29 research outputs found
THE SIGNATURE OF INTESTINAL DYSBIOSIS IN INFLAMMATORY RHEUMATIC DISEASES
No full textThe study of intestinal microbiota is an important and current subject. It is well known that the gut microbiota plays a decisive role in the development of intestinal function, contributes to the defense against different infections, gives tolerance to ingested foods, regulating and maintaining the function of the intestinal barrier. The gut microbiota is different from individual to individual, determining, through the molecular profile, an “individual profile”.
Intestinal dysbiosis is associated with multiple diseases such as IBD, irritable bowel syndrome, nosocomial infections or rheumatic inflammatory disorders. By characterizing intestinal dysbiosis in patients, a link could be made between these bacteria and the pathogenic mechanisms of the diseases, assigning these structures key roles in the onset of systemic disorders. This allows a better understanding of the pathophysiological mechanisms of the diseases and allow having a targeted treatment aimed at improving dysbiosis and restoring the normal microbial gut profile
ETIOPATHOGENIC MECHANISMS OF TOBACCO CONSTITUENTS IN RHEUMATOID ARTHRITIS
No full textActive smoking is considered a risk factor for rheumatoid arthritis. Smokers show respiratory extra-articular manifestations and complications, such as interstitial lung disease and chronic obstructive pulmonary disease. Smokers may receive a more intensive drug therapy than non-smokers, but they have a poor prognosis. Smoker’s resistance to therapy may be caused by the pharmacokinetic interactions between drugs and tobacco constituents.
The present account of some of those thousands of components of the gas and tar phase of cigarette smoke
(polynuclear aromatic hydrocarbons, quinones, cyanide, heavy metals, bacterial endotoxins, nicotine and carbon
monoxide) may help explain the inconclusive incrimination of tobacco use in the development of rheumatoid arthritis and convince more clinicians to recommend smoking cessation
Psoriatic arthritis “sine psoriasis” – a rare form of disease that raises positive and differential diagnosis problems
No full textPsoriatic arthritis is part of the big group of spondylarthropaties, presenting numerous clinical forms and having both musculoskeletal and extraarticular manifestations. Usually, the disease diagnosis is set after the presence of clinical signs of skin psoriasis. In that case, the diagnosis is made quite easily. The condition puts a lot of problems regarding differential diagnosis especially in the situation when it precedes the onset of skin lesions. Regarding the presented case, a correct diagnosis of psoriatic arthritis “sine psoriasis” was made after about 20 years of
disease evolution, at which time the specific nail lesions of psoriasis appeared
Non-Traditional Pro-Inflammatory and Pro-Atherosclerotic Risk Factors Related to Systemic Lupus Erythematosus
No full textCardiovascular diseases (CVD) are one of the leading causes of high mortality in patients with systemic lupus erythematosus (SLE). The Framingham risk score and other traditional risk factors do not fully reflect the CVD risk in SLE patients. Therefore, in order to stratify these high-risk patients, additional biomarkers for subclinical CVD are needed. The mechanisms of atherogenesis in SLE are still being investigated. During the past decades, many reports recognized that inflammation plays a crucial role in the development of atherosclerosis. The aim of this report is to present novel proinflammatory and pro-atherosclerotic risk factors that are closely related to SLE inflammation and which determine an increased risk for the occurrence of early cardiovascular events
IS THERE A PLACE FOR ANTI-NUCLEOSOME ANTIBODY ASSESSMENT IN SCLERODERMA?
No full textIntroduction. The hallmarks of systemic sclerosis (SSc) include microangiopathy, autonomic dysfunction, as
well as immune disturbance and the widespread fibrosis of the skin and visceral organs. While the significance
of SSc-specific autoantibodies such as anti-centromere and anti-topoisomerase I has long been demonstrated,
the clinical relevance of non-specific autoantibodies remains a matter of debate. Our primary objective was to
assess the relationships between non-SSc-specific antibody titers and the clinical characteristics of scleroderma patients. Secondary objectives included a comparison between SSc, SLE and healthy controls (HC) with respect to autoantibody values, as well as the analysis of the immune disturbance in elderly individuals in the 3 groups.
Material and method. We conducted a cross-sectional study in which we recruited 67 adult patients with SSc,
67 age and gender-matched individuals with SLE and healthy controls (HC). Biological samples (venous blood)
were collected in order to determine the levels of anti-SSA/Ro, anti-SSB/La, anti-U1RNP and anti-nucleosome
antibodies (ELISA). We recorded the presence of digital ulcers (DUs), ILD (thoracic X-rays), and PAH (Doppler
echocardiography) in the scleroderma cohort.
Results. The frequency of anti-nucleosome antibody positivity in the scleroderma group exceeded our expectations, resembling that of lupus patients. Moreover, our findings indicate an association between serum anti-nucleosome antibody titers and SSc-related cardiopulmonary involvement. Anti-U1RNP antibodies were linked to PAH.
