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Koletsos N, Dipla K, Triantafyllou A, Lazaridis A, Papadopoulos N, Zafeiridis A, Aslanidis S, Douma S, Gkaliagkousi E. POS0738 BLUNTED CEREBRAL OXYGENATION DURING EXERCISE IN NON-NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1867] [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: 11/04/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple organs, including the central nervous system. Subclinical brain lesions have been reported in SLE patients, even without overt neuropsychiatric manifestations (non-NPSLE). Studies using PET/MRI, examining structural or functional brain abnormalities in SLE, have been previously performed, either at rest or during a mental task (1–3). Exercise can be used to identify early alterations in brain oxygenation that might not detectable during resting conditions (4).Objectives:Our study aimed to examine possible differences in cerebral oxygenation during a handgrip exercise test between SLE patients without neuropsychiatric manifestations and age-matched controls.Methods:Fifty-two participants (26 non-NPSLE and 26 controls), following evaluation of handgrip strength, underwent a protocol involving a seated rest (baseline), a 3-min handgrip exercise (at 30% of maximal strength), and a 3-min recovery. Continuous-near-infrared-spectroscopy (NIRS) was used to monitor changes in cerebral-oxygenated hemoglobin (O2Hb), de-oxygenated (HHb) and total-hemoglobin (tHb). Beat-by-beat blood pressure (Finapres) was continuously monitored.Results:There were no differences between the two groups in age, body mass index, blood pressure, and smoking status. Median SLE duration was 7.5 (3.0 – 16.0) years. During exercise, cerebral -O2Hb increased in both groups; however, non-NPSLE exhibited a significantly lower increase in O2Hb vs. controls (average response:1.20±0.89 vs. 2.33±1.61μM, respectively, p<0.005) and lower tHb responses (p<0.05), with no differences in HHb.Conclusion:Our data show, for the first time, that SLE patients even without overt neuropsychiatric manifestations exhibit a blunted increase in cerebral-O2Hb during a submaximal exercise stimulus compared to age-matched controls. Examining brain oxygenation during a simple exercise task may assist in identifying patients with early alterations in cerebral function.References:[1]Mak A, Ren T, Fu EH yun, Cheak AA cia, Ho RCM. A Prospective Functional MRI Study for Executive Function in Patients with Systemic Lupus Erythematosus Without Neuropsychiatric Symptoms. Semin Arthritis Rheum. 2012;41(6):849–58.[2]Kozora E, Brown MS, Filley CM, Zhang L, Miller DE, West SG, et al. Memory impairment associated with neurometabolic abnormalities of the hippocampus in patients with non-neuropsychiatric systemic lupus erythematosus. Lupus. 2011;20(6):598–606.[3]Mackay M, Vo A, Tang CC, Small M, Anderson EW, Ploran EJ, et al. Metabolic and microstructural alterations in the SLE brain correlate with cognitive impairment. JCI Insight. 2019;4(1).[4]Triantafyllou GA, Dipla K, Triantafyllou A, Gkaliagkousi E, Douma S. Measurement and Changes in Cerebral Oxygenation and Blood Flow at Rest and During Exercise in Normotensive and Hypertensive Individuals. Vol. 22, Current Hypertension Reports. Springer; 2020.Disclosure of Interests:None declared
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Anyfanti P, Triantafyllou A, Chatzimichailidou S, Aslanidis S, Douma S. Arterial stiffness indexes and serum cytokine levels in seronegative spondyloarthritis: relationships between stiffness markers and metabolic and immunoinflammatory variables: comments on the article by Tuttolomondo et al. Scand J Rheumatol 2016; 45:539-540. [DOI: 10.3109/03009742.2016.1151073] [Citation(s) in RCA: 2] [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] [Indexed: 11/13/2022]
Affiliation(s)
- P Anyfanti
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Chatzimichailidou
- Rheumatology Department, 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Aslanidis
