Systemic lupus erytematosus (SLE) is a multi-organ autoimmune disease that affects women of childbearing age. SLE and lupus nephritis have more maternal and fetal complications than the general population. However, the impact of pregnancy on SLE activity is controversial in the literature, some studies reporting increased risk of lupus flare, while others indicate no increased risk.
Objectives
The aims of this study were to investigate the effect of the pregnancy on disease status, both during the pregnancy and puerparium and the predictors for lupus flare. In addition, we examine lupus activity and pregnancy outcomes in lupus pregnancies continued, discontinued or not treated with Hydroxychloroquine (HCQ) during pregnancy.
Methods
We performed a retrospective analysis of 183 pregnancies in 132 SLE patients managed in Catholic University Medical Center, Korea, between 1998 and 2012. Clinical profiles and maternal and fetal outcomes were assessed for this study population. Lupus flare was assessed with SLEDAI score. Discontinued HCQ group was defined as cessation of HCQ treatment within the 3 months prior to pregnancy. Not treated with HCQ from pre-pregnancy was defined cessation of HCQ treatment beyond 3 months prior to pregnancy.
Results
The pregnancies were divided into 2 groups: experienced lupus flare (84 pregnancies) and not experienced lupus flare (99 pregnancies). 87.4% of pregnancies had successful delivery. There were significantly more preeclampsias (27.4% vs. 7.1%, with and without lupus flare, respectively, P <0.001), preterm births (44% vs. 16.7%, P=0.01), low birth weight (2.42±0.60 kg vs. 2.85±0.54 kg, P<0.001), intrauterine growth retardation (38.6% vs. 18.9%, P=0.006) and low 1 minute Apgar score (25.7% vs. 8.9%, P=0.004) in pregnancies with lupus flare. Lupus flares were predicted by discontinuation of HCQ (OR=4.968, 95% CI, 1.114-22.145; p=0.036), history of lupus nephritis (OR, 4.417; 95% CI 1.253-15.575, p=0.021), active disease status at conception (OR, 4.526; 95% CI, 1.276-16.049; p=0.019), high serum uric acid level (OR, 2.624; 95% CI, 1.414-4.868; p=0.002) and C4 level at pre-pregnancy (OR 0.858, 95% CI 0.762-0.966; p=0.011).
Conclusions
Our study indicates that achieving remission before pregnancy and continuing HCQ treatment during pregnancy are important to prevent lupus flare during pregnancy.
References
Stojan G and Baer AN. Flares of systemic lupus erythematosus during pregnancy and the puerperium: prevention, diagnosis and management. Expert review of clinical immunology. 2012; 8: 439-53. Lateef A and Petri M. Management of pregnancy in systemic lupus erythematosus. Nature reviews Rheumatology. 2012; 8: 710-8. Stanhope TJ, White WM, Moder KG, Smyth A and Garovic VD. Obstetric nephrology: lupus and lupus nephritis in pregnancy. Clinical journal of the American Society of Nephrology: CJASN. 2012; 7: 2089-99. Ateka-Barrutia O and Khamashta M. The challenge of pregnancy for patients with SLE. Lupus. 2013; 22: 1295-308. Clowse ME. Lupus activity in pregnancy. Rheumatic diseases clinics of North America. 2007; 33: 237-52, v. Petri M. Sex hormones and systemic lupus erythematosus. Lupus. 2008; 17: 412-5.
Abstract. Typical types of natural disasters that occur in Korea are damages from heavy rain, storm, and heavy snow. In order to prepare for this, the storm and flood damage insurance program is operated. For this purpose, the risk of these damages is calculated for each region, and the storm and flood damage insurance map is created based on the risk. This map can provide insight into the degree of risk to wind and flood, snow damage, as well as policies to prevent and prepare for each type of natural disaster. In order to support decision-making by utilizing this insurance map, it is necessary to use with disaster Information contents. In order to efficiently construct such disaster information contents, it is possible to utilize public data produced by various organizations. Korea has a public data portal to open various administrative information. The public data portal currently publishes and updates about 25,000 data from 700 organizations. In this study, the linkage system is designed that can construct disaster information contents by collecting public data and processing it so that it can be overlapped with the insurance map. The system automatically links public data to keep up-to-date disaster information content. It is expected that it will be able to prevent and prepare for natural disaster by supporting the decision making of decision makers related to flood damage.
Antibodies against citrullinated peptides are specific to rheumatoid arthritis (RA), although its pathologic relevance has not been clearly understood.
Objectives
This study was undertaken to develop a novel anti-citrullinated petide antibody (ACPA) and to investigate the arthritogenecity of the ACPA in collagen-induced arthritis (CIA) model, the commonly used murine model of RA.
Methods
The novel ACPA, 12G1 was developed by injecting cyclic citrullinated antigen to mice and subsequently hybridizing the B cells producing citrullinated peptide-specific antibodies with myeloma cell line. Arthritic joints of mice with CIA and collagen antibody induced arthritis (CAIA) and IL-1Ra knockout mice underwent immunohistochemical staining with 12G1 antibody, and the staining pattern was compared. Confocal immunostaining was used to identify co-localization of 12G1 with various citrullinated peptides. 12G1 in the presence or absence of chelating bead was administered to mice with CIA on day 21 and 28 after type II collagen (CII) immunization to investigate the arthritogenecity of 12G1.
Results
12G1 could detect citrullinated peptides in the arthritic joints of various experimental arthritis models. On confocal immunostaining of arthritic joints with 12G1, it was found to be co-localized with well-known citrullintaed peptides including vimentin, collagen, anti-immunoglobulin binding protein (BiP), and fibronectin. There was no difference in the staining pattern of citrullinated peptides between the different arthritis models. The injection 12G1 apparently showed comparable effect of a booster immunization in CIA mice with single immunization of CII, which was abolished when 12G1 was injected with chelating beads.
Conclusions
The novel ACPA, 12G1 identified various citrullinated peptides in the arthritic joints of various experimental arthritis models. 12G1-treated mice develop arthritis with single immunization of CII, which suggested arthritogenic potential of ACPA in CIA mice.
References
Sakkas, L. I., et al. (2014). Anti-citrullinated peptides as autoantigens in rheumatoid arthritis-relevance to treatment. Autoimmun Rev 13(11): 1114-1120. Vossenaar, E. R., et al. (2003). Citrullination of synovial proteins in murine models of rheumatoid arthritis. Arthritis Rheum 48(9): 2489-2500.
Interferon (IFN) signatures are upregulated in patients with primary Sjogren9s syndrome (pSS) and interferons are considered to play a pathogenic role in pSS. Therefore, Janus kinase (JAK) which mediates interferon signaling pathway may be a good therapeutic target
Objectives
We set out to investigate whether a selective JAK1 inhibitor, filgotinib would ameliorate disease-related parameters in non-obese diabetic (NOD) mice, an animal model SS
Methods
Filgotinib (1.5mg/kg) or vehicle (saline) was intraperitoneally injected three times per week from 8 weeks after birth. Salivary flow rate (SFR) was addressed on 8, 12, 16 and 20 weeks. Histologic analysis was performed on 20 weeks. The effect of filgotinib on the expressions of B cell activating factor (BAFF) and chemokines (CXCL10 [IP-10], CXCL3 [fractalkine], CCL-2 [MCP-1]) in human salivary gland epithelial cell (SGEC) line or primary epithelial cells of patients with pSS was determined in vitro.
Results
The SFR of NOD mice in both groups decreased over time. Of note, SFRs of filgotinib-treated mice were greater than those of controls. Histologic evaluation of the salivary gland revealed that the lymphocytic infiltration of salivary gland was markedly reduced in the mice treated with filgotinib. Filgotinib suppressed STAT1 phosphorylation in IFN-treated SGECs. In addition, IFN-induced BAFF and chemokine production of SGECs or primary epithelial cells were abrogated by filgotinib treatment.
Conclusions
Filgotinib suppresses SFR decrease and lymphocytic infiltration of salivary glands of NOD mice by inhibiting inhibiting IFN signaling pathway, thus suppressing BAFF and chemokine production of salivary gland epithelial cells. JAK inhibition may be a novel therapeutic approach for SS.
Psoriasis is a chronic, inflammatory skin disease affecting approximately 1–3% of the general population. This nationwide, population-based study investigated the impact of body mass index (BMI) and waist circumference (WC) on the psoriasis in the Korean population. We used the health check-up database, which is sub-dataset of the Korean National Health Insurance Service database. Study population includes subjects who had undergone health screenings between 2009 and 2012. Total 22,633,536 subjects were included and psoriasis newly developed in 399,461 subjects. Mean BMI of newly developed psoriasis group was higher than non-psoriasis group (p<0.0001). Mean WC of newly developed psoriasis group was higher than non-psoriasis group (p <0.0001). BMI showed J-shaped association with the risk of psoriasis. Subjects with BMI over 30 had higher risk of psoriasis (HR 1.118, 95% CI 1.1-1.137). The risk of psoriasis increased in proportion to WC. Subjects with WC over 105 cm showed highest risk of psoriasis (HR 1.305, 95% CI 1.261-1.349) . The risk of psoriasis increased most in the male group with normal weight, abdominal obesity (HR 1.175, 95% CI 1.15-1.2). According to our study, the WC is more likely to affect the risk of psoriasis than obesity.Our study supports the association between abdominal obesity and psoriasis, which increases awareness of the role of abdominal obesity in the pathogenesis and comorbidities of psoriasis.
The purpose of this study was to investigate the prevalence of the anatomical abnormalities that can induce inadvertent dural puncture when performing caudal block. The anatomy of the lumbo-sacral area was evaluated using magnetic resonance imaging. In 2462 of the 2669 patients imaged, the dural sac terminal was located between the upper half of the 1st sacral vertebra and the lower half of the 2nd sacral vertebra. In 22 cases (0.8%), the dural sac terminal and the spinal canal were located at or below the 3rd sacral vertebra, and these were cases of simple anatomical variations. As regards pathologic conditions, there was one case of sacral meningocoele and 46 cases of sacral perineural cyst. In 21 cases (0.8%) out of the 46 perineural cyst cases, the cyst could be found at or below the 3rd sacral vertebra level. Inadvertent dural puncture may happen when performing caudal block in patients with such abnormal anatomy.
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