Chronic Systemic Inflammatory Disease Research Articles

From Traditional Medicine to Advanced Therapeutics: The Renaissance of Phyto-nano Interventions in Psoriasis.

Psoriasis is an autoimmune systemic chronic inflammatory disease that exhibits characteristic detrimental effects on the skin, often leading to infections or comorbid conditions. The multifaceted nature of psoriasis has made it very challenging to treat, especially with current chemotherapy options. Therefore, it is essential to consider phytoconstituents as novel alternatives. However, despite demonstrating higher anti-inflammatory, anti-psoriasis, and immunomodulatory potential, their clinical usage is hindered due to their poor physicochemical properties. To address these drawbacks, nanoparticulate drug delivery systems have been developed, helping to achieve better permeation of phytoconstituents through topical administration. This has breathed new life into traditional systems of medicine, particularly in the context of treating psoriasis. In this current review, we present a detailed, comprehensive, and up-to-date analysis of the literature, which will contribute to affirming the clinical role of phyto-nano interventions against psoriasis.

Role and uptake of metal-based nanoconstructs as targeted therapeutic carriers for rheumatoid arthritis.

Rheumatoid Arthritis (RA) is a chronic autoimmune systemic inflammatory disease that affects the joints and other vital organs and diminishes the quality of life. The current developments and innovative treatment options have significantly slowed disease progression and improved their quality of life. Medicaments can be delivered to the inflamed synovium via nanoparticle systems, minimizing systemic and undesirable side effects. Numerous nanoparticles such as polymeric, liposomal, and metallic nanoparticles reported are impending as a good carrier with therapeutic properties. Other issues to be considered along are nontoxicity, nanosize, charge, optical property, and ease of high surface functionalization that make them suitable carriers for drug delivery. Metallic nanoparticles (MNPs) (such as silver, gold, zinc, iron, titanium oxide, and selenium) not only act as good carrier with desired optical property, and high surface modification ability but also have their own therapeutical potential such as anti-oxidant, anti-inflammatory, and anti-arthritic properties, making them one of the most promising options for RA treatment. Regardless, cellular uptake of MNPs is one of the most significant criterions for targeting the medication. This paper discusses the numerous interactions of nanoparticles with cells, as well as cellular uptake of NPs. This review provides the mechanistic overview on MNPs involved in RA therapies and regulation anti-arthritis response such as ability to reduce oxidative stress, suppressing the release of proinflammatory cytokines and expression of LPS induced COX-2, and modulation of MAPK and PI3K pathways in Kuppfer cells and hepatic stellate cells. Despite of that MNPs have also ability to regulates enzymes like glutathione peroxidases (GPxs), thioredoxin reductases (TrxRs) and act as an anti-inflammatory agent.

Serum GAS6, sAXL, IL-10, NO, and BCL-2 levels are decreased in patients with Behçet's disease.

Behçet's disease (BD) is an autoimmune chronic systemic inflammatory disease characterized by a versatile clinical spectrum. Growth arrest specific protein 6 (GAS6)/soluble AXL (sAXL) signaling pathway draws attention in the resolution of inflammation, and its deficiency is associated with chronic inflammatory, autoimmune diseases, as well as clearance of apoptotic cells by phagocytes - efferocytosis. In this study, it was aimed to investigate whether GAS6/sAXL, interleukin (IL)-10, nitric oxide (NO), and BCL-2 levels were associated with inflammation and efferocytosis contributes to the pathogenesis of BD. A total of 37 Behçet patients with ocular involvement and 30 healthy control subjects were included in this study. GAS6, sAXL, IL-10, NO, and BCL-2 levels were quantified using enzyme-linked immunosorbent assay (ELISA) method. Serum GAS6, sAXL, IL-10, NO, and BCL-2 levels were significantly lower in patients with BD compared to the controls (P < 0.005, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). In correlation analysis, research parameters decreased in patients with BD was significantly correlated with each other: GAS6-IL-10 (r = 0.585, P < 0.001), GAS6-BCL-2 (r = 0.541, P < 0.001), sAXL-BCL-2 (r = 0.696, P < 0.001), IL-10-NO (r = 0.717, P < 0.001), IL-10-BCL-2 (r = 0.759, P < 0.001), and NO-BCL-2 (r = 0.541, P < 0.001). In conclusion, decreased serum BCL-2 level may be an indicator of increased apoptosis in these patients and decreased levels of GAS6/sAXL, IL-10, and NO may indicate insufficient clearance of apoptotic bodies released as a result of increased apoptosis in BD patients.

