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Pecher AC, Klein R, Koetter I, Wagner M, Vogel W, Wirths S, Lengerke C, Henes JC. Patients with systemic sclerosis and low CD4 numbers after autologous stem cell transplantation have a favorable outcome. Arthritis Res Ther 2024; 26:75. [PMID: 38509633 PMCID: PMC10953154 DOI: 10.1186/s13075-024-03300-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Treatment with high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (aHSCT) is an intensive treatment option for patients with severe forms of systemic sclerosis (SSc). Even though associated with a high treatment related mortality, the results in this high-risk population are generally favourable. The knowledge on the potential mechanism of action of this therapy and how it can improve patients with SSc is crucial to better select the right patients for aHSCT. METHODS This is a monocentric retrospective study from Tübingen, Germany, including 32 patients who underwent aHSCT. Peripheral blood samples were analysed for different lymphocyte subsets at various timepoints before and after aHSCT. Patients were divided into responders and non-responders according to the modified Rodnan skin score and lung function test in the three years following aHSCT. RESULTS Responders showed significantly lower levels of cluster of differentiation (CD)4 positive T cells in the first months after aHSCT (month 1 and 3), B cells (month 3 and 6 after aHSCT) and natural killer cells (month 1). Mantel-cox test showed a significant deviation of the probability curves, i.e. patients with lower CD4 + T cells and natural killer cells one month and B cells after 3 months after stem cell transplantation had a higher probability to belong to the responder group. CONCLUSIONS Taken together, this study supports the theory that a profound CD4 + T cell and B cell lymphopenia is important for patients with SSc to achieve a sustained response after aHSCT.
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Affiliation(s)
- Ann-Christin Pecher
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany.
| | - Reinhild Klein
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Ina Koetter
- Division of Rheumatology and Systemic Inflammatory Rheumatic Diseases, University Hospital Hamburg-Eppendorf and Clinic for Rheumatology and Immunology, Bad Bramstedt, Germany
| | - Marieke Wagner
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Wichard Vogel
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Stefan Wirths
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Claudia Lengerke
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Joerg Christoph Henes
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
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Pecher AC, Henes M, Henes JC. Optimal management of ANCA-associated vasculitis before and during pregnancy: current perspectives. Arch Gynecol Obstet 2023; 308:379-385. [PMID: 36104505 PMCID: PMC10293371 DOI: 10.1007/s00404-022-06744-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 11/02/2022]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are a group of systemic vasculitis characterized by autoantibodies against neutrophil cytoplasmic antigens (proteinase 3 PR3-ANCA and myeloperoxidase MPO-ANCA) and inflammation of small vessels. AAV include the diagnosis Granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA), which share many clinical and pathological features. Immunomodulatory therapies have significantly improved prognosis during the last decade. Nevertheless, especially in undiagnosed and thus uncontrolled AAV mortality due to renal impairment or pulmonary haemorrhages is still high. AAV are rare in fertile women, as the typical age of manifestation is above 50 years but there are women with AAV who are or want to become pregnant. This review focusses on how to manage patients with AAV planning to become pregnant and during their pregnancy.
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Affiliation(s)
- Ann-Christin Pecher
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases and Department of Internal Medicine II, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Melanie Henes
- Department of Obstetrics and Gynaecology, University Hospital Tuebingen, Tuebingen, Germany
| | - Joerg Christoph Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases and Department of Internal Medicine II, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany.
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Henes JC, Martac I, Vogel W, Lengerke C, Klein R, Hensen L, Pecher AC. COVID-19 infection after autologous stem cell transplantation for systemic sclerosis. Ann Rheum Dis 2023:ard-2023-223915. [PMID: 36889905 DOI: 10.1136/ard-2023-223915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Affiliation(s)
- Joerg Christoph Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Hematology, Oncology, Rheumatology and Clinical Immunology), University Hospital Tubingen, Tuebingen, Germany
| | - Ioana Martac
- Department of Internal Medicine II (Hematology, Oncology, Rheumatology and Clinical Immunology), University Hospital Tubingen, Tuebingen, Germany
| | - Wichard Vogel
- Department of Internal Medicine II (Hematology, Oncology, Rheumatology and Clinical Immunology), University Hospital Tubingen, Tuebingen, Germany
| | - Claudia Lengerke
- Department of Internal Medicine II (Hematology, Oncology, Rheumatology and Clinical Immunology), University Hospital Tubingen, Tuebingen, Germany
| | - Reinhild Klein
- Department of Internal Medicine II (Hematology, Oncology, Rheumatology and Clinical Immunology), University Hospital Tubingen, Tuebingen, Germany
| | - Luca Hensen
- Department of Internal Medicine II (Hematology, Oncology, Rheumatology and Clinical Immunology), University Hospital Tubingen, Tuebingen, Germany
| | - Ann-Christin Pecher
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Hematology, Oncology, Rheumatology and Clinical Immunology), University Hospital Tubingen, Tuebingen, Germany
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Pecher AC, Ach KR, Vogel W, Henes JC. Mobilization with reduced cyclophosphamide for autologous stem cell transplantation is feasible in patients with systemic sclerosis. Rheumatology (Oxford) 2023; 62:SI107-SI113. [PMID: 35951758 DOI: 10.1093/rheumatology/keac455] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To assess the feasibility of reduced cyclophosphamide dosing in the setting of mobilization chemotherapy prior to high dose chemotherapy and autologous stem cell transplantation in patients with SSc. The primary end point was the occurrence of 'poor mobilization' when using different cyclophosphamide dosing. The second end point was to analyse potential risk factors for difficult stem cell mobilization in this cohort of patients with SSc. METHODS This single-centre study retrospectively reviewed 32 patients with SSc who underwent autologous stem cell transplantation. We analysed the occurrence of 'poor mobilization' (defined as CD34+ progenitor cell count <2 × 106/kg body weight, the use of increasing G-CSF dose, the use of plerixafor, or leukapheresis on >2 consecutive days) in different cyclophosphamide mobilization regimens: We herein compared low dose (2 × 1-1.5 g/m2) cyclophosphamide vs high dose (2 × 2 g/m2) for mobilization. RESULTS Higher dosing of cyclophosphamide seems not to be beneficial regarding stem cell collection as there was no significant difference in stem cell yield between high dose and reduced dose cyclophosphamide (6.2 vs 5.2 × 106/kg bodyweight after CD34+ enrichment). Furthermore, higher doses of cyclophosphamide might be associated with more side effects; this difference was, however, not statistically significant. Lower bodyweight and BMI (P < 0.001) as well as rituximab pre-therapy (P < 0.05) and cardiac involvement (P < 0.01) might negatively impact stem cell collection independently from the chosen regimen. CONCLUSION Our data demonstrate that a reduced cyclophosphamide mobilization regimen seems to be feasible. Risk factors for poor mobilization might be low bodyweight, prior rituximab therapy and cardiac involvement.
