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Gaggiano C, Rigante D, Hernández-Rodríguez J, Vitale A, Tarsia M, Soriano A, Lopalco G, Iannone F, Abdel Jaber M, Giacomelli R, Wiȩsik-Szewczyk E, Cattalini M, Frassi M, Piga M, Ragab G, Sota J, Zunica F, Floris A, Sabato V, Hegazy MT, Araújo O, Pelegrín L, Fabbiani A, Renieri A, Grosso S, Fabiani C, Frediani B, Cantarini L. Anakinra and canakinumab for patients with R92Q-associated autoinflammatory syndrome: a multicenter observational study from the AIDA Network. Ther Adv Musculoskelet Dis 2021; 13:1759720X211037178. [PMID: 34527082 PMCID: PMC8436281 DOI: 10.1177/1759720x211037178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background: This study aims at describing the therapeutic outcome of patients carrying the R92Q variant in the TNFRSF1A gene treated with anakinra (ANA) or canakinumab (CAN) and identifying any factors predictive of complete response to IL-1 inhibition. Methods: Clinical data of patients treated with ANA or CAN for recurrent inflammatory attacks due to the presence of the R92Q variant were retrospectively collected and analysed. Results: Data about 20 treatment courses with IL-1 inhibitors (16 with ANA and 4 with CAN) from 19 patients were collected. Mean age at disease onset was 20.2 ± 14.8 years. In 5 cases (26%) the R92Q variant was found in a family member affected by recurrent fever. The therapeutic response was complete in 13(68%) and partial in 2 patients (11%); treatment failure was observed in 4 cases (21%). Median AIDAI decreased from 10 (interquartile range [IQR] = 28) to 0 (IQR = 1) at the 12-month follow-up visit (p < 0.001). Mean ESR and median CRP dropped respectively from 40.8 ± 24.8 to 9.1 ± 4.5 mm/h (p < 0.001) and from 3.0 (IQR = 1.9) to 0.3 (IQR = 0.3) mg/dl (p < 0.001) after 12 months of treatment. A steroid-sparing effect was observed from the third month of treatment (p < 0.01). Thirteen patients (65%) were still on treatment at the last follow-up visit (median duration of treatment 17 (IQR = 38) months). The presence of R92Q mutation in a symptomatic relative (p = 0.022), the relapsing remitting disease course (p < 0.001) and the presence of migratory erythematous skin rashes during fever attacks (p = 0.005) were associated with complete efficacy of IL-1 inhibitors. Conclusions: R92Q patients showed a favourable response to ANA and CAN, particularly when the mutation segregated in a family member and when a relapsing-remitting disease course or TNF-α receptor-associated periodic syndrome (TRAPS) typical skin rash were observed. In the subgroup of patients not taking advantage of IL-1 blockage different molecular mechanisms underlying the autoinflammatory picture are likely to exist.
