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Bica BERG, de Souza AWS, Pereira IA. Unveiling the clinical spectrum of relapsing polychondritis: insights into its pathogenesis, novel monogenic causes, and therapeutic strategies. Adv Rheumatol 2024; 64:29. [PMID: 38627861 DOI: 10.1186/s42358-024-00365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
Relapsing polychondritis is a rare multisystem disease involving cartilaginous and proteoglycan-rich structures. The diagnosis of this disease is mainly suggested by the presence of flares of inflammation of the cartilage, particularly in the ears, nose or respiratory tract, and more rarely, in the presence of other manifestations. The spectrum of clinical presentations may vary from intermittent episodes of painful and often disfiguring auricular and nasal chondritis to an occasional organ or even life-threatening manifestations such as lower airway collapse. There is a lack of awareness about this disease is mainly due to its rarity. In 2020, VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, a novel autoinflammatory syndrome, was described. VEXAS syndrome is attributed to somatic mutations in methionine-41 of UBA1, the major E1 enzyme that initiates ubiquitylation. This new disease entity connects seemingly unrelated conditions: systemic inflammatory syndromes (relapsing chondritis, Sweet's syndrome, and neutrophilic dermatosis) and hematologic disorders (myelodysplastic syndrome or multiple myeloma). Therefore, this article reviews the current literature on both disease entities.
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Affiliation(s)
- Blanca E R G Bica
- Reumatology Division of Hospital Universitário Clementino Fraga Filho (HUCFF), Universidade Federal do Rio de Janeiro, Rua Esteves Junior 62, CEP 22231-160, Laranjeiras, Rio de Janeiro, RJ, Brazil.
| | | | - Ivânio Alves Pereira
- Reumatologia da Universidade do Sul de Santa Catarina-UNISUL, Florian?polis, RJ, Brazil
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Magri SJ, Ugarte-Gil MF, Brance ML, Flores-Suárez LF, Fernández-Ávila DG, Scolnik M, Sato EI, de Souza AWS, Saldarriaga-Rivera LM, Babini AM, Zamora NV, Felquer MLA, Vergara F, Carlevaris L, Scarafia S, Guppy ERS, Unizony S. Role of plasma exchange in ANCA-associated vasculitis - Authors' reply. Lancet Rheumatol 2023; 5:e580-e581. [PMID: 38251482 DOI: 10.1016/s2665-9913(23)00235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 01/23/2024]
Affiliation(s)
| | | | | | - Luis Felipe Flores-Suárez
- Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Marina Scolnik
- Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Emilia Inoue Sato
- Medicine Department, Universidad Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Natalia V Zamora
- Rheumatology Unit, Hospital San Jose, Pergamino, Buenos Aires, Argentina
| | | | | | | | - Santiago Scarafia
- Rheumatology Unit, Hospital Municipal San Cayetano, Buenos Aires, Argentina
| | | | - Sebastian Unizony
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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de Souza AWS, Sato EI, Brance ML, Fernández-Ávila DG, Scolnik M, Magri SJ, Ugarte-Gil MF, Flores-Suárez LF, Saldarriaga-Rivera LM, Babini A, Zamora NV, Acosta Felquer ML, Vergara F, Carlevaris L, Scarafia S, Soriano Guppy ER, Unizony S. Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis. J Clin Rheumatol 2023; 29:316-325. [PMID: 37553869 DOI: 10.1097/rhu.0000000000002004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK). METHODS A panel of vasculitis experts developed a series of clinically meaningful questions addressing the treatment of TAK patients in the PICO (population/intervention/comparator/outcome) format. A systematic literature review was performed by a team of methodologists. The evidence quality was assessed according to the GRADE (Grading of Recommendations/Assessment/Development/Evaluation) methodology. The panel of vasculitis experts voted each PICO question and made recommendations, which required ≥70% agreement among the voting members. RESULTS Eleven recommendations were developed. Oral glucocorticoids are conditionally recommended for newly diagnosed and relapsing TAK patients. The addition of nontargeted synthetic immunosuppressants (e.g., methotrexate, leflunomide, azathioprine, or mycophenolate mofetil) is recommended for patients with newly diagnosed or relapsing disease that is not organ- or life-threatening. For organ- or life-threatening disease, we conditionally recommend tumor necrosis factor inhibitors (e.g., infliximab or adalimumab) or tocilizumab with consideration for short courses of cyclophosphamide as an alternative in case of restricted access to biologics. For patients relapsing despite nontargeted synthetic immunosuppressants, we conditionally recommend to switch from one nontargeted synthetic immunosuppressant to another or to add tumor necrosis factor inhibitors or tocilizumab. We conditionally recommend low-dose aspirin for patients with involvement of cranial or coronary arteries to prevent ischemic complications. We strongly recommend performing surgical vascular interventions during periods of remission whenever possible. CONCLUSION The first PANLAR treatment guidelines for TAK provide evidence-based guidance for the treatment of TAK patients in Latin American countries.