- Rheumatology Department, 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Anyfanti P, Pyrpasopoulou A, Triantafyllou A, Triantafyllou G, Chatzimichailidou S, Gavriilaki E, Panagopoulos P, Botis I, Gkaliagkousi E, Aslanidis S, Douma S. Mental health disorders, but not traditional cardiovascular risk factors, are associated with sexual dysfunction in rheumatologic patients. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Anyfanti P, Triantafyllou A, Pyrpasopoulou A, Chatzimichailidou S, Triantafyllou G, Botis I, Panagopoulos P, Aslanidis S, Douma S. AB0380 Association Between Impaired Macrovascular Function and Rheological Parameters in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Anyfanti P, Pyrpasopoulou A, Triantafyllou A, Chatzimichailidou S, Aslanidis S, Douma S. Acute inflammatory arthritis in the elderly; Old flames, new sparks. Hippokratia 2014; 18:231-233. [PMID: 25694757 PMCID: PMC4309143] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The overall world prevalence of rheumatoid arthritis (RA) ranges from 0.5-1.0%. The annual incidence of RA in most European countries ranges from roughly 0.4 to >2.5 per 1,000 adults, increasing with age. A significant proportion of newly diagnosed cases will evolve into true erosive RA. METHODS The aim of this cohort study was to study the characteristics of new developing, acute (<1 year), rheumatoid arthritis in an elderly (>65 years) population; its presenting features, accompanying manifestations and laboratory findings. One hundred twenty eight patients (103♀, 25♂) who presented to the rheumatology outpatients clinic with new-onset RA were included in the study. 42.2% of the patients had pre-existing osteoarthritis. RESULTS At presentation, 14.3% of the patients had systemic manifestations (fever, weight loss), 25.78% reported concomitant sicca symptomatology, and 50.9% were found to have abnormal haematological parameters (anemia and/or thrombocytosis). Clinical and laboratory parameters of the disease were analyzed and related to disease manifestations.. Haematological abnormalities were found to be associated both with increased inflammatory markers, as well as with increased titres of rheumatoid factor (RF), but not anti - cyclic citrullinated peptide (CCP) antibodies, in contrary to systemic manifestations which were not found to be related to the above mentioned parameters. CONCLUSIONS As the global population is becoming older, physicians will be challenged with the recognition and treatment of these conditions and their particular features in an increasing number of geriatric patients; within the context of the specific characteristics and comorbidities of this age group. Hippokratia 2014; 18 (3): 231-233.
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Affiliation(s)
- P Anyfanti
- 2 Propedeutic Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece
| | - A Pyrpasopoulou
- 2 Propedeutic Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece
| | - A Triantafyllou
- 3 Department of Internal Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - S Chatzimichailidou
- 2 Propedeutic Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece
| | - S Aslanidis
- 2 Propedeutic Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece
| | - S Douma
- 3 Department of Internal Medicine, Papageorgiou Hospital, Thessaloniki, Greece
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Settas L, Andrianakos A, Aslanidis S, Boura P, Katsounaros M, Vassilopoulos D, Athanassiou P, Tempos K, Skarantavos G, Antoniadis C, Sakkas L, Andonopoulos AP, Galanopoulou V, Solioti F, Boki K, Vritzali E, Sfikakis PP. SAT0127 Long-Term Safety and Efficacy Following the Administration of Multiple Rituximab Cycles in Rheumatoid Arthritis (RA) Patients: The Multicenter, Prospective Launch Study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ioannou M, Pyrpasopoulou A, Simos G, Paraskeva E, Nikolaidou C, Venizelos I, Koukoulis G, Aslanidis S, Douma S. AB0246 Upregulation of VEGF expression is associated with accumulation of HIF-1A in the skin of scleroderma patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Anyfanti P, Pyrpasopoulou A, Triantafyllou A, Doumas M, Gavriilaki E, Triantafyllou G, Gkaliagkousi E, Chatzimichailidou S, Petidis K, Avagianou PA, Zamboulis C, Aslanidis S, Douma S. The impact of frequently encountered cardiovascular risk factors on sexual dysfunction in rheumatic disorders. Andrology 2013; 1:556-62. [DOI: 10.1111/j.2047-2927.2013.00094.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 03/28/2013] [Accepted: 04/02/2013] [Indexed: 01/23/2023]
Affiliation(s)
- P. Anyfanti
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - A. Pyrpasopoulou
- Department of Rheumatology - 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - A. Triantafyllou
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - M. Doumas
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - E. Gavriilaki
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - G. Triantafyllou
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - E. Gkaliagkousi
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - S. Chatzimichailidou
