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Vyzhga Y, Frenkel J, Insalaco A, Anton J, Koné-Paut I, Legger GE, Fabio G, Cattalini M, Kamphuis S, Hachulla E, Krause K, Ekinci Z, Sanchez-Manubens J, Van den Berg JM, Mora CH, Brinkman D, Labrador E, Potjewijd J, Carlini L, Bustaffa M, Caorsi R, Ruperto N, Gattorno M. Monitoring of Adverse Events and Safety in Autoinflammatory Diseases: Real-Life Data from the Eurofever Registry. J Clin Immunol 2024; 44:119. [PMID: 38758228 DOI: 10.1007/s10875-024-01719-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The study is aimed to evaluate the impact of safety events in the Eurofever registry for Autoinflammatory diseases. METHODS This was a retrospective and longitudinal observational multicentre study. Data were retrieved from the international registry Eurofever, starting patients' enrolment since 2009. All moderate, severe, or very severe AEs reported by treating physician in Eurofever were analyzed regardless of a possible suspected causal relationship to any therapies and according to the latest release of the Medical Dictionary for Regulatory Activities. RESULTS Complete information on safety were available in 2464 patients enrolled in the registry. In 1499 of them retrospective data encompassing the period from disease onset to enrolment were available, whereas 965 consecutive patients entered in the longitudinal part of the study. A total of 479 AEs have been reported in 275 patients. Eighty-two AEs were reported as serious and 99 were drug-related according to the physicians. Infections or infestations (94; 19.6%), gastrointestinal disorders (66; 13.8%), nervous system disorders (41; 8.6%) and systemic disorders or administration site reactions (35; 7.3%) were the most frequent reported events. The highest absolute number of drug-related AEs were related to biologic DMARDs (40/99 reports, 40,4%) and colchicine (31/99 reports, 31.3%). CONCLUSIONS Present study shows the importance of a longitudinal and homogeneous registration of the AEs in rare conditions, with a particular focus on the safety profile of the treatments used in these conditions.
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Affiliation(s)
- Yulia Vyzhga
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia E Malattie Autoinfiammatorie, Genoa, Italy.
| | - Joost Frenkel
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, Utrecht, Netherlands
| | - Antonella Insalaco
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Jordi Anton
- Hospital Sant Joan de Déu, Department of Pediatric Rheumatology, Universitat de Barcelona. Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Isabelle Koné-Paut
- Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and Inflammatory Amyloidosis, CEREMAIA, CHU de Biĉetre, APHP, University of Paris Sud, Le Kremlin Biĉetre, Paris, France
| | - G Elizabeth Legger
- Department of Pediatric Rheumatology, University Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Giovanna Fabio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento Di Medicina Interna, UOS Malattie Rare, Milan, Italy
| | - Marco Cattalini
- Clinica Pediatrica Dell'Universita' Di Brescia, Unita' Di Immunologia E Reumatologia Pediatrica, Spedali Civili, Brescia, Italy
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eric Hachulla
- Service Medecine Interne, CHRU de Lille- Hospital Claude, Huriez - 4 Étage EST, Lille, France
| | - Karoline Krause
- Dpt. of Dermatology and Allergy, Charite University Hospital Berlin, Berlin, Germany
| | - Zelal Ekinci
- Department of Pediatric Rheumatology, Başkent University İstanbul Hospital, Istanbul, Turkey
| | - Judith Sanchez-Manubens
- Hospital Parc Taulí de Sabadell, Reumatologia Pediàtrica - Servei de Medicina Pediàtrica, Barcelona, Spain
| | - J Merlijn Van den Berg
- Emma Children Hospital, Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Danielle Brinkman
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children`S Hospital, Leiden University Medical Center, Leiden, Netherlands
| | | | - Judith Potjewijd
- Department of Internal Medicine, Section Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Luca Carlini
- Gaslini Trial Centre/Servizio Di Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, PRINTO, Genoa, Italy
| | - Marta Bustaffa
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia E Malattie Autoinfiammatorie, Genoa, Italy
| | - Roberta Caorsi
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia E Malattie Autoinfiammatorie, Genoa, Italy
| | - Nicolino Ruperto
- Gaslini Trial Centre/Servizio Di Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, PRINTO, Genoa, Italy
| | - Marco Gattorno
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia E Malattie Autoinfiammatorie, Genoa, Italy
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van Leeuwen LPM, Grobben M, GeurtsvanKessel CH, Ellerbroek PM, de Bree GJ, Potjewijd J, Rutgers A, Jolink H, van de Veerdonk FL, van Gils MJ, de Vries RD, Dalm VASH. Immunogenicity of COVID-19 booster vaccination in IEI patients and their one year clinical follow-up after start of the COVID-19 vaccination program. Front Immunol 2024; 15:1390022. [PMID: 38698851 PMCID: PMC11063285 DOI: 10.3389/fimmu.2024.1390022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
Purpose Previous studies have demonstrated that the majority of patients with an inborn error of immunity (IEI) develop a spike (S)-specific IgG antibody and T-cell response after two doses of the mRNA-1273 COVID-19 vaccine, but little is known about the response to a booster vaccination. We studied the immune responses 8 weeks after booster vaccination with mRNA-based COVID-19 vaccines in 171 IEI patients. Moreover, we evaluated the clinical outcomes in these patients one year after the start of the Dutch COVID-19 vaccination campaign. Methods This study was embedded in a large prospective multicenter study investigating the immunogenicity of COVID-19 mRNA-based vaccines in IEI (VACOPID study). Blood samples were taken from 244 participants 8 weeks after booster vaccination. These participants included 171 IEI patients (X-linked agammaglobulinemia (XLA;N=11), combined immunodeficiency (CID;N=4), common variable immunodeficiency (CVID;N=45), isolated or undefined antibody deficiencies (N=108) and phagocyte defects (N=3)) and 73 controls. SARS-CoV-2-specific IgG titers, neutralizing antibodies, and T-cell responses were evaluated. One year after the start of the COVID-19 vaccination program, 334 study participants (239 IEI patients and 95 controls) completed a questionnaire to supplement their clinical data focusing on SARS-CoV-2 infections. Results After booster vaccination, S-specific IgG titers increased in all COVID-19 naive IEI cohorts and controls, when compared to titers at 6 months after the priming regimen. The fold-increases did not differ between controls and IEI cohorts. SARS-CoV-2-specific T-cell responses also increased equally in all cohorts after booster vaccination compared to 6 months after the priming regimen. Most SARS-CoV-2 infections during the study period occurred in the period when the Omicron variant had become dominant. The clinical course of these infections was mild, although IEI patients experienced more frequent fever and dyspnea compared to controls and their symptoms persisted longer. Conclusion Our study demonstrates that mRNA-based booster vaccination induces robust recall of memory B-cell and T-cell responses in most IEI patients. One-year clinical follow-up demonstrated that SARS-CoV-2 infections in IEI patients were mild. Given our results, we support booster campaigns with newer variant-specific COVID-19 booster vaccines to IEI patients with milder phenotypes.
