1,721,001 research outputs found
Comment on "Leishmania in SLE mimicking and exacerbation"
No full textA comment about the risk of infection in immunocompromised patien
Rheumatoid arthritis in beta-thalassemia trait
No full textSubjects with beta-thalassaemic trait have a higher prevalence of a mild form of RA compared to normal population. It may be related to some environmental factors wich alter host susceptibility or it could be secondary to the biology of beta-thal population
Optimizing clinical monitoring of central nervous system involvement in SLE
No full textCentral Nervous System (CNS) involvement is a frequent SLE manifestation occurring in 15-75% of patients. However, diagnosis of CNS involvement is a difficult task and requires a careful clinical and laboratory assessment along with instrumental evaluation. In recent years major advances in neuroimaging techniques allowed a great improvement in our understanding of SLE pathogenesis. Anyway, since no single imaging technique covers all brain pathology and both inflammation and neurodegeneration contribute to SLE pathogenesis, it is very important to use a multimodality approach coupling a morphological with a functional imaging modality. In this setting, to date, conventional magnetic resonance imaging and single photon emission computed tomography are the most largely available and accessible techniques. Modern techniques such as perfusion weighted imaging, diffusion weighted imaging, magnetization transfer imaging and magnetic resonance spectroscopy provide useful information to asses..
Beta-thalassaemic trait and systemic lupus erythematosus
No full textThe coexistence of haemoglobinopathies and connective tissue disorders has rarely been investigated and published data relating
to this matter are only anecdotal. In 1975 we demonstrated that the incidence of the b-thal trait in patients with RA coming from
an area in which haemoglobinopathy is endemic, such as Ferrara and Rovigo (the Po Delta, northern Italy), is higher than would
be expected based on its occurrence in the general population (19.8% vs 13.1% of a random population from the same two areas).
In SLE, varying degrees of anaemia are quite a common finding but only rarely has the issue of concomitant haemoglobinopathies
been addressed. To the best of our knowledge 16 reported cases have described the coexistence of sickle cell disease (SCD) and SLE, but only Kaloterakis et al. described a case of sickle cell/b –
thalassaemia in a SLE patient.
In a study conducted by Montecucco et al. it was stated that the prevalence of the b-thal trait in patients with connective tissue
diseases and seronegative spondyloarthropathies is similar to that expected for the whole population according to their geographic
distribution, but the conclusion was not supported by consistent data.
Previously we observed a markedly lower incidence of the b-thal trait among a lupus population born in Ferrara and Rovigo areas
compared to a control population coming from the same two areas. However, these findings were historical and remained
unpublished because of the lack of a rigorous methodological approach to gathering and analysing the data.
We have now prospectively studied the prevalence of b-thal minor in 177 consecutive SLE patients from the Ferrara and Rovigo
areas (32 males and 145 females, mean age 54 years, range 20-89) diagnosed according to the 1997 revised ACR criteria and
followed by our Department from 1998 to the present. Their b-thal status was suspected based on findings of a low mean corpuscolar
volume, low haemoglobin value, and increased number of red blood cells; the condition was confirmed in all the cases by
haemoglobin electrophoresis. In this patient population we found 17 SLE patients (all female, mean age 53 years, range 20-88) with
b-thal minor (9.6% of the cases). This prevalence was 0.7 times lower than the expected rate of 13.1% of the control population
and almost half of the prevalence previously observed in RA patients (19.8%) coming from the same areas. These data suggest that b-thal subjects exhibit a particular immunological reactivity of different circulating lymphocyte Tcells subpopulations. If we consider that
RA is a prevalently Th1-oriented disease and SLE is a prevalently Th2-oriented disease, it could be argued that b-thal might modify the immunological profile of circulating T cells through a different immune
reactivity. Obviously confirmation of this hypothesis will require further studies on Tcell subpopulations and their functioning in b-thal subjects. On the basis of these data we conclude that the prevalence of the b-thal trait is higher in our RA patients and lower in our SLE
patients compared with the normal population. The reasons for this different frequency and the way in which the b-thal trait
interferes with the clinical characteristics of RAand SLE remains a matter of discussion. Large prospective epidemiologic studies
will be necessary to determine if the prevalence of serologic and clinical features of immune complex diseases such as SLE is
influenced by the coexistence of a haemoglobinopathy
Multicentric reticulohistiocytosis
No full textMR is an uncommon disease with joint and cutaneous manifestations most commonly affecting women in middle age. The diagnosis must be confirmed by the istological evidence of typical mononuclear histiocytes and multinucleated giant cells.
