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Goitein Inbar T, Lidar M, Eshed I. The value of a repeat MRI examination of the sacroiliac joints following an inconclusive initial examination. Skeletal Radiol 2024; 53:1183-1190. [PMID: 38196026 DOI: 10.1007/s00256-024-04561-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Assess the diagnostic utility of repeat sacroiliac joint (SIJ) magnetic resonance imaging (MRI) examinations following an inconclusive initial examination performed for suspected sacroiliitis. METHOD Subjects with > 1 SIJ MRI examinations, an inconclusive first scan and at least 6 months interval between scans, were included. All scans were evaluated for the presence of structural/active SIJ lesions as well as any other pathology. Clinical data was extracted from the patients' clinical files, and any missing data was obtained by a telephone interview. Diagnosis and active/structural scores were compared between first and follow-up examinations (t test). RESULTS Seventy-one subjects were included in the study, 77.4% females, mean age 41.0 ± 15 years, mean time interval between exams 30.4 ± 25.24 months. Twelve subjects performed > 2 scans. In only two subjects (2.81%), both females, MRI diagnosis changed from inconclusive to definite sacroiliitis. None of the subjects with > 2 scans had evidence of sacroiliitis in any of the following MRI examinations. Significant differences were observed between the scores of active SIJ lesion of the first and follow-up MRI (1.51/1.62, p = 0.02) but not for scores of structural lesions (1.22/1.68, p = 0.2). CONCLUSIONS Repeat SIJ MRI when the first MRI is inconclusive for sacroiliitis is more valuable in ruling out than in securing diagnosis of sacroiliitis. We suggest that when MRI findings are inconclusive, decision-making should be based on clinical data.
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Affiliation(s)
- Tamar Goitein Inbar
- The Goldman School of Medicine, Ben Gurion University of the Negev Affiliated With the Soroka Medical Center, Beersheba, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center Affiliated with the School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center affiliated with the, School of Medicine, Tel Aviv University, Tel Hashomer, 5265601, Tel Aviv, Israel.
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Savin E, Ben-Shabat N, Levartovsky A, Lahat A, Omar M, Gendelman O, Lidar M, Watad A, Ben-Horin S, Kopylov U, Sharif K. Biologic Treatment Modification Efficacy in Concurrent Inflammatory Bowel Disease and Ankylosing Spondylitis: A Retrospective Cohort Study at a Single Tertiary Center. J Clin Med 2023; 12:7151. [PMID: 38002764 PMCID: PMC10672021 DOI: 10.3390/jcm12227151] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The link between ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) is well-established, with concurrent prevalence estimates ranging from 5-10%. However, there are still significant gaps in our understanding, and a comprehensive treatment guideline for these co-diagnosed patients has yet to be established. Our objective was to explore patterns of treatment alterations following the diagnosis of AS in patients previously diagnosed with IBD, and vice versa. Additionally, we sought to determine how these modifications influence clinical outcomes in both conditions. METHODS This retrospective data-based cohort study included patients with coexisting IBD and AS that were diagnosed between the years 2009-2022 and were followed by the gastroenterology and the rheumatology units of the Sheba Medical Center, Israel. The data were extracted from the electronic health record and included demographic information, medication history, treatment modification at the time of second diagnosis, and the characteristics and activity of both IBD and AS at the index time and at the 3-month mark. RESULTS The study included a total of 68 patients, with a male predominance (40 patients, 59%). The median age was 43 years (IQR 31-55) and 78% had Crohn's disease (CD). The median duration between the diagnosis of the first disease to the second one was 4 years (IQR 1-9.5). A significant proportion of patients (85%) underwent treatment modification at their second diagnosis. Out of the total cohort, 28% initiated biological therapy, 17.6% switched their biologic regimen, and 16.2% discontinued NSAIDS. Patients who underwent biologic modifications at time of the second diagnosis (the initiation/switch/augmentation of a concurrent regimen) experienced significantly higher rates of clinical improvement in either IBD or AS at the 90-day follow-up compared to patients who did not (68% vs. 32%, p = 0.004), and biologic modification was found to be an independent predictor for clinical improvement (OR 3.69, CI 1.08-12.58, p = 0.037). CONCLUSIONS Our findings suggest that biologic therapy modification at the time of the second diagnosis was associated with a higher rate of improvement in AS/IBD at the 90-day follow-up.
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Affiliation(s)
- Einat Savin
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
| | - Niv Ben-Shabat
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
| | - Asaf Levartovsky
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Adi Lahat
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Mahmud Omar
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
| | - Omer Gendelman
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Merav Lidar
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Abdulla Watad
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Shomron Ben-Horin
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Uri Kopylov
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Kassem Sharif
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
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Kharouf F, Eviatar T, Braun M, Pokroy-Shapira E, Brodavka M, Zloof Y, Agmon-Levin N, Toledano K, Oren S, Lidar M, Zisman D, Tavor Y, Amit-Vazina M, Sabbah F, Breuer GS, Dagan A, Beshara-Garzuzi R, Markovits D, Elias M, Feld J, Tayer-Shifman O, Gazitt T, Reitblatt T, Rubin L, Haddad A, Giryes S, Paran D, Peleg H, Molad Y, Elkayam O, Mevorach D, Balbir-Gurman A, Braun-Moscovici Y. A deep look into the storm: Israeli multi-center experience of coronavirus disease 2019 (COVID-19) in patients with autoimmune inflammatory rheumatic diseases before and after vaccinations. Front Immunol 2023; 14:1064839. [PMID: 36993961 PMCID: PMC10040776 DOI: 10.3389/fimmu.2023.1064839] [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] [Received: 10/08/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveWe aimed to characterize the course of COVID-19 in autoimmune inflammatory rheumatic disease (AIIRD) patients in Israel, taking into consideration several remarkable aspects, including the outcomes of the different outbreaks, the effect of vaccination campaigns, and AIIRD activity post-recovery.MethodsWe established a national registry of AIIRD patients diagnosed with COVID-19, including demographic data, AIIRD diagnosis, duration and systemic involvement, comorbidities, date of COVID-19 diagnosis, clinical course, and dates of vaccinations. COVID-19 was diagnosed by a positive SARS-CoV-2 polymerase chain reaction.ResultsIsrael experienced 4 outbreaks of COVID-19 until 30.11.2021. The first three outbreaks (1.3.2020 – 30.4.2021) comprised 298 AIIRD patients. 64.9% had a mild disease and 24.2% had a severe course; 161 (53.3%) patients were hospitalized, 27 (8.9%) died. The 4th outbreak (delta variant), starting 6 months after the beginning of the vaccination campaign comprised 110 patients. Despite similar demographic and clinical characteristics, a smaller proportion of AIIRD patients had negative outcomes as compared to the first 3 outbreaks, with regards to severity (16 patients,14.5%), hospitalization (29 patients, 26.4%) and death (7 patients, 6.4%). COVID-19 did not seem to influence the AIIRD activity 1-3 months post-recovery.ConclusionsCOVID-19 is more severe and has an increased mortality in active AIIRD patients with systemic involvement, older age and comorbidities. Vaccination with 3 doses of the mRNA vaccine against SARS-CoV-2 protected from severe COVID-19, hospitalization and death during the 4th outbreak. The pattern of spread of COVID-19 in AIIRD patients was similar to the general population.
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Affiliation(s)
- Fadi Kharouf
- The Department of Medicine, Rheumatology Unit and Rare Disease Research Center, Hadassah Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tali Eviatar
- Rheumatology Department, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Braun
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elisheva Pokroy-Shapira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Rheumatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Michal Brodavka
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Yair Zloof
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nancy Agmon-Levin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Immunology, Angioedema and Allergy Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Kochava Toledano
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Shirly Oren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Rheumatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Devy Zisman
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Yonit Tavor
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Mirit Amit-Vazina
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Service, Shamir Medical Center, Be’er Ya’akov, Israel
| | - Firas Sabbah
- Rheumatology Service, Baruch Padeh Medical Center, Tiberias, Israel
| | - Gabriel S. Breuer
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Rheumatology Unit, Shaare Tzedek Medical Center, Jerusalem, Israel
| | - Amir Dagan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Clinic, Assuta Ashdod Hospital, Ashdod, Israel
| | - Rima Beshara-Garzuzi
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Doron Markovits
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Muna Elias
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Joy Feld
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Oshrat Tayer-Shifman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Tal Gazitt
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | | | - Limor Rubin
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Allergy and Clinical Immunology Unit, Department of medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Amir Haddad
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Sami Giryes
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Daphna Paran
- Rheumatology Department, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Peleg
- The Department of Medicine, Rheumatology Unit and Rare Disease Research Center, Hadassah Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair Molad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Rheumatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Ori Elkayam
- Rheumatology Department, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Mevorach
- The Department of Medicine, Rheumatology Unit and Rare Disease Research Center, Hadassah Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alexandra Balbir-Gurman
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Yolanda Braun-Moscovici
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- *Correspondence: Yolanda Braun-Moscovici,
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Ozeri D, Peretz S, Oppenheim A, Watad A, Lidar M, Braun-Moscovici Y. Development and validation of Hebrew version of the UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument 2.0. J Scleroderma Relat Disord 2023; 8:31-35. [PMID: 36743811 PMCID: PMC9896201 DOI: 10.1177/23971983221138712] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/15/2022] [Indexed: 12/13/2022]
Abstract
Aim The aim of this study was to test the reliability of the University of California, Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract (UCLA SCTC GIT) 2.0 questionnaire in Hebrew. Methods UCLA SCTC GIT 2.0 was translated into Hebrew using the translation-retranslation method. The Hebrew version of the UCLA SCTC GIT 2.0 and the Hebrew version of the Short Form 36 (SF-36) were administered to 19 Hebrew-speaking patients with systemic sclerosis. Internal reliability was assessed using Cronbach's alpha. The Hebrew questionnaire was then tested for external validity using Spearman's correlation coefficient. Correlations (rho) ⩽ 0.29 were considered small, 0.30 to 0.49 were moderate, and those ⩾0.50 were considered large. Differences were considered statistically significant at p < 0.05. Results A group of 19 patients treated at Sheba Medical Center meeting the ACR/EULAR classification system for systemic sclerosis were included in the study. The mean age of the participants was 60.4 ± 12 years with a female predominance (84%). Diffuse cutaneous scleroderma accounted for 10 of the participants (54%), 7 had limited cutaneous scleroderma (36%) with 2 having an overlap syndrome (10%). The Cronbach's alpha value for the UCLA SCTC GIT 2.0 scale was 0.908 showing reliability. In addition, the UCLA SCTC GIT 2.0 showed correlation to the SF-36. Conclusion The translation of the Hebrew UCLA SCTC GIT 2.0 scale was reliable and valid with a total Cronbach's alpha score among the participants of 0.908. Cronbach's alpha was particularly reliable in reflux, bloating, social function, and emotional well-being. Our results suggest that our Hebrew version of the UCLA SCTC GIT 2.0 scale can be used as a tool in future studies with Hebrew-speaking patients. In the abstract conclusion, it states that "Cronbach's alpha was particularly reliable in reflux, bloating, social function, and emotional well-being." The related data should be listed in the results section and then an interpretation of the results should be listed in the conclusions section. Please revise.
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Affiliation(s)
- David Ozeri
- Internal Medicine A, Sheba Medical
Center, Zabludowicz Center for Autoimmune Diseases, Sackler Faculty of Medicine, Tel
Aviv University, Tel Aviv, Israel
| | - Shani Peretz
- Internal Medicine A, Sheba Medical
Center, Zabludowicz Center for Autoimmune Diseases, Sackler Faculty of Medicine, Tel
Aviv University, Tel Aviv, Israel
| | - Amit Oppenheim
- Internal Medicine A, Sheba Medical
Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abdallah Watad
- Internal Medicine B, Sheba Medical
Center, Zabludowicz Center for Autoimmune Diseases, Sackler Faculty of Medicine, Tel
Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Sheba Medical Center, Zabludowicz
Center for Autoimmune Diseases, Sackler Faculty of Medicine, Tel Aviv University,
Tel Aviv, Israel
| | - Yolanda Braun-Moscovici
- Rheumatology Institute, Rappaport
Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Dan Lantsman C, Brodov Y, Matetzky S, Beigel R, Lidar M, Eshed I, Goitein O. No correlation between diffuse idiopathic skeletal hyperostosis and coronary artery disease on computed tomography using two different scoring systems. Acta Radiol 2023; 64:508-514. [PMID: 35369763 DOI: 10.1177/02841851221090890] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An association between diffuse idiopathic skeletal hyperostosis (DISH) and a history of coronary artery disease (CAD) was previously reported. PURPOSE To investigate the association between DISH and CAD as assessed using the coronary artery calcification score (CACS) and the CAD-Reporting and Data System (CAD-RADS) score in patients with symptomatic chest pain. MATERIAL AND METHODS Consecutive cardiac CT scans performed before and after IV contrast administration were evaluated for CACS (Agatston method), CAD-RADS, and the presence of DISH. The association of DISH with the presence and extent of CACS/CAD-RADS scores was analyzed with and without adjustment for known atherosclerotic risk factors. RESULTS The study cohort included 268 individuals (157 men, 111 women; median age = 54 years). DISH was present in 65 (24.3%) individuals. CACS was significantly higher in the DISH group compared to the non-DISH group in the univariate analysis (median CACS DISH = 2, range = 0-80.5 vs. median CACS non-DISH = 0, range = 0-11; P < 0.005) but this association did not persist on multivariate analysis. There was a positive trend toward higher CAD-RADS scores in the DISH group (P = 0.03) but after adjustment for age, male sex, and family history, this tendency was not significant. CONCLUSION No independent association was found between the presence of DISH and CACS and CAD-RADS scores. Our findings suggest a more complex and possibly non-causal relationship between coronary artery disease and DISH.
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Affiliation(s)
- Christine Dan Lantsman
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yafim Brodov
- The Leviev Heart Center, 26744Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Matetzky
- The Leviev Heart Center, 26744Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roi Beigel
- The Leviev Heart Center, 26744Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- The Rheumatology unit, 26744Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Eshed
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Goitein
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gliner-Ron M, Bercovich E, Herman A, Lidar M, Militianu D, Eshed I. Osteophytes' position in subjects with DISH and right-sided aorta: verification of the 'aortic pulsation protective effect' theory. Rheumatology (Oxford) 2022; 61:4910-4914. [PMID: 35353143 DOI: 10.1093/rheumatology/keac183] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/20/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To validate in a large cohort with right-sided aorta the theory that thoracic right-sided flowing osteophytes in DISH results from a 'protective' effect of the pulsating descending left-sided thoracic aorta. METHODS Chest CTs of patients with DISH and right-sided aorta and controls with DISH and left-sided aorta were evaluated and compared on each intervertebral space (IS) for the location of the aorta (right, left, centre) and the location of the osteophyte relative to the aorta (contralateral, ipsilateral, bilateral). RESULTS The study and control cohorts included 31 and 35 subjects, respectively (male 22/9 and female 27/8; median age 64.8/65.3 years; P = 0.86). Osteophytes contralateral to the aorta's location were recorded in the majority of ISs in both the study and control groups (47% and 60%, respectively; P > 0.05), while ipsilateral osteophytes were recorded in 6.9% and 7.7%, respectively (P = 0.002). Bilateral osteophytes located to the right and the left of the aorta were significantly more prevalent in the study group compared with the controls (17.2% and 5.4%, respectively; P = 0.04). CONCLUSIONS Aortic pulsation plays an important role in inhibiting the development of osteophytes and results in the majority of contralateral osteophytes on both right-sided and left-sided aortas. However, since both ipsilateral and bilateral osteophytes were not at all rare in both groups, other parameters, which are yet to be established, probably contribute to the location of osteophytes.
