1
|
Tseng H, Murrell DF. The potential of Bruton's tyrosine kinase (BTK) inhibitors in the pharmacotherapeutic management of immune and dermatological disease. Expert Opin Pharmacother 2024; 25:1657-1665. [PMID: 39158385 DOI: 10.1080/14656566.2024.2393280] [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: 06/24/2024] [Revised: 07/29/2024] [Accepted: 08/13/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION The review article explores the evolving role of Bruton's tyrosine kinase (BTK) inhibitors in immune-mediated dermatological conditions, addressing significant gaps in current treatment approaches. AREAS COVERED The review comprehensively discusses the mechanisms of action of BTK inhibitors, including irreversible and reversible inhibitors. Clinical applications of BTK inhibitors in dermatological diseases such as pemphigus, chronic spontaneous urticaria (CSU), hidradenitis suppurativa (HS), systemic lupus erythematosus (SLE), and atopic dermatitis are explored, highlighting recent advancements and ongoing clinical trials. Potential advantages of BTK inhibitors over existing therapies and challenges in translating preclinical findings to clinical outcomes are discussed. EXPERT OPINION/COMMENTARY BTK inhibitors represent a promising therapeutic avenue for immune-mediated dermatological conditions, offering oral administration, targeted pathway inhibition, and a favorable safety profile compared to biologic therapies. Ongoing research and clinical trials hold the potential to address unmet needs and reshape the therapeutic landscape in dermatology.
Collapse
Affiliation(s)
- Henry Tseng
- Department of Dermatology, St. George Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Dédée F Murrell
- Department of Dermatology, St. George Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia
| |
Collapse
|
2
|
Méndez-Flores S, Méndez-Pérez RA, Saeb-Lima M, Hernández-Molina G. Granulomatous Panniculitis as an Initial Manifestation of Sjögren Syndrome. Am J Dermatopathol 2024; 46:523-524. [PMID: 38842395 DOI: 10.1097/dad.0000000000002737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
ABSTRACT A 65-year-old woman presented with unexplained weight loss, recurrent fever, and a dermatosis with painful nodules on the extremities. Biopsies showed focal lobular panniculitis with neutrophilic microgranulomas. Comprehensive investigations ruled out infection and hematologic and solid organ neoplasms. Laboratory results showed anti-Ro/SSA and anti-La/SSB antibody positivity, and elevated inflammatory markers. Dry mouth and eye were confirmed. The diagnosis of Sjögren syndrome with cutaneous panniculitis was established. Prednisone treatment with 30 mg/d resulted in remission of fever and pain improvement. This case emphasizes Sjögren syndrome as an autoimmune disease with multiple cutaneous manifestations and highlights its association with granulomatous panniculitis.
Collapse
Affiliation(s)
- Silvia Méndez-Flores
- Dermatology Department, National Institute of Medical Sciences and Nutrition "Salvador Zubiran", Mexico City, Mexico
| | - R Angélica Méndez-Pérez
- Dermatology Department, National Institute of Medical Sciences and Nutrition "Salvador Zubiran", Mexico City, Mexico
| | - Marcela Saeb-Lima
- Pathology Department, National Institute of Medical Sciences and Nutrition "Salvador Zubiran" Mexico City, Mexico ; and
| | - Gabriela Hernández-Molina
- Rheumatology and Immunology Department, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| |
Collapse
|
3
|
Pugliesi A, Egypto DCSD, Duffles G, Cantali DU, Pasoto SG, Oliveira FR, Valim V, Lopes MLL, Miyamoto ST, Fernandes MLMS, Fialho SCDMS, Pinheiro AC, Santos LCD, Appenzeller S, Ribeiro SLE, Libório-Kimura TN, Santos MCLFS, Gennari JDA, Pernanbuco R, Capobiano KG, Civile VT, Pinto ACPN, Rocha-Filho CR, Rocha APD, Trevisani VFM. Recommendations on cutaneous and hematological manifestations of Sjögren's disease by the Brazilian Society of Rheumatology. Adv Rheumatol 2024; 64:51. [PMID: 38982553 DOI: 10.1186/s42358-024-00391-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024] Open
Abstract
Sjogren's disease (SjD) is an autoimmune disease that is characterized not only by the sicca symptoms it causes but also by its systemic nature, which is capable of several and not yet fully understood extraglandular manifestations. To gain a clearer understanding of these manifestations as well as a better practical approach, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of the extraglandular manifestations present in ESSDAI (EULAR Sjogren´s syndrome disease activity index), followed by a voting panel with recommendations for clinical practice. This publication is complementary to others already published and covers cutaneous and hematological manifestations, with prevalence data generated by a meta-analysis of 13 clinical or laboratory manifestations and 6 clinical management recommendations.
Collapse
Affiliation(s)
- Alisson Pugliesi
- Disciplina de Reumatologia, Departamento de Ortopedia, Reumatologia e Traumatologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), R. Tessália Vieira de Camargo, 126 - Cidade Universitária, Campinas, SP, CEP: 13083-887, Brazil.
| | - Danielle Christinne Soares do Egypto
- Disciplina de Reumatologia, Departamento de Medicina Interna, Centro de Ciências Médicas, Universidade Federal da Paraíba (UFPB), Campus I- Lot, Cidade Universitária, Paraíba, PB, CEP: 58051-900, Brazil
| | - Guilherme Duffles
- Departamento de Hematologia e Hemoterapia da Universidade Estadual de Campinas (UNICAMP), R. Tessália Vieira de Camargo, 126 - Cidade Universitária, Campinas, SP, CEP: 13083-887, Brazil
| | - Diego Ustárroz Cantali
- Serviço de Reumatologia, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande de Sul (PUCRS), Av. Ipiranga, 6690 - Jardim Botânico, Porto Alegre, RS, CEP: 90610-000, Brazil
| | - Sandra Gofinet Pasoto
- Disciplina de Reumatologia, Laboratório de Autoimunidade (DLC + LIM17), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 225- Cerqueira César, São Paulo, SP, CEP: 05403-010, Brazil
| | - Fabiola Reis Oliveira
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP), Av. Bandeirantes, 3900, Vila Monte Alegre, Ribeirão Preto, SP, CEP: 14049-900, Brazil
| | - Valeria Valim
- Serviço de Reumatologia, Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29075-910, Brazil
| | - Maria Lucia Lemos Lopes
- Disciplina de Especialidades Clínicas, Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), R. Sarmento Leite, 245 - Centro Histórico de Porto Alegre, Porto Alegre, RS, CEP: 90050-170, Brazil
| | - Samira Tatiyama Miyamoto
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29040-090, Brazil
| | | | | | - Aysa César Pinheiro
- Serviço de Reumatologia, Universidade Federal de Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Laura Caldas Dos Santos
- Departamento de Oftalmologia, Escola Paulista de Medicina- Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 820, Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
| | - Simone Appenzeller
- Disciplina de Reumatologia, Departamento de Ortopedia, Reumatologia e Traumatologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), R. Tessália Vieira de Camargo, 126 - Cidade Universitária, Campinas, SP, CEP: 13083-887, Brazil
| | - Sandra Lucia Euzébio Ribeiro
- Disciplina de Reumatologia, Universidade Federal do Amazonas, Rua Afonso Pena, 1053, Manaus, AM, CEP: 69020-160, Brazil
| | - Tatiana Nayara Libório-Kimura
- Departamento de Patologia e Medicina Legal, Universidade Federal do Amazonas, Rua Afonso Pena, 1053, Manaus, AM, CEP: 69020-160, Brazil
| | - Maria Carmen Lopes Ferreira Silva Santos
- Departamento de Patologia, Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29075-910, Brazil
| | - Juliana D Agostino Gennari
- Serviço de Reumatologia da Santa Casa de São Paulo, R. Dr. Cesário Mota Júnior, 112, Vila Buarque, São Paulo, SP, CEP: 01221-020, Brazil
| | - Roberta Pernanbuco
- Serviço de Reumatologia do Hospital do Servidor público do estado de São Paulo (HSPE- IAMSPE), Rua Pedro de Toledo 1800, São Paulo, SP, CEP 04039-000, Brazil
| | - Karina Gatz Capobiano
- Serviço de Reumatologia do Hospital Moinhos de Vento - Porto Alegre, Rua Ramiro Barcelos 910, Porto Alegre, RS, CEP: 90035-000, Brazil
| | - Vinicius Tassoni Civile
- Disciplina de Medicina de Urgência e Medicina Baseada em Evidências, Escola Paulista de Medicina- Pós-Graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 740, Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