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Affiliation(s)
- Ann-Christin Pecher
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases, University Hospital Tuebingen
| | | | - Wichard Vogel
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Tuebingen, Germany
| | - Joerg Christoph Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases, University Hospital Tuebingen
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Henes JC, Saur S. Diagnostik und Therapie der
Großgefäßvaskulitiden – Wo stehen wir
aktuell? AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1931-3989] [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: 11/06/2022]
Abstract
ZusammenfassungDie beiden Großgefäßvaskulitiden unterscheiden sich in
mehrfacher Hinsicht, vor allem aber durch das Alter der betroffenen Patienten
bei Erstmanifestation. Die Riesenzellarteriitis (RZA) ist eine Erkrankung des
älteren Patienten wohingegen die Takayasu Arteriitis per definitionem
vor dem 40 Lebensjahr auftritt. Die Diagnosen sind in den letzten Jahren durch
verbesserte Bildgebung und Therapieoptionen mehr ins Bewusstsein
gerückt. Neben der klassischen Steroidtherapie – welche bis
heute Mittel der ersten Wahl ist – steht uns mit Tocilizumab, einem
monoklonalen Antikörper gegen IL6-Rezeptor, zumindest für die
RZA, eine zusätzliche hocheffektive Therapie zur Verfügung.
Andere vielversprechende Substanzen befinden sich derzeit in Erprobung. Dieser
Artikel soll einen Überblick zu Diagnostik und Therapie, aber auch einen
Ausblick zu möglicherweise kommenden medikamentösen Optionen
bieten.
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Affiliation(s)
- Joerg Christoph Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and
Auto-inflammatory Diseases and Internal Medicine II, University Hospital
Tuebingen, Tuebingen, Germany
| | - Sebastian Saur
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and
Auto-inflammatory Diseases and Internal Medicine II, University Hospital
Tuebingen, Tuebingen, Germany
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Strunz PP, Froehlich M, Gernert M, Schwaneck EC, Fleischer A, Pecher AC, Tony HP, Henes JC, Schmalzing M. Immunological Adverse Events After Autologous Hematopoietic Stem Cell Transplantation in Systemic Sclerosis Patients. Front Immunol 2021; 12:723349. [PMID: 34539659 PMCID: PMC8447845 DOI: 10.3389/fimmu.2021.723349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/13/2021] [Indexed: 12/29/2022] Open
Abstract
Autologous hematopoietic stem cell transplantation (aHSCT) represents an effective treatment for systemic sclerosis (SSc), but it also can cause immunological adverse events (iAEs). Therefore, we aimed to determine the frequency of iAEs [engraftment syndrome (ES) and secondary autoimmune disorder (sAD)] and to identify potential risk factors for their development in a retrospective analysis on 22 patients similarly transplanted due to SSc. While nine patients (41%) suffered from ESs, seven sADs occurred in six patients (27%). Patients who developed ES were older in our cohort (52.45 vs. 42.58 years, p = .0433, Cohen’s d = 0.86), and cardiac involvement by SSc was associated with development of ES (OR = 40.11, p = .0017). Patients with manifestation of sAD had a higher modified Rodnan skin score (mRSS) reduction after aHSCT (90.50% vs. 60.00%, p = .0064, r = .65). Thus, IAEs are common after aHSCT for SSc and can occur in different stages during and after aHSCT with characteristic clinical manifestations. Good cutaneous response after aHSCT might be considered as a risk factor for sAD, and higher age at aHSCT and cardiac involvement might be considered as risk factors for the development of ES.
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Affiliation(s)
- Patrick-Pascal Strunz
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Matthias Froehlich
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Michael Gernert
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | | | - Anna Fleischer
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Ann-Christin Pecher
- Department of Internal Medicine II, University Hospital of Tuebingen, Tuebingen, Germany
| | - Hans-Peter Tony
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Joerg Christoph Henes
- Department of Internal Medicine II, University Hospital of Tuebingen, Tuebingen, Germany
| | - Marc Schmalzing
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
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Pecher AC, Kagan KO, Wagner M, Abele H, Pauluschke-Froehlich J, Tenev A, Henes M, Henes JC. Pregnancy outcome is favorable in patients with rheumatic diseases under specialized surveillance - Data from the Tuebingen registry for pregnancy in rheumatic diseases in 238 pregnancies. Joint Bone Spine 2020; 88:105073. [PMID: 33039274 DOI: 10.1016/j.jbspin.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ann-Christin Pecher
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany.
