Introduction: TNF-α blocker therapy is part of the treatment with biologics used in the management of inflammatory joint diseases. In recent years, drug-induced neutralizing antibodies have been shown to have a negative effect on the course of the disease process. Aim: To investigate drug-induced neutralizing antibodies against TNF-α blocking drugs used in patients with inflammatory joint diseases and their effect on the clinical course of the disease. Materials and methods: The study included 121 (56.8%) patients with rheumatoid arthritis, 50 (23.5%) patients with ankylosing spondylitis, 42 (19.7%) patients with psoriatic arthritis, and 31 sex and age-matched healthy controls. The patients were monitored at 0, 6, 12, and 24 months after initiation of TNF-α blocker treatment. The demographic data, vital signs and the parameters of inflammatory activity (C-reactive protein, erythrocyte sedimentation rate, and disease activity indices) were analyzed in all patients. Drug-induced anti-TNF-α blockers antibodies (adalimumab and etanercept) were analyzed using ELISA. Statistical analysis was performed with SPSS v. 24. Results: Drug-induced neutralizing antibodies against adalimumab were obtained in 11.57% of patients at 6 month, in 17.64% at 12 month, and in 24.8% at 24 month. Drug-induced neutralizing antibodies to etanercept were not demonstrated in patients followed up at 6 months, at 7.77% at 12 months, and at 9.63% at 24 months. Between the presence of neutralizing antibodies to blockers of TNF-α and indices available for disease activity, there is a strong positive correlation and Pearson Correlation = 0.701, p=0.001. Patients with poor clinical response and available antibodies against adalimumab at 12 months were 82.36% and patients treated with etanercept 71.42%. The difference between the two groups was non-significant (U = 0.527, p> 0.05). Patients with poor clinical response and available anti-adalimumab antibodies at 24 month were 75%, and in patients treated with etanercept – 87.50%, the difference between the two groups not being able to reach significance (U = 0.623, p> 0.05). Conclusion: Drug-induced neutralizing antibodies against TNF-α blockers (adalimumab and etanercept) have a negative effect on the course of inflammatory joint disease and can be used as reliable biomarker to assess the effect of the treatment with these drugs.
The role of IFN-α-induced chemokines CCL2, CXCL10 and CCL19 in different forms of SLE has not been studied in Bulgaria, with worldwide sources attributing varying degrees of importance. The aim of this study was to investigate the correlation between IFN-induced chemokines CCL2, CXCL10 and CCL19 and disease activity in patients with SLE over 24 months. Materials and methods: This study used data from 70 patients with SLE (age range 24–62 years) and a control group of 30 healthy volunteers matched for age and gender. Levels of chemokines CCL2, CXCL10 and CCL19 in lupus patients’ serum were measured by ELISA. The study examined clinical and clinical laboratory indicators, as well as measures of disease activity developed for lupus patients (SLEDAI and SLICC). Statistical program SPSS, Version 26 were used for statistical data processing with p < 0.05. At 24 months of follow-up, 12 patients were with deterioration, and they had an IFN-a of 363.76 ± 9.23 versus 116.1 ± 22.1 pg/mL of those who did not worsen, CCL2 278.3 ± 5.12 versus 89.4 ± 12.8, CXCL10 234.2 ± 6.13 versus 115.23 ± 5.9 p CCL19 776.25 ± 5.1 vs. 651.34 ± 9.0 during the first visit. Results: The mean values of CCL2, CXCL10 and CCL19 were higher in patients with SLE compared to healthy controls (p = 0.01). A strong significant association (p = 0.01) was found between the concentration of CCL2, CXCL10 and CCL19 and with patients’ age, disease duration, SLEDAI and SLICC. Conclusion: CCL2, CXCL10 and CCL19 serum levels were found to correlate with patients’ age and disease duration. The level of IFN-induced chemokines CCL2, CXCL10 and CCL19 has a prognostic value in terms of SLE disease activity and degree of organ damage.
