scholarly journals Enthesitis Related Arthritis: A Single Center Experience

Acta Medica ◽  
2021 ◽  
pp. 1-6
Author(s):  
Selcan Demir ◽  
Müşerref Kasap Cüceoğlu ◽  
Yelda Bilginer
Keyword(s):  
Laboratory Data ◽  
Inflammatory Back Pain ◽  
Hla B27 ◽  
Female Ratio ◽  
Enthesitis Related Arthritis ◽  
Spinal Involvement ◽  
Therapeutic Decisions ◽  
Number Of Patients ◽  
Spinal Mri

Objective: Enthesitis-related arthritis is a subtype of juvenile idiopathic arthritis category, characterized by enthesitis, arthritis, and the risk of axial involvement. We aimed to summarize the demographics, clinical, and laboratory findings of enthesitis-related arthritis patients and to identify the distinguishing features of enthesitis-related arthritis patients with HLA B27 positive compared to the patients who were HLA B27 negative. Materials and Methods: This retrospective study included patients with Enthesitis-related arthritis who followed up between 2015 and 2018. Demographical, clinical, and laboratory data were retrospectively reviewed from the patient files and computerized medical charts. Results: A total of 72 patients diagnosed with enthesitis-related arthritis were included in the study. The male/female ratio was 2.1/1. Fifty-three (73%) of them presented with peripheral arthritis. The most commonly affected joint was knee (81.1%), followed by the ankle (43%), hips (32%), and wrist (5%). HLA B27 was positive in 36 (50%) patients. During follow-up, the number of patients who developed enthesitis-related arthritis -associated uveitis was 8 (11.1%). During follow-up, 56 patients with inflammatory back pain and/or sacroiliac tenderness underwent spinal MRI. Ten (17.8%) patients had only thoracal and/or lumbar involvement, 18 (32%) had only sacroiliitis, and 9 (16%) patients had both of them on spinal MRI. In comparison with HLA-B27-negative children, HLA-B27-positive patients were more likely to have enthesitis (16 (44.4%) vs 8 (22.2%), p=0.046), MRI proven sacroiliitis (19 (52.7%) vs 8 (22.2%), p=0.031), MRI proven spinal involvement (13 (36.1%) vs 6 (16.6%), p=0.031), and uveitis (8 (100%) vs 0(0%), p=0.014). During follow up, 65/72 (90.2 %) of them needed disease-modifying antirheumatic drugs (DMARD), and 51/72 (70.8%) needed anti-tumor necrosis factor-α (TNF-α) therapy. Conclusion: We found that patients who were HLA-B27- positive had significantly more enthesitis, MRI-proven sacroiliitis, MRI-proven spinal involvement, and acute anterior uveitis, in comparison to patients who were HLA B27 negative. It is crucial to carefully assess those patients with concern for enthesitis-related arthritis to determine the expected prognosis and make therapeutic decisions appropriately.

scholarly journals Epidemiology of pediatric uveitis and associated systemic diseases

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yoonkyeom Shin ◽  
Ji-Man Kang ◽  
Junwon Lee ◽  
Christopher Seungkyu Lee ◽  
Sung Chul Lee ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Inflammatory Disease ◽  
Pediatric Patients ◽  
Age At Onset ◽  
Laboratory Data ◽  
Categorical Variables ◽  
Hla B27 ◽  
Female Ratio ◽  
Systemic Rheumatic Disease ◽  
Systemic Inflammatory Disease

