Belimumab for Immune-Mediated Necrotizing Myopathy Associated With Anti-SRP Antibodies: A Case Report and Retrospective Review of Patients Treated With Anti-B-Cell Therapy in a Single Center and Literature.

Background: Immune-mediated necrotizing myopathy (IMNM) is characterized by markedly elevated creatinine kinase and histologically scattered necrotic muscle fibers and generally associated with autoantibodies against signal recognition particle (SRP) or 3-hydroxy-3-methylglutaryl-coA-reductase (HMGCR). Poor clinical response to conventional therapies and relapses commonly occur in severe cases. Anti-B-cell therapies have been used in refractory/relapsing cases. Methods: The characteristics of a patient with IMNM associated with anti-SRP antibodies including physical examination, laboratory tests, and disease activity assessment were evaluated. Conventional therapy, belimumab treatment schedule, and follow-up data were recorded. Medical records of IMNM patients treated in our department from September 2014 to June 2021 were reviewed to evaluate the efficacy and safety of anti-B-cell therapy for anti-SRP IMNM. A literature review of patients with anti-SRP IMNM treated with anti-B-cell therapies was performed. Results: We describe a case of a 47-year-old woman with IMNM associated with anti-SRP antibodies who relapsed twice after conventional therapy but showed good response and tolerance to belimumab at 28 weeks follow-up. In this review, three patients from our department were treated with rituximab. Two of the three patients rapidly improved after treatment. Twenty patients and five retrospective studies were included in the literature review. All patients were administered rituximab as an anti-B-cell drug. Conclusion: Despite a lack of rigorous clinical trials, considerable experience demonstrated that anti-B-cell therapy might be effective for patients with IMNM associated with anti-SRP antibodies. Belimumab in association with steroids might be an encouraging option for refractory/relapsing cases.

Long-term outcomes of Roux-en-Y gastric bypass versus medical therapy for patients with type 2 diabetes: a meta-analysis of randomized controlled trials.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has been widely used for type 2 diabetes (T2D) patients with overweight or obesity. However, the long-term outcomes of RYGB versus medical therapy have not been well compared. OBJECTIVES: To evaluate the long-term outcomes of RYGB versus medical therapy for patients with T2D. SETTING: University-affiliated hospital, China. METHODS: Four electronic databases-PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov-were searched for articles published through February 2021. Eligible studies were randomized controlled trials. RESULTS: Of 7 randomized controlled trials (15 articles), 477 patients were included: 239 were randomly divided into RYGB groups and 238 to medical therapy groups. Statistically higher rates of T2D remission were observed in RYGB groups at 1 year (relative risk [RR], 18.01; 95% confidence interval [CI], 4.53- 71.70; P < .0001), 3 years (RR, 29.58; 95% CI, 5.92-147.82; P < .0001), and 5 years (RR, 16.92; 95% CI, 4.15-69.00; P < .0001). Meanwhile, statistically higher rates of achieving the American Diabetes Association's (ADA's) treatment goal were observed in RYGB groups at 1 year (RR, 3.99; 95% CI, 1.01-15.82; P = .05), 2 years (RR, 2.98; 95% CI, 1.62- 5.48; P = .0004), 3 years (RR, 3.16; 95% CI, 1.33-7.49; P = .009), and 5 years (RR, 6.18; 95% CI, 1.69-22.68; P = .006). CONCLUSION: This meta-analysis indicated that RYGB led to higher rates of T2D remission than medical therapy at 1, 3, and 5 years, as well as higher rates of achieving ADA's composite goal at 1, 2, 3, and 5 years.

Successful closure of ileostomy in a patient with intestinal Behçet's disease after therapy with adalimumab: A case report.

RATIONALE: Behçet's disease (BD) is a chronic immune-mediated inflammatory disorder involving multiple organ systems. In BD, intestinal ulcers can present as a refractory lesion capable of perforation, which makes the choice of treatment difficult. PATIENT CONCERNS: A 34-year-old male who was diagnosed with intestinal BD and suffered with an ileocecal perforation. He underwent surgery for an ileostomy and was given corticosteroids as treatment. However, the ulcerative lesion remained resistant to the therapy that was provided which delayed the closure operation. DIAGNOSIS: Intestinal BD with severe post-operative complication. INTERVENTIONS: A course of adalimumab (ADa) therapy was started. Subsequently surgery was performed. And ADa and thalidomide were used as a maintenance therapy. OUTCOMES: In this case, a course of ADa therapy was given which healed the intestinal ulcers and allowed us to successfully perform the closure operation. LESSONS: This case indicates that ADa may be an effective treatment option in future cases, minimizing complications and allowing the closure operation to be performed successfully.

