Is low-dose tumor necrosis factor inhibitor effective and safe in patients with ankylosing spondylitis flare-up after renal transplantation? A case report and literature review.

Rheumatic diseases, the immunosuppressant drugs used after solid organ transplantation to prevent graft rejection, and the biologics used for controlling rheumatic disease, especially tumor necrosis factor inhibitors (TNFi)-all of these could increase the risk of malignancy. The roles of biologics for disease control in rheumatic disease patients after kidney transplantation (KT) are not well established because only a few cases are reported, and the possibility of increasing infection and malignancy rates. Here, we present the first case of ankylosing spondylitis (AS) successfully treated with low-dose TNFi for disease activity flare-up 5 months after KT and review the literature to see whether the use of biologics, especially TNFi, in AS patients with disease activity flare-ups after receiving KT is effective and safe.

From psoriasis to psoriatic arthritis: epidemiological insights from a retrospective cohort study of 74,046 patients.

Introduction: To verify our hypothesis that psoriatic arthritis (PsA) is mainly genetically predetermined and distinct from psoriasis (PsO), we use the TriNetX database to investigate whether intrinsic factors outweigh externals in PsA emergence in PsO patients. Methods: We conducted three retrospective cohort studies utilizing information from the TriNetX network, whether (a) PsO patients with type 2 diabetes mellitus (DM) face an elevated risk of developing PsA compared to those without type 2 DM; (b) PsO patients who smoke face a higher risk of PsA; and (c) PsO patients with type 2 DM who smoke are more likely to develop PsA than those who do not smoke. Results: PsO patients with type 2 DM exhibited an elevated risk of developing PsA [hazard ratio (HR), 1.11; 95% CI 1.03-1.20], with the combined outcome demonstrating a heightened HR of 1.31 (95% CI 1.25-1.37). PsO patients with a smoking history exhibited an elevated risk of developing PsA (HR, 1.11; 95% CI 1.06-1.17), with the combined outcome demonstrating a heightened HR of 1.28 (95% CI 1.24-1.33). PsO patients with type 2 DM and a history of smoking were not found to be associated with an increased risk of developing PsA (HR, 1.05; 95% CI 0.92-1.20). However, the combined result revealed a higher risk of 1.15 (95% CI 1.06). Discussion: These findings suggested that intrinsic factors outweigh external factors in PsA emergence in PsO patients. Further studies may focus on genetic disparities between PsO and PsA as potential risk indicators rather than solely on phenotypic distinctions.

Experiences and coping behaviors of patients with psoriasis: a qualitative study.

BACKGROUND: Psoriasis is a complex, chronic, lifelong inflammatory skin disease characterized by the development of erythematous, indurated, scaly, pruritic, and often painful skin plaques, and it is currently incurable. It profoundly affects psychological wellbeing and social functioning and has significant associated co-morbidities. To improve clinical approaches, understanding of the experiences of patients with psoriasis is needed. OBJECTIVE: To explore the experiences and coping behaviors of patients with psoriasis. METHODS: A qualitative study approach was conducted. Through semi-structured interviews, 20 patients with psoriasis were recruited from general practices and specialist dermatology practices in a regional teaching hospital in Taiwan. Recorded interviews were transcribed and analyzed by content analysis. RESULTS: Three themes and nine subthemes were identified: (1) Symptoms distress: (a) trouble with scaling, (b) bothersome itching, and (c) complex pain experiences; (2) Psychological distress: (a) encountering discrimination and (b) feeling stigmatized; (3) Managing psoriasis: (a) coping with symptoms, (b) seeking alternative methods, (c) using biologic agents, and (d) changing thinking and coexisting with the disease. CONCLUSION: The experience of patients with psoriasis has significant negative impacts on their lives. The findings of this study can provide healthcare professionals with a reference for the care of patients with psoriasis.

Case Report: Successful treatment with methotrexate in a 10-year-old boy with co-occurrence of generalized psoriasis and vitiligo.

The co-occurrence of psoriasis (PsO) and vitiligo is rare in Asian countries, especially in children. This case report presents the first-ever occurrence of PsO combined with vitiligo in an Asian boy under 6 years of age, in whom symptom improvement was observed after the use of methotrexate (MTX) as the sole treatment. Although previous studies have indicated that there is a close correlation between the two diseases, methotrexate (MTX), which is a commonly used treatment for PsO, is not a standard treatment for vitiligo. Even with advanced progress in biologics and Janus kinase inhibitor (JAKi), the biologics and JAKi used in vitiligo are still inconsistent. In our case report, the successful use of MTX indicated that there are shared immune pathways between PsO and vitiligo. Further exploration is needed to optimize the treatment options for this co-occurrence of PsO and vitiligo.

Cytokine production from peripheral blood mononuclear cells in patients with ankylosing spondylitis and their first-degree relatives.