Abstract Background The early detection of uveitis associated with systemic inflammatory disease in children is important for proper treatment and prognosis. However, the diagnosis may be delayed because of difficulties in childhood examinations and early minor systemic symptoms. The objective of our study was to identify the pattern of childhood uveitis and investigate the frequency and clinical features of rheumatic diseases in pediatric patients with uveitis. Methods This retrospective observational study reviewed the medical records of children (age ≤ 18 years) with uveitis at a Korean tertiary hospital between January 2005 and December 2018. Data collected included the age at onset of uveitis, sex, anatomic location of ocular inflammation, comorbid disease (including systemic inflammatory disease), ocular complications, relevant laboratory data, and treatment. Fisher’s exact test was used to compare categorical variables and the Mann–Whitney U test was used to compare continuous variables. A p-value of < 0.05 was considered statistically significant. Results A total of 155 pediatric patients with uveitis were included in this study. The median age at diagnosis was 13.0 years (interquartile range, 9.5–16.0 years). The male-to-female ratio was 1.09. The process was unilateral in 51.6% of children. Anterior uveitis, panuveitis, intermediate uveitis, and posterior uveitis represented 51.6, 26.5, 6.5, and 1.9% of the cases, respectively. Idiopathic uveitis (65.2%) was the most frequent type of uveitis. Systemic rheumatic disease associations were responsible for 28.4% of the cases, among which juvenile idiopathic arthritis (JIA) was the most frequent cause (14.8%). Human leukocyte antigen (HLA)-B27 and antinuclear antibody (ANA) positive rates were significantly higher in patients with JIA than in those with idiopathic uveitis (p = 0.006 and p = 0.007, respectively). Conclusions Approximately one-third of children with uveitis in Korea have a systemic rheumatic disease, of which JIA accounts for the majority of cases. HLA-B27 and ANA can serve as risk factors for JIA-associated uveitis.

scholarly journals HEROIC: a 5-year observational cohort study aimed at identifying novel factors that drive diabetic kidney disease: rationale and study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e033923
Author(s):  
Kieran Mccafferty ◽  
Ben Caplin ◽  
Sinead Knight ◽  
Paul Hockings ◽  
David Wheeler ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Observational Study ◽  
Diabetic Kidney Disease ◽  
Laboratory Data ◽  
Premature Mortality ◽  
Primary Objective ◽  
Imaging Data ◽  
Diabetic Kidney ◽  
Number Of Patients

IntroductionDiabetic kidney disease (DKD) is the leading cause of end-stage kidney disease worldwide and a major cause of premature mortality in diabetes mellitus (DM). While improvements in care have reduced the incidence of kidney disease among those with DM, the increasing prevalence of DM means that the number of patients worldwide with DKD is increasing. Improved understanding of the biology of DKD and identification of novel therapeutic targets may lead to new treatments. A major challenge to progress has been the heterogeneity of the DKD phenotype and renal progression. To investigate the heterogeneity of DKD we have set up The East and North London Diabetes Cohort (HEROIC) Study, a secondary care-based, multiethnic observational study of patients with biopsy-proven DKD. Our primary objective is to identify histological features of DKD associated with kidney endpoints in a cohort of patients diagnosed with type 1 and type 2 DM, proteinuria and kidney impairment.Methods and analysisHEROIC is a longitudinal observational study that aims to recruit 500 patients with DKD at high-risk of renal and cardiovascular events. Demographic, clinical and laboratory data will be collected and assessed annually for 5 years. Renal biopsy tissue will be collected and archived at recruitment. Blood and urine samples will be collected at baseline and during annual follow-up visits. Measured glomerular filtration rate (GFR), echocardiography, retinal optical coherence tomography angiography and kidney and cardiac MRI will be performed at baseline and twice more during follow-up. The study is 90% powered to detect an association between key histological and imaging parameters and a composite of death, renal replacement therapy or a 30% decline in estimated GFR.Ethics and disseminationEthical approval has been obtained from the Bloomsbury Research Ethics Committee (REC 18-LO-1921). Any patient identifiable data will be stored on a password-protected National Health Services N3 network with full audit trail. Anonymised imaging data will be stored in a ISO27001-certificated data warehouse.Results will be reported through peer-reviewed manuscripts and conferences and disseminated to participants, patients and the public using web-based and social media engagement tools as well as through public events.

scholarly journals Postoperative outcome of body core temperature rhythm and sleep-wake cycle in third ventricle craniopharyngiomas

2016 ◽  
Vol 41 (6) ◽  
pp. E12 ◽  
Author(s):  
Matteo Zoli ◽  
Luisa Sambati ◽  
Laura Milanese ◽  
Matteo Foschi ◽  
Marco Faustini-Fustini ◽  
...  
Keyword(s):  
Core Temperature ◽  
De Novo ◽  
Third Ventricle ◽  
Body Core Temperature ◽  
Endoscopic Endonasal ◽  
Female Ratio ◽  
Temperature Rhythm ◽  
Number Of Patients ◽  
Body Core

