The hypothesis of the study was that polymorphisms in promoter regions -238 and -308 of
TNF-α
could be associated with different clinical outcomes in inflammatory bowel diseases (IBD) and ...immune-mediated rheumatic diseases (IMRD). The aim was to examine the possible association of both polymorphisms with concentration of C-reactive protein (CRP) and fecal calprotectin (fCAL), onset of the remission and development of the ADA in patients on therapy with anti-TNF inhibitors. The prospective study was done in patients with IBD and IMRD on infliximab (IFX) or adalimumab (ADM). Patients were genotyped for
TNF-α
-238 and -308 polymorphisms. The concentration of CRP, fCAL, IFX or ADM and antibodies to drugs were measured according to manufacturer’s instructions and followed-up for 6 or 12 months. Out of all patients (
N
= 112), number of patients in remission did not differ according to genotypes (for IBD patients
P
= 0.509 vs 0.223; for IMRD patients
P
= 0.541 vs 0.132 for
TNF-α
-238 and -308, respectively). Initial CRP concentration was higher in IBD patients with
TNF-α
-308 GG than GA/AA genotypes in patients who failed to achieve remission 11.8 (4.4–39.6) vs 3.1 (1.5–6.5),
P
= 0.033. In IBD patients with remission, fCAL concentration after at least 6 months of therapy was higher in
TNF-α
-308 GG than in GA genotype 52 (25–552) vs 20 (20–20) µg/g,
P
= 0.041. Our results showed the association of
TNF-α
-308 GG genotype with a higher concentration of CRP and fecal calprotectin in patients with inflammatory bowel diseases on IFX or ADM therapy. Clinical remission and development of antibodies to anti-TNF drugs were not associated with
TNF-α
-238 and -308 polymorphisms.
Primary angiitis of the central nervous system (PACNS) is a rare and severe disease confined to the central nervous system, i.e., the brain and spinal cord. The etiology, pathogenesis and immune ...mechanism of PACNS have not yet been completely elucidated. The diagnosis is challenging; it is based upon constellation of clinical picture, cerebrospinal fluid analysis, imaging methods or tissue biopsy as the gold standard. In differential diagnosis of PACNS, it is necessary to rule out infectious, malignant or systemic inflammatory diseases, as well as reversible cerebral vasoconstriction syndrome. Immunosuppressants are cornerstone therapy for PACNS, although evidence-based strategies for the management are lacking so far. PACNS is an entity with considerable morbidity and mortality. Awareness of this rare and heterogeneous disease is crucial for establishing early diagnosis and treatment initiation.
•Reduced health-related quality of life (HQOL), fatigue and psychological distress are common in rheumatoid arthritis (RA).•Physical activity should be an integral part of RA management yet there is ...a lack of RA-targeted exercise programs.•A 12-week Yoga in Daily Life program was not associated with change in HQOL in RA patients.•Significant and sustained improvements with yoga were observed in fatigue and mood. The yoga program proved safe and feasible.•Yoga in Daily Life program could be of benefit in facilitating physical activity in RA and complement standard RA management.
To explore the feasibility and effectiveness of a yoga program in improving health-related quality of life (HQOL), physical and psychological functioning in rheumatoid arthritis (RA) patients.
Single-centre parallel-arms randomized controlled trial comparing yoga (n = 30) and education control group (n = 27).
Tertiary care University hospital.
A 12-week yoga program, based on the Yoga in Daily Life system, included 2x weekly/90-minute sessions. The control group had 1xweekly/60-minute educational lectures on arthritis-related topics.
Assessments were performed at baseline, 12 (post-intervention) and 24 weeks (follow-up). The primary outcome was change in The Short Form-36 (SF-36) HQOL at 12 weeks. Linear regression analysis was adjusted for baseline scores.
No significant between-group differences were found for SF-36 (all p > 0.05). At 12 weeks the adjusted mean difference between groups favoured yoga for Functional Assessment of Chronic Illness Therapy-fatigue (5.08 CI 1.29 to 8.86; p = 0.009) and Hospital Anxiety and Depression Scale (HADS)-depression (−1.37 CI −2.38 to −0.36); p = 0.008) and at 24 weeks for HADS-anxiety (−1.79 CI −3.34 to − 0.23; p = 0.025), while the impact on fatigue was sustained (5.43 CI 1.33 to 9.54, p = 0.01). The program had no impact on RA disease activity. Feasibility outcomes included recruitment rate 16 %, retention 80.7 %, and adherence to yoga 87.5 vs 82.7 % for control. No serious adverse events were recorded.
Yoga in Daily Life program was not associated with change in health-related quality of life of RA patients. Significant improvements in fatigue and mood were observed at postintervention and follow-up. This yoga program was found feasible and safe for patients and may complement standard RA treat-to-target strategy.