- Department of Rheumatology - 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - K. Petidis
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - P.-A. Avagianou
- Laboratory of Developmental Psychology and Psychopathology; Preschool Education Department; University of Thessaly; Thessaly; Greece
| | - C. Zamboulis
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - S. Aslanidis
- Department of Rheumatology - 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - S. Douma
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
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Stefanidou S, Gerodimos C, Benos A, Galanopoulou V, Chatziyannis I, Kanakoudi F, Aslanidis S, Boura P, Sfetsios T, Settas L, Katsounaros M, Papadopoulou D, Giamalis P, Dombros N, Chatzistilianou M, Garyfallos A. Clinical expression and course in patients with late onset systemic lupus erythematosus. Hippokratia 2013; 17:153-156. [PMID: 24376322 PMCID: PMC3743621] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND To analyze the pattern of clinical expression and the 5-year disease course in Caucasian patients with late onset of systemic lupus erythematosus (SLE) and to compare the findings with an early onset SLE group. METHODS Medical records of 551 patients who presented with SLE at hospitals of the region of Thessaloniki between 1989 and 2007 were studied. Patients who developed SLE at or after the age of 50 years were classified as the late onset group, while younger patients served as the early onset group. Data on clinical manifestations and damage accrual at disease onset and at 5 years was obtained and compared between the two groups. RESULTS In 121 patients, the disease started after the age of 50 years. Elderly patients showed less pronounced female predominance and less often presented with malar rash, nephropathy, fever and lymphadenopathy, while lung involvement, pericarditis and sicca syndrome were more frequent. Damage accrual was similar in both groups. The main causes of damage at 5 years differed, with the elderly exhibiting more cardiovascular damage. They also had a higher incidence of hypertension and osteoporosis at 5 years. CONCLUSIONS Caucasian SLE patients with late onset of the disease present with different clinical manifestations, suggesting that age affects the expression of SLE. Damage accrual at 5 years is similar in the elderly and the younger patients. However, the causes of this damage and the occurrence of other comorbidities follow a different pattern, possibly reflecting the disease process and the effects of aging.
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Affiliation(s)
- S Stefanidou
- 4 Department of Internal Medicine, Aristotle University, Hippokration Hospital
| | - C Gerodimos
- 4 Department of Internal Medicine, Aristotle University, Hippokration Hospital
| | - A Benos
- Department of Hygiene, Aristotle University
| | | | | | - F Kanakoudi
- 1 Department of Pediatrics, Aristotle University, Hippokration Hospital
| | - S Aslanidis
- 2 Propedeutic Department of Internal Medicine, Hippokration Hospital
| | - P Boura
- 2 Department of Internal Medicine, Aristotle University, Hippokration Hospital
| | - T Sfetsios
- Department of Rheumatology, Inter-Balkan Hospital
| | - L Settas
- 1 Department of Internal Medicine, Aristotle University, AHEPA Hospital
| | - M Katsounaros
- 2 Department of Internal Medicine, Papanikolaou Hospital
| | | | - P Giamalis
- Department of Nephrology, Hippokration Hospital
| | - N Dombros
- Department of Nephrology, AHEPA Hospital
| | - M Chatzistilianou
- 2 Department of Pediatrics, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - A Garyfallos
- 4 Department of Internal Medicine, Aristotle University, Hippokration Hospital
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Triantafyllou A, Gavriilaki E, Triantafyllou G, Anyfanti P, Pyrpasopoulou A, Chatzimichailidou S, Gkaliagkousi E, Avagianou PA, Papadopoulos N, Nikolaidou B, Douma S, Aslanidis S, Doumas M. The impact of gender on the prevalence of sexual dysfunction in patients with musculoskeletal disease. Journal of Men's Health 2011. [DOI: 10.1016/j.jomh.2011.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gavriilaki E, Triantafyllou A, Anyfanti P, Avagianou PA, Triantafyllou G, Pyrpasopoulou A, Chatzimichailidou S, Gkaliagkousi E, Petidis K, Christaki E, Douma S, Aslanidis S, Doumas M. Gender effects on anxiety levels in men with rheumatic disorders. Journal of Men's Health 2011. [DOI: 10.1016/j.jomh.2011.08.