BACKGROUND: To understand the cytokine levels in different disease activities of patients with ankylosing spondylitis (AS), we measured proinflammatory and antiinflammatory cytokine production from peripheral blood mononuclear cells (PBMC) in patients with AS and their first-degree relatives (FDR). METHODS: PBMC were obtained from 26 patients with AS and 24 FDR and then stimulated with PHA for 72 h. In the supernatants, the following three cytokines, tumor necrosis factor-alpha (TNF-alpha), interleukin 1beta (IL-1beta), and IL-10, were measured by ELISA. Disease activity in AS patients was divided into high disease activity (Group 1) and low disease activity (Group 2), based on the Bath AS Disease Activity Index (BASDAI > or =4 or <4). Healthy FDR of AS patients (Group 3) and healthy subjects (Group 4) were used as a control group. RESULTS: TNF-alpha production from PBMC was significantly increased in Group 1 patients compared to Group 2 patients (1371 +/- 1008 pg/mL vs. 355 +/- 89 pg/mL, p <0.05) or FDR (1371 +/- 1008 pg/mL vs. 552 +/- 89 pg/mL, p <0.05) or healthy subjects (1371 +/- 1008 pg/mL vs. 436 +/- 114 pg/mL, p <0.01). IL-1beta also showed a similarly significant difference between the two groups (Group 1 vs. Group 2, Group 1 vs. Group 4) (p <0.05). In contrast, IL-10 was significantly decreased in Group 1 when compared to Group 2 (126 +/- 64 pg/mL vs. 272 +/- 150 pg/mL, p <0.05). CONCLUSIONS: Patients with high BASDAI had increased production of TNF-alpha and IL-1beta compared to those with low BASDAI or healthy FDR, suggesting that proinflammatory cytokines may play an important role during active inflammation.

Hepatitis, cholangitis, pulmonary hypertension, digital gangrene, and conjunctivitis sicca in a woman with anticentromere antibodies.

A 46-year-old woman presented with chronic fluctuated liver function impairment, Raynaud's phenomenon, digital gangrene, pulmonary hypertension, and intense pruritus within a period of 2 years. Laboratory investigations revealed antinuclear antibodies, anticentromere antibodies (ACA), hypergammaglobulinemia, lymphocytic infiltration of the liver parenchyma, and mild cholangitis. The associated symptoms included thyroiditis, conjunctivitis sicca, xerostomia, and polyarthralgia. There was no conspicuous sclerodactyly, calcinosis, or dysphagia. The symptoms were relieved with intravenous, as well as oral, methylprednisolone. This constellation of presentations, including chronic autoimmune hepatitis with mild cholangitis and pulmonary hypertension, suggested that the presence of serum ACA might indicate relentless visceral organ damage.

Serum anti-Yersinia antibody in Chinese patients with Kawasaki disease.

BACKGROUND: Many infectious agents have been implicated as an etiology to develop Kawasaki disease (KD). In Taiwan, studies on the relationship between Yersinia and KD have not been reported. METHODS: We measured sera for anti-Yersinia antibodies by using enzyme immunoassay (EIA) in 31 patients with KD and 60 healthy children (HC). Yersinia strains included Y. pseudotuberculosis I, II, III, IV, V, VI and Y. enterocolitica O3, O8 and O9. RESULTS: Data of 31 patients with KD showed that for the IgG antibody, serum anti-Y. pseudotuberculosis II, III, Y. O8 and O9 antibody were significantly higher when compared to the HC. Except for Y. pseudotuberculosis IV, all other Yersinia strains of either IgA or IgM antibodies increased significantly in patients with KD vs. the HC. If we compared the number of patients who had significant elevation of OD and those of HC, we found IgA anti-Yersinia antibodies (PST I, PST II, O3, O8, O9), IgM (PST VI, O8) and IgG (PST II, O8, O9) were significantly elevated in KD patients than in HC. A significant relationship was present between KD with myocarditis and increased anti-Yersinia antibody titer. CONCLUSIONS: The findings in this study suggest that preceding Yersinia infection may play a role in the pathogenesis of KD. Further study of the relationship between KD with myocarditis and increased anti-Yersinia antibody is needed.

Acute massive pulmonary hemorrhage after craniotomy in a patient with systemic lupus erythematosus.

Acute massive pulmonary hemorrhage (AMPH) is a rare life-threatening complication of systemic lupus erythematosus (SLE). We report a lupus nephritis patient with active disease, in whom AMPH developed after craniotomy for brain injury. Computed tomography scan of the brain revealed a subdural hemorrhage and intracranial hemorrhage with a midline shift, indicating increased intracranial pressure (IICP). Neurogenic pulmonary edema (NPE) was suspected 5 days after operation due to dyspnea and chest radiograph findings of bilateral infiltrations. Seven days after the craniotomy, she had bloody sputum, a sudden drop in blood hemoglobin level (from 12.3 g/dL to 8.8 g/dL), and diffuse alveolar infiltrates in both lung fields. All of these features were characteristic manifestations of AMPH. Complete blood count disclosed mild thrombocytopenia (88,000/mm3). We believe that in an SLE patient, IICP or NPE might be risk factors in the development of AMPH.