- Centro Cochrane do Brasil Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 740, Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
- Universidade Paulista, Rua Vergueiro, 1211, Paraíso, São Paulo, SP, CEP: 01504-001, Brazil
| | - Ana Carolina Pereira Nunes Pinto
- Disciplina de Medicina de Urgência e Medicina Baseada em Evidências, Escola Paulista de Medicina- Pós-Graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 740, Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
- Centro Cochrane do Brasil Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 740, Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
- Centro Cochrane Iberoamericano, Hospital de la Santa Creu i Sant Pau, C/ de Sant Quintí, 89, Horta-Guinardó, Barcelona, 08025, Spain
| | - César Ramos Rocha-Filho
- Disciplina de Medicina de Urgência e Medicina Baseada em Evidências, Escola Paulista de Medicina- Pós-Graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 740, Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
| | - Aline Pereira da Rocha
- Disciplina de Medicina de Urgência e Medicina Baseada em Evidências, Escola Paulista de Medicina- Pós-Graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 740, Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
- Centro Cochrane do Brasil Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 740, Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
| | - Virginia Fernandes Moça Trevisani
- Disciplina de Medicina de Urgência e Medicina Baseada em Evidências, Escola Paulista de Medicina- Pós-Graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 740, Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
- Centro Cochrane do Brasil Universidade Federal de São Paulo (EPM-UNIFESP), Rua Botucatu, 740, Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil
- Disciplina de Reumatologia, Universidade de Santo Amaro (UNISA), Rua Enéas Siqueira Neto, Jardim das Imbuias, São Paulo, SP, CEP: 04829-300, Brazil
| |
Collapse
|
4
|
Chang L, Zheng Z, Xiao F, Zhou Y, Zhong B, Ni Q, Qian C, Chen C, Che T, Zhou Y, Zhao Z, Zou Q, Li J, Lu L, Zou L, Wu Y. Single-cell clonal tracing of glandular and circulating T cells identifies a population of CD9+ CD8+ T cells in primary Sjogren's syndrome. J Leukoc Biol 2024; 115:804-818. [PMID: 37395700 DOI: 10.1093/jleuko/qiad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023] Open
Abstract
Primary Sjogren's syndrome (pSS) is a complex chronic autoimmune disease in which local tissue damage in exocrine glands is combined with broader systemic involvement across the body in tissues including the skin. These combined manifestations negatively impact patient health and quality of life. While studies have previously reported differences in immune cell composition in the peripheral blood of pSS patients relative to healthy control subjects, a detailed immune cell landscape of the damaged exocrine glands of these patients remains lacking. Through single-cell transcriptomics and repertoire sequencing of immune cells in paired peripheral blood samples and salivary gland biopsies, we present here a preliminary picture of adaptive immune response in pSS. We characterize a number of points of divergence between circulating and glandular immune responses that have been hitherto underappreciated, and identify a novel population of CD8+ CD9+ cells with tissue-residential properties that are highly enriched in the salivary glands of pSS patients. Through comparative analyses with other sequencing data, we also observe a potential connection between these cells and the tissue-resident memory cells found in cutaneous vasculitis lesions. Together, these results indicate a potential role for CD8+ CD9+ cells in mediating glandular and systemic effects associated with pSS and other autoimmune disorders.
Collapse
Affiliation(s)
- Ling Chang
- Institute of Immunology, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| | - Zihan Zheng
- Institute of Immunology, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
- Biomedical Analysis Center, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
- Department of Autoimmune Diseases, Chongqing International Institute for Immunology, 13 Tianchi Avenue, Banan District, Chongqing, China
| | - Fan Xiao
- Department of Pathology and Shenzhen Institute of Research and Innovation, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
| | - Yingbo Zhou
- Department of Pathology and Shenzhen Institute of Research and Innovation, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
| | - Bing Zhong
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| | - Qingshan Ni
- Biomedical Analysis Center, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| | - Can Qian
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| | - Chengshun Chen
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| | - Tiantian Che
- Institute of Immunology, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| | - Yiwen Zhou
- Institute of Immunology, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| | - Zihua Zhao
- Institute of Immunology, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| | - Qinghua Zou
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| | - Jingyi Li
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| | - Liwei Lu
- Department of Pathology and Shenzhen Institute of Research and Innovation, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
| | - Liyun Zou
- Institute of Immunology, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| | - Yuzhang Wu
- Institute of Immunology, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, China
| |
Collapse
|
5
|
Enwereji N, Santiago S, Jiang C, Durrani K, Chaudhry S, Lu J. Ocular and eyelid involvement in collagen vascular diseases. Part I. Sjögren syndrome and systemic lupus erythematosus. Clin Dermatol 2024; 42:3-8. [PMID: 37858778 DOI: 10.1016/j.clindermatol.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Collagen vascular disease is a heterogeneous group of autoimmune diseases that affect multiple organ systems. Sjögren syndrome, dermatomyositis, scleroderma, systemic lupus erythematosus, and sarcoidosis are collagen vascular diseases that often present with characteristic cutaneous manifestations. Although less known, various ocular manifestations that affect both external and internal structures of the eye can be seen in these conditions. Multidisciplinary management between dermatologists and ophthalmologists is essential in the early diagnosis and management of collagen vascular diseases affecting both the skin and eye. Part I of our series will discuss the ocular manifestations, their diagnosis, and therapeutic options in Sjögren syndrome and systemic lupus erythematosus.
Collapse
Affiliation(s)
- Ndidi Enwereji
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Sueheidi Santiago
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Christina Jiang
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Khayyam Durrani
- Division of Ophthalmology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Sona Chaudhry
- Division of Ophthalmology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jun Lu
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA.
| |
Collapse
|
6
|
El Hasbani G, Kibbi AG, Jawad A, Uthman I. Vacuolar Interface Dermatitis as a Histologic Reaction Pattern of Sjögren's Syndrome: A Case Report. Cureus 2023; 15:e46412. [PMID: 37927643 PMCID: PMC10621630 DOI: 10.7759/cureus.46412] [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: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Sjögren's syndrome (SS) has been widely known for its dry mouth and dry eyes presentation. Extraglandular disease manifestations may be protean and pose a challenge for clinicians, especially when the typical known manifestations are absent. Skin involvement of SS is variable, and cutaneous signs and symptoms may be the initial presentation of this syndrome. Vacuolar interface dermatitis has been linked to dermatomyositis and systemic lupus erythematosus, but rarely to SS. Herein, we present the case of an 87-year-old man who presented for widespread itchy erythematous scaly plaques that were refractory to topical corticosteroids as well as discontinuation of possible offending medications. A biopsy demonstrated vacuolar interface dermatitis in the setting of strongly positive anti-SSA. Hydroxychloroquine treatment was effective in resolving the plaques.
