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Rituximab-induced cystoid macular edema in a patient with systemic lupus erythematosus: A case report and literature review 一名系统性红斑狼疮患者的利妥昔单抗诱发囊样黄斑水肿:病例报告和文献综述。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103588
Victoria Lobo-Antuña , Anbar Cherti-Afailal , Marta García-Morales , Raquel Ríos-Fernández , Francisco Javier de la Hera-Fernández , Jose Luis García-Serrano , Jose Luis Callejas-Rubio

Cystoid macular edema (CME) is considered a rare adverse effect of rituximab use, with only a limited number of cases published in the literature. Although its etiopathogenesis is still unknown, its mechanism seems to be related to a transient elevation of cytokines after rituximab infusion resulting in an increased permeability of retinal vessels.

We report the first case of rituximab-induced CME in a patient with systemic lupus erythematosus (SLE), where rituximab was used to treat hematological complications. A month after the 2nd infusion, the patient developed blurred vision and decreased visual acuity in the right eye. An optic coherence tomography (OCT) was performed, being diagnosed with CME. Rituximab was then discontinued, exhibiting a complete resolution of the condition within 4 weeks. The aim of our work is to report the first case in a patient with SLE and also carry out a brief review of the subject comparing it to all previously published cases.

囊样黄斑水肿(CME)被认为是使用利妥昔单抗的一种罕见不良反应,文献中发表的病例数量有限。虽然其发病机制尚不清楚,但其机制似乎与利妥昔单抗输注后细胞因子一过性升高导致视网膜血管通透性增加有关。我们报告了第一例利妥昔单抗诱发的 CME,患者是一名系统性红斑狼疮(SLE)患者,当时利妥昔单抗被用于治疗血液并发症。第二次输注后一个月,患者右眼出现视力模糊和视力下降。患者接受了光学相干断层扫描(OCT),被诊断为 CME。随后停用利妥昔单抗,病情在 4 周内完全缓解。我们的工作旨在报告首例系统性红斑狼疮患者的病例,并对该主题进行简要回顾,与之前发表的所有病例进行比较。
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引用次数: 0
Disease phenotypes in adult patients with suspected undifferentiated autoinflammatory diseases and PFAPA syndrome: Clinical and therapeutic implications 疑似未分化自身炎症性疾病和 PFAPA 综合征成年患者的疾病表型:临床和治疗意义。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103520

Background

Undifferentiated autoinflammatory diseases are characterized by recurrent or persistent fever, usually combined with other inflammatory manifestations, and negative or inconclusive genetic studies for monogenic autoinflammatory disorders.

Aims

To define and characterize disease phenotypes in adult patients diagnosed in an adult reference center with undifferentiated autoinflammatory diseases, and to analyze the efficacy of the drugs used in order to provide practical diagnostic and therapeutic recommendations.

Methods

Retrospective study (2015–2022) of patients with undifferentiated autoinflammatory diseases among all patients visited in our reference center. Demographic, clinical, laboratory features and detailed therapeutic information was collected.

Results

Of the 334 patients with a suspected autoinflammatory disease, 134 (40%) patients (61% women) were initially diagnosed with undifferentiated autoinflammatory diseases. Mean age at disease onset and at diagnosis was 28.7 and 37.7 years, respectively. In 90 (67.2%) patients, symptoms started during adulthood. Forty-four (32.8%) patients met diagnostic/classification criteria for adult periodic fever with aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome. In the remaining patients, four additional phenotypes were differentiated according to the predominant manifestations: a) Predominantly fever phenotype (n = 18; 13.4%); b) Predominantly abdominal/pleuritic pain phenotype (n = 9; 6.7%); c) Predominantly pericarditis phenotype (n = 18; 13.4%), and d) Complex syndrome phenotype (n = 45; 33.6%). Prednisone (mainly on demand), colchicine and anakinra were the drugs commonly used. Overall, complete responses were achieved with prednisone in 41.3%, colchicine in 40.2%, and anakinra in 58.3% of patients in whom they were used. By phenotypes, prednisone on demand was more effective in adult PFAPA syndrome and colchicine in patients with the abdominal/pleuritic pain pattern and PFAPA syndrome. Patients with complex syndrome achieved complete responses with prednisone (21.9%), colchicine (25.7%) and anakinra (44.4%), and were the group more often requiring additional immunosuppressive drugs.

Conclusions

The analysis of the largest single-center series of adult patients with undifferentiated autoinflammatory diseases identified and characterized different disease phenotypes and their therapeutic approaches. This study is expected to contribute to increase the awareness of physicians for an early identification of these conditions, and to provide the best known therapeutic options.