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Affiliation(s)
| | - Emilia I Sato
- From the Rheumatology Division, Universidad Federal de São Paulo, São Paulo, Brazil
| | | | - Daniel G Fernández-Ávila
- Rheumatology Unit, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia
| | - Marina Scolnik
- Rheumatology Unit, Hospital, Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sebastián Juan Magri
- Rheumatology Unit, Hospital Italiano de La Plata, La Plata, Buenos Aires, Argentina
| | | | - Luis Felipe Flores-Suárez
- Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | | | | | | | | | | | - Santiago Scarafia
- Rheumatology Unit, Hospital Municipal San Cayetano, Virreyes, Argentina
| | | | - Sebastian Unizony
- Vasculitis and Glomerulonephritis Center, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Magri SJ, Ugarte-Gil MF, Brance ML, Flores-Suárez LF, Fernández-Ávila DG, Scolnik M, Sato EI, de Souza AWS, Saldarriaga-Rivera LM, Babini AM, Zamora NV, Felquer MLA, Vergara F, Carlevaris L, Scarafia S, Guppy ERS, Unizony S. Pan American League of Associations for Rheumatology Guidelines for the treatment of ANCA-associated vasculitis. Lancet Rheumatol 2023; 5:e483-e494. [PMID: 38251580 DOI: 10.1016/s2665-9913(23)00128-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 01/23/2024]
Abstract
Considerable variability exists in the way health-care providers treat patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in Latin America. The most frequently used treatments for ANCA-associated vasculitis are cyclophosphamide and prolonged glucocorticoid tapers; however, randomised controlled trials conducted over the past 30 years have led to the development of several evidence-based treatment alternatives for these patients. Latin America faces socioeconomic challenges that affect access to care, and the use of certain costly medications with proven efficacy ANCA-associated vasculitis is often restricted. For these reasons, the Pan American League of Associations for Rheumatology developed the first ANCA-associated vasculitis treatment guidelines tailored for Latin America. A panel of local vasculitis experts generated clinically meaningful questions related to the treatment of ANCA-associated vasculitis using the Population, Intervention, Comparator, and Outcome (PICO) format. Following the Grading of Recommendations Assessment, Development, and Evaluation methodology, a team of methodologists conducted a systematic literature review. The panel of vasculitis experts voted on each PICO question and made recommendations, which required at least 70% agreement among the voting members. 21 recommendations and two expert opinion statements for the treatment of ANCA-associated vasculitis were developed, considering the current evidence and the socioeconomic characteristics of the region. These recommendations include guidance for the use of glucocorticoids, non-glucocorticoid immunosuppressants, and plasma exchange.