Collapse
Affiliation(s)
| | - Abdul-Ghani Kibbi
- Dermatology, American University of Beirut Medical Center, Beirut, LBN
| | - Ali Jawad
- Rheumatology, Royal London Hospital, London, GBR
| | - Imad Uthman
- Rheumatology, American University of Beirut Medical Center, Beirut, LBN
| |
Collapse
|
7
|
Llamas-Molina JM, Velasco-Amador JP, De la Torre-Gomar FJ, Carrero-Castaño A, Ruiz-Villaverde R. Localized Cutaneous Nodular Amyloidosis: A Specific Cutaneous Manifestation of Sjögren's Syndrome. Int J Mol Sci 2023; 24:ijms24087378. [PMID: 37108553 PMCID: PMC10139233 DOI: 10.3390/ijms24087378] [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: 03/19/2023] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Primary localized cutaneous nodular amyloidosis (PLCNA) is a rare condition attributed to plasma cell proliferation and the deposition of immunoglobulin light chains in the skin without association with systemic amyloidosis or hematological dyscrasias. It is not uncommon for patients diagnosed with PLCNA to also suffer from other auto-immune connective tissue diseases, with Sjögren's syndrome (SjS) showing the strongest association. This article provides a literature review and descriptive analysis to better understand the unique relationship between these two entities. To date, 34 patients with PLCNA and SjS have been reported in a total of 26 articles. The co-existence of PLCNA and SjS has been reported, especially in female patients in their seventh decade of life with nodular lesions on the trunk and/or lower extremities. Acral and facial localization, which is a typical localization of PLCNA in the absence of SjS, seems to be much more unusual in patients with associated SjS.
Collapse
Affiliation(s)
- José María Llamas-Molina
- Department of Dermatology, Hospital Universitario San Cecilio, Avda Conocimiento 33, 18016 Granada, Spain
| | - Juan Pablo Velasco-Amador
- Department of Dermatology, Hospital Universitario San Cecilio, Avda Conocimiento 33, 18016 Granada, Spain
| | | | - Alejandro Carrero-Castaño
- Department of Pathological Anatomy, Hospital Universitario San Cecilio, Avda Conocimiento 33, 18016 Granada, Spain
| | - Ricardo Ruiz-Villaverde
- Department of Dermatology, Hospital Universitario San Cecilio, Avda Conocimiento 33, 18016 Granada, Spain
- Instituto Biosanitario de Granada (Ibs), 18014 Granada, Spain
| |
Collapse
|
8
|
Ashrafzadeh S, Fedeles F. What the rheumatologist needs to know about skin biopsy. Best Pract Res Clin Rheumatol 2023; 37:101838. [PMID: 37268560 DOI: 10.1016/j.berh.2023.101838] [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: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 06/04/2023]
Abstract
The skin biopsy plays an important and powerful role in helping diagnose rheumatic diseases that present with cutaneous findings. As the skin is a very accessible organ, and the skin biopsy can be performed quickly as an in-office procedure, the skin biopsy is utilized frequently in patients with rheumatic diseases. However, the more challenging aspects of performing the biopsy, such as identifying the type of biopsy to perform, the site (s) to biopsy, the type of media to use, and the interpretation of histopathologic data are nuanced and require considerable thought. In this review, we discuss the common skin findings in rheumatic diseases and the general indications for skin biopsies in these diseases. We then summarize how to perform various skin biopsy techniques and how to select the biopsy technique. Finally, we discuss important rheumatic disease-specific considerations for skin biopsy, including where to biopsy and how to interpret the pathologic reports.
Collapse
Affiliation(s)
- Sepideh Ashrafzadeh
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Flavia Fedeles
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
9
|
Liampas A, Parperis K, Erotocritou MF, Nteveros A, Papadopoulou M, Moschovos C, Akil M, Coaccioli S, Hadjigeorgiou GM, Hadjivassiliou M, Zis P. Primary Sjögren syndrome-related peripheral neuropathy: A systematic review and meta-analysis. Eur J Neurol 2023; 30:255-265. [PMID: 36086910 PMCID: PMC10087501 DOI: 10.1111/ene.15555] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Primary Sjögren syndrome (pSS) is a chronic, systemic, autoimmune disorder characterized by lymphocytic infiltrates of the exocrine organs, leading to sicca symptoms and parotid enlargement. pSS has been linked to various neurological manifestations, including peripheral neuropathy (PN). We aimed to provide a comprehensive analysis of the currently available evidence regarding pSS-related PN. METHODS A literature search in the PubMed database was performed, and 49 papers were eligible to be included in this systematic review and meta-analysis. RESULTS The pooled prevalence of PN in pSS is estimated to be 15.0% (95% confidence interval = 10.7%-20.7%). The mean age of pSS patients at PN diagnosis is 59 years. Among the patients with pSS and PN, 83% are females. Neuropathic symptoms usually precede or lead to the pSS diagnosis at a 2:1 ratio in patients with pSS-related PN. The commonest type of pSS-related PN is distal axonal polyneuropathy (80% of patients with pSS-related PN), followed by sensory ganglionopathy. Peripheral and cranial mononeuropathies-particularly trigeminal-are also frequent. Risk factors for developing PN include increasing age and presence of vasculitis. Immune-mediated pathogenetic mechanisms are discussed. Glucocorticoids are the most commonly used treatment option for managing pSS-related PN, when associated with vasculitis, followed by the use of intravenous immunoglobulin. CONCLUSIONS PN is very common in pSS patients. Evidence on long-term prognosis of PN in pSS is limited, and further research is needed. Research into the use of immunosuppressive medication in nonvasculitic neuropathies in the context of pSS merits further consideration.
Collapse
Affiliation(s)
- Andreas Liampas
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | | | | | | | - Marianna Papadopoulou
- Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Egaleo, Greece
| | - Christos Moschovos
- Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohammed Akil
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Stefano Coaccioli
- European League Against Pain, Zurich, Switzerland.,Department of Internal Medicine, Perugia University, Perugia, Italy
| | - Georgios M Hadjigeorgiou
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Panagiotis Zis
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus.,Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Medical School, University of Sheffield, Sheffield, UK
| |
Collapse
|
10
|
The Predictive Role of Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Monocytes-to-Lymphocyte Ratio (MLR) and Gammaglobulins for the Development of Cutaneous Vasculitis Lesions in Primary Sjögren's Syndrome. J Clin Med 2022; 11:jcm11195525. [PMID: 36233393 PMCID: PMC9572220 DOI: 10.3390/jcm11195525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background: In primary Sjögren’s Syndrome (pSS), cutaneous vasculitis lesions (CVL) are extraglandular manifestations with an important clinical and prognostic impact and their early detection might contribute to the improvement of disease control and even patients’ survival. The aim of this study was to evaluate the predictive potential of hematological elements in the development of CVL in pSS patients. Methods: In this single center, retrospective study, a total of 245 participants were included (124 pSS patients and 121 healthy controls). Complete blood count, inflammatory and immunological parameters were determined at the initial visit. pSS patients underwent a periodical follow-up program, when disease progression and response to therapy was monitored, including the emergence of CVL. Results: In pSS, leucocytes, lymphocyte, neutrophil, monocyte, erythrocyte and platelet counts are significantly decreased compared to healthy subjects (p < 0.001), whereas cellular ratios: NLR, PLR, MLR, and immunological and inflammatory parameters are significantly increased (p < 0.001). A total of 34 patients with pSS (27.41%) developed CVL during the follow-up period. The occurrence of CVL was positively correlated with neutrophil and platelet counts (p < 0.001), while for lymphocytes the correlation was negative (p < 0.001). Cellular ratios: NLR, PLR and MLR, and gammaglobulins also revealed significant positive correlations with the emergence of CVL in pSS (p < 0.001). The multivariate analysis confirmed the independent predictive character for CVL emergence in pSS for NLR (CI95% 0.053−0.2, p < 0.002), PLR (CI95% 0.001−0.003, p < 0.003), MLR (CI95% 0.086−0.935, p < 0.019), and gammaglobulins (CI95% 0.423−0.688, p < 0.001). Conclusions: Standard hematological parameters, widely used in the assessment of pSS patients, such as NLR, PLR, MLR and gammaglobulins could become valid elements that might be used for the early detection of patients at risk for the development of CVL.
