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Geroin C, Petracca M, Di Tella S, Marcuzzo E, Erro R, Cuoco S, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, Eleopra R, Zappia M, Nicoletti A, Dallocchio C, Arbasino C, Bono F, Laterza V, Demartini B, Gambini O, Modugno N, Olivola E, Bonanni L, Albanese A, Ferrazzano G, Tessitore A, Lopiano L, Calandra‐Buonaura G, Morgante F, Esposito M, Pisani A, Manganotti P, Tesolin L, Teatini F, Camozzi S, Ercoli T, Stocchi F, Coletti Moja M, Defazio G, Tinazzi M. Elderly Onset of Functional Motor Disorders: Clinical Correlates from the Italian Registry. Mov Disord Clin Pract 2024; 11:38-44. [PMID: 38291844 PMCID: PMC10828615 DOI: 10.1002/mdc3.13916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Functional motor disorders (FMD) are a frequent neurological condition affecting patients with movement disorders. Commonly described in younger adults, their manifestation can be also associated to an elderly onset. OBJECTIVE To assess the prevalence and describe the clinical manifestations of FMD with elderly and younger onset and their relationship with demographical and clinical variables. METHODS We recruited patients with a "clinically definite" diagnosis of FMD from the Italian Registry of FMD. Patients underwent extensive clinical assessments. For elderly onset, we set a chronological cut-off at 65 years or older according to WHO definition. Multivariate regression models were implemented to estimate adjusted odds ratio of elderly FMD onset related to clinical characteristics. RESULTS Among the 410 patients, 34 (8.2%) experienced elderly-onset FMD, with a mean age at onset of 70.9 years. The most common phenotype was tremor (47.1%), followed by gait disorders, weakness, and dystonia (29.4%, 23.5%, 14.7%, respectively). Eleven elderly patients had a combined phenomenology: 9 exhibited two phenotypes, 2 had three phenotypes. Weakness was isolated in 3/8 patients and combined with another phenotype in 5/8, manifesting as paraplegia (n = 4); upper limb diplegia (n = 2), hemiparesis/hemiplegia (n = 1), and tetraparesis/tetraplegia (n= 1). Non-motor and other functional neurological disorders occurred more frequently in the younger group (89.1%) than the elderly (73.5%). Neurological and non-neurological comorbidities were more prevalent in the elderly group (82.4%) as opposed to the younger (32.7%). In a multivariate regression analysis, elderly-onset FMD was significantly associated with neurological comorbidities, including parkinsonism (OR 6.73) and cerebrovascular diseases (OR 5.48). CONCLUSIONS These results highlight the importance of achieving an accurate diagnosis of FMD in the elderly, as it is crucial for effectively managing FMD symptoms and addressing neurological comorbidities.
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Affiliation(s)
- Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVeronaItaly
| | - Martina Petracca
- Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Sonia Di Tella
- Department of PsychologyUniversità Cattolica del Sacro CuoreMilanItaly
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVeronaItaly
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry‐Scuola Medica Salernitana, University of SalernoBaronissiItaly
| | - Sofia Cuoco
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry‐Scuola Medica Salernitana, University of SalernoBaronissiItaly
| | - Roberto Ceravolo
- Center for NeuroDegenerative Diseases Parkinson and Movement Disorders, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Sonia Mazzucchi
- Center for NeuroDegenerative Diseases Parkinson and Movement Disorders, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
- FERB Onlus, Ospedale S. Isidoro, Trescore BalnearioBergamoItaly
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Luigi Michele Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Mario Zappia
- Department G.F. Ingrassia, Section of NeurosciencesUniversity of CataniaCataniaItaly
| | - Alessandra Nicoletti
- Department G.F. Ingrassia, Section of NeurosciencesUniversity of CataniaCataniaItaly
| | | | - Carla Arbasino
- Department of Medical AreaNeurology Unit, ASST PaviaPaviaItaly
| | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater DominiCatanzaroItaly
