Folgoration as an Example of Pathergy in a Patient Affected by Pyoderma Gangrenosum and Takayasu's Arteritis

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of unknown aetiology. Clinical manifestations of PG are characterized by destructive, necrotizing, and noninfective ulceration of the skin. 20–30% of cases are initiated and aggravated by minor trauma or surgery, a phenomenon named pathergy. PG is related to several autoimmune diseases including ulcerative colitis, Crohn's disease, rheumatoid arthritis, and monoclonal gammopathy. The association with Takayasu's arteritis (TA), a chronic inflammatory and stenotic disease of large and medium-sized arteries, is instead less common. We report a case of PG associated with TA that was induced by an accident with folgoration of the skin; in this case the folgoration can be considered as an exemple of Pathergy, that is, a characteristic feature of PG

Use of biological drugs in patients with psoriasis and psoriatic arthritis in italy: Results from the PSONG survey

This Italian multicenter retrospective study compared the drug survival and efficacy of differentanti-TNF agents in psoriasis (PsO) and psoriatic arthritis (PsA) patients. A database of PsO/PsApatients treated with adalimumab, etanercept, and infliximab from May 2013 to May 2014 wasanalyzed. PASI 75, 90, and 100 was calculated at each time point to evaluate efficacy. Drug sur-vival rate and probability of maintaining PASI response were evaluated. The impact of dependentvariables on probability of PASI 75 loss was evaluated by logistic regression. 1,235 patients wereincluded, 577 with PsO and 658 with PsA. Highest survival rates were observed with adalimumabfollowed by etanercept and infliximab in PsO and PsA patients. The probability of maintainingPASI response was significantly higher for adalimumab followed by infliximab. For PsO patients,the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 8.1; 95% CI: 4.2–15.6,p<.001) or infliximab (OR: 6.6; 95% CI: 2.6–16.3,p<.001) vs. adalimumab. Likewise, for PsApatients the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 2.3; 95% CI:1.4–3.8,p5.01) or infliximab (OR: 2.2; 95% CI: 1.1–4.1,p5.018) vs. adalimumab. Adalimumabcould be the best therapeutic option over other anti-TNF agents for the treatment of PsO and PsApatients

Population structure, phenotypic characteristics and variability of locus of synthesis of the capsular polysaccharide of Porphyromonas gingivalis samples.

Porphyromonas gingivalis é um dos principais organismos associados à periodontite crônica e apresenta intensa diversidade, que poderia refletir em sua virulência. A maioria dos estudos sobre a virulência de P. gingivalis foi realizada com cepas de referência, e pouco se conhece sobre este aspecto em isolados clínicos. A capacidade de indução de abscessos difusos em modelos animais experimentais parece estar associada a cepas capsuladas, enquanto a expressão de fímbrias e a capacidade de internalização em células epiteliais não fagocíticas, foram relacionadas à cepa não capsulada. Em P. gingivalis, o lócus de biossíntese do polissacarídeo capsular (BPC) apresenta características de ter sido adquirido por transferência horizontal de genes. O objetivo do presente estudo foi testar a hipótese de que a estrutura populacional de P. gingivalis relaciona-se com a variabilidade do lócus BPC e características fenotípicas como produção de cápsula e hidrofobicidade. Foram analisadas 28 cepas de P. gingivalis pertencentes aos 5 genótipos fimA quanto a, presença da cápsula por microscopia óptica, hidrofobicidade e detecção de genes do lócus BPC por PCR. A análise filogenética foi realizada por tipagem através de seqüenciamento de genes housekeeping (multilocus sequence typing, MLST). Dezesseis entre 28 amostras estudadas apresentaram cápsula, e não foram detectadas diferenças na hidrofobicidade dos isolados clínicos capsulados e não capsulados. O gene pg0106 foi detectado por PCR em 78% das amostras capsuladas e em 80% das amostras não capsuladas, enquanto pg0111 foi detectado em apenas 25% de amostras capsuladas. Apenas um isolado clínico e a amostra padrão W83 foram classificados como K1, por apresentarem o gene pg0118. Através do MLST foi possível identificar grande variabilidade entre as amostras de P.gingivalis. Foi observada relação entre STs e o tipo fimA ou hidrofobicidade, mas nenhum cluster foi associado à presença da cápsula ou aos genes do lócus de biossíntese do polissacarídeo capsular. Os dados indicam associação entre o lócus BPC e produção de cápsula, porém a diversidade deste lócus parece ser maior do que a relatada na literatura. O lócus BPC e a produção de cápsula não se relacionam com a origem filogenética da cepa, indicando a intensa recombinação que ocorre em P. gingivalis.Porphyromonas gingivalis is one of main organisms associated with chronic periodontitis and is largely diverse, which could reflect in its virulence. Most studies on the virulence of P.gingivalis were performed with reference strains, and little is known about this aspect in clinical isolates. The ability to induce diffuse abscesses in experimental animal models seems to be associated with encapsulated strains, while expression of fimbriae and the ability to internalize into non phagocytic epithelial cells were related to noncapsulated strains. In P.gingivalis, the locus of biosynthesis of the capsular polysaccharide (GP) has characteristics of having been acquired by horizontal gene transfer. This study aimed to test the hypothesis that the structure population of P.gingivalis is related to the variability of the GPC locus and phenotypic characteristics such as capsule production and hydrophobicity. 28 P.gingivalis isolates representing fimA genotypes were screened for presence of capsule by light microscopy, hydrophobic properties and detection of genes in the GPC locus by PCR. The phylogenetic analysis was performed by sequencing of housekeeping genes typing (multilocus sequence typing, MLST). Sixteen of 28 studied samples had capsule, and there were no differences in the hydrophobic properties of capsulated and non capsulated clinical isolates. The pg0106 gene was detected by PCR in 78% of capsulated isolates and in 80% of not capsulated while pg011 was detected in only 25% of encapsulated isolates. One clinical isolate and reference strain W83 were classified as K1, due to the presence of pg0118 gene. MLST detected large variations within the P.gingivalis population. MLST clustering analysis revealed a relation between sequence type (STs) and fimA genotype or hydrophobic property, but there was no association of STs with the presence of capsule or the genes encoding for the biosynthesis of capsular polysaccharide. The data indicated an association between GPC locus and capsule production but the diversity of this locus appeared to be greater than that reported in the literature. The GPC locus and capsule production were not related to the phylogenetic origin of the strain, indicating intense recombination in P. gingivalis

Bosentan treatment of digital ulcers related to autoimmune disorders

Endothelin 1, a powerful endogenous vasoconstrictor and mitogen, may be causal to pulmonary hypertension. Evidence also suggests that endothelin (ET) may have a fundamental role in scleroderma pathogenesis, including pulmonary arterial hypertension (PAH), a leading cause of death in patients with scleroderma. The development of a new class of drug, ET receptor antagonists, provides an improved outlook for patients with scleroderma and related diseases. Increasing vigilance toward early detection of PAH in scleroderma and a multidisciplinary approach to diagnosis and treatment may improve the clinical outcome for these patients. We describe the efficacy and safety of bosentan, an orally active dual ET-receptor antagonist, in patients with digital ulcers. Bosentan increases exercise capacity and improves hemodynamics in patients with pulmonary hypertension, suggesting that ET has an important role in pulmonary hypertension but in our experience also for refractory skin ulcers. Drug Dev Res 72:750755, 2011. (C) 2011 Wiley Periodicals, Inc