Acquired Haemophilia Presenting with a Haemarthrosis in a Patient with Rheumatoid Arthritis and Carcinoma of the Lung

Jones, Stephanie; Dippy, J. E.; Gaywood, Ian

doi:10.1093/rheumatology/33.10.992

Cited by 8 publications

(3 citation statements)

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“…This information is key to better predict the varied responses of TNP patients to therapeutic interventions. Jones et al (1994, 1999) utilized [ 11 C]diprenorphine, a non-selective opioid radiotracer, to examine the in vivo availability of opioid receptors in a small group of patients diagnosed with rheumatoid arthritis and trigeminal neuralgia before and 3 weeks to 3 months after treatment and pain relief. Substantial reductions in cortical and subcortical opioid receptor availability were observed prior to treatment at resting state (baseline), which were reversed after pain relief.…”

Section: Discussionmentioning

confidence: 99%

“…One of the most important modulatory mechanisms is the endogenous opioidergic system, which is involved in the regulation of experimental and clinical pain, as well as in the effects of analgesic opiate drugs. Studies with positron emission tomography (PET) have shown decreased opioid receptor non-displaceable binding potential (BP ND ) in patients with chronic pain disorders, including rheumatoid arthritis (Jones et al, 1994), neuropathic pain (Maarrawi et al, 2007a; DosSantos et al, 2012), and fibromyalgia (Harris et al, 2007) when examined with both selective for μ-opioid receptor (μOR; Harris et al, 2007; DosSantos et al, 2012) and non-selective (Jones et al, 1994; Maarrawi et al, 2007a) opioid receptor markers. The data available points to either or both endogenous opioid release, and down-regulation of opioid receptors.…”

Section: Introductionmentioning

confidence: 99%

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Immediate Effects of tDCS on the μ-Opioid System of a Chronic Pain Patient

DosSantos¹,

Love²,

Martikainen³

et al. 2012

Front. Psychiatry

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We developed a unique protocol where transcranial direct current stimulation (tDCS) of the motor cortex is performed during positron emission tomography (PET) scan using a μ-opioid receptor (μOR) selective radiotracer, [11C]carfentanil. This is one of the most important central neuromechanisms associated with pain perception and regulation. We measured μOR non-displaceable binding potential (μOR BPND) in a trigeminal neuropathic pain patient (TNP) without creating artifacts, or posing risks to the patient (e.g., monitoring of resistance). The active session directly improved in 36.2% the threshold for experimental cold pain in the trigeminal allodynic area, mandibular branch, but not the TNP patient’s clinical pain. Interestingly, the single active tDCS application considerably decreased μORBPND levels in (sub)cortical pain-matrix structures compared to sham tDCS, especially in the posterior thalamus. Suggesting that the μ-opioidergic effects of a single tDCS session are subclinical at immediate level, and repetitive sessions are necessary to revert ingrained neuroplastic changes related to the chronic pain. To our knowledge, we provide data for the first time in vivo that there is possibly an instant increase of endogenous μ-opioid release during acute motor cortex neuromodulation with tDCS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immediate Effects of tDCS on the μ-Opioid System of a Chronic Pain Patient

DosSantos¹,

Love²,

Martikainen³

et al. 2012

Front. Psychiatry

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“…We found 35 cases ( Figure 1): 15 in systemic lupus erythematosus (SLE) [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32], 12 in rheumatoid arthritis [28,[33][34][35][36][37][38][39][40][41][42][43], 4 in Sjögren's syndrome (SS) [44][45][46][47], 2 in polymyalgia rheumatica (PMR) [48,49], 1 in systemic sclerosis (SSc) [50], and 1 in psoriatic arthritis (PA) [51].…”

Section: Case Reportmentioning

confidence: 99%

Acquired Hemophilia in a Patient With Rheumatoid Arthritis: Case Report and Literature Review

Jaber

Bortolotti

Martinelli

et al. 2019

CMI

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Acquired hemophilia (AH) is a rare bleeding disorder caused by the spontaneous development of autoantibodies against coagulation factors, most commonly factor (F) VIII (acquired hemophilia A, AHA). The clinical manifestation of AHA includes mostly spontaneous hemorrhages into skin, mucous membranes, muscles, soft tissues, or joints. AHA should be suspected when a patient with no history of hemorrhages presents with bleeding and an unexplained prolonged activated partial thromboplastin time. The diagnosis is based on the clinical picture, the presence of low FVIII activity and evidence of FVIII inhibitor. In around half of patients, an underlying disorder (rheumatic diseases, malignancy, infections) or taking some drugs are associated with AHA; the remaining cases are idiopathic. Rheumatoid arthritis is a chronic inflammatory condition, marked by swelling and tenderness of small joints; it is usually treated with steroid and immunosuppressive drugs such as methotrexate, TNF-alpha inhibitors, and other biologic therapies (abatacept, tocilizumab, rituximab).We presented a patient with rheumatoid arthritis who developed acquired hemophilia A with hemarthroses; starting from this case, we focused on the literature about AHA in rheumatic diseases. We found 35 cases, 15 in systemic lupus erythematosus and 12 in rheumatoid arthritis, while the remaining cases were reported in Sjögren’s syndrome, polymyalgia rheumatica, systemic sclerosis, and psoriatic arthritis. Ecchymosis and cutaneous hematomas were the main clinical features while hemarthroses was quite a rare condition, shown in just three patients.

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Acquired inhibitor to factor VIII in small cell lung cancer: a case report and review of the literature

Shwaiki

Lara

Ahmed

et al. 2001

Annals of Hematology

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Acquired hemophilia (antibodies or inhibitors to factor VIII) is the most common acquired disease affecting clotting factors. It has been described in association with autoimmune disease, malignancy, dermatologic disorders, in the postpartum period, and with drug interactions. Factor VIII inhibitors have been previously described with lung cancer, three with squamous cell and one with adenocarcinoma. A 54-year-old woman presented with weight loss and shoulder pain. A chest X-ray revealed a right hilar mass, confirmed by computed tomography (CT) scan and biopsy revealed small cell lung cancer. Coagulation panel prior to bronchoscopy showed an increased partial thromboplastin time (aPTT). The presence of factor VIII inhibitor was demonstrated at 5 Bethesda units. The patient was treated with fresh frozen plasma twice for hemorrhagic episodes, and six cycles of chemotherapy were begun with carboplatin and etoposide 16. Eight months after the diagnosis, her aPTT was normal and the factor VIII inhibitor titer was undetectable. This is the first case report of small cell lung cancer and acquired hemophilia. A causal relationship between the malignancy and the presence of factor VIII inhibitors is suggested by the response to therapy.

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Acquired Haemophilia Presenting with a Haemarthrosis in a Patient with Rheumatoid Arthritis and Carcinoma of the Lung

Cited by 8 publications

References 0 publications

Immediate Effects of tDCS on the μ-Opioid System of a Chronic Pain Patient

Immediate Effects of tDCS on the μ-Opioid System of a Chronic Pain Patient

Acquired Hemophilia in a Patient With Rheumatoid Arthritis: Case Report and Literature Review

Acquired inhibitor to factor VIII in small cell lung cancer: a case report and review of the literature

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