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Affiliation(s)
- Masha Gliner-Ron
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv.,Department of Diagnostic Imaging, Hadassah Medical Center, affiliated with the Hebrew University of Jerusalem, Jerusalem
| | - Eyal Bercovich
- Department of Diagnostic Imaging, Rambam Medical Center, Haifa
| | - Amir Herman
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv
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Maller T, Ben-Zvi I, Lidar M, Livneh A. Screening for Fabry's disease in a high-risk subpopulation of FMF. Eur J Med Res 2022; 27:210. [PMID: 36271470 PMCID: PMC9585770 DOI: 10.1186/s40001-022-00846-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Familial Mediterranean fever (FMF) is an autosomal recessive disease associated with mutations in the Mediterranean fever gene (MEFV) that manifests with recurrent episodes of febrile serositis. Fabry’s disease (FD) is an X-linked lysosomal storage disease caused by mutations in the alpha-galactosidase A gene and presents with a wide range of gastrointestinal, skin, vascular, renal and neurological manifestations. FMF and FD share similar manifestations, which may lead to misdiagnosis of one as the other; mostly FD is misdiagnosed as FMF. Moreover, various overlapping manifestations may stem from comorbidities, commonly coupled to FMF (such as Behcet's disease, inflammatory bowel disease, glomerulonephritis, fibromyalgia, and multiple sclerosis), as well as from colchicine adverse effects, which may add to the diagnostic confusion. Thus, we postulated that screening FMF for FD will lead to the identification of patients falsely diagnosed with FMF or who, in addition to FMF, suffer from FD that was previously missed. Methods To identify missed FD among the FMF population, we performed chemical and genetic analyses for FD in blood samples obtained from a cohort of FMF patients followed in the specialized FMF center of our institution. To increase the likelihood of detecting patients with FD, we enriched the surveyed FMF population with patients exhibiting manifestations shared by patients with FD or who deviate from the typical FMF presentation. Results and conclusions Of 172 surveyed FMF patients in a cohort derived from a clinic dedicated to FMF, none had FD. Thus, the postulation of increased odds for detecting FD in patients with FMF was not confirmed. Further exploration for FD in FMF population, is nevertheless recommended.
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Affiliation(s)
- Tomer Maller
- Medicine F, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ilan Ben-Zvi
- Medicine F, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,FMF Clinic, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Rheumatology Unit, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Talpiot Medical Leadership Program, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Merav Lidar
- FMF Clinic, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Rheumatology Unit, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Livneh
- Medicine F, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,FMF Clinic, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Rheumatology Unit, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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8
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Gendelman O, Tripto-Shkolnik L, Vered I, Lidar M. Bisphosphonates Related Ocular Side Effects: A Case Series and Review of Literature. Ocul Immunol Inflamm 2022; 30:1995-1999. [PMID: 34014797 DOI: 10.1080/09273948.2021.1922705] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/07/2020] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To describe the clinical features of patients with bisphosphonate related ocular side effects (BROSE). METHODS The medical records of all patients with BROSE between January 2009 and December 2019 were reviewed. RESULTS Nine cases with BROSE were identified. All subjects were female. Median age at diagnosis was of 69 years. The leading indication for bisphosphonate treatment was osteoporosis (n=7), Paget's disease of bone (n=1) and breast cancer (n=1). Six (66.67%) patients presented with uveitis, one (11%) episcleritis and two (22%) with orbital inflammation. Five events (55.5%) occurred within 10 days of initiating the bisphosphonate and the rest (44.44%) developed within 2 weeks to 3 years later. Four (44.44%) patients had concurrent thyroid disease. An association was found between underlying thyroid disease or autoimmunity. CONCLUSION BROSE is an uncommon complication of bisphosphonate therapy occurring more frequently in patients with an autoimmune predisposition.
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Affiliation(s)
- Omer Gendelman
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Liana Tripto-Shkolnik
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
| | - Iris Vered
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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9
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Gaggiano C, Vitale A, Tufan A, Ragab G, Aragona E, Wiesik-Szewczyk E, Ait-Idir D, Conti G, Iezzi L, Maggio MC, Cattalini M, Torre FL, Lopalco G, Verrecchia E, de Paulis A, Sahin A, Insalaco A, Sfikakis PP, Marino A, Frassi M, Ogunjimi B, Opris-Belinski D, Parronchi P, Emmi G, Shahram F, Ciccia F, Piga M, Hernández-Rodríguez J, Pereira RMR, Alessio M, Naddei R, Olivieri AN, Giudice ED, Sfriso P, Ruscitti P, Gobbi FL, Kucuk H, Sota J, Hussein MA, Malizia G, Jahnz-Różyk K, Sari-Hamidou R, Romeo M, Ricci F, Cardinale F, Iannone F, Casa FD, Natale MF, Laskari K, Giani T, Franceschini F, Sabato V, Yildirim D, Caggiano V, Hegazy MT, Marzo RD, Kucharczyk A, Khellaf G, Tarsia M, Almaghlouth IA, Laymouna AH, Mastrorilli V, Dotta L, Benacquista L, Grosso S, Crisafulli F, Parretti V, Giordano HF, Mahmoud AAMA, Nuzzolese R, Musso MD, Chighizola CB, Gentileschi S, Morrone M, Cola ID, Spedicato V, Giardini HAM, Vasi I, Renieri A, Fabbiani A, Mencarelli MA, Frediani B, Balistreri A, Tosi GM, Fabiani C, Lidar M, Rigante D, Cantarini L. The Autoinflammatory Diseases Alliance Registry of monogenic autoinflammatory diseases. Front Med (Lausanne) 2022; 9:980679. [PMID: 36160138 PMCID: PMC9500177 DOI: 10.3389/fmed.2022.980679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/08/2022] [Indexed: 01/10/2023] Open
Abstract
ObjectiveThe present manuscript aims to describe an international, electronic-based, user-friendly and interoperable patient registry for monogenic autoinflammatory diseases (mAIDs), developed in the contest of the Autoinflammatory Diseases Alliance (AIDA) Network.MethodsThis is an electronic platform, based on the Research Electronic Data Capture (REDCap) tool, used for real-world data collection of demographics, clinical, laboratory, instrumental and socioeconomic data of mAIDs patients. The instrument has flexibility, may change over time based on new scientific acquisitions, and communicate potentially with other similar registries; security, data quality and data governance are corner stones of the platform.ResultsAIDA project will share knowledge and expertise on mAIDs. Since its start, 118 centers from 24 countries and 4 continents have joined the AIDA project. Fifty-nine centers have already obtained the approval from their local Ethics Committees. Currently, the platform counts 337 users (122 Principal Investigators, 210 Site Investigators, 2 Lead Investigators, and 3 data managers). The Registry collects baseline and follow-up data using 3,748 fields organized into 21 instruments, which include demographics, patient history, symptoms, trigger/risk factors, therapies, and healthcare information for mAIDs patients.ConclusionsThe AIDA mAIDs Registry, acts both as a research tool for future collaborative real-life studies on mAIDs and as a service to connect all the figures called to participate. On this basis, the registry is expected to play a pivotal role in generating new scientific evidence on this group of rare diseases, substantially improving the management of patients, and optimizing the impact on the healthcare system. NCT 05200715 available at https://clinicaltrials.gov.
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Affiliation(s)
- Carla Gaggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Antonio Vitale
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gaafar Ragab
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Giza, Egypt
- Faculty of Medicine, Newgiza University, 6th of October City, Egypt
| | - Emma Aragona
- Division of Gastroenterology, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | - Ewa Wiesik-Szewczyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Djouher Ait-Idir
- Research Laboratory, Biodiversity, Biotechnology, Environment and Sustainable Development, Department of Biology, Faculty of Sciences, M'Hamed Bougara University, Boumerdes, Algeria
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, Azienda Ospedaliero Universitaria (AOU) G Martino, Messina, Italy
| | - Ludovica Iezzi
- Department of Life Sciences and Global Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Cristina Maggio
- University Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D'Alessandro”, University of Palermo, Palermo, Italy
| | - Marco Cattalini
- Pediatric Clinic, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Francesco La Torre
- Department of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Elena Verrecchia
- Rare Diseases and Periodic Fevers Research Centre, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Amato de Paulis
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), World Allergy Organization (WAO) Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Ali Sahin
- Division of Rheumatology, Department of Internal Medicine, Medical Faculty, Sivas Cumhuriyet University, Sivas, Turkey
| | - Antonella Insalaco
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Rome, Italy
| | - Petros P. Sfikakis
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Achille Marino
- Unit of Pediatric Rheumatology, Azienda Socio-Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Milan, Italy
| | - Micol Frassi
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Benson Ogunjimi
- Departement of Pediatrics, Antwerp University Hospital, Edegem, Belgium
- Center for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Department of Rheumatology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
- KidZ Health Castle, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Daniela Opris-Belinski
- Rheumatology and Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Farhad Shahram
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Francesco Ciccia
- Department of Precision Medicine, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rosa Maria R. Pereira
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Maria Alessio
- Pediatric Rheumatology Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Roberta Naddei
- Pediatric Rheumatology Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Alma Nunzia Olivieri
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Emanuela Del Giudice
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Hamit Kucuk
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Jurgen Sota
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Mohamed A. Hussein
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Giuseppe Malizia
- Division of Gastroenterology, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | - Karina Jahnz-Różyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Rawda Sari-Hamidou
- Research Laboratory Toxicomed, Faculty of Medicine, Abou Bekr Belkaid University, Tlemcen, Algeria
| | - Mery Romeo
- Pediatric Nephrology and Rheumatology Unit, Azienda Ospedaliero Universitaria (AOU) G Martino, Messina, Italy
| | - Francesca Ricci
- Pediatric Clinic, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Fabio Cardinale
- Department of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Francesca Della Casa
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Marco Francesco Natale
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Rome, Italy
| | - Katerina Laskari
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Teresa Giani
- Unit of Pediatric Rheumatology, Azienda Socio-Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Milan, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Derya Yildirim
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Valeria Caggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Mohamed Tharwat Hegazy
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Giza, Egypt
- Faculty of Medicine, Newgiza University, 6th of October City, Egypt
| | - Rosalba Di Marzo
- Division of Ematology II, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | - Aleksandra Kucharczyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Ghalia Khellaf
- Faculté de Médecine, Service de Néphrologie, Centre Hospitalo-Universitaire Lamine Debaghine, Université Alger 1 Benyoucef Benkhedda, Alger, Algeria
| | - Maria Tarsia
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Ibrahim A. Almaghlouth
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- College of Medicine Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Hatem Laymouna
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Violetta Mastrorilli
- Department of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy
| | - Laura Dotta
- Pediatric Clinic, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Luca Benacquista
- Department of Life Sciences and Global Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Salvatore Grosso
- Clinical Paediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Veronica Parretti
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Heitor F. Giordano
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil
| | | | - Rossana Nuzzolese
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Marta De Musso
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
- Pediatric Rheumatology Unit, Azienda Socio-Sanitaria Territoriale (ASST) Gaetano Pini Centro Specialistico Ortopedico Traumatologico (CTO), Milan, Italy
| | - Stefano Gentileschi
- Unit of Rheumatology, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Mirella Morrone
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Ilenia Di Cola
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Veronica Spedicato
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Henrique A. Mayrink Giardini
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Ibrahim Vasi
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alessandra Renieri
- Medical Genetics, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Medical Biotechnologies, Med Biotech Hub and Competence Center, University of Siena, Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Alessandra Fabbiani
- Medical Genetics, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Medical Biotechnologies, Med Biotech Hub and Competence Center, University of Siena, Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | | | - Bruno Frediani
- Unit of Rheumatology, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Alberto Balistreri
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Merav Lidar
- Familial Mediterranean Fever (FMF) Clinic, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Rheumatology Unit, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Donato Rigante
- Department of Life Sciences and Global Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Rare Diseases and Periodic Fevers Research Centre, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- *Correspondence: Luca Cantarini
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10
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Watad A, McGonagle D, Anis S, Carmeli R, Cohen AD, Tsur AM, Ben-Shabat N, Lidar M, Amital H. TNF inhibitors have a protective role in the risk of dementia in patients with ankylosing spondylitis: Results from a nationwide study. Pharmacol Res 2022; 182:106325. [PMID: 35752359 DOI: 10.1016/j.phrs.2022.106325] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/24/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Ankylosing spondylitis (AS) is a chronic progressive and debilitating form of arthritis with associated extra-articular features including uveitis, intestinal and lung apical inflammation and psoriasis. Putative associations between AS and neurologic disorders has been relatively overlooked. The purpose of this study is to assess the link between AS and major neurologic disorders and whether treatment with Tumor-Necrosis-Factor inhibitors (TNFi) has an impact on that association. METHODS A retrospective cross-sectional study was carried out based on the Clalit Health Services (CHS) computerized database. AS patients were compared to age- and gender-matched controls with respect to the proportion of Alzheimer's disease (AD), Parkinson's disease (PD), epilepsy, and multiple sclerosis (MS). The impact of AS therapy (biologic vs conventional therapy) was assessed as well. RESULTS 4,082 AS patients and 20,397 age- and gender-matched controls were identified. AS was associated with a higher prevalence of AD (odds-ratio(OR) 1.46 [95%Confidence-interval(CI) 1.13-1.87], p=0.003), epilepsy (OR 2.33 [95%CI 1.75-3.09] p<0.0001) and PD (OR 2.75 [95%CI 2.04-3.72], p<0.0001), whereas no statistically significant association was found for MS. Association with PD remained significant in the multivariate analysis (OR 1.49 [95%CI 1.05- 2.13],p=0.027). Within AS patients, the use of TNFi (OR 0.10 [95%CI 0.01-0.74], p=0.024) were associated with a lowered risk of developing AD. CONCLUSION AS is positively associated with AD, PD, and epilepsy but not MS. AS patients treated with TNFi have lower rates of AD.
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Affiliation(s)
- Abdulla Watad
- Department of Medicine 'B', Sheba Medical Centre, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.
| | - Dennis McGonagle
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Saar Anis
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Reut Carmeli
- Department of Medicine 'B', Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avishai M Tsur
- Department of Medicine 'B', Sheba Medical Centre, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Niv Ben-Shabat
- Department of Medicine 'B', Sheba Medical Centre, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Merav Lidar
- Rheumatology unit, Sheba Medical Centre, Ramat Gan, Israel
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Centre, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
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11
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Kharouf F, Eviatar T, Braun M, Pokroy-Shapira E, Brodavka M, Agmon-Levin N, Toledano K, Oren S, Lidar M, Amit Vazina M, Sabbah F, Tavor Y, Breuer G, Zisman D, Markovits D, Dagan A, Bishara Garzuzi R, Shifman O, Giryes S, Elias M, Feld J, Reitblat T, Gazit T, Hadad A, Elkayam O, Paran D, Mevorach D, Balbir-Gurman A, Braun-Moscovici Y. POS1254 RISK FACTORS FOR SEVERE COVID-19 INFECTION AMONG PATIENTS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES (AIRD) AND THE IMPACT OF VACCINATIONS - AN ISRAELI, MULTI-CENTER EXPERIENCE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAIRD patients (pts) may be more susceptible to severe COVID19.ObjectivesTo determine the risk factors for severe COVID19 and the effect of vaccinations among AIRD pts followed at dedicated rheumatology clinics.MethodsAt the onset of the pandemic, we established a national registry of AIRD pts, diagnosed with COVID19, based on voluntary reporting by the treating rheumatologist. 12 centers from Israel participated in the study. COVID19 was confirmed by a positive SARS CoV2 PCR. The indications for PCR testing were clinical symptoms or close contact with an infected person. Severe illness was defined by SpO2 <94% in room air, respiratory rate of >30 breaths/min, PaO2/FiO2 <300 mm Hg, or lung infiltrates >50% on imaging. The registry included demographic data, AIRD diagnosis and duration, visceral involvement, co-morbidities, immunomodulatory treatment, date of diagnosis and severity of COVID19 disease, management, complications, duration of hospitalization, the dates of the mRNA vaccinations, lab results and outcome. We analyzed data from 1.3.2020 to 30.11.2021ResultsDuring the study period we experienced 4 outbreaks of COVID19 infection. Initially social distancing, followed by a lockdown were imposed. The low number of cases led to relaxation of the measures. Two more severe outbreaks followed, which triggered 2 new lockdowns. The 3rd outbreak ended almost 2 months after vaccination started (BNT162b2 mRNA COVID19 vaccine). From March 1st 2020 to April 30, 2021, 298 AIRD pts (70.8% females, mean (SD) age 53.3(15.3)) with confirmed COVID19 infection were included. 43.3%(129) had visceral involvement due to the AIRD. 58.7%(175 pts) were on conventional synthetic disease modifying drugs (csDMARDs), 44.6% (133) on biologic/targeted DMARDs and 40% (120) on prednisone. Almost 2/3 of pts had at least one comorbidity.In a multivariate logistic regression analysis age, AIRD with pulmonary involvement, diabetes and treatment with prednisone, mycophenolate mofetil or JAK inhibitors were associated with hospitalization. Older age, renal and vascular involvement due to the AIRD, and congestive heart failure were associated with higher mortality.The 4th outbreak occurred 6 months after the introduction of vaccines, with spreading of the delta variant: 110 AIRD pts with COVID19 were recorded. Demographic data, clinical AIRD‘s characteristics, immunomodulatory treatment and comorbidities were similar to the previous outbreaks. However, during the 4th outbreak, the proportion of pts with severe COVID19, the hospitalization and mortality rate were significantly lower as compared to the first 3 outbreaks (15% vs 24%, 27% vs 53%, 6.7% vs 9.1%, respectively). Among COVID19 pts, 25% received a 3rd vaccine dose (booster), 56% contracted infection more than 5 months after the 2nd vaccine dose and 24% were unvaccinated. Most of the pts who received the booster contracted the disease within a week of vaccination. The odds ratio for hospitalization in vaccinated pts compared to unvaccinated was 0.11 (0.01 – 0.63 95% CI, p=0.041) in those vaccinated within the previous 1-5 months, and 0.38 (0.21-0.67 95% CI, p=0.001) in those vaccinated more than 6 months ago. 9 pts died, 5 were more than 6 months after the 2nd mRNA vaccine, 2 were unvaccinated and 1 patient received the booster on the same day of COVID19 diagnosis.ConclusionBefore the vaccination campaign, the hospitalization and mortality rate in our cohort were similar to the data reported by other registries. COVID19 tends to be more severe, with increased mortality in patients with active AIIRD and visceral involvement (pulmonary, cardiac, renal), advanced age and co-morbidities. The delta outbreak occured 6 months after the implementation of vaccinations and was associated with significantly lower hospitalization and mortality rates, despite the increased aggressiveness of the variant. Vaccination of AIIRD pts with 3 doses of mRNA vaccines protects from severe COVID19 disease, hospitalization, and death.AcknowledgementsFadi Kharouf and Tali Eviatar had equal contributionDisclosure of InterestsNone declared
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Shechtman L, Lahad K, Livneh A, Grossman C, Druyan A, Giat E, Lidar M, Freund S, Manor U, Pomerantz A, Veroslavski D, Ben-Zvi I. Safety of the BNT162b2 mRNA COVID-19 vaccine in patients with familial Mediterranean fever. Rheumatology (Oxford) 2022; 61:SI129-SI135. [PMID: 35238382 PMCID: PMC8903441 DOI: 10.1093/rheumatology/keac131] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Evidence suggests a possible association between the COVID-19 vaccine and autoimmune disease flares or new onset of various autoinflammatory manifestations, such as pericarditis and myocarditis. The objective of this study was to assess the safety of an mRNA-based BNT162b2 anti-COVID-19 vaccine in individuals with familial Mediterranean fever (FMF), a prototypic autoinflammatory disease. METHODS Patients participating in this study fulfilled the criteria for diagnosis of FMF, were older than 18 years, and received at least one dose of the vaccine. Data on baseline characteristics, features of FMF, post-vaccination side effects, and disease flares were acquired using electronic medical files and telephone interviews. RESULTS A total of 273 FMF patients were recruited for the study. More than 95% were vaccinated with two doses of the vaccine. The rates of local reactions following the first and second vaccine doses were 65.5% and 60%, respectively, and 26% and 50.4%, respectively, for systemic adverse events. These rates are lower than those reported for the general population from real-world and clinical trial settings. Postvaccination FMF activity remained stable in most patients. None of the patients reported an attack of pericarditis or myocarditis, considered the most serious vaccine-associated adverse events. Patients with a more active FMF disease and patients harboring the M694V mutation had a significantly higher rate of post-vaccination systemic side effects and attacks. CONCLUSION The BNT162b2 mRNA Covid-19 vaccine is safe in patients with FMF. Our results support the administration of this vaccine to FMF patients according to guidelines applicable to the general population.
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Affiliation(s)
- Liran Shechtman
- Department of Internal Medicine F, Sheba Medical Center, Tel-Hashomer, Israel
| | - Karney Lahad
- Department of Internal Medicine F, Sheba Medical Center, Tel-Hashomer, Israel
| | - Avi Livneh
- Department of Internal Medicine F, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Chagai Grossman
- Department of Internal Medicine F, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amit Druyan
- Department of Internal Medicine F, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eitan Giat
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Sarit Freund
- Faculty of industrial engineering and management, Ruppin Academic Center, Israel
| | - Uri Manor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Internal Medicine C, Sheba Medical Center, Tel-Hashomer, Israel
| | - Alon Pomerantz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Ilan Ben-Zvi
- Department of Internal Medicine F, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Sheba Talpiot Medical Leadership Program, Tel-Hashomer, Israel
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Eshed I, Druyan A, Stern M, Bordavka M, Lidar M. The prevalence of sacroiliitis on abdominal MRI examinations of patients with Takayasu arteritis. Acta Radiol 2022; 63:387-392. [PMID: 33843285 DOI: 10.1177/0284185121996270] [Citation(s) in RCA: 2] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Takayasu arteritis (TA), a systemic large-vessel vasculitis, was reported to have high incidence of spondyloarthropathy. PURPOSE To evaluate the prevalence of inflammatory sacroiliitis in patients with TA that underwent abdominal/pelvic magnetic resonance imaging (MRI) examinations as part of their vasculitis work-up. MATERIAL AND METHODS Consecutive abdominal/pelvic MRI examinations of 34 patients with TA fulfilling the 1990 ACR criteria and 34 age- and gender-matched controls performed between 2008 and 2020 were retrospectively reviewed for the presence sacroiliitis. The presence of active and structural lesions was scored twice (with a one-month interval between reads) by one reader. Structural lesions were also evaluated on computed tomography, when available, and correlated to MRI findings. Clinical data were extracted from the patients' clinical files. MRI scores were compared between the study and control groups and correlated with the clinical data. RESULTS Sacroiliitis was evident in 11.7% of the TA group examinations compared to 0.3% in the control group (P = 0.6). Participants with TA had significantly more erosions and fat deposition compared to the control group (Study: 0.01/0.03, Control: 0/0, P = 0.03/0.003, respectively). However, mean sacroiliitis score was not significantly different (Study: 1.06, Control: 0.78, P = 0.015). Of the four patients with TA and sacroiliitis, 3 (75%) had a diagnosis of inflammatory bowel disease (IBD). CONCLUSION Sacroiliitis was detected in 11.7% of abdominal MRI examinations of patients with TA, 75% of which had associated IBD, suggesting that both IBD and sacroiliitis should be routinely screened in the TA population as their presence may influence treatment decisions.
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Affiliation(s)
- Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Druyan
- Department of Medicine "F", Sheba Medical Center, Tel Hashomer, Israel
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Myriam Stern
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Bordavka
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Merav Lidar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
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Shouval A, Lidar M, Reitblat T, Zisman D, Balbir-Gurman A, Mashiach T, Almog R, Elkayam O. Real-world effectiveness of tofacitinib in patients with rheumatoid arthritis: a prospective observational study. Clin Exp Rheumatol 2021; 39:1378-1384. [DOI: 10.55563/clinexprheumatol/do2uxu] [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] [Received: 05/28/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Aniela Shouval
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel Aviv University, and Rheumatology Unit, The Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Ramat Gan, Israel
| | | | - Devy Zisman
- Department of Rheumatology, Carmel Medical Center, Haifa, and The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Tanya Mashiach
- Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, Israel
| | - Ronit Almog
- Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Israel.
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Druyan A, Giat E, Livneh A, Grossman C, Ben-Zvi I, Lidar M. Effect of interleukin-1 inhibition in a cohort of patients with colchicine-resistant familial Mediterranean fever treated consecutively with anakinra and canakinumab. Clin Exp Rheumatol 2021; 39 Suppl 132:75-79. [DOI: 10.55563/clinexprheumatol/rrr9zd] [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] [Received: 04/19/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Amit Druyan
- Department of Medicine F, Sheba Medical Centre, Tel Hashomer, and Rheumatology Unit, Sheba Medical Centre, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Eitan Giat
- Rheumatology Unit, Sheba Medical Centre, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Avi Livneh
- Rheumatology Unit, Sheba Medical Centre, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Chagai Grossman
- Department of Medicine F, Sheba Medical Centre, Tel Hashomer, and Rheumatology Unit, Sheba Medical Centre, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ilan Ben-Zvi
- Department of Medicine F, Sheba Medical Centre, Tel Hashomer, and Rheumatology Unit, Sheba Medical Centre, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Centre, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Israel
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Nussinovitch U, Gendelman O, Rubin S, Levy Y, Vishnevskia Dai V, Livneh A, Lidar M. Autonomic Nervous System Indices in Patients with Systemic Sclerosis without Overt Cardiac Disease. Isr Med Assoc J 2021; 23:651-656. [PMID: 34672448] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a connective tissue disease that may affect the heart and the autonomic nervous system (ANS). There is little knowledge regarding the degree of ANS involvement in SSc patients with unknown cardiac disease. OBJECTIVES To evaluate cardiac and pupillary autonomic functions in patients before cardiac involvement has emerged. METHODS The study comprised 19 patients with SSc and 29 healthy controls. Heart rate variability (HRV) analysis for time and frequency domains, as well as deep breathing test and Ewing maneuvers, were performed in all patients. Automated pupillometry for the evaluation of pupillary diameter and pupillary light reflex was completed in 8 SSc patients and 21 controls. RESULTS Both groups had similar characteristics, except for medications that were more commonly or solely prescribed for SSc patients. Compared with control subjects, the SSc patients had significantly lower HRV parameters of NN50 (15.8 ± 24.4 vs. 33.9 ± 33.1, P = 0.03), pNN50 (4.9 ± 7.4% vs.10.8 ± 10.8%, P = 0.03), and triangular index (11.7 ± 3.4 vs. 15.7 ± 5.8, P = 0.02). Abnormal adaptive responses in heart rate changes were recorded during deep breathing tests and Ewing maneuvers. There was no significant difference in any of the pupillometric indices or other HRV parameters within groups. CONCLUSIONS SSc patients may manifest cardiac autonomic dysfunction, while their autonomic pupillary function is seemingly spared. The role of certain medications, the significance of differential organ involvement, as well as the prognostic value of our findings should be evaluated in future studies.
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Affiliation(s)
- Udi Nussinovitch
- Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
| | - Omer Gendelman
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiri Rubin
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Medicine E, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Viktoria Vishnevskia Dai
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Livneh
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Agmon-Levin N, Berman M, Harel L, Lidar M, Drori T, Hajyahia S, Paran D. Rituximab for refractory manifestations of the antiphospholipid syndrome: a multicentre Israeli experience. Clin Exp Rheumatol 2021; 39:1049-1055. [PMID: 33124581 DOI: 10.55563/clinexprheumatol/cc5taf] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/07/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The clinical manifestations of the antiphospholipid syndrome (APS) are heterogeneous and related to anti-phospholipid antibodies (aPL). There is some evidence that B cells are involved in the pathogenesis of this condition. Thus the ability of rituximab (RTX) to deplete B cells makes it an appealing potential therapy for refractory antiphospholipid syndrome (APS). Real world data on RTX treatment of APS are still lacking. This study was conducted to report outcomes of RTX administration in the treatment of different aspects of APS. METHODS This is a retrospective case series study on APS patients from 3 medical centres in Israel who were treated with RTX during 2010-2019 for refractory manifestations of APS including diffuse alveolar haemorrhage, recurrent thrombosis, cytopenia, neurological and skin manifestations. Medical records were reviewed regarding the clinical indication for RTX treatment, concomitant medications, RTX protocol, aPL status and response to treatment. Outcomes were defined as complete response if full resolution of the "indicated manifestation" was achieved and maintained for at least 12 months, partial response or no response. RESULTS We identified 40 APS patients who were treated with RTX for refractory manifestations of this condition, of whom, 24 patients (60%) were female with a mean age of 40 years, and 31 patients (78%) were diagnosed with primary APS. A favourable response to RTX was documented in 32 patients (80%) including a complete response in 22 patients (55%). Response to RTX treatment was associated with a rituximab protocol of 375mg/m2 x 4 compared to a fixed dose of 1000 mg x2 (100% vs. 65%; p=0.01). Complete response was associated with a decrease in aPL titres within 4-6 months post treatment, whereas no significant change in aPL titres was observed in patients with partial or no response. CONCLUSIONS Consistent with previous small case series, we report a good therapeutic response to RTX in patients with difficult to treat manifestations of APS. In this cohort, treatment protocols were associated with outcomes. Although further studies are required to verify our observations, our data support a plausible role for B cell depletion in refractory APS.
