Flare Trigger Research Articles

Epstein–Barr virus positive gastric adenocarcinoma with systemic EBV reactivation in a patient with persistently active systemic lupus erythematosus

Abstract Objectives Epstein–Barr virus (EBV) has been associated with several types of cancers, most often with nasopharyngeal carcinomas and hematological malignancies. It is also suggested that EBV has significant role in the pathogenesis of different types of autoimmune diseases including systemic lupus erythematosus (SEL). The exact mechanisms behind these processes are not elucidated. Case presentation We present a case of a 52-years old female patients with moderately active SLE presenting with severe fatigue, purpuric lesions, alopecia, polyarthritis, mucosal ulcerations, and progressive thrombocytopenia over a period of 10 months. During the work-up, the patient was evaluated for several viral infections. Serology testing showed elevation of anti-EBV, anti-CMV and anti-HSV1/2 IgM antibodies with the presence of IgG antibodies against all mentioned viruses except HSV2. Corticosteroid therapy was escalated, and azathioprine was introduced. Due to the persistence of significant thrombocytopenia and monoclonal IgG sternal puncture was performed. Morphological and immunohistochemical analysis of bone marrow specimen presented infiltration with metastatic deposits of adenocarcinoma and monoclonal plasmacytosis. Esophagogastroduodenoscopy showed multiple prepyloric erosions of gastric mucosa, which were biopsied. Pathohistological analysis demonstrated infiltration of gastric mucosa with diffuse type adenocarcinoma. Further PCR testing of biopsied gastric adenocarcinoma revealed the presence of EBV DNA in carcinoma tissue. The patient was sent to the oncologist for further evaluation. Conclusions Assessment of SLE patients with persistently active disease should include the analysis of the herpesvirus infection status. Reactivations of EBV may be considered as possible trigger for lupus flares and the factor for increased risk of developing malignancies.

Quality of Life and Avoiding Triggers of Atopic Dermatitis Flares: A Qualitative Study.

Quality of Life and Avoiding Triggers of Atopic Dermatitis Flares: A Qualitative Study.

Quality of Life and Avoiding Triggers of Atopic Dermatitis Flares: A Qualitative Study.

Quality of Life and Avoiding Triggers of Atopic Dermatitis Flares: A Qualitative Study.

Increased core body temperature exacerbates defective protein prenylation in mouse models of mevalonate kinase deficiency.

Mevalonate kinase deficiency (MKD) is characterized by recurrent fevers and flares of systemic inflammation, caused by biallelic loss-of-function mutations in MVK. The underlying disease mechanisms and triggers of inflammatory flares are poorly understood because of the lack of in vivo models. We describe genetically modified mice bearing the hypomorphic mutation p.Val377Ile (the commonest variant in patients with MKD) and amorphic, frameshift mutations in Mvk. Compound heterozygous mice recapitulated the characteristic biochemical phenotype of MKD, with increased plasma mevalonic acid and clear buildup of unprenylated GTPases in PBMCs, splenocytes, and bone marrow. The inflammatory response to LPS was enhanced in compound heterozygous mice and treatment with the NLRP3 inflammasome inhibitor MCC950 prevented the elevation of circulating IL-1β, thus identifying a potential inflammasome target for future therapeutic approaches. Furthermore, lines of mice with a range of deficiencies in mevalonate kinase and abnormal prenylation mirrored the genotype-phenotype relationship in human MKD. Importantly, these mice allowed the determination of a threshold level of residual enzyme activity, below which protein prenylation is impaired. Elevated temperature dramatically but reversibly exacerbated the deficit in the mevalonate pathway and the defective prenylation in vitro and in vivo, highlighting increased body temperature as a likely trigger of inflammatory flares.

S818 An Insight into the Patient’s Perspective of Ulcerative Colitis Flares via Analysis of Online Public Forum Posts: Key Triggers and Symptoms of Flares