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Affiliation(s)
- Carla Gaggiano
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy; Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Donato Rigante
- Department of Life Sciences and Global Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Rare Diseases and Periodic Fevers Research Centre, Università Cattolica del Sacro Cuore, Rome, Italy
| | - José Hernández-Rodríguez
- Vasculitis Research Unit and Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Tarsia
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Alessandra Soriano
- Department of Internal Medicine, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ewa Wiȩsik-Szewczyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
| | - Marco Cattalini
- Paediatric Clinic, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Micol Frassi
- Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | - Gaafar Ragab
- Rheumatology and Clinical Immunology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Fiammetta Zunica
- Paediatric Clinic, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Alberto Floris
- Rheumatology Unit, AOU University Clinic, Cagliari, Italy
| | - Vito Sabato
- Faculty of Medicine and Health Sciences, Department of Immunology-Allergology-Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerpen, Belgium
| | - Mohamed Tharwat Hegazy
- Rheumatology and Clinical Immunology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Olga Araújo
- Vasculitis Research Unit and Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Laura Pelegrín
- Clinical Institute of Ophthalmology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Alessandra Renieri
- Medical Genetics, University of Siena, Siena, Italy; Medical Genetics, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease Clinic and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico 'Le Scotte', viale Bracci n. 1, 53100 Siena, Italy
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2
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Vitale A, Obici L, Cattalini M, Lopalco G, Merlini G, Ricco N, Soriano A, La Torre F, Verrecchia E, Insalaco A, Dagna L, Jaber MA, Montin D, Emmi G, Ciarcia L, Barneschi S, Parronchi P, Ruscitti P, Maggio MC, Viapiana O, Sota J, Gaggiano C, Giacomelli R, Sicignano LL, Manna R, Renieri A, Lo Rizzo C, Frediani B, Rigante D, Cantarini L. Biotechnological Agents for Patients With Tumor Necrosis Factor Receptor Associated Periodic Syndrome-Therapeutic Outcome and Predictors of Response: Real-Life Data From the AIDA Network. Front Med (Lausanne) 2021; 8:668173. [PMID: 34307404 PMCID: PMC8295690 DOI: 10.3389/fmed.2021.668173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/07/2021] [Indexed: 12/26/2022] Open
Abstract
Objective: To describe the role of biotechnological therapies in patients with tumor necrosis factor receptor associated periodic syndrome (TRAPS) and to identify any predictor of complete response. Methods: Clinical, laboratory, and therapeutic data from 44 Caucasian TRAPS patients treated with biologic agents were retrospectively collected in 16 Italian tertiary Centers. Results: A total of 55 biological courses with anakinra (n = 26), canakinumab (n = 16), anti-TNF-α agents (n = 10), and tocilizumab (n = 3) were analyzed. A complete response was observed in 41 (74.5%) cases, a partial response in 9 (16.4%) cases and a treatment failure in 5 (9.1%) cases. The frequency of TRAPS exacerbations was 458.2 flare/100 patients-year during the 12 months prior to the start of biologic treatment and 65.7 flare/100 patients-years during the first 12 months of therapy (p < 0.0001). The median duration of attacks was 5.00 (IQR = 10.50) days at the start of biologics and 1.00 (IQR = 0.00) days at the 12-month assessment (p < 0.0001). Likewise, a significant reduction was observed in the Autoinflammatory Disease Activity Index during the study period (p < 0.0001). A significant corticosteroid sparing effect was observed as early as the first 12 months of treatment both in the number of patients requiring corticosteroids (p = 0.025) and in the dosages employed (p < 0.0001). A significant reduction was identified in the erythrocyte sedimentation rate (p < 0.0001), C reactive protein (p < 0.0001), serum amyloid A (p < 0.0001), and in the 24-h proteinuria dosage during follow-up (p = 0.001). A relapsing-remitting disease course (OR = 0.027, C.I. 0.001-0.841, p = 0.040) and the frequency of relapses at the start of biologics (OR = 0.363, C.I. 0.301-0.953, p = 0.034) were significantly associated with a complete response. No serious adverse events were observed. Conclusions: Treatment with biologic agents is highly effective in controlling clinical and laboratory TRAPS manifestations. Patients with a relapsing-remitting course and a lower frequency of flares at the start of treatment show more likely a complete response to biologic agents.