Gout: physical activity in therapy and prevention of the disease

Gout is a systemic chronic inflammatory disease associated with purine metabolism disorders. Risk factors for gout are a combination of genetic and environmental factors. Taking into account such features of the pathogenesis of gout as hyperuricemia and the deposition of monosodium urate crystals in tissues and joints, the development of the inflammatory, researchers studied the effect of physical activity on its main links. The intensity of the load and the type of physical exercise were taken into account due to their possible effect on metabolic processes. There is currently no reliable evidence on the importance of physical activity in reducing serum uric acid levels. Research has shown that physical activity has a positive effect on inflammation between gout attacks. The use of physical exercise can indirectly affect uric acid levels by reducing body weight in comorbid pathologies. EULAR emphasizes physical activity to prevent cardiovascular risks, which is also important for gout. Conclusions. Physical activity as one of the components of lifestyle is important for gout due to its effect on the inflammatory process and the prevention of relapses, a general strengthening effect on the body, an effect on hyperuricemia due to the positive effect associated with comorbid pathology, and a decrease in cardiovascular risk and associated him premature death. Physical activity of low and moderate intensity is effective for gout. Preference is given to aerobic exercise, taking into account the nature of metabolism and the possible impact on the occurrence of gout attacks. Further study and development of the characteristics of physical activity in gout are necessary to improve the prevention and treatment of the disease, and the development of individual recommendations for patients (for the management of gout).

A narrative review on scientific evidence of mechanisms of naturopathy and yoga interventions for rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune systemic inflammatory disease, which has serious physical, psychological, and social consequences. Many RA patients continue to experience intolerable side effects from their treatments or an inadequate response, which leads to the disease progressing despite advancements in targeted biological and pharmacologic interventions. Examining the multi-modular, drugless approach of yoga and naturopathy to this autoimmune disease is equally important as it enables physicians to provide better care. Hence, the current review was undertaken to present an overview of the available scientific evidence on the mechanism of naturopathy and yoga therapeutic modalities in the management of RA. We searched PubMed and PubMed Central for pertinent English-language articles about the impact of yoga and naturopathy on RA. The results in this review are presented based on the therapeutic effect of yoga and various naturopathy treatment modalities with their mechanisms on RA. It shows naturopathy and yoga was effective in the management of RA due to its analgesic, anti-inflammatory, immunomodulatory and antioxidant effect.

Role of Virechan in the management of Ankylosing Spondylitis - A Case Study

Ankylosing Spondylitis is probably an autoimmune disorder with genetic component HLAB27 as important causative factor and having characteristic inflammatory back pain. As is a gradually progressive condition over several years until structural damage manifests clinically as sacroiliitis, loss of spinal mobility and reduce quality of life. It is also called as Marie Stumpell and Bechterew’s disease. It affects primarily the sacroiliac joint, spine, certain peripheral joints, tendon can also be affected and extra articular manifestation may be present sometimes. Ankylosing Spondylitis is a chronic systemic inflammatory disease that can cause the vertebrae to fuse in advanced stages. It is more common in male than female. Signs and symptoms typically begin in early adulthood. No satisfactory treatment is available in modern medicine for this disease. In the present case report, a 21 year old female patient presented with complaints pain the lower back region accompanied by early morning stiffness and pain radiating to B/L hip joints. This pain was insidious in onset which brought the patient to OPD of Arthritis Clinic (Aamvata) of Pandit Khushilal Sharma Government Ayurveda Institute Bhopal. As per Ayurvedic classics, this condition can be correlated with Aamvata and treated with Panchkarma procedure Virechan karma. The outcome was very remarkable she got symptomatic relief assessed by Bath Ankylosing Spondylitis Disease Activity Index without causing any adverse effect.