[Comorbidity of Autoimmune Diseases: a Field that Needs Multidisciplinary Attention].

Comorbidity of autoimmune diseases is a very important issue but easily ignored in the clinical practice. The treatment of comorbidity of autoimmune diseases needs cooperation of multiple disciplines,which is totally different from traditional clinical disciplines division and treatment mode. Based on the clinical features of the disease,we will comprehensively look through genetic,environmental,and immune factors involving in molecular and immunological compatibility pathogenesis,and also generalize common pathological features,such as immune complex deposition and accumulation of lymphocytes. We will also investigate the association and differences between the diseases with comorbidity,and explore the outcome and prognosis of comorbidity of autoimmune diseases. With clarify of the concept of autoimmune comorbidities,we hope bring more and more attention on this aspect,so as to improve the diagnosis,treatments as well as the prognosis of these diseases.

[A Retrospective Analysis of Clinical Features of Interstitial Pneumonia with Autoimmune Features].

OBJECTIVE: To analyze the clinical features of interstitial pneumonia with autoimmune features (IPAF) and the correlation between them. METHODS: We respectively analyzed the patients with interstitial lung disease (ILD) admitted in our hospital from January 2014 to January 2017. The patients who met all priori requirements and at least one feature of one domain were recuited, and the clinical features and autoimmune diseases related prognosis were analyzed. RESULTS: There were 90 patients recruited,including 38 patients completely met IPAF classification criteria and 52 patients who incompletely met. The average age was (62.34±14.98) yr.. The pneumonia pattern of complete IPAF patients was non-specific interstitial pneumonia (NSIP), while it was usually interstitial pneumonia (UIP) in the incomplete IPAF patients. During follow-up,11 patients were diagnosed with autoimmune diseases (4 with complete IPAF,and 7 with incomplete IPAF) . According to Cox regression analysis,completely meet the criteria of IPAF was related to the relapse of disease. CONCLUSION: There exist relation between IPAF and autoimmune diseases. The patients with IPAFmay finally develop into autoimmune diseases. The IPAF classification criteria provide basic structure for this disease,but the limitation of the criteria call for revising by more clinical trials.

[Association of Elevated Platelet Microparticles with Disease Activity in Rheumatoid Arthritis].

OBJECTIVES: To explore the expression of platelets microparticles (PMPs) in peripheral blood (PB) and synovial fluid (SF) of rheumatoid arthritis (RA) patients and its correlation with clinical inflammatory parameters. METHODS: The levels of PMPs in PB were detected by flow cytometry in 26 active RA patients and 15 healthy control (HC). SF was collected from 16 patients. The percentages of CD62P+PMPs, CD154+PMPs and clinical parameters (including CRP, ESR, RF and ACPA) were also measured, then the correlations of PMPs with these parameters were analyzed. RESULTS: PMPs levels in PB of RA patients were higher than those in PB from HC and those in SF of RA patients (P< 0.01). CD62P+PMPs levels in PB of RA patients were higher than those in PB of HC and those in SF of RA patients (P< 0.05). CD154+PMPs levels in PB of RA patients were higher than those in PB of HC (P< 0.01) and those in SF of RA patients (P< 0.05). The levels of PB PMPs were positively correlated with disease activity score DAS28 ( r=0.462, P=0.018), but not with ESR, CRP, RF or ACPA. The levels of SF PMPs were not correlated with any of them (P>0.05). CONCLUSIONS: PMPs may be involved in immune regulation and systemic inflammation of RA. The elevated levels of PMPs could be a potential biomarker for RA.

Neutrophil extracellular traps in sterile inflammation: the story after dying?

Evidences accumulated that the death of neutrophils are not the end of their missions. The neutrophil extracellular traps (NETs), web-like structure, formed after neutrophils dying contribute greatly to immune defense, in both innate and adaptive immunity. Interestingly, previous studies revealed that the generation and activation of NETs do not only rely on bacteria induction, but also in patients with sterile inflammatory diseases, implying an undeniable correlation between NETs and these diseases. This review summarized the latest findings that the crucial roles of NETs in sterile inflammatory diseases, as well as novel targeted therapy based on these new discoveries.