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Chaitidis N, Papadopoulou Z, Varvara ST, Panagiotidis M, Katsigianni I, Sakellariou GT. Paradoxical psoriasis induced by IL-17 inhibitors: a case series of patients with axial spondyloarthritis and a systematic literature review. Rheumatol Int 2024; 44:2659-2668. [PMID: 38914777 DOI: 10.1007/s00296-024-05647-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/08/2024] [Indexed: 06/26/2024]
Abstract
Following the market authorization of interleukin (IL)-17 inhibitors, a growing number of cases of IL-17 inhibitor-induced paradoxical psoriasis (PsO) have been reported. Our objectives were to present two cases of IL-17 inhibitor-induced paradoxical PsO and to systematically review the literature for similar cases, summarizing and presenting the relevant data. A systematic literature review of previously presented cases of paradoxical PsO induced by IL-17 inhibitors was conducted. We presented two patients with axial spondyloarthritis (axSpA) and paradoxical PsO induced by secukinumab (SEC). One patient's psoriatic lesions responded well to adjuvant topical treatment, while the other patient required a combination of topical treatment and cyclosporine Α for successful treatment. SEC was continued in both cases. We also identified 35 patients with IL-17 inhibitor-induced paradoxical PsO in the literature review. The most frequent types of paradoxical PsO were palmoplantar pustular and plaque PsO, while the median latency period was 11 weeks. Approximately one-third of patients continued IL-17 inhibitor treatment with adjunctive therapy, primarily topical, which produced satisfactory results in most patients. Almost two-thirds of the patients discontinued the IL-17 inhibitor, with the majority of patients switching to another biological agent with a different mechanism of action or initiating other systemic antipsoriatic treatments, resulting in mainly satisfactory outcomes. Therefore, paradoxical PsO induced by IL-17 inhibitors appears to respond well in both patients who continue IL-17 inhibitors with adjunctive treatment and those who discontinue IL-17 inhibitors while switching to a different class of biological agent or initiating other systemic antipsoriatic treatments.
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Affiliation(s)
- Nikolaos Chaitidis
- Department of Dermatology and Venereology, 424 General Military Training Hospital, Thessaloniki, Hellenic Republic, Greece.
| | - Zoi Papadopoulou
- 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Hellenic Republic, Greece
| | - Stavritsa Taxiarchoula Varvara
- Department of Dermatology and Venereology, 424 General Military Training Hospital, Thessaloniki, Hellenic Republic, Greece
- 2nd Department of Internal Medicine, 424 General Military Training Hospital, Thessaloniki, Hellenic Republic, Greece
| | - Michail Panagiotidis
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Thessaloniki, Hellenic Republic, Greece
| | - Ioanna Katsigianni
- Department of Rheumatology, 424 General Military Training Hospital, Thessaloniki, Hellenic Republic, Greece
| | - Grigorios T Sakellariou
- Department of Rheumatology, 424 General Military Training Hospital, Thessaloniki, Hellenic Republic, Greece
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Keluth Chavan A, Jha P, Perez JA, Harper E, Sinh P, Cooper G, Katz J, Cominelli F, Regueiro M, Mansoor E. Risk of Paradoxical Rheumatoid Arthritis in Inflammatory Bowel Disease Patients Exposed to Tumor Necrosis Factor Inhibitors: A Propensity-Matched Multicenter Study. Inflamm Bowel Dis 2024:izae203. [PMID: 39259586 DOI: 10.1093/ibd/izae203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Indexed: 09/13/2024]
Abstract
Lay Summary
Tumor necrosis factor (TNF) inhibitor therapy for inflammatory bowel disease (IBD) has been associated with an increased risk of rheumatoid arthritis and other inflammatory conditions. Our retrospective study did not show an increased risk when compared with non-anti-TNF therapy for IBD.
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Affiliation(s)
- Akash Keluth Chavan
- Department of Internal Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Pankhuri Jha
- Department of Internal Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jaime Abraham Perez
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Elleson Harper
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Preetika Sinh
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gregory Cooper
- Digestive Health Institute, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffry Katz
- Digestive Health Institute, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Fabio Cominelli
- Case Western Reserve University/University Hospitals Cleveland Medical Center/Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Emad Mansoor
- Case Western Reserve University/University Hospitals Cleveland Medical Center/Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
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Speeckaert R, Caelenberg EV, Belpaire A, Speeckaert MM, Geel NV. Vitiligo: From Pathogenesis to Treatment. J Clin Med 2024; 13:5225. [PMID: 39274437 PMCID: PMC11396398 DOI: 10.3390/jcm13175225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 08/28/2024] [Accepted: 09/01/2024] [Indexed: 09/16/2024] Open
Abstract
Recent advances in vitiligo have provided promising treatment options, particularly through understanding the immune-mediated mechanisms leading to depigmentation. The inflammatory components in both vitiligo (non-segmental) and segmental vitiligo have similarities. Both are believed to result from an immune-based destruction of melanocytes by anti-melanocyte-specific cytotoxic T cells. The JAK-STAT pathway is activated with IFN-γ as the crucial cytokine and Th1-associated chemokines such as CXCL9 and CXCL10 recruit immune cells towards vitiligo skin. Nonetheless, clear differences are also present, such as the localized nature of segmental vitiligo, likely due to somatic mosaicism and increased presence of poliosis. The differing prevalence of poliosis suggests that the follicular immune privilege, which is known to involve immune checkpoints, may be more important in vitiligo (non-segmental). Immunomodulatory therapies, especially those targeting the JAK-IFNγ pathway, are currently at the forefront, offering effective inhibition of melanocyte destruction by cytotoxic T cells. Although Janus Kinase (JAK) inhibitors demonstrate high repigmentation rates, optimal results can take several months to years. The influence of environmental UV exposure on repigmentation in patients receiving immunomodulating drugs remains largely underexplored. Nonetheless, the combined effect of phototherapy with JAK inhibitors is impressive and suggests a targeted immune-based treatment may still require additional stimulation of melanocytes for repigmentation. Identifying alternative melanocyte stimulants beyond UV light remains crucial for the future management of vitiligo.
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Affiliation(s)
| | | | - Arno Belpaire
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium
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4
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Wang Y, Yang F, Wang R, Luo S. Paradoxical psoriasis induced by IL-17 antagonists. Indian J Dermatol Venereol Leprol 2024; 90:623-631. [PMID: 38594973 DOI: 10.25259/ijdvl_719_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/20/2023] [Indexed: 04/11/2024]
Abstract
Background The paradoxical occurrence of psoriasis triggered by Interleukin-17 (IL-17) inhibitors is notable due to its prominent symptoms and the therapeutic dilemma it presents for follow-up care. Objective To describe cases in our clinic, perform an in-depth literature review, and suggest the most probable mechanisms of action. Method We conducted a literature review on published cases of IL-17 inhibitor-induced psoriasis. Results We found 22 articles reporting 30 cases of IL-17 inhibitor-induced paradoxical psoriasis, primarily observed in patients with a previous psoriasis history. Almost 60% of cases showed a change in lesion morphology, with the plaque or pustular type being prevalent. About 73.3% of patients had to discontinue the implicated drug, leading to partial or complete symptom resolution. The mechanism behind this response seemed to involve IL-17 inhibitors downregulating Tumour Necrosis Factor alpha (TNF-α), subsequently upregulating plasmacytoid dendritic cells and triggering unopposed IFN-alpha (IFN-α) production. Limitation Data are confined to case reports and case series. Conclusion More assertive measures are recommended for treating paradoxical psoriasis induced by IL-17 inhibitors than those caused by TNF-α inhibitors. Reintroducing an IL-17 inhibitor is not advised, as patients did not show improvement.
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Affiliation(s)
- Yachen Wang
- Department of Dermatology, Tianjin Medical University General Hospital, Anshan Dao, Tianjin, China
| | - Fengling Yang
- Department of Dermatology, Tianjin Medical University General Hospital, Anshan Dao, Tianjin, China
| | - Ruizhe Wang
- Department of Dermatology, Tianjin Medical University General Hospital, Anshan Dao, Tianjin, China
| | - Suju Luo
- Department of Dermatology, Tianjin Medical University General Hospital, Anshan Dao, Tianjin, China
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Alsabbagh MM. Cytokines in psoriasis: From pathogenesis to targeted therapy. Hum Immunol 2024; 85:110814. [PMID: 38768527 DOI: 10.1016/j.humimm.2024.110814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
Psoriasis is a multifactorial disease that affects 0.84% of the global population and it can be associated with disabling comorbidities. As patients present with thick scaly lesions, psoriasis was long believed to be a disorder of keratinocytes. Psoriasis is now understood to be the outcome of the interaction between immunological and environmental factors in individuals with genetic predisposition. While it was initially thought to be solely mediated by cytokines of type-1 immunity, namely interferon-γ, interleukin-2, and interleukin-12 because it responds very well to cyclosporine, a reversible IL-2 inhibitor; the discovery of Th-17 cells advanced the understanding of the disease and helped the development of biological therapy. This article aims to provide a comprehensive review of the role of cytokines in psoriasis, highlighting areas of controversy and identifying the connection between cytokine imbalance and disease manifestations. It also presents the approved targeted treatments for psoriasis and those currently under investigation.
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Affiliation(s)
- Manahel Mahmood Alsabbagh
- Princess Al-Jawhara Center for Molecular Medicine and Inherited Disorders and Department of Molecular Medicine, Arabian Gulf University, Manama, Bahrain.
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Abdelghaffar M, Kottilil S, Murphy MJ, Cohen JM, Damsky W. Paradoxical Psoriasis. Dermatol Clin 2024; 42:471-480. [PMID: 38796276 DOI: 10.1016/j.det.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Cytokine blocking therapies have revolutionized the management of psoriasis and atopic dermatitis but can lead to the development of paradoxic psoriasis (PP). Patients treated with biologics should be closely monitored for the development of PP and other paradoxical eruptions (including inflammatory joint disease, inflammatory bowel disease, eczematous eruptions, lupus like eruptions, sarcoidal eruptions, and others) and occasionally the development of cutaneous T-cell lymphoma. Further understanding the immunologic mechanism of these processes will ultimately drive our understanding of and ability to predict and manage PPs.
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Affiliation(s)
- Mariam Abdelghaffar
- School of Medicine, Royal College of Surgeons in Ireland, Building No. 2441, Road 2835, Busaiteen 228, Bahrain
| | | | - Michael J Murphy
- Department of Dermatology, Yale School of Medicine, 333 Cedar Street, PO Box 208059, New Haven, CT 06510, USA
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, 333 Cedar Street, PO Box 208059, New Haven, CT 06510, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, 333 Cedar Street, PO Box 208059, New Haven, CT 06510, USA.