Psoriasiform dermatitis in a person of colour with chronic hepatitis B

AbstractA 43‐year‐old patient from Liberia presented with itching scaly plaques, impaired quality of life persisting for 9 months and intermittent joint pain in the knees. Personal and family history was unremarkable. Coexisting diagnoses included type 1 diabetes mellitus and liver cirrhosis due to chronic hepatitis B and D. The patient reported ongoing use of Tenofovir, Propranolol, Glargine and Aspart. Clinical examination showed disseminated brownish, partly confluent hyperkeratotic plaques distributed throughout the integument in a Fitzpatrick skin type V. A skin biopsy revealed histologically a psoriasiform dermatitis. Laboratory findings included lymphocytopenia and elevated liver values. Hepatitis B serology confirmed chronic hepatitis B. Considering the clinical and histopathological findings Psoriasis vulgaris was diagnosed and psoriatic arthritis was ruled out by a rheumatologist. After consulting with the hepatologist, systemic therapy with Apremilast was initiated. Despite an initial positive response, gastrointestinal side effects led to a switch to therapy with Tildrakizumab, with regular monitoring of transaminases and HBV DNA. Despite an initial positive treatment response, a secondary loss of efficacy occurred prompting a switch to Risankizumab. Psoriasis is a chronic inflammatory systemic disease significantly impacting quality of life, necessitating optimal long‐term management. In this case, therapy with Apremilast and biologic therapy targeting IL‐23 blockade, even with concurrent hepatitis B, was well tolerated and effective. However, the evidence on the safety of modern psoriasis therapies in known chronic infections remains limited. Noteworthy in this case report is the patient's dark skin type. Diagnosing inflammatory dermatoses in People of Colour is challenging due to less visible erythema and other clinical nuances, exacerbating the already poorer healthcare for People of Colour. This case aims to raise awareness about the need for increased representation of People of Colour in education, presentations and clinical trials to ensure better care for this patient population.

Does Rheumatoid Arthritis Increase the Risk of COPD?: A Nationwide Retrospective Cohort Study

BackgroundMost reports of pulmonary manifestations in rheumatoid arthritis (RA) have been related to interstitial lung diseases. RA and chronic obstructive pulmonary disease (COPD) are both chronic inflammatory systemic diseases. Research QuestionDoes RA increase the risk of developing COPD? Is there a difference between seropositive and seronegative RA in the risk of COPD? Study Design and MethodsUsing the Korean National Health Insurance Database, we screened individuals diagnosed with RA between 2010 and 2017. We identified 46,030 patients with RA (32,608 seropositive RA and 13,422 seronegative RA) and 276,180 matched control individuals, and monitored them until December 2019. We used multivariate Cox proportional hazard models to estimate the adjusted hazard ratio (aHR) of risk factors for the development of COPD. ResultsThe incidence of COPD among patients with RA was 5.04/1,000 person-year and 2.23/1,000 person-year in the control group. Patients with RA showed a higher risk of developing COPD (aHR 2.11, 95% confidence interval [CI] 1.96–2.28) compared with the control group. While both seropositive RA and seronegative RA were associated with an increased risk of COPD, patients with seropositive RA had a higher risk for the development of COPD (aHR 1.26, 95% CI 1.09–1.46) compared with patients with seronegative RA. In the subgroup analyses, smoking history did not demonstrate significant interactions between RA and COPD development. InterpretationRA is associated with an increased risk of COPD development, augmented by seropositivity. Clinicians should monitor respiratory symptoms and pulmonary function carefully in patients with RA.

