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Affiliation(s)
- Ahmet Ozen
- From the Department of Pediatrics, Division of Allergy and Immunology, Marmara University, School of Medicine, the Istanbul Jeffrey Modell Diagnostic Center for Primary Immunodeficiency Diseases, and the Isil Berat Barlan Center for Translational Medicine - all in Istanbul, Turkey (A.O.); and the Molecular Development of the Immune System Section, Laboratory of Immune System Biology, Clinical Genomics Program, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.J.L.)
| | - Michael J Lenardo
- From the Department of Pediatrics, Division of Allergy and Immunology, Marmara University, School of Medicine, the Istanbul Jeffrey Modell Diagnostic Center for Primary Immunodeficiency Diseases, and the Isil Berat Barlan Center for Translational Medicine - all in Istanbul, Turkey (A.O.); and the Molecular Development of the Immune System Section, Laboratory of Immune System Biology, Clinical Genomics Program, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.J.L.)
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Mihai A, Caruntu C, Jurcut C, Blajut FC, Casian M, Opris-Belinski D, Ionescu R, Caruntu A. The Spectrum of Extraglandular Manifestations in Primary Sjögren's Syndrome. J Pers Med 2023; 13:961. [PMID: 37373950 DOI: 10.3390/jpm13060961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Extraglandular manifestations (EGMs) in primary Sjogren's syndrome (pSS) represent the clinical expression of the systemic involvement in this disease. EGMs are characterized by a wide heterogeneity; virtually any organ or system can be affected, with various degrees of dysfunction. The existing gaps of knowledge in this complex domain of extraglandular extension in pSS need to be overcome in order to increase the diagnostic accuracy of EGMs in pSS. The timely identification of EGMs, as early as from subclinical stages, can be facilitated using highly specific biomarkers, thus preventing decompensated disease and severe complications. To date, there is no general consensus on the diagnostic criteria for the wide range of extraglandular involvement in pSS, which associates important underdiagnosing of EGMs, subsequent undertreatment and progression to severe organ dysfunction in these patients. This review article presents the most recent basic and clinical science research conducted to investigate pathogenic mechanisms leading to EGMs in pSS patients. In addition, it presents the current diagnostic and treatment recommendations and the trends for future therapeutic strategies based on personalized treatment, as well as the latest research in the field of diagnostic and prognostic biomarkers for extraglandular involvement in pSS.
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Affiliation(s)
- Ancuta Mihai
- Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, 010825 Bucharest, Romania
- Department of Rheumatology, Faculty of General Medicine, Titu Maiorescu University, 031593 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Dermatology, Prof. N.C. Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | - Ciprian Jurcut
- Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, 010825 Bucharest, Romania
| | - Florin Cristian Blajut
- Department of General Surgery, Carol Davila Central Military Emergency Hospital, 010825 Bucharest, Romania
- Department of Medical-Surgical Specialties, "Titu Maiorescu" University of Bucharest, 040441 Bucharest, Romania
| | - Mihnea Casian
- Emergency Institute for Cardiovascular Diseases Prof. Dr. C.C. Iliescu, 022328 Bucharest, Romania
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniela Opris-Belinski
- Internal Medicine and Rheumatology Department, Sfanta Maria Clinical Hospital, 011172 Bucharest, Romania
- Internal Medicine and Rheumatology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ruxandra Ionescu
- Internal Medicine and Rheumatology Department, Sfanta Maria Clinical Hospital, 011172 Bucharest, Romania
| | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, Carol Davila Central Military Emergency Hospital, 010825 Bucharest, Romania
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Titu Maiorescu University, 031593 Bucharest, Romania
