scholarly journals Treatment approaches to patients with multiple sclerosis and coexisting autoimmune disorders

2021 ◽  
Vol 14 ◽  
pp. 175628642110355
Author(s):  
Tobias Brummer ◽  
Tobias Ruck ◽  
Sven G. Meuth ◽  
Frauke Zipp ◽  
Stefan Bittner
Keyword(s):  
Multiple Sclerosis ◽  
Autoimmune Disorders ◽  
New Era ◽  
The Past ◽  
Disease Modifying Therapies ◽  
Bowel Diseases ◽  
Autoimmune Conditions ◽  
Autoimmune Condition ◽  
Inflammatory Bowel ◽  
Attending Physician

The past decades have yielded major therapeutic advances in many autoimmune conditions – such as multiple sclerosis (MS) – and thus ushered in a new era of more targeted and increasingly potent immunotherapies. Yet this growing arsenal of therapeutic immune interventions has also rendered therapy much more challenging for the attending physician, especially when treating patients with more than one autoimmune condition. Importantly, some therapeutic strategies are either approved for several autoimmune disorders or may be repurposed for other conditions, therefore opening new curative possibilities in related fields. In this article, we especially focus on frequent and therapeutically relevant concomitant autoimmune conditions faced by neurologists when treating patients with MS, namely psoriasis, rheumatoid arthritis and inflammatory bowel diseases. We provide an overview of the available disease-modifying therapies, highlight possible contraindications, show pathophysiological overlaps and finally present which therapeutics can be utilized as a combinatory treatment, in order to ‘kill two birds with one stone’.

Autoimmune diseases prior to the diagnosis of multiple sclerosis: a population-based case-control study

2010 ◽  
Vol 16 (7) ◽  
pp. 855-861 ◽  
Author(s):  
A. Langer-Gould ◽  
KB Albers ◽  
SK Van Den Eeden ◽  
LM Nelson
Keyword(s):  
Multiple Sclerosis ◽  
Case Control Study ◽  
Care Program ◽  
Population Based ◽  
Case Control ◽  
Autoimmune Disorders ◽  
Kaiser Permanente ◽  
Inflammatory Bowel ◽  
Clinical Records ◽  
Control Study

The objective of this study was to determine whether patients with multiple sclerosis (MS) are more likely to have other autoimmune disorders particularly prior to the diagnosis of MS. We conducted a population-based case—control study of patients enrolled in the Northern California Kaiser Permanente Medical Care Program. Electronic clinical records through 2005 were used to ascertain incident and prevalent MS cases and identify the presence and timing of 44 other diagnoses. Controls were matched 5:1 for gender, age, and Kaiser membership characteristics. We identified 5296 MS cases (including 924 diagnosed between 2001 and 2004) and 26,478 matched controls. Prior to MS diagnosis, cases were more likely than controls to have uveitis (OR = 3.2, 95%; CI 1.7—5.7), inflammatory bowel disease (IBD, OR = 1.7; 95%CI 1.2—2.5), and Bell’s palsy (OR = 3.2; 95%CI 1.2—8.3). Cases were also more likely to develop Guillain— Barré syndrome (GBS, OR = 5.0; 95%CI 1.6—15.4) and bullous pemphigoid (OR = 6.7; 95%CI 1.5—29.9). Cases were not more likely than controls to have or to develop rheumatoid arthritis, lupus or thyroiditis. MS may share environmental triggers, genetic susceptibilities and/or alterations in immune homeostasis with IBD and uveitis, but not with other autoimmune disorders.

scholarly journals Management of Musculoskeletal Manifestations in Inflammatory Bowel Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Tejas Sheth ◽  
C. S. Pitchumoni ◽  
Kiron M. Das
Keyword(s):  
Inflammatory Bowel Diseases ◽  
Multidisciplinary Approach ◽  
Physical Therapist ◽  
Cost Savings ◽  
The Past ◽  
The Us ◽  
Bowel Diseases ◽  
Musculoskeletal Manifestations ◽  
Inflammatory Bowel ◽  
Near Future

Musculoskeletal manifestations are the most common extraintestinal manifestations in inflammatory bowel diseases. Some appendicular manifestations are independent of gut inflammation and are treated with standard anti-inflammatory strategies. On the other hand, axial involvement is linked to gut inflammatory activity; hence, there is a considerable amount of treatment overlap. Biological therapies have revolutionized management of inflammatory bowel diseases as well as of associated articular manifestations. Newer mechanisms driving gut associated arthropathy have surfaced in the past decade and have enhanced our interests in novel treatment targets. Introduction of biosimilar molecules is expected in the US market in the near future and will provide an opportunity for considerable cost savings on healthcare. A multidisciplinary approach involving a gastroenterologist, rheumatologist, and physical therapist is ideal for these patients.