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Affiliation(s)
- Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Mark Berman
- Department of Rheumatology, Tel Aviv Medical Center, Israel
| | - Liora Harel
- Sackler School of Medicine, Tel-Aviv University, and Paediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Merav Lidar
- Sackler School of Medicine, Tel-Aviv University, and Rheumatology Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Tali Drori
- Sackler School of Medicine, Tel-Aviv University, and Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel
| | - Soad Hajyahia
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel-Aviv University, Israel
| | - Daphna Paran
- Sackler School of Medicine, Tel-Aviv University, and Department of Rheumatology, Tel Aviv Medical Center, Israel
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Mahroum N, Watad A, Bridgewood C, Mansour M, Nasr A, Hussein A, Khamisy-Farah R, Farah R, Gendelman O, Lidar M, Shoenfeld Y, Amital H, Kong JD, Wu J, Bragazzi NL, McGonagle D. Systematic Review and Meta-Analysis of Tocilizumab Therapy versus Standard of Care in over 15,000 COVID-19 Pneumonia Patients during the First Eight Months of the Pandemic. Int J Environ Res Public Health 2021; 18:9149. [PMID: 34501738 PMCID: PMC8431489 DOI: 10.3390/ijerph18179149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/14/2021] [Accepted: 08/23/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Tocilizumab is an anti-IL-6 therapy widely adopted in the management of the so-called "cytokine storm" related to SARS-CoV-2 virus infection, but its effectiveness, use in relation to concomitant corticosteroid therapy and safety were unproven despite widespread use in numerous studies, mostly open label at the start of the pandemic. METHODS We performed a systematic review and meta-analysis of case-control studies utilising tocilizumab in COVID-19 on different databases (PubMed/MEDLINE/Scopus) and preprint servers (medRxiv and SSRN) from inception until 20 July 2020 (PROSPERO CRD42020195690). Subgroup analyses and meta-regressions were performed. The impact of tocilizumab and concomitant corticosteroid therapy or tocilizumab alone versus standard of care (SOC) on the death rate, need for mechanical ventilation, ICU admission and bacterial infections were assessed. RESULTS Thirty-nine studies with 15,531 patients (3657 cases versus 11,874 controls) were identified. Unadjusted estimates (n = 28) failed to demonstrate a protective effect of tocilizumab on survival (OR 0.74 ([95%CI 0.55-1.01], p = 0.057), mechanical ventilation prevention (OR 2.21 [95%CI 0.53-9.23], p = 0.277) or prevention of ICU admission (OR 3.79 [95%CI 0.38-37.34], p = 0.254). Considering studies with adjusted, estimated, tocilizumab use was associated with mortality rate reduction (HR 0.50 ([95%CI 0.38-0.64], p < 0.001) and prevention of ICU admission (OR 0.16 ([95%CI 0.06-0.43], p < 0.001). Tocilizumab with concomitant steroid use versus SOC was protective with an OR of 0.49 ([95%CI 0.36-0.65], p < 0.05) as was tocilizumab alone versus SOC with an OR of 0.59 ([95%CI 0.34-1.00], p < 0.001). Risk of infection increased (2.36 [95%CI 1.001-5.54], p = 0.050; based on unadjusted estimates). CONCLUSION Despite the heterogeneity of included studies and large number of preprint articles, our findings from the first eight of the pandemic in over 15,000 COVID-19 cases suggested an incremental efficacy of tocilizumab in severe COVID-19 that were confirmed by subsequent meta-analyses of large randomized trials of tocilizumab. This suggests that analysis of case-control studies and pre-print server data in the early stages of a pandemic appeared robust for supporting incremental benefits and lack of major therapeutic toxicity of tocilizumab for severe COVID-19.
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Affiliation(s)
- Naim Mahroum
- Zabludowicz Center for Autoimmune Diseases, Department of Medicine B., Sheba Medical Center, Ramat Gan 5265601, Israel; (N.M.); (A.W.); (O.G.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- International School of Medicine, Istanbul Medipol University, Istanbul 34810, Beykoz, Turkey
| | - Abdulla Watad
- Zabludowicz Center for Autoimmune Diseases, Department of Medicine B., Sheba Medical Center, Ramat Gan 5265601, Israel; (N.M.); (A.W.); (O.G.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds LS7 4SA, UK; (C.B.); (D.M.)
- Rheumatology Unit, Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Charlie Bridgewood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds LS7 4SA, UK; (C.B.); (D.M.)
| | - Muhammad Mansour
- Department of Surgery A, Galilee Medical Center, Nahariya 2210001, Israel;
- Faculty of Medicine of the Galilee, Bar-Ilan University, Safed 13100, Israel
- Division of General Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, Canada
| | - Ahmad Nasr
- Department of Pathology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy;
- Department of Pathology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Amr Hussein
- Medical Faculty, University of Parma, 43125 Parma, Italy;
| | - Rola Khamisy-Farah
- Clalit Health Service, Akko, Azrieli Faculty of Medicine, Bar-Ilan University, Safed 13100, Israel;
| | - Raymond Farah
- Department of Internal Medicine, Ziv Medical Center, Safed 13100, Israel;
| | - Omer Gendelman
- Zabludowicz Center for Autoimmune Diseases, Department of Medicine B., Sheba Medical Center, Ramat Gan 5265601, Israel; (N.M.); (A.W.); (O.G.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Rheumatology Unit, Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Department of Medicine B., Sheba Medical Center, Ramat Gan 5265601, Israel; (N.M.); (A.W.); (O.G.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Medical Department, Saint Petersburg State University, 199034 Saint Petersburg, Russia
- Ariel University, Kiryat HaMada 3, Ariel 40700, Israel
| | - Howard Amital
- Zabludowicz Center for Autoimmune Diseases, Department of Medicine B., Sheba Medical Center, Ramat Gan 5265601, Israel; (N.M.); (A.W.); (O.G.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Jude Dzevela Kong
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada; (J.D.K.); (J.W.)
| | - Jianhong Wu
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada; (J.D.K.); (J.W.)
| | - Nicola Luigi Bragazzi
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds LS7 4SA, UK; (C.B.); (D.M.)
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada; (J.D.K.); (J.W.)
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds LS7 4SA, UK; (C.B.); (D.M.)
- Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
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Chanson N, Ramos-Casals M, Pundole X, Suijkerbuik K, José de Barros E Silva M, Lidar M, Benesova K, Leipe J, Acar-Denizli N, Pradère P, Michot JM, Voisin AL, Suárez-Almazor ME, Radstake TRD, Fernandes Moça Trevisani V, Schulze-Koops H, Melin A, Robert C, Mariette X, Baughman RP, Lambotte O. Immune checkpoint inhibitor-associated sarcoidosis: A usually benign disease that does not require immunotherapy discontinuation. Eur J Cancer 2021; 158:208-216. [PMID: 34452793 DOI: 10.1016/j.ejca.2021.05.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/20/2020] [Revised: 04/27/2021] [Accepted: 05/24/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To analyse the clinical patterns of sarcoidosis triggered by immune checkpoint inhibitors (ICIs) in patients with cancer. PATIENTS AND METHODS The ImmunoCancer International Registry is a big data-sharing multidisciplinary network from 18 countries dedicated to evaluating the clinical research of immune-related adverse events related to cancer immunotherapies. RESULTS We identified 32 patients with biopsy-proven sarcoidosis. Underlying cancer included mainly melanoma (n = 24). Cancer immunotherapy consisted of monotherapy in 19 cases (anti-PD-1 in 18 and ipilimumab in 1) or combined ipilimumab + nivolumab in 13. The time median interval between initiation of ICI and sarcoidosis diagnosis was 3 months (range, 2-29 months). The use of combined ICI was associated with a shorter delay in developing sarcoidosis symptoms. The disease was symptomatic in 19 (59%) cases with mostly cutaneous, respiratory and general symptoms. The organs involved included mainly the mediastinal lymph nodes (n = 32), the lungs (n = 11), the skin (n = 10) and the eyes (n = 5). Pulmonary computed tomography studies showed bilateral hilar lymphadenopathy in all cases. There was no severe manifestation. Specific systemic therapy was required in only 12 patients (37%): oral glucocorticoids in 9, and hydroxychloroquine in 3. ICIs were held in 25 patients (78%) and definitively discontinued in 18 (56%) patients. Seven patients continued ICI treatment with a second flare in one case. In six additional patients, an ICI was reintroduced with no harm, and sarcoidosis relapsed in one of them. CONCLUSION Our study shows that ICI-related sarcoidosis seems to have a specific profile, possibly more benign than that of idiopathic sarcoidosis, and does not necessarily imply ICI discontinuation.
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Affiliation(s)
- Noémie Chanson
- AP-HP.Université Paris-Saclay, Hôpital Bicêtre, Department of Internal Medicine and Clinical Immunology, Le Kremlin Bicêtre, France; Université Paris-Saclay; INSERM; CEA, Centre Immunology of Viral Infections and Autoimmune Diseases, IDMIT Department, IBFJ, Le Kremlin-Bicêtre, France
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain; Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain.
| | - Xerxes Pundole
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karijn Suijkerbuik
- Department of Medical Oncology, UMC Utrecht Cancer Center, Utrecht, the Netherlands
| | | | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karolina Benesova
- Department of Internal Medicin and Rheumatology, Universitätsklinikum Heidelberg, Germany
| | - Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Hospital Mannheim, Medical Faculty Mannheim of the University Heidelberg, German
| | - Nihan Acar-Denizli
- Department of Statistics, Faculty of Science and Letters, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Pauline Pradère
- Department of Thoracic Surgery, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Jean-Marie Michot
- Département D'Innovation Thérapeutique et D'Essais Précoces, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Anne-Laure Voisin
- Unité Fonctionnelle de Pharmacovigilance, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Maria E Suárez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy R D Radstake
- Department of Medical Oncology, UMC Utrecht Cancer Center, Utrecht, the Netherlands
| | | | - Hendrik Schulze-Koops
- Department of Internal Medicin and Rheumatology, Universitätsklinikum Heidelberg, Germany
| | - Audrey Melin
- Department of Dermatology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Caroline Robert
- Department of Dermatology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Xavier Mariette
- Université Paris-Saclay; INSERM; CEA, Centre Immunology of Viral Infections and Autoimmune Diseases, IDMIT Department, IBFJ, Le Kremlin-Bicêtre, France; AP-HP.Université Paris-Saclay, Department of Rheumatology, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Olivier Lambotte
- AP-HP.Université Paris-Saclay, Hôpital Bicêtre, Department of Internal Medicine and Clinical Immunology, Le Kremlin Bicêtre, France; Université Paris-Saclay; INSERM; CEA, Centre Immunology of Viral Infections and Autoimmune Diseases, IDMIT Department, IBFJ, Le Kremlin-Bicêtre, France.
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20
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Marko L, Shemer A, Lidar M, Grossman C, Druyan A, Livneh A, Kivity S. Anakinra for colchicine refractory familial Mediterranean fever: a cohort of 44 patients. Rheumatology (Oxford) 2021; 60:2878-2883. [PMID: 34144604 DOI: 10.1093/rheumatology/keaa728] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/12/2020] [Revised: 10/10/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE FMF is an autoinflammatory disease of genetic origin. Colchicine is the mainstay of treatment for the prevention of attacks and long-term complications but 5-10% of FMF patients are resistant to colchicine therapy. The aim of our study was to investigate the real-life safety and efficacy of anakinra in a cohort of patients with colchicine-resistant FMF. METHODS In this retrospective study, patients treated with anakinra for colchicine-resistant FMF between 2010 and 2018 were identified using the computerized database of Sheba Medical Center and enrolled in the study. Data from structured clinical files were analysed to evaluate the efficacy and safety outcomes. To assess efficacy, we used the Global Assessment Score (GAS), a measure comprised of three different domains: number of attacks per month, duration of attacks and number of sites involved in the attacks. Reported adverse events were compiled. RESULTS A total of 44 patients (24 female) were treated with anakinra. Of these patients, 75% were homozygous for the M649V mutation. The mean duration of treatment was 18 months. The GAS decreased significantly from 6.6 (IQR 5.3-7.8) before treatment to 2 (IQR 0-4.2) while on treatment (P < 0.001). During anakinra treatment, six hospitalizations were reported (three due to related adverse effects). In addition, 11 patients suffered from injection site reactions (5 ceased treatment). Twelve patients reported mild side effects. CONCLUSION Treatment with anakinra is beneficial for the majority of colchicine-resistant FMF patients and is relatively safe.
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Affiliation(s)
- Limor Marko
- Department of Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Shemer
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Chagai Grossman
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel.,Department of Medicine F, Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Druyan
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Avi Livneh
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Department of Medicine F, Sheba Medical Center, Tel Hashomer, Israel
| | - Shaye Kivity
- Department of Medicine A, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel.,Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013 and Sheba Medical Center, Tel-Hashomer, Israel
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21
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Elalouf O, Lidar M, Reitblat T, Zisman D, Balbir-Gurman A, Hakakian O, Mashiach T, Almog R, Elkayam O. High Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis. Biologics 2021; 15:279-287. [PMID: 34321864 PMCID: PMC8312506 DOI: 10.2147/btt.s290169] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022]
Abstract
Purpose To evaluate the association between body mass index (BMI) and tumor necrosis factor α (TNF-α) blockers retention in patients with rheumatoid arthritis (RA). Patients and Methods This prospective cohort study analyzed data about patients with RA who initiated TNF blockers from the Israeli registry of inflammatory diseases from 2011 to 2019. Patients were grouped by BMI: normal (BMI <24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), obese (BMI 30–34.9 kg/m2) and morbid obese (BMI ≥35 kg/m2). Treatment cessation due to inefficacy was defined as an “event” and therapy with a drug above 3 months was defined as a “course.” Kaplan–Meier survival curve was used to describe drug survival. Event-free survival was calculated using Cox regression with a hazard ratio and confidence interval of 95%. Results The final analysis included 521 RA patients (80% females) treated with etanercept, infliximab, adalimumab or golimumab. Eight hundred and eighteen treatment initiations were included in the final analysis, 334 (41%) in the normal weight group, 261 (32%) in the overweight, 144 (17%) in the obese and 79 (10%) in the morbid obesity group. Three hundred and twenty-six (40%) treatment initiations were with etanercept, 215 (26%) with adalimumab 197 (24%) with infliximab, and 80 (10%) with golimumab. BMI was inversely associated with drug survival. Morbid obese patients were more likely to discontinue treatment compared with normal weight patients HR 2.28 (95% CI 1.67–3.10, p<0.01). This association remained significant for each drug type (except for golimumab) in a subgroup analysis. Adalimumab switch rate was higher compared to etanercept with HR =1.51 (95% CI 1.20–1.91, p<0.01), no other significant differences were noted between the other drugs. Conclusion Morbid obese RA patients have lower TNF-α blocker retention compared to normal weight patients.
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Affiliation(s)
- Ofir Elalouf
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rheumatology Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel
| | | | - Devy Zisman
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
| | | | - Odelia Hakakian
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tanya Mashiach
- Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, Israel
| | - Ronit Almog
- Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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Abstract
OBJECTIVE Systemic sclerosis (SSc) is associated with increased cardiac morbidity and mortality. Whether some electrocardiographic markers of arrhythmias predispose to early cardiogenic death in SSc remains controversial. This study evaluated the occurrence of previously reported as well as unstudied markers of repolarization in patients with SSc and assessed their prognostic implications. METHODS A total of 21 patients with SSc and 31 unaffected controls were included in this prospective study. Electrocardiograms were conducted under strict standards. Repolarization and dispersion parameters and markers of late ventricular potentials were determined using designated computer software. Results of multiple beats were averaged. RESULTS There were no significant differences between the SSc and control groups in average QT intervals, average corrected QT intervals, average QT interval dispersion (QTd), average QT corrected dispersion (QTcd), and QT dispersion ratio. However, average QT apex dispersion, average JT dispersion, average JT corrected dispersion, and Tpeak-Tend corrected were significantly higher in patients with SSc than in controls. Late ventricular potentials were not found in patients with SSc or in controls. Increased QTd and QTcd were recorded in 1 patient who experienced ventricular arrhythmia before inclusion in the study. None of the remaining patients with SSc or the controls developed arrhythmia during the 9-year follow-up. CONCLUSION Abnormal repolarization parameters may be observed in patients with SSc. However, their prognostic significance with regard to increased risk for repolarization-associated ventricular arrhythmias and increased cardiac death could not be determined in this study. Our findings endorse additional studies on this matter.
