ISSN:1040-8711    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The pathogenesis of the vasculitis syndromes slowly continues to yield its secrets. Over the past year, evidence has continued to accumulate, indicating that the endothelium exhibits a wide range of regulatory functions, mediated in large part through adhesion molecules. Several studies showed increased expression of such molecules in vasculitis. New appreciation of the Shwartzman reaction, which could explain non-immune complex-mediated vascular inflammation, continues to mount and to point toward potential future therapies. Soluble adhesion molecules were studied as potential diagnostic tools and/or markers of disease activity. Anti-endothelial cell antibodies (AECA) remain controversial as potential mediators of vasculitis. The results of recent studies suggest that AECA may be seen more frequently in ANCA-negative vasculitis and that AECA possess unique antigenic specificities in Wegener's granulomatosis and systemic lupus erythematosus. Sex steroids were shown to affect the expression of endothelial adhesion molecules, in addition to possessing well documented immunoregulatory properties. These findings may point to a critical role for sex steroids in the pathogenesis of vasculitis syndromes with female predominance, particularly Takayasu's arteritis.

ISSN:1040-8711    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Antineutrophil cytoplasmic antibodies (ANCA) are a heterogeneous group of autoantibodies with a wide and diverse range of clinical associations. In vasculitis, the diagnostic utility of proteinase 3 (PR3)-ANCA and myeloperoxidase-ANCA for Wegener's granulomatosis and microscopic polyangiitis, respectively, is now well established. Because of their significance as tools for diagnosis and prognosis, these autoantibodies have been analyzed extensively as markers for underlying immunopathogenic disturbances. In this review, we consider recent advances in the understanding of ANCA, focusing on their detection, diagnostic value, and role in the pathogenesis of vasculitis. In addition, promising new ways have been developed to elucidate the pathophysiologic and diagnostic relevance of the ANCA target antigens PR3 and myeloperoxidase. A great deal of attention and controversy has focused on the possible mechanisms underlying the ANCA-related immune response, such as antigenic cross-reactivity between human polymorphonuclear leukocyte proteins and extrinsic antigens by molecular mimicry, idiotype network regulation, and T cell reactivity to PR3 and myeloperoxidase.

ISSN:1040-8711    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The vasculitides are a heterogeneous group of disorders for which classification is needed to facilitate diagnosis and treatment. Recent studies based on a more comprehensive clinical analysis of symptoms and virologic investigations favor the recognition, in the polyarteritis nodosa (PAN) group, of a distinct form of systemic vasculitis calledmicroscopic polyangiitis(MPA). This distinction may be confusing, so the features of each condition need to be more precisely defined. Differentiation between PAN and MPA cannot be based on only histologic criteria. Clinical manifestations (especially lung and kidney involvement), biologic signs (antineutrophil cytoplasmic antibodies and hepatitis B and C infection), and angiographic data must be taken into consideration. Therapeutic strategy should differ dramatically, depending on whether primary or secondary MPA or PAN has been diagnosed, and treatment optimization is certainly the best reason for improving the classification of the systemic vasculitides.

ISSN:1040-8711    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

There are few controlled trials of immunosuppressive therapy for vasculitis, making the further study of long-term outcome of these diseases with contemporary modes of management necessary. Relapse is frequent in many forms of vasculitis. The consequences of immunosuppressive therapy, including opportunistic infection, have been emphasized. Novel forms of therapy have been described in small series and case reports, although the precise role of such therapies in the treatment of vasculitis in general is far from certain in the absence of collaborative, multicenter controlled studies. The relationship between vasculitis and hepatitis C virus has prompted the use of interferon therapy in the treatment of vasculitic complications resulting from this infection.

ISSN:1040-8711    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Molecular techniques have provided new tools to define genetic systems involved in disease susceptibility and to dissect molecular events driving inflammatory reactions. Inflammatory infiltrates in the wall of large and medium-sized arteries, sometimes associated with giant cell formation, are pathognomic for Takayasu's arteritis (TA) and giant cell (cranial) arteritis. Molecular techniques have been used successfully to define genetic host factors involved in disease susceptibility and to dissect the nature of inflammatory cells and mediators in the pathologic lesions. Careful analysis of incidence data for TA suggests that TA is a worldwide disease. Genetic comparison of western and eastern TA, however, raises the possibility of disease heterogeneity. Emerging data indicate that HLA-DRB1 genes represent important risk factors in giant cell arteritis. Whether disease association is related to the role of HLA-DR molecules in presenting a disease-inducing antigen remains to be seen. Analysis of the molecular diversity of tissue-infiltrating T cells indicates that a small proportion of CD4+T cells proliferate in situ, potentially as a result of antigen recognition. Tissue cytokine profiles reveal functional selection of T cells and are compatible with the model that Th1 cells recognize antigen on the surface of activated macrophages. The presence of T cell-derived cytokines in temporal artery tissue of patients with polymyalgia rheumatica who are lacking microscopic inflammation indicates subclinical vasculitis.

ISSN:1040-8711    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Angiitis of the central nervous system (CNS) remains a poorly understood and clinically challenging form of vascular inflammatory disease. Primary angiitis of the CNS (PACNS) has been viewed as a relentless and uniformly fatal disorder if untreated. In addition, recent trends have demonstrated an increasing reliance on angiographic diagnosis without tissue confirmation. It has been suggested that PACNS is clinically more heterogeneous than previously appreciated and may include relatively benign subsets. A reappraisal of diagnostic approaches has suggested caution in the diagnosis of CNS angiitis on purely angiographic grounds. Secondary vasculitis of the CNS is even more heterogeneous. Clinicians involved in the evaluation of patients with presumed CNS vasculitis need to be aware of the clinical spectrum of vascular inflammatory disease within the CNS as well as the strengths and limitations of currently available diagnostic modalities.

ISSN:1040-8711    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Literature on the association of malignancies with various rheumatic disorders published over the past year is summarized in this review. The possible roles of methotrexate treatment in predisposing to the development of lung cancer and Felty's syndrome in predisposing to non-Hodgkin's lymphoma in rheumatoid arthritis patients are discussed. The increased occurrence of monoclonal gammopathies and non-Hodgkin's lymphoma in patients with Sjogren's syndrome is reported. The possible increased frequency of malignancies among patients with systemic lupus erythematosus (SLE), scleroderma, and polymyositis-dermatomyositis is revisited; of interest, the overlapping clinical features of non-Hodgkin's lymphoma and SLE are presented, as well as the increased occurrence of ovarian cancer in patients (especially older women) with dermatomyositis. The proceedings of the first International Workshop on Hypertrophic Osteoarthropathy, as well as the association of this syndrome with nasopharyngeal carcinoma in the childhood years, are presented. Finally, postchemotherapy and post-bacille Calmette-Guérin rheumatism are described.

ISSN:1040-8711    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Many inflammatory rheumatic conditions may result, in part, from local release of sensory neuropeptides; substance P is currently the best studied of these. Various neurologic diseases that result in movement disorders continue to come to the attention of rheumatologists, primarily because of the pain and stiffness associated with them, and they are often misdiagnosed. Neuroarthropathies remain the most distinctive of the joint disorders that appear to result directly from neurologic injury, but little new information concerning these disorders has been generated in the past year.

ISSN:1040-8711    

出版商:OVID    

年代:1995

数据来源: OVID