scholarly journals Brief Course of Ultra-High Dose IV Methylprednisolone in the Treatment of Multiple Sclerosis Exacerbations

2020 ◽  
pp. 1-4
Author(s):  
Robert Knobler ◽  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
High Dose ◽  
Side Effect Profile ◽  
Intravenous Methylprednisolone ◽  
The Past ◽  
Disease Modifying Therapies ◽  
Cord Injury ◽  
Disease Modifying

Despite the introduction of a number of effective disease modifying therapies (DMT) for multiple sclerosis (MS) over the past 25 years, a need remains for an effective method of treating breakthrough relapses, which impact disease progression. ACTH and corticosteroids have fulfilled this role for the past 50 years. However, based upon our current understanding of the cadence of an exacerbation, and its importance in the progression of MS, an alternative is proposed. This utilizes a very brief course of an ultra-high dose of intravenous methylprednisolone, adapted from the megadose protocol of methylprednisolone in acute spinal cord injury. Despite the known side effect profile of corticosteroids, and the ultra-high dose employed, the brevity in administration yields a well-tolerated, rapid resolution of the relapse

scholarly journals Results of the Seventh Scientific Workshop of ECCO: Precision medicine in IBD - disease outcome and response to therapy

2021 ◽  
Author(s):  
Bram Verstockt ◽  
Nurulamin M Noor ◽  
Urko M Marigorta ◽  
Polychronis Pavlidis ◽  
Parakkal Deepak ◽  
...  
Keyword(s):  
Precision Medicine ◽  
Response To Therapy ◽  
Treatment Algorithms ◽  
New Era ◽  
Extreme Phenotypes ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Omic Data Integration ◽  
Omic Data ◽  
Prognostic And Predictive Markers

Abstract Inflammatory bowel diseases [IBD] are a heterogeneous spectrum with two extreme phenotypes, Crohn’s disease [CD] and ulcerative colitis [UC], which both represent numerous phenotypical variations. Hence, we should no longer approach all IBD patients similarly, but rather aim to rethink clinical classifications and modify treatment algorithms to usher in a new era of precision medicine in IBD. This scientific ECCO workshop aims to provide a state-of-the-art overview on prognostic and predictive markers, shed light on key questions in biomarker development, propose best practices in IBD biomarker development [including trial design], and discuss the potential for multi-omic data integration to help drive further advances to make precision medicine a reality in IBD.

scholarly journals Methotrexate for Inflammatory Bowel Diseases - New Developments

2016 ◽  
Vol 34 (1-2) ◽  
pp. 140-146 ◽  
Author(s):  
Hans H. Herfarth
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Inflammatory Bowel Diseases ◽  
Antibody Formation ◽  
Clinical Effectiveness ◽  
New Developments ◽  
The Past ◽  
Steroid Dependent ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Methotrexate (MTX) is an established therapy for patients with steroid-dependent Crohn's disease (CD). MTX is also frequently used in combination with anti-TNF agents to suppress anti-drug antibody formation. It has been suggested in the past that MTX lacks any clinical effectiveness in patients with ulcerative colitis (UC); however, newer data at least partially contradict this assumption. The following review will discuss recent data for the use of MTX in CD, UC and in combination with anti-TNF agents.

scholarly journals Tissue-Resident T Cells in Chronic Relapsing–Remitting Intestinal Disorders

Cells ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1882
Author(s):  
Juliana Barreto de Albuquerque ◽  
Christoph Mueller ◽  
Bilgi Gungor
Keyword(s):  
Rheumatoid Arthritis ◽  
Multiple Sclerosis ◽  
Cell Biology ◽  
Critical Factor ◽  
Therapeutic Strategies ◽  
Inflammatory Disorders ◽  
Relapsing Remitting ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Barrier Tissues

Tissue-resident memory T (TRM) cells critically contribute to the rapid immunoprotection and efficient immunosurveillance against pathogens, particularly in barrier tissues, but also during anti-tumor responses. However, the involvement of TRM cells also in the induction and exacerbation of immunopathologies, notably in chronically relapsing auto-inflammatory disorders, is becoming increasingly recognized as a critical factor. Thus, TRM cells may also represent an attractive target in the management of chronic (auto-) inflammatory disorders, including multiple sclerosis, rheumatoid arthritis, celiac disease and inflammatory bowel diseases. In this review, we focus on current concepts of TRM cell biology, particularly in the intestine, and discuss recent findings on their involvement in chronic relapsing–remitting inflammatory disorders. Potential therapeutic strategies to interfere with these TRM cell-mediated immunopathologies are discussed.