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7
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Costin D, Burlui AM, Cardoneanu A, Macovei LA, Rezus C, Bratoiu I, Richter P, Mihai IR, Gherasim A, Danielescu C, Rezus E. Paradoxical Psoriasis in Patients Receiving Therapy with Tumor Necrosis Factor Inhibitors: Potential Pathogenic Mechanisms and the Role of Genetic Factors. Int J Mol Sci 2024; 25:7018. [PMID: 39000125 PMCID: PMC11241744 DOI: 10.3390/ijms25137018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/18/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
TNF inhibitors (TNFi) have revolutionized the therapeutic management of various chronic immune-mediated inflammatory diseases. Despite their known benefits, these therapies are related to paradoxical adverse effects (PAEs), including paradoxical psoriasis (PP). Although the underlying mechanism remains somewhat unclear, some theories suggest that genetic factors, particularly certain single-nucleotide polymorphisms (SNPs), may play an important role. The present review aimed to research and analyze recent findings regarding the pathomechanisms involved in the appearance of PP and the association between various genetic factors and PP in individuals treated with TNFi. We performed a literature search and found that certain genes (IL23R, TNF, FBXL19, CTLA4, SLC12A8, TAP1) are strongly associated with the occurrence of PP in pediatric and adult patients during therapy with TNFi. The identification of the specific SNPs involved in the appearance of PP and other PAEs in patients treated with TNFi for various diseases and in different populations may later favor the recognition of those patients at a high risk of developing such adverse effects and could guide personalized therapeutic strategies in future years.
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Affiliation(s)
- Damiana Costin
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Alexandra Maria Burlui
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Anca Cardoneanu
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Luana Andreea Macovei
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- “Sfantul Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Ioana Bratoiu
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Patricia Richter
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ioana Ruxandra Mihai
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Andreea Gherasim
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- “Sfantul Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Ciprian Danielescu
- Department of Surgery II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Profesor Dr. Nicolae Oblu” Clinical Emergency Hospital, 700309 Iasi, Romania
| | - Elena Rezus
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
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8
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Sanz Segura P, Gomollón F, Casas D, Iborra M, Vela M, Fernández-Clotet A, Muñoz R, García de la Filia I, García Prada M, Ferrer Rosique JÁ, García MJ, de Francisco R, Arias L, Barrio J, Guerra I, Ponferrada Á, Gisbert JP, Carrillo-Palau M, Calvet X, Márquez-Mosquera L, Gros B, Cañete F, Monfort D, Madrigal Domínguez RE, Roncero Ó, Laredo V, Montoro M, Muñoz C, López-Cauce B, Lorente R, Fuentes Coronel A, Vega P, Martín D, Peña E, Varela P, Olivares S, Pajares R, Lucendo AJ, Sesé E, Botella Mateu B, Nos P, Domènech E, García-López S. Psoriasis induced by antiTNF therapy in inflammatory bowel disease: Therapeutic management and evolution of both diseases in a nationwide cohort study. Dig Liver Dis 2024:S1590-8658(24)00779-5. [PMID: 38876834 DOI: 10.1016/j.dld.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND some patients with inflammatory bowel disease (IBD) treated with antiTNF develop drug-induced psoriasis (antiTNF-IP). Several therapeutic strategies are possible. AIMS to assess the management of antiTNF-IP in IBD, and its impact in both diseases. METHODS patients with antiTNF-IP from ENEIDA registry were included. Therapeutic strategy was classified as continuing the same antiTNF, stopping antiTNF, switch to another antiTNF or swap to a non-antiTNF biologic. IP severity and IBD activity were assessed at baseline and 16, 32 and 54 weeks. RESULTS 234 patients were included. At baseline, antiTNF-IP was moderate-severe in 60 % of them, and IBD was in remission in 80 %. Therapeutic strategy was associated to antiTNF-IP severity (p < 0.001). AntiTNF-IP improved at week 54 with all strategies, but continuing with the same antiTNF showed the worst results (p = 0.042). Among patients with IBD in remission, relapse was higher in those who stopped antiTNF (p = 0.025). In multivariate analysis, stopping antiTNF, trunk and palms and soles location were associated with antiTNF-IP remission; female sex and previous surgery in Crohn´s disease with IBD relapse. CONCLUSION skin lesions severity and IBD activity seem to determine antiTNF-IP management. Continuing antiTNF in mild antiTNF-IP, and swap to ustekinumab or switch to another antiTNF in moderate-severe cases, are suitable strategies.
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Affiliation(s)
| | - Fernando Gomollón
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sanitaria (ISS) Aragón, Zaragoza, Spain
| | - Diego Casas
- Instituto de Investigación Sanitaria (ISS) Aragón, Zaragoza, Spain; Gastroenterology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marisa Iborra
- Gastroenterology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Milagros Vela
- Gastroenterology Department, Hospital Universitario Ntra. Sra. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Agnès Fernández-Clotet
- Gastroenterology Department, Hospital Clinic de Barcelona. Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Roser Muñoz
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | | | - María García Prada
- Gastroenterology Department, Complejo Asistencial Universitario de León, Spain
| | | | - María José García
- Gastroenterology and Hepatology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Ruth de Francisco
- Gastroenterology Department, Hospital Universitario Central de Asturias, and Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lara Arias
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Jesús Barrio
- Gastroenterology Department, Hospital Universitario Río Hortega. Gerencia Regional de Salud de Castilla y León (SACYL). Valladolid, Spain
| | - Iván Guerra
- Gastroenterology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Ángel Ponferrada
- Gastroenterology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Marta Carrillo-Palau
- Gastroenterology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Xavier Calvet
- Servei d'Aparell Digestiu. Parc Taulí, Hospital Universitari. Institutd'Investigació i Innovació Parc Taulí(I3PT-CERCA). Universitat Autònoma de Barcelona. Sabadell, Spain. Centro de Investigación Biomédica En Red de enfermedades hepáticas y digestivas (CIBERehd). Instituto de Salud Carlos III. Madrid, Spain
| | - Lucía Márquez-Mosquera
- Servei de Digestiu, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Beatriz Gros
- Gastroenterology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Fiorella Cañete
- Gastroenterology Department, Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Barcelona, Spain
| | - David Monfort
- Gastroenterology Department, Consorci Sanitari de Terrassa, Spain
| | | | - Óscar Roncero
- Gastroenterology Department, Hospital General La Mancha Centro, Ciudad Real, Spain
| | - Viviana Laredo
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Miguel Montoro
- Gastroenterology Department, Hospital San Jorge, Huesca, Spain
| | - Carmen Muñoz
- Gastroenterology Department, Hospital de Basurto, Bilbao, Spain
| | - Beatriz López-Cauce
- Gastroenterology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rufo Lorente
- Gastroenterology Department, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Ana Fuentes Coronel
- Gastroenterology Department, Hospital Virgen de La Concha, Complejo Asistencial de Zamora, Zamora, Spain
| | - Pablo Vega
- Gastroenterology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Dolores Martín
- Gastroenterology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Elena Peña
- Gastroenterology Department, Hospital Royo Villanova, Zaragoza, Spain
| | - Pilar Varela
- Gastroenterology Department, Hospital Universitario de Cabueñes, Gijón, Spain
| | | | - Ramón Pajares
- Gastroenterology Department, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Alfredo J Lucendo
- Gastroenterology Department, Hospital General de Tomelloso, IIS-IP, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM) and CIBEREHD Ciudad Real, Spain
| | - Eva Sesé
- Gastroenterology Department, Hospital Universitario Arnau de Vilanova de Lleida, Spain
| | - Belén Botella Mateu
- Gastroenterology Department, Hospital Universitario Infanta Cristina, Madrid, Spain
| | - Pilar Nos
- Gastroenterology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Eugeni Domènech
- Gastroenterology Department, Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Barcelona, Spain
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Donzella D, Bellis E, Campisi P, Crepaldi G, Data V, Dapavo P, Lomater C, Marucco E, Saracco M, Gatto M, Iagnocco A. New onset sarcoidosis following biologic treatment in patients with seronegative inflammatory arthritis: A case series and systematic literature review. Autoimmun Rev 2024; 23:103481. [PMID: 38008299 DOI: 10.1016/j.autrev.2023.103481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To report cases of new onset sarcoidosis upon biologic (bDMARDs) treatment administration in patients with seronegative inflammatory arthritis in a real-life cohort, alongside a systematic literature review (SLR) on this topic. METHODS We performed a retrospective analysis on clinical records of patients with seronegative arthritis followed up in a monocentric cohort who underwent bDMARDs treatment due to the underlying rheumatic disease and described any newly diagnosed sarcoidosis in this cohort. Only ascertained cases with available radiological and/or histological documentation were considered. A SLR on new-onset sarcoidosis in seronegative arthritis receiving bDMARDs was performed across MEDLINE (through PubMed), Scopus and Ovid (Cochrane, Embase) electronic databases using appropriate strings. RESULTS In our cohort, 4 new-onset cases of sarcoidosis were reported among patients with seronegative inflammatory arthritis receiving biologics. Three out of 4 patients were receiving anti-tumor necrosis factor alpha (TNFα) while 1 patient was on secukinumab (anti-IL17A) prior to sarcoidosis onset. The SLR disclosed 46 new-onset sarcoidosis cases upon biological treatment for seronegative arthritis, of whom 43 occurred during treatment with anti-TNFα, while 3 during anti-IL-17A therapy. In our cohort as well as in the majority of cases reported in the SLR, sarcoidosis presented with lymph nodal and lung involvement and displayed a benign course with spontaneous resolution in about 1 fourth of the cases. CONCLUSION The use of biologics may relate to the onset of sarcoidosis; hence, clinicians must remain aware of the potential occurrence or reactivation of sarcoidosis when starting biologic treatment in patients with inflammatory arthritis, performing adequate patient assessment and surveillance. Since TNFα inhibitors may represent a therapeutic option for sarcoidosis, further evaluation on larger cohorts is needed to investigate any causal link with the development of sarcoidosis.
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Affiliation(s)
- Denise Donzella
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Elisa Bellis
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | | | - Gloria Crepaldi
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Valeria Data
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Paolo Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Claudia Lomater
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Elena Marucco
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Marta Saracco
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Mariele Gatto
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy.
