ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Although atherosclerosis was linked to infections many decades ago, only recently there has been a renewed interest to study this association further. These research endeavors have provided a substantial amount of knowledge concerning the mechanisms that may link inflammation, immunity, and infections to the molecular and cellular events in the arterial wall leading to atherosclerotic lesions.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The primary symptoms of many vasculitides resemble those of infectious diseases. Patients with Wegener's granulomatosis usually seek medical care for respiratory tract symptoms resembling those caused by infection or allergy. In addition, vasculitis is a well-documented manifestation of infection by some known microbial agents. There have been relatively few controlled studies, however, seeking to identify infectious agents as the triggering factors in systemic vasculitides. Molecular methods offer powerful approaches for the identification of infectious agents in diseases of previously unknown origin. These methods include broad-range amplification of microbial nucleic acid sequences and comparative or subtractive methods, such as differential display and representational difference analysis. Host gene expression profiles (using DMA-chip technology) may also provide clues as to the possible infectious cause of an idiopathic disease. Furthermore, the application of molecular methods may reveal pathologic mechanisms and novel therapeutic strategies for the vasculitides.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The human vasculitides are idiopathic syndromes for which both autoimmune and infectious causes have been proposed. Although proof of a correlation between infection and human vasculitis would aid in patient management, it is difficult to confirm causality. To study infection-mediated vascular disease, different animal models have been developed. Infections with the bacteriumChlamydia pneumoniae, an RNA virus, and herpesviruses all cause vascular pathology and are reviewed here. Many aspects of the human diseases are recapitulated in these models, so that further animal studies may help elucidate mechanisms of infection-mediated vasculitis. Such results may improve management, and potentially prevention, of these important human diseases.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Multiple risk factors are involved in susceptibility to vasculitis. Inherited determinants may increase the risk but are insufficient to induce the disease. Environmental factors, such as infections, are important modulators and probably trigger the disease in most cases. One of the possible triggers may be a bacterial superantigen (SAg). SAgs may activate autoreactive T cells that mediate autoimmune vessel wall destruction. Furthermore, SAgs may activate autoreactive B cells to produce autoantibodies that are involved in the pathophysiology of vasculitis, such as antineutrophil cytoplasmic autoantibodies or anti-endothelial cell antibodies. In patients with Kawasaki disease, Wegener's granulomatosis, and infection-related forms of vasculitis, SAg-producing microorganisms have regularly been found. Activation of circulating T cells and skewing of the T-cell repertoire have been reported in most forms of vasculitis. In the past year, for the first time, patients were described in which T-cell receptor Vp expansions were documented simultaneously with the typing of the microbial SAgs, providing evidence that the observed changes in the T-cell repertoire could be caused by these bacterial SAgs. In the future, elucidation of the immunologic mechanisms by which SAgs may play a role in the pathophysiology of vasculitis will provide more effective methods for the treatment of vasculitis.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This review discusses the main issues of antineutrophil cytoplasm autoantibodies (ANCA) that have emerged from the literature. From January 1997 to August 1998, 216 papers were published on ANCA. Two major themes seem to be evolving from these articles. The first theme concerns the specificity and sensitivity of ANCA testing in clinical practice in relation to diagnosing systemic vasculitic syndromes. We focus on immunofluorescence patterns, ANCA antigens, testing methodology, and the (predictive) value of ANCA in clinical practice. Second, there is the unsolved question of how ANCA are etiologically involved in the development of the vasculitic lesion. Ongoing research questions the role of ANCA in stimulating granulocytes, monocytes, and the endothelium.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Glucocorticosteroids (GCs) are the drug of choice in all clinical types of giant cell arteritis (GCA); a study delineated that an unexpectedly high percentage of patients required long-term GCs, with the consequence of significant complications attributable to GC therapy. Azathioprine and methotrexate are recommended as GC-sparing drugs. Cyclosporin A was found to confer no additive effect versus GC treatment alone. Depot GCs intramuscularly every 3 weeks decreased the cumulative GC dose and were associated with fewer bone fractions compared with daily oral GCs. Pulse cyclophosphamide has been shown to be as effective as the standard therapy in necrotizing vasculitides; however, an alarmingly high rate of infections was observed in this study in both arms possibly related to the high dosage of GCs. New drugs such as mycophenolate mofetil and leflunomide appear as alternatives as maintenance therapy in antineutrophil cytoplasm autoantibody-associated vasculitides in pilot studies. Interferon-α (IFN-α) has been shown to be effective in treatment-resistant Churg-Strauss syndrome, and IFN-a or ribavirin can be used successfully in essential mixed cryoglobulinemia (induced by hepatitis C virus). Thalidomide was shown to be effective for treating oral and genital ulcers and follicular lesions in Behpet's syndrome; severe refractory Behget's syndrome uveitis responded to treatment with IFN-α.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Work originating in the 1940s led to the characterization of a rare, chronic inflammatory disorder with a unique predilection for the cornea and vestibuloauditory apparatus, now calledCogan's syndrome(CS) after the ophthalmologist who first described it. CS occurs primarily in young adults and typically presents with interstitial keratitis (IK) and Meniere's-like episodes developing within several months of each other. The inflammatory process may target other ocular sites, and the disease itself may be accompanied by aortitis or a Takayasu's-like or medium-sized vessel vasculitis. Morbidity in CS results from deafness and complications from cardiovascular disease. Most evidence suggests that the ocular and vestibuloauditory manifestations are not a consequence of vasculitis but rather mediated by other immunologic mechanisms, possibly organ-specific autoimmunity. The cornerstone of treatment in CS is corticosteroids, topically for IK and systemically for inner ear dysfunction. Early corticosteroid therapy appears to be critical for reversing hearing loss. Cochlear implants can partially restore auditory function and have been a salvation for patients who suffer from deafness as a result of permanent cochlear damage.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

There have not been any breakthroughs in understanding of the pathogenesis of Behcet's syndrome within the past year. We still do not know the meaning of the HLA-B51 association. The role of T cells in pathogenesis is still undefined, and it is not yet clear whether an extrinsic antigen or antigens produces the disease. Likewise the role of the neutrophil in pathogenesis is under scrutiny. More pediatric cases are being described. We are beginning to have a better understanding of central nervous system involvement, the prime pathology of which might not be vasculitis. Azathioprine, not a panacea, is nevertheless effective for long-term management. Thalidomide has clearly been shown to be effective in mucocutaneous disease even at a dose of 100 mg/d. However, relapses are seen with cessation of therapy.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID