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Li Y, Guo R, Li W, Feng J, Jin Y, Li J, Lu L, Feng X, Chen X. Serosal Involvement in Adult-Onset Still's Disease: A Multicenter and Retrospective Study. Mod Rheumatol 2022; 33:579-587. [PMID: 35567520 DOI: 10.1093/mr/roac048] [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: 03/04/2022] [Revised: 04/14/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study evaluated the characteristics of serosal involvement in Adult-onset Still's disease. METHODS Patients meeting the Yamaguchi classification criteria were classified into AOSD with and without serosal involvement according to their manifestations and sonography/radiography. Clinical data were retrospectively reviewed from 102 AOSD patients of two centers. RESULTS Forty-two patients (41.2%) had serosal involvement. The frequencies of pulmonary infiltrate and impaired liver function were significantly higher in patients with serosal involvement (P=0.002 and P=0.007, respectively), who also had a higher modified systemic score (P=0.009). In addition, the percentages of CD3+ T cells (P<0.0001) and, especially, the CD8+ T cells (P=0.004) were significantly increased in the peripheral blood of AOSD patients with serosal involvement. Notably, patients with serosal involvement were more likely to develop MAS (P=0.047) and develop into chronic pattern (P=0.016) during the follow-up. CONCLUSION Patients with serosal involvement demonstrated the more severe disease activity and different immune phenotypes, and these patients were more likely to develop MAS, and they may require more aggressive treatment at an early time to control their systemic inflammation.
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Affiliation(s)
- Yixuan Li
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruru Guo
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjing Li
- Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiaqi Feng
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyang Jin
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Li
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liangjing Lu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuebing Feng
- Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaoxiang Chen
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Daoud S, Alkhatib L, Nimri A, Matarneh AS. Cardiac Tamponade as a Rare Presentation of Adult-Onset Still's Disease. Cureus 2021; 13:e20147. [PMID: 35003979 PMCID: PMC8723771 DOI: 10.7759/cureus.20147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
Adult-onset Still's disease (AOSD) is a rare inflammatory disease that affects multiple organ systems. Efforts have been made to study the course of the illness and possible treatment options. Cardiac tamponade is a rare and life-threatening complication of AOSD that can be the initial presentation of the disease. We report a 34-year-old patient who presented with a picture of cardiac tamponade and underwent emergency pericardiocentesis. Upon further investigations, the diagnosis of AOSD was made based on Yamaguchi criteria. Furthermore, he showed significant improvement following treatment with prednisolone, methotrexate, and tocilizumab. Our case provides evidence that AOSD should be considered in the differential diagnosis of cardiac tamponade and how prompt treatment of AOSD can effectively prevent potentially fatal complications.
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Carvalho J, Lerner A. Still’s disease with pleural effusion submitted to a pleurodesis. Arch Rheumatol 2021; 36:623-625. [PMID: 35382363 PMCID: PMC8957776 DOI: 10.46497/archrheumatol.2022.8630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/23/2021] [Indexed: 11/06/2022] Open
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Iwata J, Yamamura H, Takano A, Horiuchi Y. A case of corticosteroid‐refractory adult‐onset Still's disease successfully controlled with tocilizumab despite transient neutropenia and thrombocytopenia. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Jun‐ichi Iwata
- Department of Dermatology International University of Health and Welfare Atami Hospital Atami Japan
| | - Hitomi Yamamura
- Department of Dermatology International University of Health and Welfare Atami Hospital Atami Japan
| | - Aiko Takano
- Department of Dermatology International University of Health and Welfare Atami Hospital Atami Japan
| | - Yoshihito Horiuchi
- Department of Dermatology International University of Health and Welfare Atami Hospital Atami Japan
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Gu Q, Deng X, Li Z, Wang J, Hu C, Lei S, Cai X. The Intrapleural Bridge Connection is One of the Reasons for Unknown Localized Pleural Adhesion. Int J Gen Med 2021; 14:1429-1435. [PMID: 33907447 PMCID: PMC8068496 DOI: 10.2147/ijgm.s299606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Simple signs of local pleural adhesion are often found in people during a physical examination. In the present study, we aimed to clarify whether the merely localized pleural adhesion was just caused by previous pleural inflammation or physiological variation. Materials and Methods Chest X-ray image materials were collected to analyze the incidence of simple pleural adhesions. Moreover, the causes of these simple pleural adhesions were further analyzed using thoracoscopy under direct vision and biopsy data. Results In all 2218 chest X-ray images, 68 cases were found to have pleural lesions (3.07%), including 15 cases of localized pleural adhesion only. Subsequently, we analyzed the characteristics of 70 cases of pleural lesions using thoracoscopy. In two lung cancer patients with pleural metastasis, we found an unusual pleural junction. This connective strip was smooth and free of inflammation, resembling the normal pleura. Conclusion Some of these purely localized pleural adhesions might be attributed to previous inflammation. However, there was still at least a possibility that there must be a physiological pleural junction, which could be the cause of the purely localized pleural adhesion shown in the chest radiograph.
