1,721,248 research outputs found
Therapeutic strategies for primary heart involvement in systemic sclerosis
Full text link: Primary heart involvement (pHI) is frequent in systemic sclerosis (SSc), even though often underdiagnosed. SSc-pHI has been recently defined as cardiac abnormalities that are predominantly attributable to SSc rather than other causes and/or complications. SSc-pHI represents a major determinant of mortality in SSc, accounting alone for about 12% of disease-related deaths; its early recognition and promptly therapeutic interventions are therefore crucial. Both perfusion defects and myocardial inflammation contribute to the occurrence of myocardial fibrosis that precipitates myocardial remodeling, potentially leading to heart failure and arrhythmic complications. To date, clear evidence and guidelines for effectively managing SSc pHI are not established yet, resulting in a lack of a defined therapeutic algorithm. In this review we summarize the most recent scientific literature on the prevailing therapeutic strategies and interventions to manage SSc-pHI, with particular focus on therapeutic strategies to counteract the 3 major pathogenic events of the disease, i.e. microvascular damage, myocardial inflammation and myocardial fibrosis
Abnormal Cardiac Biomarkers in Patients with Systemic Lupus Erythematosus and No Prior Heart Disease: The Role of Endomyocardial Biopsy
No full textTselios, et al reported in their recent study that patients with systemic lupus erythematosus (SLE) who receive prolonged antimalarial (AM) treatment are at increased risk for elevated cardiac biomarkers [brain natriuretic peptide (BNP) and high-sensitivity cardiac troponin I (HS-cTnI)], particularly when persistently elevated creatine phosphokinase (CPK) is present1 Among a well-characterized SLE cohort of 179 patients, the authors found that 16 (all without cardiac disease, renal failure, or pulmonary arterial hypertension) presented an increase of at least 1 cardiac biomarker
Interleukin-6 in ANCA-associated vasculitis: Rationale for successful treatment with tocilizumab
No full textObjective: Microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) are systemic, necrotizing, small-vessel vasculitis associated with circulating anti-neutrophil cytoplasmic autoanti-bodies (ANCA), and thus called ANCA-associated vasculitides (AAV). The aim of the present study is to evaluate a potential role of interleukin (IL)-6 and its pathway in the pathogenesis of AAV and to review previous evidence of IL-6 in MPA and GPA. Methods: Blood and histological samples from 10 untreated myeloperoxidase (MPO)-ANCA/proteinase 3 (PR3)-ANCA-positive patients with active AAV were studied. Serum levels of cytokines/chemokines were evaluated by means of a Bio-Plex Multiple Cytokine Assay. IL-6 production at sites of active vasculitis was assessed by means of both immunohistochemistry and in situ hybridization techniques. We also treated a patient with MPA who was resistant or allergic to conventional treatments with a 12-month course of the IL-6 inhibitor tocilizumab and followed him up for 24 additional months. We also reviewed all the published cases in the English literature of histologically confirmed MPA or GPA, in which elevated IL-6 serum levels or intralesional IL-6 expression were reported. Results: IL-6 serum levels were significantly increased in patients with AAV as compared to controls (median = 51.96 pg/mL; range: 34.11-84.30; versus 0.68 pg/mL; range: 0.01-1.81; P < 0.005). Also, IL-6 was expressed and produced at sites of active vasculitis. Treatment with tocilizumab was able to induce a complete and sustained disease remission in a patient with severe multisystemic MPA, as well as normalization of circulating levels of IL-6-associated pro-inflammatory cytokines and chemokines. Previous evidence of IL-6 pathway activation in AAV is scarce. Increased serum levels of IL-6 were reported in seven clinical studies for a total of approximately 120 patients, mainly affected by GPA. Conclusion: The finding of an activated IL-6 pathway in patients with AAV, together with the observed effects of tocilizumab monotherapy, provides evidence for a possible central role of IL-6 in the pathogenesis of AAV and suggests its targeting as a potential treatment. (C) 2015 Elsevier Inc. All rights reserved. OI Dagna, Lorenzo/0000-0002-7428-315X; Cavalli, Giulio/0000-0001-8728-3004 ZB 0 Z8 0 ZR 0 ZS
Anticoagulation as secondary prevention of massive lung thromboses in hospitalized patients with COVID-19
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