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10
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Yamanaka K. New treatment of pyoderma gangrenosum and hidradenitis suppurativa: A review. J Dermatol 2024; 51:172-179. [PMID: 38009911 DOI: 10.1111/1346-8138.17031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
Pyoderma gangrenosum (PG) and hidradenitis suppurativa (HS) are stubborn inflammatory skin diseases categorized as neutrophilic hypodermal dermatoses. These conditions exhibit connections with other autoinflammatory disorders driven by immune responses. Their pathogenesis is complex, rooted in significant imbalances in both innate and adaptive immune systems, particularly featuring elevated levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1, IL-8, IL-17, and IL-23. Studies involving skin tissue pathology and serology have indicated that targeting specific cytokines can bring therapeutic benefits. Indeed, many patients in clinical settings have responded positively to such interventions. Yet, given the diverse cytokines in play, focusing on a single one with antibody therapy might not always be effective. When resistance to biologics emerges, a combined approach targeting multiple overactive cytokines with immunosuppressants, for example cyclosporine and Janus kinase inhibitors, could be an option. In the current review, we explore recent therapeutic developments for PG and HS.
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Affiliation(s)
- Keiichi Yamanaka
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
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11
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Karstarlı Bakay OS, Bakay U. A case of certolizumab-induced purpura annularis telangiectodes of Majocchi and literature review. Int J Rheum Dis 2024; 27:e14854. [PMID: 37522716 DOI: 10.1111/1756-185x.14854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 06/16/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
Tumor necrosis factor alpha (TNFα) inhibitors are now widely used to treat immune-mediated inflammatory diseases. Although they have a good safety profile, they are also associated with adverse cutaneous events. Pigmented purpuric dermatoses (PPD) include a variety of skin diseases characterized by multiple petechial hemorrhages due to capillaritis. Five major clinical types of PPD have been described and purpura annularis telangiectodes of Majocchi (PATM) is a rare subtype of PPD. The cause of PPD is unknown, but drugs are implicated in a minority of cases. There are very few cases in the literature triggered by TNFα inhibitors. We present a case of PATM induced by certolizumab pegol and perform a review including 4 articles in the literature reporting 5 PPD cases induced by TNFα inhibitors. When purpuric eruptions develop in patients treated with TNFα inhibitors, PPD and vasculitis should be differentiated. Thus, patients are not exposed to unnecessary evaluations and treatments.
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Affiliation(s)
| | - Umut Bakay
- Department of Rheumatology, Denizli State Hospital, Denizli, Turkey
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12
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Ward D, Nyboe Andersen N, Gørtz S, Thorn Iversen A, Højgaard Allin K, Beaugerie L, Kirchgesner J, Jess T. Tumor Necrosis Factor Inhibitors in Inflammatory Bowel Disease and Risk of Immune Mediated Inflammatory Diseases. Clin Gastroenterol Hepatol 2024; 22:135-143.e8. [PMID: 37442315 DOI: 10.1016/j.cgh.2023.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/18/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND & AIMS Tumor necrosis factor inhibitors (anti-TNF) are effective therapies for several immune-mediated inflammatory diseases (IMIDs). However, case reports have identified the paradoxical occurrence of IMIDs in patients treated with anti-TNF. We studied the risk of rheumatoid arthritis, psoriasis, and hidradenitis suppurativa after the initiation of anti-TNF therapy for inflammatory bowel disease (IBD). METHODS We conducted 2 nationwide cohort studies comprising all patients with IBD in Denmark (2005-2018) and France (2008-2018). We obtained individual-level information on exposure to anti-TNF, diagnoses of IMIDs including rheumatoid arthritis, psoriasis, and hidradenitis suppurativa, and potential confounders from healthcare registers in the respective countries. We used Cox models to estimate hazard ratios (HRs) for the association between anti-TNF exposure and IMIDs and then pooled the estimates from the 2 cohorts. To test the robustness of our results, we performed an active comparator analysis of anti-TNF monotherapy vs azathioprine monotherapy. RESULTS The Danish and French cohorts comprised 18,258 and 88,786 subjects with IBD, respectively, contributing a total of 516,055 person-years of follow-up. Anti-TNF was associated with an increased risk of rheumatoid arthritis, psoriasis, and hidradenitis suppurativa in both the Danish (HR, 1.66; 95% confidence interval [CI], 1.34-2.07) and the French cohort (HR, 1.78; 95% CI, 1.63-1.94), with a pooled HR of 1.76 (95% CI, 1.63-1.91). Anti-TNF was also associated with an increased risk of the outcomes when compared with azathioprine (pooled HR, 2.94; 95% CI, 2.33-3.70). CONCLUSIONS In 2 nationwide cohorts of IBD patients, anti-TNF therapy was associated with an increased risk of rheumatoid arthritis, psoriasis, and hidradenitis suppurativa.
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Affiliation(s)
- Daniel Ward
- Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.
| | - Nynne Nyboe Andersen
- Section of Gastroenterology, Medical Department, Zealand University Hospital, Køge, Denmark
| | - Sanne Gørtz
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Aske Thorn Iversen
- Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Kristine Højgaard Allin
- Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark; Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Laurent Beaugerie
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France
| | - Julien Kirchgesner
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France
| | - Tine Jess
- Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark; Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
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13
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Nelson NC, Kogan R, Condos R, Hena KM. Emerging Therapeutic Options for Refractory Pulmonary Sarcoidosis: The Evidence and Proposed Mechanisms of Action. J Clin Med 2023; 13:15. [PMID: 38202021 PMCID: PMC10779381 DOI: 10.3390/jcm13010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
Sarcoidosis is a systemic disease with heterogenous clinical phenotypes characterized by non-necrotizing granuloma formation in affected organs. Most disease either remits spontaneously or responds to corticosteroids and second-line disease-modifying therapies. These medications are associated with numerous toxicities that can significantly impact patient quality-of-life and often limit their long-term use. Additionally, a minority of patients experience chronic, progressive disease that proves refractory to standard treatments. To date, there are limited data to guide the selection of alternative third-line medications for these patients. This review will outline the pathobiological rationale behind current and emerging therapeutic agents for refractory or drug-intolerant sarcoidosis and summarize the existing clinical evidence in support of their use.
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Affiliation(s)
| | | | | | - Kerry M. Hena
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University, 301 E 17th St Suite 550, New York, NY 10003, USA
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14
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Alnaqbi KA, Al Zeyoudi J, Fazal F, Alhaj OM, Jassim I, Albreiki FA. Paradoxical Psoriasis and Worsening Spondylitis Due to Secukinumab in a Patient With Ankylosing Spondylitis: A Case Report and Literature Review. Cureus 2023; 15:e50726. [PMID: 38111814 PMCID: PMC10726796 DOI: 10.7759/cureus.50726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 12/20/2023] Open
Abstract
Axial spondyloarthritis (axSpA) is an autoimmune disease primarily affecting the axial skeleton, with associated extra-musculoskeletal manifestations. Treatment strategies targeting cytokines tumor necrosis factor-alpha (TNF-α) and interleukin 17 (IL-17) have proven effective. However, paradoxical reactions, including paradoxical psoriasis and arthritis, have been reported in axSpA patients receiving TNF-α inhibitors. IL-17 inhibitors have been used as an alternative treatment option, but paradoxical reactions have also been rarely observed. This case report presents a 45-year-old man with axSpA who responded to infliximab for six years before discontinuing it due to secondary failure. After the washout period of infliximab, he was started on secukinumab but developed paradoxical psoriasis and worsening of inflammatory back pain after receiving the second loading dose which necessitated replacing it with upadacitinib. Complete resolution of paradoxical psoriasis and significant improvement in his back pain after three months ensued. This case contributes to understanding the complex dynamics in treating axSpA and managing paradoxical reactions.
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Affiliation(s)
- Khalid A Alnaqbi
- Internal Medicine, Tawam Hospital and College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, ARE
- Internal Medicine/Rheumatology, Tawam Hospital, Al Ain, ARE
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15
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Ogawa T, Tsujimoto K, Shimagami H, Fukuda C, Hirano T. The Onset of IgG4-related Retroperitoneal Fibrosis under Administration of a TNF Inhibitor in a Rheumatoid Arthritis Patient. Intern Med 2023; 62:3251-3254. [PMID: 36927972 PMCID: PMC10686727 DOI: 10.2169/internalmedicine.1326-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/27/2023] [Indexed: 03/16/2023] Open
Abstract
An 80-year-old woman with rheumatoid arthritis during treatment with etanercept, a tumor necrosis factor (TNF) inhibitor, showed swelling of the salivary glands and retroperitoneal fibrosis, which was diagnosed as IgG4-related disease. Although some reports have shown the efficacy of TNF inhibitors for IgG4-related disease or retroperitoneal fibrosis, TNF inhibitors sometimes cause paradoxical reactions like psoriasis, and the mechanisms are considered to involve the upregulation of plasmacytoid dendritic cells and IFN-α, which is also common in patients with IgG4-related disease. This is a case report of IgG4-related retroperitoneal fibrosis with the possibility of a rare paradoxical reaction by a TNF inhibitor.