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The Efficacy of Hydroxychloroquine Combined with Huangqi Tablets in the Treatment of Diabetic Nephropathy. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:7988924. [PMID: 34707799 PMCID: PMC8545567 DOI: 10.1155/2021/7988924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/28/2021] [Accepted: 09/16/2021] [Indexed: 01/28/2023]
Abstract
Objective This study aimed to analyze the effect of hydroxychloroquine combined with Huangqi tablets in the treatment of diabetic nephropathy (DN). Methods Eighty patients with DN were enrolled and divided into two groups by a random number table. 27 patients received routine treatment + hydroxychloroquine (group A), while 27 patients received routine treatment + hydroxychloroquine + Huangqi tablets (group B) and 26 patients received routine treatment (group C). Results FPG, 2h PG, and HbA1c levels as well as TC and TG levels were lower in group B than in groups A and C at the end of 3 months of treatment and were lower in group A than in group C (P < 0.05). SCR, BUN, and 24-hour urine protein were reduced in group B after therapy, whereas eGFR was increased and the difference between groups A and C was significant (P=0.05). After treatment, VEGF, IGF-1, and TGF-1 levels were lower in group B than in groups A and C and in group A than in group C (P=0.05). Total symptom scores at 2, 4, and 6 months after treatment was lower in group B than in groups A and C, and they were lower in group A than in group C at all time points (P < 0.05). The total effective rates of treatment in groups A, B, and C were 66.67%, 88.89%, and 38.46% (P < 0.05). The incidence of adverse reactions in groups A, B, and C was 37.04%, 25.93%, and 11.54% (P > 0.05). Conclusion Hydroxychloroquine combined with Huangqi tablets in the treatment of DN showed the best efficacy, with better control of blood glucose and lipids, which can more effectively delay the progression of renal lesions and effectively inhibit the expression of VEGF, IGF, and TGF-β1 in tethered cells with high safety.
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de Carvalho JF, Lerner A, Gonçalves CM, Shoenfeld Y. Sjögren syndrome associated with protein-losing enteropathy: case-based review. Clin Rheumatol 2020; 40:2491-2497. [PMID: 33145631 DOI: 10.1007/s10067-020-05487-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
The association between Sjögren's syndrome (SS) and protein-losing enteropathy (PLE) was scarcly reported. To analyze the clinical, therapeutic, and outcome characteristics of patients with SS and PLE and also to delineate the potential mechanisms and pathways connecting the gut to SS targeted organ's pathology. Systematic screening was conducted using PubMed/MEDLINE, LILACS, SciELO, Web of Science, and Cochrane, dating 1980 to 2020. SS and PLE were the key words. Eighteen patients with SS and PLE were summarized. The patient's ages ranged between 20 and 88 years, and only 4 were males. Primary SS was observed in most cases. Anti-Ro was detected in 100% of the cases while anti-La was reported in 64% of them. The clinical manifestations were protein loss, edema of the lower limbs, pleural effusion, ascites, facial edema, anasarca, diarrhea, and weight loss. Among these clinical manifestations, edema of the lower limbs was the most severe. Albumin concentration was 0.9-3.4 g/dL which increased to 2.8-4.3 g/dL after treatment. Small bowel biopsy was performed in all of the cases. Concerning the therapy, all the patients received systemic glucocorticoids. All of them improved. The period of onset of improvement ranged from 3 weeks to 36 months (an average of 3 months). The early diagnosis and appropriate therapy of PLE in patients with anti-Ro positive SS and who present edema, anasarca, or hypoalbuminemia is vital for a beneficial outcome. An excellent clinical improvement in all the cases was observed when treated early enough by cortico-therapy, thus preventing patient's deterioration, complications, and reducing morbidity and potential mortality.
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Affiliation(s)
- Jozélio Freire de Carvalho
- Institute for Health Sciences from Federal University of Bahia, Rua das Violetas, 42, ap. 502, Pituba, Salvador, Bahia, Brazil.
