- Strategies toward rheumatoid arthritis therapy; the old and the new. [Review]
- JCJ Cell Physiol 2018 Dec 07
- Currently, medications used to treat rheumatoid arthritis (RA) are glucocorticoids (GCs) and nonsteroidal anti-inflammatory drugs (NSAIDs), predominantly used for controlling the pain and inflammatio...
Currently, medications used to treat rheumatoid arthritis (RA) are glucocorticoids (GCs) and nonsteroidal anti-inflammatory drugs (NSAIDs), predominantly used for controlling the pain and inflammation, disease-modifying antirheumatic drugs (DMARDs), administered as first-line medication for newly diagnosed RA cases, and biological therapies, used to target and inhibit specific molecules of the immune and inflammatory responses. NSAIDs and other GCs are effective in alleviating the pain, inflammation, and stiffness due to RA. DMARDs that are used for RA therapy are hydroxychloroquine, methotrexate, leflunomide, and sulfasalazine. The biological therapies, on the contrary, are chimeric anti-CD20 monoclonal antibody, rituximab, inhibitors of tumor necrosis factor-α (TNF-α) like etanercept, infliximab, and adalimumab, a recombinant inhibitor of interleukin-1 (IL-1), anakinra, and costimulation blocker, abatacept. Moreover, newly under evaluation biological therapies include new TNF-α inhibitors, JAK inhibitors, anti-interleukin-6-receptor monoclonal antibodies (mABs), and antibodies against vital molecules involved in the survival and development of functional B cells. The new strategies to treat RA has improved the course of the disease and most of the patients are successful in remission of the clinical manifestations if the diagnosis of the disease occur early. The probability of remission increase if the diagnosis happens rapidly and treat-to-target approach are implemented. In this review article, we have attempted to go through the treatment strategies for RA therapy both the routine ones and those which have been developed over the past few years and currently under investigation.
- BK virus nephropathy and multiorgan involvement in a child with heart transplantation . [Journal Article]
- CNClin Nephrol 2018 Dec 11
- BK virus is a known cause of renal failure in kidney transplant recipients, but there is little data regarding its effect on native kidneys in heart transplant patients. Here, we describe the case of...
BK virus is a known cause of renal failure in kidney transplant recipients, but there is little data regarding its effect on native kidneys in heart transplant patients. Here, we describe the case of a child who underwent heart transplantation and was later diagnosed with BK virus with multiorgan involvement. This patient was diagnosed with dilated cardiomyopathy at 4 months of age and underwent heart transplantation at the age of 5 years. Before transplantation, the patient suffered from cardiac arrest and fungal pyelonephritis. The patient had no evidence of azotemia. Ten months after transplantation, the patient was diagnosed with diffuse large B-cell lymphoma associated with Epstein-Barr virus infection. She underwent chemotherapy, and later developed azotemia and BK viremia. The findings on renal biopsy were compatible with BK nephropathy. After the biopsy, she was treated with intravenous cidofovir, immunoglobulins, and oral leflunomide. The tacrolimus dose was also reduced. However, the patient's renal function continued to worsen. She developed end-stage renal disease and started peritoneal dialysis. After experiencing a seizure, the patient was found to have positive BK virus polymerase chain reaction in the cerebrospinal fluid. Brain magnetic resonance image revealed a new white matter lesion in the splenium. On immunohistochemistry, there was SV40-positive staining in gastric and heart biopsy specimens. Therefore, BK virus enteropathy and cardiac involvement were suspected. This case suggests that BK virus infection can lead to systemic involvement and can be fatal. .
- Combined immunosuppressive treatment (CIST) in lupus nephritis: a multicenter, randomized controlled study. [Journal Article]
- CRClin Rheumatol 2018 Nov 28
- CONCLUSIONS: Treatment with a combined immunosuppressive agent is superior to routine CYC only therapy in lupus nephritis.
- Dystrophic calcinosis in a patient with overlap syndrome (scleroderma and rheumatoid arthritis) treated by leflunomide: A case report. [Journal Article]
- MMedicine (Baltimore) 2018; 97(47):e13319
- CONCLUSIONS: The control of underlying disease is important in the treatment of dystrophic calcinosis. The use of leflunomide maybe an option in treatment of dystrophic calcinosis combined with RA.
- Leflunomide versus cyclophosphamide in the induction treatment of proliferative lupus nephritis in Chinese patients: a randomized trial. [Journal Article]
- CRClin Rheumatol 2018 Nov 13
- CONCLUSIONS: Compared with cyclophosphamide, low-dose leflunomide in combination with prednisone showed both effectiveness and safety in the induction therapy of proliferative lupus nephritis in Chinese patients.
- Phylogeography and Molecular Species Delimitation of Pratylenchus capsici n. sp., a New Root-Lesion Nematode in Israel on Pepper (Capsicum annuum). [Journal Article]
- PPhytopathology 2018 Nov 13
- Root-lesion nematodes of the genus Pratylenchus parasitize the roots of numerous plants and can cause severe damage and yield loss. Here, we report on a new species, Pratylenchus capsici n. sp., from...