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Affiliation(s)
- Takao Ogawa
- Department of Rheumatology, Nishinomiya Municipal Central Hospital, Japan
| | - Kohei Tsujimoto
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Japan
| | - Hiroshi Shimagami
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Japan
| | - Chiaki Fukuda
- Department of Rheumatology, Nishinomiya Municipal Central Hospital, Japan
| | - Toru Hirano
- Department of Rheumatology, Nishinomiya Municipal Central Hospital, Japan
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16
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Toh EQ, Wang ECE. Targeted immunotherapy for hair regrowth and regeneration. Front Med (Lausanne) 2023; 10:1285452. [PMID: 37881630 PMCID: PMC10595013 DOI: 10.3389/fmed.2023.1285452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- En Qi Toh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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17
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Paez-Escamilla M, Caplash S, Kalra G, Odden J, Price D, Marroquin OC, Koscumb S, Commiskey P, Indermill C, Finkelstein J, Gushchin AG, Coca A, Friberg TR, Eller AW, Gallagher DS, Harwick JC, Waxman EL, Chhablani J, Bonhomme G, Prensky C, Anetakis AJ, Martel JN, Massicotte E, Ores R, Girmens JF, Pearce TM, Sahel JA, Dansingani K, Westcott M, Errera MH. Challenges in posterior uveitis-tips and tricks for the retina specialist. J Ophthalmic Inflamm Infect 2023; 13:35. [PMID: 37589912 PMCID: PMC10435440 DOI: 10.1186/s12348-023-00342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/07/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gagan Kalra
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamie Odden
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Danielle Price
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Stephen Koscumb
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Commiskey
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jerome Finkelstein
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anna G Gushchin
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andreea Coca
- Department of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas R Friberg
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jean C Harwick
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gabrielle Bonhomme
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexander J Anetakis
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erika Massicotte
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raphaelle Ores
- Department of Ophthalmology, McGill University Campus Outaouais, Gatineau, QC, Canada
| | | | - Thomas M Pearce
- Division of Neuropathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kunal Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark Westcott
- Department of Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- UPMC Eye Center, University of Pittsburgh School of Medicine, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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18
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Tsiogka A, Liakou AI, Agiasofitou E, Gregoriou S, Stratigos A, Rigopoulos D, Kontochristopoulos G. Adalimumab-Induced Paradoxical Psoriasis Treated with Biologics Targeting the IL-17/IL-23 Axis in Patients with Hidradenitis Suppurativa. Dermatology 2023; 239:937-941. [PMID: 37579735 DOI: 10.1159/000533370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Paradoxical psoriasis (PP) has been mainly described in patients receiving tumor necrosis factor-α (TNFα) inhibitors for inflammatory bowel disease or psoriasis vulgaris, while such data in the context of hidradenitis suppurativa (HS) are scarce. The purpose of this study was to demonstrate the course of PP and the underlying HS upon switching from adalimumab to a biologic agent targeting the interleukin (IL)-17/IL-23 axis. METHODS The electronic medical database of the outpatient department for HS of a tertiary hospital for skin diseases was searched to identify patients with moderate-to-severe HS under treatment with adalimumab, who developed PP and were switched to biological therapy with an IL-17 or IL-23 inhibitor between February 2016 and January 2022. Disease assessment scores were evaluated at baseline, at time of PP development, as well as six and 12 months thereafter. RESULTS Among the 83 patients who received adalimumab for the treatment of HS between February 2016 and January 2022, 10 patients (12%) developed paradoxical psoriasiform skin reactions after a median time of seven (range, 2-48) months. There were four females (40%) and six males (60%) with a median age of 42.5 (range, 33-56) years. Five patients presented with plaque psoriasis and five with palmoplantar pustulosis, while four had intertriginous and three nail involvement. In most of the patients, HS responded well to adalimumab at onset of PP. Eight patients were changed to secukinumab, one to ustekinumab, and one to risankizumab. HS further improved in all but 2 patients, one receiving secukinumab and one receiving risankizumab. In addition, all patients achieved improvement of PP. CONCLUSION Despite the small number of patients, this study provides support that patients with adalimumab-induced PP may benefit from biologics targeting the IL-17/IL-23 axis. Further studies are needed to establish the optimal therapeutic strategy of the anti-TNFα-induced PP in the context of HS.
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Affiliation(s)
- Aikaterini Tsiogka
- Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini I Liakou
- Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthimia Agiasofitou
- Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatis Gregoriou
- Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Stratigos
- Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Rigopoulos
- Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Kontochristopoulos
- Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
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19
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Wu X, Tao M, Zhu L, Zhang T, Zhang M. Pathogenesis and current therapies for non-infectious uveitis. Clin Exp Med 2023; 23:1089-1106. [PMID: 36422739 PMCID: PMC10390404 DOI: 10.1007/s10238-022-00954-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
Non-infectious uveitis (NIU) is a disorder with various etiologies and is characterized by eye inflammation, mainly affecting people of working age. An accurate diagnosis of NIU is crucial for appropriate therapy. The aim of therapy is to improve vision, relieve ocular inflammation, prevent relapse, and avoid treatment side effects. At present, corticosteroids are the mainstay of topical or systemic therapy. However, repeated injections are required for the treatment of chronic NIU. Recently, new drug delivery systems that may ensure intraocular delivery of therapeutic drug levels have been highlighted. Furthermore, with the development of immunosuppressants and biologics, specific therapies can be selected based on the needs of each patient. Immunosuppressants used in the treatment of NIU include calcineurin inhibitors and antimetabolites. However, systemic immunosuppressive therapy itself is associated with adverse effects due to the inhibition of immune function. In patients with refractory NIU or those who cannot tolerate corticosteroids and immunosuppressors, biologics have emerged as alternative treatments. Thus, to improve the prognosis of patients with NIU, NIU should be managed with different drugs according to the response to treatment and possible side effects.
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Affiliation(s)
- Xue Wu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Mengying Tao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ling Zhu
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Ting Zhang
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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20
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Sandoval AGW, Vaughn LT, Huang JT, Barbieri JS. Role of Tumor Necrosis Factor-α Inhibitors in the Treatment and Occurrence of Acne: A Systematic Review. JAMA Dermatol 2023; 159:504-509. [PMID: 36930143 PMCID: PMC10024242 DOI: 10.1001/jamadermatol.2023.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/24/2023] [Indexed: 03/18/2023]
Abstract
Importance Tumor necrosis factor-α inhibitors (TNFis) approved to treat several inflammatory diseases are sometimes used off label to treat severe forms of acne that are refractory to conventional therapies. However, use of TNFis can also be followed by acne occurrence, suggesting an association between TNFis and acne. Most of the literature on the topic comprises case reports and series that have not been reviewed in a systematic manner. Objective To characterize the demographic characteristics, clinical presentations, treatments, and outcomes of patients receiving TNFis to treat acne and patients who develop acne following treatment of other conditions with TNFis. Evidence Review A systematic literature review was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. PubMed and Web of Science were searched from inception through October 17, 2022. Included studies reported on patients of any sex or age who received TNFis whose treatment was followed by resolution or occurrence of acne. Two independent reviewers screened studies based on predefined criteria and extracted data from each study, which were quantitatively combined. Findings A total of 53 studies reporting on 64 patients who received TNFis for the treatment of acne (n = 47) or who experienced acne after treatment with TNFis for a different condition (n = 17) (mean age, 28.7 years; range, 12-64 years; 6 female individuals [8.8%]) were included. The TNFis used included adalimumab, infliximab, and etanercept. Among the 47 patients treated for acne with TNFis, most had previously received antibiotics (31 [66.0%]) or isotretinoin (32 [68.1%]). Most (44 [93.6%]) experienced partial improvement (25 [53.2%]) or clearance (19 [40.4%]) with very few adverse effects reported (3 [6.4%]). Acne manifested as part of an inflammatory syndrome for 30 patients (63.8%). Among the 17 patients treated TNFis for a different condition followed by the occurrence of acne, only 1 patient (5.9%) reported having a history of acne. Therapy with TNFis was either discontinued (8 [47.1%]) or altered (6 [35.3%]) in most patients due to acne occurrence, typically with improvement in symptoms. Conclusions and Relevance The results of this systematic review suggest that TNFis can be effective in treating refractory acne but can also be associated with the occurrence of acne in certain instances. Further studies elucidating the role that TNF plays in treating and inducing acne could yield insight into off-label TNFi use and acne pathogenesis, potentially guiding clinical care of patients with acne treated or induced by TNFis.
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Affiliation(s)
| | | | - Jennifer T. Huang
- Department of Dermatology, Boston Children’s Hospital, Boston, Massachusetts
| | - John S. Barbieri
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Associate Editor, JAMA Dermatology
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21
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Yu Z, Tsapis N, Fay F, Chen L, Karpus A, Shi X, Cailleau C, García Pérez S, Huang N, Vergnaud J, Mignani S, Majoral JP, Fattal E. Amphiphilic Phosphorus Dendrons Associated with Anti-inflammatory siRNA Reduce Symptoms in Murine Collagen-Induced Arthritis. Biomacromolecules 2023; 24:667-677. [PMID: 36599673 DOI: 10.1021/acs.biomac.2c01117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Small interfering RNA (siRNA) holds promise for treating rheumatoid arthritis by inhibiting major cytokines such as tumor necrosis factor-α (TNF-α). We developed original cationic amphiphilic phosphorus dendrons to produce dendriplexes associated with TNF-α siRNA. The dendrons were made of 10 pyrrolidinium end groups and a C17 aliphatic chain. The dendriplexes demonstrated the ability to protect siRNA from nuclease degradation and to promote macrophage uptake. Moreover, they led to potent inhibition of TNF-α expression in the lipopolysaccharide-activated mouse macrophage cell line RAW264.7 in vitro model. A significant anti-inflammatory effect in the murine collagen-induced arthritis model was observed through arthritis scoring and histological observations. These results open up essential perspectives in using this original amphiphilic dendron to reduce the disease burden and improve outcomes in chronic inflammatory diseases.
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Affiliation(s)
- Zhibo Yu
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay91400, France
| | - Nicolas Tsapis
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay91400, France
| | - François Fay
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay91400, France
| | - Liang Chen
- Laboratoire de Chimie de Coordination, CNRS, Université de Toulouse, Toulouse Cedex 431077, France.,Université Toulouse, 118 Route de Narbonne, Toulouse Cedex431077, France
| | - Andrii Karpus
- Laboratoire de Chimie de Coordination, CNRS, Université de Toulouse, Toulouse Cedex 431077, France.,Université Toulouse, 118 Route de Narbonne, Toulouse Cedex431077, France
| | - Xiangyang Shi
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai201620, PR China
| | - Catherine Cailleau
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay91400, France
| | - Samuel García Pérez
- Rheumatology & Immuno-mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-Uvigo36213, Spain
| | - Nicolas Huang
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay91400, France
| | - Juliette Vergnaud
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay91400, France
| | - Serge Mignani
- Laboratoire de Chimie et Biochimie Pharmacologiques et Toxicologique, University Paris Descartes, Pres Sorbonne Paris Cité, CNRS UMR 860, 45 Rue des Saints Peres, Paris75006, France.,CQM─Centro de Química da Madeira, Universidade da Madeira, Funchal9020-105, Portugal
| | - Jean-Pierre Majoral
- Laboratoire de Chimie de Coordination, CNRS, Université de Toulouse, Toulouse Cedex 431077, France
| | - Elias Fattal
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay91400, France
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22
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Kim SR, Kim SK, Fujii T, Kobayashi H, Okuda T, Hayakumo T, Nakai A, Fujii Y, Suzuki R, Sasase N, Otani A, Koma YI, Sasaki M, Kumabe T, Nakashima O. Drug-induced sarcoidosis-like reaction three months after BNT162b2 mRNA COVID-19 vaccination: A case report and review of literature. World J Clin Cases 2023; 11:177-186. [PMID: 36687201 PMCID: PMC9846985 DOI: 10.12998/wjcc.v11.i1.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/21/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A 70-year-old man with hepatitis C virus-related recurrent hepatocellular carcinoma was admitted for further diagnosis of a 1 cm iso-hyperechoic nodule in segment (S) 5. CASE SUMMARY Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) revealed the nodule in S5 with a defect at the hepatobiliary phase, hyperintensity on diffusion weighted imaging (DWI) and hypointensity on apparent diffusion coefficient (ADC) map. Contrast-enhanced computed tomography revealed hypervascularity at the early phase, and delayed contrast-enhancement was observed at the late phase. Contrast-enhanced ultrasound (US) revealed incomplete defect at the late vascular phase. Inflammatory liver tumor, lymphoproliferative disease, intrahepatic cholangiocarcinoma (small duct type) and bile duct adenoma were suspected through the imaging studies. US guided biopsy, however, showed a noncaseating hepatic sarcoid-like epithelioid granuloma (HSEG), and histopathological analysis disclosed spindle shaped epithelioid cells harboring Langhans-type multinucleated giant cells. One month after admission, EOB-MRI signaled the disappearance of the defect at the hepatobiliary phase, of hyperintensity on DWI, of hypointensity on ADC map, and no stain at the early phase. CONCLUSION That the patient had received BNT162b2 messenger RNA (mRNA) coronavirus disease 2019 vaccination 3 mo before the occurrence of HSEG, and that its disappearance was confirmed 4 mo after mRNA vaccination suggested that the drug-induced sarcoidosis-like reaction (DISR) might be induced by the mRNA vaccination. Fortunately, rechallenge of drug-induced DISR with the third mRNA vaccination was not confirmed.