| | - Karl-Oliver Kagan
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
| | - Marieke Wagner
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany
| | - Harald Abele
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
| | - Jan Pauluschke-Froehlich
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
| | - Alina Tenev
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Melanie Henes
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
| | - Joerg Christoph Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany
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Kedor C, Listing J, Zernicke J, Weiß A, Behrens F, Blank N, Henes JC, Kekow J, Rubbert-Roth A, Schulze-Koops H, Seipelt E, Specker C, Feist E. Canakinumab for Treatment of Adult-Onset Still's Disease to Achieve Reduction of Arthritic Manifestation (CONSIDER): phase II, randomised, double-blind, placebo-controlled, multicentre, investigator-initiated trial. Ann Rheum Dis 2020; 79:1090-1097. [PMID: 32404342 PMCID: PMC7392486 DOI: 10.1136/annrheumdis-2020-217155] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inhibition of interleukin (IL)-1 represents a promising treatment option in adult-onset Still's disease (AOSD). OBJECTIVE To investigate the efficacy and safety of canakinumab in patients with AOSD and active joint involvement by means of a multicentre, double-blind, randomised, placebo-controlled trial. METHODS Patients with AOSD and active joint involvement (tender and swollen joint counts of ≥4 each) were treated with canakinumab (4 mg/kg, maximum 300 mg subcutaneous every 4 weeks) or placebo. The primary endpoint was the proportion of patients with a clinically relevant reduction in disease activity at week 12 as determined by the change in disease activity score (ΔDAS28>1.2). RESULTS At enrolment, patients had high active disease with a mean DAS28(ESR) of 5.4 in the canakinumab and 5.3 in the placebo group, respectively. In the intention-to-treat analysis, 12 patients (67%) in the canakinumab group and 7 patients (41%) in the placebo group fulfilled the primary outcome criterion (p=0.18). In the per-protocol analysis, significantly higher American College of Rheumatology (ACR) 30% (61% vs 20%, p=0.033), ACR 50% (50% vs 6.7%, p=0.009) and ACR 70% (28% vs 0%, p=0.049) response rates were observed in the canakinumab group compared with the placebo group. Two patients in the canakinumab group experienced a serious adverse event. CONCLUSION Although the study was terminated prematurely and the primary endpoint was not achieved, treatment with canakinumab led to an improvement of several outcome measures in AOSD. The overall safety findings were consistent with the known profile of canakinumab. Thus, our data support indication for IL-1 inhibition with canakinumab in AOSD.
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Affiliation(s)
- Claudia Kedor
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Listing
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Jan Zernicke
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Weiß
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Frank Behrens
- CIRI/Rheumatology and Fraunhofer TMP, Goethe-University, Frankfurt, Germany
| | - Norbert Blank
- Internal Medicine 5, University of Heidelberg, Heidelberg, Germany
| | - Joerg Christoph Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Oncology, Haematology, Immunology, Rheumatology, Pulmology), University Hospital Tuebingen, Tuebingen, Germany
| | - Joern Kekow
- Clinic of Rheumatology and Orthopaedics, Otto-von-Guericke University Magdeburg, Vogelsang-Gommern, Germany
| | - Andrea Rubbert-Roth
- Division of Rheumatology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Eva Seipelt
- Abteilung Rheumatologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Standort Berlin-Buch, Berlin, Germany
| | - Christof Specker
- Klinik für Rheumatologie und Klinische Immunologie, KEM Kliniken Essen-Mitte, Essen, Germany
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Xenitidis T, Henes JC. Behçet-Syndrom. Laryngorhinootologie 2020; 99:377-390. [DOI: 10.1055/a-1076-9742] [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: 10/24/2022]
Abstract
ZusammenfassungDas Behçet-Syndrom gehört zu den Vaskulitiden variabler Gefäßgröße. Das klinische Bild ist sehr vielfältig und erfordert in der Regel eine interdisziplinäre Zusammenarbeit. Pathogenetisch scheint es eine Mittelstellung zwischen einer polygenetischen Autoinflammationserkrankung und einer autoimmunen Erkrankung einzunehmen. 2018 wurden neue EULAR-Empfehlungen herausgegeben. Die Therapie richtet sich nach der führenden Beteiligung der einzelnen Organe. Seit 2016 ist Adalimumab zugelassen für die Behandlung der hinteren Augenbeteiligung. Infliximab, Interferon a2a, Interleukin-1-Antagonisten und Apremilast können Therapiealternativen darstellen.
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Affiliation(s)
- Theodoros Xenitidis
- Abteilung und Lehrstuhl II, Hämatologie/Onkologie/klinische Immunologie/Rheumatologie, Medizinische Universitätsklinik, Universitätsklinikum Tübingen
| | - Joerg Christoph Henes
- Abteilung und Lehrstuhl II, Hämatologie/Onkologie/klinische Immunologie/Rheumatologie, Medizinische Universitätsklinik, Universitätsklinikum Tübingen
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Pecher AC, Kettemann F, Asteriti E, Schmid H, Duerr-Stoerzer S, Keppeler H, Henes JC, Klein R, Hinterleitner C, Secker KA, Schneidawind C, Kanz L, Schneidawind D. Invariant natural killer T cells are functionally impaired in patients with systemic sclerosis. Arthritis Res Ther 2019; 21:212. [PMID: 31615552 PMCID: PMC6792213 DOI: 10.1186/s13075-019-1991-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 09/05/2019] [Indexed: 12/12/2022] Open
Abstract
Background Systemic sclerosis (SSc) is a potentially fatal autoimmune disease that leads to extensive fibrosis of the skin and internal organs. Invariant natural killer T (iNKT) cells are potent immunoregulatory T lymphocytes being able to orchestrate dysregulated immune responses. The purpose of this study was to evaluate numbers and function of iNKT cells in patients with SSc and to analyze their correlation with disease parameters. Methods Human iNKT cells from 88 patients with SSc and 33 healthy controls were analyzed by flow cytometry. Their proliferative capacity and cytokine production were investigated following activation with CD1d ligand α-galactosylceramide (α-GalCer). Results We observed an absolute and relative decrease of iNKT cells in patients with SSc compared with healthy controls. Interestingly, the subtype of SSc, disease severity, or treatment with immunosuppressive drugs did not affect iNKT cell numbers. However, T helper (Th) cell immune polarization was biased towards a Th17 immunophenotype in SSc patients. Moreover, iNKT cells from patients with SSc showed a significantly decreased expansion capacity upon stimulation with α-GalCer. Conclusion iNKT cells are deficient and functionally impaired in patients with SSc. Therefore, adoptive transfer strategies using culture-expanded iNKT cells could be a novel approach to treat SSc patients.
