Profile of common inflammatory markers in treatment-naïve patients with systemic rheumatic diseases

2020 ◽  
Author(s):  
Min Jung Kim ◽  
Eun Bong Lee ◽  
Yeong Wook Song ◽  
Jin Kyun Park
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Inflammatory Markers ◽  
Acute Phase Proteins ◽  
Acute Infection ◽  
Inflammatory Myopathy ◽  
University Hospital ◽  
Treatment Naïve ◽  
Systemic Rheumatic Diseases ◽  
Wbc Count

Abstract Background The host inflammatory response against infection is characterized by leukocytosis, and the release of cytokines and acute phase proteins. However, routine inflammatory markers are not always elevated in systemic rheumatic diseases (SRD). Here, we aimed to systematically evaluate and compare the clinical implications of common inflammatory markers in systemic rheumatic diseases (SRDs). Methods We investigated the profiles of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and white blood cell (WBC) count in treatment-naïve patients with SRDs, osteoarthritis and pneumonia diagnosed at Seoul National University Hospital during 2004-2016. SRDs included rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), systemic sclerosis (SSc), idiopathic inflammatory myopathy (IIM) and adult onset of Still disease (AOSD). Associations between inflammatory markers were evaluated using Pearson’s correlation and regression analysis. Differences between correlations were compared using Steiger’s z-test. Receiver operating characteristic (ROC) curve analysis was performed to examine the predictive value of inflammatory markers for SRD diagnosis. Results We identified 1191 patients with SRDs, osteoarthritis and pneumonia. Leukocytosis was present in <15% SRD patients. There was marked variability in ESR and CRP levels among different SRDs. The highest mean CRP levels (mean ± SD, mg/dL) were observed in those with AOSD (11.3±7.9), followed by RA (2.0±3.3), IIM (1.8±3.5), SLE (1.5±3.1), SSc (0.6±1.3) and AS (0.08±0.1). Mean ESR (mm/hr) was also highest in AOSD (71.2±31.0), followed by SLE (47.3±34.2), RA (45.5±30.6), IIM (40.8±24.8) and SSc (27.8±26.0). All SRDs showed significant positive correlations between ESR and CRP: greatest in RA (r=0.53, p<0.001) and weakest in SLE (r=0.20, p=0.03). WBC correlated weakly with CRP but not with ESR in most SRDs. While the AUC for WBC count (0.54-0.68) was less than that of ESR or CRP, the AUC for ESR and CRP (0.69-0.86) were similar in SRD. The optimal cuff-off values for inflammatory markers predicting SRD were within or slightly above the normal limit. Conclusions Unlike acute infection, ESR, CRP and WBC count are not always elevated in treatment-naïve patients with SRD. Thus, common inflammatory markers have limited value for diagnosis and assessment of disease activity of SRD.

scholarly journals Profile of common inflammatory markers in treatment-naïve patients with systemic rheumatic diseases

2020 ◽  
Vol 39 (10) ◽  
pp. 2899-2906
Author(s):  
Min Jung Kim ◽  
Eun Bong Lee ◽  
Yeong Wook Song ◽  
Jin Kyun Park
Keyword(s):  
Rheumatic Diseases ◽  
Inflammatory Markers ◽  
Treatment Naïve ◽  
Systemic Rheumatic Diseases

scholarly journals POS1494-HPR THE COLLABORATION OF RHEUMATOLOGY-DERMATOLOGY IN THE EVALUATION OF RHEUMATIC DISEASES PATIENTS: EXPERIENCE IN A UNIVERSITY HOSPITAL

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1031.1-1032
Author(s):  
G. Figueroa-Parra ◽  
A. Moreno-Salinas ◽  
C. M. Gamboa-Alonso ◽  
M. A. Villarreal-Alarcón ◽  
D. Á. Galarza-Delgado
Keyword(s):  
Quality Of Care ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Direct Interaction ◽  
Final Diagnosis ◽  
Underlying Disease ◽  
University Hospital ◽  
Rheumatology Clinic ◽  
Important Interaction