Root-lesion nematodes of the genus Pratylenchus parasitize the roots of numerous plants and can cause severe damage and yield loss. Here, we report on a new species, Pratylenchus capsici n. sp., from the Arava rift, Israel, which was characterized by integrative methods, including detailed morphology, molecular phylogeny, population genetics and phylogeography. This species is widely spread across the Arava rift, causing significant infection in pepper (Capsicum annuum) roots and inhibiting plant growth. Both morphological and molecular species delimitation support the recovered species as a new species. We found high cytochrome oxidase subunit I haplotype diversity, and phylogeography analysis suggests that contemporary gene flow is prevented among different agricultural farms, while population dispersal from weeds (Chenopodium album and Sonchus oleraceus) to pepper occurs on a relatively small scale. Our results suggest that weeds are important reservoir for the dispersal of P. capsici n. sp., either as the original nematode source or at least in maintaining the population between growing seasons.
- Digestive side-effects with teriflunomide: Thoughts on lactose. [Journal Article]
- RNRev Neurol (Paris) 2018 Nov 05
- CONCLUSIONS: In cases of prolonged digestive side-effects after the introduction of teriflunomide, a lactose-malabsorption breath test should be proposed to confirm the culpability or not of an enzymatic defect in the occurrence of adverse events.
- The mysterious gross haematuria in patient on Leflunomide: A case report and literature review. [Journal Article]
- UCUrol Case Rep 2019; 22:44-46
- [Xinfeng capsule improves pulmonary function of rats with rheumatoid arthritis by inhibiting PKC/NF-κB pathway]. [Journal Article]
- XBXi Bao Yu Fen Zi Mian Yi Xue Za Zhi 2018; 34(7):589-594
- Objective To observe the effect of Xinfeng capsule (XFC) on PKC/NF-κB pathway in the lung tissue of adjuvant arthritis (AA) rats. Methods Rats were divided into normal control(NC) group, model contro...
Objective To observe the effect of Xinfeng capsule (XFC) on PKC/NF-κB pathway in the lung tissue of adjuvant arthritis (AA) rats. Methods Rats were divided into normal control(NC) group, model control(MC) group, XFC group, and leflunomide group (LEF). Except the NC group, the other three groups were induced into AA models with complete Freund's adjuvant (CFA). The XFC [0.34 g/(kg.d), 1 mL/100 g) or LEF 0.05 mg/(kg.d)] was administrated from day 19 after the injection of CFA by gavage, once a day for 30 days. Pulmonary function was observed. The levels of IL-6, IL-12, IL-10, IL-17, IL-35 and matrix metalloproteinases (MMP)-9 were detected by ELISA. Ras-associated C3 botoxin substrate 1 (Rac-1), PKC, NF-κBp65 mRNA were detected by real-time quantitative PCR. The levels of Rac-1, PKC, NF-κBp65 proteins were determined by Western blot analysis. The expression and distribution of PKC and NF-κB in the lung tissues were analyzed by immunohistochemical staining. Results The pulmonary function parameters such as FEV1, FEF50, FEF75 and peak expiratory flow (PEF) in the XFC group were significantly higher than those in the MC group. The expression of IL-10, IL-35 in the serum increased, and IL-6, IL-17 and MMP-9 decreased. Compared with the MC group, the expression of PKC, NF-κBp65 and Rac-1 decreased in the XFC group. Conclusion XFC improves the lung function by inhibiting the PKC/NF-κB pathway and balancing the cytokine network.
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- Cyclophosphamide-induced severe acute hepatitis in a rheumatic disease: case-based review. [Review]
- RIRheumatol Int 2018 Oct 30
- In rheumatology practice, the risk of hepatotoxicity from medications, including non-steroidal anti-inflammatory drugs, notably, and methotrexate, sulfasalazine, leflunomide, and azathioprine is high...
In rheumatology practice, the risk of hepatotoxicity from medications, including non-steroidal anti-inflammatory drugs, notably, and methotrexate, sulfasalazine, leflunomide, and azathioprine is highly recognized by the rheumatologists. On the other hand, hepatotoxicity is neither a commonly expected nor a well-known side effect of cyclophosphamide (CYC) which is particularly used for vital organ involvements in systemic lupus erythematosus (SLE) and systemic vasculitis. Here we reported a 19-year-old case of SLE who, while on oral CYC treatment of 100 mg/day, was detected to have asymptomatic liver enzyme elevation and then developed acute hepatitis due to intravenously administered high-dose (1 g) CYC for neuro-lupus. Results of liver biopsy indicated drug-related toxicity. We discussed here with the other, although rare, cases available in the literature with an attempt to highlight the risk of hepatotoxicity and acute hepatitis due to CYC.