The arthritic complaints may be confused with those of more common rheumatic disorders. A careful clinical and radiological evaluation may offer the key to the correct diagnosis
Apoptosi e lupus eritematoso sistemico.
No full textL'immunopatogenesi del LES permane sconosciuta. L'ipotesi di una alterata apoptosi può giocare un ruolo nel condizionare molte delle alterazioni immunologiche. Sono state in particolare studiate due molecole. il recettore Fas/Apo-1 e la proteina Bcl-2. Alcuni dati sperimentali sembrerebbero suggerire l'ipotesi che il LES possa essere caratterizzato da una eccessiva apoptosi
Elevated levels of TRAIL in systemic lupus erythematosus are associated to the presence of anti-SSA/SSB antibodies
No full textThe objective of this study was to determine potential relationship between the levels of serum TNF-related apoptosis inducing ligand (TRAIL) and osteoprotegerin (OPG) and clinical markers in systemic lupus erythematosus (SLE) patients. Forty SLE patients with inactive disease were enrolled in this study. For comparison, 20 Sjögren's syndrome (SS) patients and 30 normal controls were also analysed. Serum levels of TRAIL and OPG were determined by ELISA. Serum TRAIL and OPG concentrations in SLE patients were significantly (P < 0.05) higher than those in healthy volunteers. Of note, serum TRAIL but not OPG was significantly (P < 0.05) higher in the SLE patient subset characterized by the presence of anti-SSA/SSB antibodies. The relationship between high levels of TRAIL and SSA/SSB antibodies was further supported by the analysis of SS patients characterized by SSA/SSB antibodies positivity, in which TRAIL levels resulted comparable to the subgroup of anti-SSA/SSB positive SLE patients. The presence of SSA/SSB antibodies, targeting a specific subset of SLE and SS patients, is related to increased serum levels of TRAIL but not of OPG
Systemic lupus erythematosus
No full textThis review covers major advances in clinical issues related to systemic lupus erythematosus (SLE) published between 1995 and 2000. The classification criteria for both SLE and antiphospholipid syndrome (APS) have been updated, and up to 19 different subsets of neuropsychiatric lupus have been defined. New epidemiological data show that the incidence of new cases and the survival of patients with SLE are both increasing. Several randomised controlled trials have defined the role of cyclophosphamide, methotrexate, antimalarials, and hormonal treatment in the management of SLE. New data are available for drugs such as ciclosporin and thalidomide. Finally, several new treatments for severe refractory cases, such as mycophenolate mofetil and stem-cell transplantation, are being increasingly used. New data also refer to management of thrombosis in APS and high-risk pregnancies in women with SLE or APS
Neuropsychiatric systemic lupus erythematosus: where are we now?
No full textWhen dealing with Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) there are still many controversial topics. In 1999 the American College of Rheumatology gave classification criteria for 19 clinical syndromes. However major problems are still related to low specificity of some of them such as headache, cognitive impairment or mood disorders. Even though a frequency of CNS involvement from 14 to 75% has been described, depending on both the population studied and the methodology of assessment, a lower frequency ranging from 21 to 28 % derived by larger case series seems more realistic. The introduction of the concept of "borderline cases", proposed by Italian Study Group for NP-SLE, is based both on clinical and instrumental evaluation and could represent a useful tool when dealing with conditions which do not fulfil ACR classification. Also the relationship between SLE activity and NP involvement is a debated issue. Concerning pathogenesis, it seems reasonable to consider multifactorial mechanisms related to antibody-mediated damage, antiphospholipid pro-thrombotic effect, non-inflammatory vasculopathy and cytokines mediated cytotoxycity. However, direct and unequivocal evidence for the implication of any of the above-mentioned mechanisms is still lacking. Although a wide range of neuroimaging tools have been used to evaluate CNS involvement, no single technique has proven to be definitive and, when dealing with a patient with suspected NPSLE, it is important to combine different diagnostic techniques. Due to the lack of effective imaging along with limitation in knowledge of underlying pathogenetic mechanisms and paucity of histopathologic findings, therapeutic approach in NPSLE remains a difficult issue and is currently based on personal experience. Italian Study Group for NP-SLE proposes the creation of a national registry on NPSLE to validate ACR classification criteria. Furthermore, the possibility to collect large series and stratifying them for each of the included neuro-psychiatric syndromes seems a good strategy for planning multicentric controlled therapeutic trials in the near future
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