scholarly journals Tildrakizumab and omalizumab: An interlocking therapy for autoimmune conditions

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Laura Diluvio ◽  
◽  
Chiara Pensa ◽  
Arianna Piccolo ◽  
Caterina Lanna ◽  
...  
Keyword(s):  
Psoriasis Vulgaris ◽  
Biologic Therapy ◽  
Autoimmune Disorder ◽  
Cytokine Balance ◽  
Humanized Monoclonal Antibody ◽  
Autoimmune Conditions ◽  
Autoimmune Condition ◽  
Interleukin 23 ◽  
Number Of Individuals ◽  
Adult Female Patient

In Western countries the number of individuals suffering from an autoimmune condition is constantly growing and often patients suffering from autoimmune disease are susceptible to developing a second autoimmune disorder. We report a case of an adult female patient affected by psoriasis vulgaris and treated with tildrakizumab, a humanized monoclonal antibody targeting interleukin-23, who later developed chronic spontaneous urticaria and started omalizumab, a humanized antibody to IgE, showing a favorable outcome. We speculate that the two combined therapies have restored the cytokine balance bringing it towards tolerance and remission of the two pathologies. It is conceivable that tildrakizumab may have a synergic action with omalizumab in the treatment of urticaria in patients affected by both psoriasis and urticaria. Our case and the study of the mechanisms of action of the two drugs suggest how the two therapies can act with an interlocking mechanism in achieving the final therapeutic effect. Keywords: Chronic spontaneous urticarial; dual biologic therapy; omalizumab; psoriasis; tildrakizumab.

scholarly journals Health system wide “big data” analysis of rheumatologic conditions and scleritis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Meghan K. Berkenstock ◽  
Andrew R. Carey
Keyword(s):  
Relative Risk ◽  
Health System ◽  
Systemic Disease ◽  
Autoimmune Disorder ◽  
Future Research ◽  
Inflammatory Conditions ◽  
Autoimmune Conditions ◽  
Icd 10 ◽  
Autoimmune Condition ◽  
Referral Bias

Abstract Background The development of scleritis in the setting of autoimmune conditions has been well documented. Prior series have assessed the relationship between systemic autoimmune disorders and scleritis only in patients referred for rheumatologic or ocular inflammation. This can lead to a referral bias. We reviewed all charts within the electronic medical record (EMR) of a health system for patients with systemic autoimmune and scleritis diagnoses to determine the prevalence of both and which disorders had the highest relative risk of developing scleritis. Methods The EMR was searched for scleritis and systemic inflammatory diagnoses in the past medical history and diagnosis tabs, and for associated disease specific laboratory values. The intersection of scleritis and systemic inflammatory conditions was assessed through searching both SNOMED Clinical Terminology and ICD-10 codes for diagnoses. The prevalence of each autoimmune disorder, scleritis prevalence, the percentage of patients with an autoimmune condition having scleritis, the percentage of patients with scleritis having an autoimmune condition; the relative risk (RR) of scleritis patients having a specific autoimmune disorder were calculated. Results A total of 5.9 million charts were searched with autoimmune conditions identified in 148,993 patients. The most common autoimmune conditions overall were HLA-B27-associated diseases (n = 26,680; prevalence 0.45%); rheumatoid arthritis (RA)(N = 19,923; prevalence 0.34%). Conversely, 2702 patients were identified with scleritis (prevalence 0.05%), of which 31.4% had an associated autoimmune condition. Patients with RA represented the highest percentage of patients with an autoimmune condition having scleritis. Granulomatosis with polyangiitis (GPA) represented the highest the percentage of patients with scleritis having an autoimmune condition. Sjogrens was the third most common condition associated with scleritis- making up 4.5% of cases. An association with juvenile idiopathic arthritis (JIA) was seen in 0.3% of patients. Conclusions While this is the largest retrospective review examining the association between autoimmune disease and scleritis, the findings are similar to prior studies with nearly a third of scleritis patients having an underlying autoimmune diagnosis. Limitations of the study included accurate chart coding; having laboratory results within the searchable EMR. Future research is needed to delineate associations of systemic disease with the anatomic location of scleritis using EMR.

scholarly journals Testicular vasculitis: a diagnostic conundrum

2020 ◽  
Vol 2020 (4-5) ◽  
Author(s):  
Alice M Malpas ◽  
Richard Y Ball ◽  
Chetan Mukhtyar ◽  
James W MacKay ◽  
Mohammed Omer
Keyword(s):  
Rheumatoid Arthritis ◽  
Patient Care ◽  
Inflammatory Process ◽  
Biologic Therapy ◽  
Autoimmune Disorder ◽  
Diagnostic Bias ◽  
Diagnostic Confusion ◽  
Testicular Lesions ◽  
Single Organ

