scholarly journals Off-label Use of Secukinumab: A Potential Therapeutic Option for SAPHO Syndrome

2021 ◽  
pp. jrheum.211155
Author(s):  
Gang Wang ◽  
Ning Zhuo ◽  
Jingyang Li
Keyword(s):  
Therapeutic Option ◽  
Skin Lesions ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Substantial Improvement ◽  
Sapho Syndrome ◽  
Whole Body ◽  
Antiinflammatory Drugs ◽  
Before And After ◽  
Body Magnetic Resonance Imaging ◽  
Clinical Conditions

We read the recent article by Wang et al with great interest.1 The authors described a cohort of 4 patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome who showed substantial improvement in skin lesions, clinical conditions, and whole-body magnetic resonance imaging before and after treatment with secukinumab without concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), nonsteroidal antiinflammatory drugs (NSAIDs), or other biologics, and suggested a potential benefit of secukinumab in the treatment of SAPHO syndrome. However, there are some details that need further clarification.

Dexamethasone and indomethacin modify endotoxin-induced respiratory failure in pigs

1985 ◽  
Vol 58 (1) ◽  
pp. 274-284 ◽  
Author(s):  
N. C. Olson ◽  
T. T. Brown ◽  
D. L. Anderson
Keyword(s):  
Respiratory Failure ◽  
Phase 1 ◽  
Dynamic Compliance ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Arachidonic Acid Metabolism ◽  
Antiinflammatory Drugs ◽  
Lung Water ◽  
Pulmonary Response ◽  
Flunixin Meglumine ◽  
Before And After

We studied the porcine pulmonary response to endotoxemia before and after administration of nonsteroidal antiinflammatory drugs (NSAID, i.e., indomethacin or flunixin meglumine) or dexamethasone (DEX). Escherichia coli endotoxin was infused intravenously into anesthetized 10- to 12-wk old pigs for 4.5 h. In endotoxemic pigs, the phase 1 (i.e., 0–2 h) increases in pulmonary arterial pressure, pulmonary vascular resistance (PVR), and alveolar-arterial O2 gradient and the decreases in cardiac index (CI) and lung dynamic compliance (Cdyn) were blocked by NSAID. Thus phase 1 changes were cyclooxygenase dependent. Furthermore, these effects were blocked or greatly attenuated by DEX. During phase 2 of endotoxemia (i.e., 2–4.5 h), the increased PVR and decreased CI and Cdyn were not blocked by NSAID but were attenuated by DEX, suggesting the presence of cyclooxygenase-independent metabolites. Both NSAID and DEX blocked the endotoxin-induced increases in lung water, bronchoalveolar lavage (BAL) neutrophil, and BAL albumin content. The fall in plasma proteins persisted in NSAID but not DEX-treated pigs. We conclude that endotoxemia in the pig causes severe acute respiratory failure largely mediated by cyclooxygenase and possibly lipoxygenase products of arachidonic acid metabolism.

scholarly journals Drug-associated Cutaneous Vasculitis: Study of 239 Patients from a Single Referral Center

2014 ◽  
Vol 41 (11) ◽  
pp. 2201-2207 ◽  
Author(s):  
Francisco Ortiz-Sanjuán ◽  
Ricardo Blanco ◽  
José L. Hernández ◽  
Trinitario Pina ◽  
María C. González-Vela ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Bed Rest ◽  
Skin Lesions ◽  
Immunosuppressive Drugs ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Consensus Conference ◽  
Cutaneous Vasculitis ◽  
Drug Discontinuation ◽  
Antiinflammatory Drugs ◽  
Tertiary Referral Hospital

Objective.The 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides defined drug-associated immune complex vasculitis as a distinct entity included within the category of vasculitis associated with probable etiology. In the present study we assessed the clinical spectrum of patients with drug-associated cutaneous vasculitis (DACV).Methods.Case records were reviewed of patients with DACV treated at a tertiary referral hospital over a 36-year period. A diagnosis of DACV was considered if the drug was taken within a week before the onset of the disease.Results.From a series of 773 unselected cutaneous vasculitis cases, 239 patients (30.9%; 133 men and 106 women; mean age 36 yrs) were diagnosed with DACV. Antibiotics (n = 149; 62.3%), mainly β-lactams and nonsteroidal antiinflammatory drugs (NSAID; n = 24; 10%) were the most common drugs. Besides skin lesions (100%), the most common clinical features were joint (51%) and gastrointestinal (38.1%) manifestations, nephropathy (34.7%), and fever (23.8%). The most remarkable laboratory data were increased erythrocyte sedimentation rate (40.2%), presence of serum cryoglobulins (26%), leukocytosis (24.7%), positive antinuclear antibodies (21.1%), anemia (18.8%), and positive rheumatoid factor (17.5%). Despite drug discontinuation and bed rest, 108 patients (45.2%) required medical treatment, mainly corticosteroids (n = 71) or immunosuppressive drugs (n = 7). After a median followup of 5 months, relapses occurred in 18.4% of patients, and persistent microhematuria or renal insufficiency in 3.3% and 5%, respectively.Conclusion.DACV is generally associated with antibiotics and NSAID. In most cases it has a favorable prognosis, although a small percentage of patients may develop residual renal damage.