Rheumatoid arthritis (RA) is among the most prevalent and debilitating autoimmune inflammatory chronic diseases. Although it is primarily characterized by destructive peripheral arthritis, it is a ...systemic disease, and RA-related extraarticular manifestations (EAMs) can affect almost every organ, exhibit a multitude of clinical presentations, and can even be asymptomatic. Importantly, EAMs largely contribute to the quality of life and mortality of RA patients, particularly substantially increased risk of cardiovascular disease (CVD) which is the leading cause of death in RA patients. In spite of known risk factors related to EAM development, a more in-depth understanding of its pathophysiology is lacking. Improved knowledge of EAMs and their comparison to the pathogenesis of arthritis in RA could lead to a better understanding of RA inflammation overall and its initial phases. Taking into account that RA is a disorder that has many faces and that each person experiences it and responds to treatments differently, gaining a better understanding of the connections between the joint and extra-joint manifestations could help to create new treatments and improve the overall approach to the patient.
Key Clinical Message
Alpha‐gal syndrome is an immunoglobulin E‐mediated hypersensitivity characterized by delayed allergic reactions to ingested products containing alpha‐gal carbohydrate. We present ...a patient with recurrent urticaria and suspected repaglinide hypersensitivity, who was eventually diagnosed with alpha‐gal syndrome, wanting to emphasize possible drug allergy misdiagnosis and required caution with the medication choice.
Alpha‐gal syndrome—Food or drug allergy: A case report .
Systemic sclerosis (SSc) is a systemic autoimmune disease characterised by generalized microangiopathy and fibrosis of skin and internal organs. The 2013 American College of Rheumatology (ACR) / ...European League Against Rheumatism (EULAR) criteria have contributed considerably to classifying patients with SSc in earlier stages, but they still lack sensitivity for a very early stage of the disease. Criteria for a very early diagnosis of SSc (VEDOSS) have been proposed by EULAR Scleroderma Trial and Research group (EUSTAR) which include three red flags: Raynaud's phenomenon, puffy fingers and antinuclear antibody positivity, plus SSc specific antibodies positivity and/or abnormal nailfold capillaroscopy. We report a case of a 54-year-old female patient with 6-week history of puffy fingers, Raynaud phenomenon and positive antinuclear antibodies. Further workup revealed early pathologic capillary pattern by nailfold capillaroscopy and positive anticentromere antibodies. Screening for internal organ involvement detected no heart, lung, or upper gastrointestinal tract involvement. The patient was started on pentoxifylline with further follow-up. The aim of the implementation of VEDOSS criteria is to diagnose SSc at the earliest possible stage, so that subclinical internal organ involvement could be detected and appropriate treatment started at a potentially reversible stage.
The diaphragm is the most important muscle in respiration. Nevertheless, its function is rarely evaluated. Patients with systemic sclerosis (SSc) could be at risk of diaphragmatic dysfunction because ...of multiple factors. These patients often develop interstitial lung disease (SSc-ILD) and earlier studies have indicated that patients with different ILDs have decreased diaphragmatic mobility on ultrasound (US). This study aimed to evaluate diaphragmatic function in SSc patients using US with regard to the ILD, evaluated with the Warrick score on high-resolution computed tomography (HRCT), and to investigate associations between ultrasonic parameters and dyspnea, lung function, and other important clinical parameters. In this cross-sectional study, we analyzed diaphragm mobility, thickness, lung function, HRCT findings, Modified Medical Research Council (mMRC) dyspnea scale, modified Rodnan skin score (mRSS), autoantibodies, and esophageal diameters on HRCT in patients with SSc. Fifty patients were enrolled in the study. Patients with SSc-ILD had lower diaphragmatic mobility in deep breathing than patients without ILD. The results demonstrated negative correlations between diaphragmatic mobility and mMRC, mRSS, anti-Scl-70 antibodies, esophageal diameters on HRCT, and a positive correlation with lung function. Patients with SSc who experience dyspnea should be evaluated for diaphragmatic dysfunction for accurate symptom phenotyping and personalized pulmonary rehabilitation treatment.
Eozinofilni pleuralni izljev (EPI) ubrajamo u skupinu eksudativnih izljeva. Označava ga prisutnost od najmanje 10% eozinofilnih granulocita u pleuralnoj tekućini.1 Najčešća stanja povezana s EPI jesu ...maligne bolesti, infekcije, postkirurška i posttraumatska stanja, hipersenzitivnost, sistemske autoimunosne bolesti, srčana dekompenzacija, ciroza jetre, plućna embolija, azbestoza i reakcija na lijekove.2–4 U sistemskim autoimunosnim bolestima pleuralni se izljev najčešće nalazi u bolesnika sa sistemskim eritemskim lupusom5,6 i reumatoidnim artritisom,6 a rjeđe u sistemskoj sklerozi i polimiozitisu6 dok je iznimno rijedak u Churg-Straussovu sindromu.7 U 14 do 25% bolesnika uzrok EPI ostaje nepoznat i tada EPI nazivamo idiopatskim.2–4 Liječenje EPI zasniva se na liječenju primarne bolesti, a idiopatski oblik liječi se primjenom glukokortikoida. U radu smo prikazali bolesnika s idiopatskim eozinofilnim pleuralnim izljevom i dijagnostički postupak kojim su isključene druge bolesti ili stanja te liječenje metilprednizolonom koje je dalo odličan klinički odgovor uz izlječenje
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