| | - Vincenzo Laterza
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater DominiCatanzaroItaly
| | - Benedetta Demartini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health SciencesUniversity of MilanMilanItaly
| | - Orsola Gambini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health SciencesUniversity of MilanMilanItaly
| | | | | | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G. d'AnnunzioChieti‐PescaraItaly
| | - Alberto Albanese
- Department of NeurologyIRCCS Humanitas Research HospitalRozzanoItaly
| | - Gina Ferrazzano
- Department of Human NeurosciencesUniversità La SapienzaRomeItaly
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgery SciencesUniversity of Campania—Luigi VanvitelliNaplesItaly
| | - Leonardo Lopiano
- Department of Neuroscience—Rita Levi MontalciniUniversity of TurinTurinItaly
| | - Giovanna Calandra‐Buonaura
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of LondonLondonUnited Kingdom
- Department of Experimental and Clinical MedicineUniversity of MessinaMessinaItaly
| | | | - Antonio Pisani
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of TriesteTriesteItaly
| | - Lucia Tesolin
- Functional Movement Disorders Outpt.Clinic, Clinical Neurology and Stroke Unit Dep.Central Country HospitalBolzanoItaly
| | - Francesco Teatini
- Functional Movement Disorders Outpt.Clinic, Clinical Neurology and Stroke Unit Dep.Central Country HospitalBolzanoItaly
| | - Serena Camozzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVeronaItaly
| | - Tommaso Ercoli
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Fabrizio Stocchi
- University and Institute of Research and Medical Care San Raffaele RomaRomeItaly
| | | | - Giovanni Defazio
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVeronaItaly
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Shergill M, McAdam RF, Tarafdar N, Sachdeva M, Maliyar K, Georgakopoulos JR, Mufti A, Yeung J. Elderly Onset Generalized Pustular Psoriasis: A Systematic Review. J Cutan Med Surg 2024; 28:89-90. [PMID: 37947255 DOI: 10.1177/12034754231211341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Mahek Shergill
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rochelle F McAdam
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nawar Tarafdar
- Western University, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Muskaan Sachdeva
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Khalad Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jorge R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
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3
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Shiozumi T, Okada N, Matsuyama T, Yamahata Y, Ohta B. Anti-Muscle-Specific Kinase (MuSK) Antibody-Positive Myasthenia Gravis Presenting With Dyspnea in an Elderly Woman: A Case Report. Cureus 2023; 15:e50480. [PMID: 38222201 PMCID: PMC10786710 DOI: 10.7759/cureus.50480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Myasthenia gravis (MG) is an autoimmune disease and represents one of the most common disorders associated with neuromuscular transmission defects. Within MG, the anti-muscle-specific kinase antibody-positive subtype (MuSK-positive MG) is rare. While it shares similarities with the common form of MG by presenting with ocular weakness, MuSK-positive MG typically presents with more atypical symptoms. Although MuSK-positive MG can lead to type 2 respiratory failure due to respiratory weakness, there have been limited reports where initial presentation involves only respiratory compromise. This study details a case of MuSK-positive MG presenting dyspnea. An 84-year-old female presented to the emergency department due to a three-day history of progressive respiratory distress, characterized by increased respiratory effort and shallow breathing, resulting in a diagnosis of type 2 respiratory failure. Despite the absence of neurological abnormalities, she tested positive for anti-muscle-specific kinase antibodies, confirming a diagnosis of MuSK-positive MG. This case highlights the significance of considering MG in the context of type 2 respiratory failure, even in the absence of typical neurological symptoms, especially in elderly patients.