| | - Aaron Lerner
- Chaim Sheba Medical Center, The Zabludowicz Research Center for Autoimmune Diseases, Tel Hashomer, Israel
| | | | - Yehuda Shoenfeld
- Chaim Sheba Medical Center, The Zabludowicz Research Center for Autoimmune Diseases, Tel Hashomer, Israel.,Saint Petersburg State University, St. Petersburg, Russia
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Li X, Lin F, Wu Z, Chen Y, Zhu P. A case report of Sjögren's syndrome associated with protein-losing gastroenteropathy successfully treated with methylprednisolone. J Int Med Res 2020; 48:300060519874543. [PMID: 31594442 PMCID: PMC7783283 DOI: 10.1177/0300060519874543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Protein-losing gastroenteropathy (PLGE) is a rare manifestation of primary
Sjögren’s syndrome that is most commonly reported in Japan. Herein, the case of
a 71-year-old Chinese male patient, diagnosed with PLGE and Sjögren’s syndrome,
is reported. The patient presented with peripheral oedema, and PLGE was
diagnosed based on the result of technetium-99m (99mTc)-labelled
albumin scintigraphy. In addition to a positive Schirmer’s test, the patient had
atrophy of the salivary gland with lymphocyte infiltration, impaired
parotid-gland secretory and excretory function, and an increased level of
anti-SSA antibodies, fulfilling the criteria for Sjögren’s syndrome. He was
successfully treated with methylprednisolone. Follow-up
99mTc-labelled albumin scintigraphy results correlated well with
clinical improvement and increased serum albumin levels. The present case study
highlights the necessity of considering a diagnosis of protein loss enteropathy
associated with primary Sjögren’s syndrome when patients have unexplained
hypoproteinaemia.
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Affiliation(s)
- Xiaoming Li
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Provincial Key Laboratory of Geriatric Diseases, Fujian Medical University, Fuzhou, China
| | - Fan Lin
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Provincial Key Laboratory of Geriatric Diseases, Fujian Medical University, Fuzhou, China
| | - Ziyu Wu
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Provincial Key Laboratory of Geriatric Diseases, Fujian Medical University, Fuzhou, China
| | - Yan Chen
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Provincial Key Laboratory of Geriatric Diseases, Fujian Medical University, Fuzhou, China
| | - Pengli Zhu
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Provincial Key Laboratory of Geriatric Diseases, Fujian Medical University, Fuzhou, China
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Akaishi T, Yasaka K, Abe M, Fujii H, Watanabe M, Shirai T, Ishizawa K, Takayama S, Kagaya Y, Harigae H, Ishii T. Protein-losing gastroenteropathy with severe hypoalbuminemia associated with Sjögren's syndrome: A case report and review of the literature. J Gen Fam Med 2020; 21:24-28. [PMID: 31911886 PMCID: PMC6942935 DOI: 10.1002/jgf2.281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 12/16/2022] Open
Abstract
A 30-year-old man with severe hypoalbuminemia (serum albumin: 0.9 g/dL) was admitted with severe bilateral leg edema and unilateral pleural effusion. Serum anti-SS-A and SS-B antibody levels were abnormally elevated, and his symptoms fulfilled the diagnostic criteria for Sjögren's syndrome. Technetium-99m albumin scintigraphy revealed protein leakage from a large area of the small intestine. Immunohistochemistry revealed perivascular deposition of C1q, C3d, and immunoglobulin G in the duodenal mucosa. The patient was diagnosed with protein-losing gastroenteropathy associated with Sjögren's syndrome. Within 2 months of treatment with oral prednisolone and mycophenolate mofetil, the clinical symptoms of hypoalbuminemia and Sjögren's syndrome disappeared completely.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Education and Support for Regional MedicineTohoku University HospitalSendaiJapan
| | - Ken Yasaka
- Department of Hematology and RheumatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Michiaki Abe
- Department of Education and Support for Regional MedicineTohoku University HospitalSendaiJapan
| | - Hiroshi Fujii
- Department of Hematology and RheumatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Mika Watanabe
- Department of PathologyTohoku University HospitalSendaiJapan
| | - Tsuyoshi Shirai
- Department of Hematology and RheumatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Kota Ishizawa
- Department of Education and Support for Regional MedicineTohoku University HospitalSendaiJapan
| | - Shin Takayama
- Department of Education and Support for Regional MedicineTohoku University HospitalSendaiJapan
| | - Yutaka Kagaya
- Office of Medical EducationTohoku University Graduate School of MedicineSendaiJapan
| | - Hideo Harigae
- Department of Hematology and RheumatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Tadashi Ishii
- Department of Education and Support for Regional MedicineTohoku University HospitalSendaiJapan
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Abstract
Autoimmune diseases, such as rheumatoid arthritis, systematic lupus erythematosus and Sjögren's syndrome, are a group of diseases characterized by the activation of immune cells and excessive production of autoantibodies. Although the pathogenesis of these diseases is still not completely understood, studies have shown that multiple factors including genetics, environment and immune responses play important roles in the development and progression of the diseases. In China, there are great achievements in the mechanisms of autoimmune diseases during the last decades. These studies provide new insight to understand the diseases and also shed light on the development of novel therapy.