RACIAL AND GENDER DISPARITIES IN THE DEVELOPMENT OF CROHN’S DISEASE COMPLICATIONS: A RETROSPECTIVE ANALYSIS

Abstract BACKGROUND Crohn’s disease (CD) is a chronic systemic inflammatory disease that most commonly affects the gastrointestinal tract (GI) and is characterized by transmural inflammation. Complications of CD include fistulization, abscess formation, and GI bleed. CD predominantly affects patients with European ancestry, however Black and Hispanic patients have been noted to have phenotypic differences in disease presentation. Gender may also play a role in CD, with some studies suggesting that men develop more severe disease. METHODS Patients with a diagnosis of CD were identified using the 2020 Nationwide Inpatient Sample (NIS). Patients were stratified based on the presence of CD complications which included fistula, abscess, and bleed. Patients with complications were further stratified based on the specific complication. Data were collected regarding age, gender, race, primary insurance, median income, hospital region, hospital bed size, and comorbidities. The relationship between gender, race, and the development of fistula, abscess, or bleed among patients hospitalized with CD was analyzed using multivariate regression analysis. RESULTS A total of 178,279 patients with a diagnosis of CD were included in the study. Of these, 23,889 (13.4%) developed a complication of CD including fistula, abscess, or bleed. Female patients with CD had a statistically significant lower odds of developing a CD complication (aOR 0.79, P &amp;lt; 0.001). Higher odds of developing a complication of CD were seen in Black patients (aOR 1.47, P &amp;lt; 0.001) and Hispanic patients (aOR 1.29, P &amp;lt; 0.001). Black patients with CD had increased odds of developing fistula (aOR 1.35, P &amp;lt; 0.001), abscess (aOR 1.26, P = 0.004), and bleed (aOR 1.60, P &amp;lt; 0.001). Hispanic patients with CD had higher odds of developing a bleed (1.46, P &amp;lt; 0.001). CONCLUSION CD is a complex inflammatory process that is influenced by both genetic and environmental factors. Complications of CD such as fistulization, abscesses, and GI bleed are commonly seen. Our study found that women are at lower risk of developing these complications compared to men. Despite CD being primarily seen in White patients, our study found that Black and Hispanic patients are more likely to develop complications of CD. Further studies are needed to elucidate the socioeconomic and genetic factors that are responsible for these findings. Inclusion process for the study.

Ayurvedic management of Ankylosing Spondylitis (Kati prishtha trika graha): A case report

Ankylosing Spondylitis (AS) is a chronic systemic inflammatory disease affecting the axial (sacroiliac and spinal), girdle (hip and shoulder), peripheral joints, and the entheseal sites (such as heel, ankles, and patellar region). The condition manifests in chronic inflammatory back pain. As the disease progresses, patients develop a loss of flexibility due to spinal fusion. Considering the clinical features, the condition can be correlated with Kati prishtha trika graha in Ayurveda. This study presents a case of a 28-year-old male, who started with gradually progressing low backache with spinal stiffness for the last ten years, kyphosis, and morning stiffness (&gt;30 min). The patient was admitted to the hospital for management. Panchakarma (~five internal bio-cleansing therapies) procedures including Ruksha churna pinda swedana (~dry fomentation), Snehapana (~internal oleation), Virechana (~therapeutic purgation), Kala basti (~course of 16 therapeutic enemas), Snigdha churna pinda swedana (~bolus fomentation with oil), and Kati prishtha greeva basti (~therapeutic retention of oil over vertebral column) were adopted strategically along with Shamana chikitsa (~palliative management). The assessment was made using Bath AS Metrology Index, Bath AS Functional Index, and Bath AS Disease Activity Index. Encouraging results in the management of pain, stiffness, and spinal mobility were observed with the treatment, while no adversities were noticed during the treatment period.

Evaluación de la depresión, el estrés, la ansiedad y la calidad de vida relacionada con la salud bucal en personas con síndrome de Sjögren: estudio piloto de casos y controles

Objective: Sjögren’s syndrome (SS) is a chronic auto-immune inflammatory systemic disease, in which the infiltration of mo-nonuclear cells in the exocrine glands leads to physiological and morphological changes. This pilot case-control study aims to describe the profile, evaluate the oral condition, quality of life (QoL) and psychological condition, through complete clinical examination, OHIP-14 and DASS-21 questionnaires. Materials and Methods: The study was conducted with seven individuals with a final diagnosis of SS (case group [CG]), and seven individuals with symptoms of dry mouth (control group [GCO]), consulting at the institution from January to November 2021. participants were selected by free demand and those previously seen at the institution with a diagnosis of SS between 19 and 70 years of age. The questionnaire OHIP-14 was applied to assess the patient’s quality of life, where seven dimensions are assessed, subdivided into 14 questions through the Lickert scale (0 to 4) assigned by the individual and which quantifies the impact of oral health on QoL. The questionnaire DASS-21 assessed the psychological condition of the patient, which presents seven questions for each emotional state (depression, anxiety, and stress), totaling 21 questions. The general clinical condition, evolution of SS, oral clinical condition, and the profile of this population were related to QoL factors and psychological conditions, using these assessment instruments. Results: There was no statistically significant difference between the groups regarding stimulated salivary flow. The only symptom with a statistically significant difference in the CG was difficulty in phonation (p&lt; 0.001). The dimensions related to functional limitation and physical pain showed the most expressive results (p=0.004) (p=0.025), showing a strong negative impact on the QoL of the CG individuals, and the dimension related to disability was the least affected (p=0.684). The analysis of depression, anxiety, and stress did not show statistically significant results between the groups; however, in the CG, 5 (71.42%) individuals showed a severe degree of depression, anxiety, and stress. Conclusions: Individuals in the case group showed some changes, with a strong negative impact on QoL compared to the control group. Keywords: Sjogren’s syndrome; Quality of life; Depression; Anxiety; Stress, psychological; Case-control studies.