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Anyfanti P, Triantafyllou A, Gavriilaki E, Avagianou PA, Triantafyllou G, Pyrpasopoulou A, Chatzimichailidou S, Gkaliagkousi E, Papadopoulos N, Lazaridis N, Douma S, Aslanidis S, Doumas M. Prevalence of depression in male and female patients with rheumatic disorders. Journal of Men's Health 2011. [DOI: 10.1016/j.jomh.2011.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Stefanidou S, Benos A, Galanopoulou V, Chatziyannis I, Kanakoudi F, Aslanidis S, Boura P, Sfetsios T, Settas L, Katsounaros M, Papadopoulou D, Giamalis P, Dombros N, Chatzistilianou M, Garyfallos A. Clinical expression and morbidity of systemic lupus erythematosus during a post-diagnostic 5-year follow-up: a male:female comparison. Lupus 2011; 20:1090-4. [PMID: 21700658 DOI: 10.1177/0961203311403640] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to analyse the prevalence of the most relevant clinical features of the diagnosis of systemic lupus erythematosus (SLE) in a sample of male patients with lupus as well as the incidence of the main causes of morbidity in a 5-year period after the diagnosis. A further aim of this study was to investigate the impact of gender on expression and morbidity of SLE. Data were collected from the medical records of 59 male and 535 female patients with SLE who were diagnosed at the hospitals in the region of Thessaloniki. Several differences in the expression and morbidity of the disease were found in relation to the gender of the patient. Male patients had a higher prevalence of thromboses, nephropathy, strokes, gastrointestinal tract symptoms and antiphospholipid syndrome when compared with female patients, but tended to present less often with arthralgia, hair loss, Raynaud's phenomenon and photosensitivity as the initial clinical manifestations. During the 5-year follow-up, positive associations have been found between male gender and the incidence of tendonitis, myositis, nephropathy and infections, particularly of the respiratory tract. In conclusion, this study has provided information regarding the features of clinical expression and morbidity in male patients, and has shown that gender is a possible factor that can influence the clinical expression of SLE.
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Affiliation(s)
- S Stefanidou
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece
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Aslanidis S, Pyrpasopoulou A, Doumas M, Triantafyllou A, Chatzimichailidou S, Zamboulis C. Association of capillaroscopic microhaemorrhages with clinical and immunological antiphospholipid syndrome. Clin Exp Rheumatol 2011; 29:307-309. [PMID: 21385543] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Accepted: 11/02/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Patients with clinical signs of vasculopathy were screened with capillaroscopy for microangiopathy, and its presence was evaluated in the diagnosis of antiphospholipid syndrome (APS). For this purpose, autoantibody profiles in high risk patients with microhaemorrhages were correlated with thrombotic events. METHODS 738 patients from a Rheumatology Outpatients cohort were consecutively screened with capillaroscopy. Patients with microhaemorrhages were selected from the total of individuals screened and tested for anticardiolipin (αCL) and anti-beta2 glycoprotein 1 (anti-β2GP1) Abs. Positive autoantibody profile was subsequently correlated with arterial and venous thrombotic events. Patients with scleroderma were excluded from the analysis. RESULTS 149 patients with various rheumatologic conditions and capillary microhaemorrhages were included in the study. Antiphospholipid profile screening in these individuals revealed a 15.4% of newly diagnosed secondary laboratory APS. αCL antibodies and anti-β2-glycoprotein 1 (anti-β2GP1 Abs were both found to independently correlate significantly with thrombotic events. Subanalysis of the type of anti-β2GP1 Abs indicated that the correlation with thrombotic events was significant for IgG-type (p<0.001) and IgM-type (p=0.051), but not IgA-type Abs (p=0.292). CONCLUSIONS In patients with microhaemorrhages, αCL and anti-β2GP1 Abs were associated with thrombotic events. The observation that, although IgA type-anti-β2GP1 Abs were detected in patients with microangiopathy, they lacked any significant association with thrombotic complications, suggests, that either the type/conformation of the autoantibodies and/or additional factors may be critical for the development of thromboses. In conclusion, capillaroscopy can aid diagnostically to screen for or verify APS in combination with other parameters.