背景:未分化自身炎症性疾病的特点是反复发热或持续发热,通常伴有其他炎症表现,单基因自身炎症性疾病的基因研究结果为阴性或不确定。目的:对在成人参考中心确诊的未分化自身炎症性疾病成年患者的疾病表型进行定义和特征描述,并分析所用药物的疗效,以提供实用的诊断和治疗建议:方法:回顾性研究(2015-2022 年)我们参考中心就诊的所有未分化自身炎症性疾病患者。收集了人口统计学、临床、实验室特征和详细的治疗信息:结果:在334名疑似自身炎症性疾病患者中,134名(40%)患者(61%为女性)被初步诊断为未分化自身炎症性疾病。发病和确诊时的平均年龄分别为 28.7 岁和 37.7 岁。90名患者(67.2%)的症状始于成年期。44名患者(32.8%)符合成人 PFAPA 综合征的诊断/分类标准。在其余患者中,根据主要表现又分为四种表型:a) 主要发热表型(n = 18;13.4%);b) 主要腹痛/瘙痒表型(n = 9;6.7%);c) 主要心包炎表型(n = 18;13.4%);d) 复杂综合征表型(n = 45;33.6%)。常用药物包括泼尼松(主要按需使用)、秋水仙碱和阿纳金雷。总体而言,41.3%的泼尼松患者、40.2%的秋水仙碱患者和58.3%的阿纳金拉患者获得了完全应答。从表型上看,泼尼松按需治疗对成人 PFAPA 综合征更有效,而秋水仙碱对腹部/瘙痒疼痛模式和 PFAPA 综合征患者更有效。复杂综合征患者在使用泼尼松(21.9%)、秋水仙碱(25.7%)和阿那曲林(44.4%)后获得了完全应答,是更常需要额外免疫抑制剂的群体:通过对最大的单中心未分化自身炎症性疾病成年患者系列进行分析,确定并描述了不同的疾病表型及其治疗方法。这项研究有望提高医生早期识别这些疾病的意识,并提供已知的最佳治疗方案。
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引用次数: 0
Biological markers of high risk of thrombotic recurrence in patients with antiphospholipid syndrome: A literature review 抗磷脂综合征患者血栓复发高风险的生物标志物:文献综述。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-06-01 DOI: 10.1016/j.autrev.2024.103585
Mathilde Lambert , Alexandre Brodovitch , Jean-Louis Mège , Daniel Bertin , Nathalie Bardin

Objectives

This review aims to identify biological markers associated with the risk of recurrence of thrombotic and/or obstetric events in patients with antiphospholipid syndrome (APS).

Methods

A comprehensive review of literature was conducted to evaluate established and potential novel biological markers associated with thrombosis in APS. To this end, a PubMed literature search was conducted for the last twenty years using the following keywords or their combinations: thrombotic risk, recurrence of thrombosis, risk stratification, severity, predictive value.

Results

Previous studies showed that multiple aPL positivity correlates with an increased risk of thrombosis in APS. Moreover, the analysis of N-glycosylation of antiphospholipid antibodies (aPL) revealed that low levels of IgG sialylation, fucosylation or galactosylation increases the pro-inflammatory activity of aPL, predisposing to thrombosis. In addition, quantification of neutrophil extracellular traps (NETs) and antibodies directed against NETs (anti-NETs) in serum demonstrates promising prognostic utility in assessing APS severity. Oxidative stress plays a role in the pathogenicity of APS and paraoxonase 1 (PON1) activity emerges as a promising biomarker of thrombotic risk in APS. Furthermore, identification of novel antigenic targets involved in the pathophysiology of APS, such as lysobisphosphatidic acid (LBPA), had led to the discovery of unconventional aPL, antibodies directed against the LBPA (aLBPA), whose clinical value could make it possible to identify APS patients at high risk of thrombotic recurrence.

Conclusion

The immunological profile of aPL, N-glycosylation of aPL, quantification of NETs and anti-NETs, analysis of biomarkers of oxidative stress and the discovery of aLBPA offer potential prognostic tools for risk stratification in APS patients.