Aspirin Synergistically Potentiates Isoflurane Minimum Alveolar Concentration Reduction Produced by Morphine in the Rat 

1998 ◽  
Vol 89 (6) ◽  
pp. 1489-1494 ◽  
Author(s):  
Ignacio A. Gomez de Segura ◽  
Ana B. Criado ◽  
Martin Santos ◽  
Francisco J. Tendillo
Keyword(s):  
Side Effects ◽  
Minimum Alveolar Concentration ◽  
Synergistic Effects ◽  
Objective Measure ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Before And After ◽  
Male Wistar Rats ◽  
Clinically Significant ◽  
Analgesic Potency

Background The combination of opioids and nonsteroidal antiinflammatory drugs is more analgesic than the summed effect of each drug administered separately. This synergism has been used to obtain analgesia in the postoperative period at doses at which side effects are minimal. The aim of this study is to evaluate the analgesic interaction between aspirin and morphine in the rat during isoflurane anesthesia. The reduction in minimum alveolar concentration of isoflurane (MAC(ISO)) was used as an objective measure of the analgesic potency of individual drugs and their use in combination. Methods Thirty-seven male Wistar rats were anesthetized with isoflurane in oxygen, and the MAC(ISO) was determined before and after the intravenous administration of aspirin and morphine. Rats were administered morphine alone (1, 3, and 10 mg/kg) or morphine (1 and 3 mg/kg) and aspirin (30 mg/kg). The MAC(ISO) was determined from alveolar gas samples at the time of tail clamp. The duration of MAC(ISO) reduction was recorded. Results Aspirin did not have an effect on MAC(ISO), (average, 1.35+/-0.1%), whereas the combination of morphine (1 and 3 mg/kg) and aspirin (30 mg/kg) produced a reduction in the dose of morphine needed to produce the same degree of MAC(ISO) reduction. Actual MAC(ISO+drug) data were as follows: 1 mg/kg morphine, 1.17+/-0.14%; 3 mg/kg morphine, 0.98+/-0.15%; 1 mg/kg morphine plus aspirin, 0.90+/-0.04%; 10 mg/kg morphine, 0.63+/-0.13%; and 3 mg/kg morphine plus aspirin, 0.64+/-0.06%. Conclusions The synergistic effects of aspirin and morphine allow a clinically significant reduction in the requirements of isoflurane and isoflurane plus morphine, and these drug combinations may decrease the side effects associated with the use of single higher, equianalgesic doses of these drugs.

scholarly journals Failure of tocilizumab in treating two patients with refractory SAPHO syndrome: a case report

2018 ◽  
Vol 46 (12) ◽  
pp. 5309-5315 ◽  
Author(s):  
Xiao-Chuan Sun ◽  
Shuang Liu ◽  
Chen Li ◽  
Shuo Zhang ◽  
Mu Wang ◽  
...  
Keyword(s):  
Immunohistochemical Staining ◽  
Clinical Utility ◽  
Conventional Treatment ◽  
Autoinflammatory Disease ◽  
Standard Treatment ◽  
Present Report ◽  
Therapeutic Option ◽  
Skin Lesions ◽  
Sapho Syndrome ◽  
New Onset

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare autoinflammatory disease with no standard treatment. Interleukin (IL)-6 inhibitors represent a novel therapeutic option for rheumatoid arthritis and some autoinflammatory diseases. However, the clinical utility of IL-6 inhibitors in treating SAPHO syndrome has been poorly investigated. In the present report, we describe two patients with SAPHO syndrome that was unresponsive to conventional treatment. Tocilizumab, an anti-IL-6 receptor monoclonal antibody, was putatively administered according to positive IL-6 immunohistochemical staining in biopsied bone tissues. However, the disease continued to progress, and new-onset or worsening skin lesions were noted with transient neutropenia. These cases demonstrate that tocilizumab may not be an ideal option for treating SAPHO syndrome.

scholarly journals The effect of GH replacement therapy on different fat compartments: a whole-body magnetic resonance imaging study

2011 ◽  
Vol 164 (1) ◽  
pp. 23-29 ◽  
Author(s):  
A Egger ◽  
T Buehler ◽  
C Boesch ◽  
P Diem ◽  
C Stettler ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Replacement Therapy ◽  
Imaging Study ◽  
Whole Body ◽  
Model Assessment ◽  
Resonance Imaging ◽  
Gh Replacement ◽  
Before And After ◽  
Body Magnetic Resonance Imaging

ObjectivePatients with GH deficiency (GHD) are insulin resistant with an increase in visceral fat mass (FM). Whether this holds true when sedentary control subjects (CS) are matched for waist has not been documented.GH replacement therapy (GHRT) results in a decrease in FM. Whether the decrease in FM is mainly related to a reduction in visceral FM remains to be proven. The aim was to separately assess visceral and subcutaneous FM in relation to insulin resistance (IR) in GHD patients before and after GHRT and in sedentary CS.MethodsTen patients with GHD were investigated before and 6 months after GHRT. Sedentary CS matched for age, gender, body mass index, and waist were assessed. Exercise capacity was measured as VO2maxusing an incremental work load on a treadmill. Visceral and subcutaneous FM were measured using whole-body magnetic resonance imaging and IR by the homeostasis model assessment of IR (HOMA-IR) index.ResultsGHD patients had a non-significantly lower VO2maxbut did not have increased subcutaneous and visceral FM compared with CS. GHRT resulted in a similar relative decrease in subcutaneous and visceral FM. Compared with CS, GHD patients showed a lower HOMA-IR. GHRT tended to increase HOMA-IR.ConclusionMatching for waist and separate assessment of visceral and subcutaneous FM may be critical in the evaluation of body composition and IR in GHD patients before and after GHRT.

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