scholarly journals Epidemiology and diagnosis of inflammatory bowel diseases

2021 ◽  
Vol 64 (9) ◽  
pp. 579-587
Author(s):  
Kang-Moon Lee
Keyword(s):  
Inflammatory Bowel Diseases ◽  
Public Awareness ◽  
Intestinal Tuberculosis ◽  
Diagnostic Delay ◽  
Perianal Fistula ◽  
Diagnostic Tools ◽  
Male Predominance ◽  
The Past ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Background: Over the past three decades, inflammatory bowel diseases (IBD) have been rapidly increasing in the African, South American, and Asian countries, including Korea. However, in Korea, the public awareness of IBD remains low, and diagnostic delay is not uncommon due to the physicians' lack of clinical experience. It is essential to understand the trends and regional differences in the epidemiology of IBD for proper diagnosis and treatment.Current Concepts: Although lower than those of the West, the prevalence and incidence of IBD in Korea rank among the highest in Asia and are steadily increasing. In the past 10 years, the prevalence of IBD has almost doubled, while its incidence has decreased gradually. As compared to Western IBD patients, Korean patients have higher proportion of proctitis in ulcerative colitis, male predominance, more ileocolonic involvement, and higher incidence of perianal fistula in Crohn disease. There is no single gold standard for the diagnosis of IBD. Thus, diagnosis can be made by clinical evaluation, including a detailed history taking, physical examination, and a combination of endoscopic, radiologic, laboratory, and histologic findings.Discussion and Conclusion: Population-based studies have revealed the current trends and characteristics of the epidemiology of IBD in Korea. Continued education and development of diagnostic tools will help clinicians to diagnose IBD accurately and differentiate it from other diseases such as intestinal tuberculosis.

scholarly journals Seronegative Myasthenia Gravis, as a Rare Autoimmune Condition in Turner Syndrome

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Rimah Sharief ◽  
Amir Miodovnik ◽  
Roja Motaghedi
Keyword(s):  
Myasthenia Gravis ◽  
Developmental Delay ◽  
Turner Syndrome ◽  
Muscle Weakness ◽  
Unique Combination ◽  
Bilateral Ptosis ◽  
The Past ◽  
Seronegative Myasthenia Gravis ◽  
Autoimmune Conditions ◽  
Autoimmune Condition

Girls with Turner syndrome (TS), especially with isochromosome 46,X,i(X)(q10), are prone to develop autoimmunity. Associations of several autoimmune conditions with TS have been frequently described in the past. However, the unique combination of TS and myasthenia gravis (MG) has been reported only once before in a girl with mosaic monosomy 45,X/46,XX. Here, we present the second case of a girl affected with seronegative MG but with mosaic isochromosome TS. This is a child with developmental delay presented with muscle weakness, frequent fall, and bilateral ptosis. Diagnosis of MG was made based on positive Tensilon and electromyography tests and excellent response to intravenous immunoglobulin. At the age of 11 years due to short stature and developmental delay, a karyotype was done and revealed the mosaic isochromosome 45,X/46,X,i(X)(q10). Overall, clinicians should be aware of the vulnerability of girls with TS to autoimmunity, especially if the isochromosome 46,X,i(X)(q10) karyotype is identified. Furthermore, if a child with TS develops muscle weakness, ptosis, or ophthalmoplegia, MG should also be included in the differential diagnosis, particularly if other concurrent autoimmune conditions are present.

scholarly journals The use and quality of reporting of propensity score methods in multiple sclerosis literature: A review

2020 ◽  
pp. 135245852097255
Author(s):  
Mohammad Ehsanul Karim ◽  
Fabio Pellegrini ◽  
Robert W Platt ◽  
Gabrielle Simoneau ◽  
Julie Rouette ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Propensity Score ◽  
Statistical Tests ◽  
Quality Of Reporting ◽  
Propensity Score Methods ◽  
The Past ◽  
Disease Modifying Therapies ◽  
Pubmed Database ◽  
Effectiveness Studies

Background: Propensity score (PS) analyses are increasingly used in multiple sclerosis (MS) research, largely owing to the greater availability of large observational cohorts and registry databases. Objective: To evaluate the use and quality of reporting of PS methods in the recent MS literature. Methods: We searched the PubMed database for articles published between January 2013 and July 2019. We restricted the search to comparative effectiveness studies of two disease-modifying therapies. Results: Thirty-nine studies were included in the review, with most studies (62%) published within the past 3 years. All studies reported the list of covariates used for the PS model, but only 21% of studies mentioned how those covariates were selected. Most studies used PS matching (72%), followed by PS adjustment (18%), weighting (15%), and stratification (3%), with some overlap. Most studies using matching or weighting reported checking post-PS covariate imbalance (91%), although about 45% of these studies relied on p values from various statistical tests. Only 25% of studies using matching reported calculating robust standard errors for the PS analyses. Conclusions: The quality of reporting of PS methods in the MS literature is sub-optimal in general, and in some cases, inappropriate methods are used.

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