Collapse
|
11
|
Mitschang C, Ehrchen J, Görge T. Differentialdiagnose Vaskulitis und Vaskulopathie aus
dermatologischer Sicht. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1876-2616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
ZusammenfassungVaskulopathien und Vaskulitiden stellen diagnostisch und therapeutisch eine
interdisziplinäre Herausforderung dar. Zugrunde liegen unterschiedliche
pathophysiologische Mechanismen, die zu vielfältigen klinischen
Krankheitsbildern führen können und therapeutisch
unterschiedliche Ansätze erlauben. Sowohl Vaskulitiden als auch
Vaskulopathien müssen nicht zwangsläufig mit einer
Systembeteiligung einhergehen, sondern können auch als rein kutane
Varianten auftreten. Aufgrund mangelnder pathognomonischer Laborparameter ist
die Diagnose häufig klinisch zu stellen. Dieser Artikel soll den
differentialdiagnostischen Blick, insbesondere auf die kutanen
Manifestationsformen bei Vaskulopathien und Vaskulitiden, schärfen.
Collapse
Affiliation(s)
- Carolin Mitschang
- Abteilung für Wundheilung/Phlebologie,
Universitätsklinikum Münster Klinik für Hautkrankheiten,
Münster, Germany
| | - Jan Ehrchen
- Abteilung für Autoimmun-Dermatologie,
Universitätsklinikum Münster Klinik für Hautkrankheiten,
Münster, Germany
| | - Tobias Görge
- Abteilung für Wundheilung/Phlebologie,
Universitätsklinikum Münster Klinik für Hautkrankheiten,
Münster, Germany
| |
Collapse
|
12
|
André F, Böckle BC. Sjögren-Syndrom. J Dtsch Dermatol Ges 2022; 20:980-1003. [PMID: 35881105 DOI: 10.1111/ddg.14823_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Fiona André
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Barbara C Böckle
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| |
Collapse
|
13
|
André F, Böckle BC. Sjögren's syndrome. J Dtsch Dermatol Ges 2022; 20:980-1002. [PMID: 35775593 PMCID: PMC9539881 DOI: 10.1111/ddg.14823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
Sjögren’s syndrome (SjS) is an autoimmune disease characterized by the triad of sicca symptoms, fatigue and pain. This diagnosis is usually made in women at the average age of 60 years. Diagnosis is made when sicca symptoms persist for more than three months, after the exclusion of possible differential diagnoses, and using the ACR/EULAR 2016 classification criteria for SjS. Many organs can be affected in the course of this disease. Xerosis cutis and pruritus are the most common skin manifestations, followed by leukocytoclastic vasculitis and subacute cutaneous lupus erythematosus. In addition, SjS patients often have myoarthralgia and neuropsychiatric symptoms. In the long term, attention must be paid to the increased risk of cardiovascular disease and lymphoma. Due to the multiorgan involvement in SjS patients, interdisciplinary care is required.
Collapse
Affiliation(s)
- Fiona André
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara C Böckle
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
14
|
Zhao EJ, Gauiran DTV, Slack GW, Dutz JP, Chen LYC. A 54-Year-Old Woman with Cutaneous Nodules. NEJM EVIDENCE 2022; 1:EVIDmr2200035. [PMID: 38319205 DOI: 10.1056/evidmr2200035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
A 54-Year-Old Woman with Cutaneous NodulesA 54-year-old woman presented with chronic cutaneous nodules and plaques. How do you approach the evaluation, and what is the diagnosis?
Collapse
Affiliation(s)
- Eric J Zhao
- The University of British Columbia Hematology Fellowship Program
| | | | - Graham W Slack
- The University of British Columbia Hematology Fellowship Program
| | - Jan P Dutz
- The University of British Columbia Hematology Fellowship Program
| | - Luke Y C Chen
- The University of British Columbia Hematology Fellowship Program
| |
Collapse
|
15
|
Caban M, Omulecki W, Latecka-Krajewska B. Dry eye in Sjögren's syndrome - characteristics and therapy. Eur J Ophthalmol 2022; 32:3174-3184. [PMID: 35354331 DOI: 10.1177/11206721221091375] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Sjögren's syndrome is an autoimmune disease, and its important feature is the lymphocyte infiltration of exocrine glands, including lacrimal glands. It contributes to defects of their activity and causes that one of the main manifestation of Sjögren's syndrome is dry eye. Unfortunately, the discrimination between dry eye related and non-related to Sjögren's syndrome is difficult at the initial stages of diseases. In addition, the available agents for the treatment of Sjögren's syndrome-related dry eye have limited efficacy. AIM The purpose of this study was to describe and emphasize differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye together with the determination of novel therapeutic options for Sjögren's Syndrome-related dry eye. METHOD A review of the relevant papers describing characteristics of Sjögren's Syndrome-related dry eye and its therapy was conducted. This article is based on both pre-clinical and clinical evidences. RESULTS On the basis of our analysis, we indicated differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye. Moreover, there are some novel markers that could be used in the diagnosis of Sjögren's Syndrome-related dry eye. In addition, expect artificial tear, other agents e.g. hydroxychloroquine can be effective in therapy of disease. CONCLUSIONS Sjögren's Syndrome-related dry eye is a disorder, whose diagnosis may be difficult and mistaken for non-Sjögren's Syndrome-related dry eye. However, Sjögren's Syndrome-related dry eye has some specific features. In addition, the development of newer and safer therapeutic agents for Sjögren's syndrome-related dry eye is needed, and therefore further clinical, randomized studies are necessary.
Collapse
Affiliation(s)
- Miłosz Caban
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
| | - Wojciech Omulecki
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
| | - Beata Latecka-Krajewska
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
| |
Collapse
|
16
|
Stenger S, Grasshoff H, Hundt JE, Lange T. Potential effects of shift work on skin autoimmune diseases. Front Immunol 2022; 13:1000951. [PMID: 36865523 PMCID: PMC9972893 DOI: 10.3389/fimmu.2022.1000951] [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] [Received: 07/22/2022] [Accepted: 11/29/2022] [Indexed: 02/16/2023] Open
Abstract
Shift work is associated with systemic chronic inflammation, impaired host and tumor defense and dysregulated immune responses to harmless antigens such as allergens or auto-antigens. Thus, shift workers are at higher risk to develop a systemic autoimmune disease and circadian disruption with sleep impairment seem to be the key underlying mechanisms. Presumably, disturbances of the sleep-wake cycle also drive skin-specific autoimmune diseases, but epidemiological and experimental evidence so far is scarce. This review summarizes the effects of shift work, circadian misalignment, poor sleep, and the effect of potential hormonal mediators such as stress mediators or melatonin on skin barrier functions and on innate and adaptive skin immunity. Human studies as well as animal models were considered. We will also address advantages and potential pitfalls in animal models of shift work, and possible confounders that could drive skin autoimmune diseases in shift workers such as adverse lifestyle habits and psychosocial influences. Finally, we will outline feasible countermeasures that may reduce the risk of systemic and skin autoimmunity in shift workers, as well as treatment options and highlight outstanding questions that should be addressed in future studies.