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Affiliation(s)
- Tadaharu Shiozumi
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, JPN
| | - Nobunaga Okada
- Department of Emergency Medicine, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, JPN
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, JPN
| | - Yoshihiro Yamahata
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, JPN
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, JPN
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Ando T, Abe Y, Yamaji K, Nishikomori R, Tamura N. A case of cryopyrin-associated periodic syndrome due to somatic mosaic mutation complicated with recurrent circinate erythematous psoriasis. Mod Rheumatol Case Rep 2023:rxad067. [PMID: 38036300 DOI: 10.1093/mrcr/rxad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/13/2023] [Accepted: 11/30/2023] [Indexed: 12/02/2023]
Abstract
Cryopyrin-associated periotic syndrome (CAPS) is a rare autoinflammatory disease (AID) caused by genetic variants in innate immunity genes. AIDs, including CAPS, mediate proinflammatory cytokines such as interleukin (IL)-1 and IL-18 and result in severe systemic inflammation. A gain-of-function mutation in the NLRP3 gene, which encodes the protein cryopyrin, was identified to be responsible for CAPS in 2001, and since then several additional pathogenic mutations have been found. Moreover, other phenotypes have been identified based on severity and symptomatology, including familial cold autoinflammatory syndrome, Muckle-Wells syndrome (MWS), and neonatal-onset multisystem inflammatory disease (NOMID)/chronic neurologic cutaneous articular syndrome (CINCA). Prompt diagnosis of CAPS remains challenging, however, due to unspecific, extensive clinical signs, and delayed diagnosis and treatment targeting IL-1 lead to multiorgan damage. Another factor complicating diagnosis is the existence of somatic mosaic mutations in the NLRP3 gene in some cases, resulting in symptoms and clinical courses that are atypical. The frequency of somatic mosaic mutations in CAPS was estimated to be 19% in a systematic review. Psoriasis is a chronic inflammatory skin disease that affects about 3% of the global population. Although no reports have shown complication between CAPS and psoriasis, these diseases have several similarities and potential relationships, for instance activation of Th17 cells in the dermis and increased NLRP3 gene expression in psoriatic skin compared with normal skin. Here we report a case of CAPS due to a somatic mosaic mutation with recurrent circinate erythematous psoriasis.
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Affiliation(s)
- Taiki Ando
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Abe
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ken Yamaji
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryuta Nishikomori
- The Department of Pediatrics and Child Health, Kurume University School of Medicine
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
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Abstract
We present the case of a woman in her 70s who was diagnosed with rheumatoid vasculitis (RV) after initially presenting with systemic joint pain and erythema. RV, a rare complication of rheumatoid arthritis, involves inflammation of blood vessels, leading to various skin manifestations. The patient's complaints included fever, generalized joint pain, and skin manifestations that initially resembled erythema multiforme. However, a skin biopsy revealed vasculitis, which guided the RV diagnosis. Although rheumatoid arthritis primarily affects the joints, systemic implications such as RV can arise in rare cases. This case underscores the importance of a holistic and meticulous diagnostic approach, especially in older patients, as early detection and treatment are crucial for managing disease progression and associated complications. Collaborative care involving multidisciplinary teams is vital to achieving optimal outcomes in complex cases.
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Affiliation(s)
- Taiki Amao
- Family Medicine, Shimane University Faculty of Medicine, Izumo, JPN
| | - Fusa Koda
- Family Medicine, Shimane University Faculty of Medicine, Izumo, JPN
| | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Cosme I, Nobre E, Bugalho MJ. Newly Diagnosed Type 1 Diabetes in an Elderly Patient. Cureus 2023; 15:e43646. [PMID: 37719609 PMCID: PMC10505049 DOI: 10.7759/cureus.43646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Type 1 diabetes (T1D) is typically diagnosed in young people; however, it can appear at any age. Its incidence in adulthood is not as well-known as in childhood, particularly if it is diagnosed in geriatric age. T1D diagnosed in adulthood can be explained by the development of antibodies in adulthood or also by the existence of slow-disease progressors. A 71-year-old normal-weight woman presented to the Emergency Department complaining of polyuria, polydipsia, and tiredness. She was identified with hyperglycemia (450mg/dL) and high blood and urine ketone bodies. Her arterial gasometry revealed mild metabolic ketoacidosis. Further laboratory work-up was remarkable for positive anti-GAD and anti-ICA antibodies and her HbA1c was 14.1%. The diagnosis of T1D was established. A urinary infection was also identified. The patient's symptoms in association with metabolic ketoacidosis, in the presence of high titers of more than one positive T1D-related antibody, have helped us to diagnose T1D in this elderly woman. A prompt diagnosis enabled us to establish adequate diabetes treatment. The urinary infection was probably a trigger to the symptomatic phase of diabetes. T1D can be diagnosed at any age, even in elderly patients. A prompt T1D diagnosis can avoid the misdiagnosis of type 2 diabetes (T2D), enabling the beginning of correct medication earlier.