OBJECTIVE One of the more serious risks in the treatment of third ventricle craniopharyngiomas is represented by hypothalamic damage. Recently, many papers have reported the expansion of the indications for the endoscopic endonasal approach (EEA) to be used for these tumors as well. The aim of this study was to assess the outcome of sleep-wake cycle and body core temperature (BCT), both depending on hypothalamic control, in patients affected by craniopharyngiomas involving the third ventricle that were surgically treated via an EEA. METHODS All consecutive adult patients with craniopharyngiomas that were treated at one center via an EEA between 2014 and 2016 were prospectively included. Each patient underwent neuroradiological, endocrinological, and ophthalmological evaluation; 24-hour monitoring of the BCT rhythm; and the sleep-wake cycle before surgery and at follow-up of at least 6 months. RESULTS Ten patients were included in the study (male/female ratio 4:6, mean age 48.6 years, SD 15.9 years). Gross-total resection was achieved in 8 cases. Preoperative BCT rhythm was pathological in 6 patients. After surgery, these disturbances resolved in 2 cases, improved in another 3, and remained the same in 1 patient; also, 1 case of de novo onset was observed. Before surgery the sleep-wake cycle was pathological in 8 cases, and it was restored in 4 patients at follow-up. After surgery the number of patients reporting diurnal naps increased from 7 to 9. CONCLUSIONS The outcome of the sleep-wake cycle and BCT analyzed after EEA in this study is promising. Despite the short duration of the authors' experience, they consider these results encouraging; additional series are needed to confirm the preliminary findings.

Recurrences of disease activity in patients with cardiac sarcoidosis under corticosteroid therapy: prevalence, clinical background and prognosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kaneta ◽  
H Takahama ◽  
E Tateishi ◽  
K Moriuchi ◽  
M Amano ◽  
...  
Keyword(s):  
Disease Activity ◽  
Corticosteroid Therapy ◽  
Cardiac Sarcoidosis ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Laboratory Data ◽  
Left Ventricular ◽  
Kaplan Meier ◽  
Number Of Patients

Abstract Background Corticosteroid therapy (CTx) has been widely accepted as first-line therapy for cardiac sarcoidosis (CS), but there are very limited data regarding recurrence of disease activity of CS. We retrospectively investigated the prevalence, patient characteristics and prognostic significance in patients with recurrences of CS. Methods We identified 102 consecutive patients who were clinically diagnosed CS (admission: 2012 and 2019) and whose disease activity was diminished clinically at least once. Recurrence of CS was defined as detection of increased uptake of 18F-fluoro-2-deoxyglucose or gallium-67 in the follow-up examination. Composite adverse events (events) were defined as all-cause of death or hospitalization for heart failure. Echocardiographic and laboratory data before initiation of CTx were obtained. Results During the follow-up term (median: 4.9 years), the recurrences of CS occurred in 28 patients at 30 months (median) after the initiation of CTx. In patients with recurrence, left ventricular (LV) ejection fraction before initiation of CTx was lower than in those without recurrences (median: 31% vs. 39%, p&lt;0.05). After the detection of CS recurrences, 17 patients were treated with only increases of PSL and remaining 11 patients were treated with adding other immunosuppressive therapies to CTx. The univariate analysis demonstrated that there were no parameters in echocardiographic and laboratory examinations to predict the recurrences of CS. The results of univariate analysis for event occurrences (n=12) are shown in the Table. Additionally, the Kaplan-Meier analysis showed that there were no differences in event free survival rate in the patients with and without CS recurrences (Figure). Conclusion This study showed that the recurrences of disease activity were observed in a substantial number of patients with CS even under the CTx. All patients received intensification of CTx or additional immunosuppressive therapy, and LV systolic function, rather than the recurrence itself, was associated with clinical outcomes in this study. Kaplan-Meier analysis for events Funding Acknowledgement Type of funding source: None

Platelet Associated IgG in Chronic Hepatitis

1979 ◽  
Author(s):  
R. Landolfi ◽  
G. Fedeli ◽  
S. Storti ◽  
F. Laghi ◽  
G. Leone
Keyword(s):  
Rheumatoid Arthritis ◽  
Differential Diagnosis ◽  
Chronic Hepatitis ◽  
Needle Biopsy ◽  
Laboratory Data ◽  
Inverse Correlation ◽  
Significant Inverse Correlation ◽  
Pathological Conditions ◽  
Therapeutic Decisions

