A pharmacometabonomics study to predict azathioprine (AZA)-induced myelotoxicity in patients with rheumatological disease

BACKGROUND: Fibromyalgia syndrome (FMS) is an extra-articular rheumatological disease characterised by widespread chronic musculoskeletal pain. Metal-induced oxidative stress contributes to the severity of FMS. AIMS: First, this study evaluated the association between plasma levels of toxic heavy metals and essential metals with oxidative stress (OS) markers. Second, the OS markers and metal contents were correlated with the disease severity by assessing the Fibromyalgia Impact Questioner Revised (FIQR) and tender points (TP). METHOD: A total of 105 FMS patients and 105 healthy controls of similar age and sex were recruited. OS parameter such as lipid peroxidation (LPO), protein carbonyl group (PCG), nitric oxide (NO) and essential metals such as zinc (Zn), magnesium (Mg), manganese (Mn), copper (Cu) and toxic heavy metals such as aluminium (Al), arsenic (As), lead (Pb) were estimated. RESULTS: Levels of LPO, PCG, NO (p< 0.001) and Cu, Mn, and Al (p< 0.001), were significantly higher, and Mg (p< 0.001) and Zn (p< 0.001) were significantly lower in patients compared to controls. A positive association was observed between OS parameters, FIQR and TP with Cu, Al and Mn. A significant negative association was observed between Zn and Mg with FIQR, TP and OS parameters. CONCLUSION: Heavy metals such as Al induce OS parameters and decrease the levels of essential trace elements such as Mg and Zn, which may be responsible for the severity of FMS.

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Staphylococcus-associated acute glomerulonephritis in a patient with dermatomyositis

BMJ Case Reports ◽

10.1136/bcr-2020-236695 ◽

2021 ◽

Vol 14 (1) ◽

pp. e236695 ◽

Cited By ~ 1

Author(s):

Rasmi Ranjan Sahoo ◽

Sourav Pradhan ◽

Akhil Pawan Goel ◽

Anupam Wakhlu

Keyword(s):

Infective Endocarditis ◽

Kidney Biopsy ◽

Kidney Injury ◽

Staphylococcal Infection ◽

Left Knee ◽

The Body ◽

Acute Glomerulonephritis ◽

Disease Course ◽

Rheumatological Disease ◽

Per Se

Staphylococcus-associated glomerulonephritis (SAGN) occurs as a complication of staphylococcal infection elsewhere in the body. Dermatomyositis (DM) can be associated with glomerulonephritis due to the disease per se. We report a case of a 40-year-old male patient with DM who presented with acute kidney injury, and was initially pulsed with methylprednisolone for 3 days, followed by dexamethasone equivalent to 1 mg/kg/day prednisolone. He was subsequently found to have SAGN on kidney biopsy along with staphylococcus bacteraemia and left knee septic arthritis. With proof of definitive infection, intravenous immunoglobulin 2 g/kg over 2 days was given and steroids were reduced. He was treated with intravenous vancomycin. With treatment, the general condition of the patient improved. On day 38, he developed infective endocarditis and died of congestive heart failure subsequently. Undiagnosed staphylococcal sepsis complicating a rheumatological disease course can lead to complications like SAGN, infective endocarditis and contribute to increased morbidity and mortality, as is exemplified by our case.

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Real-world observational study of assessment of CHA2DS2-VASc, C2HEST and HAVOC scores for atrial fibrillation among patients with rheumatological disorders: a nationwide analysis

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-140754 ◽

2021 ◽

pp. postgradmedj-2021-140754

Author(s):

Wei Syun Hu ◽

Cheng Li Lin

Keyword(s):

Atrial Fibrillation ◽

Retrospective Study ◽

Predictive Models ◽

Operating Characteristic ◽

Predictive Accuracy ◽

Scoring Systems ◽

Gray Model ◽

Discriminative Ability ◽

Discriminatory Ability ◽

Rheumatological Disease

PurposeThis is a nationwide-based retrospective study aiming to compare the three different scoring systems (CHA2DS2-VASc, C2HEST and HAVOC scores) in the prediction of atrial fibrillation (AF) in patients with rheumatological disease.MethodsWe used the Fine and Gray model to estimate the risk of AF (subhazard ratio and 95% CI). The predictive accuracy and discriminatory ability of the predictive model were evaluated by receiver operating characteristic (ROC) curve.ResultsAmong the three predictive models, the model using CHA2DS2-VASc score had the better discriminative ability with an ROC of 0.79. The model with C2HEST score had an ROC of 0.78. The discriminative ability of the HAVOC score was 0.77, estimated by ROC.ConclusionWe concluded the CHA2DS2-VASc score has better performance in predicting AF compared with C2HEST score or HAVOC score.