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Affiliation(s)
- Inês Cosme
- Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
| | - Ema Nobre
- Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
| | - Maria João Bugalho
- Clínica Universitária de Endocrinologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, PRT
- Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
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Muacevic A, Adler JR, Labban AA, Alsawaf AH, Alnofeay KA. Iselin Disease With a Rare Presentation in an Elderly Patient: A Case Report. Cureus 2023; 15:e33922. [PMID: 36819335 PMCID: PMC9936917 DOI: 10.7759/cureus.33922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
We report the case of a 55-year-old female with a rare presentation and different pathophysiology of Iselin's disease. Iselin's disease is a rare condition caused by traction apophysitis of the peroneus brevis tendon at the base of the fifth metatarsal bone. It is usually a case in the adolescent age group due to their repetitive use of the peroneus tendon in daily activities, but not in the elderly group. This type of apophysitis is rare and easily missed or misdiagnosed as a fracture in the base of the fifth metatarsal bone. However, a simple radiographic image can confirm the diagnosis. In this case, we aim to raise awareness of Iselin's disease for better comprehension of the clinical presentation, differential diagnosis, radiological features, management, and prognosis of Iselin's disease.
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Hernandez Fustes OJ, Arteaga Rodriguez C, Hernandez Fustes OJ. Myasthenia Gravis with Elderly Onset at Advanced Age. Cureus 2020; 12:e6808. [PMID: 32038895 PMCID: PMC6991148 DOI: 10.7759/cureus.6808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/14/2020] [Accepted: 01/29/2020] [Indexed: 11/17/2022] Open
Abstract
Myasthenia gravis (MG) in older adults has not been extensively studied. The prevalence of this disease in older people seems to be higher in recent epidemiological studies. In patients with disease onset after the age of 70, the diagnosis is more difficult as other conditions are more easily taken to be the causal element. The mortality is higher than in young patients, so prompt specific treatment can improve prognosis. We present an 85-year-old female patient with speech disturbance and difficulty in swallowing solids, and neurological examination with palpebral ptosis, disphonia, convergent strabismus and weakness and mild progressive fatigue in arms, with electroneuromyography and acetylcholine receptor antibody who was diagnosed with MG, emphasizing the importance of this entity in geriatric patients.
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Kinboshi M, Morimoto Y, Yoshida T, Kuzume D, Yamasaki M. [An elderly case of Guillain-Barré syndrome with anti-GT1b antibodies]. Rinsho Shinkeigaku 2019; 59:600-603. [PMID: 31474642 DOI: 10.5692/clinicalneurol.cn-001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An 85-year-old Japanese female was admitted with sudden onset of quadriparesis with areflexia. Preceding infection was not present. IgG anti-GT1b antibodies were prominently positive in serum. Nerve conduction study results suggested Guillain-Barré syndrome (GBS) classified as acute motor sensory axonal neuropathy (AMSAN). While intravenous immunoglobulin (IVIg) was started, bulbar palsy and respiratory failure progressed and the condition deteriorated. Although mechanical ventilation was required, second IVIg course led to gradual improvement of quadriparesis and bulbar palsy. In the present case with elderly-onset disease, the levels of anti-GT1b antibodies were elevated, which is relatively rare in GBS. It was suggested that anti-GT1b antibodies may be related to the development of axonal GBS with bulbar palsy.