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Affiliation(s)
- Udi Nussinovitch
- Department of Cardiology, Meir Medical Center, Kfar Saba,
Israel,Applicative Cardiovascular Research Center (ACRC), Meir Medical Center, Kfar Saba,
Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel
| | - Gil Beeri
- Department of Cardiology, Meir Medical Center, Kfar Saba,
Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel
| | - Shiri Rubin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel,Unit of Rheumatology, Chaim Sheba Medical Center, Tel Hashomer,
Israel
| | - Yair Levi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel,Department of Medicine E, Meir Medical Center, Kfar Saba,
Israel
| | - Avi Livneh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel,Unit of Rheumatology, Chaim Sheba Medical Center, Tel Hashomer,
Israel,Department of Medicine and the Heller Institute of Medical Research, Chaim Sheba Medical Center, Tel Hashomer,
Israel
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23
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Kharouf F, Eviatar T, Braun M, Pokroy-Shapira E, Brodavka M, Agmon-Levin N, Toledano K, Oren S, Lidar M, Tavor Y, Amit Vazina M, Sabbah F, Breuer G, Dagan A, Zisman D, Markovits D, Reitblat T, Giryes S, Mevorach D, Paran D, Elkayam O, Balbir-Gurman A, Braun-Moscovici Y. POS1217 THE PATTERN OF COVID 19 PANDEMIC AMONG PATIENTS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES (AIIRD). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The epidemiology of COVID19 among patients with AIIRD may be influenced by a dysregulated immune system, immunosuppressive therapies and behavioral patterns. Data regarding the epidemiology of COVID19 among patients with AIIRD is scarce.Objectives:To assess the pattern of COVID19 pandemic among patients with AIIRD compared to the general population in IsraelMethods:At the beginning of the COVID-19 pandemic, we established a national registry of patients with AIIRD, diagnosed with COVID-19, based on voluntary reporting by the treating rheumatologist. All the members of the Israeli Society of Rheumatology were encouraged to participate and repeatedly reminded to report any new cases. Rheumatology centers from 11 hospitals from the Northern and Central part of Israel participated in this study. The registry included demographic data, AIIRD diagnosis and duration, systemic organ involvement, co-morbidities, treatment (conventional synthetic disease modifying drugs (csDMARDs), biologic/targeted (b/ts) DMARDs, corticosteroids use, dose and treatment duration, date of COVID19 diagnosis, severity of the viral disease and complications, duration of hospitalization, if required, treatment for COVID 19, laboratory results and outcome. The diagnosis of COVID 19 was made by a positive SARS CoV2 PCR. The indications for SARS CoV2 PCR testing in Israel comprise clinical symptoms or exposure to a confirmed close contact. Severe illness was defined by SpO2 <94% in room air, respiratory rate of >30 breaths/min, PaO2/FiO2 <300 mm Hg, or lung infiltrates >50% on chest imaging.The epidemiological data regarding the number of COVID19 confirmed patients, the number of severe cases and the rate of mortality among the general population per day and per week, were extracted from the data dashboard of the Israeli Ministry of Health. We analyzed data from 02.2020 to 15.01.2021.Results:During the study period we experienced 3 waves of COVID 19 pandemic. The governmental management of COVID19 spread, at the beginning of the pandemic, included inforcement of severe travel restrictions and social distancing, followed eventually by a preventive lockdown, in spite of the relatively low number of cases. Easing of the restrictions, lifting the travel ban, opening of the commerce and schools led to 2 much more severe waves, which triggered 2 new lockdowns. Up to January 2021, 549763 Israelis had confirmed COVID19, 30% of whom had severe disease, 0.84% died (30% of the patients with severe disease).We identified 190 AIIRD patients (mean(SD) age 52(18), 30% males) who had confirmed COVID19. The weekly incidence curve of patients with rheumatic diseases correlated with the curve of the general population (Figure 1).Sixty-one % of the patients with AIIRD received csDMARDs, 41% were on b/tsDMARDs, 39% on chronic corticosteroids, 12% on ≥10mg prednisone. Forty-seven% of patients required hospitalization, 20% had severe COVID19. Sixteen patients (42% of patients with severe COVID19) (mean(SD), median age 64.7(15.4),67)) died (systemic sclerosis-4 patients, rheumatoid arthritis – 6, systemic lupus erythematosus – 2, antiphospholipid syndrome-2, granulomatous polyangiitis -1, polymyalgia rheumatica-1). The AIIRD was active in 56% of them, 50% received csDMARDs, none of them were on b/tsDMARDs, 31% received chronic prednisone>10 mg. All patients who died had at least 2 comorbidities.Conclusion:The pattern of spread of COVID19 in AIIRD patients is similar to the general population despite repeated mass media alerts for enhanced social distancing for elderly and immune suppressed patients. The disease tends to be more severe with enhanced mortality, especially in those with active AIIRD disease and organ involvement (lungs, heart, renal), older age and co-morbidities. A reporting bias cannot be excluded.Figure 1.Acknowledgements:Both first authors contributed equally to the manuscript.Disclosure of Interests:None declared.
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24
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Tocut M, Lidar M. [A CASE OF A WOMAN WITH VISION LOSS AND LOWER EXTREMITY ULCERS]. Harefuah 2021; 160:332-333. [PMID: 34028228] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Milena Tocut
- Department of Internal Medicine C, Wolfson Medical Center
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Merav Lidar
- Department of Rheumatology, Sheba Medical Center
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
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25
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Watad A, De Marco G, Mahajna H, Druyan A, Eltity M, Hijazi N, Haddad A, Elias M, Zisman D, Naffaa ME, Brodavka M, Cohen Y, Abu-Much A, Abu Elhija M, Bridgewood C, Langevitz P, McLorinan J, Bragazzi NL, Marzo-Ortega H, Lidar M, Calabrese C, Calabrese L, Vital E, Shoenfeld Y, Amital H, McGonagle D. Immune-Mediated Disease Flares or New-Onset Disease in 27 Subjects Following mRNA/DNA SARS-CoV-2 Vaccination. Vaccines (Basel) 2021; 9:vaccines9050435. [PMID: 33946748 PMCID: PMC8146571 DOI: 10.3390/vaccines9050435] [Citation(s) in RCA: 244] [Impact Index Per Article: 81.3] [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: 03/14/2021] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Infectious diseases and vaccines can occasionally cause new-onset or flare of immune-mediated diseases (IMDs). The adjuvanticity of the available SARS-CoV-2 vaccines is based on either TLR-7/8 or TLR-9 agonism, which is distinct from previous vaccines and is a common pathogenic mechanism in IMDs. METHODS We evaluated IMD flares or new disease onset within 28-days of SARS-CoV-2 vaccination at five large tertiary centres in countries with early vaccination adoption, three in Israel, one in UK, and one in USA. We assessed the pattern of disease expression in terms of autoimmune, autoinflammatory, or mixed disease phenotype and organ system affected. We also evaluated outcomes. FINDINGS 27 cases included 17 flares and 10 new onset IMDs. 23/27 received the BNT - 162b2 vaccine, 2/27 the mRNA-1273 and 2/27 the ChAdOx1 vaccines. The mean age was 54.4 ± 19.2 years and 55% of cases were female. Among the 27 cases, 21 (78%) had at least one underlying autoimmune/rheumatic disease prior the vaccination. Among those patients with a flare or activation, four episodes occurred after receiving the second-dose and in one patient they occurred both after the first and the second-dose. In those patients with a new onset disease, two occurred after the second-dose and in one patient occurred both after the first (new onset) and second-dose (flare). For either dose, IMDs occurred on average 4 days later. Of the cases, 20/27 (75%) were mild to moderate in severity. Over 80% of cases had excellent resolution of inflammatory features, mostly with the use of corticosteroid therapy. Other immune-mediated conditions included idiopathic pericarditis (n = 2), neurosarcoidosis with small fiber neuropathy (n = 1), demyelination (n = 1), and myasthenia gravis (n = 2). In 22 cases (81.5%), the insurgence of Adverse event following immunization (AEFI)/IMD could not be explained based on the drug received by the patient. In 23 cases (85.2%), AEFI development could not be explained based on the underlying disease/co-morbidities. Only in one case (3.7%), the timing window of the insurgence of the side effect was considered not compatible with the time from vaccine to flare. INTERPRETATION Despite the high population exposure in the regions served by these centers, IMDs flares or onset temporally-associated with SARS-CoV-2 vaccination appear rare. Most are moderate in severity and responsive to therapy although some severe flares occurred. FUNDING none.
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Affiliation(s)
- Abdulla Watad
- Department of Medicine ‘B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 10457, Israel; (A.W.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
| | - Gabriele De Marco
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
| | - Hussein Mahajna
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Gastroenterology Department, Sheba Medical Center, Tel-Aviv 10457, Israel
| | - Amit Druyan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Mailam Eltity
- Department of Neurology, Sheba Medical Center, Tel-Aviv 10457, Israel;
| | - Nizar Hijazi
- Rheumatology Unit, Carmel Medical Center, Michal Street, Haifa 3436212, Israel; (N.H.); (A.H.); (M.E.); (D.Z.); (M.A.E.)
| | - Amir Haddad
- Rheumatology Unit, Carmel Medical Center, Michal Street, Haifa 3436212, Israel; (N.H.); (A.H.); (M.E.); (D.Z.); (M.A.E.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Muna Elias
- Rheumatology Unit, Carmel Medical Center, Michal Street, Haifa 3436212, Israel; (N.H.); (A.H.); (M.E.); (D.Z.); (M.A.E.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Michal Street, Haifa 3436212, Israel; (N.H.); (A.H.); (M.E.); (D.Z.); (M.A.E.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Mohammad E. Naffaa
- Department of Rheumatology, Galilee Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Safed 22100, Israel;
| | - Michal Brodavka
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Yael Cohen
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Arsalan Abu-Much
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Tel Aviv 10457, Israel;
| | - Muhanad Abu Elhija
- Rheumatology Unit, Carmel Medical Center, Michal Street, Haifa 3436212, Israel; (N.H.); (A.H.); (M.E.); (D.Z.); (M.A.E.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Charlie Bridgewood
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
| | - Pnina Langevitz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Joanna McLorinan
- Department of Rheumatology, Mid Yorkshire Hospitals, West Yorkshire WF8 1PL, UK;
| | - Nicola Luigi Bragazzi
- Centre for Disease Modelling, Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
- Fields-CQAM Laboratory of Mathematics for Public Health (MfPH), York University, Toronto, ON M3J 1P3, Canada
- Correspondence: (N.L.B.); (D.M.)
| | - Helena Marzo-Ortega
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Cassandra Calabrese
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A50, Cleveland, OH 44195, USA; (C.C.); (L.C.)
| | - Leonard Calabrese
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A50, Cleveland, OH 44195, USA; (C.C.); (L.C.)
| | - Edward Vital
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
| | - Yehuda Shoenfeld
- Department of Medicine ‘B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 10457, Israel; (A.W.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
| | - Howard Amital
- Department of Medicine ‘B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 10457, Israel; (A.W.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Dennis McGonagle
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
- Correspondence: (N.L.B.); (D.M.)
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Haj-Yahia S, Ben-Zvi I, Lidar M, Livneh A. Familial Mediterranean fever (FMF)-response to TNF-blockers used for treatment of FMF patients with concurrent inflammatory diseases. Joint Bone Spine 2021; 88:105201. [PMID: 33932573 DOI: 10.1016/j.jbspin.2021.105201] [Citation(s) in RCA: 3] [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: 01/06/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Familial Mediterranean fever (FMF) is the most common interleukin 1 (IL-1)-driven monogenic autoinflammatory disease. Yet published data also suggest that tumor necrosis factor (TNF) may have a role in the pathogenesis of FMF and may serve as a target for treatment. In the present study we evaluate this hypothesis. METHODS To this goal, we studied the incidental effect on FMF of TNF-directed treatment, administered to colchicine-refractory FMF patients for the management of a concurrent inflammatory disease. The rates of FMF patients and of treatments with complete or nearly complete FMF response were determined, based on the number of FMF attacks during TNF-blocker exposures. The possible effect of various FMF and non-FMF features on the outcome was determined using comparative analysis. Patients were identified and data were retrieved using electronic files from the FMF clinic. RESULTS Twenty-six patients were identified, each receiving ≥1 of four TNF-blockers for a mean duration of 27.6±16.4months. The TNF-blockers were found to induce complete or nearly complete FMF response in 10 (38.5%) of the patients, and in 13 of 50 (26%) exposures. No clinical, genetic, demographic, or therapeutic feature could predict which FMF patient would respond favorably to TNF-blocker therapy. CONCLUSION This study suggests that TNF-blockers may be beneficial for a small proportion of colchicine-resistant FMF patients.
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Affiliation(s)
- Soad Haj-Yahia
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ilan Ben-Zvi
- Heller Institute of Medical Research, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Rheumatology Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Department of Medicine F, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Talpiot Medical Leadership Program, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Merav Lidar
- Rheumatology Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Livneh
- Heller Institute of Medical Research, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Rheumatology Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Department of Medicine F, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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27
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Tocut M, Lidar M. [A severe case of deformative rheumatoid arthritis]. Harefuah 2021; 160:186-187. [PMID: 33749183] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Milena Tocut
- Department of Internal Medicine C, Wolfson Medical Center
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Merav Lidar
- Department of Rheumatology, Sheba Medical Center
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Druyan A, Lidar M, Brodavka M, Levy I, Barzilai A, Pavlotsky F. The risk for severe COVID 19 in patients with autoimmune and/or inflammatory diseases: First wave lessons. Dermatol Ther 2020; 34:e14627. [PMID: 33277764 PMCID: PMC7883029 DOI: 10.1111/dth.14627] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/29/2022]
Abstract
Data regarding the risk for severe COVID19 in patients with autoimmune or inflammatory diseases are scarce. To estimate the risk of those patients to develop a more severe COVID19 infection All active patients and those with dermatologic and/or rheumatologic autoimmune/inflammatory diseases were identified in a single tertiary center. The charts of those tested positive for COVID19 between 1 March 2020 and 31 May 2020 reviewed including demographics, co‐morbidities, and medications. COVID19 outcome of those with dermatologic and/or rheumatologic autoimmune/inflammatory diseases were compared to COVID19 infected matched controls without an autoimmune/inflammatory background. Overall, 974 of 381 268 active patients were tested positive for COVID19, including 35 out of 13 225 with dermatologic and/or rheumatologic autoimmune/inflammatory diseases. No statistically significant difference in severity of COVID19 infection or mortality rate was found. The rate of asymptomatic, mild, moderate, severe/critical and fatal COVID19 infection was 11.4%, 37.1%, 22.8%, 11.4%, and 17.1%, respectively, for the patients with autoimmune diseases and 17.8%, 45.8%, 10.9%, 6.8%, and 18.4%, respectively for the controls . Patients with autoimmune/inflammatory diseases seem not to develop a more severe COVID19 infection than controls.
