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Query: UMLS:C0004364 (autoimmune disease)
 24,845 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A significant correlation between autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and premature or accelerated coronary atherosclerosis was found. The objectives of the study were: a) evaluate myocardial perfusion in patients with rheumatic diseases by means of contrast echocardiography (CE) and to establish its usefulness as compared to the results obtained by nuclear medicine (NM) (reference method). b) evaluate the prevalence of alterations in subclinical myocardial perfusion in autoimmune diseases and to establish a strategy to evaluate the cardiovascular changes in this disease. Myocardial perfusion in 37 outpatients of the rheumatology department was evaluated by CE at rest and with pharmacological stress (dobutamine) and NM. The prevalence of alterations in the myocardial perfusion in autoimmune diseases by CE and NM, when these methods were analyzed independently or when both methods were used was 27%. The positive predictive value (PPV) and negative predictive value (NPV) of both tests was 80% and 93%, respectively, the sensitivity was 80% and the specificity was 93%. The prevalence of alterations of perfusion in the primary antiphospholipid syndrome (PAPS) was of 30%. In this patients it was found that when both diagnostic tests are performed, NM reaches a sensitivity of 100% if the CE is positive and an specificity of 100% when the CE is negative. We can conclude that it is important to determine the presence of subclinic coronary artery disease in patients with autoimmune disease by noninvasive studies such as Sestamibi SPECT and/or CE for assessment of myocardial perfusion in order to plan an adequate treatment and follow-up.
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PMID:[Analysis of the ulsefulnes of contrast echocardiography and nuclear medicine in cardiovascular affection due to autoimmune diseases]. 1590 39

Antiphospholipid syndrome (APS) is a clinical autoimmune disorder characterized by thrombosis/pregnancy morbidity associated with the persistence of lupus anticoagulant (LA) and/or anticardiolipin (aCL) antibodies. We assessed the contribution of antibodies to beta2-glycoprotein I (anti-beta2GPI) and prothrombin (anti-PT) to the thrombotic risk in a cohort of 194 consecutive patients with persistent LA and/or aCL. Median follow-up was 45 months. A total of 39 patients (20.1%) had one documented episode of thrombosis during follow-up. Eleven of these patients had no previous thrombosis before enrollment in the study and 28 had recurrences of thrombosis. There were 21 venous and 18 arterial thrombotic events and the overall incidence of thrombosis was 5.6% per patient-year. After multivariate analysis, the male sex (P = 0.025), a previous thrombosis (P < 0.01), the presence of anti-beta2GPI (P = 0.001), and the presence of anti-PT (P = 0.03) remained as independent risk factors for recurrent thrombosis. Only IgG anti-beta2GPI and anti-PT were associated with an increased risk of thrombosis (P < 0.01 and P = 0.005). Patients testing positive for anti-beta2GPI had a higher rate of thrombosis than did antiphospholipid patients without anti-beta2GPI (8.0% vs. 3.1% per patient-year). Similarly, a higher rate of thrombosis was found in patients with positive anti-PT compared with patients without anti-PT (8.6% vs. 3.5% per patient-year). Considering only the group of 142 LA positive patients, the highest incidence of thrombosis was found in LA patients positive for both anti-beta2GPI and anti-PT (8.4% per patient-year). In conclusion, the presence of IgG anti-beta2GPI and anti-PT in patients with LA and/or aCL and mainly in those with LA predicts a higher risk of thromboembolic events.
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PMID:A prospective study of antibodies to beta2-glycoprotein I and prothrombin, and risk of thrombosis. 1594 13