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Near-germline human monoclonal antibodies neutralize and protect against multiple arthritogenic alphaviruses

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2100104118 ◽

2021 ◽

Vol 118 (37) ◽

pp. e2100104118

Author(s):

Ryan J. Malonis ◽

James T. Earnest ◽

Arthur S. Kim ◽

Matthew Angeliadis ◽

Frederick W. Holtsberg ◽

...

Keyword(s):

Monoclonal Antibodies ◽

Neutralizing Antibodies ◽

Natural Infection ◽

Human Mabs ◽

Isolation And Characterization ◽

Neutralizing Capacity ◽

Rheumatological Disease ◽

Mayaro Virus ◽

Alphavirus Infection ◽

Globally Distributed

Arthritogenic alphaviruses are globally distributed, mosquito-transmitted viruses that cause rheumatological disease in humans and include Chikungunya virus (CHIKV), Mayaro virus (MAYV), and others. Although serological evidence suggests that some antibody-mediated heterologous immunity may be afforded by alphavirus infection, the extent to which broadly neutralizing antibodies that protect against multiple arthritogenic alphaviruses are elicited during natural infection remains unknown. Here, we describe the isolation and characterization of MAYV-reactive alphavirus monoclonal antibodies (mAbs) from a CHIKV-convalescent donor. We characterized 33 human mAbs that cross-reacted with CHIKV and MAYV and engaged multiple epitopes on the E1 and E2 glycoproteins. We identified five mAbs that target distinct regions of the B domain of E2 and potently neutralize multiple alphaviruses with differential breadth of inhibition. These broadly neutralizing mAbs (bNAbs) contain few somatic mutations and inferred germline–revertants retained neutralizing capacity. Two bNAbs, DC2.M16 and DC2.M357, protected against both CHIKV- and MAYV-induced musculoskeletal disease in mice. These findings enhance our understanding of the cross-reactive and cross-protective antibody response to human alphavirus infections.

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Theme 13: Management of rheumatological disease

Get ahead! Medicine: 150 EMQs for Finals ◽

10.1201/b13298-93 ◽

2008 ◽

pp. 187-187

Keyword(s):

Rheumatological Disease

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Drugs used in rheumatology practice

Oxford Handbook of Rheumatology ◽

10.1093/med/9780198728252.003.0023 ◽

2018 ◽

pp. 645-688

Author(s):

Gavin Clunie ◽

Nick Wilkinson ◽

Elena Nikiphorou ◽

Deepak R. Jadon

Keyword(s):

Pulmonary Hypertension ◽

Intravenous Immunoglobulin ◽

Bone Disease ◽

Evidence Based ◽

Disease Modifying Antirheumatic Drugs ◽

Biologic Dmards ◽

Rheumatological Disease ◽

Disease Modifying ◽

Paediatric Disease ◽

Rheumatology Practice

The Oxford Handbook of Rheumatology, 4th edition, emphasizes the importance of evidence-based therapeutics and therefore devotes a whole chapter to medications used to treat rheumatological and bone disease (‘Drugs used in rheumatological disease’). Details about treatments are cross-referenced to specific use of medications for specific diseases and conditions elsewhere in the book. There are chapter sections on analgesics including opiate-based medications, NSAIDs, conventional synthetic disease-modifying antirheumatic drugs (DMARDs), biologic DMARDs, intravenous immunoglobulin, and other immunosuppressants. There is a specific focus in the chapter on drugs used for Raynaud’s disease, osteoporosis (e.g. bisphosphonates), pulmonary hypertension, gout, and hyperuricaemia. Overall there is reference to both adult and paediatric disease treatments in the chapter.