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Affiliation(s)
- Antonio Vitale
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, University of Siena, Siena, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Marco Cattalini
- Pediatric Clinic, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Nicola Ricco
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, University of Siena, Siena, Italy
| | - Alessandra Soriano
- Department of Internal Medicine, Arcispedale Santa Maria Nuova-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | | | - Elena Verrecchia
- Periodic Fever Research Center, Institute of Internal Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Antonella Insalaco
- Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Davide Montin
- Division of Immunology and Rheumatology, Department of Paediatric Infectious Diseases, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luisa Ciarcia
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, University of Siena, Siena, Italy
| | - Sara Barneschi
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, University of Siena, Siena, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Piero Ruscitti
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Maria Cristina Maggio
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Ombretta Viapiana
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Jurgen Sota
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, University of Siena, Siena, Italy
| | - Carla Gaggiano
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Roberto Giacomelli
- Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Ludovico Luca Sicignano
- Periodic Fever Research Center, Institute of Internal Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Raffaele Manna
- Periodic Fever Research Center, Institute of Internal Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Alessandra Renieri
- Medical Genetics, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Bruno Frediani
- Rheumatology Unit, Department of Medical Sciences, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena, Italy
| | - Donato Rigante
- Department of Life Sciences and Public Health, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.,Università Cattolica Sacro Cuore, Rome, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, University of Siena, Siena, Italy
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3
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Crisafulli F, Vitale A, Airò P, Grigis M, Gaggiano C, Dagna L, Cavalli G, Cimaz R, Viapiana O, Iannone F, Lopalco G, Bortolotti R, Abdel Jaber M, Montecucco C, Monti S, Balduzzi S, Emmi G, Mattioli I, Franceschini F, Cantarini L, Frassi M. Retention rate of IL-1 inhibitors in Schnitzler's syndrome. Clin Exp Rheumatol 2021; 40:2011-2017. [DOI: 10.55563/clinexprheumatol/14hu2k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Italy.
| | - Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Italy
| | - Marco Grigis
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Italy
| | - Carla Gaggiano
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UniRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Cavalli
- Vita-Salute San Raffaele University, Milan, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UniRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, Research Center for Adult and Paediatric Rheumatic Diseases, Università degli Studi di Milano, and Division of Paediatric Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari Aldo Moro, Bari, Italy
| | | | | | - Carlomaurizio Montecucco
- Department of Rheumatology, IRCCS Fondazione Policlinico S. Matteo, Pavia, and University of Pavia, Italy
| | - Sara Monti
- Department of Rheumatology, IRCCS Fondazione Policlinico S. Matteo, Pavia, and University of Pavia, Italy
| | - Silvia Balduzzi
- Department of Rheumatology, IRCCS Fondazione Policlinico S. Matteo, Pavia, and University of Pavia, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Micol Frassi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Italy
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Abdel Jaber M, Bortolotti R, Martinelli S, Felicetti M, Aloisi T, Paolazzi G. Acquired Hemophilia in a Patient With Rheumatoid Arthritis: Case Report and Literature Review. CMI 2019. [DOI: 10.7175/cmi.v12i1.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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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Jaber MA. Intraoral minor salivary gland tumors: a review of 75 cases in a Libyan population. Int J Oral Maxillofac Surg 2006; 35:150-4. [PMID: 16181771 DOI: 10.1016/j.ijom.2005.07.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Revised: 05/10/2005] [Accepted: 07/11/2005] [Indexed: 10/25/2022]
Abstract
Minor salivary gland carcinomas are uncommon but most often occur in the oral cavity, particularly the hard palate. Dental examination may provide an opportunity for early detection. During the period of 1977-2000 a group of 75 patients (31 males and 44 females, median age 44.2 years and range 15-86 years) with minor salivary gland tumors were diagnosed, based on the 1991 WHO classification. The peak occurrence of the tumors was in the fifth decade for males and sixth decade for females. The frequency of benign tumors was 38.6% (n = 29) and malignant tumors 61.3% (n = 46). Pleomorphic adenoma was the most common histological type of benign tumor identified whereas mucoepidermoid carcinoma and adenoid cystic carcinoma were the most common malignant tumors. The most common primary location of the tumors was the palate followed by the cheek. A benign tumor usually presented as an asymptomatic swelling and ulceration, pain being more frequently associated with the malignant tumors. This study shows that intraoral tumors of minor salivary glands vary widely in presentation, and should be taking into account by medical and dental practitioners in any differential diagnosis when assessing intraoral pathology. Any lesion arising from the hard palate (the most common site in this series) should be considered as a possible minor salivary gland tumor. Referral to a multidisciplinary head and neck clinic following diagnosis is strongly recommended.
