Alopecia universalis after discontinuation of pegylated interferon and ribavirin combination therapy for hepatitis C: a case report

Abstract For the last decade, the combination therapy of pegylated interferon (Peg-IFN) plus ribavirin (RBV) has been considered as the standard of care treatment for chronic hepatitis C virus (HCV) infection. However, it has been associated with an increased incidence of many adverse cutaneous reactions and emergence of autoantibodies or even autoimmune diseases. We report a case of irreversible alopecia universalis (AU) with complete hair loss extended to the whole body, which started after discontinuation of Peg-IFN/RBV combination therapy for chronic HCV infection. In conclusion, this case represents an uncommon presentation of a common disease. Physicians must be aware of the potential adverse reactions of an antiviral therapy containing IFN, which might occur even after the discontinuation, and fully inform the patient at the beginning of his treatment course. We hope that interferon-free regimens will utterly supplant interferon-based therapy for most or all HCV patients avoiding the emergence of autoimmune manifestations

Residual inflammation in psoriatic arthritis patients in stable minimal disease activity

Background: In psoriatic arthritis (PsA), low disease activity as defined by the Minimal Disease Activity (MDA) index is considered a good treatment target. However, as MDA is based only on clinical findings, it might not capture pauci-symptomatic inflammation. Sensitive imaging such as ultrasound (US) might disclose residual inflammatory signs in PsA patients in MDA. Methods: In this cross-sectional multicentre study, adult PsA patients on biologic treatment in MDA for at least 6 months were consecutively enrolled for a thorough clinical and US examination. Data collection included demographics, personal history, main patient's reported outcomes, clinical and US findings of joints, tendon sheaths, tendons, bursae, and entheses involvement. All centers performed the US investigation in B-mode and Power Doppler (PD)-mode using a similar US machine equipped with a 18–6 and 13–5 MHz multifrequency linear probe. Statistical analysis included comparisons between groups and correlation tests. Results: The 72 PsA patients enrolled in the study had a median duration of MDA of 12 (6–65) months. Overall, US examination revealed a low number of acute lesions. However, 54% of patients had at least one PD signal in the examined tissues. A joint or enthesis positive PD signal was found in about 19 and 24% of patients, respectively. Synovial hypertrophy, at least one acute entheseal lesions, and bursitis were the most common changes, detected in 41.7, 41.7 and 26% of patients, respectively. Conclusions: PsA patients in a stable state of MDA may still have residual inflammation in peripheral articular structures detectable by US examination

Power Doppler signal at the enthesis and bone erosions are the most discriminative OMERACT ultrasound lesions for SpA: Results from the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) multicentre study

Objectives To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population. Methods In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). 'Active enthesitis' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas). Results In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses. Conclusions This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA

Urticaria

Thyroid autoimmiunity has been clearly shown to be significantly associated with chronic idiopathic urticaria and any review dealing with this condition should take into consideration the topic. Much less clear is the relationship with Helicobacter pylori infection and, therefore, the connection should not be emphasized until more evidence is obtained

Allergy to fungal allergens in Northern Italy

IgE-mediated allergy to fungal allergens was found in 8.1% out of 4174 patients undergoing skin prick test with commercial extracts. The most frequently involved fungi were A. Alternata (which accounted for 67% skin prick test positivities) and C. herbarum (14%). Monosensitization to fungi was very rare (6% of sensitized subjects) and was less frequently associated with asthma (38%) as compared to polysensitization (52% of subjects also sensitized to other inhalant allergens)

Prevalence and severity of the oral allergy syndrome in pollen monosensitized subjects living in an area of Northen Italy

Background: The term “oral allergy syndrome” (OAS) is currently used to report immediate reactions following the ingestion of raw fruit and vegetables. It is believed to be due to cross-reactivity between inhalant and food allergens. The exact prevalence and severity of OAS is still not clarified. Objective: To evaluate the prevalence and severity of OAS in two groups of pollen (grass and birch/hazel) monosensitized subjects. Materials and Methods: 141 subjects skin prick test (SPT) positive only to birch/hazel (group I) and 809 only to grass (group II) were interviewed about the occurence and the severity of any adverse reaction to fruit and vegetables. Latex- and poly-sensitized subjects were excluded. Results: The overall prevalence of OAS was 21% and was mild/moderate in 93%. In both groups OAS was more frequent in women (38% and 22%, p<0.05 and p<0.001, respectively) than men (22% and 15%) and less frequent in group II overall (18% vs 31%, p<0.001). Severe reactions were more prevalent in group I (overall prevalence 3.5% vs 0.7%, p<0.02). Reactions to apple (p<0.0001), vegetables of the Umbelliferae family (p<0.0001) and nuts (p<0.03) were more frequent in group I, whereas those to Cucurbitaceae (p<0.0005) and to vegetables of the Solanaceae family in group II (p<0.03). Conclusion: Although generally benign, SOA is a relevant phenomenon, affecting 18%-31% pollen monosensitized individuals and even more frequently women. Our data support the implementation of both clinical and laboratory studies to better define it and to draw guidelines for its management