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Affiliation(s)
- Soo Ryang Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
| | - Soo Ki Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
| | - Takako Fujii
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
| | - Hisato Kobayashi
- Department of Radiology, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
| | - Toyokazu Okuda
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
| | - Takanobu Hayakumo
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
| | - Atsushi Nakai
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
| | - Yumi Fujii
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
| | - Ryuji Suzuki
- Department of Clinical Laboratory, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
| | - Noriko Sasase
- Department of Pharmacy, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
| | - Aya Otani
- Department of Pharmacy, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
| | - Yu-ichiro Koma
- Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe 6530801, Hyogo, Japan
| | - Motoko Sasaki
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 9208640, Ishikawa, Japan
| | - Tsutomu Kumabe
- Department of Gastroenterology, Kumabe Clinic, Kumamoto 8611331, Kumamoto, Japan
| | - Osamu Nakashima
- Laboratory Services Center, St. Mary's Hospital, Kurume 830-8543, Fukuoka, Japan
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23
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Fujimoto R, Fujiwara S, Takata M, Umezono Y, Miura H. Palisaded neutrophilic granulomatous dermatitis as a paradoxical adverse reaction following tocilizumab use. Int J Dermatol 2023; 62:103-105. [PMID: 35789999 DOI: 10.1111/ijd.16346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/21/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Rai Fujimoto
- Dermatology Department and Minato Center of Elderly's Skin Tumor, Osaka Minato Central Hospital, Osaka, Japan
| | - Sakuhei Fujiwara
- Dermatology Department and Minato Center of Elderly's Skin Tumor, Osaka Minato Central Hospital, Osaka, Japan
| | - Mayumi Takata
- Dermatology Department and Minato Center of Elderly's Skin Tumor, Osaka Minato Central Hospital, Osaka, Japan
| | - Yuko Umezono
- Dermatology Department and Minato Center of Elderly's Skin Tumor, Osaka Minato Central Hospital, Osaka, Japan
| | - Hiroyuki Miura
- Dermatology Department and Minato Center of Elderly's Skin Tumor, Osaka Minato Central Hospital, Osaka, Japan
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24
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Zhang M, Zhang X. T cells in ocular autoimmune uveitis: Pathways and therapeutic approaches. Int Immunopharmacol 2023; 114:109565. [PMID: 36535124 DOI: 10.1016/j.intimp.2022.109565] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Autoimmune uveitis is a non-infectious intraocular condition that affects the uveal tract of the eye and threatens vision if not treated properly. Increasing evidence suggests that activated CD4+ T cells are associated with progressive and permanent destruction of photoreceptors in ocular autoimmune diseases. As such, the purpose of this review is to offer an overview of the role of CD4+ T cells in autoimmune uveitis as well as a justification for the current development and assessment of innovative autoimmune uveitis medications targeting CD4+ T cells. With an emphasis on T helper (Th)17, Th1, and Th2 cells, follicular helper CD4+ T cells, and regulatory T cells, this review presents a summary of recent research related to the pathways and signaling that encourage CD4+ T cells to develop into specialized effector cells. We also describe immunotherapeutic approaches based on CD4+ T cell subsets and their potential as therapeutic agents for autoimmune disorders.
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Affiliation(s)
- Mi Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaomin Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
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25
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Camela E, Potestio L, Fabbrocini G, Megna M. Paradoxical reactions to biologicals for psoriasis. Expert Opin Biol Ther 2022; 22:1435-1437. [PMID: 36445319 DOI: 10.1080/14712598.2022.2153593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Elisa Camela
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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26
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Yavuz NC, Ozer MA, Sari IF, Kulakli S, Tatli S, Ogut H. Optical coherence tomography changes in ankylosing spondylitis patients on long-term adalimumab treatment. Rev Assoc Med Bras (1992) 2022; 68:1626-1630. [PMID: 36449785 PMCID: PMC9779966 DOI: 10.1590/1806-9282.20220052] [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: 07/21/2022] [Accepted: 08/17/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Long-term ocular effects of tumor necrosis factor-alpha inhibitors remain to be elucidated. This study aimed to examine the long-term effects of adalimumab use on neural tissue of the anterior visual pathways using optical coherence tomography in patients with ankylosing spondylitis. METHODS This was a single-center, open-label, cross-sectional study conducted at the Giresun University Faculty of Medicine, Physical Medicine and Rehabilitation Department, between November 2019 and August 2020. This study included 26 ankylosing spondylitis patients receiving adalimumab for at least 1 year and 21 healthy controls. All subjects underwent a full ophthalmological examination and optical coherence tomography examination with the following measurements: peripapillary retinal nerve fiber layer thickness, peripapillary retinal thickness, peripapillary choroidal thickness, ganglion cell complex thickness, and the optic head properties. RESULTS Peripapillary retinal nerve fiber layer thickness and retinal thickness measurements were lower in the adalimumab group. In addition, ganglion cell complex thickness was significantly lower and the cup-to-disc ratio was significantly higher in the adalimumab group (p<0.05). However, the two groups did not differ in terms of peripapillary choroidal thickness and disc area (p>0.05). CONCLUSION Although tumor necrosis factor-alpha inhibitors have some favorable effects on the ocular involvement of patients with ankylosing spondylitis, they may also have paradoxical detrimental effects as evidenced by structural changes observed by optical coherence tomography. Future studies with better design, probably including a large number of patients with a range of rheumatological diseases and tumor necrosis factor-alpha inhibitors, are warranted.
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Affiliation(s)
- Nurce Cilesizoglu Yavuz
- Giresun University, Medical Faculty, Department of Physical Therapy and Rehabilitation – Giresun, Turkey.,Corresponding author:
| | - Murat Atabey Ozer
- Giresun University, Medical Faculty, Department of Ophthalmology – Giresun, Turkey
| | - Ilker Fatih Sari
- Giresun University, Medical Faculty, Department of Physical Therapy and Rehabilitation – Giresun, Turkey
| | - Sevgi Kulakli
- Giresun University, Medical Faculty, Department of Dermatology – Giresun, Turkey
| | - Samet Tatli
- Giresun University, Medical Faculty, Department of Physical Therapy and Rehabilitation – Giresun, Turkey
| | - Halil Ogut
- Hatay Mustafa Kemal University, Medical Faculty, Department of Physical Therapy and Rehabilitation – Hatay, Turkey
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27
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Ocular Manifestations in Patients with Inflammatory Bowel Disease in the Biologics Era. J Clin Med 2022; 11:jcm11154538. [PMID: 35956153 PMCID: PMC9369806 DOI: 10.3390/jcm11154538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Extra-intestinal manifestations are frequent in inflammatory bowel disease (IBD). Ocular disorders are generally under diagnosed as they are challenging diagnosis. Aims: We assessed the prevalence of ophthalmological manifestations in patients with IBD, and investigated characteristics associated with ocular manifestations. Methods: We performed a retrospective study including patients followed for IBD and had an ophthalmologic visit from January 2013 to July 2020, among 1432 patients followed during this period. Two groups were considered: the first group included patients whose an ocular diagnosis was considered as “related to IBD”, and the second group including patients whose an ocular diagnosis was considered “not related to IBD”. Results: Among 1432 patients with IBD, eighty-seven (6.1%) patients had an ophthalmologic visit. Fifty-three patients (3.7%) were considered to have an ocular extra-intestinal manifestation or an iatrogenic effect of IBD treatment, and 34 diagnoses (2.4%) were considered not related to IBD. Inflammatory surface pathologies were the most frequent (33.2%), including 15 patients with dry eye (17.2%), 9 with blepharitis (10.3%), and 5 with chalazions (meibomian cyst) (5.7%). Uveitis was diagnosed in 13 patients (14.9%), episcleritis in 5 patients (5.7%), and scleritis in 2 patients (2.3%). Characteristics of patients with an ophthalmological diagnosis “related to IBD” versus “not related to IBD” were not statistically different. Conclusion: In our cohort, less than 5% of patients had ophthalmological extra-intestinal manifestation. The most frequent ocular diagnosis were dry eye and uveitis. No disease characteristics of IBD were found to be associated with ocular manifestations.
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28
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Hlača N, Žagar T, Kaštelan M, Brajac I, Prpić-Massari L. Current Concepts of Vitiligo Immunopathogenesis. Biomedicines 2022; 10:biomedicines10071639. [PMID: 35884944 PMCID: PMC9313271 DOI: 10.3390/biomedicines10071639] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/20/2022] [Accepted: 07/04/2022] [Indexed: 12/11/2022] Open
Abstract
Vitiligo is an acquired immune-mediated disorder of pigmentation clinically characterized by well-defined depigmented or chalk-white macules and patches on the skin. The prevalence of vitiligo varies by geographical area, affecting 0.5% to 2% of the population. The disease imposes a significant psychological burden due to its major impact on patients’ social and emotional aspects of life. Given its autoimmune background, vitiligo is frequently associated with other autoimmune diseases or immune-mediated diseases. Vitiligo is a multifaceted disorder that involves both genetic predisposition and environmental triggers. In recent years, major predisposing genetic loci for the development of vitiligo have been discovered. The current findings emphasize the critical role of immune cells and their mediators in the immunopathogenesis of vitiligo. Oxidative-stress-mediated activation of innate immunity cells such as dendritic cells, natural killer, and ILC-1 cells is thought to be a key event in the early onset of vitiligo. Innate immunity cells serve as a bridge to adaptive immunity cells including T helper 1 cells, cytotoxic T cells and resident memory T cells. IFN-γ is the primary cytokine mediator that activates the JAK/STAT pathway, causing keratinocytes to produce the key chemokines CXCL9 and CXCL10. Complex interactions between immune and non-immune cells finally result in apoptosis of melanocytes. This paper summarizes current knowledge on the etiological and genetic factors that contribute to vitiligo, with a focus on immunopathogenesis and the key cellular and cytokine players in the disease’s inflammatory pathways.
