Restoration of the peace in autoimmune disease: tired of fighting?

Autoimmune diseases are chronic conditions initiated by the loss of immunological tolerance to self-antigens. They constitute heterogeneous group of disorders, in which multiple alterations in the immune system result in a spectrum of syndromes that either target specific organs or affect the body systematically. Recent epidemiological studies have shown a possible shift of one autoimmune disease to another or the fact that more than one autoimmune disease may coexist in a single patient or in the same family. Numerous autoimmune diseases have been shown to coexist frequently with thyroid autoimmune diseases. AUTOIMMNUNE THYROID DISEASE AND OTHER ORGAN SPECIFIC NON-ENDOCRINE AUTOIMMUNE DISEASES: This part of the study reviews the prevalence of autoimmune thyroid disease coexisting with: pernicious anaemia, vitiligo, celiac disease, autoimmune liver disease, miastenia gravis, alopecia areata and sclerosis multiplex, and several recommendations for screening have been given. AUTOIMMUNE THYROID DISEASE AND OTHER ORGAN NON-SPECIFIC NON-ENDOCRINE AUTOIMMUNE DISEASES: Special attention is given to the correlation between autoimmune thyroid disease and rheumatoid arthritis, systemic lupus erythematosus, syndrome Sjögren, systemic sclerosis and mixed connective tissue disease. Screening for autoimmune thyroid diseases should be recommended in everyday clinical practice, in patients with primary organ-specific or organ non-specific autoimmune disease. Otherwise, in patients with primary thyroid autoimmune disease, there is no good reason of seeking for all other autoimmune diseases, although these patients have a greater risk of developing other autoimmune disease. Economic aspects of medicine require further analyzing of these data, from cost/benefit point of view to justified either mandatory screening or medical practitioner judgment.

Celiac Disease Beyond the Gut

Introduction: Panorama studies of autoimmune and auto-inflammatory diseases are still very little carried out in Africa and particularly in Mali. The objective of this descriptive study with retrospective collection was to describe the epidemiological and clinical profile of all autoimmune and auto-inflammatory diseases in the department of internal medicine at the University Hospital Center of the Point G. Methods: This was a descriptive study with a retrospective survey of the records of patients hospitalized for autoimmune and auto-inflammatory diseases in the department of internal medicine at the CHU of Point G for a study period of 15 years from January 1, 2005 to December 31, 2019. We included in the study all patients hospitalized for autoimmune and auto-inflammatory diseases. Results: During the study period (January 31, 2005 to December 31, 2019), 6383 patients were hospitalized in internal medicine at the University Hospital Center of the Point G, of which 317 patients presented with autoimmune and/or auto-inflammatory disease with an average annual hospital recruitment rate of 21 ± 7.87 cases per year. The female sex accounted for 64.98% with a sex ratio of 0.54. The mean age of patients was 35.27 ± 16.27 years and the extreme ages were 07 and 79 years. Out of the 317 medical records included according to our inclusion criteria, there were 07 cases of association between autoimmune disease and autoinflammatory disease, i.e. 14 cases of autoimmune and autoinflammatory diseases. A total of 331 autoimmune diseases and/or auto-inflammatory diseases were collected, i.e. a frequency of 5.19%, including 291 cases of autoimmune diseases (221 cases of organ-specific autoimmune diseases and 70 cases of systemic autoimmune diseases) and 40 cases of autoinflammatory diseases (no case of monogenic forms, 08 cases of “systemic” polygenic forms and 32 cases of “organ-specific” polygenic forms). Organ-specific autoimmune diseases were dominated by type 1 diabetes (141 cases), Graves’ disease (48 cases) and systemic autoimmune diseases by systemic lupus erythematosus (43 cases), rheumatoid arthritis (16 cases). Among the auto-inflammatory diseases, the “systemic” polygenic forms were dominated by Horton’s disease (02 cases) and the “organ-specific” polygenic forms by gout (16 cases), ulcerative colitis (08 cases). Conclusion: It appears from our study that autoimmune and autoinflammatory diseases are characterized in internal medicine by their frequent occurrence in women and preferably between 25 and 44 years of age with very disparate distribution. We also observed a predominance of organ-specific autoimmune diseases over systemic ones, and “organ-specific” polygenic autoinflammatory diseases over “systemic” ones.

