Dysregulation of innate and adaptive serum mediators precedes systemic lupus erythematosus classification and improves prognostic accuracy of autoantibodies.

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with a poorly understood preclinical stage of immune dysregulation and symptom accrual. Accumulation of antinuclear autoantibody (ANA) specificities is a hallmark of impending clinical disease. Yet, many ANA-positive individuals remain healthy, suggesting that additional immune dysregulation underlies SLE pathogenesis.

Anthrax Vaccine and the Risk of Rheumatoid Arthritis and Systemic Lupus Erythematosus in the U.S. Military: A Case-Control Study.

U.S. military personnel assigned to areas deemed to be at high risk for anthrax attack receive Anthrax Vaccine Adsorbed (AVA).

Altered type II interferon precedes autoantibody accrual and elevated type I interferon activity prior to systemic lupus erythematosus classification.

Objectives: The relationship of immune dysregulation and autoantibody production that may contribute to systemic lupus erythematosus (SLE) pathogenesis is unknown. This study evaluates the individual and combined contributions of autoantibodies, type I interferon (IFN-α) activity, and IFN-associated soluble mediators to disease development leading to SLE.

Methods: Serial serum specimens from 55 individuals collected prior to SLE classification (average timespan=4.

Treatment of hemophagocytic lymphohistiocytosis with alemtuzumab in systemic lupus erythematosus.

Hemophagocytic lymphohistiocytosis (HLH) is an immune disorder characterized by cytokine dysregulation and uncontrolled activation of T lymphocytes and macrophages. It is categorized as primary when associated with specific genetic mutations or secondary when associated with infections, malignancies, or autoimmune disorders. Clinical features of HLH include unexplained fever, hepatosplenomegaly, pancytopenia, and severe hyperferritinemia.

Perspectives on rheumatoid arthritis for the orthopedic surgeon: overview of non-tumor necrosis factor biologic drugs and perioperative management.

Early use of disease modifying antirheumatic drug (DMARD) therapy has become the standard of care in the treatment of rheumatoid arthritis (RA). Methotrexate remains the DMARD of choice in patients without contraindications for its use. The addition of a tumor necrosis factor-α antagonist to methotrexate makes clinical remission more likely.

Perspectives on rheumatoid arthritis for the orthopedic surgeon: overview of early diagnosis and the tumor necrosis factor antagonists.

Rheumatoid arthritis (RA) is the most common inflammatory arthritis in the United States. As part of ongoing efforts to halt joint damage, preserve function, and reduce associated mortality, the current emphasis in RA management is on prompt diagnosis and the early use of disease modifying antirheumatic drug (DMARD) therapy. Improved serologic tests and updated classification criteria are now available to assist in making an earlier diagnosis of RA.

Raynaud phenomenon of the nipple: a rare finding in rheumatology clinic.

Many clinicians are familiar with the common presentation of Raynaud phenomenon affecting the hands and feet. Patients with Raynaud phenomenon, even in the absence of systemic disease, are frequently treated by rheumatologists. Raynaud phenomenon of the nipple is an important entity to recognize as a cause of severe nipple pain with breast-feeding and is perhaps underrecognized by patients and physicians.

Ribosomal P autoantibodies are present before SLE onset and are directed against non-C-terminal peptides.

Autoantibodies to ribosomal P (ribo P) are found in 15-30% of systemic lupus erythematosus (SLE) patients and are highly specific for SLE. The goal of this study is to assess the temporal association of anti-ribosomal P (anti-P) responses with SLE disease onset, as well as to characterize select humoral ribo P epitopes targeted in early, pre-diagnostic SLE samples. Patients with stored serial serum samples available prior to SLE diagnosis were identified from a military cohort.

60 kD Ro and nRNP A frequently initiate human lupus autoimmunity.

Systemic lupus erythematosus (SLE) is a clinically heterogeneous, humoral autoimmune disorder. The unifying feature among SLE patients is the production of large quantities of autoantibodies. Serum samples from 129 patients collected before the onset of SLE and while in the United States military were evaluated for early pre-clinical serologic events.

Refractory polyarticular gouty arthritis as a manifestation of immune reconstitution inflammatory syndrome.

Immune reconstitution inflammatory syndrome (IRIS) describes the initial clinical deterioration some patients manifest upon initiation of effective antiretroviral therapy (ART) for HIV infection. In this report we describe a case of IRIS manifesting as polyarticular gout, a previously unreported rheumatological manifestation of IRIS. A 53-year-old HIV-infected man with a history of intermittent attacks of gout and an initial CD4 count of 112 cells/microL and a viral load of >100,000 copies/mL presented to our institution with severe, refractory, polyarticular gout approximately 4 weeks after initiating ART.

A 31-year-old Army specialist presenting with acute oligoarthritis.

A 31-year-old Army specialist was evaluated at Walter Reed Army Medical Center for an acute attack of arthritis in the left hand. After an initial evaluation, the patient was referred to the rheumatology service, and gout was diagnosed on the basis of synovial fluid analysis. This case demonstrates an uncommon presentation of a common disorder in an active duty soldier.

Anti-ribonucleoprotein antibodies mediate enhanced lung injury following mesenteric ischemia/reperfusion in Rag-1(-/-) mice.

Natural Abs and autoantibodies bind antigens displayed by ischemia-conditioned tissues, followed by complement activation and enhanced tissue injury during reperfusion. Anti-ribonucleoprotein (RNP) Ab is associated with lung disease in patients with autoimmune disease but it is not known whether these abs contribute to lung injury. Mesenteric I/R in mice leads to local and remote lung injury.

Updates in the management of gout.

The majority of patients with gout are cared for by primary care physicians. Although both the physician and patient may easily recognize the acute arthritis of gout, errors in selecting the most appropriate medication and proper dose are common. The clinical stages of gout include asymptomatic hyperuricemia, intermittent gouty arthritis, and chronic tophaceous gout.

Anti-RNP immunity: implications for tissue injury and the pathogenesis of connective tissue disease.

Certain autoantibodies are characteristic of autoimmune disease manifestations and contribute to organ pathology. The presence of high-titer antibodies to U1-RNP are associated with mixed connective tissue disease, although these antibodies may also be present in systemic lupus erythematosus and systemic sclerosis. However, the role of antibodies to U1-RNP in the pathogenesis of connective tissue disease remains unclear.

Polymyalgia rheumatica and breast cancer.

Polymyalgia rheumatica is infrequently the initial manifestation of underlying malignancy. A patient is described with infiltrating ductal carcinoma of the breast presenting with left breast mass and polymyalgia rheumatica (PMR)-like symptoms. Physicians should consider an associated malignancy in PMR when patients present with atypical features such as young age, modest elevation of the sedimentation rate, and incomplete response to corticosteroids.