Background Pulmofibrosis and in general pulmonary involvement is very common feature in patients with systemic sclerosis (SSc). It is detectable in more than 80% of SSc population and is one of the main cause of internal organ involvement and death. The golden standard of pulmonary involvement was high resolution CT (HRCT), but it has high cost and radiological risk for the patient. Typical alterations present increased ground glass opacities – increased lung attenuation in the absence of architectural distortion; intralobular interstitial thickening. Lung ultrasound (LUS) evaluates B-lines – the sonographic marker of pulmonary interstitial complication. Objectives To estimate the diagnostic value of LUS in patients with SSc compared to HRCT. Methods 49 patients (women, mean age 57±13 years) that fulfilled the ACR diagnostic criteria for SSc were evaluated by LUS, HRCT and pulmonary functional test. LUS was performed with 2.5-3.5 MHz transducer for anterior, posterior and lateral chest consecutively in determinated areas. All patients underwent echocardiography examination to evaluate the pressure in pulmonary artery, left and right ventricular systolic and diastolic function and to detect pulmonary hypertension. Results Pulmonary fibrosis was detected in 43 patients (87.76±4.68%) of the SSc population at HRCT and in 41 patients (83.67±5.28%) at lung ultrasound. There was no difference between detected number of B-lines in younger and older patients, duration of disease (P>0.05). One patient was false positive at LUS. The analysis of results showed a corelation between LUS and HRCT (rxy=0.91, p<0.05). ROC curve analysis was used to confirm the analytical relationship between the number of B-lines and the presence of ILD at HRCT (AUC=0.89, Std. Err. =0.92, 95% CI 0.7 to 1.063, p<0.0001; Test results to sensitivity is equal to 0.83; to specificity – 0.07. It means that the used lung ultrasound is validated and has a high efficiency and reliability as a prospective, wholesome method. Conclusions Lung ultrasound is a reliable technique in the diagnostic assessement and recognition of pulmonary involvement in SSc. The presence of B-lines at LUS examination correlates with ILD at HRCT. LUS is very sensitive for detecting ILD. The use of LUS as a screening tool for ILD may be feasible to guide further investigation with HRCT. References Barskova T, Gargani L, Guiducci S, Bellando Randone S, Bruni C, Carnesecchi G, Conforti M, Porta F, Pignone A, Caramella D, Oicano E, Matucci-Gerinic M. Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis. Ann Rheum Dis 2013;72:390-395. Delle Sedie A, Carli L, Cioffi E, Bombardieri S, Riente L. The promising role of lung ultrasound in systemic sclerosis. Clin Rhematol (2012) 31:1537-1541. Gargani L, Doveri M, D'Errico L, Frassi F, Bazzichi M, Delle Sedie A, Scali M, Monti S, Mondillo S, Bombardieri S, Carmella D, Picano E. Ultrasound lung comets in systemic sclerosis: a chest sonography hallmark of pulmonary interstitial fibros...
Introduction. Mirizzi syndrome (MS) represents a rare clinical entity caused by impaction of one or multiple stones in the infundibulum of the gall bladder or the cystic duct resulting in partial or complete obstruction of the common hepatic or common bile duct (CBD). Though described more than a century ago, MS is still one of the most challenging diseases in the spectrum of biliary pathology. In recent years, endoscopic treatment has become an increasingly popular treatment modality. Patients and methods. Three consecutive patients subjected to cholangioscopy-assisted laser lithotripsy (CA-LL) for postocholecystectomy MS (pMS) were retrospectively evaluated. Case reports. Successful clearance of the cystic duct was achieved in all patients in one or two sessions. One complication in the form of mild cholangitis was observed. Clinical success was 100%. Discussion. According to current research, CA-LL achieves a high rate of ductal clearance and acceptable complication rate in patients with pMS. A 250 µm laser fiber seems to be the optimal choice for CA-LL. Our results suggest that procedure duration is closely associated to the stone size and possibly to the operator experience. In our opinion, upon obtainment of successful ductal clearance and drainage, prophylactic stenting does not improve clinical outcome. Conclusions. Our results demonstrate that CA-LL is a safe and effective treatment for pMS.
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