Current Rheumatology Reviews - Volume 4, Issue 1, 2008

As a medical student in the 1970s, we were told about a mysterious entity characterized by relapsing fevers, arthritis and abdominal pain in young patients termed Familial Mediterranean Fever. Cloning of the MEFV gene on chromosome 16p13.3 in 1997 was a major step forward in our understanding of the disease. MEFV encodes pyrin, which plays a role in the regulation of the inflammasome which results in the produc Read More

Autoantibodies are pathogenic in systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). These pathogenic autoantibodies are generally characterized by IgG isotype and high affinity binding to particular antigens. In SLE, antibodies to double-stranded DNA (dsDNA), nucleosomes and alpha-actinin are particularly important. In APS, pathogenic antibodies that cause thrombosis or fetal loss are particul Read More

Ileocolonoscopic evidence for subclinical gut inflammation is found in a subpopulation of spondyloarthropathy (SpA) patients. The prevalence of microscopic intestinal lesions is even higher and can be classified as either an acute or a chronic type of inflammation. The latter condition is associated with an increased risk of developing overt inflammatory bowel disease (IBD), especially Crohn's disease (CD), over time. Evid Read More

T cells in SLE patients are dysfunctional as a result of altered signalling inputs and altered signal processing. They contribute to pathogenesis through expansion of autoreactive T cells, aberrant B-cell help and direct T cell-mediated tissue damage. Tissue inflammation and damage, in turn, produce nuclear autoantigens and perpetuate antigen presentation to T cells. Improvements in T cell-targeted therapy will require biom Read More

The autoinflammatory syndromes are group monogenic diseases related to mutations of genes involved in the control and in the regulation of the inflammatory response. All of them display an early onset in childhood. Familial Mediterranean Fever, Mevalonate-kinase deficiency and Tumour necrosis factor (TNF) Receptor-Associated Syndrome are characterised by recurrent episodes of systemic inflammation presenting as fe Read More

Although depression is known to be an important complication in patients with rheumatoid arthritis (RA) or Sjogren's syndrome (SS), at present little is known about the mental states of RA patients who also have SS. To address that issue, we recently used a standardized questionnaire, the self-rating depression scale (SDS), to compare the mental states of patients with RA alone and those with RA complicated by SS. There were Read More

The association between malignancy and rheumatic diseases is complex and many factors contribute to it. Malignancies may lead to rheumatic manifestations either directly by invasion or metastases, or indirectly by remote paraneoplastic effects. Chemotherapeutic agents and bone marrow stimulatory biologic agents such as G-CSF and GM-CSF used in the treatment of malignant diseases may also result in rheumati Read More

What is the magnitude of cancer risk in systemic lupus erythematosus (SLE) compared to the general population? Recent data confirmed a slight increased risk in SLE for all cancers combined, as well as a moderate increased risk of lung cancer, and a strikingly increased risk for hematological malignancies. The hematological cancer type most clearly elevated in SLE is non-Hodgkin's lymphoma (NHL); Hodgkin's lymphoma appe Read More

Rheumatoid arthritis is an autoimmune disease that results in joint deformity and disability. Conventional nonsteroidal anti-inflammatory drugs (NSAIDs), steroids and disease modifying antirheumatic drugs (DMARD's) are used for its treatment. Unconventional therapies, like enzyme oligodeoxy nucleotides, boron neutron capture therapy & radioisotopes are also being tried. The use of all these drugs is limited by a nu Read More

Henoch-Schonlein Pupura (HSP) is a small vessel vasculitis resulting from immunoglobulin A (IgA)-mediated inflammation and characterized by leukocytoclastic angiitis and predominant cutaneous involvement. It is more common in children and characterized by a more benign, shorter and self-limiting course, in contrast to adults where it is relatively rarer but associated with a higher frequency of renal involvement and mor Read More

In rheumatoid arthritis (RA) chronic inflammation results in pain, swelling and ultimately destruction of joints. This inflammation is also related to systemic bone loss and an increased fracture risk. Glucocorticoids (GC) are widely used to suppress the symptoms of inflammation in RA. There is increasing evidence from clinical studies that GC are disease modifying, in early disease and in combination with slow acting anti-rheum Read More