Abstract Vasculitis is rare in the context of testicular lesions but, when found, can be classified as a single organ vasculitis or part of a multi-organ inflammatory process. In the context of a patient with a pre-existing autoimmune disorder, this finding might cause diagnostic confusion and preferentially bias a physician towards attributing the condition to the known diagnosis or its treatment. This diagnostic bias can interfere with patient care and lead to over caution, resulting in a worse outcome for the patient involved. We describe such a patient with rheumatoid arthritis on biologic therapy.

scholarly journals Clinical factors associated with Guillain-Barré syndrome following surgery

2018 ◽  
Vol 8 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Sara Hocker ◽  
Elanagan Nagarajan ◽  
Mark Rubin ◽  
Eelco F.M. Wijdicks
Keyword(s):  
Conscious Sedation ◽  
Univariate Analysis ◽  
Autoimmune Disorder ◽  
Guillain Barre Syndrome ◽  
Factors Associated ◽  
Guillain Barré Syndrome ◽  
Autoimmune Conditions ◽  
Clinical Associations ◽  
Guillain Barré ◽  
A Prospective Study

BackgroundWe sought to identify clinical associations and potential triggers of Guillain-Barré syndrome (GBS) within 6 weeks of surgery.MethodsWe retrospectively reviewed consecutive patients diagnosed with GBS within 6 weeks of a surgery between January 1995 and June 2014 at Mayo Clinic. Postsurgical GBS was defined as symptom onset within 6 weeks of surgery. Patients with postsurgical GBS were compared with patients who did not have a surgery prior to GBS onset to determine differences between groups.ResultsA total of 208 patients with GBS, median age 55 years (interquartile range [IQR] 41–68), were included. Nineteen patients (9.1%) developed postsurgical GBS. Median duration from the surgery to onset of first GBS symptom was 15 days (IQR 9–37). The main types of surgeries preceding GBS were gastrointestinal, orthopedic, and cardiac. General anesthesia was used in 18 (95%) and conscious sedation in 1 (5%) patient. Among the 19 patients with postsurgical GBS, 11 (57.9%) had a known diagnosis of malignancy. Autoimmune conditions were present in 5 (26.3%) patients. Postoperative infection was found in 4 (21%) patients. On univariate analysis, the factors that showed an association with postsurgical GBS were age (p = 0.02), malignancy (p ≤ 0.0004), active malignancy (p = 0.03), preexisting autoimmune disorder (p = 0.02), and infection (p = 0.0001). On multivariate analysis, only active malignancy (0.03) remained associated.ConclusionsSurgery antedated GBS in 9.1% of patients. Postsurgical GBS was more common in patients with an active malignancy. A prospective study is needed to determine whether active malignancy represents an independent risk factor for the development of postsurgical GBS.

scholarly journals Cardiometabolic Comorbidities in Patients With Psoriasis: Focusing on Risk, Biological Therapy, and Pathogenesis

2021 ◽  
Vol 12 ◽  
Author(s):  
Jiangluyi Cai ◽  
Lian Cui ◽  
Yu Wang ◽  
Ying Li ◽  
Xilin Zhang ◽  
...  
Keyword(s):  
Biologic Therapy ◽  
Life Quality ◽  
Chronic Inflammatory Disease ◽  
Inflammatory Pathways ◽  
Th 17 ◽  
Increased Risk ◽  
Interleukin 23 ◽  
Psoriasis Severity ◽  
Necrosis Factor

Psoriasis is a chronic inflammatory disease characterized by erythematous scaly plaques, accompanied by systemic damage that leads to the development of multiple comorbidities. In particular, the association between psoriasis and cardiometabolic comorbidities, including cardiovascular diseases (CVDs), obesity, diabetes mellitus, and metabolic syndrome, has been verified in a considerable number of clinical trials. Moreover, the increased risk of cardiometabolic comorbidities positively correlates with psoriasis severity. Biologic therapy targeting inflammatory pathways or cytokines substantially improves the life quality of psoriasis patients and may affect cardiometabolic comorbidities by reducing their incidences. In this review, we focus on exploring the association between cardiometabolic comorbidities and psoriasis, and emphasize the benefits and precautions of biologic therapy in the management of psoriasis with cardiometabolic comorbidities. The pathogenic mechanisms of cardiometabolic comorbidities in psoriasis patients involve common genetic factors, lipid metabolism, insulin resistance, and shared inflammatory pathways such as tumor necrosis factor-α and interleukin-23/Th-17 pathways.

scholarly journals When One Autoimmune Condition Predisposes You to Another!

