An update on the microbiome in vasculitis
Purpose of review
To summarize recent evidence regarding the presence and potential role of the microbiome in systemic vasculitides.
Recent findings
Microbiomic descriptions are now available in patients with small, medium and large vessel vasculitis. The majority of studies have evaluated gastrointestinal inhabitants, with a smaller number of studies describing the nasal, pulmonary or vascular microbiomes. Most published studies are observational and cross-sectional. Dysbiosis is seen frequently in vasculitis patients with reduced microbial diversity observed in nasal, fecal and vascular samples compared with d...
Source: Current Opinion in Rheumatology - November 30, 2020 Category: Rheumatology Tags: VASCULITIS SYNDROMES: Edited by Hasan Yazici and Yusuf Yazici Source Type: research
Management of primary vasculitides with biologic and novel small molecule medications
Purpose of review
Vasculitides can affect small, medium and/or large vessels, leading to end-organ damage, decreased quality of life and death. Glucocorticoids remain the backbone of treatment for systemic vasculitis but are associated with numerous toxicities. In recent years, the efficacy of glucocorticoid-sparing biologic and novel small molecule therapies has been demonstrated.
Recent findings
In giant cell arteritis, tocilizumab was superior to glucocorticoid monotherapy in maintenance remission and cumulative glucocorticoid exposure and is now approved for the treatment of giant cell arteritis. In addition...
Source: Current Opinion in Rheumatology - November 30, 2020 Category: Rheumatology Tags: VASCULITIS SYNDROMES: Edited by Hasan Yazici and Yusuf Yazici Source Type: research
Cryoglobulinemic vasculitis: pathophysiological mechanisms and diagnosis
Purpose of review
Cryoglobulins (CG) are immunoglobulins that precipitate in the cold, and dissolve at 37°C. In vivo, in cold exposed tissues and organs, they can induce vasculitis and occlusive vasculopathy after deposition on vascular endothelium under low temperature and high concentration conditions. Clinical manifestations are cutaneous (purpura, ulcers, vasomotor symptoms, and livedo reticularis), rheumatological (arthralgia and arthritis), and peripheral neuropathy (paresthesia and pain in the lower limbs). In profound organs such as the kidneys, CG deposition is less temperature-dependent, favored by local pro...
Source: Current Opinion in Rheumatology - November 30, 2020 Category: Rheumatology Tags: VASCULITIS SYNDROMES: Edited by Hasan Yazici and Yusuf Yazici Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - November 30, 2020 Category: Rheumatology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Biologics in the treatment of Sjogren's syndrome, systemic lupus erythematosus, and lupus nephritis
Purpose of review
It is an understatement to say that drug approvals in systemic lupus erythematosus (SLE), lupus nephritis, and Sjogren's syndrome have lagged far behind those in other autoimmune diseases, such as rheumatoid arthritis and psoriatic arthritis. Reasons for this are multiple and include the molecular and clinical heterogeneity of these conditions; confounding by background medications, especially corticosteroids; and clinical trial endpoints. However, the tides are changing, and there have been several bright spots in our attempts to bring more efficacious drugs to our patients.
Recent findings
Several ...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research
Biologic therapies for systemic lupus erythematosus: where are we now?
Purpose of review
Conventional approaches using hydroxychloroquine, corticosteroids and immunosuppressives have improved the prognosis for systemic lupus erythematosus (SLE) patients. Unfortunately, they have reached the limits of what they can achieve and patients still die prematurely and/or find their quality of life greatly impaired. Here, we discuss the problems of assessing activity in SLE, optimizing clinical trial design and more recent biologic approaches.
Recent findings
The success of B-cell depletion using Rituximab in open clinical studies, the approval of Belimumab (blocks the B-cell activating factor BA...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research
New classification criteria for systemic lupus erythematosus
Purpose of review
To compare the recently published European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for SLE with the Systemic Lupus International Collaborating Centers (SLICC) criteria and the earlier ACR criteria, focusing on their key concepts.
Recent findings
Although the SLICC criteria introduced numbers of new criteria items, the new EULAR/ACR criteria added only noninfectious fever, based on an early SLE cohort study and an SLE patient survey, and condensed hematological, mucocutaneous and neurological items. Whereas the SLICC criteria maintained the over...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research
Cutaneous and systemic connections in lupus
Purpose of review
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multiple manifestations, with a majority of SLE patients having cutaneous involvement. Despite ongoing research, the relationship between SLE and cutaneous lupus erythematosus (CLE) pathogeneses remains unknown. This review will compare advances in understanding the cause and pathogenesis of SLE and CLE.