Collapse
Affiliation(s)
- Sarah Stenger
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Grasshoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Jennifer Elisabeth Hundt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Tanja Lange
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| |
Collapse
|
17
|
Şenyuva İ, Koca C, Karabag Çoban F, Tarhan Ö. Salivary Histatin 5 Level in Women with Vaginal Candidiasis. Int J Clin Pract 2022; 2022:5279323. [PMID: 35832797 PMCID: PMC9252690 DOI: 10.1155/2022/5279323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Histatins (Hsts) are considered a prominent member of antimicrobial peptides rich in histidine, bearing antifungal activity against Candida species. Hst5 is the most effective among them. Although Hst5 is not found in the cervicovaginal fluid, it has been detected in the human serum. Saliva acts as a mirror, reflecting the cause and effect relationship between several diseases. We aimed to show the salivary Hst5 levels with vaginal candidiasis. Women in the reproductive age group (18-50 years) were enrolled in the study. Patients and controls were classified based on the presence or absence of vaginal discharge suggestive of candidiasis, respectively. Vaginal and salivary samples were collected from all the women. Vaginal samples were cultured for the growth of Candida species. Salivary samples were tested by protein electrophoresis to detect Hst5 levels, and the results were compared between the two groups. A total of 80 women were included in this study. The mean age of women in vaginal candidiasis and control groups was 34.25 ± 8.06 and 36.83 ± 7.29 years, respectively. Candida species were isolated from the vaginal samples of the patient group (34 C. albicans, 6 non-Candida albicans) but not from the control group. Hst5 levels in the patient and control group were found to be 0.0571 ± 0.003 ng/mL and 0.0641 ± 0,0031 ng/mL, respectively. Hst5 levels were found to be significantly lower in the vaginal candidiasis group (p=0.001). We conclude that decreased salivary Hst5 levels in women are associated with vaginal candidiasis. Candida infection is a cause or result of lower salivary Hst5 levels, and it may be an important finding for the etiopathogenesis, diagnosis, and treatment of the disease, but further analysis is needed.
Collapse
Affiliation(s)
- İrem Şenyuva
- Usak Training and Research Hospital, Department of Obstetrics and Gynecology, Usak, Turkey
| | - Cansu Koca
- University Faculty of Dentistry, Department of Maxillo Facial Surgery, Usak, Turkey
| | | | - Özgür Tarhan
- Usak University, Faculty of Engineering, Department of Food Engineering, Usak, Turkey
| |
Collapse
|
18
|
Appelt LM, Lander F, Beissert S, Günther C. Annular erythematous plaques as manifestation of vasculitis in pediatric Sjogren's Syndrome. Rheumatology (Oxford) 2021; 61:e43-e45. [PMID: 34599800 DOI: 10.1093/rheumatology/keab736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Linda M Appelt
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Fabian Lander
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
19
|
Chihaby N, Orliaguet M, Le Pottier L, Pers JO, Boisramé S. Treatment of Sjögren's Syndrome with Mesenchymal Stem Cells: A Systematic Review. Int J Mol Sci 2021; 22:10474. [PMID: 34638813 PMCID: PMC8508641 DOI: 10.3390/ijms221910474] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 01/10/2023] Open
Abstract
Mesenchymal stem cells (MSCs) are ubiquitous in the human body. Mesenchymal stem cells were initially isolated from bone marrow and later from other organs such as fatty tissues, umbilical cords, and gingiva. Their secretory capacities give them interesting immunomodulatory properties in cell therapy. Some studies have explored the use of MSCs to treat Sjögren's syndrome (SS), a chronic inflammatory autoimmune disease that mainly affects exocrine glands, including salivary and lacrimal glands, although current treatments are only palliative. This systematic review summarizes the current data about the application of MSCs in SS. Reports show improvements in salivary secretions and a decrease in lymphocytic infiltration in salivary glands in patients and mice with SS after intravenous or infra-peritoneal injections of MSCs. MSC injections led to a decrease in inflammatory cytokines and an increase in anti-inflammatory cytokines. However, the intrinsic mechanism of action of these MSCs currently remains unknown.
Collapse
Affiliation(s)
- Najwa Chihaby
- UFR d’Odontologie, University of Western Brittany, 29200 Brest, France; (N.C.); (M.O.); (L.L.P.); (S.B.)
| | - Marie Orliaguet
- UFR d’Odontologie, University of Western Brittany, 29200 Brest, France; (N.C.); (M.O.); (L.L.P.); (S.B.)
- CHU de Brest, 29609 Brest, France
| | - Laëtitia Le Pottier
- UFR d’Odontologie, University of Western Brittany, 29200 Brest, France; (N.C.); (M.O.); (L.L.P.); (S.B.)
- Inserm, LBAI, University of Western Brittany, UMR1227, 29609 Brest, France
| | - Jacques-Olivier Pers
- UFR d’Odontologie, University of Western Brittany, 29200 Brest, France; (N.C.); (M.O.); (L.L.P.); (S.B.)
- CHU de Brest, 29609 Brest, France
- Inserm, LBAI, University of Western Brittany, UMR1227, 29609 Brest, France
| | - Sylvie Boisramé
- UFR d’Odontologie, University of Western Brittany, 29200 Brest, France; (N.C.); (M.O.); (L.L.P.); (S.B.)
- CHU de Brest, 29609 Brest, France
| |
Collapse
|
20
|
Epidemiology of cutaneous involvement in Sjögren syndrome: Data from three French pSS populations (TEARS, ASSESS, diapSS). Joint Bone Spine 2021; 88:105162. [PMID: 33617999 DOI: 10.1016/j.jbspin.2021.105162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the prevalence and significance of dermatological disorders in primary Sjögren syndrome (pSS). METHODS We used 2 pSS French cohorts (ASSESS, in which prevalence of skin disorders in 395 patients was evaluated; and diapSS, in which 76 on 139 pSS patients had an examination by a dermatologist) and baseline data of the TEARS randomized trial (110 patients with recent or active pSS treated with rituximab or placebo and evaluated for skin dryness using a visual analogue scale (VAS) out of 100). RESULTS Skin manifestations included in the EULAR Sjögren syndrome disease activity index (ESSDAI) were rare in the ASSESS cohort (n=16/395, 4.1%, mainly purpuras; only 3 had high activity), but they were associated with activity in the other ESSDAI domains (peripheral neurological (P<0.001), muscular (P<0.01), haematological (P<0.05), biological (P<0.05), history of arthritis (P<0.01), splenomegaly (P<0.05) and higher gamma globulin levels (P<0.01)). In the diapSS cohort, compared to pSS patients not receiving a dermatological consultation, the pSS patients who had a dermatological consultation had significantly more dermatological involvement outside the ESSDAI score [38.2% (29/76) versus 15.9% (10/63); P<0.01]. The TEARS study showed a high prevalence of cutaneous dryness (VAS>50; 48.2%) and found that patients with dry skin had higher VAS pain (P<0.01) and drought (P<0.01) scores. CONCLUSION ESSDAI skin activity is rare and associated with hypergammaglobulinemia and ESSDAI activity. Systematic dermatological examination is informative for non-specific lesions. The most common skin disorder is skin dryness, which is associated with a higher pain and overall subjective dryness.