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Affiliation(s)
- Leanne P. M. van Leeuwen
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
- Travel Clinic, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marloes Grobben
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Pauline M. Ellerbroek
- Department of Internal Medicine, Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Judith Potjewijd
- Department of Internal Medicine, Division Clinical Immunology, Maastricht UMC, Maastricht, Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, UMC Groningen, Groningen, Netherlands
| | - Hetty Jolink
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Frank L. van de Veerdonk
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Marit J. van Gils
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Rory D. de Vries
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Virgil A. S. H. Dalm
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
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3
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Busch MH, Ysermans R, Aendekerk JP, Timmermans SAMEG, Potjewijd J, Damoiseaux JGMC, Spronk HMH, ten Cate H, Reutelingsperger CP, Nagy M, van Paassen P. The intrinsic coagulation pathway plays a dominant role in driving hypercoagulability in ANCA-associated vasculitis. Blood Adv 2024; 8:1295-1304. [PMID: 38175623 PMCID: PMC10918483 DOI: 10.1182/bloodadvances.2023011937] [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: 10/17/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
ABSTRACT The risk of a venous thrombotic event (VTE) is increased in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV); however, a detailed understanding of the underlying mechanisms of hypercoagulability is limited. We assessed prospectively different coagulation parameters in 71 patients with active AAV at baseline and after 6 months of follow-up. D-dimers and fibrinogen were increased in most patients at presentation and remained elevated in half of the patients. Particularly, thrombin-antithrombin (T:AT) complex and activated coagulation factors in complex with their natural inhibitors of the intrinsic coagulation pathway (ie, activated FXII:C1 esterase inhibitor [FXIIa:C1Inh], FXIa:AT, and FXIa:alpha1-antitrypsin [FXIa:α1AT]) were profoundly elevated in patients at baseline. Thrombin formation was dominantly correlated with coagulation factors of the intrinsic pathway (ie, FXIIa:AT, FXIa:AT, FXIa:α1AT, and FXIa:C1Inh) compared to the extrinsic pathway (ie, FVIIa:AT). Hypercoagulability correlated with higher disease activity, ANCA levels, C-reactive protein, serum creatinine, and proteinuria. VTEs were observed in 5 out of 71 (7%) patients within 1 month (interquartile range, 1-5) after inclusion. Baseline T:AT levels were significantly higher in patients with VTE than in those without VTE (P = .044), but other clinical or laboratory markers were comparable between both groups. Hypercoagulability is dominantly characterized by activation of the intrinsic coagulation pathway and elevated D-dimers in active AAV. The driving factors of hypercoagulability are yet to be studied but are most likely related to an interplay of increased disease activity, vascular inflammation, and endothelial damage. Future targets for intervention could include inhibitors of the intrinsic coagulation pathway and compounds specifically reducing the hyperinflammatory state.
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Affiliation(s)
- Matthias H. Busch
- Department Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Renée Ysermans
- Department Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Joop P. Aendekerk
- Department Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Sjoerd A. M. E. G. Timmermans
- Department Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Judith Potjewijd
- Department Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan G. M. C. Damoiseaux
- Department of Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Henri M. H. Spronk
- Department Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Hugo ten Cate
- Department Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
- Department of Internal Medicine, Thrombosis Expertise Center, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Magdolna Nagy
- Department Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Pieter van Paassen
- Department Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Aendekerk JP, Ysermans R, Busch MH, Theunissen ROMFIH, Bijnens N, Potjewijd J, Damoiseaux JGMC, Reutelingsperger CP, van Paassen P. Assessment of longitudinal serum neutrophil extracellular trap-inducing activity in anti-neutrophil cytoplasmic antibody-associated vasculitis and glomerulonephritis in a prospective cohort using a novel bio-impedance technique. Kidney Int 2023; 104:151-162. [PMID: 37088424 DOI: 10.1016/j.kint.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/23/2023] [Accepted: 03/17/2023] [Indexed: 04/25/2023]
Abstract
Neutrophil extracellular traps (NET) have been implicated in the pathogenesis of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Here, we developed a novel, label-free, high-throughput bio-impedance technique to effectively measure serum NET-inducing activity. Using this technique, NET-inducing activity of serum derived from patients with AAV was assessed in a prospective cohort of 62 patients presenting with active AAV with major organ involvement. Thirty-five patients presented with new and 27 patients presented with relapsing AAV, of whom 38 had kidney and/or 31 had lung involvement. NET-inducing activity was assessed at diagnosis of active AAV (time zero), during the first 6 weeks of treatment, and after 6 months of treatment. Forty-seven patients revealed elevated NET-inducing activity at time zero. After initiation of immunosuppressive treatment, NET-inducing activity was reduced at six weeks. A subsequent increase at six months could potentially identify patients with relapsing disease (hazard ratio, 11.45 [interquartile range 1.36-96.74]). NET-inducing activity at time zero correlated with kidney function and proteinuria. Importantly, in kidney tissue, NETs co-localized with lesions typical of ANCA-associated glomerulonephritis and even correlated with systemic serum NET-inducing activity. Thus, our prospective data corroborate the importance of NET formation in AAV and ANCA-associated glomerulonephritis and the potential of longitudinal evaluation, as monitored by our novel bio-impedance assay and detailed histological evaluation.
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Affiliation(s)
- Joop P Aendekerk
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Renée Ysermans
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Matthias H Busch
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Ruud O M F I H Theunissen
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nele Bijnens
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Judith Potjewijd
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan G M C Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Chris P Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Pieter van Paassen
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
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van Leeuwen LPM, Grobben M, GeurtsvanKessel CH, Ellerbroek PM, de Bree GJ, Potjewijd J, Rutgers A, Jolink H, van de Veerdonk FL, van Gils MJ, de Vries RD, Dalm VASH. Immune Responses 6 Months After mRNA-1273 COVID-19 Vaccination and the Effect of a Third Vaccination in Patients with Inborn Errors of Immunity. J Clin Immunol 2023:10.1007/s10875-023-01514-7. [PMID: 37231290 DOI: 10.1007/s10875-023-01514-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Patients with inborn errors of immunity (IEI) are at increased risk of severe coronavirus disease-2019 (COVID-19). Effective long-term protection against COVID-19 is therefore of great importance in these patients, but little is known about the decay of the immune response after primary vaccination. We studied the immune responses 6 months after two mRNA-1273 COVID-19 vaccines in 473 IEI patients and subsequently the response to a third mRNA COVID-19 vaccine in 50 patients with common variable immunodeficiency (CVID). METHODS In a prospective multicenter study, 473 IEI patients (including X-linked agammaglobulinemia (XLA) (N = 18), combined immunodeficiency (CID) (N = 22), CVID (N = 203), isolated or undefined antibody deficiencies (N = 204), and phagocyte defects (N = 16)), and 179 controls were included and followed up to 6 months after two doses of the mRNA-1273 COVID-19 vaccine. Additionally, samples were collected from 50 CVID patients who received a third vaccine 6 months after primary vaccination through the national vaccination program. SARS-CoV-2-specific IgG titers, neutralizing antibodies, and T cell responses were assessed. RESULTS At 6 months after vaccination, the geometric mean antibody titers (GMT) declined in both IEI patients and healthy controls, when compared to GMT 28 days after vaccination. The trajectory of this decline did not differ between controls and most IEI cohorts; however, antibody titers in CID, CVID, and isolated antibody deficiency patients more often dropped to below the responder cut-off compared to controls. Specific T cell responses were still detectable in 77% of controls and 68% of IEI patients at 6 months post vaccination. A third mRNA vaccine resulted in an antibody response in only two out of 30 CVID patients that did not seroconvert after two mRNA vaccines. CONCLUSION A similar decline in IgG titers and T cell responses was observed in patients with IEI when compared to healthy controls 6 months after mRNA-1273 COVID-19 vaccination. The limited beneficial benefit of a third mRNA COVID-19 vaccine in previous non-responder CVID patients implicates that other protective strategies are needed for these vulnerable patients.