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Affiliation(s)
- Qihua Gu
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Xinhao Deng
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Zhao Li
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Jing Wang
- Department of Pathology, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Shuhua Lei
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Xiaoling Cai
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
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Yu F, Qin SY, Zhou CY, Zhao L, Xu Y, Jia EN, Wang JB. Atypical adult-onset Still’s disease with an initial and sole manifestation of liver injury: A case report and review of literature. World J Clin Cases 2021; 9:224-231. [PMID: 33511189 PMCID: PMC7809657 DOI: 10.12998/wjcc.v9.i1.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/21/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adult-onset Still's disease (AOSD) typically presents with a high spiking fever, polyarthritis, transient maculopapular rash, neutrophilic leukocytosis, and hepatosplenomegaly. It has a wide spectrum of clinical symptoms ranging from mild to severe, with extensive involvement of almost every organ. Although liver involvement in the form of increased hepatic enzymes and bilirubin is common, no AOSD case with liver involvement as the initial manifestation of AOSD has been reported.
CASE SUMMARY A 35-year-old woman presented to the hepatology department with progressively worsening jaundice for one week. Liver chemistry tests revealed a significantly increased liver enzymes and bilirubin level. Given that the clinical examination was unremarkable, liver biopsy was considered because the patient had a history of AOSD 6 years ago. Liver histopathology revealed that most hepatic lobules were still recognizable. Fusional necrosis was observed around most central veins. A few bridging necrotic zones were also found. Infiltration of multiple plasma cells were observed in the necrotic zone, and the reticular scaffold was still expanded. Additionally, no obvious fibrosis was observed in the portal area. Mild mixed inflammatory cell infiltration was noted in the interstitium of the portal area. Further examination was unremarkable except for a remarkably high level of ferritin. Collectively, a presumptive diagnosis of liver injury secondary to AOSD was made. The hepatic involvement responded well to glucocorticoid treatment.
CONCLUSION This case highlights that hepatic involvement as an initial and sole manifestation could be a pattern of relapsed AOSD. The diagnosis of AOSD should be considered in the case of nonresolving liver injury after the exclusion of common etiologies for liver diseases. A liver biopsy can be useful for the differential diagnosis of liver injury associated with AOSD.
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Affiliation(s)
- Fan Yu
- Department of Gastroenterology and Hepatology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Shao-You Qin
- Department of Gastroenterology and Hepatology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Chang-Yu Zhou
- Department of Gastroenterology and Hepatology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Lu Zhao
- Department of Digestive, Heze Municipal Hospital, Heze 274000, Shandong Province, China
| | - Yan Xu
- Department of Gastroenterology and Hepatology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Er-Na Jia
- Department of Gastroenterology and Hepatology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jiang-Bin Wang
- Department of Gastroenterology and Hepatology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
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Abstract
PURPOSE OF REVIEW We review the epidemiology, pathophysiology, and management of pericarditis most commonly complicating autoimmune and autoinflammatory conditions. RECENT FINDINGS Typically, pericarditis occurs in the context of a systemic flare of the underlying disease but infrequently, it is the presenting manifestation requiring a high index of suspicion to unravel the indolent cause. Pericardial involvement in rheumatic diseases encompasses a clinical spectrum to include acute, recurrent and incessant pericarditis, constrictive pericarditis, asymptomatic pericardial effusion, and pericardial tamponade. Direct evidence on the pathophysiology of pericarditis in the context of rheumatic diseases is scant. It is theorized that immune perturbations within pericardial tissue result from the underlying central immunopathology of the respective autoimmune or autoinflammatory disease. Pericarditis management depends on acuity, the underlying cause and epidemiological features such as patient's immune status and geographic prevalence of infections such as tuberculosis. Immunosuppressive medications including biologics such as interleukin 1 blockers emerge as possible steroid sparing agents for pericarditis treatment.