Guilt by Association: Inflammation and Shared Genetic Risk Between Stress-Related and Immune Disorders

The epidemiological, clinical, pathophysiological, and immunogenetic characterization of autoimmune and autoinflammatory diseases as a whole would provide relevant clinical and paraclinical clues, therapeutic targets, and preventive medicine approaches in common for some autoimmune and autoinflammatory diseases. Panorama studies of autoimmune and auto-inflammatory diseases are still very little carried out in Africa and particularly in Mali. Here, first of all, the objective of this observational cross-sectional and descriptive study with retrospective data collection for 15 years was to describe the epidemiological and clinical profile of all autoimmune and auto-inflammatory diseases in the department of internal medicine at the University Hospital Center of the Point G. Globally, 6,383 patients were hospitalized in internal medicine at the University Hospital Center of the Point G, of which 317 patients presented with autoimmune and/or auto-inflammatory disease with an average annual hospital recruitment rate of 21 ± 7.87 cases per year. Out of the 317 medical records that met our inclusion criteria,there were 07 cases of association between autoimmune disease and autoinflammatory disease, totaling 14 instances of both autoimmune and autoinflammatory disorders. A total of 331 autoimmune diseases and/or auto-inflammatory diseases were collected, i.e. a frequency of 5.19%, including 291 cases of autoimmune diseases (221 cases of organ-specific autoimmune diseases and 70 cases of systemic autoimmune diseases) and 40 cases of autoinflammatory diseases (no case of monogenic forms, 08 cases of “systemic” polygenic forms and 32 cases of “organ-specific” polygenic forms). Organ-specific autoimmune diseases were dominated by type 1 diabetes (141 cases), Graves’ disease (48 cases) and systemic autoimmune diseases by systemic lupus erythematosus (43 cases), rheumatoid arthritis (16 cases). Among the auto-inflammatory diseases, the “systemic” polygenic forms were dominated by Horton's disease (02 cases) and the “organ-specific” polygenic forms by gout (16 cases), ulcerative colitis (08 cases). According to our findings, autoimmune and autoinflammatory diseases are characterized in internal medicine by their frequent occurrence in women, preferably between the ages of 25 and 44, with a very disparate distribution. We also found that organ-specific autoimmune diseases outnumbered systemic ones, and "organ-specific" polygenic autoinflammatory diseases outnumbered "systemic" ones.

Presence of Other Autoimmune Diseases in Subjects with Autoimmune Thyroid Disease

Autoimmune diseases are independently associated with COVID-19 severity: Evidence based on adjusted effect estimates

reportedon the CAH–PBC overlap syndrome, citing 11 casesthat were clinically typical, although not studied for theauto-antibodies characteristic of AIH: their cases wereseropositive for anti-M2 but an anti-M4 type of reac-tivity was not demonstrable.The report of the Interna-tional Autoimmune Hepatitis Group (IAIHG),

Autoimmune encephalitis associated with autoimmune blistering diseases: A case series and retrospective review

Pemphigus is an autoimmune blistering disease affecting the skin and mucosa, which mostly in anecdotal reports has been associated with several autoimmune diseases. The aim of this study was to assess the frequency of autoimmune diseases in a large group of patients with pemphigus and their first-degree relatives. One hundred and ten patients with pemphigus were interviewed for the existence of various autoimmune diseases. Patients' sera were examined for the presence of several autoantibodies. The existence of autoimmune diseases in 969 first-degree relatives of the patients was assessed via questionnaires. Seven of 110 (6.3%) patients with pemphigus had concurrent autoimmune diseases, including four (3.6%) with autoimmune thyroid disease and three (2.7%) with rheumatoid arthritis. Ten of 969 (1.03%) first-degree relatives of patients with pemphigus had autoimmune thyroid disease, three (0.31%) had rheumatoid arthritis, and three (0.31%) had type 1 diabetes mellitus. The patient's group had a statistically significant higher prevalence of thyroid disease and rheumatoid arthritis than their first-degree relatives (P = 0.046 and 0.016 respectively). Patients with pemphigus seem to have a higher rate of autoimmune thyroid disease and rheumatoid arthritis than both the general population and their own first-degree relatives. Further studies comparing patients with pemphigus with healthy controls are needed to stratify their risk factors for developing other autoimmune diseases and to define guidelines regarding diagnosis and treatment of coexistent autoimmune disorders.