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A620-A620
Author(s):  
Deepika Panday ◽  
Sathya G Jyothinagaram ◽  
Rong Rong Guo ◽  
Ricardo Rafael Correa ◽  
Karyne Lima Vinales
Keyword(s):  
Pituitary Gland ◽  
Serum Sodium ◽  
Plasma Cells ◽  
Urine Osmolality ◽  
Pituitary Hormone ◽  
Gadolinium Contrast ◽  
Blurred Vision ◽  
Autoimmune Thyroid ◽  
Autoimmune Conditions ◽  
Autoimmune Condition

Abstract Introduction: Lymphocytic hypophysitis (LYH) is an autoimmune condition in which pituitary gland is infiltrated by lymphocytes, plasma cells and macrophages. It is more common in pregnant and postpartum women, presenting with headache, visual field changes and one or more pituitary hormone impairment. Case Presentation: 32year-old female recently diagnosed with RA complicated by uveitis, presented to our facility with headache, shortness of breath, blurred vision and dysphagia. MRI head revealed a 1.9cm sellar mass with suprasellar extension displacing the optic chiasm. There was clear thickening of the pituitary stalk which raised suspicion for autoimmune hypophysitis. Exam in the ED revealed an anxious female wit hypertension, tachycardia and BMI 30. The rest of the physical exam was unremarkable. Her pituitary gonadal axis workup revealed panhypopituitarism with TSH 0.01uIU/ml, FSH <0.3Miu/ml, LH <0.3mIU/ml, ACTH <5pg/ml, IGF-1 31ng/ml and prolactin 14.4ng/ml. She was started on prednisone 50mg daily and on levothyroxine 150mcg daily. On day 2, she developed polyuria and the work up revealed a serum sodium of 146 meq/L, serum osmolality 315mOsm/kg, urine osmolality 281mOsm/kg and urine output 5.6L in 24hrs. The diagnosis of DI was made and she was started on desmopressin. On day 7, the serum sodium normalized and she did not require any other dose of desmopressin. On the day of discharge, a repeat MRI head was done which showed reduced enhancement of the pituitary which was reassuring. Discussion: LYH is a neuroendocrine disorder characterized by autoimmune inflammation of the pituitary gland with various degrees of pituitary dysfunction. Associated autoimmune diseases are seen in 18%– 50% of cases of AH. The most commonly-associated disease is autoimmune thyroid disease (15%–25%), while concurrent autoimmune conditions including RA are reported as well. Homogenous symmetrical enlargement of the pituitary gland, a thickened non deviated stalk, and a prompt, intense and homogenous enhancement of the mass after gadolinium contrast are the characteristic findings on MRI. Spontaneous resolution is the usual course and surgery is indicated only when the symptoms of sellar compression are serious and progressive. Conclusion: LYH is predominantly a disease of young females. We present this case in order to create awareness about the co-existence of LH with other autoimmune conditions and its usual course of regression with steroids.

scholarly journals Does Autoimmunity in Family Members of Children with Immune Thrombocytopenia Help Identify Patients at Higher Risk of Chronic Immune Thrombocytopenia?

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3168-3168
Author(s):  
Michell Lozano Chinga ◽  
Mark Fluchel ◽  
Jessica Meznarich
Keyword(s):  
Immune Thrombocytopenia ◽  
Chart Review ◽  
Family Members ◽  
Immune Dysregulation ◽  
University Of Utah ◽  
Autoimmune Conditions ◽  
History Of ◽  
Autoimmune Condition ◽  
The University ◽  
Chronic Immune Thrombocytopenia