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Affiliation(s)
- M A Jaber
- Faculty of Dentistry, Ajman University of Science and Technology, Ajman, United Arab Emirates.
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Abstract
To detail the clinical presentation of oral epithelial dysplasia in a large cohort of residents in western Europe. Descriptive statistical analysis of the data were calculated using chi-square and Fisher's exact tests. Oral epithelial dysplasia manifested typically as a white or mixed red and white lesion on the tongue, buccal mucosa or floor of mouth. The peak age of presentation of oral epithelial dysplasia was the 6th decade. Most clinically detected lesions had only mild oral epithelial dysplasia. Although uncommon, lesions with severe dysplasia were most likely to arise on the floor of mouth or lateral border of tongue. Oral epithelial dysplasia is likely to manifest as a solitary white patch, but it is not possible to accurately predict the likely degree of dysplasia from the clinical features of such lesions.
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Affiliation(s)
- M A Jaber
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK
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Jaber MA, Porter SR, Bain L, Scully C. Lack of association between hepatitis C virus and oral epithelial dysplasia in British patients. Int J Oral Maxillofac Surg 2003; 32:181-3. [PMID: 12729779 DOI: 10.1054/ijom.2002.0258] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Oral lichen planus may be a premalignant condition. An association between hepatitis C virus (HCV) infection and oral lichen planus has been described in Southern European and Japanese patients, and recently an association between HCV and oral squamous cell carcinoma was suggested from a study of Japanese patients. The present study investigated the frequency of chronic liver disease and HCV infection in UK patients with oral epithelial dysplasia (OED), a known premalignant disorder. Subjects included 75 patients with histologically proven OED and 110 healthy controls. Liver function and IgG antibodies to HCV were examined serologically. No patient with OED or control subject had serological evidence of hepatic disease, and anti-HCV antibodies were detected in only two (2.6%) of the 75 patients with OED, none of the controls being HCV seropositive. It is concluded that in the UK there is no association between HCV infection and OED.
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Affiliation(s)
- M A Jaber
- Eastman Dental Institute and Hospital for Oral Health Care Sciences, Department of Oral Medicine, University of London, 256 Gray's Inn Road, London, WC1X 8LD, UK
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Abstract
The present study provides an assessment of the importance of tobacco and alcohol consumption upon the development of oral epithelial dysplasia (OED) in a large group of European patients. Data were collected in a case-control study based upon 630 patients with OED and 643 control subjects selected from UK dental hospital patients with oral disease not caused by tobacco or alcohol. Logistic regression was used to determine the association of several independent factors on the risk of OED. No relationship emerged between patient's gender, age or ethnicity and risk of OED. The regression model demonstrated a combined effect of tobacco smoking and alcohol drinking upon the risk of OED. Non-filter cigarette smoking was a significant predictor of OED, as was alcohol consumption, and the two habits compounded one another in the overall risk of disease. When both factors combined were included in the model through interaction terms, their individual impact was only moderately reduced, illustrating the importance of both factors in their own right. However, more detailed analysis of tobacco smoking habits revealed that the increased risk of OED from smoking was largely attributable to heavy smoking (20 cigarettes per day, OR = 4.38, 95% C.I. = 2.6, 7.2) especially non-filter cigarettes (OR = 1.95, 95% C.I. = 0.9, 4.0) relative to non-smoking. Both heavy smoking and non-filtered tobacco were higher risks for OED than alcohol consumption alone. Tobacco cessation was associated with a significant decline in risk of OED, the reduction being rapid and marked. For alcohol consumption the association with OED was considerably stronger for drinkers of fortified wines and spirits (OR = 3.75, 95% C.I. = 1.40, 10.05 and OR = 1.36, 95% C.I. = 0.76, 2.45, respectively). It is concluded that, while tobacco and alcohol synergistically influence the development of OED, exclusive tobacco consumption is more likely than exclusive alcohol consumption to give rise to OED. The risk of OED may thus be significantly reduced by behavioural changes such as moderation of tobacco and alcohol use.