Evaluación de la depresión, el estrés, la ansiedad y la calidad de vida relacionada con la salud bucal en personas con síndrome de Sjögren: estudio piloto de casos y controles

Objective: Sjögren’s syndrome (SS) is a chronic auto-immune inflammatory systemic disease, in which the infiltration of mo-nonuclear cells in the exocrine glands leads to physiological and morphological changes. This pilot case-control study aims to describe the profile, evaluate the oral condition, quality of life (QoL) and psychological condition, through complete clinical examination, OHIP-14 and DASS-21 questionnaires. Materials and Methods: The study was conducted with seven individuals with a final diagnosis of SS (case group [CG]), and seven individuals with symptoms of dry mouth (control group [GCO]), consulting at the institution from January to November 2021. participants were selected by free demand and those previously seen at the institution with a diagnosis of SS between 19 and 70 years of age. The questionnaire OHIP-14 was applied to assess the patient’s quality of life, where seven dimensions are assessed, subdivided into 14 questions through the Lickert scale (0 to 4) assigned by the individual and which quantifies the impact of oral health on QoL. The questionnaire DASS-21 assessed the psychological condition of the patient, which presents seven questions for each emotional state (depression, anxiety, and stress), totaling 21 questions. The general clinical condition, evolution of SS, oral clinical condition, and the profile of this population were related to QoL factors and psychological conditions, using these assessment instruments. Results: There was no statistically significant difference between the groups regarding stimulated salivary flow. The only symptom with a statistically significant difference in the CG was difficulty in phonation (p&lt; 0.001). The dimensions related to functional limitation and physical pain showed the most expressive results (p=0.004) (p=0.025), showing a strong negative impact on the QoL of the CG individuals, and the dimension related to disability was the least affected (p=0.684). The analysis of depression, anxiety, and stress did not show statistically significant results between the groups; however, in the CG, 5 (71.42%) individuals showed a severe degree of depression, anxiety, and stress. Conclusions: Individuals in the case group showed some changes, with a strong negative impact on QoL compared to the control group. Keywords: Sjogren’s syndrome; Quality of life; Depression; Anxiety; Stress, psychological; Case-control studies.

Associations of long-term exposure to air pollution and physical activity with the risk of systemic inflammation-induced multimorbidity in Chinese adults: results from the China multi-ethnic cohort study (CMEC)

ObjectivePrevious studies proved the effect of long-term exposure to air pollution or physical activity (PA) on the risk of systemic inflammation-induced multimorbidity (SIIM), while the evidence regarding their joint effects was rare, especially in low- and middle-income countries. Therefore, we aimed to examine the extent of interaction or joint relations of PA and air pollution with SIIM.MethodsThis study included 72,172 participants from China Multi-Ethnic Cohort.The average concentrations of ambient particulate matter pollutants (PM1, PM2.5, and PM10) were estimated using satellite-based random forest models. Self-reported information on a range of physical activities related to occupation, housework, commuting, and leisure activities was collected by an interviewer-administered questionnaire. A total of 11 chronic inflammatory systemic diseases were assessed based on self-reported lifetime diagnosis or medical examinations. SIIM was defined as having ≥ 2 chronic diseases related to systemic inflammation. Logistic regression models were used to assess the complex associations of air pollution particulate matter and PA with SIIM.ResultsWe found positive associations between long-term air pollution particulates exposure and SIIM, with odds ratios (95%CI) of 1.07 (1.03 to 1.11), 1.18 (1.13 to 1.24), and 1.08 (1.05 to 1.12) per 10 µg/m3 increase in PM1, PM2.5, and PM10. No significant multiplicative interaction was found between ambient air pollutant exposure and PA on SIIM, whereas negative additive interaction was observed between long-term exposure to PM2.5 and PA on SIIM. The positive associations between low volume PA and SIIM were stronger among those exposed to high-level air pollution particulates. Compared with individuals engaged in high volume PA and exposed to low-level ambient air pollutants, those engaged in low volume PA and exposed to high-level ambient air pollutants had a higher risk of SIIM (OR = 1.49 in PM1 exposure, OR = 1.84 in PM2.5 exposure, OR = 1.19 in PM10 exposure).ConclusionsLong-term (3 years average) exposure to PM1, PM2.5, and PM10 was associated with an increased risk of SIIM. The associations were modified by PA, highlighting PA’s importance in reducing SIIM for all people, especially those living in high-level air pollution regions.