Raised levels of platelet-associated IgG have been described in many pathological conditions such as ITP, LES, rheumatoid arthritis, lymphoma, drug thrombocytopenia. We measured surface-bound platelet IgG in 60 patients suffering from chronic hepatitis. In all cases diagnosis was confirmed by needle biopsy of the liver and by pertinent laboratory data; the technique used was that described by Dixon et al.(1975). In chronic active hepatitis (40 cases) we found increased amounts of platelet-associated IgG with values ranging from 110 to 480 ng/107 platelets (mean 195 ng; < 0.O01). In persistent hepatitis (40 cases) surface-bound platelet IgG were always less than 70 ng/107 platelets. A significant inverse correlation between increased amount of platelet IgG and the platelet count was not found. This test can be of considerable help in the differential diagnosis of chronic hepatitis as well in the follow up of these patients for prognostic and therapeutic decisions.

scholarly journals Psychopharmacological Medication Has No Influence on Vitamin Status After Bariatric Surgery in Long-term Follow-up

2020 ◽  
Vol 30 (10) ◽  
pp. 3753-3760
Author(s):  
Hannes Beiglböck ◽  
Alexander Kautzky ◽  
Paul Fellinger ◽  
Tamara Ranzenberger-Haider ◽  
Bianca Itariu ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Laboratory Data ◽  
Control Group ◽  
Vitamin Deficiencies ◽  
Vitamin Status ◽  
Number Of Patients ◽  
Long Term Follow Up ◽  
The Impact

Abstract Context A substantial number of patients undergoing bariatric surgery are prescribed psychopharmacological medication. However, the impact of concomitant psychopharmacological medication on the frequency of relevant vitamin deficiencies in postoperative follow-up is not known. Methods Five hundred twenty-four patients with obesity who underwent bariatric surgery (January 2004 to September 2018) with follow-up of at least 12 months, were included in retrospective analysis. Postoperative follow-up visits between January 2015 and September 2019 were analyzed. Anthropometric and laboratory data were analyzed at the first documented follow-up visit after on average 39.5 ± 37.3 months and at every following visit during the observation period. Patients with prescribed psychopharmacological drugs (PD) were compared with patients without (control group, CON). Results Psychopharmacological medication was documented in 25% (132) of patients. In 59 patients documented prescription of more than one psychiatric drug was found, whereas psychopharmacological monotherapy was found in 73 patients. Frequencies of vitamin deficiencies were comparable between PD and CON (vitamin A: p = 0.852; vitamin D: p = 0.622; vitamin E: p = 0.901; folic acid: p = 0.941). Prevalence of vitamin B12 deficiency was rare (6% CON, 1% PD) but was significantly higher in CON (p = 0.023). A comparison of CON and POLY also showed no significant differences between the groups concerning prevalence of vitamin deficiencies. Conclusions Intake of psychopharmacological medication is highly prevalent in patients after bariatric surgery. Patients with psychopharmacological medication, who participate in structured follow-up care after bariatric surgery, are not at higher risk for vitamin deficiencies compared with controls.

scholarly journals Epidemiology of pediatric uveitis and associated systemic diseases

2020 ◽  
Author(s):  
Yoonkyeom Shin ◽  
Ji-Man Kang ◽  
Junwon Lee ◽  
Christopher Seungkyu Lee ◽  
Sung Chul Lee ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Inflammatory Disease ◽  
Pediatric Patients ◽  
Laboratory Data ◽  
Screening Tools ◽  
Categorical Variables ◽  
Hla B27 ◽  
Female Ratio ◽  
Systemic Rheumatic Disease ◽  
Systemic Inflammatory Disease