Recent findings
Recently, mechanisms by which immune cell populations contribute to the pathogenesis of SLE and CLE have been queried. Studies have pointed to transitional B cells and B-cell activating factor (BAFF) signaling as...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research
Update on antimalarials and systemic lupus erythematosus
Purpose of review
The purpose of this review is highlighting the most recent evidence on the clinical efficacy and toxicity of antimalarials in systemic lupus erythematosus (SLE).
Recent findings
New data confirm the effects of antimalarials in preventing SLE activity, damage and infections and in decreasing mortality. An important reduction in use of health resources is related to continued antimalarial use. Hydroxychloroquine (HCQ) may prevent preeclampsia in pregnant women with SLE. HCQ ocular toxicity is infrequent and could be associated with blood levels. Gastrointestinal and skin toxicity are underrecognized an...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research
Immunometabolism in the pathogenesis of systemic lupus erythematosus: an update
Purpose of review
To provide an update on state-of-the-art evidence on the role of immunometabolism reprogramming in the pathogenesis of systemic lupus erythematosus (SLE).
Recent findings
Mitochondrial dysfunction and enhanced oxidative stress, along with specific defects in other metabolic pathways, can promote dysregulation of innate and adaptive immune responses in SLE. These abnormalities appear to be driven by genetic and epigenetic factors, modulated by stochastic events. In addition to extensive descriptions of abnormalities in immunometabolism of lupus lymphocytes, recent studies support the critical role of ...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research
Monitoring disease activity and damage in adult and juvenile idiopathic inflammatory myopathy
Purpose of review
We have reviewed the literature to identify significant advances related to disease activity and damage in the idiopathic inflammatory myopathies (IIMs) from January 2019 to July 2020.
Recent findings
New observations in the field from 2019 to 2020 have resulted in a better understanding of the clinical association and pathogenic origins of IIM. The use of patient-reported outcome measures and perspectives, identifying biomarkers and making better use of autoantibody testing are summarized. Basic sciences have led to an improved understanding of the role of NETosis in calcinosis, and of interferon ty...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research
Myositis autoantibodies: recent perspectives
Purpose of review
To provide an overview of recent discoveries related to myositis-specific autoantibodies (MSAs) and assays used for their measurement.
Recent findings
New autoantibody specificities have been reported including a MSA directed against eukaryotic initiation factor 3 and a myositis-associated autoantibody directed against heat shock factor 1. The association of anti-TIF1γ with cancer-associated dermatomyositis dependent on age has been confirmed in several large cohorts. Despite MSAs being almost entirely mutually exclusive, several myositis autoantigens are overexpressed in regenerating muscle and do ...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research
Pathogenesis of inclusion body myositis
Purpose of review
To review the pathogenesis of inclusion body myositis (IBM).
Recent findings
IBM is an autoimmune disease. Multiple arms of the immune system are activated, but a direct attack on muscle fibers by highly differentiated T cells drives muscle destruction.
Summary
Further understanding of the pathogenesis of IBM guides rational approaches to developing therapeutic strategies. (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research
Cytokines and inflammatory mediators as promising markers of polymyositis/dermatomyositis
Purpose of review
Idiopathic inflammatory myopathies (IIMs), known also as myositis, represent challenging group of heterogeneous muscle disorders characterized by symmetric proximal muscle weakness and evidence of muscle inflammation. The purpose of this review is to provide important updates on cytokines and inflammatory mediators related to myositis.
Recent findings
In the past 5 years, multiple studies brought a fresh insight into the pathogenesis of myositis by introducing new factors or further characterizing the role of the well established mediators in myositis. Among the mediators reviewed in this article, sp...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research
Cardiac involvement in inflammatory myopathies and inherited muscle diseases
Purpose of review
To examine recent developments relating to cardiac involvement in the adult idiopathic inflammatory myopathies (IIM) and those inherited muscle diseases which may present in adulthood and mimic IIM.
Recent findings
Cardiac involvement is a common feature of IIM and inherited muscle diseases. Frequency according to disease subtype varies, with serotype having particular influence in IIM, and genotype in the inherited muscle diseases. Innovative techniques for examining cardiac function have been investigated further, including speckle-tracking echocardiography and cardiac magnetic resonance tomography...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research