Machine learning identifies right index finger tenderness as key signal of DAS28-CRP based psoriatic arthritis activity

Psoriatic arthritis (PsA) is a chronic inflammatory systemic disease whose activity is often assessed using the Disease Activity Score 28 (DAS28-CRP). The present study was designed to investigate the significance of individual components within the score for PsA activity. A cohort of 80 PsA patients (44 women and 36 men, aged 56.3 ± 12 years) with a range of disease activity from remission to moderate was analyzed using unsupervised and supervised methods applied to the DAS28-CRP components. Machine learning-based permutation importance identified tenderness in the metacarpophalangeal joint of the right index finger as the most informative item of the DAS28-CRP for PsA activity staging. This symptom alone allowed a machine learned (random forests) classifier to identify PsA remission with 67% balanced accuracy in new cases. Projection of the DAS28-CRP data onto an emergent self-organizing map of artificial neurons identified outliers, which following augmentation of group sizes by emergent self-organizing maps based generative artificial intelligence (AI) could be defined as subgroups particularly characterized by either tenderness or swelling of specific joints. AI-assisted re-evaluation of the DAS28-CRP for PsA has narrowed the score items to a most relevant symptom, and generative AI has been useful for identifying and characterizing small subgroups of patients whose symptom patterns differ from the majority. These findings represent an important step toward precision medicine that can address outliers.

Relationship between the lymphocyte to C‑reactive protein ratio and coronary artery disease severity.

Coronary atherosclerosis is a chronic systemic inflammatory disease. Laboratory parameters such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune inflammation index (SII) have been used to assess inflammation degree and coronary artery disease (CAD) severity. The lymphocyte-to-C-reactive protein ratio (LCR) is a new SII. However, its relationship with CAD development and severity is unclear. A total of 1,107 patients (479 in control group, 628 in CAD group) underwent coronary angiography. The routine and biochemical indices of the venous blood of patients were assessed before coronary angiography. LCR, SII, NLR and PLR were calculated and statistical analyses were performed. Propensity score matching (PSM) and a logistic regression model were used to analyze the relationship between LCR and CAD. After the PSM, 384 pairs of patients with or without CAD were successfully matched. After the median binary classification of all indicators, uni- and multivariate logistic regression analyses showed that platelet count was an independent risk factor and LCR was an independent protective factor. Using the same method, in the coronary heart disease severity group, 212 pairs were successfully matched and NLR and PLR were independent risk factors, while LCR was an independent protective factor. In conclusion, LCR is an independent protective factor against CAD development and severity.

Updates in psoriasis diagnosis and treatment status in China: results from the National Psoriasis Center Registry.

Updates in psoriasis diagnosis and treatment status in China: results from the National Psoriasis Center Registry.

Tetrahedral Framework Nuclear Acids Can Regulate Interleukin-17 Pathway to Alleviate Inflammation and Inhibit Heterotopic Ossification in Ankylosing Spondylitis.

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that leads to serious spinal deformity and ankylosis. Persistent inflammation and progressive ankylosis lead to loss of spinal flexibility in patients with AS. Tetrahedral framework nucleic acids (tFNAs) have emerged as a one kind of nanomaterial composed of four specially designed complementary DNA single strands with outstanding biological properties. Results from in vivo experiments demonstrated that tFNAs treatment could inhibit inflammatory responses and heterotopic ossification to halt disease progression. In vitro, tFNAs were proved to influence the biological behavior of AS primary chondrocytes and inhibit the secretion of pro-inflammatory cytokines through interleukin-17 pathway. The osteogenic process of chondrocytes was as well inhibited at the transcriptional level to regulate the expression of related proteins. Therefore, we believe tFNAs had a strong therapeutic effect and could serve as a nonsurgical remedy in the future to help patients suffering from AS.

