Tolerogenic dendritic cells: role and therapeutic implications in systemic lupus erythematosus

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Corticosteroid injections for common soft tissue rheumatism

Soft tissue injuries are probably the most commonly encountered rheumatic complaints and yet they are often overlooked. The diagnosis of most of these lesions relies on the physician's clinical acumen and a thorough understanding of the anatomy and function of the soft tissue involved is essential. A lot can be done to improve the patient's symptomatology once the diagnosis is made. Intralesional injection of corticosteroids is an effective form of treatment but care should be taken in the choice and dose of the steroid preparation used, the site of the injection and the monitoring of the patient's condition post-injection. In this article, the diagnosis and techniques of intralesional steroid injection of common soft tissue injuries are described.published_or_final_versio

Drug therapy in rheumatoid arthritis

Rheumatoid arthritis is such a debilitating illness that much effort has been made to find the ideal therapeutic regimen that has a high efficacy but low toxicity rate. Although such regimen has not been found yet, judicious use of what are currently available can improve the outcome of many of our patients.published_or_final_versio

The relation of cytokines of IL-17/IL-23 axis to Th1/Th2 cytokines and disease activity in systemic lupus erythematosus

INTRODUCTION: Interleukin (IL)-17 is recently linked to the pathogenesis of systemic lupus erythematosus (SLE) but its relation to disease activity has not been well characterised. The objectives of this study were to examine the relation of serum cytokine levels from the IL-17/IL-23 axis (IL-17, IL-23) to Th1 (IL-12, IFN-γ), Th2 (IL-10, IL-6, IL-4) cytokines and disease activity in SLE patients. METHODS: Serum cytokines were measured by enzyme-linked immunosorbent assays. Disease activity was determined by SLE disease activity index (SLEDAI), anti-dsDNA antibody, C3 and C4 levels. RESULTS: Serum levels of IL-17, IL-10 and IFN-γ were higher in SLE patients (n=70) compared to age- and sexmatched controls (n=14) [P<0.001]. Higher serum IL-23 level was found in active lupus patients who had cutaneous manifestation (P=0.003) and serositis (P=0.03) compared to those who had not. Serum IL-17 was not different between patients who had active lupus nephritis (n=23), non-renal active lupus (n=13) and inactive disease (n=34) [P=0.23]. However, an inverse correlation between serum IL-17 with proteinuria was found among all SLE patients (r= –0.27, P=0.03). Serum IL-17 level was, otherwise, not related to SLEDAI, glomerular filtration rate, activity or chronicity score and ISN/RPS class among patients with active lupus nephritis and was not found to correlate with serum IFN-γ or IL-10. CONCLUSIONS: Elevated serum IL-23 was found in patients with inflammatory manifestations including cutaneous involvement and serositis. Serum IL-17 level was not shown to correlate with disease activity but demonstrated an inverse correlation with proteinuria suggesting urinary loss of IL-17 and its involvement in lupus renal pathology.published_or_final_versionThe 15th Medical Research Conference (15th MRC), Department of Medicine, University of Hong Kong, Hong Kong, 16 January 2010. In Hong Kong Medical Journal, 2010, v. 16 n. 1, suppl. 1, p. 45, abstract no. 7

Intermittent monthly intravenous infusion of iloprost may improve the prognosis of systemic lupus erythematosus (SLE) associated severe pulmonary hypertension (PHT)

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A comparison of the performance of the Assessment of SpondyloArhritis international Society (ASAS) classification criteria, European Spondyloarthropathy Study Group (ESSG) classification criteria, and Modified New York (MNY) criteria in a cohort of Chinese spondyloarthritis patients

BACKGROUND: The existing Modified New York (MNY) criteria and European Spondyloarthropathy Study Group (ESSG) criteria are defective in early diagnosis of patients with spondyloarthritis. The objective of this study was to reclassify a Chinese cohort of patients with previous expert-diagnosed spondyloarthritis according to the recently issued Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis and the two existing criteria, the ESSG criteria and MNY criteria and to compare the clinical characteristics including disease duration, disease activity, and spinal mobility between patients fulfilling these criteria. METHODS: Consecutive patients diagnosed by expert opinion from a tertiary centre were classified into three groups: the Ankylosing Spondyloarthritis (AS) by MNY criteria; undifferentiated spondyloarthritis (USpA) by ESSG criteria (USpA/ESSG), and those by ASAS classification criteria only (USpA/ASAS). Functional status was studied by Bath Ankylosing Spondylitis Functional Index (BASFI). Disease activity was evaluated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and C-reactive protein. Spinal mobility including modified Schober test and chest expansion was determined. RESULTS: A total of 128 spondyloarthritis patients (92 male and 36 female) were recruited. USpA/ASAS group identified patients with shortest disease duration (9.2±2.3 years, 11.6±3.8, 18.7±2.2 years in USpA/ASAS group, USpA group, and AS group respectively; P<0.01). USpA/ASAS and USpA/ESSG groups were better than AS group in terms of BASFI, modified Schober test and chest expansion. C-reactive protein and BASDAI were similar in the three groups. CONCLUSION: The ASAS classification criteria are shown to identify spondyloarthritis patients at an earlier stage when spinal mobility and functional status are preserved. This group of USpA patients demonstrated comparable disease activity to other groups, suggesting a need and predictably better outcome for early treatment.published_or_final_versionThe 15th Medical Research Conference (15th MRC), Department of Medicine, University of Hong Kong, Hong Kong, 16 January 2010. In Hong Kong Medical Journal, 2010, v. 16 n. 1, suppl. 1, p. 18, abstract no. 2

Intestinal pseudoobstruction is an uncommon but important clinical manifestation of systemic lupus erythematosus (SLE)

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Effects of CD8+CD28- T suppressor lymphocyte (Ts) on B- and T- lymphocyte function in systemic lupus erythematosus (SLE)

Conference Theme: Challenges to specialists in the 21st centurypublished_or_final_versio

Peripheral lumphocyte apoptosis and bcl-2 expression in systemic lupus erythematosus: correlation with disease activity

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Ethnic differences in cardiovascular risk in rheumatic disease: Focus on Asians

Rheumatic diseases are associated with high cardiovascular morbidity and mortality. Considerable differences exist in the frequency of cardiovascular disease (CVD) risk factors and events among people of different ethnic origins, but little is known of the ethnic variations in the relative distribution of CVD risk factors and the degree of atherosclerosis in patients with rheumatic diseases. Understanding this variation will provide insight into the underlying pathogenesis of CVD in patients with rheumatic diseases, and aid in future studies of the detection and management of this complication. In general, although Asian patients seem to have fewer background CVD risk factors and are less affected by metabolic syndrome (MetS) than their non-Asian counterparts, those with rheumatic disease are equally as susceptible to CVD. Furthermore, it seems that systemic inflammation and mechanisms that do not involve conventional CVD risk factors and MetS have an important role in the development of atherosclerosis in patients with rheumatic diseases. Here we examine the frequency of conventional CVD risk factors and the prevalence of MetS in both Asian and non-Asian patients with selected rheumatic diseases. We also discuss the burden of CVD, as evaluated using various surrogate markers in these patients, and their overall CVD mortality rate. © 2011 Macmillan Publishers Limited. All rights reserved.postprin