Intravenous immunoglobulin (IVIg) is used to treat a number of immune-deficiencies and autoimmune diseases. It has been shown that IVIg contains anti-idiotypic antibodies, which explains its immunomodulatory action. In murine models, recent investigations have demonstrated that IVIg can prevent and reduce the affliction by systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS) and scleroderma. Relevant disease-specific fractions of IVIg were able to reproduce and even enhance the therapeutic effect in a murine model.IVIg treatment before tumor resection in rodents inoculated with melanoma and sarcoma cells dramatically improved the cure rate (50%) in comparison to the control group (0%). In patients affected by SLE, several clinical manifestations responded to IVIg treatment including serositis, hematological manifestations, treatment-resistant nephritis and central nervous system involvement. Similarly, in women with recurrent fetal loss due to APS, IVIg was able to diminish the abortion rate. Vasculitides such as Churg-Strauss' and Wegener's and skin fibrosis in patients affected by scleroderma improved after IVIg treatment. In agreement with in vitro investigations, prolonged survival has been noted in cancer patients treated with IVIg. We suggest that in the presence of a steroid and immunosuppressive-resistant autoimmune disease, IVIg is a rational and safe choice.
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PMID:IVIg therapy in autoimmunity and related disorders: our experience with a large cohort of patients. 1604 Mar 33

Antiphospholipid syndrome is an autoimmune disorder characterized by the association between antiphospholipid antibodies and venous or arterial thrombosis or obstetric complications. In spite of the recent progresses, many aspects of this disease remain unclear. In this review, we briefly focus on the most important advances in the pathophysiology, diagnosis and treatment of this condition.
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PMID:The antiphospholipid syndrome. 1608 37

The prevalence of mono-organic and multi-organic involvement during long-term follow-up in patients with primary antiphospholipid syndrome (pAPS) was investigated. We studied 60 pAPS patients followed up at least 5 years. Patients with associated systemic lupus erythematosus were excluded. All patients received oral anticoagulant therapy. A diagnosis of mono-organic involvement was considered when one organ was affected exclusively, and multi-organic involvement was considered when two or more organs became affected during follow-up. Average age at diagnosis was 32.9 +/- 12.4 years, 40 subjects were female and 20 male, and mean disease evolution totaled 11.5 +/- 4.5 years. The mean number of clinical events was 3.75 +/- 1.87. Among patients, immunoglobulin G anticardiolipin (IgM aCL) titers totaled 50 +/- 40.3 IgG phospholipid units, and IgM aCL titers totaled 47.3 +/- 35.4 IgM phospholipid units. The most frequent clinical manifestations at study onset were deep venous thrombosis, stroke, pulmonary thromboembolism, fetal loss, and pre-eclampsia. At the beginning of follow-up, 46 patients had mono-organic involvement and 14 had multi-organic involvement (P = 0.0001). In contrast, at the end of the study, only 8 patients still had mono-organic involvement, leading to deep venous thrombosis (n = 3), stroke (n = 3), and retinal thrombosis (n = 2) (P = 0.0001). Kaplan-Meier analysis showed that the probability of remaining with mono-organic involvement decreased throughout the cumulative years, especially during the first 3. The hazard risk ratio for developing multi-organic involvement was 1.47 patients per year. In conclusion, PAPS is a chronic disorder with unpredictable clinical course and multi-organic involvement, especially during the first years. The conversion to multi-organic involvement supports the concept that pAPS is a systemic autoimmune disease.
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PMID:Mono-organic versus multi-organic involvement in primary antiphospholipid syndrome. 1612 72

If a woman suffers from autoimmune disease (AD), several factors can affect pregnancy or neonatal outcome: repeated spontaneous pregnancy losses (frequently related to antiphospholipid antibodies (aPL)), neonatal lupus with complete congenital heart block (CHB) (linked to transplacental passage of IgG anti Ro/SS-A antibodies) and the disease activity itself that can affect the mother, the pregnancy and fetal outcome. If appropriately managed, the antiphospholipid syndrome (APS) is "one of the few tractable causes of pregnancy losses." A recent case control study, on babies from APS-mothers and healthy mothers, did not show any difference in the occurrence of neonatal complications. There are few data about the long-term outcome of babies born to patients with AD. We recently reported increased occurrence of learning disabilities in children born to aPL positive mothers with systemic lupus erythematosus (SLE). The modern management of pregnancy in patients with AD includes the treatment of disease flares, using drugs effective but safe for fetus. Corticosteroids and some immunosuppressive drugs can be used in pregnancy to control maternal disease. A prolonged fetal exposure to dexamethasone was reported to impair cerebral development, but we recently studied 6 children, born to patients treated with dexamathasone because of CHB, showing a normal intelligence quotient. The last 10-year experience shows that fetal exposure to antimalarial drugs should not be regarded as an important risk factor for gestational nor neonatal complications. However, information about long-term outcome of children exposed to immunosuppressive drugs "in utero" are still lacking and more efforts are needed in this research area.
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PMID:Pregnancy and autoimmunity: maternal treatment and maternal disease influence on pregnancy outcome. 1613 7