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Affiliation(s)
- M A Jaber
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University of London, UK
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Abstract
Oral epithelial dysplasia (OED) is an important risk factor in predicting subsequent development of invasive carcinoma. Despite the malignant potential of OED, the current state of knowledge regarding aetiological risk factors associated with OED is limited. The aim of our study was to evaluate the aetiological role of alcohol consumption in non-tobacco smokers and smoking behaviour in non-drinkers, in patients presenting with OED. Data from a hospital-based case-control study of OED were used to analyse the risk associated with alcohol in non-smokers and with tobacco in non-drinkers. A total of 140 cases and 236 controls were included. In the non-drinkers, the risks of OED increased with tobacco smoking of more than 20 cigarettes per day, particularly non-filter cigarettes. The risk of OED declined following smoking cessation, with ex-smokers of 10 or more years demonstrating no excess risk relative to non-smokers. In the nonsmokers, consumption of alcohol was not a significant predictor of OED. However, there was a synergistic effect of alcohol when combined with some aspects of tobacco smoking. Our results confirm that tobacco has an independent role in the aetiology of OED. The role of alcohol, however, is principally only important in conjunction with tobacco use.
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Affiliation(s)
- M A Jaber
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University of London, UK
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Jaber MA, Diz Dios P, Vázquez García E, Cutando Soriano A, Porter SR. Spanish dental students knowledge of oral malignancy and premalignancy. Eur J Dent Educ 1997; 1:167-171. [PMID: 9516286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND In view of the gradual rise in oral malignancy in Europe, there is an increased need for undergraduate dental students to have some appropriate training in the recognition of the signs and symptoms of oral Premalignancy and malignancy, and be aware of the appropriate early management of patients with such oral lesions. The present study outlines the results of a pilot study to determine the knowledge and awareness of a cohort of undergraduate dental students in Spain regarding the management of oral premalignancy and malignancy. METHOD In March 1997 a self-administered questionnaire (SAQ) addressing student's knowledge, opinions, and related aspects of screening and detection of oral malignancy and premalignancy, was mailed to 200 undergraduate dental students in two Spanish Universities. The present report details the responses of this cohort of undergraduates. Statistical analysis of the data was performed using the chi(2) test and the results were considered significant when P < 0.05. RESULTS 37.0% of the respondents were male and 63.0% female. Almost all of the respondents (99.0%) had attended general dental congresses and 81.5% had attended specific courses on oral malignancy and premalignancy. Only 20% of undergraduate students had witnessed at least one patient with oral malignancy. Squamous cell carcinoma (SCC) was the most frequently observed (94.4%) oral tumour. 79% of the respondents had examined or witnessed at least one patient with a potentially malignant lesion. Leukoplakias were the most commonly observed (80.0%) premalignant lesions. 5th year students were more likely to have performed a biopsy than 4th year students (P < 0.05), particularly male students (P < 0.005). 40.0% of respondents believed that the lower lip was the most common site of an oral cancer; almost half realised that a tumour could have a speckled appearance. 79% to 82% of the respondents indicated that tobacco and alcohol were the principal causes of oral SCC, but 34.6% suggested that HIV disease was a risk factor for oral SCC. Almost all respondents routinely recorded the tobacco or alcohol consumption of patients and would offer advice to patients regarding modification of these habits. 64.0% of undergraduates suggested that clinical screening at intervals of 6 to 12 months was an effective means of diagnosing oral premalignant and malignant lesions, and almost all considered oral health promotion to be an effective means of reducing oral cancer mortality. CONCLUSIONS Undergraduate dental students in Spain have limited clinical experience or knowledge of related aspects of oral premalignant and malignant lesions, and they may fail to recognise appropriate signs and symptoms and aetiological factors of such disease.
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Affiliation(s)
- M A Jaber
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University of London, UK.
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Affiliation(s)
- M A Jaber
- Department of Oral Medicine, Eastman Dental Institute for Oral Healthcare Sciences, London, England
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