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Affiliation(s)
- S Aslanidis
- 2nd Propedeutic Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece.
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Aslanidis S, Pyrpasopoulou A, Douma S, Poulakos P, Triantafyllou A. Restoration of menstruation in premature ovarian failure after initiation of adalimumab. Scand J Rheumatol 2009; 37:488-90. [DOI: 10.1080/03009740802241733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Raptopoulou A, Sidiropoulos P, Siakka P, Boki K, Drosos AA, Aslanidis S, Karras D, Pikazis D, Vassilopoulos D, Karassa F, Boumpas DT. Evidence-based recommendations for the management of ankylosing spondylitis: results of the Hellenic working group of the 3E Initiative in Rheumatology. Clin Exp Rheumatol 2008; 26:784-792. [PMID: 19032809] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The 3E (Evidence, Experts and Exchange) Initiative is a multi-national effort that involves a large number of experts and practicing rheumatologists addressing specific questions relevant to everyday clinical practice, concerning the management of Ankylosing Spondylitis. Within this multinational group, the Hellenic working group, addressed specific issues complementary to the international ones, and formulated evidence-based recommendations, in order to improve everyday clinical practice for patients with Ankylosing Spondylitis. METHODS A scientific committee of rheumatologists specializing in AS formulated a set of 7 questions in three domains: diagnosis, monitoring and treatment. Literature search in MedLine for papers published up to August 2006 was conducted. The evidence to support each proposition was evaluated and scored. To avoid any conflict of interest with the sponsor issues related to the use of biologics were not discussed. After extensive discussion among 50 rheumatologists and one Delphi round of votes, the final recommendations were formulated. RESULTS A literature search resulted in a total of 320 relevant papers of which 29 were evaluated. A total of seven recommendations were formulated: two concerning diagnosis (role of HLA-B27 and MRI) and prognosis, one concerning monitoring for extra-articular manifestations and four concerning treatment (analgesics, disease modifying agents and physical therapy) were made. The level of evidence and the strength of recommendation were reported. The compiled agreement among experts ranged from 90% up to 100%. CONCLUSION Recommendations for the management of AS were developed using an evidence-based approach followed by physicians' consensus with high level of agreement. These are complementary to existing ones, and address specific domains of everyday clinical practice.
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Affiliation(s)
- A Raptopoulou
- Department of Internal Medicine, Division of Rheumatology, Clinical Immunology and Allergy, University of Crete, Medical School, Heraklion, Greece
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Douloumpakas I, Pyrpasopoulou A, Triantafyllou A, Sampanis C, Aslanidis S. Prevalence of musculoskeletal disorders in patients with type 2 diabetes mellitus: a pilot study. Hippokratia 2007; 11:216-218. [PMID: 19582198 PMCID: PMC2552988] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Diabetes mellitus is associated with a variety of musculoskeletal disorders. The prevalence of connective tissue disorders in these patients has increased in the recent years affecting significantly their quality of life. METHODS-RESULTS We conducted a pilot study including 208 sequentially selected patients with type 2 diabetes mellitus regularly followed-up at the Diabetes Center of the Hippokration University Hospital. Among the diabetic patients who were screened according to the Short Musculoskeletal Function Assessment Questionnaire for musculoskeletal symptoms and findings, 82.6% were found to exhibit musculoskeletal abnormalities, mainly of the degenerative, noninflammatory type. CONCLUSIONS Musculoskeletal disorders are a common finding among patients with type 2 diabetes. Obesity and accumulation of abnormally glycosylated byproducts have been proposed as potential pathogenetic mediators of these connective tissue abnormalities. Of particular interest is, however, the common association of osteoarthritis, involving even non-weight bearing joints in patients with type 2 diabetes, indicating a common pathophysiologic mechanism connecting these two clinical conditions.