Heart damage, mediated by different autoantibodies can involve several anatomical heart structures: valves, arteries, conduction tissue. Verrucous endocarditis is frequently reported in patients with antiphospholipid syndrome (APS) with or without systemic lupus erythematosus (SLE), particularly if they suffer from central nervous system involvement. Antiphospholipid antibodies (aPL) were shown deposited at subendothelial level of the affected valves. According to several in vitro and in vivo experimental models, aPL, anti-oxidized LDL (oxLDL), anti-heat shock protein 65 (HSP65) and anti-endothelial cells antibodies (AECA) seem to be involved in the pathogenesis of the atherosclerosis phenomena described in systemic autoimmune disease and vasculitis. However, the observation of the association of the same antibodies with clinical and subclinical atherosclerosis in patients is still controversial. The children of anti-Ro/SSA positive mothers can be affected by the congenital heart block. Anti Ro/SS-A antibodies play a major pathogenic role in affecting the heart conduction tissue in this rare condition.
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PMID:Nonorgan specific autoantibodies and heart damage. 1621 61

Antiphospholipid syndrome (APS) is a systemic autoimmune disease, associated with a hypercoagulable state and fetal loss and with other clinical manifestations including cardiac involvement. Cardiac manifestations of APS are valve abnormalities (valve thickening and vegetations), occlusive arterial disease (atherosclerosis and myocardial infarction), intracardiac emboli, ventricular dysfunction, and pulmonary hypertension. Antiphospholipid antibodies (aPLs) may have a role in the accelerated atherosclerotic arterial disease observed in APS, related to their ability to induce endothelial activation. aPLs have been incriminated in the pathogenesis of heart valve lesions in APS patients. Markers of endothelial cell activation are up-regulated with prominent deposition of aPL in heart valves, suggesting aPL deposition initiates an inflammatory process that recruits complement leading to the valve lesion. Autoantibody-mediated endothelial cell activation probably plays a role in sustaining a proadhesive, proinflammatory, and procoagulant phenotype. The heterogeneity of APS clinical manifestations is likely linked to the varied effects that aPL can induce on endothelial cells and to the different functions that endothelial cells display depending on the anatomic localization.
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PMID:Cardiac involvement in the antiphospholipid syndrome. 1621 69

Antiphospholipid syndrome (APS) is an autoimmune disorder defined by the occurrence of venous and arterial thromboses and pregnancy morbidity, frequently accompanied by a moderate thrombocytopenia, in the presence of antiphospholipid antibodies. There is both laboratory and clinical evidence for the beneficial role of intravenous immunoglobulin (IVIg) in APS. Data on the use of IVIg in patients with APS have focused on its obstetric complications and antiphospholipid antibodies-positive patients undergoing in vitro fertilization, but there are also case reports about treatments of other clinical manifestations (mainly hematological) of the syndrome. Future research should determine when to use anticoagulation, IVIg, or both in the treatment of APS.
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PMID:Intravenous immunoglobulin therapy in antiphospholipid syndrome. 1639 98

Antiphospholipid syndrome is an autoimmune disease that is characterised by tendency to thrombosis, obstetrical and hematological complications. Corticosteroids may be useful for therapy of some features of this syndrome, such as thrombocytopenia. Nocardia is an important opportunistic infectious agent in immunocompromised hosts, i.e. in patients taking corticosteroids. It is important to be aware of these rare complications, which are correlated with the prognosis. In this paper, we report a patient with primary anti-phospholipid syndrome treated by corticosteroid, who developed disseminated nocardiosis.
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PMID:Nocardiosis in a patient with primary anti-phospholipid syndrome. 1640 63


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