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Smiyan S, Komorovsky R, Koshak B, Duve K, Shkrobot S. Central nervous system manifestations in rheumatic diseases. Rheumatol Int 2024; 44:1803-1812. [PMID: 39136787 DOI: 10.1007/s00296-024-05679-1] [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: 06/02/2024] [Accepted: 08/03/2024] [Indexed: 09/14/2024]
Abstract
As the role of neurologists in managing patients with rheumatic diseases expands, collaboration between rheumatologists and neurologists becomes increasingly vital. This literature review provides an overview of the central nervous system (CNS) manifestations of major autoimmune rheumatic disorders, which may include parenchymal brain and meningeal disease (stroke, meningoencephalitis, meningitis), myelopathies, psychosis, chorea, seizure disorders, and various forms of cephalea. Novel findings linking specific autoimmune markers to CNS damage reveal a direct, previously underestimated link between systemic inflammation and neural injury. Besides, with the increasing use of biological therapies, it is crucial to recognize when neurological manifestations are related to adverse events of therapy, as this may significantly influence treatment decisions. Neurologists play a key role in this assessment, working closely with rheumatologists. Overall, addressing CNS involvement in rheumatic diseases is important for improving patient outcomes and advancing medical knowledge in this complex field. A thorough understanding of the neurologic aspects of rheumatic diseases is essential for optimal patient care, necessitating a multidisciplinary approach to management.
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Affiliation(s)
- Svitlana Smiyan
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Roman Komorovsky
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
| | - Bohdan Koshak
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Khrystyna Duve
- Department of Neurology, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Svitlana Shkrobot
- Department of Neurology, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Schutzer SE, Coyle PK. How Do I Approach the Evaluation and Treatment of Early Lyme Disease? NEJM EVIDENCE 2024; 3:EVIDccon2300131. [PMID: 39041869 DOI: 10.1056/evidccon2300131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
AbstractThe incidence and geographic spread of Lyme disease are increasing, and more than 476,000 new cases a year are estimated to occur in the United States. Therefore, many clinicians in North America will need to consider how to approach a patient with a concern for Lyme disease. This Curbside Consult addresses common clinical considerations, including discussion of signs of early Lyme disease, available laboratory tests, when to treat and with which antibiotics.
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Affiliation(s)
- Steven E Schutzer
- Department of Medicine, Rutgers New Jersey Medical School, Division of Allergy and Immunology, Newark, NJ
| | - Patricia K Coyle
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
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Melicherčík P, Mazura M, Hodík M, Dundrová K, Landor I, Jahoda D, Horváth R, Barták V, Kizek R, Klapková E. Synovial fluid alpha-defensins in Lyme arthritis-a useful marker. Folia Microbiol (Praha) 2024:10.1007/s12223-024-01173-0. [PMID: 38869776 DOI: 10.1007/s12223-024-01173-0] [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: 11/27/2023] [Accepted: 05/15/2024] [Indexed: 06/14/2024]
Abstract
Lyme arthritis, one of the possible late manifestations of Lyme borreliosis, predominantly affects the supporting joints and in adults most often occurs in the form of monoarthritis of the knee. Early diagnosis is based on clinical findings and serology. PCR detection of Borrelia in synovial fluid has become an integral part of the laboratory testing algorithm. The clinical presentation and inflammatory markers in Lyme arthritis can resemble septic arthritis. Determining the levels of alpha-defensins (human neutrophil peptide (HNP 1-3)) in synovial fluid by liquid chromatography is a highly sensitive method revealing the presence of inflammatory process. Between 2020 and 2022, we examined eleven patients with Lyme arthritis of the knee. We measured levels of HNP 1-3 from synovial fluid by HPLC in patients, and we compared it with the corresponding C-reactive protein (CRP) levels in paired serum samples. In patients diagnosed with Lyme arthritis, HNP 1-3 levels in synovial fluid ranged from 2.5 to 261 mg/L, with a median of 46.5 mg/L. Average serum CRP was 43 mg/L. The results show that elevated HNP 1-3 can be consistent with not only septic arthritis or systemic disease, but also with Lyme arthritis, especially in patients with negative culture and 16S PCR from synovial fluid. Final diagnosis must be verified by examination for anti-Borrelia antibodies from serum and synovial fluid. The aim of this work is to introduce an HPLC method for the determination of alpha-defensins as one of the possible diagnostic markers.