Collapse
|
21
|
Abstract
Dermatologic changes occur in a variety of rheumatic diseases. Skin can be the initial site of involvement, thus providing important clues for an accurate diagnosis based on cutaneous findings. Dermatologic findings can also be an indicator of systemic involvement and prognostic outcome; however, many connective tissue disorders have a wide variety of cutaneous manifestations, with significant overlap between different diseases. These skin signs often precede systemic clinical manifestations. Careful attention to characteristic dermatologic findings in Behçet's disease, systemic lupus erythematosus, rheumatoid arthritis, and various vasculitis can provide prompt therapeutic approaches in the case of life-threatening complications of systemically involved rheumatologic diseases.
Collapse
Affiliation(s)
- Burhan Engin
- Department of Dermatology and Venereology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | - Ayşegül Sevim
- Department of Dermatology and Venereology, Haydarpasa Numune Research and Teaching Hospital, Istanbul, Istanbul, Turkey
| | - Seher Küçükoğlu Cesur
- Department of Dermatology and Venereology, Altınbaş University, Bahçelievler Medical Park Hospital, Istanbul, Istanbul, Turkey
| | - Yalçın Tüzün
- Department of Dermatology and Venereology, Bahçelievler Medical Park Hospital, Istanbul, Istanbul, Turkey
| |
Collapse
|
22
|
Orgeolet L, Foulquier N, Misery L, Redou P, Pers JO, Devauchelle-Pensec V, Saraux A. Can artificial intelligence replace manual search for systematic literature? Review on cutaneous manifestations in primary Sjögren’s syndrome. Rheumatology (Oxford) 2019; 59:811-819. [DOI: 10.1093/rheumatology/kez370] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/09/2019] [Indexed: 01/12/2023] Open
Abstract
Abstract
Objectives
Manual systematic literature reviews are becoming increasingly challenging due to the sharp rise in publications. The primary objective of this literature review was to compare manual and computer software using artificial intelligence retrieval of publications on the cutaneous manifestations of primary SS, but we also evaluated the prevalence of cutaneous manifestations in primary SS.
Methods
We compared manual searching and searching with the in-house computer software BIbliography BOT (BIBOT) designed for article retrieval and analysis. Both methods were used for a systematic literature review on a complex topic, i.e. the cutaneous manifestations of primary SS. Reproducibility was estimated by computing Cohen’s κ coefficients and was interpreted as follows: slight, 0–0.20; fair, 0.21–0.40; moderate, 0.41–0.60; substantial, 0.61–0.80; and almost perfect, 0.81–1.
Results
The manual search retrieved 855 articles and BIBOT 1042 articles. In all, 202 articles were then selected by applying exclusion criteria. Among them, 155 were retrieved by both methods, 33 by manual search only, and 14 by BIBOT only. Reliability (κ = 0.84) was almost perfect. Further selection was performed by reading the 202 articles. Cohort sizes and the nature and prevalence of cutaneous manifestations varied across publications. In all, we found 52 cutaneous manifestations reported in primary SS patients. The most described ones were cutaneous vasculitis (561 patients), xerosis (651 patients) and annular erythema (215 patients).
Conclusion
Among the final selection of 202 articles, 155/202 (77%) were found by the two methods but BIBOT was faster and automatically classified the articles in a chart. Combining the two methods retrieved the largest number of publications.
Collapse
Affiliation(s)
- Laure Orgeolet
- Dermatology Unit, UMR 1101, IBRBS, Université de Brest, Inserm, CHU
| | - Nathan Foulquier
- LATIM, Laboratoire de Traitement de l’Information Médicale, UMR 1101, IBRBS, Université de Brest, Inserm, CHU
| | - Laurent Misery
- Dermatology Unit, UMR 1101, IBRBS, Université de Brest, Inserm, CHU
| | - Pascal Redou
- LATIM, Laboratoire de Traitement de l’Information Médicale, UMR 1101, IBRBS, Université de Brest, Inserm, CHU
| | - Jacques-Olivier Pers
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, CHU Brest, LabEx IGO
| | - Valérie Devauchelle-Pensec
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, CHU Brest, LabEx IGO
- Rheumatology Unit, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU, Brest, France
| | - Alain Saraux
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, CHU Brest, LabEx IGO
- Rheumatology Unit, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU, Brest, France
| |
Collapse
|
23
|
Yu J. Noninvasive Score in Classification Diagnosis of Sjögren's Syndrome. Open Rheumatol J 2019. [DOI: 10.2174/1874312901913010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
To develop simple, practical classification criteria for Sjögren's Syndrome (SS) without Labial Salivary Gland Biopsy (LSGB).
Methods:
In the new criteria (noninvasive score, NIS) set, classification as “definite SS” is based on the ocular and oral symptoms and signs, autoantibodies and the existence of autoimmune thyroid disease, which were calculated. Patients with a score ≥5 were classified as having definite SS and patients with a score <4 were supposed to be excluded from SS. For the patients with a score of 4, LSGB was suggested.
Result:
76 patients with suspected SS were recruited between April 2013 and September 2014, 42 of which were definitive diagnosis of SS and 34 were excluded from SS. Sensitivity and specificity for the NIS criteria in the diagnosis of SS were 97.6% and 94.1%, respectively. The Negative Predictive Value (NPV) and Positive Predictive Value (PPV) to detect SS were 97.0% and 95.3% respectively, and the diagnostic accuracy was 96.1%. The area under the ROC curves (AUC; 95% CI) for NIS criteria was 0.959 (0.905-1.000), which performed better than the American-European Consensus Group’s (AECG) criteria and LSGB in the diagnosis of SS (P < 0.05).
Conclusion:
The NIS criteria are an alternative to the AECG criteria in classification diagnosis of SS, which are with high diagnostic efficiency. We recommend using a score <4 and ≥5 to rule out or to diagnose SS respectively. For the patients with a score of 4, LSGB is necessary and able to diagnose SS.
Collapse
|
24
|
Jhorar P, Torre K, Lu J. Cutaneous features and diagnosis of primary Sjögren syndrome: An update and review. J Am Acad Dermatol 2018; 79:736-745. [DOI: 10.1016/j.jaad.2018.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/02/2018] [Accepted: 05/14/2018] [Indexed: 12/25/2022]
|
25
|
Abstract
Sjögren's syndrome is currently considered an "autoimmune epithelitis," as exocrine glands, especially salivary and lacrimal, are progressively destructed by an immune-mediated process associated with specific serum autoantibodies and local lymphocyte infiltrate. Xerostomia remains a key complain in patients with Sjögren's syndrome but should be evaluated also for other causes such as xerogenic medications, followed by radiation and chemotherapy for head and neck cancers, hormone disorders, infections, or other connective tissue diseases. Further, xerophtalmia (also known as dry eye) frequently associated with keratoconjunctivitis sicca cumulatively affects approximately 10-30% of the general population with increasing incidence with age and is more frequently secondary to non-autoimmune diseases. On the other hand, numerous patients with Sjögren's syndrome manifest signs of systemic dryness involving the nose, the trachea, the vagina, and the skin, suggesting that other glands are also affected beyond the exocrine epithelia. Skin involvement in Sjögren's syndrome is relatively common, and various manifestations may be present, in particular xeroderma, eyelid dermatitis, annular erythema, and cutaneous vasculitis. Additional skin non-vasculitic manifestations include livedo reticularis which may occur in the absence of vasculitis, and localized nodular cutaneous amyloidosis possibly representing lymphoproliferative diseases related to Sjögren's syndrome. The treatment of skin and mucosal manifestations in Sjögren's syndrome is similar regardless of the cause, starting from patient education to avoid alcohol and tobacco smoking and to pursue dental hygiene. In conclusion, a strict collaboration between the dermatologist and the rheumatologist is essential in the adequate management of Sjögren's syndrome skin and mucosal manifestations.