目的:本综述旨在确定抗磷脂综合征(APS)患者血栓和/或产科事件复发风险的生物标志物:本综述旨在确定抗磷脂综合征(APS)患者血栓和/或产科事件复发风险的生物标志物:方法:对文献进行全面综述,评估与 APS 血栓形成相关的已确定和潜在的新型生物标记物。为此,我们使用以下关键词或关键词组合对过去 20 年的 PubMed 文献进行了检索:血栓风险、血栓复发、风险分层、严重程度、预测价值:抗磷脂抗体(aPL)的 N-糖基化分析表明,低水平的 IgG sialylation、fucosylation 或 galactosylation 会增加 aPL 的促炎活性,从而导致血栓形成。此外,对血清中的中性粒细胞胞外捕获物(NETs)和针对NETs的抗体(抗NETs)进行定量分析,可用于评估APS的严重程度。氧化应激在 APS 的致病过程中起着重要作用,而副氧合酶 1 (PON1) 的活性则是 APS 中血栓风险的一种有希望的生物标志物。此外,溶血双磷脂酸(LBPA)等参与APS病理生理学的新型抗原靶点的鉴定导致了非常规aPL的发现,即针对LBPA的抗体(aLBPA),其临床价值可使识别血栓复发高风险的APS患者成为可能:aPL的免疫学特征、aPL的N-糖基化、NETs和抗NETs的定量、氧化应激生物标志物的分析以及aLBPA的发现为APS患者的风险分层提供了潜在的预后工具。
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引用次数: 0
Exposome: Epigenetics and autoimmune diseases 暴露体:表观遗传学与自身免疫性疾病。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-06-01 DOI: 10.1016/j.autrev.2024.103584
Maria Giovanna Danieli , Marco Casciaro , Alberto Paladini , Martina Bartolucci , Martina Sordoni , Yehuda Shoenfeld , Sebastiano Gangemi

Systemic autoimmune diseases are complex conditions characterized by an immune system dysregulation and an aberrant activation against self-antigens, leading to tissue and organ damage. Even though genetic predisposition plays a role, it cannot fully explain the onset of these diseases, highlighting the significant impact of non-heritable influences such as environment, hormones and infections. The exposome represents all those factors, ranging from chemical pollutants and dietary components to psychological stressors and infectious agents.

Epigenetics, which studies changes in gene expression without altering the DNA sequence, is a crucial link between exposome and the development of autoimmune diseases. Key epigenetic mechanisms include DNA methylation, histone modifications, and non-coding RNAs.

These epigenetic modifications could provide a potential piece of the puzzle in understanding systemic autoimmune diseases and their connection with the exposome.

In this work we have collected the most important and recent evidence in epigenetic changes linked to systemic autoimmune diseases (systemic lupus erythematosus, idiopathic inflammatory myopathies, ANCA-associated vasculitis, and rheumatoid arthritis), emphasizing the roles these changes may play in disease pathogenesis, their potential as diagnostic biomarkers and their prospective in the development of targeted therapies.

全身性自身免疫性疾病是一种复杂的疾病,其特点是免疫系统失调和针对自身抗原的异常激活,从而导致组织和器官损伤。尽管遗传易感性起着一定的作用,但它并不能完全解释这些疾病的发病原因,而环境、激素和感染等非遗传影响因素的重大影响则凸显了这一点。暴露体代表了所有这些因素,从化学污染物和饮食成分到心理压力和传染源。表观遗传学研究在不改变 DNA 序列的情况下基因表达的变化,它是暴露体与自身免疫性疾病发展之间的重要联系。关键的表观遗传学机制包括 DNA 甲基化、组蛋白修饰和非编码 RNA。这些表观遗传修饰可为了解全身性自身免疫性疾病及其与暴露体的联系提供一个潜在的拼图。在这项工作中,我们收集了与系统性自身免疫性疾病(系统性红斑狼疮、特发性炎症性肌病、ANCA 相关性血管炎和类风湿性关节炎)有关的表观遗传学变化方面最重要的最新证据,强调了这些变化在疾病发病机制中可能扮演的角色、其作为诊断生物标志物的潜力以及在开发靶向疗法中的前景。
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引用次数: 0
Cardiovascular and cerebrovascular outcomes in anti-neutrophil cytoplasmic antibody-associated vasculitis: A systematic review with meta-analysis 抗中性粒细胞胞浆抗体相关性血管炎的心血管和脑血管预后:系统回顾与荟萃分析。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-06-01 DOI: 10.1016/j.autrev.2024.103587
Wenhui Xie , Shiyu Xiao , Xiaoyuan Li , Jing Huang , Zhuoli Zhang

Objective

To quantify the magnitude of the risk of total and type-specific cardiovascular and cerebrovascular diseases (CCVD) in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV).

Method

Searches of PubMed, Embase, and the Cochrane Library were conducted. Observational studies were included if they reported data on CCVD in AAV patients. Pooled risk ratios (RR) with 95% confidence intervals were calculated.