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Affiliation(s)
- Sebastián Juan Magri
- Rheumatology Unit, Hospital Italiano de La Plata, La Plata, Buenos Aires, Argentina
| | | | | | - Luis Felipe Flores-Suárez
- Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Marina Scolnik
- Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Emilia Inoue Sato
- Medicine Department, Universidad Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Santiago Scarafia
- Rheumatology Unit, Hospital Municipal San Cayetano, Virreyes, Argentina
| | | | - Sebastian Unizony
- Vasculitis and Glomerulonephritis Center, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Vieira M, Ochtrop MLG, Sztajnbok F, Souto Oliveira Elias C, Verztman JF, Bica BERG, Ciconelli RM, de Souza AWS. The Epidemiology of Takayasu Arteritis in Rio de Janeiro, Brazil: A Large Population-Based Study. J Clin Rheumatol 2023:00124743-990000000-00102. [PMID: 37068270 DOI: 10.1097/rhu.0000000000001964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Few population-based studies for Takayasu arteritis (TAK) have been performed, and Latin America prevalence/incidence data are unavailable. We aimed to understand TAK epidemiology in Rio de Janeiro City in 2020 (i.e., 6,747,815 inhabitants). METHODS This was a cross-sectional fieldwork study where physicians who regularly followed TAK patients in public or private practices from Rio de Janeiro were invited to complete a REDCap survey. Patients should fulfill internationally accepted criteria for TAK and be living in the city. The 2020 prevalence was calculated as cases per 1,000,000 inhabitants (106). National government databases were analyzed for comparative prevalence assessment. The incidence rate was estimated using retrospective sections of cases diagnosed between 2010 and 2019; relative incidence risk was assessed by Poisson regression models with robust variance. RESULTS Between May 2020 and May 2021, 114 patients were analyzed. Ninety-seven (85.1%) were female, and the most frequent races were White (44.7%), Mestizo (33.3%), and Black (16.7%). Takayasu arteritis 2020 prevalence was 16.9 cases/106 (95% confidence interval [CI], 14.1-20.3 cases/106); female patients and Black Brazilians had higher prevalence rates at 27.0 (95% CI, 22.2-33.3) and 25.1 cases/106 (95% CI, 16.1-39.3 cases/106), respectively. Government databases' analyses generated a lower prevalence (7.26 cases/106; 95% CI, 5.49-9.60 cases/106). The 2010-2019 mean incidence rate was 0.94 cases/106 per year (95% CI, 0.73-1.21 cases/106). Female patients had a higher risk than male patients of having TAK between 2010 and 2019 (relative risk, 2.70; 95% CI, 1.59-4.55; p < 0.0001). CONCLUSION In the largest population-based fieldwork to date and the first Latin American study on TAK prevalence, Rio de Janeiro City in 2020 showed an intermediate prevalence between Europe and Asia. Female patients and Black Brazilians were more affected than the general population.
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Affiliation(s)
| | - Manuella L G Ochtrop
- Rheumatology Division, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ)
| | | | | | - José Fernando Verztman
- Department of Rheumatology, Hospital dos Servidores do Estado do Rio de Janeiro (HFSE), Rio de Janeiro
| | - Blanca E R G Bica
- Internal Medicine Department, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ)
| | | | - Alexandre Wagner S de Souza
- From the Rheumatology Division, Department of Medicine, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo
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Mackie SL, Dejaco C, Appenzeller S, Camellino D, Duftner C, Gonzalez-Chiappe S, Mahr A, Mukhtyar C, Reynolds G, de Souza AWS, Brouwer E, Bukhari M, Buttgereit F, Byrne D, Cid MC, Cimmino M, Direskeneli H, Gilbert K, Kermani TA, Khan A, Lanyon P, Luqmani R, Mallen C, Mason JC, Matteson EL, Merkel PA, Mollan S, Neill L, Sullivan EO, Sandovici M, Schmidt WA, Watts R, Whitlock M, Yacyshyn E, Ytterberg S, Dasgupta B. British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis: executive summary. Rheumatology (Oxford) 2020; 59:487-494. [PMID: 31970410 DOI: 10.1093/rheumatology/kez664] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christian Dejaco
- Rheumatology, Medical University Graz, Graz, Austria.,South Tyrol Health Trust, Department of Rheumtaology, Hospital of Bruneck, Bruneck, Italy
| | - Simone Appenzeller
- Rheumatology Unit, Department of Medicine, University of Campinas, São Paulo, Brazil
| | - Dario Camellino
- Division of Rheumatology, La Colletta Hospital, Local Health Trust 3 Genoa.,Autoimmunology Laboratory, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Alfred Mahr
- Internal Medicine, Hôpital Saint-Louis, University Paris Diderot, Paris, France
| | - Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich
| | | | - Alexandre Wagner S de Souza
- Rheumatology Division, Universidade Federal de Sao Paulo Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil
| | - Elisabeth Brouwer
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marwan Bukhari
- Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, Cumbria, UK
| | - Frank Buttgereit
- Department of Medicine (Rheumatology and Clinical Immunology), Charité University Medicine, Berlin, Germany
| | | | - Maria C Cid
- Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions, Biomèdiques, August Pi I, Sunyer (IDIBAPS), Catalunya, Barcelona, Spain
| | - Marco Cimmino
- Dipartimento di Medicina Interna, Università degli Studi di Genova, Genoa, Italy
| | - Haner Direskeneli
- Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | | | - Asad Khan
- Rheumatology, Solihull Hospital, University Hospitals Birmingham, Birmingham
| | - Peter Lanyon
- Academic Rheumatology, Nottingham University Hospitals, Nottingham
| | - Raashid Luqmani
- Nuffield Orthopaedic Centre - Rheumatology, University of Oxford, Oxford
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Staffordshire
| | | | - Eric L Matteson
- Division of Rheumatology and Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Peter A Merkel
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Mollan
- Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | | | - Eoin O' Sullivan
- Department of Ophthalmology, King's College Hospital, London, UK
| | - Maria Sandovici
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Hospital Berlin, Berlin, Germany
| | - Richard Watts
- Rheumatology, Ipswich Hospital, Ipswich, UK.,University of East Anglia, Ipswich
| | - Madeline Whitlock
- Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Elaine Yacyshyn
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven Ytterberg
- Department of Rheumatology, Mayo Clinic of Medicine and Science, Rochester, MN, USA
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
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Mackie SL, Dejaco C, Appenzeller S, Camellino D, Duftner C, Gonzalez-Chiappe S, Mahr A, Mukhtyar C, Reynolds G, de Souza AWS, Brouwer E, Bukhari M, Buttgereit F, Byrne D, Cid MC, Cimmino M, Direskeneli H, Gilbert K, Kermani TA, Khan A, Lanyon P, Luqmani R, Mallen C, Mason JC, Matteson EL, Merkel PA, Mollan S, Neill L, Sullivan EO, Sandovici M, Schmidt WA, Watts R, Whitlock M, Yacyshyn E, Ytterberg S, Dasgupta B. British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis. Rheumatology (Oxford) 2020; 59:e1-e23. [DOI: 10.1093/rheumatology/kez672] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christian Dejaco
- Rheumatology, Medical University Graz, Graz, Austria
- South Tyrol Health Trust, Department of Rheumtaology, Hospital of Bruneck, Bruneck, Italy
| | - Simone Appenzeller
- Rheumatology Unit, Department of Medicine, University of Campinas, São Paulo, Brazil
| | - Dario Camellino
- Division of Rheumatology, La Colletta Hospital, Local Health Trust 3 Genoa
- Autoimmunology Laboratory, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Alfred Mahr
- Internal Medicine, Hôpital Saint-Louis, University Paris Diderot, Paris, France
| | - Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich
| | | | - Alexandre Wagner S de Souza
- Rheumatology Division, Universidade Federal de Sao Paulo Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil
| | - Elisabeth Brouwer
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marwan Bukhari
- Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, Cumbria, UK
| | - Frank Buttgereit
- Department of Medicine (Rheumatology and Clinical Immunology), Charité University Medicine, Berlin, Germany
| | | | - Maria C Cid
- Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions, Biomèdiques, August Pi I, Sunyer (IDIBAPS), Catalunya, Barcelona, Spain
| | - Marco Cimmino
- Dipartimento di Medicina Interna, Università degli Studi di Genova, Genoa, Italy
| | - Haner Direskeneli
- Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | | | - Asad Khan
- Rheumatology, Solihull Hospital, University Hospitals Birmingham, Birmingham
| | - Peter Lanyon
- Academic Rheumatology, Nottingham University Hospitals, Nottingham
| | - Raashid Luqmani
- Nuffield Orthopaedic Centre – Rheumatology, University of Oxford, Oxford
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Staffordshire
| | | | - Eric L Matteson
- Division of Rheumatology and Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Peter A Merkel
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Mollan
- Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | | | - Eoin O’ Sullivan
- Department of Ophthalmology, King’s College Hospital, London, UK
| | - Maria Sandovici
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Hospital Berlin, Berlin, Germany