Collapse
|
26
|
Xuan L, Zhang YD, Li L, Zeng YP, Zhang HZ, Wang J, Dong ZH. Clinical Profile and Significance of Mucocutaneous Lesions of Primary Sjögren's Syndrome: A Large Cross-sectional Study with 874 Patients. Chin Med J (Engl) 2018; 130:2423-2428. [PMID: 29052562 PMCID: PMC5684622 DOI: 10.4103/0366-6999.216403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Mucocutaneous lesions are common features of primary Sjögren's syndrome (pSS), but only a few studies have focused on them. To demonstrate the profile of mucocutaneous lesions of pSS and further explore their potential clinical significance, we performed a cross-sectional study on 874 patients. Methods: Demographic data, clinical manifestations, and laboratory results of 874 pSS patients were collected. Patients were divided into two groups according to the presence of mucocutaneous lesions. Differences in primary symptoms and systemic impairments between the two groups were analyzed. Results of laboratory tests were also compared after excluding those who had taken corticosteroid from both groups. One-year follow-up was done, and occurrences of various new complications were compared. Results: Among the 874 pSS patients, 181 patients had mucocutaneous lesions, accounting for 20.7%. Multiple mucocutaneous manifestations were displayed, and the top four most common types of lesions were purpuric eruptions (39.8%), urticaria (23.8%), Raynaud's phenomenon (14.9%), and angular stomatitis (9.9%). Incidences of pulmonary interstitial fibrosis, pulmonary bullae, leukopenia, and anemia were significantly higher among patients with mucocutaneous lesions (P < 0.05). Increase in IgG and decrease in C4 among patients with mucocutaneous lesions displayed statistical significance after excluding patients from both groups who had taken corticosteroid (P < 0.05). After one-year follow-up, patients with mucocutaneous lesions presented a slightly higher incidence of new complications compared to those without. Conclusions: Mucocutaneous manifestations of pSS patients were common and diverse. Patients with mucocutaneous manifestations had more systemic damages, higher level of IgG, and lower level of serum C4, suggesting a higher activity of the primary disease.
Collapse
Affiliation(s)
- Lei Xuan
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yi-Dong Zhang
- Department of Traditional Chinese Medicine, Peking Union Medical College, Beijing 100730, China
| | - Li Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yue-Ping Zeng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hao-Ze Zhang
- Department of Rheumatology, Peking University First Hospital, Beijing 100034, China
| | - Jing Wang
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhen-Hua Dong
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
27
|
Gray A, Lockwood S, Mirrakhimov AE, Gelber AC, Manesh R. Near and Far. J Hosp Med 2018; 13:424-428. [PMID: 29261817 DOI: 10.12788/jhm.2893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Adam Gray
- Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Department of Medicine, Lexington Veterans Affairs Medical Center, Lexington, Kentucky, USA
| | - Sean Lockwood
- Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Department of Medicine, Lexington Veterans Affairs Medical Center, Lexington, Kentucky, USA
| | - Aibek E Mirrakhimov
- Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Allan C Gelber
- Department of Medicine, Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Reza Manesh
- Department of Medicine, Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| |
Collapse
|
28
|
Zhou Z, Jiang W, Wang M, Liu Y, Zhang W, Huang M, Liang D. Primary Sjögren syndrome that initially presented with repeated hypergammaglobulinemic purpura after prolonged sitting: A case report. Medicine (Baltimore) 2017; 96:e9187. [PMID: 29390329 PMCID: PMC5815741 DOI: 10.1097/md.0000000000009187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE Purpura is a common dermatologic manifestation in Sjögren syndrome (SS). When a patient presents with sicca symptoms, the diagnosis of SS is not difficult. PATIENT CONCERNS Here, we reported a case of a 52-year-old Chinese woman who initially presented with nonpalpable purpura on both lower extremities, and these lesions had developed soon after prolonged sitting. In the past 2 years, she had repeated cutaneous nonpalpable purpura 4 times. She had no sicca symptoms, dry eyes, or dry mouth. DIAGNOSES Combining the laboratory findings, Schirmer test, and labial gland biopsy, primary SS was confirmed. INTERVENTIONS The patient was placed on a trial of hydroxychloroquine (200 mg once daily). OUTCOMES The purpura on both lower extremities had faded at the sixth day after onset and at the third day after hydroxychloroquine treatment. LESSONS These case was not easy to diagnosis primary SS because she had no sicca symptoms. A patient with primary SS who initially presented with recurrent purpura associated with prolonged sitting. Prolonged sitting had been a possible aggravating factor for the cutaneous purpura of this patient with primary SS.
Collapse
|
29
|
Pathological Analysis of Ocular Lesions in a Murine Model of Sjögren's Syndrome. Int J Mol Sci 2017; 18:ijms18061209. [PMID: 28587293 PMCID: PMC5486032 DOI: 10.3390/ijms18061209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/27/2017] [Accepted: 06/03/2017] [Indexed: 01/22/2023] Open
Abstract
Sjögren’s syndrome (SS) is a systemic autoimmune disease characterized by severe inflammation of exocrine glands such as the salivary and lacrimal glands. When it affects the lacrimal glands, many patients experience keratoconjunctivitis due to severely dry eyes. This study investigated the pathological and immunological characteristics of ocular lesions in a mouse model of SS. Corneal epithelial injury and hyperplasia were confirmed pathologically. The number of conjunctival mucin-producing goblet cells was significantly decreased in the SS model mice compared with control mice. Expression levels of transforming growth factor (TGF)-β, interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-X-C motif chemokine (CXCL) 12 were significantly higher in the corneal epithelium of the SS model mice than in control mice. Inflammatory lesions were observed in the Harderian, intraorbital, and extraorbital lacrimal glands in the SS model mice, suggesting that the ocular glands were targeted by an autoimmune response. The lacrimal glands of the SS model mice were infiltrated by cluster of differentiation (CD)4+ T cells. Real-time reverse transcription-polymerase chain reaction (RT-PCR) revealed significantly increased mRNA expression of TNF-α, TGF-β, CXCL9, and lysozyme in the extraorbital lacrimal glands of the SS model mice compared with control mice. These results add to the understanding of the complex pathogenesis of SS and may facilitate development of new therapeutic strategies.
Collapse
|
30
|
Hu YH, Zhou PF, Long GF, Tian X, Guo YF, Pang AM, Di R, Shen YN, Liu YD, Cui YJ. Elevated Plasma P-Selectin Autoantibodies in Primary Sjögren Syndrome Patients with Thrombocytopenia. Med Sci Monit 2015; 21:3690-5. [PMID: 26613867 PMCID: PMC4668912 DOI: 10.12659/msm.895144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Primary Sjögren’s syndrome (pSS) is one of the most common chronic systemic autoimmune diseases, and thrombocytopenia is one of the hematological manifestations of pSS. When platelet and endothelial cells are activated, P-selectin is expressed on the cell surface. This study aimed to investigate the role of P-selectin autoantibodies in the pathogenesis of thrombocytopenia in pSS. Material/Methods P-selectin autoantibodies were measured by enzyme-linked immunosorbent assay (ELISA) in 38 pSS patients without thrombocytopenia and 32 pSS patients with thrombocytopenia, 32 idiopathic thrombocytopenic purpura (ITP) patients, and 35 healthy controls. Results The plasma P-selectin autoantibodies (A490) in ITP patients and pSS patients with/without thrombocytopenia were significantly higher than those in healthy controls, but there were no significant differences between ITP patients and pSS patients with thrombocytopenia. The positive rate of P-selectin autoantibodies in pSS patients with thrombocytopenia was significantly higher than that in ITP patients. The platelet count was lower in P-selectin autoantibodies-positive patients, while among pSS patients with thrombocytopenia, the platelet count was lower in P-selectin autoantibodies-positive patients than in P-selectin autoantibodies-negative patients. In ITP patients and pSS patients with thrombocytopenia, the platelet count was lower in P-selectin autoantibodies-positive patients. Conclusions Elevated plasma P-selectin autoantibodies may play a role in the pathogenesis of thrombocytopenia in pSS patients.
