, Nikolovska S, Gucev F. Adult-onset Still's disease as a cutaneous marker of systemic disease. Clin Dermatol 2019; 37:668-674. [PMID: 31864446 DOI: 10.1016/j.clindermatol.2019.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adult-onset Still's disease (AOSD) is a rare, systemic, inflammatory disorder characterized by spiking fevers, an evanescent eruption, arthritis, and multiorgan involvement. The disease has been recently classified as a polygenic autoinflammatory disorder at the "crossroads" of autoinflammatory and autoimmune diseases. The highly characteristic salmon-colored eruption is a cutaneous manifestation of a generalized inflammatory reaction and an important diagnostic criterion. In addition to the evanescent eruption, there are atypical persistent papules and plaques in many patients with AOSD. Emerging data suggest that AOSD with this typical evanescent eruption has a different clinicopathologic presentation and clinical course than AODS with atypical cutaneous manifestations. It appears that there are two subtypes of AOSD with different immunologic profiles, including (1) a systemic disease with high fever, organ involvement, and elevated levels of ferritin, and (2) a chronic disease course with arthritis as the predominant finding. These observations provide novel insight into the disease pathogenesis, suggesting that the underlying mechanisms might differ between these two forms, partially explaining the reported differences in drug response. Recent advances in the understanding of AOSD are summarized with a focus on the spectrum of cutaneous manifestations and its relationship to systemic inflammation.
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Affiliation(s)
- Katerina Damevska
- University Clinic of Dermatology, Ss Cyril and Methodius University, Skopje, Macedonia.
| | - Katlein França
- Department of Dermatology and Cutaneous Surgery, Department of Psychiatry and Behavioral Sciences, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Suzana Nikolovska
- University Clinic of Dermatology, Ss Cyril and Methodius University, Skopje, Macedonia
| | - Filip Gucev
- Univeristy Clinic of Rheumatology, Ss Cyriland Methodius University, Skopje, Macedonia
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