Our knowledge of the role of cytokines in pathologic conditions has increased considerably with the emergence of molecular and genetic studies, particularly in the case of autoinflammatory monogenic ...diseases. Many rare disorders, considered orphan until recently, are directly related to abnormal gene regulation, and the treatment with biologic agents (biologics) targeting cytokine receptors, intracellular signaling or specific cytokines improve the symptoms of an increasing number of chronic inflammatory diseases. As it is currently impossible to systematically conduct genetic studies for all patients with autoinflammatory and autoimmune diseases, the evaluation of cytokines can be seen as a simple, less time consuming, and less expensive alternative. This approach could be especially useful when the diagnosis of syndromes of diseases of unknown etiology remains problematic. The evaluation of cytokines could also help avoid the current trial-and-error approach, which has the disadvantages of exposing patients to ineffective drugs with possible unnecessary side effects and permanent organ damages. In this review, we discuss the various possibilities, as well as the limitations of evaluating the cytokine profiles of patients suffering from autoinflammatory and autoimmune diseases, with methods such as direct detection of cytokines in the plasma/serum or following ex vivo stimulation of PBMCs leading to the production of their cytokine secretome. The patients' secretome, combined with biomarkers ranging from genetic and epigenetic analyses to immunologic biomarkers, may help not only the diagnosis but also guide the choice of biologics for more efficient and rapid treatments.
Le méthotrexate a été incriminé dans la survenue de nodules de type rhumatoïde dans la polyarthrite rhumatoïde, et l’on parle alors de phénomène « d’efflorescence nodulaire ». Récemment, ces nodules ...ont été observés chez des patients porteurs d’autres pathologies inflammatoires traitées par méthotrexate, et une nouvelle entité anatomopathologique a été individualisée : la panniculite. Nous décrivons un cas de panniculite chez une patiente porteuse d’un syndrome de Sharp traitée par méthotrexate.
Accelerated nodulosis during methotrexate therapy for rheumatoid arthritis has been well described. There have been recent reports of nodulosis in patients on methotrexate for other inflammatory conditions. Panniculitis is a newly discovered pathological entity in this setting. We describe a case of panniculitis in a woman receiving methotrexate for mixed connective tissue disease.
PDF