Abstract Background: The early detection of uveitis associated with systemic inflammatory disease in children is important for proper treatment and prognosis. However, the diagnosis may be delayed because of difficulties in childhood examinations and early minor systemic symptoms. The objective of our study was to identify the pattern of childhood uveitis and investigate the frequency and clinical features of rheumatic diseases in pediatric patients with uveitis. Methods: This retrospective observational study reviewed the medical records of children (age ≤18 years) with uveitis at a Korean tertiary hospital between January 2005 and December 2018. Data collected included the age at onset of uveitis, sex, anatomic location of ocular inflammation, comorbid disease (including systemic inflammatory disease), ocular complications, relevant laboratory data, and treatment. Fisher’s exact test was used to compare categorical variables and the Mann–Whitney U test was used to compare continuous variables. A p-value of <0.05 was considered statistically significant. Results: A total of 155 pediatric patients with uveitis were included in this study. The median age at diagnosis was 13.0 years (interquartile range, 9.5–16.0 years). The male-to-female ratio was 1.09. The process was unilateral in 51.6% of children. Anterior uveitis, panuveitis, intermediate uveitis, and posterior uveitis represented 51.6%, 26.5%, 6.5%, and 1.9% of the cases, respectively. Idiopathic uveitis (65.2%) was the most frequent type of uveitis. Systemic rheumatic disease associations were responsible for 28.4% of the cases, among which juvenile idiopathic arthritis (JIA) was the most frequent cause (14.8%). Human leukocyte antigen (HLA)-B27 and antinuclear antibody (ANA) positive rates were significantly higher in patients with JIA than in those with idiopathic uveitis (p=0.006 and p=0.007, respectively). Conclusions: Approximately one-third of children with uveitis in Korea have a systemic rheumatic disease, of which JIA accounts for the majority of cases. HLA-B27 and ANA can be useful screening tools in children with JIA-associated uveitis.

AB0701 ANTERIOR UVEITIS AND HLA B27, ARE THERE ANY CLINICAL OR THERAPEUTIC DIFFERENCES IN PATIENTS WITH POSITIVE HLA B27 VERSUS THOSE WITH HLA B27 NEGATIVE?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1647.1-1647
Author(s):  
L. Lojo ◽  
B. Sánchez Marugán ◽  
C. Plasencia ◽  
L. Cebrian ◽  
M. A. Matias de la Mano ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Anterior Uveitis ◽  
Systemic Treatment ◽  
Clinical Profile ◽  
Categorical Variables ◽  
Hla B27 ◽  
Negative Group ◽  
Positive Group ◽  
Therapeutic Decisions ◽  
Number Of Patients

Background:Anterior uveitis is the most frequent form of presentation of uveitis. An important part of patients do not associate extraocular manifestations, so more information about the clinical profile is needed to optimize therapeutic decisions.Objectives:To describe the clinical profile of patients with anterior uveitis related and not related to the antigen HLA-B27. Compare both groups to establish differences.Methods:Retrospective cohort study. Consecutive patients diagnosed with non-infectious anterior uveitis, assessed in the multidisciplinary uveitis unit of the Infanta Leonor University Hospital (Madrid) from its establishment in October 2017 to December 2019, were included. To compare categorical variables Chi square was used and the test of Fisher; and Student’s T or Mann-Whitney U test for continuous variables. Finally, a multivariate analysis was performed to established differences between the two groups. A value of p <0.05 was considered statistically significant.Results:62 patients with anterior uveitis, 26 (42%) with HLA B27 positive and 36 (58%) with HLA B27 negative were included. There were no differences between the two groups regarding sex. Differences were found in the mean age at diagnosis, 35 + -9.6 in the HLA B27 positive group vs 47 + -14.9 in the HLA B27 negative group (p 0.01). The time since uveítis diagnosis was longer in the HLA B27 positive group: 7.08 years (3.45-11.79) versus 2.41 years (1.66-3) in the HLA B27 negative group (p 0.000). Regarding the etiology, the majority of patients in the HLA B27 negative group had a diagnosis of idiopathic anterior uveitis (72.2%), and 53.8% of the patients in the HLA B27 positive group were diagnosed with spondyloarthritis (p 0.000). There were no significant differences in the number of patients that require systemic treatment. There were no differences regarding oral corticosteroids intake, with very few patients needing it (2 patients in the HLA B27 positive group and 5 patients in the HLA B27 negative group (p 0.699). The percentage of patients who needed to start an immunosuppressive treatment were similar between the two groups, 6 patients (23.1%) in the HLA B27 positive group and 11 patients (30.6%) in the HLA B27 negative group (p 0.717) No significant differences could be detected between groups in the multivariate analysis in terms of laterality, clinical course, treatment with immunosuppressants or development of complications.Conclusion:In our cohort patients with HLA B27 positive debut at an earlier age. There were no differences between both groups in laterality, course of uveitis, systemic treatment or ocular complications.Disclosure of Interests:None declared

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