Background:Dermatological manifestations are not rare in patients with rheumatic diseases (RD). Multidisciplinary management and direct interaction between these disciplines are essential. According to Dermatology-Rheumatology clinics, most diagnoses evaluated are systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), with dermatitis being the most common manifestation. It is important to be aware that skin problems in RD patients are not always related to the underlying condition(1). Nowadays, there is significant evidence to support the manifold advantages of the joint dermatology-rheumatology clinics, including improved quality of care for patients and multidisciplinary training for new physicians(2). This ongoing trend is intended to highlight the important interaction between specialties that treat overlapping conditions, and it has been incorporated in academic health centers to give a comprehensive approach to patients.Objectives:Our purpose was to describe the collaboration between the Rheumatology and Dermatology services during the evaluation of RD patients.Methods:An observational, retrospective study was performed in the Rheumatology Service of the University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico, between March 2019 and February 2020. All the patients with a Rheumatology or Dermatology consultation requested were included (hospitalized and outpatients). Demographic (age, gender, baseline diagnosis), the reason for consultation, specialty requested, type of treatment, final diagnoses, and agreement in final diagnosis were registered. Results are shown in descriptive statistics.Results:One hundred and seventy-four patients were included, 142 (81.6%) patients from the outpatient clinic and 32 (18.4%) patients hospitalized. The mean age was 45.1 (SD±15.8) years, 135 (77.6%) were females, 54 (31%) patients were under initial diagnosis evaluation, 30 (17.2%) had RA, 25 (14.4%) patients had SLE, 15 (8.6%) patients had psoriatic arthritis, 12 (6.9%) patients had systemic sclerosis, 6 (3.4%) patients had dermatomyositis. The main reasons for consultation in hospitalized patients were acute lupus (15.6%), subacute lupus (12.5%), purpura (12.5%), cutaneous vasculitis (9.4%), urticarial dermatitis (9.4%), dermatomyositis (6.3%) and others (34.3%). The consultation requested was: 156 (89.7%) to Dermatology and 18 (10.3%) to Rheumatology. The type of treatment prescribed was topic/local in 37 (21.3%) patients, systemic in 25 (14.4%) and both in 92 (52.9%) patients. The final diagnoses were related to the underlying disease in 102 (77%) patients and unrelated in 40 (23%) patients. The agreement between initial clinical suspicion and final diagnoses reached 75.9% between Rheumatology and Dermatology services. Figure 1.Conclusion:The collaboration between Rheumatology and Dermatology services are very important. Most of the patients were under initial evaluation. All the rheumatologists and dermatologists should be aware of the interdependence from both specialties to give the best quality of care to the patients.References:[1]Samycia M, McCourt C, Shojania K, Au S. Experiences From a Combined Dermatology and Rheumatology Clinic: A Retrospective Review. J Cutan Med Surg. 2016;20(5):486-489. doi:10.1177/1203475416649138.[2]Theodorakopoulou E, Dalamaga M, Katsimbri P, Boumpas DT, Papadavid E. How does the joint dermatology-rheumatology clinic benefit both patients and dermatologists?. Dermatol Ther. 2020;33(3):e13283. doi:10.1111/dth.13283Figure 1.Disclosure of Interests:None declared

scholarly journals Blocking IL-17: A Promising Strategy in the Treatment of Systemic Rheumatic Diseases

2020 ◽  
Vol 21 (19) ◽  
pp. 7100
Author(s):  
Carlos Rafael-Vidal ◽  
Nair Pérez ◽  
Irene Altabás ◽  
Samuel Garcia ◽  
Jose M. Pego-Reigosa
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Therapeutic Option ◽  
Premature Mortality ◽  
Interleukin 17 ◽  
Multiple Organs ◽  
Systemic Rheumatic Diseases ◽  
Bacteria And Fungi ◽  
Potential Use

Systemic rheumatic diseases are a heterogeneous group of autoimmune disorders that affect the connective tissue, characterized by the involvement of multiple organs, leading to disability, organ failure and premature mortality. Despite the advances in recent years, the therapeutic options for these diseases are still limited and some patients do not respond to the current treatments. Interleukin-17 (IL-17) is a cytokine essential in the defense against extracellular bacteria and fungi. Disruption of IL-17 homeostasis has been associated with the development and progression of rheumatic diseases, and the approval of different biological therapies targeting IL-17 for the treatment of psoriatic arthritis (PsA) and ankylosing spondylitis (AS) has highlighted the key role of this cytokine. IL-17 has been also implicated in the pathogenesis of systemic rheumatic diseases, including systemic lupus erythematosus (SLE), Sjögren’s syndrome (SS) and systemic sclerosis (SSc). The aim of this review is to summarize and discuss the most recent findings about the pathogenic role of IL-17 in systemic rheumatic and its potential use as a therapeutic option.

scholarly journals Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Chung-Yuan Hsu ◽  
Chi-Hua Ko ◽  
Jiun-Ling Wang ◽  
Tsai-Ching Hsu ◽  
Chun-Yu Lin
Keyword(s):  
Cohort Study ◽  
Opportunistic Infection ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Opportunistic Infections ◽  
Preventive Therapy ◽  
Incidence Rates ◽  
First Year ◽  
Health Insurance Data ◽  
Systemic Rheumatic Diseases