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Affiliation(s)
- Leanne P M van Leeuwen
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Travel Clinic, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marloes Grobben
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Corine H GeurtsvanKessel
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Godelieve J de Bree
- Department of Infectious Diseases, Amsterdam UMC, Amsterdam, The Netherlands
| | - Judith Potjewijd
- Department of Internal Medicine, Division Nephrology and Clinical Immunology, Maastricht UMC, Maastricht, The Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, UMC Groningen, Groningen, The Netherlands
| | - Hetty Jolink
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank L van de Veerdonk
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marit J van Gils
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rory D de Vries
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Virgil A S H Dalm
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Department of Immunology, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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van Daele PLA, van der Made CI, Leavis HL, Hak AEL, Potjewijd J, Rutgers AB. [Chronic anemia and unexplained inflammation: think of VEXAS syndrome]. Ned Tijdschr Geneeskd 2023; 167. [PMID: 37078566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND VEXAS-syndrome is an X-linked acquired multisystemic autoinflammatory disease caused by a somatic mutation in UBA1. CASE DESCRIPTION In this manuscript we describe a 79-year-old male suffering from skin lesions, macrocytic anemia and lab results showing inflammation in which, based on finding a mutation in UBA1, VEXAS was diagnosed. He was treated with a combination of high dose corticosteroids and anti-IL-6 with good response. CONCLUSION In middle aged males presenting with multisystemic inflammation without evidence of infection a diagnosis of VEXAS should be considered, especially if there is evidence of a macrocytic anemia. Early testing for UBA1 mutations helps in making the diagnosis. Despite treatment with intensive immunosuppression mortality remains high.
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Affiliation(s)
- Paul L A van Daele
- Erasmus MC, afd. Interne Geneeskunde en Immunologie, Rotterdam
- Contact: Paul L.A. van Daele
| | | | - Helen L Leavis
- UMC Utrecht, afd. Reumatologie en Klinische Immunologie, Utrecht
| | - A E Liesbeth Hak
- Amsterdam UMC, afd. Interne Geneeskunde, Reumatologie en Klinische Immunologie, Amsterdam
| | - Judith Potjewijd
- MUMC+, afd. Interne Geneeskunde, sectie Klinische Immunologie, Maastricht
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7
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Busch MH, Timmermans SAMEG, Van Kuijk SMJ, Aendekerk JP, Ysermans R, Van Doorn DPC, Potjewijd J, Van de Poll MCG, Van der Horst ICC, Damoiseaux JGMC, Spronk HMH, Cate HT, Reutelingsperger CP, Nagy M, Van Paassen P. Thrombin formation via the intrinsic coagulation pathway and von Willebrand factor reflect disease severity in COVID-19. Haematologica 2022; 108:1417-1422. [PMID: 36519327 PMCID: PMC10153543 DOI: 10.3324/haematol.2022.281693] [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: 06/30/2022] [Indexed: 12/23/2022] Open
Abstract
Not available.
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Affiliation(s)
- Matthias H Busch
- Dept. Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands; Dept. Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht
| | - Sjoerd A M E G Timmermans
- Dept. Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands; Dept. Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht
| | | | - Joop P Aendekerk
- Dept. Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht
| | - Renée Ysermans
- Dept. Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht
| | - Daan P C Van Doorn
- Dept. Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht
| | - Judith Potjewijd
- Dept. Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands; Dept. Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht
| | | | | | | | - Henri M H Spronk
- Dept. Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Thrombosis Expertise Center, Maastricht University Medical Center, Maastricht
| | - Hugo Ten Cate
- Dept. Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Thrombosis Expertise Center, Maastricht University Medical Center, Maastricht
| | | | - Magdolna Nagy
- Dept. Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht
| | - Pieter Van Paassen
- Dept. Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands; Dept. Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht.
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Potjewijd J, Tobal R, Silvertand D, Gietema H, Damoiseaux J, van Paassen P. Favorable long term effects of intensified immunosuppression combined with therapeutic plasma exchange in patients with early-onset progressive systemic sclerosis-related interstitial lung disease. J Transl Autoimmun 2022; 5:100174. [DOI: 10.1016/j.jtauto.2022.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
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9
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van Leeuwen LP, GeurtsvanKessel CH, Ellerbroek PM, de Bree GJ, Potjewijd J, Rutgers A, Jolink H, van de Veerdonk F, van Gorp EC, de Wilt F, Bogers S, Gommers L, Geers D, Bruns AH, Leavis HL, van Haga JW, Lemkes BA, van der Veen A, de Kruijf-Bazen S, van Paassen P, de Leeuw K, van de Ven AA, Verbeek-Menken PH, van Wengen A, Arend SM, Ruten-Budde AJ, van der Ent MW, van Hagen PM, Sanders RW, Grobben M, van der Straten K, Burger JA, Poniman M, Nierkens S, van Gils MJ, de Vries RD, Dalm VA. Immunogenicity of the mRNA-1273 COVID-19 vaccine in adult patients with inborn errors of immunity. J Allergy Clin Immunol 2022; 149:1949-1957. [PMID: 35421449 PMCID: PMC8996444 DOI: 10.1016/j.jaci.2022.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 01/20/2022] [Revised: 03/27/2022] [Accepted: 04/04/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patients with inborn errors of immunity (IEI) are at increased risk of severe coronavirus disease-2019 (COVID-19). Effective vaccination against COVID-19 is therefore of great importance in this group, but little is known about the immunogenicity of COVID-19 vaccines in these patients. OBJECTIVES We sought to study humoral and cellular immune responses after mRNA-1273 COVID-19 vaccination in adult patients with IEI. METHODS In a prospective, controlled, multicenter study, 505 patients with IEI (common variable immunodeficiency [CVID], isolated or undefined antibody deficiencies, X-linked agammaglobulinemia, combined B- and T-cell immunodeficiency, phagocyte defects) and 192 controls were included. All participants received 2 doses of the mRNA-1273 COVID-19 vaccine. Levels of severe acute respiratory syndrome coronavirus-2-specific binding antibodies, neutralizing antibodies, and T-cell responses were assessed at baseline, 28 days after first vaccination, and 28 days after second vaccination. RESULTS Seroconversion rates in patients with clinically mild antibody deficiencies and phagocyte defects were similar to those in healthy controls, but seroconversion rates in patients with more severe IEI, such as CVID and combined B- and T-cell immunodeficiency, were lower. Binding antibody titers correlated well to the presence of neutralizing antibodies. T-cell responses were comparable to those in controls in all IEI cohorts, with the exception of patients with CVID. The presence of noninfectious complications and the use of immunosuppressive drugs in patients with CVID were negatively correlated with the antibody response. CONCLUSIONS COVID-19 vaccination with mRNA-1273 was immunogenic in mild antibody deficiencies and phagocyte defects and in most patients with combined B- and T-cell immunodeficiency and CVID. Lowest response was detected in patients with X-linked agammaglobulinemia and in patients with CVID with noninfectious complications. The assessment of longevity of immune responses in these vulnerable patient groups will guide decision making for additional vaccinations.