Collapse
Affiliation(s)
- Ya-Hui Hu
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China (mainland)
| | - Peng-Fei Zhou
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China (mainland)
| | - Guang-Feng Long
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China (mainland)
| | - Xin Tian
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China (mainland)
| | - Yu-Fan Guo
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Ai-Ming Pang
- Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Tianjin, China (mainland)
| | - Ran Di
- Hubei University of Chinese Medicine, Wuhan, Hubei, China (mainland)
| | - Yan-Na Shen
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China (mainland)
| | - Yun-De Liu
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China (mainland)
| | - Yu-Jie Cui
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China (mainland)
| |
Collapse
|
31
|
Işık M, Aydın Ç. Cutis laxa (elastolysis) in a patient with Sjögren's syndrome. Eur J Rheumatol 2015; 2:41-42. [PMID: 27708922 DOI: 10.5152/eurjrheumatol.2014.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/11/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Metin Işık
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Çisel Aydın
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
32
|
Kurz C, Wunderlich S, Spieler D, Schwaiger BJ, Andres C, Traidl-Hoffmann C, Ilg R. Acute transverse myelitis and psoriasiform dermatitis associated with Sjoegren's syndrome: a case report. BMC Res Notes 2014; 7:580. [PMID: 25167870 PMCID: PMC4162968 DOI: 10.1186/1756-0500-7-580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 08/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical complications of Sjoegren's syndrome include myelitis and skin manifestations. There is scarce observational data and a lack of randomised controlled studies regarding the treatment of Sjoegren's syndrome in the presence of such complications. CASE PRESENTATION Here we report the case of a 41-year-old Caucasian female patient with biopsy-proven Sjoegren's syndrome who initially presented with generalized exanthema and subsequently developed acute extensive transverse myelitis. In view of the rapid deterioration we opted for an intensive treatment using a combination of corticosteroid pulse therapy, plasmapheresis and cyclophosphamide, which we later changed to rituximab. Under that treatment the skin manifestations resolved entirely whereas transverse myelitis showed incomplete remission. CONCLUSION Severe neurological and dermatological complications may occur in Sjoegren's syndrome. This suggests a close yet currently unclear pathogenetic relationship. Intensive immunosuppressant treatment resulted in significant improvement of both symptom clusters. Skin manifestations may precede other severe complications in Sjoegren's syndrome and therefore require particular attention.
Collapse
Affiliation(s)
- Carolin Kurz
- Department of Neurology, Klinikum rechts der Isar, Technische Universität, Ismaninger Strasse 22, Munich 81675, Germany.
| | | | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Tincani A, Andreoli L, Cavazzana I, Doria A, Favero M, Fenini MG, Franceschini F, Lojacono A, Nascimbeni G, Santoro A, Semeraro F, Toniati P, Shoenfeld Y. Novel aspects of Sjögren's syndrome in 2012. BMC Med 2013; 11:93. [PMID: 23556533 PMCID: PMC3616867 DOI: 10.1186/1741-7015-11-93] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/15/2013] [Indexed: 12/16/2022] Open
Abstract
Sjögren's syndrome (SS) is a systemic progressive autoimmune disease characterized by a complex pathogenesis requiring a predisposing genetic background and involving immune cell activation and autoantibody production. The immune response is directed to the exocrine glands, causing the typical 'sicca syndrome', but major organ involvement is also often seen. The etiology of the disease is unknown. Infections could play a pivotal role: compared to normal subjects, patients with SS displayed higher titers of anti-Epstein-Barr virus (EBV) early antigens, but lower titers of other infectious agent antibodies such as rubella and cytomegalovirus (CMV) suggest that some infections may have a protective role against the development of autoimmune disease. Recent findings seem to show that low vitamin D levels in patients with SS could be associated with severe complications such as lymphoma and peripheral neuropathy. This could open new insights into the disease etiology. The current treatments for SS range from symptomatic therapies to systemic immunosuppressive drugs, especially B cell-targeted drugs in cases of organ involvement. Vitamin D supplementation may be an additional tool for optimization of SS treatment.
Collapse
Affiliation(s)
- Angela Tincani
- Rheumatology and Clinical Immunology Unit, Spedali Civili, Piazzale Spedali Civili 1, 25100 Brescia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Sisto M, Lisi S, Lofrumento DD, Ingravallo G, De Lucro R, D'Amore M. Salivary gland expression level of IκBα regulatory protein in Sjögren's syndrome. J Mol Histol 2013; 44:447-54. [PMID: 23377923 DOI: 10.1007/s10735-013-9487-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/28/2013] [Indexed: 12/22/2022]
Abstract
Diagnosis and therapeutic strategies in Sjögren's syndrome (SS) might greatly benefit of the present multidisciplinary approach to studying the molecular pathogenesis of the disease. A deregulated inflammatory response has been described in the SS. The research in the last years sheds light on the importance of the NF-κB pathway regulating the pro-inflammatory cytokine production and leukocyte recruitment. These are important contributors to the inflammatory response during the development of SS. In this study we examine the expression of the NF-κB inhibitory protein termed IκBα in salivary glands epithelial cells (SGEC) comparing it with SGEC from healthy controls, to test the hypothesis that an altered expression of IκBα occurs in SGEC from SS biopsies. Real-Time PCR, western blot and immunohistochemistry demonstrated that the expression level of IκBα was significantly lower in SS with respect to healthy controls leading to an increased NF-κB activity. Our results suggest that the analysis of IκBα expression at salivary gland epithelial cell level could be a potential new hallmark of SS progression and sustain a rationale to more deeply investigate the therapeutic potential of specific NF-κB inhibitors in SS.
Collapse
Affiliation(s)
- Margherita Sisto
- Laboratory of Cell Biology, Section of Human Anatomy and Histology, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Medical School, piazza Giulio Cesare 1, 70124, Bari, Italy.
| | | | | | | | | | | |
Collapse
|
36
|
García-Carrasco M, Mendoza-Pinto C, Jiménez-Hernández C, Jiménez-Hernández M, Nava-Zavala A, Riebeling C. Serologic features of primary Sjögren's syndrome: clinical and prognostic correlation. ACTA ACUST UNITED AC 2012; 7:651-659. [PMID: 23525186 DOI: 10.2217/ijr.12.64] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Sjögren's syndrome (SS) is a chronic inflammatory systemic autoimmune disease. The disease spectrum extends from sicca syndrome to systemic involvement and extraglandular manifestations, and SS may be associated with malignancies, especially non-Hodgkin's lymphoma. Patients with SS present a broad spectrum of serologic features. Certain serological findings are highly correlated with specific clinical features, and can be used as prognostic markers.
Collapse
Affiliation(s)
- Mario García-Carrasco
- Systemic Autoimmune Diseases Research Unit, HGR 36-CIBIOR IMSS, 10 Poniente 2721, Puebla, Mexico ; Department of Rheumatology, School of Medicine, BUAP, Mexico
| | | | | | | | | | | |
Collapse
|