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Affiliation(s)
- Amit Druyan
- Department of Medicine F, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Brodavka
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itzchak Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Aviv Barzilai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Felix Pavlotsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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29
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Watad A, McGonagle D, Bragazzi NL, Damiani G, Comaneshter D, Lidar M, Cohen AD, Amital H. Systemic sclerosis is an independent risk factor for ischemic heart disease, especially in patients carrying certain antiphospholipid antibodies: A large cross-sectional study. Eur J Intern Med 2020; 81:44-49. [PMID: 32620499 DOI: 10.1016/j.ejim.2020.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/05/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND A higher prevalence of ischemic heart disease (IHD) in patients with systemic sclerosis (SSc) was reported. However, contrasting findings were published concerning the role of SSc-related autoantibodies in IHD risk which remains controversial. The current study explored the link between SSc and IHD, impact of putative links on SSc mortality and the role of SSc-related and antiphospholipid autoantibodies in disease associated IHD. METHODS A large cohort study utilising the Clalit-Health-Service (CHS) database was conducted on 2431 SSc patients and 12,710 age- and sex matched controls. The proportion of IHD was compared between patients diagnosed with SSc and age- and gender-matched controls. The role of SSc-linked and antiphospholipid autoantibodies in disease associated IHD was assessed. RESULTS The prevalence rate of IHD was significantly higher in SSc than controls (20.4% vs 15.0%, p <0.001). At the multivariate analysis, SSc was an independent predictor of IHD with an OR of 1.91 (95%CI 1.57-2.31, p < 0.0001). SSc patients with IHD had a higher mortality rate with an HR of 2.67 (95%CI 2.03-3.53, p < 0.0001) than those without IHD. In SSc patients positivity for anti-beta2GPI (IgM-isotype) or anti-cardiolipin (aCL) (IgA-isotype) represented a risk factor for IHD with an OR 1.89 (95% 1.04-3.45, p = 0.0369) and OR of 3.72 (95% 1.25-11.11, p = 0.0184), respectively. CONCLUSIONS Patients with SSc are at higher risk for developing IHD with an additional risk for the latter in those positive for aCL or anti-beta2GPI. A high degree of suspicion is needed during routine patient follow-up and pre-emptive screening should be considered.
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Affiliation(s)
- Abdulla Watad
- Department of Medicine 'B', The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
| | - Dennis McGonagle
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Nicola L Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Canada
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Doron Comaneshter
- Chief Physician's Office, Faculty of Health Sciences, Clalit Health Services Tel Aviv, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Faculty of Health Sciences, Clalit Health Services Tel Aviv, Israel; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine 'B', The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Abstract
18F-FDG PET/CT occupies a growing role in the diagnosis of large vessel vasculitis (LVV), illustrating enhanced uptake in the lining of large vessels. A retrospective single center study was conducted of patients who underwent 18F-FDG PET/CT scans between 2009 and 2019 at Sheba Medical Center, Israel. The imaging results were analyzed for evidence of LVV. We reviewed the PET/CT scans of 126 patients and identified 57 studies that either showed evidence of active LVV or that had been performed in patients previously treated for systemic vasculitis. In 6 patients with fevers of unknown origin and elevated inflammatory markers, PET/CT revealed LVV. Six of 13 patients previously treated for systemic vasculitis demonstrated persistent large vessel uptake. LVV was identified in 8 patients with other autoimmune diseases, and in 4 diagnosed with infectious aortitis. In 26 patients who underwent malignancy surveillance, PET/CT revealed more localized large vessel wall inflammation. Our results illustrate that PET/CT may identify large vessel wall inflammation in patients with a suspicion of LVV, and incidentally in patients who undergo malignancy surveillance. PET/CT may also help delineate the presence and extent of vessel inflammation in patients with LVV and in those with other autoimmune diseases.
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Affiliation(s)
- Jennifer Ben Shimol
- Department of Medicine, E. Wolfson Medical Center, Holon, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Howard Amital
- Department of Medicine, 'B' and Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Saint Petersburg Research Institute of Phthisiopulmonology, Saint-Petersburg, Russian Federation
| | - Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Langevitz P, Lidar M, Rosner I, Feld J, Tishler M, Amital H, Aamar S, Elkayam O, Balbir-Gurman A, Abu-Shakra M, Mevorach D, Kimhi O, Molad Y, Kuperman A, Ehrlich S. A Study of the Efficacy and Safety of Subcutaneous Injections of Tocilizumab in Adults with Rheumatoid Arthritis. Isr Med Assoc J 2020; 22:557-563. [PMID: 33236554] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Tocilizumab is an interleukin 6 (IL-6) receptor antagonist used treat moderate to severe active rheumatoid arthritis (RA). Both intravenous (IV) and subcutaneous (SC) routes are approved for the treatment of adults with RA. OBJECTIVES To evaluate SC tocilizumab in a real-life clinical setting. METHODS Our study was a multi-center, open-label, single-arm study. Participants were adults with a diagnosis of active RA, previously treated with disease-modifying antirheumatic drugs (DMARDs), with or without biologic agents. Participants received a weekly SC injection of tocilizumab 162 mg as monotherapy or in combination with methotrexate or DMARDs for 24 weeks. Efficacy, safety, and immunogenicity were assessed. RESULTS Treatment of 100 patients over 24 weeks resulted in improvement in all efficacy parameters assessed: Clinical Disease Activity Index, Disease Activity Score using 28 joint counts and erythrocyte sedimentation rate, American College of Rheumatology response scores, Simplified Disease Activity Index, tender and swollen joint counts, and patient-reported outcomes including fatigue, global assessment of disease activity, pain, and Health Assessment Quality of Life Disease Index. Improvement was achieved as early as the second week of treatment. There were 473 adverse events (AEs)/100 patient-years (PY) and 16.66 serious AEs/100 PY. The most common AEs were neutropenia (12%), leukopenia (11%), and increased hepatic enzymes (11%). Of a total of 42 PY, the rates of serious infections and AEs leading to discontinuation were 4.8, and 11.9 events/100 PY, respectively. CONCLUSIONS The safety, tolerability, and efficacy profile of tocilizumab SC were comparable to those reported in other studies evaluating the IV and SC routes of administration.
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Affiliation(s)
- Pnina Langevitz
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
| | - Itzhak Rosner
- Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel
| | - Joy Feld
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Moshe Tishler
- Department of Internal Medicine B, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Howard Amital
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel
| | - Suhail Aamar
- Rheumatology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Mahmoud Abu-Shakra
- Rheumatology Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Dror Mevorach
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Oded Kimhi
- Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel
| | - Yair Molad
- Rheumatology Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ana Kuperman
- Rheumatology Clinic, Rabin Medical Center (Hasharon Campus), Petah Tikva, Israel
| | - Sharon Ehrlich
- Roche Pharmaceuticals (Israel) Ltd., Hod HaSharon, Israel
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Tiosano S, Yavne Y, Watad A, Langevitz P, Lidar M, Feld J, Tishler M, Aamar S, Elkayam O, Balbir-Gurman A, Molad Y, Ehrlich S, Abu-Shakra M, Amital D, Amital H. The impact of tocilizumab on anxiety and depression in patients with rheumatoid arthritis. Eur J Clin Invest 2020; 50:e13268. [PMID: 32478417 DOI: 10.1111/eci.13268] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/25/2020] [Accepted: 05/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mood disorders, such as anxiety and depression, are extremely prevalent among patients with rheumatoid arthritis (RA). In this study, we assessed the impact of treatment with tocilizumab (TCZ), an IL-6 antagonist, upon anxiety and depressive symptoms in a cohort of RA patients. MATERIALS AND METHODS Study participants were adults diagnosed with RA who received a weekly subcutaneous injection of tocilizumab for 24 weeks. We used the Hamilton Depression (HDRS) and Anxiety (HAMA) scores in order to assess the severity of depression and anxiety, respectively. RA disease activity indices and depression and anxiety levels were assessed at baseline, 4 weeks and study completion. RESULTS Ultimately, 91 patients were included in the study. The mean age was 54 years, and the majority were female (79%). The mean score in all disease activity indices as well as depression and anxiety levels decreased dramatically from baseline to study completion. Sixty patients (66%) demonstrated a significant decrease in anxiety and/or depression levels. When logistic regression was performed, an HDRS score indicative of depression at study baseline demonstrated an independent association with a significant psychiatric response whilst older age and increased baseline weight were negatively associated. HAMA and HDRA scores correlated with the following RA disease activity parameters, respectively; HAQ-DI (r = .4, .42), DAS28 (r = .29, .32) and CDAI (0.28 and 0.33), all of them were statistically significant (P < .01). CONCLUSIONS This study has demonstrated a favourable impact of TCZ therapy on parameters reflecting depression and anxiety severity in patients with RA.
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Affiliation(s)
- Shmuel Tiosano
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yarden Yavne
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Abdulla Watad
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Pnina Langevitz
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Rheumatology Disease Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Merav Lidar
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Rheumatology Disease Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Joy Feld
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Moshe Tishler
- Internal Department B, Assaf Harofeh Medical Center, Zrifin, Israel
| | - Suhail Aamar
- Rheumatology Unit, Hadassah Mount Scopus Medical Center, Jeursalem, Israel
| | - Ori Elkayam
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Yair Molad
- Institute of Rheumatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Ehrlich
- Roche Pharmaceuticals (Israel) Ltd., Hod HaSharon, Israel
| | - Mahmoud Abu-Shakra
- Soroka University Medical Center Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniela Amital
- Ness Ziona Beer-Yaacov Mental Health Center, Beer Yaakov, Israel
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
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Tocut M, Lidar M. [A severe case of deformative rheumatoid arthritis]. Harefuah 2020; 159:524-525. [PMID: 32720773] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Milena Tocut
- Department of Internal Medicine C, Wolfson Medical Center, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Merav Lidar
- Department of Rheumatology, Sheba Medical Center, Israel
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Watad A, Mcgonagle D, Bragazzi NL, Comanesther D, Cohen A, Lidar M, Amital H. SAT0603 SYSTEMIC SCLEROSIS IS AN INDEPENDENT RISK FACTOR FOR ISCHEMIC HEART DISEASE WITH AN ADDITIONAL RISK IN THOSE POSITIVE FOR CERTAIN ANTI-PHOSPHOLIPID ANTIBODIES: A VERY LARGE CASE-CONTROL STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:A higher prevalence of ischemic heart disease (IHD) in patients with systemic sclerosis (SSc) was reported. However, contrasting findings were published concerning the role of SSc-related autoantibodies in IHD risk which remains controversial.Objectives:The current study explored the link between SSc and IHD, impact of putative links on SSc mortality and the role of SSc-related and antiphospholipid autoantibodies in disease associated IHD.Methods:A large cohort study utilising the Clalit-Health-Service (CHS) database was conducted on 2,431 SSc patients and 12,710 age- and sex matched controls. The proportion of IHD was compared between patients diagnosed with SSc and age- and gender-matched controls. The role of SSc-linked and antiphospholipid autoantibodies in disease associated IHD was assessed.Results:The rate of IHD was significantly higher in SSc than controls (20.4%vs15.0%, p<0.001). At the multivariate analysis, SSc was an independent predictor of IHD with an OR of 1.91 (95%CI 1.57-2.31, p<0.0001). SSc patients with IHD had a higher mortality rate with an HR of 2.67 (95%CI 2.03-3.53, p<0.0001) than those without IHD. SSc patients with positive anti-beta2GPI (IgM-isotype) or anti-cardiolipin (aCL) (IgA-isotype) exhibited a higher risk of IHD than SSc patients without these antibodies with an OR 1.89 (95% 1.04-3.45, p=0.0369) and OR of 3.72 (95% 1.25-11.11, p=0.0184), respectively.Conclusion:Patients with SSc are at higher risk for developing IHD with an additional risk for the latter in those positive for aCL or anti-beta2GPI. A high degree of suspicion is needed during routine patient follow-up and pre-emptive screening should be considered.Disclosure of Interests:Abdulla Watad: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC, Nicola Luigi Bragazzi: None declared, Doron Comanesther: None declared, Arnon Cohen: None declared, Merav Lidar: None declared, Howard Amital: None declared
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Eviatar T, Zisman D, Lidar M, Reitblat T, Balbir-Gurman A, Elkayam O. FRI0337 REAL WORLD SECUKINUMAB DRUG-SURVIVAL IN PSORIATIC ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Secukinumab (Cosentyx) is a human IgG1 monoclonal antibody that selectively binds to and neutralizes IL-17A. Several prospective randomized control trials have demonstrated the efficacy and safety of secukinumab in PsA, but there is a paucity of real life data in the PsA population.Objectives:To prospectively study secukinumab’s safety, efficacy, and tolerability in the cohort of PsA patients from the Israeli registry of inflammatory diseases.Methods:PsA patients fulfilling the CASPAR criteria from the Israeli registry of inflammatory diseases were included in the analysis, from 2010 to November 2019. The primary end point was secukinumab drug survival compared to other available TNFi drug. Bivariate and multivariate analysis of the factors that affect the drug event free survival was done by cox regression analysis. Drug survival according to treatment line (all treatment lines, or 2ndand above treatment lines) was examined using Kaplan-Meier curves.Results:Four hundred and four PsA patients were included, which had 709 treatment episodes (initiations) during the study period. Ninety patients had been treated with secukinumab (22%). Secukinumab treated patients were significantly older at time of initiation of treatment, and disease duration was longer. Secukinumab was more likely to be a second, third or forth line of treatment than the TNFi. . Time to an inefficacy event was longer for secukinumab than any other anti-TNF treatment. As a first line treatment secukinumab had drug survival similar to other TNFi. As a second or third line treatment, secukinumab had a better drug survival than other TNFi. Methotrexate did not have a significant effect on inefficacy event rate in combination treatment with secukinumab. Secukinumab, as infliximab and golimumab, was as effective in the higher BMI group as it was in the normal weight to obese groups. Smokers (current or past) did better on secukinumab than on TNFi. Secukinumab had a similar rate of adverse events compared to TNFi.Conclusion:In this multicenter real world study, secukinumab had a comparable drug survival to TNFi. As a second and beyond line of treatment secukinumab had a better drug survival and lower HR for an inefficacy event. IL-17 inhibition is an effective mechanism of action to treat PsA in real life, and should be used more frequently as a first and second line treatment.Tables and a graph:Table 1.Inefficacy events according to treatment and drug survival in 1, 2, and 3 years.DrugTotal episodesInefficacy events (%)HR95% CIP value1styear survival %2ndyear survival %3rdyear survival %SEC9030 (33.3)10.095865841ETA20286 (42.6)1.160.77-1.760.479755850IFX8734 (39.1)1.010.62-1.650.966826452ADA227103 (45.4)1.360.9-2.040.143715346GOL103103 (50)1.641.05-2.590.031635042Table 2.inefficacy events and drug survival according to line of treatment.DrugTotal episodesInefficacy events (%)HR95% CIP value1styear survival %2ndyear survival %3rdyear survival %1stlineSEC132 (15.4)10.216929276ETA13055 (42.3)3.250.79-13.340.101765951IFX2811 (39.3)2.880.64-13.010.168816352ADA10337 (35.9)2.630.63-10.910.183796359GOL2514 (56)4.551.03-200.0456050402ndand 3rdlinesSEC347 (20.6)10.039906666ETA6829 (42.6)1.680.74-3.850.218735751IFX5120 (39.2)1.420.6-3.360.431856454ADA11962 (52.1)2.51.15-5.480.022654635GOL5223 (44.2)2.260.97-5.270.066550464thlineSEC4321 (48.8)10.082824424ETA42 (50)1.10.25-4.730.9026733–IFX83 (37.5)0.830.25-2.790.7626969–ADA54 (80)4.871.6-14.810.00530––GOL2613 (50)1.290.64-2.580.473625231Figure 1.Cumulative survival without an inefficacy event of secukinumab compared to TNFα inhibitors regardless of treatment line.Disclosure of Interests:Tali Eviatar: None declared, Devy Zisman Consultant of: Novartis, Merav Lidar Consultant of: Novartis, Tatyana Reitblat Consultant of: Novartis, Alexandra Balbir-Gurman Consultant of: Novartis, Ori Elkayam Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Novartis, Jansen