Result

Fourteen studies met the inclusion criteria, comprising 20,096 AAV patients (over 46,495 person-years) with 5757 CCVD events. Compared with non-vasculitis population, AAV patients showed an 83% increased risk of incident CCVD (1.83 [1.37–2.45]; n = 10), 48% for coronary artery disease (1.48 [1.26–1.75]; n = 9), and 56% for cerebrovascular accident (1.56 [1.22–1.99]; n = 9). For type-specific CCVD, the risks of myocardial infarction, stroke, heart failure were increased by 67% (1.67 [1.29–2.15]; n = 6), 97% (1.97 [1.19–3.25]; n = 8) and 72% (1.72 [1.28–2.32]; n = 4), whereas there was only a trend toward a higher risk of angina pectoris (1.46 [0.90–2.39]; n = 2), and ischemic stroke (1.88 [0.86–4.12]; n = 4). Subgroup analyses by AAV type found significantly increased CCVD risk in both granulomatosis with polyangiitis (1.87 [1.29–2.73]; n = 7) and microscopic polyangiitis (2.93 [1.58–5.43]; n = 3). In three studies reporting impact of follow-up period after AAV diagnosis, the CCVD risk was significantly higher in the first two years after diagnosis than the subsequent follow-up (2.23 [2.00–2.48] vs. 1.48 [1.40–1.56]; p < 0.01). Significant heterogeneity existed in the main analyses.

Conclusion

This meta-analysis demonstrates that AAV is associated with increased risks of overall and type-specific CCVD, especially within two years after AAV diagnosis.

目的量化抗中性粒细胞胞浆抗体相关性脉管炎(AAV)患者罹患心脑血管疾病(CCVD)的总风险和特定类型风险的大小:方法:检索 PubMed、Embase 和 Cochrane 图书馆。如果观察性研究报告了 AAV 患者的心血管疾病数据,则将其纳入研究范围。计算汇总风险比(RR)及 95% 置信区间:14项研究符合纳入标准,包括20,096名AAV患者(超过46,495人年)和5757起CCVD事件。与非血管炎人群相比,AAV患者发生心血管疾病的风险增加了83%(1.83 [1.37-2.45];n = 10),冠心病增加了48%(1.48 [1.26-1.75];n = 9),脑血管意外增加了56%(1.56 [1.22-1.99];n = 9)。对于特定类型的慢性心血管疾病,心肌梗死、中风、心力衰竭的风险分别增加了 67% (1.67 [1.29-2.15]; n = 6)、97% (1.97 [1.19-3.25]; n = 8)和 72% (1.72 [1.28-2.32]; n = 4),而心绞痛(1.46 [0.90-2.39]; n = 2)和缺血性中风(1.88 [0.86-4.12]; n = 4)的风险仅有升高趋势。按 AAV 类型进行的亚组分析发现,肉芽肿伴多血管炎(1.87 [1.29-2.73]; n = 7)和显微镜下多血管炎(2.93 [1.58-5.43]; n = 3)的心血管疾病风险均显著增加。在三项报告了 AAV 诊断后随访期影响的研究中,诊断后头两年的心血管疾病风险显著高于随后的随访期(2.23 [2.00-2.48] vs. 1.48 [1.40-1.56];P 结论:这项荟萃分析表明,AAV 与总体和类型特异性心血管疾病风险的增加有关,尤其是在 AAV 诊断后的两年内。
{"title":"Cardiovascular and cerebrovascular outcomes in anti-neutrophil cytoplasmic antibody-associated vasculitis: A systematic review with meta-analysis","authors":"Wenhui Xie ,&nbsp;Shiyu Xiao ,&nbsp;Xiaoyuan Li ,&nbsp;Jing Huang ,&nbsp;Zhuoli Zhang","doi":"10.1016/j.autrev.2024.103587","DOIUrl":"10.1016/j.autrev.2024.103587","url":null,"abstract":"<div><h3>Objective</h3><p>To quantify the magnitude of the risk of total and type-specific cardiovascular and cerebrovascular diseases (CCVD) in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV).</p></div><div><h3>Method</h3><p>Searches of PubMed, Embase, and the Cochrane Library were conducted. Observational studies were included if they reported data on CCVD in AAV patients. Pooled risk ratios (RR) with 95% confidence intervals were calculated.</p></div><div><h3>Result</h3><p>Fourteen studies met the inclusion criteria, comprising 20,096 AAV patients (over 46,495 person-years) with 5757 CCVD events. Compared with non-vasculitis population, AAV patients showed an 83% increased risk of incident CCVD (1.83 [1.37–2.45]; <em>n</em> = 10), 48% for coronary artery disease (1.48 [1.26–1.75]; <em>n</em> = 9), and 56% for cerebrovascular accident (1.56 [1.22–1.99]; n = 9). For type-specific CCVD, the risks of myocardial infarction, stroke, heart failure were increased by 67% (1.67 [1.29–2.15]; <em>n</em> = 6), 97% (1.97 [1.19–3.25]; <em>n</em> = 8) and 72% (1.72 [1.28–2.32]; <em>n</em> = 4), whereas there was only a trend toward a higher risk of angina pectoris (1.46 [0.90–2.39]; <em>n</em> = 2), and ischemic stroke (1.88 [0.86–4.12]; n = 4). Subgroup analyses by AAV type found significantly increased CCVD risk in both granulomatosis with polyangiitis (1.87 [1.29–2.73]; <em>n</em> = 7) and microscopic polyangiitis (2.93 [1.58–5.43]; <em>n</em> = 3). In three studies reporting impact of follow-up period after AAV diagnosis, the CCVD risk was significantly higher in the first two years after diagnosis than the subsequent follow-up (2.23 [2.00–2.48] vs. 1.48 [1.40–1.56]; <em>p</em> &lt; 0.01). Significant heterogeneity existed in the main analyses.</p></div><div><h3>Conclusion</h3><p>This meta-analysis demonstrates that AAV is associated with increased risks of overall and type-specific CCVD, especially within two years after AAV diagnosis.</p></div>","PeriodicalId":8664,"journal":{"name":"Autoimmunity reviews","volume":"23 6","pages":"Article 103587"},"PeriodicalIF":9.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Relapses in giant cell arteritis: Updated review for clinical practice 巨细胞动脉炎复发:临床实践最新回顾。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-06-01 DOI: 10.1016/j.autrev.2024.103580
Marco A. Alba , Tanaz A. Kermani , Sebastian Unizony , Giuseppe Murgia , Sergio Prieto-González , Carlo Salvarani , Eric L. Matteson