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Sato S, Yashiro M, Matsuoka N, Asano T, Kobayashi H, Watanabe H, Migita K. Clinical features and outcomes in patients with elderly-onset anti-neutrophil cytoplasmic antibody-associated vasculitis. Geriatr Gerontol Int 2018; 18:1453-1457. [PMID: 30168252 DOI: 10.1111/ggi.13511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 07/01/2018] [Accepted: 07/14/2018] [Indexed: 11/28/2022]
Abstract
AIM Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is commonly seen in older patients. The present study intended to clarify whether elderly-onset AAV (at age ≥75 years) shows any specific clinical features and outcomes in Japanese patients. METHODS This study was a retrospective cohort study. A total of 36 AAV patients who were initially treated at the Department of Rheumatology, Fukushima Medical University Hospital (Fukushima, Japan) between 2004 and 2016 were included. AAV patients were divided into an elderly group (≥75 years) and a younger group (<75 years), and their clinical records were reviewed. RESULTS Elderly AAV patients showed similar clinical features to younger AAV patients, except that they were more often women, weighed less, had an increased frequency of kidney involvement and had lower serum ferritin levels. Kaplan-Meier analyses showed significantly lower 1-year survival in elderly AAV (P =0.008) as well as AAV patients enrolled not receiving additional immunosuppressive treatment (P =0.023). The cause of death was disease progression itself or infection. CONCLUSIONS The clinical features of AAV are similar between elderly and younger patients, except for increased kidney involvement and lower serum ferritin levels. Proper monitoring of the disease and adverse events, and providing conventional immunosuppressive therapy is suggested to avoid a poor outcome, especially in elderly AAV patients. Geriatr Gerontol Int 2018; 18: 1453-1457.
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Affiliation(s)
- Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Makiko Yashiro
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Naoki Matsuoka
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroko Kobayashi
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroshi Watanabe
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by erosive arthritis and systemic organ involvement. The disease may affect all ages and both sexes; usually it is seen in young women aged 25-45. Recent studies have shown that RA is among the most common inflammatory disease in older age groups. While elderly-onset rheumatoid arthritis (EORA) is still discussed in the literature, it is generally accepted as a disease beginning after 65 years of age. Compared with young-onset rheumatoid arthritis (YORA), it was found that EORA had different characteristics. EORA is characterized by more equal gender distribution, higher frequency of acute onset with constitutional symptoms, more frequent involvement of large joints, and lower frequency of rheumatoid factor (RF) positivity. Earlier diagnosis, less erosive disease and less disease-modifying antirheumatic drug usage were reported as distinguishing EORA from YORA patients. These various clinical presentations may cause difficulties in diagnosis and differential diagnosis of EORA. However, different clinical and treatment approaches may be needed in these patients. In this article, the clinical and laboratory characteristics, prognosis and treatment principles of EORA will be discussed in light of recent literature data.
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Affiliation(s)
- Senol Kobak
- Department of Rheumatology, Istinye University Faculty of Medicine, Liv Hospital, Canan Sok. No:5, 34340 Ulus/Istanbul, Turkey
| | - Cemal Bes
- Department of Rheumatology, Health Sciences University Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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12
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Suzuki T, Yoshida R, Hidaka Y, Seri Y. Proliferative Synovitis of the Shoulder Bursae is a Key Feature for Discriminating Elderly Onset Rheumatoid Arthritis Mimicking Polymyalgia Rheumatica From Polymyalgia Rheumatica. Clin Med Insights Arthritis Musculoskelet Disord 2017. [PMID: 29242702 DOI: 10.1177/1179544117745851.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Semiquantitative scoring for subacromial bursa (SAB), subdeltoid bursa (SDB), and subcoracoid bursa by both gray-scale (GS) and power Doppler (PD) ultrasonography was performed in 15 patients with polymyalgia rheumatica (PMR) (72.6 ± 7.7 years old) and 15 patients with elderly onset rheumatoid arthritis with PMR-like onset (pm-EORA) (70.7 ± 7.0 years old) before starting treatment. The GS grades of SAB were significantly higher in the shoulders with pm-EORA than in the shoulders with PMR. The GS and PD scores of SAB and the PD scores of SDB were significantly higher in pm-EORA than in PMR cases. The sums of GS and/or PD scores for the three bursae were significantly higher in pm-EORA than in patients with PMR. The sums of GS and PD scores for SAB were significantly higher in pm-EORA than in PMR cases. Moderate to severe proliferative synovitis of the shoulder bursae, especially in SAB, is a key feature for discriminating pm-EORA from PMR.