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Affiliation(s)
- Leanne P.M. van Leeuwen
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Travel Clinic, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | | | - Judith Potjewijd
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht UMC, Maastricht, The Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, UMC Groningen, Groningen, The Netherlands
| | - Hetty Jolink
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank van de Veerdonk
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric C.M. van Gorp
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Travel Clinic, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Faye de Wilt
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Susanne Bogers
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lennert Gommers
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Daryl Geers
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anke H.W. Bruns
- Department of Internal Medicine, UMC Utrecht, Utrecht, The Netherlands
| | - Helen L. Leavis
- Department of Internal Medicine, UMC Utrecht, Utrecht, The Netherlands
| | - Jelle W. van Haga
- Department of Infectious Diseases, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bregtje A. Lemkes
- Department of Infectious Diseases, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - S.F.J. de Kruijf-Bazen
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht UMC, Maastricht, The Netherlands
| | - Pieter van Paassen
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht UMC, Maastricht, The Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, UMC Groningen, Groningen, The Netherlands
| | | | - Petra H. Verbeek-Menken
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Annelies van Wengen
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Sandra M. Arend
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Anja J. Ruten-Budde
- Department of Biostatistics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marianne W. van der Ent
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P. Martin van Hagen
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands,Department of Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rogier W. Sanders
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marloes Grobben
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karlijn van der Straten
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith A. Burger
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Meliawati Poniman
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefan Nierkens
- Center for Translational Immunology, UMC Utrecht, Utrecht, The Netherlands,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marit J. van Gils
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rory D. de Vries
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Virgil A.S.H. Dalm
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands,Department of Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands,Corresponding author: Virgil A. S. H. Dalm, MD, PhD, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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10
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Elsink K, Huibers MMH, Hollink IHIM, Simons A, Zonneveld-Huijssoon E, van der Veken LT, Leavis HL, Henriet SSV, van Deuren M, van de Veerdonk FL, Potjewijd J, Berghuis D, Dalm VASH, Vermont CL, van de Ven AAJM, Lambeck AJA, Abbott KM, van Hagen PM, de Bree GJ, Kuijpers TW, Frederix GWJ, van Gijn ME, van Montfrans JM. Implementation of Early Next-Generation Sequencing for Inborn Errors of Immunity: A Prospective Observational Cohort Study of Diagnostic Yield and Clinical Implications in Dutch Genome Diagnostic Centers. Front Immunol 2022; 12:780134. [PMID: 34992599 PMCID: PMC8724043 DOI: 10.3389/fimmu.2021.780134] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/20/2021] [Accepted: 12/01/2021] [Indexed: 01/07/2023] Open
Abstract
Objective Inborn errors of immunity (IEI) are a heterogeneous group of disorders, affecting different components of the immune system. Over 450 IEI related genes have been identified, with new genes continually being recognized. This makes the early application of next-generation sequencing (NGS) as a diagnostic method in the evaluation of IEI a promising development. We aimed to provide an overview of the diagnostic yield and time to diagnosis in a cohort of patients suspected of IEI and evaluated by an NGS based IEI panel early in the diagnostic trajectory in a multicenter setting in the Netherlands. Study Design We performed a prospective observational cohort study. We collected data of 165 patients with a clinical suspicion of IEI without prior NGS based panel evaluation that were referred for early NGS using a uniform IEI gene panel. The diagnostic yield was assessed in terms of definitive genetic diagnoses, inconclusive diagnoses and patients without abnormalities in the IEI gene panel. We also assessed time to diagnosis and clinical implications. Results For children, the median time from first consultation to diagnosis was 119 days versus 124 days for adult patients (U=2323; p=0.644). The median turn-around time (TAT) of genetic testing was 56 days in pediatric patients and 60 days in adult patients (U=1892; p=0.191). A definitive molecular diagnosis was made in 25/65 (24.6%) of pediatric patients and 9/100 (9%) of adults. Most diagnosed disorders were identified in the categories of immune dysregulation (n=10/25; 40%), antibody deficiencies (n=5/25; 20%), and phagocyte diseases (n=5/25; 20%). Inconclusive outcomes were found in 76/165 (46.1%) patients. Within the patient group with a genetic diagnosis, a change in disease management occurred in 76% of patients. Conclusion In this cohort, the highest yields of NGS based evaluation for IEI early in the diagnostic trajectory were found in pediatric patients, and in the disease categories immune dysregulation and phagocyte diseases. In cases where a definitive diagnosis was made, this led to important disease management implications in a large majority of patients. More research is needed to establish a uniform diagnostic pathway for cases with inconclusive diagnoses, including variants of unknown significance.
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Affiliation(s)
- Kim Elsink
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Manon M H Huibers
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Iris H I M Hollink
- Department of Clinical Genetics, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Annet Simons
- Department of Human Genetics, Nijmegen Center for Molecular Life Sciences, Radboud University Medical Centre, Radboud University, Nijmegen, Netherlands.,Radboud Institute for Oncology, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands
| | - Evelien Zonneveld-Huijssoon
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lars T van der Veken
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Helen L Leavis
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Stefanie S V Henriet
- Department of Pediatric Infectious Diseases and Immunology, Amalia's Children Hospital, Radboud University Nijmegen Medical Centre, Radboud University, Nijmegen, Netherlands
| | - Marcel van Deuren
- Department of Internal Medicine, Radboud University Medical Center, Radboud Center for Infectious Diseases, Nijmegen, Netherlands
| | - Frank L van de Veerdonk
- Department of Internal Medicine, Radboud University Medical Center, Radboud Center for Infectious Diseases, Nijmegen, Netherlands
| | - Judith Potjewijd
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands
| | - Dagmar Berghuis
- Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | - Virgil A S H Dalm
- Department of Internal Medicine, Division of Allergy & Clinical Immunology; Department of Immunology, Erasmus University Medical Center Rotterdam, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Clementien L Vermont
- Department of Pediatric Infectious Diseases, Immunology and Rheumatology, Sophia Children's Hospital, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Annick A J M van de Ven
- Department of Internal Medicine and Allergology, Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, Netherlands
| | - Annechien J A Lambeck
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Kristin M Abbott
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - P Martin van Hagen
- Department of Internal Medicine, Division of Allergy & Clinical Immunology; Department of Immunology, Erasmus University Medical Center Rotterdam, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Godelieve J de Bree
- Department of Internal Medicine, Institute for Infection and Immunity, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Mariëlle E van Gijn
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Joris M van Montfrans
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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11
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Tobal R, Potjewijd J, van Empel VPM, Ysermans R, Schurgers LJ, Reutelingsperger CP, Damoiseaux JGMC, van Paassen P. Vascular Remodeling in Pulmonary Arterial Hypertension: The Potential Involvement of Innate and Adaptive Immunity. Front Med (Lausanne) 2022; 8:806899. [PMID: 35004784 PMCID: PMC8727487 DOI: 10.3389/fmed.2021.806899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/01/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a severe disease with high morbidity and mortality. Current therapies are mainly focused on vasodilative agents to improve prognosis. However, recent literature has shown the important interaction between immune cells and stromal vascular cells in the pathogenic modifications of the pulmonary vasculature. The immunological pathogenesis of PAH is known as a complex interplay between immune cells and vascular stromal cells, via direct contacts and/or their production of extra-cellular/diffusible factors such as cytokines, chemokines, and growth factors. These include, the B-cell—mast-cell axis, endothelium mediated fibroblast activation and subsequent M2 macrophage polarization, anti-endothelial cell antibodies and the versatile role of IL-6 on vascular cells. This review aims to outline the major pathophysiological changes in vascular cells caused by immunological mechanisms, leading to vascular remodeling, increased pulmonary vascular resistance and eventually PAH. Considering the underlying immunological mechanisms, these mechanisms may be key to halt progression of disease.
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Affiliation(s)
- Rachid Tobal
- Division of Nephrology and Clinical and Experimental Immunology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Judith Potjewijd
- Division of Nephrology and Clinical and Experimental Immunology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Vanessa P M van Empel
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Renee Ysermans
- Division of Nephrology and Clinical and Experimental Immunology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Leon J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Chris P Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Jan G M C Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, Netherlands
| | - Pieter van Paassen
- Division of Nephrology and Clinical and Experimental Immunology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
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12
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Damoiseaux J, Potjewijd J, Smeets RL, Bonroy C. Autoantibodies in the disease criteria for systemic sclerosis: The need for specification for optimal application. J Transl Autoimmun 2022; 5:100141. [PMID: 35028553 PMCID: PMC8741499 DOI: 10.1016/j.jtauto.2022.100141] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/02/2022] [Indexed: 01/03/2023] Open
Abstract
The ACR/EULAR classification criteria for systemic sclerosis (SSc) entail three autoantibodies: anti-centromere antibodies (ACA), anti-topoisomerase I antibodies (ATA), and anti-RNA-polymerase III antibodies (ARA). The importance of ACA and ATA in the classification criteria is evidence based, but the diagnostic value is overestimated by clinicians. Fortunately, these autoantibodies are characterized by good agreement between different immuno-assays. Inclusion of ARA, however, is based on limited evidence and is related to limited agreement between different immuno-assays. Harmonization of immuno-assays in terms of interpretation based on likelihood ratio's may improve future classification criteria for SSc and this needs to be achieved by close collaboration between clinicians, laboratory specialists and the diagnostic industry.