Giant cell arteritis (GCA), the most common primary vasculitis in adults, is a granulomatous systemic vasculitis usually affecting the aorta and its major branches, particularly the carotid and vertebral arteries. Although remission can be achieved in most patients with GCA using high-dose glucocorticoids (GC), relapses are frequent, occurring in >40% of GC-only treated patients, mostly during the first two years after diagnosis. Relapsing courses lead to high GC exposure, increasing the risk of treatment-related adverse effects. Although tocilizumab is an efficacious GC-sparing therapy that allows increased sustained remission and reduced cumulative GC doses, relapses are common after drug discontinuation.

This narrative review examines the most relevant features of relapses in GCA, including its definition, classification, frequency, clinical, laboratory, and imaging characteristics, chronology, probable pathophysiology, and predictive factors. In addition, we discuss treatment options for relapsing patients and the effect of relapses on patient outcomes.

巨细胞动脉炎(GCA)是成人中最常见的原发性血管炎,是一种肉芽肿性全身性血管炎,通常累及主动脉及其主要分支,尤其是颈动脉和椎动脉。尽管使用大剂量糖皮质激素(GC)可使大多数 GCA 患者的病情得到缓解,但复发却很频繁,在只接受 GC 治疗的患者中复发率大于 40%,且大多发生在确诊后的头两年。复发病程会导致大量糖皮质激素暴露,增加治疗相关不良反应的风险。尽管托西珠单抗是一种有效的节省 GC 的疗法,可提高持续缓解率并减少 GC 的累积剂量,但停药后复发仍很常见。这篇叙述性综述探讨了 GCA 复发的最相关特征,包括其定义、分类、频率、临床、实验室和影像学特征、时序、可能的病理生理学和预测因素。此外,我们还讨论了复发患者的治疗方案以及复发对患者预后的影响。
{"title":"Relapses in giant cell arteritis: Updated review for clinical practice","authors":"Marco A. Alba ,&nbsp;Tanaz A. Kermani ,&nbsp;Sebastian Unizony ,&nbsp;Giuseppe Murgia ,&nbsp;Sergio Prieto-González ,&nbsp;Carlo Salvarani ,&nbsp;Eric L. Matteson","doi":"10.1016/j.autrev.2024.103580","DOIUrl":"10.1016/j.autrev.2024.103580","url":null,"abstract":"<div><p>Giant cell arteritis (GCA), the most common primary vasculitis in adults, is a granulomatous systemic vasculitis usually affecting the aorta and its major branches, particularly the carotid and vertebral arteries. Although remission can be achieved in most patients with GCA using high-dose glucocorticoids (GC), relapses are frequent, occurring in &gt;40% of GC-only treated patients, mostly during the first two years after diagnosis. Relapsing courses lead to high GC exposure, increasing the risk of treatment-related adverse effects. Although tocilizumab is an efficacious GC-sparing therapy that allows increased sustained remission and reduced cumulative GC doses, relapses are common after drug discontinuation.</p><p>This narrative review examines the most relevant features of relapses in GCA, including its definition, classification, frequency, clinical, laboratory, and imaging characteristics, chronology, probable pathophysiology, and predictive factors. In addition, we discuss treatment options for relapsing patients and the effect of relapses on patient outcomes.</p></div>","PeriodicalId":8664,"journal":{"name":"Autoimmunity reviews","volume":"23 6","pages":"Article 103580"},"PeriodicalIF":9.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Practical guidance for the early recognition and follow-up of patients with connective tissue disease-related interstitial lung disease 结缔组织病相关间质性肺病患者的早期识别和随访实用指南。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-06-01 DOI: 10.1016/j.autrev.2024.103582
Julien Guiot , Jelle Miedema , Ana Cordeiro , Jeska K. De Vries-Bouwstra , Theodoros Dimitroulas , Klaus Søndergaard , Argyrios Tzouvelekis , Vanessa Smith