Effective Anti-IL-17 response in psoriasis affecting hard-to-treat places with previous immunobiological failure

Psoriasis is a chronic inflammatory systemic disease that predominantly presents with skin, nail and joint manifestations. It can be a disabling disease, both due to the skin lesions and the presence of the articular form. The article aims to report a case of successful treatment of har-to-treat places os psoriasis with an immunobiological drug and reforce the importance of the dermatologist in evaluating and monitoring together with the rheumatologist stands out in patients with seronegative axial arthritis.

Evaluation of the Salivary Oxidative Stress, and Non-Enzymatic Antioxidants Marker in Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease that preferentially affects diarthrodial joints. Oxidative stress is elevated in RA patients implying reactive oxygen species (ROS) are possible mediators of tissue damage. Assess the level of total antioxidant capacity (TAC), malondialdehyde (MDA), and non-enzymatic antioxidants (vitamin E, and C )in the saliva of in patients with rheumatoid arthritis(RA). For the realization of our goals we included sixty rheumatoid arthritis patients (RA) (21 female and 39 male) who were fulfilling the American College of Rheumatology and European League Against Rheumatism 2010 revised criteria for classification of RA ,picked randomly, at the age from 25-57 years, and 60 as age matched control group, who attended to Tikrit Teaching Hospital / Tikrit / Iraq during the period from January 2017 to March 2018. Stimulated saliva specimens were collected at the morning. TAC of saliva was evaluated by spectrophotometric assay. Statistical comparisons were performed using Student’s t-test, by SPSS 13. Levels of salivary pH, flow rate, TAC, vit E and C were decreased significantly, whereas the salivary level of MDA were increased significantly in RA patients when compared with healthy controls. There was an increased oxidative stress and a low antioxidant status in patients with RA. These changes are probably due to efforts for reducing lipid peroxidation and hence to lower tissue damage.

Ligneous periodontitis exacerbated by Behçet’s disease in a patient with plasminogen deficiency and a stop-gained variant PLG c.1468C > T: a case report

BackgroundPlasminogen serves as the precursor to plasmin, an essential element in the fibrinolytic process, and is synthesized primarily in the liver. Plasminogen activation occurs through the action of plasminogen activator, converting it into plasmin. This conversion greatly enhances the fibrinolytic system within tissues and blood vessels, facilitating the dissolution of fibrin clots. Consequently, congenital deficiency of plasminogen results in impaired fibrin degradation. Patients with plasminogen deficiency typically exhibit fibrin deposits in various mucosal sites throughout the body, including the oral cavity, eyes, vagina, and digestive organs. Behcet's disease is a chronic recurrent systemic inflammatory disease with four main symptoms: aphthous ulcers of the oral mucosa, vulvar ulcers, skin symptoms, and eye symptoms, and has been reported worldwide. This disease is highly prevalent around the Silk Road from the Mediterranean to East Asia.We report a case of periodontitis in a patient with these two rare diseases that worsened quickly, leading to alveolar bone destruction. Genetic testing revealed a novel variant characterized by a stop-gain mutation, which may be a previously unidentified etiologic gene associated with decreased plasminogen activity.Case presentationThis case report depicts a patient diagnosed with ligneous gingivitis during childhood, originating from plasminogen deficiency and progressing to periodontitis. Genetic testing revealed a suspected association with the PLG c.1468C > T (p.Arg490*) stop-gain mutation. The patient's periodontal condition remained stable with brief intervals of supportive periodontal therapy. However, the emergence of Behçet's disease induced acute systemic inflammation, necessitating hospitalization and treatment with steroids. During hospitalization, the dental approach focused on maintaining oral hygiene and alleviating contact-related pain. The patient's overall health improved with inpatient care and the periodontal tissues deteriorated.ConclusionsCollaborative efforts between medical and dental professionals are paramount in comprehensively evaluating and treating patients with intricate complications from rare diseases. Furthermore, the PLG c.1468C > T (p.Arg490*) stop-gain mutation could contribute to the association between plasminogen deficiency and related conditions.