| | - Richard Watts
- Rheumatology, Ipswich Hospital, Ipswich, UK
- University of East Anglia, Ipswich
| | - Madeline Whitlock
- Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Elaine Yacyshyn
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven Ytterberg
- Department of Rheumatology, Mayo Clinic of Medicine and Science, Rochester, MN, USA
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
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Perazzio SF, Soeiro-Pereira PV, de Souza AWS, Condino-Neto A, Andrade LEC. Behçet's disease heterogeneity: cytokine production and oxidative burst of phagocytes are altered in patients with severe manifestations. Clin Exp Rheumatol 2015; 33:S85-S95. [PMID: 26394190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To test the hypothesis that classical phagocytic functions are constitutively stimulated in patients with Behçet's disease (BD). METHODS Four study groups were analysed: active BD (aBD; n=30), inactive BD (iBD; n=31); septic patients (SP; n=25); healthy controls (HC; n=30). Microbicide activity against Streptococcus pneumoniae, Streptococcus sanguinis and Candida albicans was determined by means of 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) reduction and absorbance read by ELISA. Flow cytometry analysis evaluated phagocytosis (zymosan particles and microrganisms) and oxidative burst by dihidrorhodamine oxidation before and after stimulation with phorbol myristate acetate (PMA). The supernatant of PBMC cultures under TLR or microbial stimuli and of neutrophil cultures under PMA, LPS or microbial stimuli were used for determination of cytokine production by ELISA. RESULTS We found no significant differences between the BD patient groups and control groups with regard to oxidative burst, phagocytic activity, microbicide activity or cytokine production. However, the cells from patients with severe BD (based on clinical manifestation) exhibit significantly higher oxidative burst activity, both before and after PMA stimulation, compared to cells from patients with mild BD. Furthermore, we found significant correlations between the BD patients' scores on the simplified Behçet's Disease Current Activity Form adapted for Portuguese (BR-BDCAFs) and Streptococcus sanguinis-stimulated production of IL23 by PBMC and IL8 by neutrophils, and between BR-BDCAFs score and constitutive production of TNF-α, IFNγ, IL6 and IL23 by PBMC. CONCLUSIONS Patients with severe active BD do exhibit phagocytic dysfunction and some evidence of constitutive activation regarding oxidative burst and cytokine production.
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Affiliation(s)
- Sandro F Perazzio
- Division of Rheumatology, Federal University of São Paulo, São Paulo; and Fleury Group, Research and Development, São Paulo, Brazil
| | | | | | - Antônio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luis Eduardo C Andrade
- Division of Rheumatology, Federal University of São Paulo, São Paulo; and Fleury Group, Research and Development, São Paulo, Brazil.
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Souza AWSD, Rosa DP, Buosi ALP, Oliveira ACD, Natour J. Testicular vasculitis: a rare manifestation of rheumatoid arthritis. Rev Bras Reumatol 2013; 53:365-367. [PMID: 24217669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 05/14/2013] [Indexed: 06/02/2023] Open
Abstract
Testicular vasculitis is a very rare extra-articular manifestation of rheumatoid arthritis (RA). We describe the case of a 53-year-old man diagnosed with RA for eight years, who was poorly controlled and developed rheumatoid vasculitis, which manifested as leg ulcers and peripheral polyneuropathy. The patient also had acute neutrophilic meningitis and was treated with antibiotics and intravenous pulse therapy with methylprednisolone (500 mg daily) for three days, followed by oral cyclophosphamide (2 mg/kg daily) and prednisone. Overall improvement was observed, and the patient was discharged. But 15 days later, the meningitis recurred, and the patient was readmitted and treated again with antibiotics. Three days later, he developed pain and enlargement of his left testicle with gangrene. Unilateral orchiectomy was performed, revealing lymphocytic vasculitis. The patient died two days later due to aspiration pneumonia. This case illustrates a rare and severe manifestation of rheumatoid vasculitis.
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de Souza AWS, Pereira Rosa D, Pirozzi Buosi AL, Oliveira ACD, Natour J. Vasculite testicular – uma manifestação rara de artrite reumatoide. Revista Brasileira de Reumatologia 2013. [DOI: 10.1590/s0482-50042013000400009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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