Background

The early detection and management of (progressive) interstitial lung disease in patients with connective tissue diseases requires the attention and skills of a multidisciplinary team. However, there are currently no well-established standards to guide the daily practice of physicians treating this heterogenous group of diseases.

Research question

This paper aimed to identify gaps in scientific knowledge along the journey of patients with connective tissue disease-related interstitial lung disease and to provide tools for earlier identification of interstitial lung disease and progressive disease.

Study Design and Methods

The opinions of an international expert panel, which consisted of pulmonologists and rheumatologists were collected and interpreted in the light of peer-reviewed data.

Results

Interstitial lung disease is a common complication of connective tissue diseases, but prevalence estimates vary by subtype. Screening and monitoring by means of clinical examination, chest radiography, pulmonary function testing, and disease-specific biomarkers provide insight into the disease activity of patients presenting with connective tissue diseases in a routine setting. Multiple phenotypic and genotypic characteristics have been identified as predictors of the development and progression of interstitial lung disease. However, these risk factors differ between subtypes. To ensure earlier diagnosis of rapidly progressive phenotypes, a risk-based method is necessary for determining the need for HRCT and additional testing.

Interpretation

To reduce the underdiagnosis of CTD-ILDs in clinical practice, a standardized and systematic multidisciplinary risk-based approach is suggested. Collaboration across disciplines is essential for the management of CTD-ILD.

背景:结缔组织病患者(进行性)间质性肺病的早期发现和治疗需要多学科团队的关注和技能。然而,目前还没有完善的标准来指导治疗这类异质性疾病的医生的日常工作:本文旨在找出结缔组织病相关间质性肺疾病患者在治疗过程中存在的科学知识空白,并为早期识别间质性肺疾病和进展性疾病提供工具:研究设计与方法:收集由肺病学家和风湿病学家组成的国际专家小组的意见,并根据同行评审数据进行解释:间质性肺病是结缔组织病的常见并发症,但不同亚型的发病率估计值各不相同。通过临床检查、胸片检查、肺功能检测和疾病特异性生物标记物进行筛查和监测,可以深入了解结缔组织病患者在常规情况下的疾病活动情况。多种表型和基因型特征已被确定为间质性肺病发生和发展的预测因素。然而,这些风险因素在不同亚型之间存在差异。为确保更早地诊断出快速进展的表型,有必要采用一种基于风险的方法来确定是否需要进行 HRCT 和其他检测:为减少 CTD-ILD 在临床实践中的漏诊,建议采用基于风险的标准化、系统化多学科方法。跨学科合作对于 CTD-ILD 的管理至关重要。
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引用次数: 0
Unraveling the global burden of inflammatory bowel disease (1990–2019): A Joinpoint regression analysis of divergent trends in 10–24 and 50–69 age cohorts 揭示炎症性肠病的全球负担(1990-2019 年):对 10-24 岁年龄组和 50-69 岁年龄组不同趋势的连接点回归分析。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-06-01 DOI: 10.1016/j.autrev.2024.103586
Xinyi Wang , Ruipu Xiu , Liping Gong , Wei Sun , Yuxin Dong , Weitong Liu , Xiaoxuan Liu , Chuanyong Liu , Jingxin Li , Yanqing Wang

Background and aims

The escalating prevalence of IBD within specific age cohorts, 10–24 and 50–69 years, necessitates a refined understanding of its epidemiological patterns. Prior investigations have often been constrained by their limited scope, particularly in employing age-specific analyses and utilizing advanced statistical methods such as joinpoint regression. Our research examines these demographic segments to elucidate the epidemiological trajectory of IBD.