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Watad A, Mcgonagle D, Lidar M, Bragazzi NL, Comanesther D, Cohen A, Amital H. OP0253 AUTOANTIBODY STATUS IN DERMATOMYOSITIS AND POLYMYOSITIS PATIENTS DEFINES BOTH CANCER RISK AND SURVIVAL WITH ANA NEGATIVITY IN CASES WITH CONCOMITANT CANCER HAVING A WORSE SURVIVAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:We previously reported that ANA-negative cases with systemic sclerosis (SSc) and concomitant cancer had a worse survival than ANA-positive cases with associated cancer possibly suggesting that humoral mediated autoimmunity conferred a survival advantage (1). Dermatomyositis (DM) and polymyositis (PM) are two immune-mediated myopathies associated with numerous autoantibodies.Objectives:The present large-scale, population-based study tested the hypothesis that humoral autoimmunity associated with cancer in solid/haematological malignancies impacted on DM/PM patient survival.Methods:Over 2000 cases with either DM or PM were recruited from the Clalit Health Service (CHS) chronic diseases registry, one of the largest healthcare maintenance Israeli organization, serving approximately half of the entire country’s population. Over 10000 matched controls were recruited. The data collected range from 2000 to 2018.Results:Altogether 12,278 subjects were recruited (2,085 cases, and 10,193 controls, 5,042 males, 41.1%, and 7,236 females, 58.9%). Among cases, 1,475 individuals (70.7%) were diagnosed with DM, whereas 610 (29.3%) with PM. Mean age was 47.81±22.51 years. 1,379 cases of cancers (11.2%) were diagnosed. At the univariate analysis and as expected, the rate of malignancies was significantly (p<0.0001) higher in DM/PM (n=361, 17.3%) with respect to controls (n=1,018, 10.0%).Concerning prognosis, ANA positivity in PM/DM was associated with a better prognosis for all cancers (OR 0.39 [95% 0.24-0.63], p=0.0001). For individual cancer types; thyroid cancer (OR 0.39 [95% 0.24-0.63], p=0.0001), gastric cancer (OR 0.40 [95% 0.25-0.64], p=0.0001), kidney cancer (OR 0.39 [95% 0.24-0. 62], p=0.0001), acute leukaemia (OR 0.40 [95% 0.25-0.65], p=0.0002), non-Hodgkin’s lymphoma (OR 0.39 [95% 0.25-0.63], p=0.0001), but not for myelodysplastic syndrome.The main cancers linked to PM/DM were thyroid cancer (OR 3.17 [95%CI 2.27-4.43]), gastric cancer (OR 5.96 [95%CI 4.24-8.38]), kidney cancer (OR 3.83 [95%CI 1.02-14.31], p=0.0462), and myelodysplastic syndrome (OR 2.01 [95%CI 1.17-3.46], p=0.0111). Regarding gastric cancer, positivity for anti-RNP (OR 5.68 [95%CI 3.02 to 10.71], p<0.0001), anti-SSA (OR 21.99 [95%CI 11.21 to 43.14], p<0.0001), and anti-Jo1 (OR 12.23 [95%CI 7.12 to 21.01], p<0.0001) was associated with a higher risk of cancer development.Conclusion:ANA positivity is an independent predictor of favorable prognosis in PM/DM patients with cancer, possibly suggesting that cancer directed humoral autoimmunity may have some benefit. Therefore, humoral autoimmunity in SSc and PM/DM is a broad mechanism that confers a survival advantage and is relevant for disease understanding and elucidating optimal anti tumoural immunity in the current age of cancer immunotherapy.References:[1]Watad A, McGonagle D, Bragazzi NL, Tiosano S, Comaneshter D, Shoenfeld Y, Cohen AD, Amital H. Autoantibody status in systemic sclerosis patients defines both cancer risk and survival with ANA negativity in cases with concomitant cancer having a worse survival. Oncoimmunology. 2019 Mar 24;8(6):e1588084.Disclosure of Interests:Abdulla Watad: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC, Merav Lidar: None declared, Nicola Luigi Bragazzi: None declared, Doron Comanesther: None declared, Arnon Cohen: None declared, Howard Amital: None declared
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Oude Voshaar MAH, Das Gupta Z, Bijlsma JWJ, Boonen A, Chau J, Courvoisier DS, Curtis JR, Ellis B, Ernestam S, Gossec L, Hale C, Hornjeff J, Leung KYY, Lidar M, Mease P, Michaud K, Mody GM, Ndosi M, Opava CH, Pinheiro GRC, Salt M, Soriano ER, Taylor WJ, Voshaar MJH, Weel AEAM, de Wit M, Wulffraat N, van de Laar MAFJ, Vonkeman HE. International Consortium for Health Outcome Measurement Set of Outcomes That Matter to People Living With Inflammatory Arthritis: Consensus From an International Working Group. Arthritis Care Res (Hoboken) 2020; 71:1556-1565. [PMID: 30358135 PMCID: PMC6900179 DOI: 10.1002/acr.23799] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023]
Abstract
Objective The implementation of value‐based health care in inflammatory arthritis requires a standardized set of modifiable outcomes and risk‐adjustment variables that is feasible to implement worldwide. Methods The International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary working group that consisted of 24 experts from 6 continents, including 6 patient representatives, to develop a standard set of outcomes for inflammatory arthritis. The process followed a structured approach, using a modified Delphi process to reach consensus on the following decision areas: conditions covered by the set, outcome domains, outcome measures, and risk‐adjustment variables. Consensus in areas 2 to 4 were supported by systematic literature reviews and consultation of experts. Results The ICHOM Inflammatory Arthritis Standard Set covers patients with rheumatoid arthritis (RA), axial spondyloarthritis, psoriatic arthritis, and juvenile idiopathic arthritis (JIA). We recommend that outcomes regarding pain, fatigue, activity limitations, overall physical and mental health impact, work/school/housework ability and productivity, disease activity, and serious adverse events be collected at least annually. Validated measures for patient‐reported outcomes were endorsed and linked to common reporting metrics. Age, sex at birth, education level, smoking status, comorbidities, time since diagnosis, and rheumatoid factor and anti‐citrullinated protein antibody lab testing for RA and JIA should be collected as risk‐adjustment variables. Conclusion We present the ICHOM inflammatory arthritis Standard Set of outcomes, which enables health care providers to implement the value‐based health care framework and compare outcomes that are important to patients with inflammatory arthritis.
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Affiliation(s)
| | - Zofia Das Gupta
- International Consortium for Health Outcomes Measurement, London, UK
| | | | - Annelies Boonen
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jeffrey Chau
- Hong Kong Psoriatic Arthritis Association, Hong Kong, China
| | | | | | | | | | - Laure Gossec
- Sorbonne Université and Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | | | | | - Katy Y Y Leung
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | | | - Phillip Mease
- Providence St. Joseph Health System, University of Washington, Seattle
| | - Kaleb Michaud
- University of Nebraska Medical Center Omaha, and the National Databank for Rheumatic Diseases, Wichita, Kansas
| | | | | | | | | | - Matthew Salt
- International Consortium for Health Outcomes Measurement, London, UK
| | - Enrique R Soriano
- Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Maarten de Wit
- VU University Medical Centre, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Nico Wulffraat
- Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Mart A F J van de Laar
- University of Twente, Enschede, The Netherlands, and International Consortium for Health Outcomes Measurement, London, UK
| | - Harald E Vonkeman
- University of Twente, Enschede, The Netherlands, and International Consortium for Health Outcomes Measurement, London, UK
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Broitman S, Herman A, Stern M, Lidar M, Eshed I. Enthesopathy of the anterior chest wall joints in patients with diffuse idiopathic skeletal hyperostosis (DISH): a retrospective analysis of computed tomography scans. Skeletal Radiol 2020; 49:461-467. [PMID: 31501958 DOI: 10.1007/s00256-019-03307-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate and characterize anterior chest wall (ACW) joint's enthesopathy on CT scans in patients with DISH compared with age- and gender-matched control group. MATERIAL AND METHODS Retrospective evaluation for enthesopathy features of ACW joints-sterno-clavicular (SCJ), manubrio-sternal (MSJ), costo-sternal 1-7 (CSJ)-on chest CT scans of subjects with DISH (Resnick criteria) and of age- and gender-matched control subjects was performed. 183 subjects (DISH: 92, control: 91); male:female: 126:57, average age: 71.7 years (range 50-94) were evaluated. Total enthesopathy scores per subjects and per each joint were compared. RESULTS Total enthesopathy score of ACW joints was significantly higher among DISH compared to controls (64.03 ± 15.1, 50.47 ± 12.4, p < 0.001). At joint level, SCJ and CSJ enthesopathy, but not MSJ was significantly more prevalent in DISH compared to controls. CONCLUSION ACW joints' enthesopathy as seen on CT scans, an entity not included in the Resnick classification criteria, is common among DISH subjects. The difference between SCJ and CSJ prevalence compared to MSJ may result from different joint type. ACW joints' enthesopathy may be considered to be included in future modified radiographic criteria for DISH.
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Affiliation(s)
- Shani Broitman
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, 52621, Tel Aviv, Israel
| | - Amir Herman
- Department of Orthopedic Surgery, Assuta Ashdod Medical Center, Ashdod, affiliated to Ben Gurion University, Beer Sheva, Israel
| | - Myriam Stern
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, 52621, Tel Aviv, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, 52621, Tel Aviv, Israel.
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Rotem G, Herman A, Lidar M, Eshed I. Post-traumatic arthritis of the sacroiliac joints mimicking inflammatory sacroiliitis: analysis of consecutive computed tomography examinations. Clin Radiol 2020; 75:433-440. [PMID: 32044095 DOI: 10.1016/j.crad.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 01/08/2020] [Indexed: 12/27/2022]
Abstract
AIM To assess the presence, prevalence and characteristics of post-traumatic, inflammatory-like changes of the sacroiliac joint (SIJ) on pelvic computed tomography (CT). MATERIALS AND METHODS Sequential CT examinations from the acute (index) and follow-up post-traumatic periods of 24 patients that underwent pelvic trauma with SIJ involvement were evaluated and compared to 32 control patients with pelvic fractures that did not involve the SIJs. Index CT was evaluated for the presence of fracture, intra-articular step, and diastasis, whereas follow-up CT was scored for periarticular sclerosis, erosions, ankylosis, and backfill. Clinical follow-up was performed by pain provocation SIJ tests and a questionnaire (study representative subgroup, n=11, 46%) and from clinical files (control group, n=26, 31%). Pearson correlation coefficient was assessed between the index and follow-up CT variables. Linear regression was used to predict the influence of trauma variables on the development of inflammatory-like structural changes. RESULTS Total "structural, arthritis-like lesions' score from the follow-up CT examination was significantly higher in the study compared to the control group (3.25 versus 0.05 respectively, p<0.001). The presence of intra-articular diastasis and fracture were significant risk factors for the development of structural inflammatory-like lesions in the SIJ (1.19 and 2.1 respectively, p<0.001). Painful SIJs by physical examination were found in 50% of the clinically evaluated subgroup which was mechanical by nature in 81.8%. CONCLUSION Traumatic SIJ fracture or diastasis is associated with the development of post-traumatic SIJ structural inflammatory-like lesions on pelvic CT, mimicking sacroiliitis. These findings may be the result of focal, post-traumatic joint inflammation, which leads to mechanical rather than inflammatory symptoms.
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Affiliation(s)
- G Rotem
- Department of Orthopedic Surgery, Sheba Medical Center, 52621, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Herman
- Department of Orthopedic Surgery, Assuta Ashdod Medical Center, 7747629, Affiliated to Ben Gurion University, Beer Sheva, Israel
| | - M Lidar
- Rheumatology Unit, Sheba Medical Center, 52621, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, 52621, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Druyan A, Giat E, Livneh A, Kedem R, Lidar M. [IS THERE A CORRELATION BETWEEN CARRIAGE OF AN MEFV MUTATION AND GOUT?]. Harefuah 2019; 158:576-578. [PMID: 31507107] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Gout is an inflammatory condition mediated by Interleukin-1-beta (IL-1β). A mutation in the MEFV gene (the gene related to Familial Mediterranian fever) may cause an elevation in IL-1β, and is associated with a variety of inflammatory conditions. Reports in the literature are inconsistent as to whether a mutated MEFV gene is related to the phenotype of gout. OBJECTIVES To assess whether a carriage state of a mutation in the MEFV gene correlates with the expression and severity of gout. METHODS A total of 73 patients, 50 with gout and 23 with hyperuricemia were examined for an MEFV mutation. Carriage rate was compared between hyperuricemic and gout patients, and disease activity measures were compared between MEFV mutation carriers and non-carriers. RESULTS We did not find a statistically significant difference in the carriage rate of an MEFV mutation between gout patients and hyperuricemic patients without gout, nor did we find a correlation between MEFV mutation carriage and gout severity. CONCLUSIONS Further large-scale studies should be conducted in order to determine a possible correlation between MEFV mutation carriage and gout.
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Affiliation(s)
- Amit Druyan
- The Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Eitan Giat
- The Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Avi Livneh
- The Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | | | - Merav Lidar
- The Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
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Gazitt T, Oren S, Reitblat T, Lidar M, Gurman AB, Rosner I, Halabe N, Feld J, Kassem S, Lavi I, Elkayam O, Zisman D. Treat-to-target concept implementation for evaluating rheumatoid arthritis patients in daily practice. Eur J Rheumatol 2019; 6:136-141. [PMID: 31329541 DOI: 10.5152/eurjrheum.2019.18195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/14/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We aimed to assess the implementation of the treat-to-target (T2T) concept in rheumatoid arthritis (RA) patients in daily practice. METHODS All RA patients visiting one of the 7 academic medical centers in Israel in June 2015 with at least 3 previous clinic visits were included in this study. A common questionnaire was used to collect data from patients' medical records, and two independent rheumatologists evaluated the collected data for the implementation of the T2T concept. The associations between T2T implementation and the categorical and continuous variables were assessed. RESULTS The study included 724 patients with a mean (standard deviation) age of 62.6 (13.97) years and 575 (80.4%) of them were women. Four centers used more than one scoring method, with Disease Activity Score-28 and Clinical Disease Activity Index) being most commonly used. Only 276 (38.1%) patients had disease score results in ≥3 visits, and the T2T recommendations were implemented for 245 (33.8%) of the 724 patients. The rate of implementation was higher in younger (p=0.028) rheumatoid factor-positive patients (p=0.011) and varied between centers (11.1%-87% p<0.0001). T2T implementation did not correlate to gender, place of residence, education, tobacco use, treatment regimens, and presence of erosions or comorbidities. CONCLUSION The T2T concept was implemented on only 33.8% of patients and was not affected by RA disease severity. Further studies are needed to determine the reasons for this deviation from the T2T standard of care for RA as well as its consequences.