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Affiliation(s)
- Ann-Christin Pecher
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Felix Kettemann
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Elisa Asteriti
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Hannes Schmid
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Silke Duerr-Stoerzer
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Hildegard Keppeler
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Joerg Christoph Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Reinhild Klein
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Clemens Hinterleitner
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Kathy-Ann Secker
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Corina Schneidawind
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany.
| | - Lothar Kanz
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Dominik Schneidawind
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
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Abstract
Eosinophilia is defined as an elevated absolute number of eosinophilic leukocytes in peripheral blood or tissue. Its absolute number also defines the grade of eosinophilia. The main causes are allergic (including drug side effects) and infectious triggers but malignant and autoimmune diseases can also result in eosinophilia. Severe eosinophilia with the number of eosinophils >5000/µl are mostly caused by myeloproliferative disorders, eosinophilic granulomatosis with polyangiitis or during tissue migration in parasitic tissue infections. Hypereosinophilic syndrome is defined as eosinophilia with >1500 eosinophils/µl and a duration of more than 6 months by exclusion of parasitic infections, allergies or other causes of tissue eosinophilia with end-organ damage. For the diagnosis of a persistent eosinophilia a detailed medical history and physical examination should be followed by early organ screening, infection diagnostics especially for helminth infections and hematological laboratory analyses including bone marrow investigations.
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Affiliation(s)
- J C Henes
- Zentrum für Interdisziplinäre Klinische Immunologie, Rheumatologie und Autoimmunerkrankungen (INDIRA), Universitätsklinikum, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland. .,Medizinische Klinik II (Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmologie), Universitätsklinikum Tübingen, Tübingen, Deutschland.
| | - S Wirths
- Medizinische Klinik II (Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmologie), Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - B Hellmich
- Vaskulitiszentrum-Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken, Akademisches Lehrkrankenhaus, Universität Tübingen, Kirchheim u. Teck, Deutschland
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Valentini G, Huscher D, Riccardi A, Fasano S, Irace R, Messiniti V, Matucci-Cerinic M, Guiducci S, Distler O, Maurer B, Avouac J, Tarner IH, Frerix M, Riemekasten G, Siegert E, Czirják L, Lóránd V, Denton CP, Nihtyanova S, Walker UA, Jaeger VK, Del Galdo F, Abignano G, Ananieva LP, Gherghe AM, Mihai C, Henes JC, Schmeiser T, Vacca A, Moiseev S, Foeldvari I, Gabrielli A, Krummel-Lorenz B, Rednic S, Allanore Y, Müeller-Ladner U. Vasodilators and low-dose acetylsalicylic acid are associated with a lower incidence of distinct primary myocardial disease manifestations in systemic sclerosis: results of the DeSScipher inception cohort study. Ann Rheum Dis 2019; 78:1576-1582. [PMID: 31391176 DOI: 10.1136/annrheumdis-2019-215486] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/12/2019] [Accepted: 07/31/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the influence of vasodilator drugs on the occurrence of features depending on myocardial ischaemia/fibrosis (ventricular arrhythmias, Q waves, cardiac blocks, pacemaker implantation, left ventricular ejection fraction (LVEF) <55%, and/or congestive heart failure and sudden cardiac death) in systemic sclerosis (SSc). METHODS 601 patients with SSc were enrolled from 1 December 2012 to 30 November 2015 and had a second visit 0.5-4 years apart. 153 received no vasodilators; 448 received vasodilator therapy (ie, calcium channel blockers and/or ACE inhibitors or angiotensin II receptor blockers or combinations of them), 89 of them being also treated with either endothelin receptor antagonists or PDE5 inhibitors or prostanoids. Associations between the occurrence of myocardial disease manifestations and any demographic, disease and therapeutic aspect were investigated by Cox regression analysis. A Cox frailty survival model with centre of enrolment as random effect was performed. RESULTS During 914 follow-up patient-years, 12 ventricular arrhythmias, 5 Q waves, 40 cardiac blocks, 6 pacemaker implantations and 19 reduced LVEF and/or congestive heart failure (CHF) occurred. In multivariate Cox regression analysis, vasodilator therapy was associated with a lower incidence of ventricular arrhythmias (p=0.03); low-dose acetylsalicylic acid (ASA) with a lower incidence of cardiac blocks and/or Q waves and/or pacemaker implantation (p=0.02); active disease with a higher incidence of LVEF <55% and/or CHF and cardiac blocks and/or Q waves and/or pacemaker implantation (p=0.05). CONCLUSIONS The present study might suggest a preventative effect on the occurrence of distinct myocardial manifestations by vasodilator therapy and low-dose ASA.