Methods

This study analyzed GBD 2019 data on IBD, focusing on age groups 10–24 and 50–69. We integrated the socio-demographic index for socio-economic context and employed joinpoint regression to analyze time-segmented disease trends, prioritizing average annual percent change for a comprehensive view.

Results

A notable global decline in IBD incidence, particularly in the 50–69 age group, was observed. The 10–24 cohort, however, presented a marginal rise across three decades, with a discernible decline between 2010 and 2019. The study also revealed pivotal gender disparities, with increasing incidence rates in males, especially in the High-income Asia Pacific region. Conversely, females demonstrated decreasing trends across the board. Regional variations accentuated East Asia's escalated IBD incidence and prevalence, whereas high-income North American and Asia-Pacific regions, along with Europe, reflected the highest age-standardized incidence rates.

Conclusion

The burden of IBD between 1990 and 2019 presents notable disparities across different regions and age demographics. While older populations are seeing a decrease in IBD incidence, young adults and adolescents in regions like East Asia and high-income Asia Pacific are experiencing a concerning uptick. This uneven distribution, influenced by both age and gender, underscores the multifaceted nature of IBD's global impact.

背景和目的:IBD 在 10-24 岁和 50-69 岁这两个特定年龄段的发病率不断上升,因此有必要对其流行病学模式进行深入了解。之前的调查往往受到范围有限的限制,尤其是在采用特定年龄分析和使用联结点回归等高级统计方法方面。我们的研究对这些人口学细分进行了研究,以阐明 IBD 的流行病学轨迹:本研究分析了 GBD 2019 有关 IBD 的数据,重点关注 10-24 岁和 50-69 岁年龄组。我们整合了社会经济背景下的社会人口指数,并采用连接点回归分析了疾病的时间分段趋势,优先考虑年均百分比变化,以获得全面的视角:结果:观察到全球 IBD 发病率明显下降,尤其是在 50-69 岁年龄组。然而,10-24 岁年龄组的发病率在三十年间略有上升,2010 年至 2019 年期间出现明显下降。研究还揭示了关键的性别差异,男性发病率不断上升,尤其是在高收入的亚太地区。相反,女性的发病率则呈全面下降趋势。地区差异加剧了东亚地区的 IBD 发病率和流行率,而高收入的北美和亚太地区以及欧洲则反映出最高的年龄标准化发病率:结论:1990 年至 2019 年期间,IBD 的负担在不同地区和年龄人口中呈现出明显的差异。虽然老年人群的 IBD 发病率有所下降,但东亚和高收入亚太地区等地区的年轻成人和青少年的发病率却出现了令人担忧的上升。这种受年龄和性别影响的不均衡分布凸显了 IBD 对全球影响的多面性。
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引用次数: 0
Metabolic heterogeneity in tumor microenvironment – A novel landmark for immunotherapy 肿瘤微环境中的代谢异质性--免疫疗法的新里程碑
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-06-01 DOI: 10.1016/j.autrev.2024.103579
Chen Chen , Peng Han , Yanping Qing

The surrounding non-cancer cells and tumor cells that make up the tumor microenvironment (TME) have various metabolic rhythms. TME metabolic heterogeneity is influenced by the intricate network of metabolic control within and between cells. DNA, protein, transport, and microbial levels are important regulators of TME metabolic homeostasis. The effectiveness of immunotherapy is also closely correlated with alterations in TME metabolism. The response of a tumor patient to immunotherapy is influenced by a variety of variables, including intracellular metabolic reprogramming, metabolic interaction between cells, ecological changes within and between tumors, and general dietary preferences. Although immunotherapy and targeted therapy have made great strides, their use in the accurate identification and treatment of tumors still has several limitations. The function of TME metabolic heterogeneity in tumor immunotherapy is summarized in this article. It focuses on how metabolic heterogeneity develops and is regulated as a tumor progresses, the precise molecular mechanisms and potential clinical significance of imbalances in intracellular metabolic homeostasis and intercellular metabolic coupling and interaction, as well as the benefits and drawbacks of targeted metabolism used in conjunction with immunotherapy. This offers insightful knowledge and important implications for individualized tumor patient diagnosis and treatment plans in the future.