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Affiliation(s)
- Tal Gazitt
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
| | - Shirley Oren
- Department of Rheumatology, Rabin Medical Center, Petah Tikva, Israel
| | - Tatiana Reitblat
- Department of Rheumatology, Barzilai Medical Center, Ashkelon, Israel
| | - Merav Lidar
- Rheumatology Unit, Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Aviv, Israel
| | | | - Itzhak Rosner
- Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel
| | - Nimer Halabe
- Department of Internal Medicine, Carmel Medical Center, Haifa, Israel
| | - Joy Feld
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
| | - Sameer Kassem
- Department of Internal Medicine, Carmel Medical Center, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Devy Zisman
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
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Ben-David H, Livneh A, Lidar M, Feld O, Haj Yahia S, Grossman C, Ben-Zvi I. Toll-like receptor 2 is overexpressed in Familial Mediterranean fever patients and is inhibited by colchicine treatment. Best Pract Res Clin Rheumatol 2019; 32:651-661. [PMID: 31203923 DOI: 10.1016/j.berh.2019.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM To study the role of Toll-like receptor (TLR) 2 in Familial Mediterranean fever (FMF) inflammatory process. METHODS TLR2 expression on monocytes of FMF attack-free patients (n = 20) and the effect of sera of FMF patients with an acute attack (n = 9) on TLR2 expression on monocytes of healthy donors were studied by flow cytometry (FACS). TLR2 expression was also studied in THP-1 cells, and TLR2 downstream signaling was studied by ELISA for the secretion of IL-1β and pro-inflammatory cytokines or by western blotting to measure nuclear factor (NF)-κB. RESULTS FMF attack-free patients had increased CD14 + TLR2+ cell count as compared to healthy donors. High-dose colchicine treatment (≥2 mg/d) inhibited this increased expression in FMF patients. Colchicine in vitro also inhibited TLR2 expression on THP-1 cells. Sera from FMF patients with an acute attack induced TLR2 expression by both monocytes of healthy donors and THP-1 cells as well as pro-inflammatory cytokine secretion by healthy monocytes, while colchicine inhibited this induction. Pam2CSK4 increased interleukin-1β (IL-1β) secretion by peripheral blood mononuclear cells (PBMCs) of healthy donors, and this activation was inhibited by colchicine. THP-1 cells presented elevated NF-κB expression when cultured with Pam2CSK4, whereas colchicine inhibited this elevation. CONCLUSIONS TLR2 activation was upregulated in monocytes of FMF patients, and colchicine inhibited this upregulation both in -vitro and in -vivo. This indicates that elevated expression of TLR2 promotes the production of pro-inflammatory cytokines, which may contribute to uncontrolled inflammation in FMF.
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Affiliation(s)
- Hava Ben-David
- Heller Institute of Medical Research, Tel-Aviv University, Tel-Aviv, Israel; Department of Internal Medicine F, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Avi Livneh
- Heller Institute of Medical Research, Tel-Aviv University, Tel-Aviv, Israel; Rheumatology Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; Department of Internal Medicine F, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Merav Lidar
- Rheumatology Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Olga Feld
- Department of Internal Medicine F, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Souad Haj Yahia
- Department of Internal Medicine F, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Chagai Grossman
- Rheumatology Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; Department of Internal Medicine F, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Ben-Zvi
- Heller Institute of Medical Research, Tel-Aviv University, Tel-Aviv, Israel; Rheumatology Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; Department of Internal Medicine F, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel.
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Slonimsky E, Lidar M, Stern M, Eshed I. Degenerative changes of the thoracic spine do exist in patients with diffuse idiopathic skeletal hyperostosis: a detailed thoracic spine CT analysis. Acta Radiol 2018; 59:1343-1350. [PMID: 29482347 DOI: 10.1177/0284185118761205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Degenerative intervertebral disease (DID) is an exclusion criterion in the Resnick and Niwayama radiographic classification for diffuse idiopathic skeletal hyperostosis (DISH). However, although DID was previously described in DISH, no systematic computed tomography (CT) analysis has been reported so far. Purpose To assess for the presence and prevalence of such changes on CT examinations of the thoracic spine of individuals with DISH. Material and Methods Intervertebral space (D1-L1) on chest CT examinations of DISH patients was retrospectively evaluated for the presence of DID. Parameters evaluated were disc space height, disc protrusion, subchondral cysts/sclerosis, Schmorl nodes, vacuum phenomenon, and posterior elements including costovertebral and facet joints. Parameters were compared with two age- and gender-matched control groups of individuals whose entire spine CT lacked evidence of DISH (Control 1 individuals < 2 flowing osteophytes, Control 2 individuals < 4 and ≥ 2 flowing osteophytes). Results A total of 158 participants (DISH/Control 1/Control 2 = 54/54/50; 106 men, 52 women; average age = 70.6 years) were evaluated. Average intervertebral disc height was significantly lower in the DISH group compared with both control groups (DISH/Control 1/Control 2 = 4.55/5.13/5.01 mm, P < 0.001). Costovertebral degenerative changes were more prevalent in DISH patients ( P < 0.05) and, except for vacuum phenomenon (more prevalent in controls), other DID changes were as prevalent in DISH as in controls. Conclusion The presence of degenerative intervertebral changes on thoracic CT should not deter from diagnosing DISH. Thus, the radiographic Resnick and Niwayama DISH criteria cannot be directly adapted to CT.
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Affiliation(s)
- Einat Slonimsky
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Merav Lidar
- The Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Myriam Stern
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
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44
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Druyan A, Lidar M. Diagnosis of Systemic Sclerosis Based on Raynaud's Phenomenon, Capillaroscopy Findings, and Autoantibodies in the Absence of Sclerodactyly. Isr Med Assoc J 2018; 20:658. [PMID: 30324790] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Amit Druyan
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
- Department of Medicine F, Sheba Medical Center, Tel Hashomer, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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45
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Shovman O, Gilburd B, Watad A, Amital H, Langevitz P, Bragazzi N, Adawi M, Perez D, Bornstein G, Grossman C, Lidar M, Blank M, Azuri J, Biln N, Marotta A, Shoenfeld Y. The diagnostic value of 14-3-3η protein levels in patients with rheumatoid arthritis. Best Pract Res Clin Rheumatol 2018; 32:610-617. [DOI: 10.1016/j.berh.2019.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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46
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Bornstein G, Lidar M, Langevitz P, Fardman A, Ben-Zvi I, Grossman C. The prevalence and clinical effect of immunogenicity of TNF-α blockers in patients with axial spondyloarthritis. Clin Exp Rheumatol 2018; 36:228-232. [PMID: 29185966] [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: 03/23/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the prevalence of immunogenicity of TNF-α blockers in axial spondyloarthritis (SpA) patients and to assess the effect of immunogenicity on drug levels and clinical response. METHPDS Patients with axial SpA treated with either infliximab (INF), adalimumab (ADA) or etanercept (ETN) were recruited to our observational cross-sectional study. Demographic and clinical data were collected and disease activity scores were assessed. Drug trough levels and anti-drug antibodies were measured in serum samples and collected before the next administration. RESULTS Thirty-nine patients with axial SpA with a mean age of 46.3±12.7 (10 women) were recruited to the study (14 receiving INF, 16 ADA and 9 ETN). Patients' mean therapy duration was 50.6 months (±46.4) and 6 (15%) of them were using MTX concomitantly with the TNF-α blockers. Anti-drug antibodies were found in 6 (15%) patients (4 with INF and 2 with ADA), all of which had undetectable drug level. No anti-drug antibodies were detected in patients treated with ETN. Immunogenicity was associated with higher BASDAI (Bath Ankylosing Spondylitis Disease Index), ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score) and ASDAS-ESR. CONCLUSIONS Axial SpA patients failure to respond to TNF-α blockers may be at least partially related to immunogenicity. Measurement of anti-drug antibodies and drug levels in these patients may assist in determining further treatment strategies.
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Affiliation(s)
- Gil Bornstein
- The Talpiot Medical Leadership Program, and Department of Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
| | - Merav Lidar
- Rheumatology Unit, The Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Pnina Langevitz
- Rheumatology Unit, The Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Alexander Fardman
- Department of Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Ilan Ben-Zvi
- Department of Internal Medicine F, The Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Chagai Grossman
- Department of Internal Medicine F, The Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
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47
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Lidar M, Giat E, Garelick D, Horowitz Y, Amital H, Steinberg-Silman Y, Schachter J, Shapira-Frommer R, Markel G. Rheumatic manifestations among cancer patients treated with immune checkpoint inhibitors. Autoimmun Rev 2018; 17:284-289. [PMID: 29341936 DOI: 10.1016/j.autrev.2018.01.003] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [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: 11/04/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of immune checkpoint inhibitors (ICI) has grown incessantly since they were first approved in 2014. These monoclonal antibodies inhibit T cell activation, yielding a dramatic tumor response with improved survival. However, immunotherapy is frequently hampered by immune adverse events (iAE) such as hypophysitis, colitis, hepatitis, pneumonitis and rash. Until recently, rheumatic side effects were only infrequently reported. AIM To describe the rheumatic manifestations encountered among patients treated with ICIs in a large tertiary cancer center in Israel METHODS: The cancer center's patient registry was screened for patients who had ever been treated with ipilimumab, pembrolizumab and/or nivolumab with relevant data gathered from clinical charts. RESULTS Rheumatic manifestations were encountered in 14 of 400 patients (3.5%) who had received immunotherapy between January 1st 2013 and April 30th, 2017. The most common rheumatic manifestation was inflammatory arthritis (85%) for which a third (4/11) had a clear cut predisposing factor such as a personal or family history of psoriasis, a prior episode of uveitis or ACPA positivity. Pulmonary sarcoidosis and biopsy-proven eosinophilic fasciitis were diagnosed in two additional patients. Treatment with NSAIDS was mostly unsuccessful while steroid therapy was beneficial in doses ≥20 mg/d. Methotrexate enabled steroid tapering without an excess of side effects or tumor progression in the short follow-up available. Overall, rheumatic manifestations tended to occur later in the course of immunotherapy as compared to other iAE. CONCLUSIONS Our findings underscore that rheumatic iAE are part of the side effect profile of ICIs and require heightened awareness as these therapies are becoming the standard of care for various malignancies. We show that these appear later in the course of iAEs and respond preferentially to high dose steroids. MTX appears effective as a steroid sparing agent.
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Affiliation(s)
- Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eitan Giat
- Rheumatology Unit, Sheba Medical Center, Israel
| | | | | | - Howard Amital
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine B, Sheba Medical Center, Israel
| | | | - Jacob Schachter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Israel
| | | | - Gal Markel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Israel.
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48
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Sharif K, Watad A, Bragazzi NL, Asher E, Abu Much A, Horowitz Y, Lidar M, Shoenfeld Y, Amital H. Anterior ST-elevation myocardial infarction induced by rituximab infusion: A case report and review of the literature. J Clin Pharm Ther 2018; 42:356-362. [PMID: 28440561 DOI: 10.1111/jcpt.12522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/29/2016] [Accepted: 03/05/2017] [Indexed: 12/23/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Rituximab is a chimeric monoclonal anti-CD20 antibody approved for the treatment of some lymphoid malignancies as well as for autoimmune diseases including rheumatoid arthritis (RA), idiopathic thrombocytopenic purpura (ITP) and vasculitis. Generally, rituximab is well tolerated; nevertheless, some patients develop adverse effects including infusion reactions. Albeit rare, these reactions may in some cases be life-threatening conditions. Rituximab cardiovascular side effects include more common effects such as hypertension, oedema and rare cases of arrhythmias and myocardial infarction. CASE SUMMARY In this article, we report a case of a 58-year-old man with a history of overlap syndrome including RA and limited scleroderma who was treated with rituximab and developed a dramatic ST-elevation myocardial infarction (STEMI) during the drug administration. WHAT IS NEW AND CONCLUSION This report underlines previous published reports emphasizing the awareness of such an association. This communication also warrants the importance of screening for ischaemic heart disease in selected cases of patients treated with rituximab.
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Affiliation(s)
- K Sharif
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - A Watad
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - N L Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - E Asher
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - A Abu Much
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Y Horowitz
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - M Lidar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Y Shoenfeld
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - H Amital
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
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49
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Levy T, Bader S, Hermann KG, Yaniv G, Grinberg G, Mozes O, Lidar M, Eshed I. Styloid Process Elongation on Cervical Spine Computed Tomography is Associated with the Enthesopathy-Related Diseases of Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis. Isr Med Assoc J 2017; 19:670-673. [PMID: 29185278] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Enthesopathy may lead to calcification of the stylohyoid ligament and can cause elongation of the styloid process (SP). OBJECTIVES To evaluate whether SP elongation is associated with two common enthesitis-related diseases: ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). METHODS Cervical spine computed tomography (CT) examinations of patients with DISH (n=64, Resnick criteria), AS (n=24, New York criteria) and a controls (no radiological signs of DISH or AS, n=54) were retrospectively evaluated. The DISH group was further divided into patients with and without cervical DISH. The length of right and left SP was measured independently by two readers on coronal and sagittal curved reformats. The average right and left styloid length and average length per person were compared among the groups. RESULTS Demographic characteristics were similar between the DISH and control groups (average age 68.2 ± 15.7, 69.2 ± 12.7 years, male:female ratio 48:16 and 35:19, respectively, P > 0.05), whereas age was significantly lower (average age: 53 ± 15 years, P < 0.0001) in the AS group, which was also composed mainly of men. The AS and DISH groups had significantly longer SP compared to controls (AS 37.9 ± 9.6 mm, DISH 34.4 ± 9 mm, control 30.3 ± 10.1 mm, P < 0.05). There was no correlation between age and SP length. Inter-reader reliability of SP measurements was excellent in all groups (ICC = 0.998, P < 0.0001). CONCLUSIONS SP elongation is associated with both AS and DISH substantiating the enthesopathy-related pathophysiology of this finding.
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Affiliation(s)
- Talia Levy
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Salim Bader
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Gal Yaniv
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gahl Grinberg
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oshry Mozes
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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50
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Davidson T, Druyan A, Goshen E, Lidar M. The PET-CT Radiological Appearance of Facial Cosmetic Injections: A Pitfall in the Evaluation of the Oncological Patient. Isr Med Assoc J 2017; 19:679-681. [PMID: 29185280] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Facial rejuvenation using different dermal and sub-dermal injectable compounds is a popular cosmetic procedure which may pose a diagnostic dilemma to the radiologist. OBJECTIVES To describe the appearance of cosmetic facial fillers on PET-CT. METHODS All PET-CT exams performed between January 2015 and May 2017 in which findings suggestive of prior facial filler procedures was evident and where anamnestic confirmation with the patient was possible were reviewed. RESULTS We describe five females who had undergone facial filler procedures leading to calcifications around the mouth and nasolabial triangle. CONCLUSIONS Familiarity with the appearance of such cosmetic procedures on PET-CT is of paramount importance in order to avoid misinterpretation of the findings leading to unnecessary apprehension and work-up.
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Affiliation(s)
- Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Druyan
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Elinor Goshen
- Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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