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Affiliation(s)
- Ru Li
- Department of Rheumatology & Immunology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.
| | - Xing Sun
- Department of Rheumatology & Immunology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Xu Liu
- Department of Rheumatology & Immunology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Yue Yang
- Department of Rheumatology & Immunology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Zhanguo Li
- Department of Rheumatology & Immunology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
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Watanabe K, Murakami S, Misago M, Yoshikawa M, Tamai D, Nakao S, Ueoka T, Ito M, Shinomura Y, Kajiwara N. Sjögren's syndrome concurrent with protein-losing gastroenteropathy with secondary systemic capillary leak syndrome : A case report. Clin Case Rep 2018; 6:1829-1833. [PMID: 30214773 PMCID: PMC6132162 DOI: 10.1002/ccr3.1675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/04/2018] [Accepted: 06/12/2018] [Indexed: 02/06/2023] Open
Abstract
Sjögren's syndrome concurrent with protein-losing gastroenteropathy can develop into secondary systemic capillary leak syndrome. Thus, it is important to diagnose the condition as soon as possible and simultaneously administer treatment for Sjögren's syndrome, protein-losing gastroenteropathy, and systemic capillary leak syndrome.
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Affiliation(s)
- Kei Watanabe
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Shinichiro Murakami
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Masahiro Misago
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Mai Yoshikawa
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Daisuke Tamai
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Shinichiro Nakao
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Takato Ueoka
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Mototoshi Ito
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
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Nakamura T, Shiraishi N, Morikami Y, Fujii H, Itoshima H, Kamio T. Protein-losing enteropathy may be an important characteristic manifestation in Sjögren's syndrome. Mod Rheumatol 2018. [PMID: 29532703 DOI: 10.1080/14397595.2018.1452335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Tadashi Nakamura
- a Section of Clinical Rheumatology , Sakurajyuji Hospital , Kumamoto , Japan
| | - Naoki Shiraishi
- b Section of Nephrology , Sakurajyuji Hospital , Kumamoto , Japan
| | | | - Hiromi Fujii
- c Section of Cardiology , Sakurajyuji Hospital , Kumamoto , Japan
| | - Hisashi Itoshima
- d Section of Gastroenterology , Saiseikai Kumamoto Hospital , Kumamoto , Japan
| | - Takihiro Kamio
- e Section of Clinical Pathology , Saiseikai Kumamoto Hospital , Kumamoto , Japan
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Abstract
Gastrointestinal (GI) manifestations of rheumatoid arthritis (RA) are rare, but can be impactful for patients. Some GI processes are directly related to RA, whereas others may be sequelae of treatment or caused by concomitant autoimmune diseases. This article discusses the role of the GI tract in RA pathogenesis; the presentation, epidemiology, and diagnosis of RA-related GI manifestations; concomitant GI autoimmune diseases that may affect those with RA; and GI side effects of RA treatment. The importance of appropriately considering conditions unrelated to RA in the differential diagnosis when evaluating new GI symptoms in patients with RA is noted.
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Affiliation(s)
- Ethan Craig
- Johns Hopkins University School of Medicine, Division of Rheumatology, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Laura C Cappelli
- Johns Hopkins University School of Medicine, Division of Rheumatology, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
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