Abstract Objective To estimate and compare the burdens of opportunistic infections and herpes zoster in real-world practice among patients with various systemic rheumatic diseases. Methods This 13-year cohort study used national health insurance data to compare the incidence rates (IRs) of nine opportunistic infections among patients with five rheumatic diseases. The analyses were stratified according to follow-up duration using Poisson regression, and Cox models were used to compare the risk of first opportunistic infection. Results During 2000–2013, we identified 76,966 patients who had polymyositis/dermatomyositis (PM/DM, 2270 cases), systemic lupus erythematosus (SLE, 15,961 cases), systemic sclerosis (SSc, 2071 cases), rheumatoid arthritis (RA, 38,355 cases), or primary Sjögren’s syndrome (pSS, 18,309 cases). The IR of opportunistic infections was highest for PM/DM cases (61.3/1000 person-years, 95% confidence interval [CI] 56.6–66.2), followed by SLE cases (43.1/1000 person-years, 95% CI 41.7–44.5), SSc cases (31.6/1000 person-years, 95% CI 28.3–35.1), RA cases (25.0/1000 person-years, 95% CI 24.4–25.7), and pSS cases (24.1/1000 person-years, 95% CI 23.1–25.2). Multivariable Cox analysis revealed that, relative to SLE, PM/DM was associated with a significantly higher risk of opportunistic infections (hazard ratio 1.18, 95% CI 1.08–1.29). The risk of opportunistic infections was highest during the first year after the diagnosis of all five rheumatic diseases. Conclusions The risk of opportunistic infection was highest for PM/DM, followed by SLE, SSc, RA, and pSS. Careful observation and preventive therapy for opportunistic infections may be warranted in selected PM/DM patients, especially during the first year after the diagnosis.

scholarly journals AB0477 OVARIAN RESERVE IN PATIENTS WITH RHEUMATIC DISEASES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1536.2-1537
Author(s):  
Z. Alekberova ◽  
R. Goloeva ◽  
M. Cherkasova ◽  
A. Lila
Keyword(s):  
Rheumatic Diseases ◽  
Ovarian Reserve ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Ovarian Function ◽  
Clinical Manifestations ◽  
Statistical Processing ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Treatment Naïve

Background:Access to assays of circulating anti-Mullerian hormone (AMH) levels has opened a new page in the assessment of ovarian function and fertility in various diseases, including rheumatic diseases (RDs). The definition of AMH as a marker of ovarian reserve significantly simplified its interpretation as well as measuring the contribution of the disease itself to the patients’ infertility.Objectives:To evaluate the effects of the disease and it’s treatment on serum AMH levels for Behcet’s disease (BD), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic scleroderma (SSD).Methods:The study included 73 patients with RDs from 18 to 40 years: 42 patients with BD, 12 with SLE, 11 with RA, 8- with SSD, the control group consisted of 15 healthy women. Enzyme-linked immunosorbent assay (ELISA) was used to measure AMH levels. Parametric and nonparametric statistical methods of Statistica 8.0 package were used for statistical processing of data.Results:Mean age in BD patients was 30.0 years, in SLE and RA -33.5 years, in SSD - 35.0 years, and 32.0 years in the control group. The average disease duration was 4.5 years, 11.5 years, 4.0 years and 6.0 years, respectively.BD, n=42SLE, n=12RA, n=11SSD, n=8Control, n=15Mean age, years30,0[26;35]33.5[29;38]33,5[24;36]35,0[28;40]32,0[26;35]Average disease duration, years4,5[2,6;9,0]11,5[2,8;18]4,0[4,0;6,0]6,0[2,0-10,0]-Mean AMH level, ng/ml2,5[1,1;3,7]3,5[0,4-7,1]3,35[2,0;7,6]2,5 [0,3;7,1]3,1[1,9;5,4]There were no significant differences in the mean AMH levels between the groups. No association between AMG levels and clinical manifestations, disease activity or duration of rheumatic disease was found. Baseline AMH – in treatment-naïve patients before initiation of any DMARDs was assessed in 11 BD patients. A significant (p>0.05) decrease of AMH levels was established in patients with high SLE activity treated with CP. Of notice, all examined patients were additionally receiving a GEBD -Rituximab.Conclusion:Decreased ovarian function was found in patients with high SLE activity treated with CP with Rituximab.Disclosure of Interests:None declared

scholarly journals Diagnostic and prognostic role of renal histopathology in rheumatic diseases