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Affiliation(s)
- Takeshi Suzuki
- Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan.,Division of Rheumatology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Ryochi Yoshida
- Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuka Hidaka
- Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yu Seri
- Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan
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13
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Ueda Y, Komine M, Kamiya K, Tsuda H, Maekawa T, Murata S, Ohtsuki M. Generalized pustular psoriasis in a 92-year-old man with a homozygous nonsense mutation in IL36RN. J Dermatol 2017; 45:326-328. [PMID: 29215143 DOI: 10.1111/1346-8138.14132] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 10/15/2017] [Indexed: 11/30/2022]
Abstract
A 92-year-old man developed an erythematous eruption on the trunk and extremities with numerous pustules accompanied by fever. He had never experienced pustular eruption or been diagnosed with psoriasis previously. Skin biopsy revealed Kogoj's spongiform pustule, and he was diagnosed with generalized pustular psoriasis (GPP). Genomic DNA was extracted from his peripheral blood and the sequence of IL36RN gene was analyzed, which revealed a p.Arg10X homozygous mutation. Several cases of elderly-onset GPP have been reported, however, this is the oldest case of GPP. The existence of splice variants of IL36RN was suspected, but we could not detect any splice variants of IL36RN in this case or in a healthy control from peripheral blood samples.
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Affiliation(s)
- Yoshitaka Ueda
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Hidetoshi Tsuda
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Satoru Murata
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
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Suzuki T, Yoshida R, Hidaka Y, Seri Y. Proliferative Synovitis of the Shoulder Bursae is a Key Feature for Discriminating Elderly Onset Rheumatoid Arthritis Mimicking Polymyalgia Rheumatica From Polymyalgia Rheumatica. Clin Med Insights Arthritis Musculoskelet Disord 2017; 10:1179544117745851. [PMID: 29242702 PMCID: PMC5724643 DOI: 10.1177/1179544117745851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/08/2017] [Indexed: 12/02/2022]
Abstract
Semiquantitative scoring for subacromial bursa (SAB), subdeltoid bursa (SDB), and subcoracoid bursa by both gray-scale (GS) and power Doppler (PD) ultrasonography was performed in 15 patients with polymyalgia rheumatica (PMR) (72.6 ± 7.7 years old) and 15 patients with elderly onset rheumatoid arthritis with PMR-like onset (pm-EORA) (70.7 ± 7.0 years old) before starting treatment. The GS grades of SAB were significantly higher in the shoulders with pm-EORA than in the shoulders with PMR. The GS and PD scores of SAB and the PD scores of SDB were significantly higher in pm-EORA than in PMR cases. The sums of GS and/or PD scores for the three bursae were significantly higher in pm-EORA than in patients with PMR. The sums of GS and PD scores for SAB were significantly higher in pm-EORA than in PMR cases. Moderate to severe proliferative synovitis of the shoulder bursae, especially in SAB, is a key feature for discriminating pm-EORA from PMR.
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Affiliation(s)
- Takeshi Suzuki
- Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan.,Division of Rheumatology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Ryochi Yoshida
- Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuka Hidaka
- Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yu Seri
- Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan
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