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Affiliation(s)
- Apostolos Kontzias
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA.
| | - Amir Barkhodari
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - QingPing Yao
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
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Fauter M, Gerfaud-Valentin M, Delplanque M, Georgin-Lavialle S, Sève P, Jamilloux Y. [Adult-onset Still's disease complications]. Rev Med Interne 2020; 41:168-179. [PMID: 31924392 DOI: 10.1016/j.revmed.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/29/2019] [Accepted: 12/08/2019] [Indexed: 12/15/2022]
Abstract
Adult-onset Still's disease (AOSD), first described in 1971 by Bywaters, is a rare systemic auto-inflammatory disorder of unknown etiology, characterized by a symptomatic triad associating prolonged fever, polyarthritis and rash. The management of this disease has significantly improved since its first description, and, although the overall prognosis of the AOSD is good, with a low attributable mortality, below 3% (but up to 18% depending on the series), some rare complications are still possible, can be life-threatening and change the prognosis of the disease. A literature search was performed to review AOSD's complications: reactive hemophagocytic lymphohystiocytosis, coagulation disorders, fulminant hepatitis, cardiovascular (pericarditis, myocarditis, HTAP) or pulmonary complications, neurologic, renal complications, and AA amyloidosis. For most of AOSD-related complications, corticosteroids remain the first-line treatment, in association with supportive care measures in case of severe complications. In case of inadequate response, multidisciplinary care with concil from a referral center is advised, and IL-1 or IL-6 blockers, but also ciclosporine, are the molecule to use in second intention.
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Affiliation(s)
- M Fauter
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - M Gerfaud-Valentin
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - M Delplanque
- Service de médecine interne, hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - S Georgin-Lavialle
- Service de médecine interne, hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - Y Jamilloux
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France.
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The Two-Faced Cytokine IL-6 in Host Defense and Diseases. Int J Mol Sci 2018; 19:ijms19113528. [PMID: 30423923 PMCID: PMC6274717 DOI: 10.3390/ijms19113528] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023] Open
Abstract
Interleukein-6 (IL-6), is produced locally from infectious or injured lesions and is delivered to the whole body via the blood stream, promptly activating the host defense system to perform diverse functions. However, excessive or sustained production of IL-6 is involved in various diseases. In diseases, the IL-6 inhibitory strategy begins with the development of the anti-IL-6 receptor antibody, tocilizumab (TCZ). This antibody has shown remarkable effects on Castleman disease, rheumatoid arthritis and juvenile idiopathic arthritis. In 2017, TCZ was proven to work effectively against giant cell arteritis, Takayasu arteritis and cytokine releasing syndrome, initiating a new era for the treatment of these diseases. In this study, the defensive functions of IL-6 and various pathological conditions are compared. Further, the diseases of which TCZ has been approved for treatment are summarized, the updated results of increasing off-label use of TCZ for various diseases are reviewed and the conditions for which IL-6 inhibition might have a beneficial role are discussed. Given the involvement of IL-6 in many pathologies, the diseases that can be improved by IL-6 inhibition will expand. However, the important role of IL-6 in host defense should always be kept in mind in clinical practice.
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Mitrovic S, Fautrel B. Complications of adult-onset Still's disease and their management. Expert Rev Clin Immunol 2018; 14:351-365. [PMID: 29658384 DOI: 10.1080/1744666x.2018.1465821] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Adult-onset Still's disease (AOSD) is a rare systemic auto-inflammatory disorder in which management and treatment have considerably progressed over the past decade. Despite wide use of interleukin (IL)-1 or IL-6 inhibitors, serious complications remain possible. Areas covered: A comprehensive literature search in MEDLINE via Pubmed was performed to review AOSD's severe and sometimes life-threatening complications: reactive hemophagocytic lymphohystiocytosis, coagulation disorders, fulminant hepatitis, cardiac or pulmonary complications and amyloid A amyloidosis. Expert commentary: Early recognition and prompt management is essential to significantly decrease morbi-mortality. The key question is to determine whether the complication is related to the disease itself or related to or favored by (e.g. infection) the ongoing treatment. For all severe AOSD-related complications, high-dose corticosteroids and supportive measures remain the first-line treatment. In case of inadequate response, combination with IL-1 or IL-6 blockers is justified. Cyclosporine A and etoposide remain of interest, especially in case of reactive hemophagocytic lymphohysitocytosis. Plasma exchange may be useful in case of thrombotic microangiopathy. In the near future, new biologic or non-biologic drugs targeting IL-18 or other cytokines or kinases could be of help.
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Affiliation(s)
- Stéphane Mitrovic
- a Department of Rheumatology , Pitié-Salpêtrière Hospital, AP-HP , Paris , France.,b Department of Internal Medicine , Institut Mutualiste Montsouris , Paris , France
| | - Bruno Fautrel
- a Department of Rheumatology , Pitié-Salpêtrière Hospital, AP-HP , Paris , France.,c Sorbonne Université , Faculté de Médecine et Institut Pierre Louis d'Epidémiologie et Santé publique , Paris , France.,d CRI-IMIDIATE, a FCRIN Clinical Research Network network , Paris , France
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