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29
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Pyoderma Gangrenosum: An Updated Literature Review on Established and Emerging Pharmacological Treatments. Am J Clin Dermatol 2022; 23:615-634. [PMID: 35606650 PMCID: PMC9464730 DOI: 10.1007/s40257-022-00699-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 12/12/2022]
Abstract
Pyoderma gangrenosum is a rare inflammatory skin disease classified within the group of neutrophilic dermatoses and clinically characterized by painful, rapidly evolving cutaneous ulcers with undermined, irregular, erythematous-violaceous edges. Pyoderma gangrenosum pathogenesis is complex and involves a profound dysregulation of components of both innate and adaptive immunity in genetically predisposed individuals, with the follicular unit increasingly recognized as the putative initial target. T helper 17/T helper 1-skewed inflammation and exaggerated inflammasome activation lead to a dysregulated neutrophil-dominant milieu with high levels of tumor necrosis factor-α, interleukin (IL)-1β, IL-1α, IL-8, IL-12, IL-15, IL-17, IL-23, and IL-36. Low-evidence studies and a lack of validated diagnostic and response criteria have hindered the discovery and validation of new effective treatments for pyoderma gangrenosum. We review established and emerging treatments for pyoderma gangrenosum. A therapeutic algorithm based on available evidence is also provided. For emerging treatments, we review target molecules and their role in the pathogenesis of pyoderma gangrenosum.
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30
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Jung JM, Yang HJ, Lee WJ, Won CH, Lee MW, Chang SE. Association between psoriasis and alopecia areata: A systematic review and meta-analysis. J Dermatol 2022; 49:912-915. [PMID: 35510645 DOI: 10.1111/1346-8138.16420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/06/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
Abstract
The association between psoriasis and alopecia areata has not been thoroughly investigated. The objective of this study is to investigate the association of psoriasis with alopecia areata. An electronic search was conducted in August 2021. The analysis included studies that reported sufficient data on the prevalence, odds, or hazard of alopecia areata in patients with psoriasis or that of psoriasis in patients with alopecia areata. Meta-analysis using an inverse variance method was performed with a random-effects model, assuming inherent heterogeneity between the included studies. The subgroup analyses were performed according to the age group and study quality. A total of 27 studies were included. The pooled prevalence of alopecia areata among patients with psoriasis was 0.5% (95% confidence interval [CI], 0.3-0.7%). The pooled odds ratio of alopecia areata among patients with psoriasis was 2.71 (95% CI, 2.29-3.21), whereas the pooled prevalence of psoriasis among patients with alopecia areata was 2.5% (95% CI, 2.0-3.0%). Moreover, the pooled odds ratio of psoriasis among patients with alopecia areata was 3.52 (95% CI, 1.27-9.74). The association of psoriasis and alopecia areata remained in the subgroup analyses according to the age group and study quality. In conclusion, this study suggests a bidirectional association between psoriasis and alopecia areata. Clinical examinations may be necessary to determine the presence of comorbid alopecia areata in patients with psoriasis and vice versa.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Joo Yang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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31
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Kamoi K, Watanabe T, Uchimaru K, Okayama A, Kato S, Kawamata T, Kurozumi-Karube H, Horiguchi N, Zong Y, Yamano Y, Hamaguchi I, Nannya Y, Tojo A, Ohno-Matsui K. Updates on HTLV-1 Uveitis. Viruses 2022; 14:v14040794. [PMID: 35458524 PMCID: PMC9030471 DOI: 10.3390/v14040794] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 02/06/2023] Open
Abstract
HTLV-1 uveitis (HU) is the third clinical entity to be designated as an HTLV-1-associated disease. Although HU is considered to be the second-most frequent HTLV-1-associated disease in Japan, information on HU is limited compared to that on adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy (HAM). Recent studies have addressed several long-standing uncertainties about HU. HTLV-1-related diseases are known to be caused mainly through vertical transmission (mother-to-child transmission), but emerging HTLV-1 infection by horizontal transmission (such as sexual transmission) has become a major problem in metropolitan areas, such as Tokyo, Japan. Investigation in Tokyo showed that horizontal transmission of HTLV-1 was responsible for HU with severe and persistent ocular inflammation. The development of ATL and HAM is known to be related to a high provirus load and hence involves a long latency period. On the other hand, factors contributing to the development of HU are poorly understood. Recent investigations revealed that severe HU occurs against a background of Graves’ disease despite a low provirus load and short latency period. This review highlights the recent knowledge on HU and provides an update on the topic of HU in consideration of a recent nationwide survey.
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Affiliation(s)
- Koju Kamoi
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (H.K.-K.); (N.H.); (Y.Z.); (K.O.-M.)
- Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (T.W.); (K.U.); (S.K.); (T.K.); (Y.N.); (A.T.)
- Correspondence: ; Tel.: +81-3-5803-5302
| | - Toshiki Watanabe
- Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (T.W.); (K.U.); (S.K.); (T.K.); (Y.N.); (A.T.)
- Department of Practical Management of Medical Information, St. Marianna University School of Medicine, Kanagawa 216-8512, Japan
| | - Kaoru Uchimaru
- Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (T.W.); (K.U.); (S.K.); (T.K.); (Y.N.); (A.T.)
- Department of Medical Computational Biology and Genome Sciences, Laboratory of Tumor Cell Biology, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo 108-8639, Japan
| | - Akihiko Okayama
- Department of Rheumatology, Infectious Diseases and Laboratory Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1601, Japan;
| | - Seiko Kato
- Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (T.W.); (K.U.); (S.K.); (T.K.); (Y.N.); (A.T.)
| | - Toyotaka Kawamata
- Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (T.W.); (K.U.); (S.K.); (T.K.); (Y.N.); (A.T.)
| | - Hisako Kurozumi-Karube
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (H.K.-K.); (N.H.); (Y.Z.); (K.O.-M.)
| | - Noe Horiguchi
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (H.K.-K.); (N.H.); (Y.Z.); (K.O.-M.)
| | - Yuan Zong
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (H.K.-K.); (N.H.); (Y.Z.); (K.O.-M.)
| | - Yoshihisa Yamano
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan;
| | - Isao Hamaguchi
- Department of Safety Research on Blood and Biological Products, National Institute of Infectious Diseases, Tokyo 208-0011, Japan;
| | - Yasuhito Nannya
- Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (T.W.); (K.U.); (S.K.); (T.K.); (Y.N.); (A.T.)
| | - Arinobu Tojo
- Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (T.W.); (K.U.); (S.K.); (T.K.); (Y.N.); (A.T.)
- Institute of Innovation Advancement, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (H.K.-K.); (N.H.); (Y.Z.); (K.O.-M.)
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Interstitial Granulomatous Drug Reaction to Ustekinumab. Case Rep Dermatol Med 2022; 2022:1461145. [PMID: 35371573 PMCID: PMC8975670 DOI: 10.1155/2022/1461145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/09/2022] [Accepted: 03/08/2022] [Indexed: 01/24/2023] Open
Abstract
Interstitial granulomatous drug reaction (IGDR) is a distinct inflammatory process that often presents as annular, violaceous plaques distributed on the extremities, proximal trunk, and intertriginous areas. The list of drugs implicated for inciting IGDR is growing, but most prominently includes ACE inhibitors, antihistamines, beta-blockers, antidepressants, and anticonvulsants. Ustekinumab is a human monoclonal antibody that targets inflammatory cytokines IL-12 and IL-23 and has been have shown to be effective in treating IGDR. However, we present a case that suggests ustekinumab can also act as an inciting agent for IGDR.
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Abstract
OBJECTIVE To summarize clinical outcomes of paradoxical pyoderma gangrenosum (PG) onset in patients on biologic therapy. METHODS The authors conducted MEDLINE and EMBASE searches using PRISMA guidelines to include 57 patients (23 reports). RESULTS Of the included patients, 71.9% (n = 41/57) noted PG onset after initiating rituximab, 21.1% (n = 12/57) noted tumor necrosis factor α (TNF-α) inhibitors, 5.3% (n = 3/57) reported interleukin 17A inhibitors, and 1.8% (n = 1/57) reported cytotoxic T-lymphocyte-associated protein 4 antibodies. The majority of patients (94.3%) discontinued biologic use. The most common medications used to resolve rituximab-associated PG were intravenous immunoglobulins, oral corticosteroids, and antibiotics, with an average resolution time of 3.3 months. Complete resolution of PG in TNF-α-associated cases occurred within an average of 2.2 months after switching to another TNF-α inhibitor (n = 1), an interleukin 12/23 inhibitor (n = 2), or treatment with systemic corticosteroids and cyclosporine (n = 3), systemic corticosteroids alone (n = 1), or cyclosporine alone (n = 1). CONCLUSIONS Further investigations are warranted to determine whether PG onset is associated with underlying comorbidities, the use of biologic agents, or a synergistic effect. Nevertheless, PG may develop in patients on rituximab or TNF-α inhibitors, suggesting the need to monitor and treat such adverse effects.
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Godwin KS, Mathai M, Do BK. A case of ustekinumab-induced sclerouveitis. Am J Ophthalmol Case Rep 2022; 25:101331. [PMID: 35146201 PMCID: PMC8819278 DOI: 10.1016/j.ajoc.2022.101331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 11/14/2021] [Accepted: 01/19/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Biologics have proven to be essential therapeutic agents in immune-mediated systemic diseases. Ophthalmologic adverse effects have been reported in the use of more traditional agents, such as TNF-α inhibitors, but there are limited data on ocular side effects associated with the newer generation of biologics. Observations In this report, we present a case of a suspected ustekinumab-associated recurrent sclerouveitis. Conclusions To the best of our knowledge, this is the first reported case of this type seen with ustekinumab injections. Our goal is to add to the existing literature in order to better understand the mechanism and management of this condition.
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Affiliation(s)
- Kristen S. Godwin
- Medstar Georgetown/ Washington Hospital Center Department of Ophthalmology, 110 Irving St NW, Washington, D.C, 20010, USA
| | - Mariam Mathai
- The Retina Group of Washington, 8270 Willow Oaks Corporate Drive, 6th Floor, Fairfax, VA, 22031, USA
| | - Brian K. Do
- The Retina Group of Washington, 8270 Willow Oaks Corporate Drive, 6th Floor, Fairfax, VA, 22031, USA
- Corresponding author. Retina Group of Washington, 8270 Willow Oaks Corporate Drive, 6th Floor, Fairfax, VA, 22031, USA.