构成肿瘤微环境(TME)的周围非癌细胞和肿瘤细胞具有不同的代谢节律。肿瘤微环境的代谢异质性受到细胞内部和细胞之间错综复杂的代谢控制网络的影响。DNA、蛋白质、运输和微生物水平是 TME 代谢平衡的重要调节因素。免疫疗法的效果也与肿瘤组织代谢的改变密切相关。肿瘤患者对免疫疗法的反应受多种变量的影响,包括细胞内代谢重编程、细胞间的代谢相互作用、肿瘤内和肿瘤间的生态变化以及一般饮食偏好。尽管免疫疗法和靶向疗法取得了长足的进步,但它们在准确识别和治疗肿瘤方面的应用仍存在一些局限性。本文总结了TME代谢异质性在肿瘤免疫疗法中的作用。文章重点阐述了代谢异质性是如何随着肿瘤的进展而发展和调控的,细胞内代谢平衡失调和细胞间代谢耦合与相互作用的确切分子机制和潜在临床意义,以及靶向代谢与免疫疗法结合使用的益处和弊端。这为未来肿瘤患者的个体化诊断和治疗计划提供了深刻的知识和重要的意义。
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引用次数: 0
Global prevalence of obesity in patients with psoriasis: An analysis in the past two decades 银屑病患者肥胖的全球流行率:过去二十年的分析。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-06-01 DOI: 10.1016/j.autrev.2024.103577
Jiao Wang , Yuanting Yu , Liu Liu , Chunxiao Wang , Xiaoying Sun , Yaqiong Zhou , Seokgyeong Hong , Xiaoce Cai , Wenbin Xu , Xin Li

Background

Obesity is the risk factor for psoriasis. Therefore, we conducted a comprehensive review and meta-analysis to determine the prevalence of obesity in patients with psoriasis.

Methods

We examined four databases from their inception to October 2023 and used the Agency for Healthcare Research and Quality and the Newcastle-Ottawa Scale to assess the quality of observational studies. Data analysis was conducted by R language. Meta-regression, sensitivity and subgroup analyses were used to evaluate inter-study heterogeneity. Egger's test and funnel plots were used to evaluate publication bias.

Results

The global prevalence of psoriasis and obesity comorbidity was 25% (95% confidence interval [CI]: 0.21–0.30). Furthermore, the co-morbidity rate was 18% (95% CI: 0.11–0.24) in children and adolescents, and 35% (95% CI: 0.30–0.39) in adults. The gender-specific prevalence rates were 23% (95% CI: 0.16–0.32) in men and 38% (95% CI: 0.20–0.61) in women. Africa had the highest prevalence (60%, 95% CI: 0.21–0.99), followed by Asia (40%, 95% CI: 0.28–0.51), while Europe and North America had similar prevalence rates at 34% (95% CI: 0.27–0.41) and 31% (95% CI: 0.27–0.38), respectively. Regarding psoriasis severity, obesity prevalence was higher in moderate psoriasis (36%, 95% CI: 0.20–0.64) and lower in mild psoriasis (27%, 95% CI: 0.16–0.46). The prevalence of obesity in the patients with severe psoriasis was 30% (95% CI: 0.20–0.45).

Conclusion

This study underscores the importance of identifying and treating obesity in patients with psoriasis to mitigate disease progression. However, more high-quality observational studies are required to elucidate their global prevalence and comorbid associations.

背景:银屑病和肥胖是银屑病的危险因素。因此,我们进行了一项综合回顾和荟萃分析,以确定银屑病患者的肥胖患病率:方法:我们研究了从开始到2023年10月的四个数据库,并使用美国医疗保健研究与质量机构和纽卡斯尔-渥太华量表评估观察性研究的质量。数据分析使用 R 语言进行。元回归、敏感性和亚组分析用于评估研究间的异质性。Egger检验和漏斗图用于评估发表偏倚:银屑病和肥胖合并症的总体发病率为 25%(95% 置信区间 [CI]:0.21-0.30)。此外,儿童和青少年的合并发病率为 18%(95% 置信区间:0.11-0.24),成人为 35%(95% 置信区间:0.30-0.39)。男性和女性的患病率分别为 23% (95% CI:0.16-0.32)和 38%(95% CI:0.20-0.61)。非洲的患病率最高(60%,95% CI:0.21-0.99),其次是亚洲(40%,95% CI:0.28-0.51),而欧洲和北美的患病率相似,分别为 34%(95% CI:0.27-0.41)和 31%(95% CI:0.27-0.38)。就银屑病的严重程度而言,肥胖在中度银屑病中的发病率较高(36%,95% CI:0.20-0.64),而在轻度银屑病中的发病率较低(27%,95% CI:0.16-0.46)。严重银屑病的发病率为 30%(95% CI:0.20-0.45):这项研究强调了识别和治疗银屑病患者肥胖症以缓解疾病进展的重要性。然而,还需要更多高质量的观察性研究来阐明肥胖症的总体发病率和合并症。
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引用次数: 0
期刊
Autoimmunity reviews
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