Infections and systemic lupus erythematosus

Esposito, Susanna; Bosis, Samantha; Semino, Margherita; Rigante, Donato

doi:10.1007/s10096-014-2098-7

Cited by 86 publications

(90 citation statements)

References 99 publications

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“…Notably, infection (especially the upper respiratory tract infection, even the minor ones) was a very common discernible trigger. The possible role of infections even the occult ones in triggering activity of autoimmune diseases has been speculated [29][30][31][32][33][34]. The challenging question is after an OMG child has attained so-called pharmaceutical remission for 1 year or longer on low dosage of prednisone, we lack guidelines or markers to discontinue the corticotherapy since long-term usage of prednisone would handicap the children.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of 424 childhood-onset myasthenia gravis patients

et al. 2015

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The objective of this study was to describe the clinical characteristics, outcome and factors that may affect the outcome of childhood-onset myasthenia gravis (CMG) patients in China. We have followed up 424 patients with CMG for at least 5 years at Tongji Hospital. At the end of follow-up, the outcome of all the patients was measured according to MGFA Post-intervention Status. In this study, the patients have been followed up for 9.8 ± 5.4 years. The mean onset age was 5.4 ± 3.6 years. Ocular myasthenia gravis (OMG) was the major type of CMG within 2 years after onset (95%). Thymic hyperplasia was found in 116 patients, and thymoma was confirmed in 6 patients. Acetylcholine receptor antibodies were elevated in 69.5% of the patients. All the patients were routinely treated. Thymectomy was performed in 34 patients (8.0%). At the end of follow-up, seventy-one patients (16.7%) were significantly improved, 66 patients (15.6%) remained unchanged, 53 patients (12.5%) were worsened, and 234 patients (55.2%) were exacerbated. Importantly, fifty OMG patients (12.4%) had transformed into generalized myasthenia gravis (GMG) over 2 years after onset. Thymectomy did not effectively reduce the transformation from OMG to GMG. However, GMG cases significantly benefited from the surgery. This study indicated that the cases with autoimmune CMG account for over 50% in Chinese MG population. The long-term follow-up discloses that CMG patients have a low percentage of improvement, and a high percentage of worsening and exacerbation. The treatment should not be withdrawn too early after the patients obtain complete stable remission. More studies are needed to gain better control of CMG symptoms.

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Section: Discussionmentioning

confidence: 99%

Long-term outcome of 424 childhood-onset myasthenia gravis patients

et al. 2015

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“…Some data collected in this study and other studies regarding cytokine imbalance in patients with EB suggest that the induction of a chronic inflammatory response could explain, at least in part, the activation of autoimmunity and the deterioration and extensions of the basal EB lesions. Cytokines play a pivotal role in the pathogenesis of autoimmune diseases, and increased serum levels of a number of cytokines are associated with the development and progression of systemic autoimmune diseases [21,22]. In particular, pro-inflammatory cytokines contribute to the initiation and propagation of autoimmune inflammation, although the role of each cytokine is significantly influenced by the concentration, the stage of disease during which the cytokine is secreted and its combination with other cytokines, particularly those with an anti-inflammatory effect [22].…”

Section: Discussionmentioning

confidence: 99%

Autoimmunity and Cytokine Imbalance in Inherited Epidermolysis Bullosa

Esposito

Guez

Orenti

et al. 2016

IJMS

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In order to evaluate the serum anti-skin autoantibodies and cytokine concentrations in patients with different epidermolysis bullosa (EB) types and severity, 42 EB patients and 38 controls were enrolled. Serum anti-skin antibodies were significantly higher in the patients than in the controls (p = 0.008, p < 0.001, p < 0.001, p < 0.001 and p < 0.001 for desmoglein 1 (DSG1) desmoglein 3 (DSG3), bullous pemphigoid 180 (BP180), BP230 and type VII collagen (COL7), respectively). The same trend was observed for interleukin (IL)-1β, IL-2, IL-6, IL-10, tumor necrosis factor-β, and interferon-γ (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p < 0.001 and p = 0.002, respectively). Increases in anti-skin antibodies and cytokine concentrations were higher in patients with recessive dystrophic EB than in those with different types of EB, in generalized cases than in localized ones, and in patients with higher Birmingham Epidermolysis Bullosa Severity (BEBS) scores than in those with a lower score. The BEBS score was directly correlated with BP180, BP230, COL7 (p = 0.015, p = 0.008 and p < 0.001, respectively) and IL-6 (p = 0.03), whereas IL-6 appeared significantly associated with DSG1, DSG3, BP180, BP230 and COL7 (p = 0.015, p = 0.023, p = 0.023, p = 0.015 and p = 0.005, respectively). This study showed that autoimmunity and inflammatory responses are frequently activated in EB, mainly in severe forms, suggesting the use of immunosuppressive drugs or biologicals that are active against pro-inflammatory cytokines to reduce clinical signs and symptoms of disease.

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“…Many pathogens are known to contribute toward abnormal immune responses in genetically susceptible individuals through molecular mimicry, epitope spreading, bystander activation, or other mechanisms [5]. …”

Section: Infection As a Triggering Factor For Slementioning

confidence: 99%

Infection in systemic lupus erythematosus, similarities, and differences with lupus flare

Jung

Suh

2017

Korean J Intern Med

102

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Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse manifestations, and its pathogenesis is unclear and complicated. Infection and SLE are similar in that they both cause inf lammatory reactions in the immune system; however, one functions to protect the body, whereas the other is activated to damage the body. Infection is known as one of the common trigger factors for SLE; there are a number of reports on infectious agents that provoke autoimmune response. Several viruses, bacteria, and protozoa were revealed to cause immune dysfunction by molecular mimicry, epitope spreading, and bystander activation. In contrast, certain pathogens were revealed to protect from immune dysregulation. Infection can be threatening to patients with SLE who have a compromised immune system, and it is regarded as one of the common causes of mortality in SLE. A clinical distinction between infection and lupus f lare up is required when patients with SLE present fevers. With a close-up assessment of symptoms and physical examination, C-reactive protein and disease activity markers play a major role in differentiating the different disease conditions. Vaccination is necessary because protection against infection is important in patients with SLE.

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Infections and systemic lupus erythematosus

Cited by 86 publications

References 99 publications

Long-term outcome of 424 childhood-onset myasthenia gravis patients

Long-term outcome of 424 childhood-onset myasthenia gravis patients

Autoimmunity and Cytokine Imbalance in Inherited Epidermolysis Bullosa

Infection in systemic lupus erythematosus, similarities, and differences with lupus flare

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