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Affiliation(s)
- Gabriele Valentini
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Dörte Huscher
- Institute of Biostatistics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Antonella Riccardi
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Serena Fasano
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Rosaria Irace
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Valentina Messiniti
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Jérôme Avouac
- Department of Rheumatology, Cochin Hospital, University of Paris Descartes, Paris, France
| | - Ingo H Tarner
- Department of Rheumatology and Clinical Immunology, Justus Liebig Universitat Giessen, Bad Nauheim, Germany
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Justus Liebig Universitat Giessen, Bad Nauheim, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology, Universitatsklinikum Schleswig Holstein-Campus Lubeck, Lübeck, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité - Universitäetsmedizin Berlin, Berlin, Germany
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Veronika Lóránd
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Christopher P Denton
- Department of Rheumatology, University College London, Royal Free Hospital, London, United Kingdom
| | - Svetlana Nihtyanova
- Department of Rheumatology, University College London, Royal Free Hospital, London, United Kingdom
| | - Ulrich A Walker
- Department of Rheumatology, University of Basel, Basel, Switzerland
| | | | - Francesco Del Galdo
- Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom
| | - Giuseppina Abignano
- Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom.,Rheumatology Institute of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Lidia P Ananieva
- Institute of Rheumatology, Russian Academy of Medical Science, Moscow, Russian Federation
| | - Ana Maria Gherghe
- Internal Medicine and Rheumatology Department, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Carina Mihai
- Internal Medicine and Rheumatology Department, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Joerg Christoph Henes
- Department of Internal Medicine II, University Hospitals Tübingen, Tübingen, Germany
| | - Tim Schmeiser
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | | | - Sergey Moiseev
- Sechenov First Moscow State Medical University and Lomonosov Moscow State University, Moscow, Russia
| | - Ivan Foeldvari
- Klinikum Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
| | - Armando Gabrielli
- Clinical Medicine, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | - Simona Rednic
- Department of Rheumatology, University of Medicine and Pharmacy 'luliu Hatieganu' Cluj, Cluj-Napoca, Romania
| | - Yannick Allanore
- Department of Rheumatology, Cochin Hospital, University of Paris Descartes, Paris, France
| | - Ulf Müeller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus Liebig Universitat Giessen, Bad Nauheim, Germany
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Henes JC. [Autologous stem cell transplantation with a myeloablative regimen for treatment of severe systemic sclerosis]. Z Rheumatol 2018; 77:343-344. [PMID: 29654391 DOI: 10.1007/s00393-018-0448-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J C Henes
- Zentrum für Interdisziplinäre Rheumatologie, klinische Immunologie und Autoimmunerkrankungen (INDIRA) und Innere Medizin II (Onkologie, Hämatologie, Rheumatologie, Immunologie und Pulmologie), Universitätsklinik Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
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Henes M, Rall K, Igney-Oertel A, Taran FA, Brucker S, Henes JC. Anti-Müllerian hormone levels are not reduced in patients with adult autoinflammatory diseases compared to healthy controls. Scand J Rheumatol 2016; 46:165-166. [PMID: 27636858 DOI: 10.1080/03009742.2016.1218930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M Henes
- a Department for Women's Health , University Hospital Tübingen , Tübingen , Germany
| | - K Rall
- a Department for Women's Health , University Hospital Tübingen , Tübingen , Germany
| | - A Igney-Oertel
- b Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases (INDIRA) and Department of Internal Medicine II , University Hospital Tübingen , Tübingen , Germany
| | - F-A Taran
- a Department for Women's Health , University Hospital Tübingen , Tübingen , Germany
| | - S Brucker
- a Department for Women's Health , University Hospital Tübingen , Tübingen , Germany
| | - J C Henes
- b Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases (INDIRA) and Department of Internal Medicine II , University Hospital Tübingen , Tübingen , Germany
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Henes JC, Kötter I. [Importance of stem cell therapy in autoimmune diseases]. Z Rheumatol 2016; 75:760-761. [PMID: 27596145 DOI: 10.1007/s00393-016-0192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J C Henes
- Zentrum für Interdisziplinäre Rheumatologie, klinische Immunologie und Autoimmunerkrankungen (INDIRA) und Innere Medizin II (Onkologie, Hämatologie, Rheumatologie, Immunologie und Pulmologie), Universitätsklinik Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - I Kötter
- 4. Medizinische Abteilung, Rheumatologie, Klinische Immunologie, Nephrologie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland.
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Abstract
According to experimental animal models and experiences of patients with coexisting autoimmune diseases, allogeneic stem cell transplantation has the potential to reestablish and maintain immunological tolerance. On the other hand, it is associated with significant treatment related mortality and may induce diverse immunological diseases by graft-versus-host reaction. Other than with severe aplastic anemia, it is not an established therapy for autoimmune diseases; it is under investigation in clinical trials and might be considered in severe, refractory immune cytopenia.
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Affiliation(s)
- S Wirths
- Abteilung für Onkologie, Hämatologie, klinische Immunologie, Rheumatologie, Pulmologie, Medizinische Klinik der Universität Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
| | - W Bethge
- Abteilung für Onkologie, Hämatologie, klinische Immunologie, Rheumatologie, Pulmologie, Medizinische Klinik der Universität Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - J C Henes
- Abteilung für Onkologie, Hämatologie, klinische Immunologie, Rheumatologie, Pulmologie, Medizinische Klinik der Universität Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
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Henes JC, Xenitidis T, Horger M. Tocilizumab for refractory relapsing polychondritis-long-term response monitoring by magnetic resonance imaging. Joint Bone Spine 2015; 83:365-6. [PMID: 26750763 DOI: 10.1016/j.jbspin.2015.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/26/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Joerg Christoph Henes
- University Hospital Tuebingen, Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases, Department of Internal Medicine II (Oncology, Hematology, Immunology, Rheumatology, Pulmology), Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany.