Reumatismo ◽  
2018 ◽  
pp. 165-177
Author(s):  
F. Saccon ◽  
M. Gatto ◽  
M. Larosa ◽  
F. Ometto ◽  
M. Felicetti ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Renal Involvement ◽  
Direct Result ◽  
Prognostic Role ◽  
Disease Treatment ◽  
Therapeutic Decisions ◽  
Systemic Rheumatic Diseases ◽  
Per Se

The objective was to evaluate renal involvement in several rheumatic diseases (i.e. rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, systemic sclerosis, systemic vasculitides). The method chosen was to define histopathological profiles reported in renal biopsies performed on patients with renal involvement due to different rheumatic diseases. Renal involvement observed in patients with rheumatic disease can be the direct result of the disease per se and/or a complication of drugs used in the disease treatment. The clinical-pathological correlations derived from the study of renal tissues can be useful for differential diagnosis, prognosis assessment and therapeutic decisions. Renal biopsy should be considered as an important tool for the management of nephropathies in patients with systemic rheumatic diseases.

scholarly journals Invasive fungal infections in children with rheumatic diseases

2021 ◽  
Vol 12 (5) ◽  
pp. 48-55
Author(s):  
O. P. Kozlova ◽  
M. M. Kostik ◽  
M. D. Kuznetsova ◽  
M. F. Dubko ◽  
L. S. Snegireva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Invasive Aspergillosis ◽  
Rheumatic Diseases ◽  
Invasive Candidiasis ◽  
Lupus Erythematosus ◽  
Fungal Infections ◽  
Immunosuppressive Agents ◽  
Severe Neutropenia ◽  
Systemic Rheumatic Diseases ◽  
Invasive Mycoses

Introduction. In children with rheumatic diseases, severe fungal infections (invasive mycoses – IM) are not well understood.Objectives. To analyze risk factors, disease course of IM in children with systemic rheumatic diseases.Materials and methods. For diagnosis of IM were used criteria EORTC/MSGERC, 2019. We reviewed the literature over the past 15 years on IM in children with rheumatic diseases from the international databases Pubmed and Web of Science.Results. In retrospective multicenter study were included 8 children with IM and systemic rheumatic diseases: ANCA-associated vasculitis (n=4), systemic lupus erythematosus (n=3), juvenile rheumatoid arthritis (n=1). Median age was 13,5 (8-17) y., boys – 67%. Invasive aspergillosis was diagnosed in 5 patients and invasive candidiasis – 3. The risk factors of invasive mycoses were high rheumatic disease activity (100%), corticosteroids (prednisolone ≥ 0,3 mg/kg/d) use for ≥21 d (87,5%), immunosuppressive therapy (87,5%), recent (≤ 2 weeks) pulse steroid therapy (75%), hemophagocytic lymphohistiocytosis (62,5%), prolonged (≥ 10 days) severe neutropenia (≤ 0,5х109/l) (62,5%), and prolonged (≥10 days lymphopenia (≤ 1,0х109/l) (37,5%). In patients with invasive aspergillosis the involved organ was the lung, in patients with invasive candidiasis a candidemia was diagnoses. All patients received antifungal therapy. The overall 30 days survival rate was 37,5%.Сonclusions. Children with high rheumatic diseases activity and intensive treatment with immunosuppressive agents should be considered as patients with a high risk of invasive mycoses with a high mortality. 

scholarly journals AB0868-HPR ADHERENCE TO DISEASE-MODIFYING ANTIRHEUMATIC DRUGS IN RHEUMATIC DISEASES DURING COVID-19 PANDEMIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1458.1-1458
Author(s):  
I. A. Moreno-Arquieta ◽  
G. G. Sánchez Mendieta ◽  
D. E. Flores Alvarado ◽  
J. A. Esquivel Valerio ◽  
D. Á. Galarza-Delgado
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Sclerosis ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Electronic Monitoring ◽  
The United States ◽  
Self Report ◽  
University Hospital ◽  
Inflammatory Myopathies ◽  
Systemic Lupus