The Importance of Patient-Focused Drug Development in Pemphigus and Pemphigoid

Relapsed/refractory autoimmune hematological diseases, belong to the thrombus and hemorrhagic disease, are characterized by autoantibody-mediated blood cells or plasma protein destruction caused by the disorder of the immune system, which have poor responses to conventional immunosuppression, including corticosteroids, immunosuppressive agents etc.. Severe illness can endanger the patient′s life and follow-up treatment is difficult. It is still a clinical challenging to explore new treatments to improve the survival rate and long term prognosis of this type of patients. Bortezomib as the only proteasome inhibitor applied to the clinical treatment of tumors has achieved good clinical results in the treatment of multiple myeloma (MM). In addition, proteasome inhibitor such as bortezomib, demonstrating pleiotropic immunomodulatory effects, including inducing apoptosis of plasma cells, influencing process of antigen cells, inhibiting proliferation of autoreactive T cells and reducing expression of inflammatory cytokines. These diverse effects have provided the feasibility for the utility of proteasome inhibitor as a salvage therapy for relapsed/refractory autoimmune hematological diseases. In recent years, some foreign studies have shown that bortezomib can be used as a salvage treatment for patients with relapsed/refractory auto immune hematological diseases. Therefore, the article summarizes the recent research progress of proteasome inhibitor treatment in relapsed/refractory autoimmune hematological diseases. Key words: Bortezomib; Proteasome inhibitor; Relapsed/refractory autoimmune hematological diseases; Autoimmune diseases; Thrombocytopenia

Advances in autoimmune rheumatic diseases

Background: The common causes of Dry eye syndrome (DES) were autoimmune or non-autoimmune disorders. DES is common but lack of data in quality of life (QoL) of DES patients in Thailand. The primary outcome of this study was to determine QoL and health utility in patients of DES by EuroQol 5-domain (EQ-5D) of the 5-level version (5L) instrument. The secondary outcome was comparison of the utility in the patients of DES classified by severity and causes including the autoimmune and non-autoimmune diseases. Methods: The study was a cross-sectional study at a hospital in the northern part of Thailand. The inclusions DES patients were followed by Tear Film and Ocular surface Society the Dry Eye WorkShop II definition. The EQ-5D-5L (Thai version) descriptive system and the EQ visual analogue scale (VAS) was instrument for QoL evaluation. Results: Total patients of DES were fifty-six. The most patients were female. The mean age was 57.7(± 13.9) years. Most patients (94.6%) were female. The mean age was 59.7 (± 13.9) years old. The median time from diagnosis of DES was 4.7 years (IQR = 2.2 to 6.8 years). The common cause of DES associated was autoimmune disease. Primary Sjogren syndrome and idiopathic causes were the most common causes in autoimmune diseases and non- autoimmune diseases, respectively. In autoimmune disease, Primary Sjogren syndrome, was 41.18%. The most common causes of non-autoimmune diseases were idiopathic. The mean of EQ-5D-utility and EQ-VAS of DES were 0.76 (± 0.18) and 72.86 (± 15.19), respectively. The mean of EQ-5D-utility and EQ-VAS in these patients who were classified by severity including mild, moderate and severe were 0.84 (± 0.16) and 67.31(± 15.76), 0.78 (± 0.14) and 74.47 (± 15.71), 0.71 (± 0.22) and 74.58 (± 14.36), respectively. The mean of EQ-5D-utility and EQ-VAS in these patients who were classified by autoimmune or non-autoimmune disorders were 0.75 (± 0.21) and 75.78 (± 14.21), 0.78 (± 0.15) and 68.96 (± 15.88), respectively. There is no statistic significant in the EQ-5D-utility and EQ-VAS among severity and the causes including autoimmune or non-autoimmune disorders of these patients. Conclusions: This study demonstrated the importance of assessing QoL in DES. Primary Sjogren syndrome and idiopathic causes were the most common causes in autoimmune diseases and non-autoimmune diseases, respectively. The EQ-5D-utility was accorded with the severity of DES. However, no statistic significant was showed in the mean of EQ-5D-utility and EQ-VAS between the severity and between the causes including the autoimmune and non-autoimmune diseases of these patients.

Comorbidity profiles among patients with alopecia areata: The importance of onset age, a nationwide population-based study