| | - Theodoros Xenitidis
- University Hospital Tuebingen, Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases, Department of Internal Medicine II (Oncology, Hematology, Immunology, Rheumatology, Pulmology), Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany
| | - Marius Horger
- Department of diagnostic and interventional radiology, Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany
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Kötter I, Henes JC. [Established medications : new areas of application]. Z Rheumatol 2013; 72:853-66. [PMID: 24193188 DOI: 10.1007/s00393-013-1137-6] [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: 11/25/2022]
Abstract
During the last 10 years several new medications from hemato-oncology and transplantation medicine have been transferred to rheumatology. Additionally, medications which are approved for rheumatoid arthritis were increasingly also studied and used for other systemic inflammatory rheumatic diseases. This is especially the case for rituximab and mycophenolate and to a lesser extent also for leflunomide, tumor necrosis factor (TNF) antagonists, tocilizumab and abatacept. Recently, rituximab was approved for severe granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) after the publication of two prospective randomized trials in 2010. The situation concerning rituximab is much more problematic for systemic lupus erythematosus (SLE) where randomized placebo-controlled trials exist but unfortunately did not meet the primary endpoint requirements (too many highly effective additional forms of treatment in both arms and unsuitable endpoints), although data from registries suggest efficacy especially in cases resistant to treatment. In the case of mycophenolate (MPS) the problem with SLE is totally different. All prospective trials met the endpoints and in one trial MPS was even superior to azathioprine for treatment of lupus nephritis (LN) which led to the recommendation of MPS for induction and maintenance in LN by EULAR and EDTRA as well as more recently by the ACR. However, MPS still is not approved for SLE or LN. The present manuscript gives an overview of existing data for selected connective tissue diseases and vasculitides (for which at least larger retrospective case series or registry data exist) being treated with medications approved for other indications.
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Affiliation(s)
- I Kötter
- Rheumatologische Schwerpunktpraxis und Rheumatologie, Robert-Bosch-Krankenhaus, Abt. Allgemeine Innere Medizin und Nephrologie, Auerbachstr. 110, 70376, Stuttgart, Deutschland,
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Henes JC, Xenitidis T. [Tocilizumab for treatment of large vessel vasculitis and polymyalgia rheumatica]. Z Rheumatol 2013; 72:486-7. [PMID: 23615930 DOI: 10.1007/s00393-013-1177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J C Henes
- Innere Medizin II - Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmologie, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
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Xenitidis T, Horger M, Zeh G, Kanz L, Henes JC. Sustained inflammation of the aortic wall despite tocilizumab treatment in two cases of Takayasu arteritis. Rheumatology (Oxford) 2013; 52:1729-31. [PMID: 23463808 DOI: 10.1093/rheumatology/ket107] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Henes M, Henes JC, Neunhoeffer E, Von Wolff M, Schmalzing M, Kötter I, Lawrenz B. Fertility preservation methods in young women with systemic lupus erythematosus prior to cytotoxic therapy: experiences from the FertiPROTEKT network. Lupus 2012; 21:953-8. [PMID: 22438026 DOI: 10.1177/0961203312442753] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Despite new treatment options, some patients with systemic lupus erythematosus (SLE) need to be treated with the cytotoxic agent cyclophosphamide (CYC). Unlike malignant disease, there are no recommendations for ovarian protection in SLE. The clinical experience of the FertiPROTEKT network as well as recommendations after literature review will be presented in this paper. METHODS Retrospective analyses of counselling and treatment data from the FertiPROTEKT register with special respect to SLE patients under 40 years prior to planned CYC treatment. RESULTS A total of 2836 patients were advised prior to cytotoxic treatment in one of the FertiPROTEKT centres during January 2007 to November 2011. Of those, 68 patients (mean age 25 +/- 6.07 years) were counselled for severe SLE. Only five women did not make use of a fertility preservation method. Sixty-three patients (92.6%) decided in favour of a fertility preservation method. The largest proportion (91.2%) opted for treatment with a GnRH analogue. Ovarian tissue removal for cryoconservation was performed in 16 patients (25%). Stimulation therapy for cryoconservation of fertilized egg cells was performed in three patients (4.4%). CONCLUSIONS When counselling patients with SLE for fertility preservation one has to be aware of the disease-specific risks. According to the literature, a safe and effective option in SLE up to now has been the use of a GnRH analogue. Cryoconservation of ovarian tissue must still be seen as an experimental treatment, but as data on removal, cryoconservation, retransplantation and pregnancies are steadily rising, this presents a promising option for young SLE patients. Cryoconservation of oocytes must be very critically evaluated due to the need for a stimulation therapy and should only be performed after particular consideration of the individual risks.
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Affiliation(s)
- M Henes
- University Hospital for Women, University of Tuebingen Hospitals, Germany
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Baerlecken NT, Linnemann A, Gross WL, Moosig F, Vazquez-Rodriguez TR, Gonzalez-Gay MA, Martin J, Kötter I, Henes JC, Melchers I, Vaith P, Schmidt RE, Witte T. Association of ferritin autoantibodies with giant cell arteritis/polymyalgia rheumatica. Ann Rheum Dis 2012; 71:943-7. [PMID: 22228484 DOI: 10.1136/annrheumdis-2011-200413] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are relatively common inflammatory disorders. Establishing the diagnosis however may be difficult, since so far no specific biomarkers of the disorders are available. METHODS As a screening procedure, the authors used protein arrays for the detection of new autoantigens in GCA and PMR. The results of the protein array were confirmed by different ELISAs detecting IgG antibodies against the human ferritin heavy chain, N-terminal 27 amino acids of the human ferritin heavy chain or the homologous peptide of Staphylococcus epidermidis. Sera of patients with only GCA (n=64), only PMR (n=47) and both PMR and GCA (n=31) were used. RESULTS In the ELISA using the human ferritin peptide, the sensitivity of IgG antibodies against ferritin was 92% in 36 GCA and/or PMR patients before initiation of treatment, 22/32 (69%) in patients with disease flares and 64/117 (55%) in the total cohort including treated and inactive patients. In controls, the false positive rate was 11/38 (29%) in systemic lupus erythematosus, 1/36 (3%) in rheumatoid arthritis, 0/31 (0%) in late onset rheumatoid arthritis, 3/46 (6.5%) in B-non-Hodgkin's lymphoma and 1/100 (1%) in blood donors. In the ELISA using the ferritin peptide of S epidermidis, 89% of 27 patients with untreated GCA and PMR were positive. CONCLUSION Antibodies against the ferritin peptide were present in up to 92% of untreated, active GCA and PMR patients. They can be useful as a diagnostic marker of PMR and GCA.