We did not identify a notable relationship between the 4 autoantibodies studied and DUs. However, the latter were
significantly more frequent in male patients. Although elderly individuals with scleroderma did not demonstrate
a significantly decreased autoantibody production, lupus patients over 60 years of age exhibited a decline in
anti-nucleosome antibody titers.
Discussions. Earlier research reported an association between anti-nucleosome and anti-U1RNP antibodies
with SSc-related cardiopulmonary impairment. Moreover, male gender is currently regarded as an important risk
factor for the development of scleroderma DUs.
Conclusions. Recent research provides new insights on the pathogenic processes of autoimmune rheumatic
diseases, in an attempt to identify potential risk factors for organ involvement. Our study confirms the link between
anti-nucleosome antibodies and cardiopulmonary involvement in the SSc population. Moreover, the impact of immunosenescence on the dynamics of autoantibody production in connective tissue diseases remains in need
of further investigation
What can be hidden behind a persistent fever syndrome?
No full textFever is a defence mechanism of the body that occurs in various pathological situations, most often being secondary to an infectious disease. A prolonged febrile syndrome can hide many clinical problems, thus delaying a correct diagnosis and treatment. We present the case of a 52-year-old patient who addressed with a high fever associated with a generalized skin rash, arthralgia, myalgia and fatigue. Initially, the patient was referred to the infectious disease clinic where numerous paraclinical investigations were performed which ultimately ruled out an infectious cause of fever. Prompt response to corticosteroid therapy after performing numerous combinations of antibiotics, led to a possible autoimmune disease, the patient being redirected to the rheumatology clinic. Following the biological, immunological and radiological investigations, the diagnosis of adult Still’s disease was supported and the corresponding immunosuppressive treatment was initiated with good clinical-biological evolution
Cytokines in Systemic Lupus Erythematosus—Focus on TNF-α and IL-17
No full textSystemic lupus erythematosus (SLE) is an autoimmune disorder known for its complex pathogenesis, in which cytokines play an essential role. It seems that the modulation of these cytokines may impact disease progression, being considered potential biomarkers. Thus, TNF (tumor necrosis factor)-α and IL (interleukin)-17 are molecules of great interest in SLE. TNF-α plays a dual role in SLE, with both immunosuppressive and proinflammatory functions. The role of IL-17 is clearly described in the pathogenesis of SLE, having a close association with IL-23 in stimulating the inflammatory response and consecutive tissue destruction. It appears that patients with elevated levels of these cytokines are associated with high disease activity expressed by the SLE disease activity index (SLEDAI) score, although some studies do not confirm this association. However, TNF-α and IL-17 are found in increased titers in lupus patients compared to the general population. Whether inhibition of these cytokines would lead to effective treatment is under discussion. In the case of anti-TNF-α therapies in SLE, the possibility of ATIL (anti-TNF-induced lupus) is a serious concern that limits their use. The use of anti-IL-17 therapies in SLE is a promising option, but not yet approved. Future studies of these cytokines in large cohorts will provide valuable information for the management of SLE
ARTICULAR INVOLVEMENT IN INFLAMMATORY BOWEL DISEASE – THE MOST FREQUENT EXTRAINTESTINAL MANIFESTATION
No full textObjectives. Inflammatory bowel disease (IBD) are part of a pathology that has an ascending incidence both in
Romania and around the world. It is well known that intestinal inflammation in IBD is not limited to the intestinal
epithelium. Sometimes, extraintestinal manifestations (EIM) may have a more severe clinical expression than
the intestinal disorder or may even encourage an increased morbidity. The research motivation focused on the
development of specific clinical and epidemiological data for patients diagnosed with IBD who associate EIM.
Material and methods. We performed a retrospective study including 517 patients with intestinal inflammation
(Crohn disease - CD, ulcerative colitis - UC or undifferentiated colitis - NC) diagnosed during 1975-2016 in the N-E
region of Romania. All the cases were extracted from the national database (IBD Prospect).
Results. In our study the prevalence of UC versus CD cases prevailed. There were 368 cases (71.2%) of UC,
135 cases (26.1%) of CD and 10 cases of NC (1.9%). The prevalence of EIM in IBD patients in N-E Romania was
9,9% which was quite low. In the study group, EIMs occurred with a higher frequency in patients diagnosed with
CD compared to UC. Thus, of the 51 cases of IBD and EIM, 27 (52.9%) belonged to the CD’s phenotype and 24
cases (47.1%) of the UC’s phenotype.
Discussions. Both patients with CD and UC experienced a greater risk than the rest of patients for developing
EIM. The most frequent EIMs were highlighted at the level of musculoskeletal system. Among EIM, there were
38 cases (74,5%) with articular manifestations (of which 26 had peripheral manifestations - arthritis, 12 cases
developed axial manifestations – sacroiliitis/ankylosing spondylitis - SI/AS). Also, cases with multiple EIM had at
least one articular manifestation.
Conclusions. Our results sustain, once again, the fact that inflammation in IBD is not limited at the level of
gastrointestinal tract. The presence of EIM, especially joint involvement, is a certainty validated by the results of
many clinical trials