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Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Judith Potjewijd
- Department of Internal Medicine, Division Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ruben L. Smeets
- Department of Laboratory Medicine, Radboudumc Laboratory for Diagnostics, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Laboratory Medicine—Medical Immunology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carolien Bonroy
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
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13
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Stöcker JK, Schouffoer AA, Spierings J, Schriemer MR, Potjewijd J, de Pundert L, van den Hoogen FHJ, Nijhuis-van der Sanden MWG, Staal JB, Satink T, Vonk MC, van den Ende CHM. Evidence and consensus-based recommendations for non-pharmacological treatment of fatigue, hand function loss, Raynaud's phenomenon, and digital ulcers in patients with systemic sclerosis. Rheumatology (Oxford) 2021; 61:1476-1486. [PMID: 34260723 PMCID: PMC8996778 DOI: 10.1093/rheumatology/keab537] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Systemic sclerosis is a complex connective tissue disease affecting mental and physical health. Fatigue, hand function loss, and Raynaud's phenomenon are the most prevalent disease-specific symptoms of systemic sclerosis. This study aimed to develop consensus and evidence-based recommendations for non-pharmacological treatment of these symptoms. METHODS A multidisciplinary task force was installed comprising 20 Dutch experts. After agreeing on the method for formulating the recommendations, clinically relevant questions about patient education and treatments were inventoried. During a face-to-face task force meeting, draft recommendations were generated through a systematically structured discussion, following the nominal group technique. To support the recommendations, an extensive literature search was conducted in MEDLINE and six other databases until September 2020, and 20 key systematic reviews, randomized controlled trials, and published recommendations were selected. Moreover, 13 Dutch medical specialists were consulted on non-pharmacological advice regarding Raynaud's phenomenon and digital ulcers. For each recommendation the level of evidence and the level of agreement was determined. RESULTS Forty-one evidence and consensus-based recommendations were developed, and 34, concerning treatments and patient education of fatigue (12), hand function loss (8), and Raynaud's phenomenon/digital ulcers-related problems (14), were approved by the task force. CONCLUSIONS These 34 recommendations provide guidance on non-pharmacological treatment of three of the most frequently described symptoms in patients with systemic sclerosis. The proposed recommendations can guide referrals to health professionals, inform the content of non-pharmacological interventions, and can be used in the development of national and international postgraduate educational offerings.
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Affiliation(s)
- Juliane K Stöcker
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,HAN University of Applied Sciences, Musculoskeletal Rehabilitation Research group, Nijmegen, The Netherlands.,Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
| | - Anne A Schouffoer
- Leiden University Medical Center, Department of Rheumatology, Leiden, The Netherlands.,Haga Teaching Hospital, Department of Rheumatology, The Hague, The Netherlands
| | - Julia Spierings
- University Medical Center Utrecht, Department of Rheumatology and Clinical Immunology, Utrecht, The Netherlands.,Royal Free and University College London, Department of Inflammation, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - Marisca R Schriemer
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,National Association for people with Lupus, Systemic Sclerosis, Antiphospholipid syndrome, and Mixed Connective Tissue Disease, Utrecht, The Netherlands
| | - Judith Potjewijd
- Maastricht University Medical Center, Department of Clinical immunology, Maastricht, The Netherlands
| | - Lian de Pundert
- Haga Teaching Hospital, Department of physical therapy, The Hague, The Netherlands.,University Medical Center Utrecht, Department of Rehabilitation, Physical Therapy Science and Sport, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Frank H J van den Hoogen
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
| | | | - J Bart Staal
- HAN University of Applied Sciences, Musculoskeletal Rehabilitation Research group, Nijmegen, The Netherlands.,Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Ton Satink
- HAN University of Applied Sciences, Research group Neuro Rehabilitation, Nijmegen, The Netherlands.,European Masters of Science in Occupational Therapy, Amsterdam, The Netherlands
| | - Madelon C Vonk
- Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
| | - Cornelia H M van den Ende
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
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14
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van der Made CI, Potjewijd J, Hoogstins A, Willems HPJ, Kwakernaak AJ, de Sevaux RGL, van Daele PLA, Simons A, Heijstek M, Beck DB, Netea MG, van Paassen P, Elizabeth Hak A, van der Veken LT, van Gijn ME, Hoischen A, van de Veerdonk FL, Leavis HL, Rutgers A. Adult-onset autoinflammation caused by somatic mutations in UBA1: A Dutch case series of patients with VEXAS. J Allergy Clin Immunol 2021; 149:432-439.e4. [PMID: 34048852 DOI: 10.1016/j.jaci.2021.05.014] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND A novel autoinflammatory syndrome was recently described in male patients who harbored somatic mutations in the X-chromosomal UBA1 gene. These patients were characterized by adult-onset, treatment-refractory inflammation with fever, cytopenia, dysplastic bone marrow, vacuoles in myeloid and erythroid progenitor cells, cutaneous and pulmonary inflammation, chondritis, and vasculitis, which is abbreviated as VEXAS. OBJECTIVE This study aimed to (retrospectively) diagnose VEXAS in patients who had previously been registered as having unclassified autoinflammation. We furthermore aimed to describe clinical experiences with this multifaceted, complex disease. METHODS A systematic reanalysis of whole-exome sequencing data from a cohort of undiagnosed patients with autoinflammation from academic hospitals in The Netherlands was performed. When no sequencing data were available, targeted Sanger sequencing was applied in cases with high clinical suspicion of VEXAS. RESULTS A total of 12 male patients who carried mutations in UBA1 were identified. These patients presented with adult-onset (mean age 67 years, range 47-79 years) autoinflammation with systemic symptoms, elevated inflammatory parameters, and multiorgan involvement, most typically involving the skin and bone marrow. Novel features of VEXAS included interstitial nephritis, cardiac involvement, stroke, and intestinal perforation related to treatment with tocilizumab. Although many types of treatment were initiated, most patients became treatment-refractory, with a high mortality rate of 50%. CONCLUSION VEXAS should be considered in the differential diagnosis of males with adult-onset autoinflammation characterized by systemic symptoms and multiorgan involvement. Early diagnosis can prevent unnecessary diagnostic procedures and provide better prognostic information and more suitable treatment options, including stem cell transplantation.
