ABSTRACT
The treatment of articular and extra-articular manifestations associated with HLA-B27 has undergone dramatic changes over the past two decades, mainly as a consequence of the introduction of biologic agents and in particular anti-tumor necrosis factor α (anti-TNFα) agents. Uveitis is known to be the most frequent extra-articular feature in HLA-B27-associated spondyloarthritides. Topical corticosteroids and cycloplegic agents remain the cornerstones of treatment. However, biologic therapy may be effective in the management of refractory or recurrent forms of uveitis. This review gives an update on the management of HLA-B27-associated ocular disorders with biologics, including anti-TNFα agents and non-anti-TNFα biologic modifier drugs. There is an emerging role for newer biologics targeting interleukin-12/23 and interleukin-17 for the treatment of spondyloarthritides but data on their efficacy on anterior uveitis are sparse.
Subject(s)
Biological Therapy , HLA-B27 Antigen/immunology , Spondylarthropathies/therapy , Uveitis/therapy , Glucocorticoids/therapeutic use , Humans , Mydriatics/therapeutic use , Spondylarthropathies/immunology , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Uveitis/immunologyABSTRACT
We investigated the association with Yersinia infection in patients with arthropathies in our region. To assess the reactivity to articular antigens, the correlation of anti-Yersinia with anti-type I and type II collagen antibodies was studied. Sera from 124 patients with musculoskeletal symptoms, and 47 synovial fluids (SF) from patients with rheumatoid arthritis (RA), spondyloarthopathies (SpA) or osteoarthritis (OA) were examined. Immunoglobulins against Yersinia enterocolitica, type I and type II collagens were determined by enzyme-linked immunosorbent assay. Immunoglobulin (Ig) A to Yersinia lipopolysaccharide (LPS) was present in 13/124 sera (10%) and 3/47 SF (6%). By Western blot, IgA to Yersinia outer proteins (Yops) was found in 14/124 sera (11%) and 2/47 SF (4%). Yersinia DNA from SF was not amplified by polymerase chain reaction. We found a significant correlation with anti-collagen type I but not type II antibodies. These results suggest different reactivity to articular collagen in patients with Yersinia antibodies.
Subject(s)
Arthritis/immunology , Arthritis/microbiology , Collagen Type I/immunology , Yersinia Infections/immunology , Yersinia enterocolitica/immunology , Adult , Aged , Antibodies, Bacterial/blood , Arthritis, Reactive/immunology , Arthritis, Reactive/microbiology , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/immunology , Blotting, Western , Collagen Type II/immunology , Enzyme-Linked Immunosorbent Assay , Epitopes , Female , Humans , Lipopolysaccharides/immunology , Male , Middle Aged , Osteoarthritis/complications , Osteoarthritis/immunology , Polymerase Chain Reaction , Spondylarthropathies/complications , Spondylarthropathies/immunology , Synovial Fluid/immunology , Yersinia Infections/complications , Yersinia enterocolitica/geneticsABSTRACT
The treatment armamentarium in rheumatic inflammatory diseases has drastically increased in the last years. Earlier uses of conventional disease-modifying antirheumatic drugs (DMARDs), along with the arrival of newer therapies including the so-called "biologic" agents, have provided better long-term outcomes for patients suffering from these illnesses. Biologic agents have shown efficacy for several diseases and failed in others. Due to a high prevalence of some of these diseases in the elderly population, this age group may also benefit, although treatment will have to be tailored to its special needs. In this mini review, we will discuss the use of these medications in rheumatic diseases with a significant prevalence in the elderly, their proven and potential uses, and the considerations that need to be taken into account when using them in this population.
Subject(s)
Biological Therapy/methods , Musculoskeletal Diseases/drug therapy , Vascular Diseases/drug therapy , Aged , Amyloidosis/drug therapy , Amyloidosis/immunology , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/immunology , Biological Therapy/adverse effects , Cryoglobulinemia/drug therapy , Cryoglobulinemia/immunology , Giant Cell Arteritis/drug therapy , Giant Cell Arteritis/immunology , Granulomatosis with Polyangiitis/drug therapy , Granulomatosis with Polyangiitis/immunology , Humans , Muscular Diseases/drug therapy , Muscular Diseases/immunology , Musculoskeletal Diseases/immunology , Spondylarthropathies/drug therapy , Spondylarthropathies/immunology , Vascular Diseases/immunology , Vasculitis/drug therapy , Vasculitis/immunologyABSTRACT
Autoimmune chronic inflammatory diseases (ACIDs) represent a growing part of chronic diseases and their cellular and molecular pathways have been deeply investigated in recent years in order to disclose some clue aspects that could be optimal targets of specific therapies. Among the autoimmune rheumatic diseases a major molecular driver was discovered (TNFalpha) which represents along with IL1beta, a key driver of the ongoing chronic inflammation. The same molecule arose as a major player in the pathological mechanism of Crohn's disease. The biomolecular pathways of Ulcerative Colitis appear more complex and not yet defined, although targeting specific integrins (alpha4beta7) has shown some promises, pending the severe side effects related to treatment.