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Paradoxical Hidradenitis Suppurativa during Biologic Therapy, an Emerging Challenge: A Systematic Review. Biomedicines 2022; 10:biomedicines10020455. [PMID: 35203664 PMCID: PMC8962303 DOI: 10.3390/biomedicines10020455] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease usually occurring after puberty with painful, deep-seated, inflammatory lesions in the apocrine gland-bearing areas of the body. Although HS pathogenesis is still unproven, recent major research advantages have increased our knowledge of the mechanisms behind HS lesions. Particularly, follicular occlusion followed by follicular rupture has been shown to be crucial to HS development, leading to immune response activation, and resulting in typical clinical HS lesions. Moreover, an increased and imbalanced cytokine production, such as interleukin (IL) 17 and tumor necrosis factor (TNF) α, may play a role in HS. In recent years, paradoxical adverse events have been described during treatment. Since the recent increased use of biologic treatments in HS, an increased number of paradoxical HS occurrences have been reported. In this review, we analyzed all current data on paradoxical HS triggered by biological drugs.
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Ahmed F, Masur S, Ben Khadra S, Baig M. Sweet's syndrome in the setting of newly initiated risankizumab therapy for pre-existing psoriasis. BMJ Case Rep 2022; 15:e246774. [PMID: 35135798 PMCID: PMC8830209 DOI: 10.1136/bcr-2021-246774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/04/2022] Open
Abstract
Sweet's syndrome (acute febrile neutrophilic dermatosis) is a rare disorder of unclear aetiology characterised by painful cutaneous lesions, sometimes accompanied by systemic symptoms. It has been associated with several autoimmune conditions, drugs, malignancies and infections, though many cases are idiopathic. We describe a case of Sweet's syndrome in a 49-year-old man with pre-existing psoriasis following recent initiation of risankizumab therapy. There are very few reported cases of Sweet's syndrome in association with psoriasis and no existing reports in association with an IL-23 inhibiting medication. Further investigation of the potentially overlapping immunologic pathways implicated in cutaneous reactions to biologic agents and autoimmune conditions such as psoriasis may yield insights into the pathogenesis of such conditions and guide advancements in the rapidly evolving field of targeted biologic therapies.
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Affiliation(s)
- Fadwa Ahmed
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Samuel Masur
- Department of Pediatrics and Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shaza Ben Khadra
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Muhammad Baig
- Department of Medicine, Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Kremenevski I, Sander O, Sticherling M, Raithel M. Paradoxical Reactions to Biologicals in Chronic Inflammatory Systemic Diseases. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:88-95. [PMID: 34939919 DOI: 10.3238/arztebl.m2022.0067] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/01/2021] [Accepted: 11/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biological agents that contain substances affecting the immune system are increasingly being used to treat chronic inflammatory systemic diseases. Aside from the expected adverse effects, they can also induce unexpected paradoxical reactions (PR). A reaction is called paradoxical when a substance that is generally therapeutically effective induces the opposite of what is intended, with the new appearance or exacerbation of inflammatory changes in the skin and other organs. METHODS The paradoxical reactions that have been described since 1997 are presented here on the basis of the available literature on the main types of chronic inflammatory systemic disease, which was retrieved by a selective search in the PubMed and Google Scholar databases. RESULTS Many studies and registers to date contain no mention of paradoxical reactions. Anti- TNF-alpha treatment for patients with ankylosing spondylitis leads to paradoxical reactions in 19 per 1000 patient years, compared to 11 per 1000 patient years with conventional treatment; the corresponding frequency for paradoxical psoriasis in patients with other chronic inflammatory systemic diseases are 1.04-3.68 versus 1.45 per 1000 patient years. Paradoxical reactions tend to be more common with anti-TNF-alpha treatment than, for example, with the administration of ustekinumab, vedolizumab, and other agents. It is unclear whether some drugs have been noted to cause PR more commonly than others because of varying times since their approval, differences in immunogenicity, and differences between their target structures. CONCLUSION Paradoxical reactions induced by biological agents are a problem confronting physicians in multiple specialties. They need to be distinguished from infectious and neoplastic diseases and from autoimmune conditions of other types. The treatment options for paradoxical reactions include local treatment, symptomatic therapy, prednisolone administration, and the discontinuation or switching of the biological agent, although some patients will react with a further paradoxical reaction to a different biological agent that is used instead.
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VILLANI A, DE FATA SALVATORES G, NAPPA P, MEGNA M, FABBROCINI G, NAPOLITANO M. Cutaneous leucocytoclastic vasculitis during secukinumab treatment. Ital J Dermatol Venerol 2022; 156:9-10. [DOI: 10.23736/s2784-8671.18.06203-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Immunomodulatory Agents for Treatment of Patients with Inflammatory Bowel Disease (Review safety of anti-TNF, Anti-Integrin, Anti IL-12/23, JAK Inhibition, Sphingosine 1-Phosphate Receptor Modulator, Azathioprine / 6-MP and Methotrexate). Curr Gastroenterol Rep 2021; 23:30. [PMID: 34913108 DOI: 10.1007/s11894-021-00829-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE OF THE REVIEW As treatment options for Inflammatory Bowel Disease (IBD) expand each class of medication will have specific safety concerns and side-effect profiles that need to be considered for optimal treatment of patients. We will review the most recent safety data for the newly approved immunomodulator therapies for the treatment of IBD. RECENT FINDINGS There are a growing number of publications outlining safety concerns for medications used to treat IBD. We reviewed safety profile of anti-tumor necrosis factor antibodies (TNF) with specific attention to combination therapy (anti-TNF plus immunomodulator). Recent publications have demonstrated increased risk of serious infection and malignancy (lymphoma and overall cancer rates) in patients receiving anti-TNF combination therapy when compared with patients receiving anti-TNF monotherapy or immunomodulator monotherapy. Recent publications on Janus Kinase Inhibitors indicate an increased risk of infection, specifically Herpes Zoster, and increased risk of major cardiovascular events and venous thromboembolic events resulting in a black box warning for the medication. In contrast, anti-interleukin 12/23 agents and gut selective anti-integrin antibody agents have demonstrated a favorable side-effect profile with low rates of infection and malignancy. The latest class of medications to be approved, sphingosine 1-phosphate (S1P) receptor modulators, have cardiac and infectious precautions. The field of IBD treatment is rapidly evolving with several mechanistic classes of medications now available. While corticosteroids continue to be associated with the greatest, overall, safety risks, each of the newer mechanistic classes have unique safety concerns. In the future, as we gain more experience with these agents, we will need to continue to evaluate the safety profile of our therapies used alone or in combination to make informed treatment decisions with our patients.
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Paradoxical hidradenitis suppurativa in Crohn's disease patients receiving infliximab: a case report and review of literature. Eur J Gastroenterol Hepatol 2021; 33:e1046-e1050. [PMID: 33905217 DOI: 10.1097/meg.0000000000002170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The introduction of TNF blockers in the therapeutic armamentarium of inflammatory bowel diseases (IBD) has largely advanced the way by which clinicians manage these disorders. However, some patients develop de novo immune-mediated diseases during the treatment. We here present the case of paradoxical hidradenitis suppurativa, a chronic inflammatory skin disease characterized by the development of recurrent nodules and abscesses in intertriginous areas, in a 20-year-old, nonsmoker, normal-weight women, with no family history of hidradenitis suppurativa or IBD, diagnosed with nonstricturing nonpenetrating ileocolonic Crohn's disease in 2013, during treatment with infliximab. Infliximab discontinuation was followed by a significant improvement of skin lesions. We also discuss 22 additional cases of paradoxical hidradenitis suppurativa in IBD patients on TNF antagonists reported in the literature with the aim to identify potential risk factors for the development of such a complication. All the patients had Crohn's disease, and the majority of them were women (19/23; 82.6%). All cases occurred during therapy with anti-TNF agents [14/23 (61%) patients were treated with adalimumab and 9/23 (39%) patients were treated with infliximab]. The therapeutic approach directed at maintaining/holding the undergoing biologic therapy is still uncertain. Further studies are needed to determine the most appropriate treatment choice toward ongoing biologic therapy.
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Determining Response to Treatment for Drug-Induced Bronchocentric Granulomatosis by the Forced Oscillation Technique. Medicina (B Aires) 2021; 57:medicina57121315. [PMID: 34946260 PMCID: PMC8704422 DOI: 10.3390/medicina57121315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/13/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022] Open
Abstract
Anti-tumor necrosis factor alpha (TNFα) therapy is widely used to treat various inflammatory conditions. Paradoxically, there are several case reports describing the development of bronchocentric granulomatosis treated with TNFα inhibitors, and it is difficult to determine the effect of treatment using conventional spirometry because the lesions are located in small airways. However, it has been reported that the forced oscillation technique (FOT) is useful in the evaluation of small airway disease in bronchial asthma or chronic obstructive pulmonary disease. We performed the FOT to determine the effect of treatment on bronchocentric granulomatosis and found it to be useful. We report the case of a 55-year-old female with ulcerative colitis who was treated with golimumab and who developed bronchocentric granulomatosis as a sarcoid-like reaction to golimumab. She was successfully treated with prednisone, and the treatment efficacy was confirmed by the FOT. The FOT may be useful in the evaluation of small airway disease in bronchocentric granulomatosis. This case may help inform clinicians of the usefulness of the FOT to assess small airway disease in various diseases.
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Ji M, Sun Q, Zhang G, Huang Z, Zhang Y, Shen Q, Guan H. Microglia-derived TNF-α mediates Müller cell activation by activating the TNFR1-NF-κB pathway. Exp Eye Res 2021; 214:108852. [PMID: 34801535 DOI: 10.1016/j.exer.2021.108852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 02/08/2023]
Abstract
Microglia and its interaction with Müller cells are responsible to retinal surveillance during retinal neurodegeneration, however, the role and mechanism of microglia-derived tumor necrosis factor (TNF)-α in the activation of retinal Müller cells have not been fully elucidated. In the present study, primary microglia and Müller cells were isolated from newborn Sprague-Dawley (SD) rats with purities of 88.2 ± 6.2% and 92.2 ± 2.2%, respectively. By performing immunofluorescence and Western blot analysis, we found that TNF receptor (TNFR)-1 and TNFR2 were expressed in Müller cells. After co-cultured with microglia-conditioned medium (MCM), the elevated mRNA levels of glial fibrillary acidic protein (GFAP), proinflammatory factors (TNF-α, IL-1β, CXCL-1, CSF-1, NOS2, COX2) and decreased CNTF mRNA levels were found in Müller cells. However, pretreatment with R-7050 (a TNF-α receptor inhibitor) or anti-TNFR1 significantly abrogated the changes. Simultaneously, pretreatment with anti-TNFR2 slightly inhibited the expression of GFAP in MCM-incubated Müller cells. Meanwhile, anti-TNFR1 treatment reversed the increased expression of CSF-1 and IL-1β induced by TNF-α. Compared to the control groups, the phosphorylation of NF-κB P65, MAPK P38 and ERK1/2 in TNF-α-treated Müller cells was significantly increased. Nevertheless, pretreatment with anti-TNFR1 inhibited the phosphorylation of NF-κB P65 and MAPK p38, especially NF-κB P65. Additionally, pretreatment with Bay117082 (an NF-κB inhibitor) also significantly inhibited NF-κB P65 phosphorylation and GFAP expression. Moreover, anti-TNFR1 and Bay117082 treatment reduced NF-κB P65 phosphorylation of Müller cells induced by MCM. These results suggested that microglia-derived TNF-α served as a vital role in regulating Müller cells activation during retinal neurodegeneration.
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Affiliation(s)
- Min Ji
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Qing Sun
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Guowei Zhang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Zeyu Huang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Yujian Zhang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Qianyi Shen
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Huaijin Guan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, 226001, China.
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Nguyen MH, Molland JG, Kennedy S, Gray TJ, Limaye S. Idiopathic granulomatous mastitis: case series and clinical review. Intern Med J 2021; 51:1791-1797. [PMID: 34713960 DOI: 10.1111/imj.15112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/15/2020] [Accepted: 07/12/2020] [Indexed: 01/16/2023]
Abstract
Idiopathic granulomatous mastitis is a chronic inflammatory breast disorder that typically affects young, parous women, often following lactation. Patients present with tender, erythematous breast lesions with histological evidence of non-caseating granulomata and an inflammatory cell infiltrate. An immune-mediated pathophysiology is hypothesised and an association with lipophilic Corynebacterium species is observed. Initial diagnosis is often delayed due to lack of awareness of the condition and management of refractory disease can be challenging. We present an extensive case series of patients collaboratively managed by subspecialty physicians and surgeons at a single centre in Sydney, Australia. The accompanying review expands on features of this condition and supports the utility of a multidisciplinary approach.
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Affiliation(s)
- Matthew H Nguyen
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Janice G Molland
- Department of Breast and Endocrine Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - Suellyn Kennedy
- Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Timothy J Gray
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, Concord Hospital Clinical School, Sydney, New South Wales, Australia
| | - Sandhya Limaye
- Faculty of Medicine, Concord Hospital Clinical School, Sydney, New South Wales, Australia.,Department of Immunology, Concord Hospital, Sydney, New South Wales, Australia
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Yang M, Liu W, Deng Q, Liang Z, Wang Q. The incidence of psoriasis among smokers and/or former smokers inflammatory bowel diseases patients treated with tumor necrosis factor antagonist: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27510. [PMID: 34678884 PMCID: PMC8542134 DOI: 10.1097/md.0000000000027510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/24/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Infliximab (IFX) and adalimumab (ADA) refer to the classic drugs to treat moderate-severe inflammatory bowel disease (IBD), which have been proven to be effective to control IBD. However, the side effects exerted by IFX and ADA should be monitored in therapies, especially the paradoxical reaction of the skin system (e.g., psoriasis). Psoriasis is recognized as the most common skin lesion, capable of significantly affecting the quality of patients' life. METHODS This study searched literatures published in English language with the qualifications on PubMed, Embase, Web of Science, Google, and Geenmedical databases. Over 2 co-authors assessed the quality of the articles and extracted the data independently. The data acquired were statistically analyzed with the statistical software of Revman and Stata. RESULTS The ADA Group achieved a higher incidence of psoriasis (odds ratio [OR] = 0.658, 95% confidence interval [CI] [0.471-0.919]); Females achieved a higher incidence of psoriasis than males (OR = 1.941, 95%CI [1.326-2.843], P < .05); Smoking up-regulated the incidence of psoriasis (OR = 1.679, 95%CI [1.237-2.279], P < .05); The interval of medication was over 1 year, and the interval of medication applying IFX was longer than that of the ADA Group; most cases could be relieved by using local hormone, phototherapy, or systemic hormone therapy under the strategy of biological agents. CONCLUSIONS The frequency of reported in IBD exceeds those of other autoimmune diseases, and the ADA treatment for IBD is safer than IFX. Psoriasis is more common in females than in males. Smoking refers to one of risk factors of psoriasis.
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Marasca C, Fornaro L, Martora F, Picone V, Fabbrocini G, Megna M. Onset of vitiligo in a psoriasis patient on ixekizumab. Dermatol Ther 2021; 34:e15102. [PMID: 34436817 PMCID: PMC9285348 DOI: 10.1111/dth.15102] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/01/2021] [Accepted: 08/16/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Vitiligo is an acquired skin disorder clinically characterized by hypopigmentated macules and patches. Psoriasis is a chronic-inflammatory-skin-condition characterized by erythematous-plaques covered with scales particularly over the extensor-surfaces, scalp, and lumbosacral region. Recent major-researches-advancements have significantly expanded our understanding of psoriasis-pathophysiology, resulting in the development of highly effective targeted-therapies, such as anti TNFα, IL-12/23-inhibitors, IL-17-inhibitors, or IL-23-inhibitors. Particularly, ixekizumab, a humanized-monoclonal immunoglobulin-G 4 antibody, specifically binding IL-17A, demonstrated strong efficacy in threating recalcitrant psoriasis. Nevertheless, paradoxical reactions due to IL-17 inhibitors have been described. CASE REPORT Herein, we report the case of a 53-year-old Caucasian man who obtained complete skin clearance of psoriasis plaques after 16 weeks of ixekizumab treatment together with the appearance of vitiligo patches localized on the facial area. He had never suffered of vitiligo and his family history excluded vitiligo diagnosis. We also could exclude post inflammatory psoriasis hypopigmentation because of absence of facial involvement at baseline. Our experience suggests that vitiligo might be considered a rare adverse effects of anti-IL-17 therapy.
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Affiliation(s)
- Claudio Marasca
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Luigi Fornaro
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Fabrizio Martora
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Vincenzo Picone
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Kang JH. IgA nephropathy in adult-onset Still's disease after tocilizumab treatment: a case report. Int Urol Nephrol 2021; 54:1167-1168. [PMID: 34269969 DOI: 10.1007/s11255-021-02956-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ji-Hyoun Kang
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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A Primer on the Clinical Aspects of Sarcoidosis for the Basic and Translational Scientist. J Clin Med 2021; 10:jcm10132857. [PMID: 34203188 PMCID: PMC8268437 DOI: 10.3390/jcm10132857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 12/19/2022] Open
Abstract
The immunopathogenesis of sarcoidosis remains unclear. This failure in understanding has been clinically impactful, as it has impeded the accurate diagnosis, treatment, and prevention of this disease. Unraveling the mechanisms of sarcoidosis will require input from basic and translational scientists. In order to reach this goal, scientists must have a firm grasp of the clinical aspects of the disease, including its diagnostic criteria, the immunologic defects, clinical presentations, response to therapy, risk factors, and clinical course. This manuscript will provide an overview of the clinical aspects of sarcoidosis that are particularly relevant for the basic and translational scientist. The variable phenotypic expression of the disease will be described, which may be integral in identifying immunologic disease mechanisms that may be relevant to subgroups of sarcoidosis patients. Data concerning treatment and risk factors may yield important insights concerning germane immunologic pathways involved in the development of disease. It is hoped that this manuscript will stimulate communication between scientists and clinicians that will eventually lead to improved care of sarcoidosis patients.
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Jordan DR, Park JSY, Al-Breiki D. Acute orbital inflammation with loss of vision: a paradoxical adverse event associated with infliximab therapy for Crohn's disease. Orbit 2021; 41:791-796. [PMID: 34120561 DOI: 10.1080/01676830.2021.1939726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Anti-TNF-α agents (e.g. infliximab, adalimumab, etanercept) are effective management options in various inflammatory and autoimmune diseases (e.g. inflammatory bowel disease). The occurrence during anti-TNF-α agent therapy of a new onset or exacerbation of an inflammatory condition that usually responds to this class of drug has been termed a paradoxical adverse event (PAE). A wide range of ophthalmic PAEs have been reported including uveitis, optic neuritis/neuropathy, scleritis, orbital myositis, retinal vasculitis, and others. The patient reported herein developed a dramatic orbital inflammatory PAE during his infliximab infusions, which manifested as an acute orbital apex syndrome with vision loss. Physicians using this medication should be aware of this serious vision-threatening PAE, and urgent therapy with high dose intravenous corticosteroids may be required.
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Affiliation(s)
- David R Jordan
- Department of Ophthalmology, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
| | - John S Y Park
- Department of Ophthalmology, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
| | - Danah Al-Breiki
- Department of Ophthalmology, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
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Qi HJ, Li LF. New Biologics for the Treatment of Atopic Dermatitis: Analysis of Efficacy, Safety, and Paradoxical Atopic Dermatitis Acceleration. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5528372. [PMID: 34195265 PMCID: PMC8181104 DOI: 10.1155/2021/5528372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/21/2021] [Indexed: 01/18/2023]
Abstract
Atopic dermatitis (AD) is a chronic, inflammatory skin disease with an eczematous rash and itching. Due to undesired adverse effects of traditional systemic treatment, there is still an unmet need for safe and effective long-term therapy for refractory AD. As our understanding of the pathogenesis underlying AD grows, novel treatments targeting specific molecules have been developed. Here, we discuss the efficacy and safety profiles of these drugs in recent clinical trials. Among their adverse effects, of particular note is AD acceleration. Although there is still debate about whether certain adverse reactions can be said to be paradoxical adverse events (PAEs), a wide range of PAEs have been reported during biological treatment for chronic immune-mediated diseases. Close surveillance of novel biologics is crucial to detect new undescribed paradoxical reactions and to shed light on the convoluted pathogenesis of AD.
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Affiliation(s)
- Hong-jiao Qi
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lin-Feng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Hlaca N, Zagar T, Kastelan M, Brajac I, Prpic-Massari L. Ixekizumab-induced paradoxical pustular reaction successfully treated with guselkumab. Clin Exp Dermatol 2021; 46:1572-1573. [PMID: 34028847 DOI: 10.1111/ced.14757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- N Hlaca
- Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia.,Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - T Zagar
- Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - M Kastelan
- Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia.,Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - I Brajac
- Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia.,Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - L Prpic-Massari
- Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia.,Medical Faculty, University of Rijeka, Rijeka, Croatia
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