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Affiliation(s)
- N T Baerlecken
- Department of Immunology and Rheumatology, Medical University, Hannover, Germany.
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Henes M, Henes JC, Schmalzing M, Neunhoeffer E, Kötter I, Lawrenz B. Fertilitätserhaltende Maßnahmen bei prämenopausalen Frauen mit Autoimmunerkrankung vor einer zytotoxischen Therapie – Implementierung in die klinische Routine. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Lawrenz B, Henes JC, Henes M, Neunhoeffer E, Schmalzing M, Fehm T, Kötter I. Einfluss des Systemischen Lupus erythematodes auf die ovarielle Reserve bei prämenopausalen Frauen – Evaluation mittels Anti-Müller-Hormon. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Lawrenz B, Henes JC, Henes M, Neunhoeffer E, Schmalzing M, Fehm T, Kïtter I. Impact of systemic lupus erythematosus on ovarian reserve in premenopausal women: Evaluation by using anti-Muellerian hormone. Lupus 2011; 20:1193-7. [DOI: 10.1177/0961203311409272] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease which may negatively influence fertility. Treatment with cyclophosphamide can damage the ovaries. The ovarian function can also be reduced by autoimmune oophoritis in lupus patients. We analysed the influence of SLE on the ovarian reserve against disease intensity and duration of illness. We determined the ovarian reserve in 33 premenopausal SLE patients without previous cyclophosphamide-treatment by measuring the anti-Muellerian hormone (AMH) and compared these with the AMH values of 33 age-matched healthy controls. Numbers of children and miscarriages were reported. Disease intensity of the SLE patients was determined using SLEDAI and ECLAM and duration of illness was taken into account. We found that the AMH values in the SLE group were significantly lower than in the healthy control group. No significant differences between the groups regarding number of children and miscarriages were noted and no correlation between the AMH value and the duration of illness or the SLEDAI as an indicator of disease activity was found. Despite mild disease activity SLE patients had a significantly lower ovarian reserve than age-matched healthy women. This could be a sign that SLE itself has a negative influence on the ovarian reserve.
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Affiliation(s)
- B Lawrenz
- University Hospital for Women, Tuebingen University Hospitals, Tuebingen, Germany
| | - JC Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Internal Medicine II (Oncology, Haematology, Immunology, Rheumatology, Pulmology), Tuebingen University Hospitals, Tuebingen, Germany
| | - M Henes
- University Hospital for Women, Tuebingen University Hospitals, Tuebingen, Germany
| | - E Neunhoeffer
- University Hospital for Women, Tuebingen University Hospitals, Tuebingen, Germany
| | - M Schmalzing
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Internal Medicine II (Oncology, Haematology, Immunology, Rheumatology, Pulmology), Tuebingen University Hospitals, Tuebingen, Germany
| | - T Fehm
- University Hospital for Women, Tuebingen University Hospitals, Tuebingen, Germany
| | - I Kïtter
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Internal Medicine II (Oncology, Haematology, Immunology, Rheumatology, Pulmology), Tuebingen University Hospitals, Tuebingen, Germany
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Henes JC, Kanz L, Koetter I. Rituximab and leflunomide for Wegener’s granulomatosis: a long-term follow-up. Rheumatol Int 2010; 31:425-6. [PMID: 20349065 DOI: 10.1007/s00296-010-1462-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 03/12/2010] [Indexed: 11/29/2022]
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Schraml C, Schwenzer NF, Kötter I, Henes JC, Schick F, Claussen C, Horger M. Bedeutung der MRT-Kontrastmitteldynamik in der Differenzialdiagnose von Psoriasis-Arthritis und erosiver Osteoarthrose der Hand. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1253053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schwenzer NF, Schraml C, Kötter I, Henes JC, Schick F, Claussen C, Horger M. Bedeutung der Diffusionstensorbildgebung in der Diagnostik Sklerodermie-assoziierter Myopathien – erste Ergebnisse. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1253054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schwenzer NF, Kötter I, Henes JC, Schraml C, Fritz J, Claussen CD, Schick F, Horger M. Bedeutung der MRT-Kontrastmitteldynamik in der Differenzialdiagnose von rheumatoider und Psoriasis-Arthritis. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Boss A, Martirosian P, Fritz J, Kötter I, Henes JC, Claussen CD, Schick F, Horger M. Kontrastmittelfreie MR-Perfusionsbildgebung rheumatoider Arthritis der Handgelenke bei 3 Tesla. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Henes JC, Heinzelmann F, Wacker A, Seelig HP, Klein R, Bornemann A, Faul C, Kanz L, Koetter I. Antisignal recognition particle-positive polymyositis successfully treated with myeloablative autologous stem cell transplantation. Ann Rheum Dis 2009; 68:447-8. [DOI: 10.1136/ard.2008.094755] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Henes JC, Müller M, Krieger J, Balletshofer B, Pfannenberg AC, Kanz L, Kötter I. [18F] FDG-PET/CT as a new and sensitive imaging method for the diagnosis of large vessel vasculitis. Clin Exp Rheumatol 2008; 26:S47-S52. [PMID: 18799053] [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] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine the value of the new imaging modality positron-emission tomography/computed tomography (PET/CT) for the diagnosis and re-evaluation of large vessel vasculitis. METHODS Thirteen patients newly diagnosed or re-evaluated for suspected clinical disease activity of Takayasu arteritis (TA, 3 patients) or giant cell arteritis (GCA, 10 patients) underwent PET/CT. Clinical activity status, serological markers, and alternative imaging methods were evaluated. RESULTS In patients with clinical activity despite nearly normal erythrocyte sedimentation rate (ESR) and C reactive protein (CRP), disease activity could be shown by PET-CT. A long segmental, increased fluoro-deoxyglucose (FDG) uptake in the vessel wall served as confirmation of the vascular inflammation. The aortic arch was involved in all patients with active disease (n=12). In the complementary CT scans, stenotic lesions were found in 8 out of 13 patients. Duplex ultrasonography was performed in 11/13 patients and was positive in nine of these patients at least at one site. Magnetic resonance imaging (MRI) was done for confirmation in 10 patients. CONCLUSION Doppler ultrasonography is a very useful and widely available method to confirm a first suspicion of vasculitis, but it has limitations especially at the large thoracic vessels, which are affected in many cases. ESR and CRP alone are not sufficient to evaluate disease activity. The new imaging modality PET/CT provides the additional information. It allows the evaluation of disease activity and vessel morphology as well as the localization of the inflammatory process in the same session.