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Affiliation(s)
- Caspar I van der Made
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith Potjewijd
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Annemiek Hoogstins
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Huub P J Willems
- Department of Internal Medicine, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - Arjan J Kwakernaak
- Department of Internal Medicine and Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, location AMC/Meibergdreef, Amsterdam, The Netherlands
| | - Ruud G L de Sevaux
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul L A van Daele
- Department of Internal Medicine and Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annet Simons
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marloes Heijstek
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David B Beck
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Md
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pieter van Paassen
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A Elizabeth Hak
- Department of Internal Medicine and Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, location AMC/Meibergdreef, Amsterdam, The Netherlands
| | - Lars T van der Veken
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marielle E van Gijn
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alexander Hoischen
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank L van de Veerdonk
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helen L Leavis
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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15
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Zanella D, Guiot J, Stefanuto PH, Giltay L, Henket M, Guissard F, André B, Malaise M, Potjewijd J, Schleich F, Louis R, Focant JF. Breathomics to diagnose systemic sclerosis using thermal desorption and comprehensive two-dimensional gas chromatography high-resolution time-of-flight mass spectrometry. Anal Bioanal Chem 2021; 413:3813-3822. [PMID: 33903944 DOI: 10.1007/s00216-021-03333-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/11/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
Systemic sclerosis is a rare autoimmune disease associated with rapidly evolving interstitial lung disease, responsible for the disease severity and mortality. Specific biomarkers enabling the early diagnosis and prognosis associated with the disease progression are highly needed. Volatile organic compounds in exhaled breath are widely available and non-invasive and have the potential to reflect metabolic processes occurring within the body. Comprehensive two-dimensional gas chromatography coupled to high-resolution mass spectrometry was used to investigate the potential of exhaled breath to diagnose systemic sclerosis. The exhaled breath of 32 patients and 30 healthy subjects was analyzed. The high resolving power of this approach enabled the detection of 356 compounds in the breath of systemic sclerosis patients, which was characterized by an increase of mainly terpenoids and hydrocarbons. In addition, the use of 4 complementary statistical approaches (two-tailed equal variance t-test, fold change, partial least squares discriminant analysis, and random forest) resulted in the identification of 16 compounds that can be used to discriminate systemic sclerosis patients from healthy subjects. Receiver operating curves were generated that provided an accuracy of 90%, a sensitivity of 92%, and a specificity of 89%. The chemical identification of eight compounds predictive of systemic sclerosis was validated using commercially available standards. The analytical variations together with the volatile composition of room air were carefully monitored during the timeframe of the study to ensure the robustness of the technique. This study represents the first reported evaluation of exhaled breath analysis for systemic sclerosis diagnosis and provides surrogate markers for such disease.
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Affiliation(s)
- Delphine Zanella
- Molecular System, Organic & Biological Analytical Chemistry Group, University of Liege, 11 Allee du Six Aout, 4000, Liege, Belgium.
| | - Julien Guiot
- Respiratory Medicine, GIGA I3, CHU Liege, 4000, Liege, Belgium
| | - Pierre-Hugues Stefanuto
- Molecular System, Organic & Biological Analytical Chemistry Group, University of Liege, 11 Allee du Six Aout, 4000, Liege, Belgium
| | - Laurie Giltay
- Respiratory Medicine, GIGA I3, CHU Liege, 4000, Liege, Belgium
| | - Monique Henket
- Respiratory Medicine, GIGA I3, CHU Liege, 4000, Liege, Belgium
| | | | - Béatrice André
- Rheumatology Department, CHU Liege, 4000, Liege, Belgium
| | - Michel Malaise
- Rheumatology Department, CHU Liege, 4000, Liege, Belgium
| | - Judith Potjewijd
- Department of Internal Medicine, Division of Clinical and Experimental Immunology, Maastricht University Medical Center, 6229 HX, Maastricht, The Netherlands
| | | | - Renaud Louis
- Respiratory Medicine, GIGA I3, CHU Liege, 4000, Liege, Belgium
| | - Jean-François Focant
- Molecular System, Organic & Biological Analytical Chemistry Group, University of Liege, 11 Allee du Six Aout, 4000, Liege, Belgium
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16
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Aendekerk JP, Timmermans SAMEG, Busch MH, Potjewijd J, Heeringa P, Damoiseaux JGMC, Reutelingsperger CP, van Paassen P. Urinary Soluble CD163 and Disease Activity in Biopsy-Proven ANCA-Associated Glomerulonephritis. Clin J Am Soc Nephrol 2020; 15:1740-1748. [PMID: 33203735 PMCID: PMC7769013 DOI: 10.2215/cjn.07210520] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/18/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES ANCA-associated GN is a common cause of rapidly progressive GN, with high relapse rates. The early recognition of an ANCA-associated GN relapse is of importance to prevent loss of kidney function. Urinary soluble CD163 has been identified as a promising marker of active ANCA-associated GN. Previous studies, however, are limited by the lack of histologic data. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We analyzed urinary soluble CD163 in 95 patients with ANCA-associated vasculitis who underwent a kidney biopsy. In total, 125 kidney tissue sections (first kidney biopsy, n=67; repeated biopsy, n=58) with concurrent 24-hour urine samples were studied. Correlation analyses comparing urinary soluble CD163 levels and morphologic features of ANCA-associated GN were performed using Spearman rank correlation analysis. The diagnostic performance of biomarkers to detect relapsing ANCA-associated GN was evaluated using receiver operating characteristics curve analysis. RESULTS High levels of urinary soluble CD163 were found in 96 (87%) of 110 biopsies with active ANCA-associated GN compared with one (7%) of 15 biopsies without active ANCA-associated GN and one (6%) of 17 healthy controls. Urinary soluble CD163 correlated with fibrinoid necrosis (Rho=0.48, P<0.001) and cellular crescents (Rho=0.70, P<0.001) on kidney biopsy. In repeated biopsies, urinary soluble CD163's sensitivity of 0.94 and specificity of 0.91 for the recognition of relapsing ANCA-associated GN appeared better than routine clinical measures. The presence of CD163+ cells in affected glomeruli confirmed urinary soluble CD163's origin. CONCLUSIONS Urinary soluble CD163 is associated with active ANCA-associated GN and correlates with histologic features as seen in ANCA-associated GN. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_11_17_CJN07210520_final.mp3.