Background:The pandemic COVID-19 has set a new challenge in adherence to treatment in patients with rheumatic diseases. Prior studies in Latin America had reported adherence of 16.4% on Rheumatoid Arthritis (RA) and 45.9% in Systemic Lupus Erythematous (SLE). There is evidence that these patients believe their treatment increases the risk and gravity of COVID-19 and therefore, suspending the treatment could reduce this risk. It has been shown that a “Good adherence” is associated to a better survival.Objectives:Describe the adherence to DMARDs in patients with Rheumatic diseases during COVID-19.Methods:Descriptive, cross-sectional, self-report study conducted in rheumatology outpatient clinic of University Hospital in Monterrey, México. Consecutive patients with RA, SLE, Inflammatory Myopathies and Systemic Sclerosis, were approached during their routine appointments, March 2020 to December 2020 period during COVID-19 pandemic. They were asked how many days of the month they took the DMARD indicated in the previous appointment, with Based on this, adherence was classified into four categories: Good 100-75% (> 21 days), Regular 74-50% (21-15 days), Bad 49-25% (14-8 days) and Null <25% (<7 days). Data was obtained from our internal electronic patient record registry and analyzed with SPSS V.22.Results:n (DMARDs)GoodRegularBadNulln (%)n (%)n (%)n (%)Rheumatoid Arthritis302255 (84.4)13 (4.3)20 (6.6)14 (4.6)Systemic Lupus Erithematous126111 (88)3 (2.3)8 (6.3)4 (3.1)Inflammatory Myopathies1110 (90.9)0 (0)1 (9)0 (0)Systemic Sclerosis3027 (90)2 (6.6)1 (3.3)0 (0)TOTAL469Conclusion:Despite what it is believed, patients are not changing therapeutic regimes. The adherence found in this group of patients was good, for the definition used in this study. It should be considered that the self-report method may overestimate adherence, so the data found must be correlated with objective methods in the future.References:[1]Resende Prudente L, Souza Diniz J, Matteucci Ferreira TXA, Marçal Lima D, Antônio Silva N, Saraiva G, et al. Medication adherence in patients in treatment for rheumatoid arthritis and systemic lupus erythematosus in a university hospital in Brazil. Patient Preference and Adherence. 2016:10 863–870.[2]Michaud K, Wipfler K, Shaw Y, et al. Experiences of patients with rheumatic diseases in the United States during early days of the COVID-19 pandemic. ACR Open Rheumatol 2020. doi:10.1002/acr2.11148.[3]Waimann ChA, Marengo MF, de Achaval S, Cox VL, Garcia-Gonzalez A, Reveille JD. Electronic Monitoring of Oral Therapies in Ethnically Diverse and Economically Disadvantaged Patients With Rheumatoid Arthritis. Arthritis & Rheumatism. 2013:6 1421-1429.Disclosure of Interests:None declared

Effectiveness of PD1-inhibitors in advanced Merkel cell carcinoma: Real life data in a Swedish cohort.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22063-e22063
Author(s):  
Hannah Bjorn-Andtback ◽  
Giuseppe V. Masucci ◽  
Lisa Elena Esther Villabona
Keyword(s):  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Lupus Erythematosus ◽  
Real Life ◽  
The Elderly ◽  
University Hospital ◽  
Merkel Cell ◽  
Response Data ◽  
Real Life Data ◽  
Treatment Naïve

e22063 Background: Merkel Cell Carcinoma (MCC) is a highly aggressive neuroendocrine skin cancer that affects the elderly. Most cases are associated with the Merkel cell polyomavirus. It has previously been shown in clinical trials that MCC respond to immunotherapy with PD1 and PDL1-inhibition. PD1-inhibitiors have been used to treat MCC at Karolinska University Hospital in Sweden since 2016. The aim of this study is to describe the PD1-MCC-cohort at Karolinska. Methods: Patients with inoperable MCC that were treated with PD1-inhibitor at the oncology dept between August 2016 and February 2020 at Karolinska were included in the study, and response data was assessed retrospectively. Response was assessed clinically and through CT-scans. Results: Among 12 treated pts, median age was 75 yrs, 8 male and 4 female, 10 were treatment naive, 2 with prior chemotherapy. 10 pts received pembrolizumab and 2 pts nivolumab. No pts discontinued treatment due to side-effects. Comorbidities seen in the cohort were amongst others Atrial fibrillation (4 pts), Systemic Lupus Erythematosus (1), Hypertension (6), COPD (1), Aortic stenosis (2) and congestive heart failure (1). Follow-up time was median 10 months (range 2-43). First evaluation varied between 2-4 months with the majority at ~3 months. At first evaluation ORR was 75% and PFS and OS was 75% and 100% respectively. At 10 months, PFS and OS rates were 58% and 67% respectively. At study end mean PFS was 15,4 months and mean OS 17,8 months. 6 pts (50%) were still in response. Conclusions: PD1-inhibitors in clinical use in this cohort induced rapid and durable tumor responses in patients with advanced MCC, and the treatment was well tolerated. Our conclusion is that a PD1-inhibitor is a feasible and effective treatment for advanced Merkel Cell Carcinoma in the clinical setting.

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