Second-degree atrioventricular block as an early manifestation of adult systemic lupus erythematosus.

Second-degree atrioventricular (AV) block had not been reported as an early manifestation of adult systemic lupus erythematosus (SLE). An 18-year-old woman of SLE presented with asymptomatic second-degree AV block with 2:1 conduction block on electrocardiogram (ECG) during admission. Serologic tests were negative for anti-Sjögren's syndrome A (anti-SS-A/Ro) and anti-SS-B/La antibodies, but positive for anti-ribonuclearprotein antibodies. Her abnormal ECG completely resolved soon after high-dose intravenous methylprednisolone infusion, and she was maintained successfully with a low dose of oral steroid. The possible pathogenesis of this complication is discussed. Follow-up with periodical ECG is recommended for adult lupus patients to screen for possible conduction system involvement, and treatment should be started as soon as possible.

Severe, recurrent lupus enteritis as the initial and only presentation of systemic lupus erythematosus in a middle-aged woman.

We describe a previously unreported condition of severe, recurrent lupus enteritis accompanied with severe hypocomplementemia as the initial and only presentation of systemic lupus erythematosus. Systemic lupus erythematosus should be suspected in any patient with computed tomography findings of enteral vasculitis or ischemic enteritis, even without lupus-related symptoms or signs; C3/C4 levels may be helpful in the differential diagnosis. If the symptoms do not improve after medical treatment, such as using steroid or cyclophosphamide pulse therapy, or necrosis and perforation of the intestines are highly suspected, surgical intervention should be considered.

Predictive and prognostic value of antinuclear antibodies and rheumatoid factor in primary Sjogren's syndrome.

AIMS: To assess the predictive and prognostic value of antinuclear antibodies (ANA) and rheumatoid factor (RF) in primary Sjögren's syndrome (pSS). METHODS: This retrospective study includes 201 patients that fulfilled the 1993 European preliminary classification criteria for pSS. The patients were further categorized by the 2002 revised criteria, with or without the inclusion of ANA and RF as classification criteria, and were further subgrouped by the presence of ANA, RF, anti-SS-A, and anti-SS-B, and different ANA titers. The clinical manifestations, serological markers, and results of lip biopsies among these subgroups were compared. RESULTS: Our results showed pSS patients who are seropositive for one of the following markers: ANA, RF, anti-SS-A, or anti-SS-B are younger, predominantly female, and had more serological abnormalities than those with seronegativity of ANA, RF, anti-SS-A, or anti-SS-B. Higher ANA titers (> or = 1:640) correlated with higher frequency of serum anti-SS-A+ and anti-SS-B+, and elevations of serum immunoglobulin G and A in all three different classification criteria groups. The clinical manifestations and laboratory results in the 2002 revised criteria groups with or without the inclusion of ANA and RF as classification criteria items were highly concordant. CONCLUSION: Regardless of the classification criteria for pSS, patients who are seropositive for one of the ANA, RF, anti-SS-A and anti-SS-B biomarkers are more likely to have autoimmune-related Sjögren's syndrome. ANA and RF have shown to possess the predictive and prognostic values for those who do not fulfill the higher stringent 2002 revised criteria but are indicated for immunomodulatory therapy. Thus we suggest that ANA and RF should be reconsidered as items of classification criteria for pSS.

Lack of association of interleukin-6 and interleukin-8 gene polymorphisms in Chinese patients with systemic lupus erythematosus.

The purpose of this study was to determine whether interleukin (IL)-6 and IL-8 gene polymorphisms were markers of susceptibility to or severity of systemic lupus erythematosus (SLE) in Chinese patients. The study included 150 Chinese patients with SLE. A total of 130 unrelated healthy individuals living in central Taiwan served as control subjects. Polymorphisms of the IL-6 and IL-8 gene were typed from genomic DNA. The genotypes, allelic frequencies, and carriage rates were compared between SLE patients and control subjects. The relationship between allelic frequencies and clinical manifestations of 135 SLE patients was evaluated. There were no statistically significant differences in IL-6 and IL-8 gene polymorphisms between the SLE and control groups (chi-squared test, P=0.53, chi(2)=1.27 and P=0.44, chi(2)=1.62, respectively). In addition, there was no significant association between the two groups in allelic frequency of IL-6 and IL-8 (P=0.89 and P=0.26, respectively). We also did not detect any association between the IL-6 and IL-8 genotype and clinical or laboratory profiles in SLE patients. The results suggest that the IL-6 and IL-8 gene polymorphisms are not related to SLE.