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Affiliation(s)
- Joop P Aendekerk
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sjoerd A M E G Timmermans
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Matthias H Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Judith Potjewijd
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter Heeringa
- Department of Medical Biology and Pathology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan G M C Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Chris P Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
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17
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Busch MH, Timmermans SAMEG, Nagy M, Visser M, Huckriede J, Aendekerk JP, de Vries F, Potjewijd J, Jallah B, Ysermans R, Oude Lashof AML, Breedveld PH, van de Poll MCG, van de Horst ICC, van Bussel BCT, Theunissen ROMFIH, Spronk HMH, Damoiseaux JGMC, Ten Cate H, Nicolaes GAF, Reutelingsperger CP, van Paassen P. Neutrophils and Contact Activation of Coagulation as Potential Drivers of COVID-19. Circulation 2020; 142:1787-1790. [PMID: 32946302 PMCID: PMC7594534 DOI: 10.1161/circulationaha.120.050656] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthias H Busch
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Sjoerd A M E G Timmermans
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Magdolna Nagy
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Mayken Visser
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Joram Huckriede
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Joop P Aendekerk
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Femke de Vries
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Judith Potjewijd
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands
| | - Borefore Jallah
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands
| | - Renée Ysermans
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands
| | - Astrid M L Oude Lashof
- Department of Medical Microbiology (A.M.L.O.L.), Maastricht University Medical Center, The Netherlands
| | - Paul H Breedveld
- Department of Surgery (P.H.B.), Maastricht University Medical Center, The Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care Medicine (M.C.G.v.d.P., I.C.C.v.d.H., B.C.T.v.B.), Maastricht University Medical Center, The Netherlands
| | - Iwan C C van de Horst
- Department of Intensive Care Medicine (M.C.G.v.d.P., I.C.C.v.d.H., B.C.T.v.B.), Maastricht University Medical Center, The Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care Medicine (M.C.G.v.d.P., I.C.C.v.d.H., B.C.T.v.B.), Maastricht University Medical Center, The Netherlands
| | - Ruud O M F I H Theunissen
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Henri M H Spronk
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Jan G M C Damoiseaux
- Central Diagnostic Laboratory (J.G.M.C.D.), Maastricht University Medical Center, The Netherlands
| | - Hugo Ten Cate
- Thrombosis Expertise Center (H.t.C.), Maastricht University Medical Center, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Gerry A F Nicolaes
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Chris P Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
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18
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Spierings J, van den Ende CHM, Schriemer RM, Bernelot Moens HJ, van der Bijl EA, Bonte-Mineur F, de Buck MPD, de Kanter MAE, Knaapen-Hans HKA, van Laar JM, Mulder UDJ, Potjewijd J, de Pundert LAJ, Schoonbrood THM, Schouffoer AA, Stel AJ, Vercoutere W, Voskuyl AE, de Vries-Bouwstra JK, Vonk MC. How do patients with systemic sclerosis experience currently provided healthcare and how should we measure its quality? Rheumatology (Oxford) 2020; 59:1226-1232. [PMID: 31539063 PMCID: PMC7244783 DOI: 10.1093/rheumatology/kez417] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/31/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives To gain insight into SSc patients’ perspective on quality of care and to survey their preferred quality indicators. Methods An online questionnaire about healthcare setting, perceived quality of care (CQ index) and quality indicators, was sent to 2093 patients from 13 Dutch hospitals. Results Six hundred and fifty patients (mean age 59 years, 75% women, 32% limited cutaneous SSc, 20% diffuse cutaneous SSc) completed the questionnaire. Mean time to diagnosis was 4.3 years (s.d. 6.9) and was longer in women compared with men (4.8 (s.d. 7.3) vs 2.5 (s.d. 5.0) years). Treatment took place in a SSc expert centre for 58%, regional centre for 29% or in both for 39% of patients. Thirteen percent of patients was not aware of whether their hospital was specialized in SSc. The perceived quality of care was rated with a mean score of 3.2 (s.d. 0.5) (range 1.0–4.0). There were no relevant differences between expert and regional centres. The three prioritized process indicators were: good patient-physician interaction (80%), structural multidisciplinary collaboration (46%) and receiving treatment according to SSc guidelines (44%). Absence of disease progression (66%), organ involvement (33%) and digital ulcers (27%) were the three highest rated outcome indicators. Conclusion The perceived quality of care evaluated in our study was fair to good. No differences between expert and regional centres were observed. Our prioritized process and outcome indicators can be added to indicators suggested by SSc experts in earlier studies and can be used to evaluate the quality of care in SSc.
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Affiliation(s)
- Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek.,Department of Rheumatology, Radboud University Medical Center, Nijmegen
| | - Rita M Schriemer
- NVLE, Dutch patient organization for systemic autoimmune diseases, Utrecht
| | | | | | | | | | | | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Udo D J Mulder
- Department of Internal Medicine, division Vascular Medicine, University of Groningen, Groningen
| | - Judith Potjewijd
- Department of Clinical immunology, Maastricht University Medical Center+, Maastricht
| | | | | | | | - Alja J Stel
- Department of Rheumatology, University Medical Center Groningen, Groningen
| | - Ward Vercoutere
- Department of Rheumatology, Zuyderland Medical Center, Heerlen
| | - Alexandre E Voskuyl
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, loc. VUMC, Amsterdam
| | | | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen
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19
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van Leersum FS, Potjewijd J, van Geel M, Steijlen PM, Vreeburg M. Schnitzler's syndrome - a novel hypothesis of a shared pathophysiologic mechanism with Waldenström's disease. Orphanet J Rare Dis 2019; 14:151. [PMID: 31228950 PMCID: PMC6589170 DOI: 10.1186/s13023-019-1117-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 06/04/2019] [Indexed: 01/13/2023] Open
Abstract
Schnitzler’s syndrome is an auto-inflammatory disorder which is characterized by two mandatory features: an urticarial rash and a monoclonal gammopathy. Although the pathophysiology of this syndrome is not yet fully understood, a role for interleukin-1 seems apparent. While this presumed link between interleukin-1 and the monoclonal gammopathy is not yet elucidated, a mutual factor in pathophysiology however seems likely. Here we present a novel hypothesis of a shared pathophysiologic mechanism between Schitzler’s syndrome and monoclonal gammopathy.
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Affiliation(s)
- F S van Leersum
- Department of Dermatology, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands.
| | - J Potjewijd
- Department of Internal Medicine, Division of Clinical and Experimental Immunology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M van Geel
- Department of Dermatology, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands.,Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands.,Grow Research School for Oncology And Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P M Steijlen
- Department of Dermatology, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands.,Grow Research School for Oncology And Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Vreeburg
- Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
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20
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Aendekerk J, Timmermans S, Potjewijd J, Damoiseaux J, van Paassen P. 276. SEVERE NON-INFECTIOUS MIXED-TYPE CRYOGLOBULINEMIC VASCULITIS: LONG-TERM OUTCOME DURING A CYCLOPHOSPHAMIDE-FREE TREATMENT REGIMEN. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Joop Aendekerk
- Maastricht University Medical Center Maastricht, Netherlands
| | | | | | - Jan Damoiseaux
- Maastricht University Medical Center Maastricht, Netherlands
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21
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Busch M, Potjewijd J, van Hulst G, Aendekerk J, Damoiseaux J, de Wit N, Vanderlocht J, van Paassen P. 006. ANCA-ASSOCIATED VASCULITIS: IS THERAPY THE LESSER EVIL? Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez057.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthias Busch
- Maastricht University Medical Center Maastricht, Netherlands
| | | | - Glenn van Hulst
- Maastricht University Medical Center Maastricht, Netherlands
| | - Joop Aendekerk
- Maastricht University Medical Center Maastricht, Netherlands
| | - Jan Damoiseaux
- Maastricht University Medical Center Maastricht, Netherlands
| | - N de Wit
- Maastricht University Medical Center Maastricht, Netherlands
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22
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Aendekerk J, Timmermans S, Potjewijd J, Heeringa P, van Paassen P. 001. URINARY SOLUBLE CD163 AND ACTIVE CRESCENTIC GLOMERULONEPHRITIS IN ANCA-ASSOCIATED VASCULITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joop Aendekerk
- Maastricht University Medical Center Maastricht, Netherlands
| | | | | | - Peter Heeringa
- University Medical Center Groningen Groningen, Netherlands
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23
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Nawrot JE, Brouwers M, van Paassen P, Potjewijd J, Nieuwhof C. An unusual cause of hyperammonaemia. Neth J Med 2018; 76:259. [PMID: 30019687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- J E Nawrot
- Department of Internal Medicine, Division of Immunology, Maastricht University Medical Centre, Maastricht, the Netherlands
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24
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Timmermans SAMEG, Abdul-Hamid MA, Potjewijd J, Theunissen ROMFIH, Damoiseaux JGMC, Reutelingsperger CP, van Paassen P. C5b9 Formation on Endothelial Cells Reflects Complement Defects among Patients with Renal Thrombotic Microangiopathy and Severe Hypertension. J Am Soc Nephrol 2018; 29:2234-2243. [PMID: 29858281 DOI: 10.1681/asn.2018020184] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/25/2018] [Indexed: 01/08/2023] Open
Abstract
Background Severe hypertension can induce thrombotic microangiopathy (TMA) in the renal vasculature, the occurrence of which has been linked to mechanical stress to the endothelium. Complement defects may be the culprit of disease in patients who present with severe renal disease and often progress to ESRD, despite BP control.Methods We studied a well defined cohort of 17 patients with hypertension-associated TMA to define the prevalence of complement defects by a specific ex vivo serum-based microvascular endothelial cell assay.Results Compared with normal human serum and samples from patients with hypertensive arterionephrosclerosis, 14 of 16 (87.5%) serum samples collected at presentation from 16 patients with hypertension-associated TMA induced abnormal C5b9 formation on microvascular endothelial cells. We detected rare variants in complement genes in eight of 17 (47%) patients. ESRD occurred in 14 of 17 (82%) patients, and recurrent TMA after transplant occurred in seven of 11 (64%) donor kidneys. Eculizumab improved the renal function in three patients and prevented TMA recurrence in an allograft recipient.Conclusions These observations point to complement defects as the key causative factor of ESRD and recurrent TMA after transplant in patients presenting with severe hypertension. Complement defects can be identified by measurements of complement activation on microvascular endothelial cells, which should substantially influence treatment and prognosis.