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Affiliation(s)
- I Douloumpakas
- 2nd Propedeutic Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece
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Aslanidis S, Vassiliadis T, Pyrpasopoulou A, Douloumpakas I, Zamboulis C. Inhibition of TNFalpha does not induce viral reactivation in patients with chronic hepatitis C infection: two cases. Clin Rheumatol 2006; 26:261-4. [PMID: 16924392 DOI: 10.1007/s10067-006-0394-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 06/27/2006] [Indexed: 02/06/2023]
Abstract
Chronic infections, such as hepatitis C, in the setting of rheumatic disorders pose a potential hindrance to optimal management because of possible complications linked to the institution of immune suppression, as well as the high incidence of hepatotoxicity associated with many of the disease-modifying antirheumatic drugs included in the conventional therapeutic regimens. In the setting of hepatitis C, however, the effect of TNFalpha blockade may be potentially beneficial because TNFalpha appears to be involved in the pathogenesis of liver fibrosis through the stimulation of apoptotic pathways. Data related to this subject are, unfortunately, still limited and without detailed information regarding the clinical progression of the rheumatic disorder. We report the cases of two patients, one with ankylosing spondylitis and one with psoriatic arthritis, who were efficiently treated long-term with anti-TNF agents for their rheumatic disease without any evidence of reactivation or flaring of their hepatitis C infection or deterioration of their liver function. Our results indicate that TNFalpha blockade is a highly efficient and uncompromising therapy in hepatitis C-affected individuals with connective tissue disorders. However, systematic, large-scale studies addressing the issue of safety of these new efficient drugs, i.e., monoclonal antibodies targeted against TNFalpha, in patients with chronic hepatitis C will be needed to properly assess the risks and benefits of this treatment in analogous cases.
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MESH Headings
- Adalimumab
- Adult
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antirheumatic Agents/therapeutic use
- Arthritis, Psoriatic/drug therapy
- Arthritis, Psoriatic/immunology
- Arthritis, Psoriatic/pathology
- Arthritis, Psoriatic/virology
- Female
- Hepacivirus/drug effects
- Hepacivirus/immunology
- Hepatitis C, Chronic/drug therapy
- Hepatitis C, Chronic/immunology
- Hepatitis C, Chronic/pathology
- Humans
- Infliximab
- Liver/pathology
- Liver Cirrhosis/pathology
- Male
- Middle Aged
- Spondylitis, Ankylosing/drug therapy
- Spondylitis, Ankylosing/immunology
- Spondylitis, Ankylosing/pathology
- Spondylitis, Ankylosing/virology
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Virus Activation/drug effects
- Virus Activation/immunology
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Affiliation(s)
- S Aslanidis
- B' Propaedeutic Department of Internal Medicine, Hippokration General Hospital, Konstantinoupoleos 49, 54642, Thessaloniki, Greece.
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Iliopoulos A, Psathakis K, Aslanidis S, Skagias L, Sfikakis PP. Tuberculosis and granuloma formation in patients receiving anti-TNF therapy. Int J Tuberc Lung Dis 2006; 10:588-90. [PMID: 16704045] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
In patients receiving anti-tumor necrosis factor (TNF) therapy, a probable exacerbation of latent tuberculosis (TB) is a major adverse event. The impairment of granuloma differentiation is considered a characteristic feature of TB in these patients. In this report we present three patients with rheumatic disease who developed TB under infliximab treatment. All of them had typical granulomas on the biopsy specimens, indicating that the expected impairment of granuloma formation is not always the case. The notion of granuloma-free TB in patients receiving anti-TNF therapy could shift a clinician's path away from performing a biopsy, thus delaying the establishment of a correct diagnosis.
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Affiliation(s)
- A Iliopoulos
- Department of Rheumatology, Army General Hospital of Athens, Athens, Greece
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