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The spectrum of disorders associated with adult rheumatic and musculoskeletal diseases

Oxford Handbook of Rheumatology ◽

10.1093/med/9780198728252.003.0004 ◽

2018 ◽

pp. 205-240

Author(s):

Gavin Clunie ◽

Nick Wilkinson ◽

Elena Nikiphorou ◽

Deepak R. Jadon

Keyword(s):

General Practitioners ◽

Musculoskeletal Diseases ◽

Real Life ◽

General Medicine ◽

Differential Diagnoses ◽

Medical Comorbidities ◽

Adult Disease ◽

Adults And Children ◽

Rheumatological Disease ◽

Rheumatic Conditions

The Oxford Handbook of Rheumatology, 4th edition, takes the reader through a pragmatic and realistic way of assessing musculoskeletal and rheumatological disease presentation in its first four chapters. The text reflects real life, with differential diagnoses suggested as information becomes available through the details from history, then examination, then investigations. The chapters focus on patterns of, and focal regional, symptoms in adults and children. In this chapter, the book considers musculoskeletal and rheumatic conditions which occur in, or are closely associated with, other conditions of the skin, eye, heart, lung, kidney, and in hormonal, neurological, and gastrointestinal systems. Such an approach should help general practitioners and rheumatology trainees caring for their patients across their medical comorbidities and in general medicine. There is also a section on musculoskeletal–rheumatological features in patients with neoplasia. The chapter focuses primarily on adult disease.

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Skin

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0017 ◽

2013 ◽

pp. 127-139

Author(s):

Christopher Griffiths ◽

Amy Foulkes

Keyword(s):

Quality Of Life ◽

Skin Disease ◽

Drug Toxicity ◽

Holistic Approach ◽

Differential Diagnoses ◽

Joint Disease ◽

Accurate Description ◽

Shared Knowledge ◽

Rheumatological Disease

Optimal rheumatological care involves a holistic approach to the patient. As rheumatologists frequently see dermatological manifestations of rheumatological disease, as well as cutaneous signs of drug toxicity, knowledge of how to approach the diagnosis and management of the patient with skin disease is essential. With many successful examples of joint rheumatology/dermatology clinics, the subsequent shared knowledge and management will improve the quality of life of patients with combined skin and joint disease. This chapter includes basic skin anatomy and morphological definitions, which facilitate accurate description of skin disease. Common differential diagnoses and common dermatological manifestations of rheumatological disease are discussed with appropriate options for management.

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Primary Neural Leprosy mimicking rheumatological disorders

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.65.6.767 ◽

2019 ◽

Vol 65 (6) ◽

pp. 767-770 ◽

Cited By ~ 1

Author(s):

Renata Carolina Schlögel de Freitas ◽

Carlos Augusto Zanardini Pereira ◽

Nadia Tannous Muri ◽

Valéria Aparecida Zanela Franzon ◽

Carlos Alberto Camorim Fatuch

Keyword(s):

Sural Nerve ◽

Functional Disability ◽

Public Health Problem ◽

Nerve Biopsy ◽

Skin Lesions ◽

Sural Nerve Biopsy ◽

Minimal Amount ◽

High Prevalence ◽

Rheumatological Disease ◽

Nerve System

SUMMARY Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which affects mainly the skin and peripherical nerves. Brasil has not yet achieved its goal of elimination of the number of cases of this disease, ranking second in terms of absolute numbers worldwide, with India occupying the first position. Primary Neural Leprosy is considered to be a challenge in diagnosis, since it affects the peripherical nerve system with the absence of skin lesions, thus mimicking rheumatological disorders, like in the case presented. A male, 31, with no previous comorbidities, five years ago, started feeling severe pain in the left ankle as well as morning hand pain and stiffness. After many years of being submitted to intense rheumatological disease investigation, they all proved to be negative. Upon physical examination, the patient presented no skin lesions, symmetric polyarthritis in metacarpophalangeal joints and thickness of the left sural nerve. Lab exams showed no alterations and bacilloscopy was negative. Ultrasonography was used to investigate the thickness of the left sural nerve. Biopsy showed a minimal amount of perineural lymphocytes and positive AFB testing. Based on the electroneuromyography, the conclusion was multiple mononeuropathy, and multibacillary polychemotherapy was started. Leprosy remains a public health problem in Brasil. Due to the high prevalence of the disease, our medical colleagues must be alert and trained to recognize this clinical presentation of leprosy. Correct referral to Reference Centers accelerates research, contributing to an accurate diagnosis, classification, and treatment, thus preventing irreversible sequelae with severe functional disability.

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PP15. CHRONIC PERIAORTITIS – A MISSED RHEUMATOLOGICAL DISEASE!

Rheumatology ◽

10.1093/rheumatology/keh768 ◽

2005 ◽

Vol 44 (suppl_3) ◽

pp. iii19-iii19

Author(s):

R. N. Jois ◽

K. Gaffney ◽

T. Marshall ◽

P. Merry ◽

D. G. I. Scott

Keyword(s):

Rheumatological Disease ◽

Chronic Periaortitis

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