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Affiliation(s)
| | | | | | | | - Jan G M C Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands; and
| | - Chris P Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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25
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van Hooff L, Barten DG, Potjewijd J, van Paassen P. Necrotizing vasculitis in immediate response to a shoulder dislocation. Am J Emerg Med 2018; 36:1523.e1-1523.e3. [PMID: 29691104 DOI: 10.1016/j.ajem.2018.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 12/01/2022] Open
Abstract
The shoulder is one of the most commonly dislocated joints in the human body. Complications usually represent local damage. However, it is unclear whether joint dislocations can have systemic sequellae as wSell. Here we present the case of an 86-year-old female who developed necrotizing cryoglobulinaemic vasculitis in immediate response to a shoulder dislocation. We hypothesize there might be a link between trauma and systemic disease.
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Affiliation(s)
- Loes van Hooff
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands.
| | - Judith Potjewijd
- Department of Internal Medicine, Division of Clinical and Experimental Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - P van Paassen
- Department of Internal Medicine, Division of Clinical and Experimental Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
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26
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Potjewijd J, de Paus RA, van Wengen A, Damoiseaux J, Verbon A, van de Vosse E. Disseminated Mycobacterium genavense infection in a patient with a novel partial interleukin-12/23 receptor β1 deficiency. Clin Immunol 2012; 144:83-6. [PMID: 22695533 DOI: 10.1016/j.clim.2012.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 04/11/2012] [Accepted: 05/16/2012] [Indexed: 10/28/2022]
Abstract
A patient presented with late onset disseminated nontuberculous mycobacterium (NTM) infection due to a novel interleukin-12/interleukin-23 receptor β1 (IL-12/IL-23Rβ1) mutation, r.1561C>G, leading to the amino acid substitution R521G. This is the second patient reported with a partial IL-12/IL-23Rβ1 defect.
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Affiliation(s)
- Judith Potjewijd
- Department of Internal Medicine, Division of Clinical and Experimental Immunology, Maastricht University Medical Center, Maastricht, The Netherlands.
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27
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Potjewijd J, van Paassen P, Tervaert JWC. Case 27-2009: A woman with fever, rash, and lymphadenopathy. N Engl J Med 2009; 361:2295; author reply 2295. [PMID: 19967795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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28
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Scholte JBJ, Potjewijd J, Voogt PJ, Custers FLJ, Jie KSG. [Interstitial pneumonitis as an adverse effect of thalidomide]. Ned Tijdschr Geneeskd 2009; 153:A452. [PMID: 20051154] [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: 05/28/2023]
Abstract
A 67-year-old man was admitted to the hospital with symptoms of progressive dyspnoea. For 2 months he had received second-line treatment with dexamethasone and thalidomide for a multiple myeloma. Physical examination revealed a tachypnoeic patient and arterial blood gas analysis revealed a respiratory alkalosis and severe hypoxaemia. A high-resolution CT scan showed diffuse ground glass opacities in both lungs. Pulmonary function testing indicated severe diffusion capacity impairment. Bronchoalveolar lavage and cultures excluded the possibility of an infectious agent. The thalidomide treatment was discontinued whereupon the hypoxaemia and the ground glass opacities resolved and the diffusion capacity impairment improved. When a patient treated with thalidomide presents with dyspnoea and hypoxaemia with ground glass opacities, thalidomide-induced pneumonitis should be considered. Withdrawing thalidomide is the only treatment.
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Affiliation(s)
- Jan B J Scholte
- Atrium Medisch Centrum (Parkstad), afd. Interne Geneeskunde, Heerlen, The Netherlands.
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29
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Scholte JBJ, Potjewijd J, Voogt PJ, Custers FLJ, Lie KSG. [Interstitial pneumonitis as an adverse effect of thalidomide]. Ned Tijdschr Geneeskd 2009; 153:A452. [PMID: 19785872] [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: 05/28/2023]
Abstract
A 67-year-old man was admitted to the hospital with symptoms of progressive dyspnoea. For 2 months he had received second-line treatment with dexamethasone and thalidomide for a multiple myeloma. Physical examination revealed a tachypnoeic patient and arterial blood gas analysis revealed a respiratory alkalosis and severe hypoxaemia. A high-resolution CT scan showed diffuse ground glass opacities in both lungs. Pulmonary function testing indicated severe diffusion capacity impairment. Bronchoalveolar lavage and cultures excluded the possibility of an infectious agent. The thalidomide treatment was discontinued whereupon the hypoxaemia and the ground glass opacities resolved and the diffusion capacity impairment improved. When a patient treated with thalidomide presents with dyspnoea and hypoxaemia with ground glass opacities, thalidomide-induced pneumonitis should be considered. Withdrawing thalidomide is the only treatment.
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Affiliation(s)
- Jan B J Scholte
- Atrium Medisch Centrum (Parkstad), afd. Interne Geneeskunde, Heerlen, The Netherlands.
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30
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Potjewijd J, Buijs J. [An aphasic man with high fever; difficulty with diagnostic procedure]. Ned Tijdschr Geneeskd 2008; 152:1579-1582. [PMID: 18712228] [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: 05/26/2023]
Abstract
A 73-year-old man, with known motor aphasia presented with high fever, dyspnoea, and vomiting. Only after several days it appeared that these signs were due to a sepsis as a consequence of a phlegmon of the neck, caused by an aspired part of his set of false teeth. The delay before diagnosis was due to the fact that adequate medical history taking was difficult because of the aphasia and attempts at non-verbal communication were poorly understood. The localization of the corpus alienum was a second pitfall, because it could not be visualized during physical examination or on the initial chest X-ray. The increased risk of colonization of dentures with pathogenic micro-organisms in nursing home residents may have played a role in the severe course of this infection. This case illustrates the diagnostic problems that may exist in patients who are unable to communicate adequately.
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Affiliation(s)
- J Potjewijd
- Atrium Medisch Centrum, afd. Interne Geneeskunde, Heerlen.
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Joore MA, Potjewijd J, Timmerman AA, Anteunis LJC. Response shift in the measurement of quality of life in hearing impaired adults after hearing aid fitting. Qual Life Res 2002; 11:299-307. [PMID: 12086115 DOI: 10.1023/a:1015598807510] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
UNLABELLED REASON FOR THE STUDY: Response shift is the change in the meaning of one's self-evaluation of a target construct, like quality of life (QOL). The objective of this study was to investigate whether response shift in the measurement of generic and specific QOL occurred in persons with a relatively mild health condition. For this purpose hearing impairment was used as a research model. MAJOR FINDINGS Response shift effects were observed in the scores on the dimensions of hearing related QOL. In the scores on overall hearing related QOL, and in the scores on the generic control items, no response shift occurred. CONCLUSIONS This study showed that response shift effects can take place in a relatively mild condition as well. The occurrence of response shift in QOL ratings over time could have large implications for the estimation of the effectiveness of medical interventions and for the use of these estimations in cost-effectiveness analyses. After a successful treatment the conventional change could be an underestimation of the effectiveness of the treatment, although it has also been argued that psychological adaptation is a welcome capacity of human beings, and that then-test changes do no justice to this capacity.
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Affiliation(s)
- M A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands.
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