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Affiliation(s)
- Pavel Melicherčík
- Department of Orthopedics, Charles University, First Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic
| | - Matěj Mazura
- Department of Orthopedics, Charles University, First Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic
| | - Martin Hodík
- Department of Medical Chemistry and Clinical Biochemistry, Charles University, Second Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Kamila Dundrová
- Department of Medical Microbiology, Charles University, Second Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Ivan Landor
- Department of Orthopedics, Charles University, First Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic
| | - David Jahoda
- Department of Orthopedics, Charles University, First Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic
| | - Rudolf Horváth
- Department of Rheumatology of Children and Adults, Charles University, Second Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Vladislav Barták
- Department of Orthopedics, Charles University, First Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic
| | - René Kizek
- Department of Medical Chemistry and Clinical Biochemistry, Charles University, Second Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Eva Klapková
- Department of Medical Chemistry and Clinical Biochemistry, Charles University, Second Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06, Prague, Czech Republic.
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Diakou A. Biting Back: Advances in Fighting Ticks and Understanding Tick-Borne Pathogens. Pathogens 2024; 13:73. [PMID: 38251380 PMCID: PMC10819772 DOI: 10.3390/pathogens13010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Ticks are blood-feeding arthropods and obligate ectoparasites of virtually all animal species (except fish) and humans [...].
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Affiliation(s)
- Anastasia Diakou
- Laboratory of Parasitology and Parasitic Diseases, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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de la Fuente J, Estrada-Peña A, Gortázar C, Vaz-Rodrigues R, Sánchez I, Carrión Tudela J. Citizen Science on Lyme Borreliosis in Spain Reveals Disease-Associated Risk Factors and Control Interventions. Vector Borne Zoonotic Dis 2023; 23:441-446. [PMID: 37462912 DOI: 10.1089/vbz.2023.0016] [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: 09/12/2023] Open
Abstract
Background: Lyme borreliosis (LB) caused by Borrelia burgdorferi sensu lato complex spirochetes is one of the tick-borne diseases with high prevalence and social/economic burden in the United States, Spain, and other European countries. The objective is to address limited information available about the incidence, prevalence, and symptoms of LB, current prevention, and treatment interventions that are not adequately focused and thus not very effective against this disease. Methods: To address these limitations, in this study, we used a citizen science approach to evaluate the LB-associated risks and implementation of control interventions in Spain. A total of 405 participants in the survey were included in the analysis. Responses to the questionnaire were received during January-July 2022. The questionnaire contained qualitative and quantitative questions. Homogeneity among binary variables was analyzed using a Fisher's exact test. Results: Despite limitations of the study associated with response to the questionnaire and information on tick species, the results evidenced the effect of factors such as age, gender, tick bites, disease clinical signs, comorbidities such as alpha-gal syndrome, health care services, and treatment effectiveness affecting LB. Conclusions: The main conclusions of the study highlight the need for better surveillance of tick infestations, pathogen infection, and diagnosis of LB and related comorbidities. To advance in disease prevention, diagnosis, and treatment, new interventions need to be developed and implemented in both public and private health care services. Providing access to these results to the society, health care system, and scientists is important to further advance in disease surveillance, diagnosis, control, and prevention.
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Affiliation(s)
- José de la Fuente
- SaBio (Health and Biotechnology), Instituto de Investigación en Recursos Cinegéticos IREC-CSIC-UCLM-JCCM, Ciudad Real, Spain
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Agustín Estrada-Peña
- Department of Animal Health, Faculty of Veterinary Medicine, Zaragoza, Spain
- Group of Research on Emerging Zoonoses, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
| | - Christian Gortázar
- SaBio (Health and Biotechnology), Instituto de Investigación en Recursos Cinegéticos IREC-CSIC-UCLM-JCCM, Ciudad Real, Spain
| | - Rita Vaz-Rodrigues
- SaBio (Health and Biotechnology), Instituto de Investigación en Recursos Cinegéticos IREC-CSIC-UCLM-JCCM, Ciudad Real, Spain
| | - Isabel Sánchez
- Asociación de Enfermedades Raras D'Genes, Totana-Murcia, Spain
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