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Affiliation(s)
- J C Henes
- Department of Internal Medicine II (Haematology, Oncology, Immunology, Rheumatology, Pulmology), University Hospital Tübingen, Germany
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Horger M, Boss A, Vogel MN, Kötter I, Henes JC, Fritz J, Brodöfel H, Claussen CD. Rheumatoide Arthritis (RA): multimodale Diagnostik in der 3T-Ära. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1074057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fritz J, Henes JC, Thomas C, Clasen S, Claussen CD, Lewin JS, Pereira PL. Kombinierte diagnostische und interventionelle Hochfeld-MRT der Sakroiliakalgelenke bei Patienten mit tiefem Rückenschmerz. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Henes JC, Richter C, Kanz L, Koetter I. B-cell depletion in patients with rheumatoid arthritis refractant to multiple TNF blockers and the interleukin 1 receptor-antagonist anakinra. Rheumatol Int 2007; 28:33-7. [PMID: 17562043 DOI: 10.1007/s00296-007-0376-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Accepted: 05/19/2007] [Indexed: 10/23/2022]
Abstract
To evaluate the efficacy of Rituximab in a negatively selected patient cohort, with inadequate response to different disease modifying drugs (DMARDs) and to at least two biologicals. Fifteen patients with severe rheumatoid arthritis with inefficacy of an average of 5 DMARDS and 2.5 TNF antagonists were treated with Rituximab. Eight patients were ineffectively pretreated with Anakinra as well. The disease activity score (DAS28) and the morning stiffness served for assessment of the clinical response. For maintenance treatment different conventional DMARDs were used (4xMTX, 4xLeflunomide, 1xmycophenolate, 1xsirolimus, 1xhydroxychloroquine). At baseline visit the mean DAS 28 was 5.9. The mean duration of morning stiffness was 99.6 min. At month 6 the mean DAS28 was 3.95. Forty percent (6 patients) showed a good and 33% (5 patients) a moderate response. Morning stiffness improved to 43 min. In this negatively selected group of patients Rituximab was safe and effective.
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Affiliation(s)
- J C Henes
- Department of Internal Medicine II (Rheumatology, Immunology, Hematology, Oncology, Pulmology), University Hospital, Otfried-Mueller-Str. 10, 72076 Tuebingen, Germany
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Henes JC, Fritz J, Koch S, Klein R, Horger M, Risler T, Kanz L, Koetter I. Rituximab for treatment-resistant extensive Wegener`s granulomatosis—additive effects of a maintenance treatment with leflunomide. Clin Rheumatol 2007; 26:1711-5. [PMID: 17502992 DOI: 10.1007/s10067-007-0643-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 04/23/2007] [Accepted: 04/23/2007] [Indexed: 11/26/2022]
Abstract
Extensive Wegener's granulomatosis (WG) is treated by glucocorticosteroids (GC) and cyclophosphamide (CYC). In some cases, the disease is refractory to CYC. For those patients the depletion of B-lymphocytes with rituximab is a promising new treatment modality. This is a retrospective study of six patients receiving rituximab (RTX) with 4 x 375 mg/m(2) body surface weekly because of inefficacy of CYC. Proteinase-3-antineutrophil cytoplasmic antibodies (PR3-ANCA) and c-ANCAs were assessed. For clinical follow-up the Birmingham Vasculitis Activity Score for WG (BVAS/WG) was used. In five of the six cases, leflunomide (LEF) was given as maintenance treatment. Mean follow up was 16 months (12-21 months). The median PR3-ANCA titer fell from 36.8 U/ml at baseline to 21.4 U/ml after 3 months, 8.3 after 6 months, and 4.3 at month 12. The median BVAS/WG at baseline was 5 and 0 after 1 month. Two minor relapses could be noticed at month 3. After 6 months, one patient still had a BVAS of 1, all the others had a BVAS of 0. At month 18, a major relapse occurred in one patient, which was successfully retreated with RTX. The RTX infusions were well tolerated. Rituximab is a well-tolerated, very effective medication for patients with Wegener's granulomatosis. Leflunomide maintenance may increase the efficacy of rituximab and prolong the disease-free period.
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Affiliation(s)
- J C Henes
- Department of Internal Medicine II ,University Hospital, Otfried-Mueller-Str. 10, 72076, Tuebingen, Germany
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Müller M, Henes JC, Heners H, Kötter I, Claussen CD, Pfannenberg C, Bares R, Reimold M. F-18-FDG-PET/CT zur Vasculitisdiagnostik: Ist das kontrastangehobene CT zur PET-Schwächungskorrektur geeignet? ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Müller M, Henes JC, Heners H, Kötter I, Claussen CD, Pfannenberg C, Bares R, Reimold M. Vasculitisnachweis mit der F-18 FDG-PET/CT: Quantifizierung der Gefäßwandaktivität bei Vasculitispatienten und einem Kontrollkollektiv. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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