Abstract Background Immune thrombocytopenia (ITP) is the most common cause of thrombocytopenia during childhood. Approximately 10-30% of pediatric patients will develop chronic ITP (cITP), which is defined as thrombocytopenia lasting over 12 months, and constitutes a significant burden for patients and their caregivers. Patients with cITP may require ongoing medications to treat symptomatic thrombocytopenia, may have asymptomatic thrombocytopenia not requiring medical interventions, or may experience complete resolution of their ITP. There are not specific patient nor disease characteristics that can help us predict how cITP may progress, and which patients are more likely to require ongoing treatments. ITP can be a manifestation of immune dysregulation in patients with other autoimmune conditions or primary immunodeficiency disorders (PIDDs). We aimed to assess the characteristics of patients with cITP including the presence of autoimmune or allergic disorders in the patients and in first-, second-, and third-degree family members. We hypothesized that patients with cITP may have a higher incidence of immune dysregulation in family members in contrast to patients with acute aITP. Methods The study was approved by the institutional review and ethics boards at the University of Utah. We queried the Primary Children's Hospital database for cases of "immune thrombocytopenia" from January 1 st, 2001 to January 1 st,2021. Retrospective chart review was done to confirm the diagnosis. Patient demographics, clinical presentation, and family history of patients were reviewed. Data was collected in RedCap at the University of Utah. Descriptive summaries of data were done. Results Medical charts from 266 ITP patients diagnosed during the study period were reviewed; 182/266 (68.5%) had acute ITP (aITP) and 84/266 (31.5%) patients had cITP, defined as platelet count <150 K/µl for >12 months. Resolution of ITP occurred in 28/84 (33.3%) patients with cITP (resolved cITP), while 56/84 (66.7%) had ongoing thrombocytopenia (unresolved cITP). Mean duration of ITP in patients with resolved cITP was 2.9 years, and 4.6 years in patients with unresolved cITP at the time of the last known platelet count. Mean age at diagnosis was 7.4 years in the cITP group and 5.1 years in the aITP group. Concurrent allergic conditions were identified in 10/84 (12%) of patients with cITP and 5/182 (2.7%) of patients with aITP. Autoimmune conditions were identified in 3 patients (3.5%) with cITP, and 4 patients (2.2%) with aITP. First-degree family members of cITP patients were more likely to be reported with an autoimmune condition than first-degree family members of aITP patients (15.5% vs. 5.5%, p=0.007 using Chi-square test); this effect was not seen amongst second- or third-degree relatives. The most common autoimmune condition reported in family members was autoimmune thyroid disease in both cohorts (2.7% in aITP and 9.5% in cITP). Common variable immunodeficiency (CVID) was reported in second degree relatives of 3/84 (3.6%) patients with cITP; no relatives of patients with aITP had a report of PIDD. Additionally, we identified 14 patients with Evans syndrome (ES), all with chronic immune thrombocytopenia and all patients had been followed for over a year at the time of the chart review. Four ES patients were previously diagnosed with 22q11.2 deletion, and one with CVID. In patients with ES, 4/14 (28.6%) and 5/14 (35.7%) had first- and second-degree family members with a reported autoimmune condition, respectively. No PIDDs were identified in first, second-, or third-degree relatives of patients with ES. Conclusions There is increasing evidence that patients with chronic ITP may exhibit polyautoimmunity or other signs of immune dysregulation, suggesting that ITP may be the initial manifestation of another autoimmune process or PIDD. We evaluated medical histories of patients with ITP and their family members. Patients with cITP have a history of autoimmunity in their family stronger than in patients with aITP. This association was even stronger in patients with ES. Disclosures No relevant conflicts of interest to declare.

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’.

scholarly journals Incidence of Autoimmune and Related Disorders After Resolution of Endogenous Cushing Syndrome in Children

2018 ◽  
Vol 50 (04) ◽  
pp. 290-295 ◽  
Author(s):  
Christina Tatsi ◽  
Meg Keil ◽  
Charalampos Lyssikatos ◽  
Elena Belyavskaya ◽  
Constantine Stratakis ◽  
...  
Keyword(s):  
Autoimmune Diseases ◽  
Chart Review ◽  
Cushing Syndrome ◽  
Retrospective Chart Review ◽  
Autoimmune Disorder ◽  
Hashimoto Thyroiditis ◽  
National Institutes Of Health ◽  
Glucocorticoid Treatment ◽  
Related Disorder ◽  
Autoimmune Conditions

AbstractGlucocorticoids are widely used for immunosuppression in autoimmune diseases. After the resolution of hypercortisolemia, the immune system recovers allowing for autoimmune diseases to manifest. Here we investigated the presence of autoimmune and related diseases that developed after cure of endogenous Cushing syndrome (CS) in children. We identified 129 children who were diagnosed and successfully treated for endogenous CS at the National Institutes of Health from 1997 until 2017, and who were followed for at least 6 months after treatment. We performed a retrospective chart review analysis to identify the presence of autoimmune or related diseases after cure. Ten children were diagnosed with a new autoimmune or related disorder after resolution of hypercortisolemia. This results in a frequency of 7.8% of our pediatric CS population. The identified patients had a shorter duration of hypercortisolemia prior to diagnosis, but did not otherwise differ from the remaining patients. The various identified diseases were: celiac disease (n=1), psoriasis (n=1), Hashimoto thyroiditis (n=1), Graves disease (n=1), optic neuritis (n=2), skin hypopigmented lesions/vitiligo (n=2), allergic rhinitis/asthma (n=1), and neuropathy responding to glucocorticoid treatment (n=1). The reported time between the treatment of CS and diagnosis of autoimmune disorder ranged from 6 to 19 months. The presence of autoimmune or related diseases might be masked by the hypercortisolemic state in endogenous CS. After resolution of hypercortisolemia, the presentation of new autoimmune diseases or recurrence of previously known autoimmune conditions should be considered when concerning symptoms arise.

Sign in / Sign up

Export Citation Format

Share Document