Introduction: Prediction of flares in UC remains a challenge, with limited analyses on patient (pt)-reported themes associated with onset. The aim of this analysis was to identify the most common pt-reported triggers and symptoms of UC flares. Methods: We reviewed online posts written by pts with UC on 8 public forums in 6 countries between January 1, 2019 and February 14, 2021. Flare-related posts (identified by keywords; Table), including pre- and post-flare posts from the same pts, were captured using Netbase Quid™ artificial intelligence text analytics and natural language processing software. Once identified, all flare-related posts were analyzed and mapped semantically to uncover the most prevalent conversational topics and themes regarding flares to outline the unmet needs and challenges discussed and to examine self-reported triggers of flares. Results: Of > 27,000 pt posts, 12,900 were identified as flare-related. The most common themes identified were treatment experiences, side-effects (28%), and flare symptoms (22%; Figure a). Of the top topics discussed, the most common was emotional / peer support (9.4% of posts), followed by posts on the individual experiences and recommendations of mesalamine (and other oral / rectal suppositories; 8.0% of posts), the most common treatment option discussed, and dietary recommendations (6.0% of posts; Figure b). Pain was a high-impact topic (fatigue and joint pain, 2.4% of posts; Figure b). Stress and anxiety were the most reported triggers of flares (38% of posts), followed by diet (28% of posts; Table), with discussions suggesting pts with UC had difficulty managing external stressors. Depression, anxiety, and fatigue were frequently identified as both triggers for and symptoms of flares. Initial symptoms of flares (e.g., blood in stool; diarrhea and loose stool; stool frequency) were often not distinguished from full flares. Blood in the stool was the most discussed flare indicator (58%; Table). Conclusion: The results of this analysis of pt posts suggest that some frequently discussed triggers and / or symptoms of UC flares, such as depression, anxiety, pain, and sleep disturbances, are not always captured using traditional clinical disease activity measures.1,2 Physicians should consider additional pt-reported outcomes, including emotional and psychological aspects, during the assessment of pts.Figure 1.: a) Top themes and b) top topics in UC patient forum flare-related posts. Flare-related posts, including those from the same author pre- and post-flare, were identified from online posts written by patients with UC on 8 public forums (Afa Crohn RCH, Carenity, Crohn Club Forum, Crohn’s Forum, Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung; Educainflamatoria, HealingWell, Patient) in 6 countries (France, Germany, Italy, Spain, United Kingdom, and United States) between January 1, 2019 and February 14, 2021. Flare-related posts were identified as those containing relevant keywords, including flare, remission, inflammation, cramps, attack, relapse, symptoms, and bloody stool. Flare-related post data were color-coded by a) themes and b) topics; each node represents a post, and connections represent similar language used across the posts. Centrally located nodes represent core concepts, and peripheral nodes represent niche concepts. UC, ulcerative colitis Table 1. - Most discussed flare triggers and initial flare symptoms in patients with UC Ranking Flare triggers (percentage of posts), (N=1,161) Initial flare symptoms (percentage of posts), (N=645) 1 Stress and anxiety (38%) Blood in stool / passing blood (58%) 2 Diet (28%) Diarrhea and loose stool (19%) 3 Smoking cessation (9%) Stool frequency (19%) 4 Antibiotics (9%) Mucus in stool / passing mucus (17%) 5 Bacterial or viral infection (7%)a Pain and cramping (14%) 6 NSAID usage (6%) Fatigue (7%) Flare-related posts, including those from the same author pre- and post-flare, were identified from online posts written by patients with UC on 8 public forums (Afa Crohn RCH, Carenity, Crohn Club Forum, Crohn’s Forum, Deutsche Morbus Crohn / Colitis ulcerosa Vereinigung, Educainflamatoria, HealingWell, and Patient) in 6 countries (France, Germany, Italy, Spain, United Kingdom, United States) between January 1, 2019 and February 14, 2021. Flare-related posts were identified as those containing relevant keywords, including flare, remission, inflammation, cramps, attack, relapse, symptoms, and bloody stool.aPatients who identified bacterial or viral infections as a flare trigger had uniquely low confidence and were unsure about infections being the cause of their triggers.NSAID, nonsteroidal anti-inflammatory drug; UC, ulcerative colitis.

Stress, mindfulness, and systemic lupus erythematosus: An overview and directions for future research.

Although the pathogenesis of autoimmunity is not fully understood, it is thought to involve genetic, hormonal, immunologic, and environmental factors. Stress has been evaluated as a potential trigger for autoimmunity and disease flares in patients with systemic lupus erythematosus (SLE). The physiologic changes that occur with stress involve numerous catecholamines, hormones, and cytokines that communicate intricately with the immune system. There is some evidence that these systems may be dysregulated in patients with autoimmune disease. Mindfulness-based techniques are practices aimed at mitigating stress response and have been shown to improve quality of life in general population. This review will discuss pathophysiology of chronic stress as it relates to SLE, evidence behind mindfulness-based practices in these patients, and directions for future research.

A Comparative Analysis of Machine-learning Models for Solar Flare Forecasting: Identifying High-performing Active Region Flare Indicators

Solar flares create adverse space weather impacting space- and Earth-based technologies. However, the difficulty of forecasting flares, and by extension severe space weather, is accentuated by the lack of any unique flare trigger or a single physical pathway. Studies indicate that multiple physical properties contribute to active region flare potential, compounding the challenge. Recent developments in machine learning (ML) have enabled analysis of higher-dimensional data leading to increasingly better flare forecasting techniques. However, consensus on high-performing flare predictors remains elusive. In the most comprehensive study to date, we conduct a comparative analysis of four popular ML techniques (k nearest neighbors, logistic regression, random forest classifier, and support vector machine) by training these on magnetic parameters obtained from the Helioseismic and Magnetic Imager on board the Solar Dynamics Observatory for the entirety of solar cycle 24. We demonstrate that the logistic regression and support vector machine algorithms perform extremely well in forecasting active region flaring potential. The logistic regression algorithm returns the highest true skill score of 0.967 ± 0.018, possibly the highest classification performance achieved with any strictly parametric study. From a comparative assessment, we establish that magnetic properties like total current helicity, total vertical current density, total unsigned flux, R_VALUE, and total absolute twist are the top-performing flare indicators. We also introduce and analyze two new performance metrics, namely, severe and clear space weather indicators. Our analysis constrains the most successful ML algorithms and identifies physical parameters that contribute most to active region flare productivity.

Sphk2 deletion is involved in structural abnormalities and Th17 response but does not aggravate colon inflammation induced by sub-chronic stress

The chronic inflammatory process that characterizes inflammatory bowel diseases (IBD) is mainly driven by T-cell response to microbial and environmental antigens. Psychological stress is a potential trigger of clinical flares of IBD, and sphingosine-1-phosphate (S1P) is involved in T-cell recruitment. Hence, stress impact and the absence of sphingosine kinase 2 (Sphk2), an enzyme of S1P metabolism, were evaluated in the colon of mice after sub-chronic stress exposure. Here, we show that sub-chronic stress increased S1P in the mouse colon, possibly due to a decrease in its degradation enzymes and Sphk2. S1P accumulation could lead to inflammation and immune dysregulation reflected by upregulation of toll-like receptor 4 (TLR4) pathway, inhibition of anti-inflammatory mechanisms, cytokine-expression profile towards a T-helper lymphocyte 17 (Th17) polarization, plasmacytosis, decrease in IgA+ lymphoid lineage cells (CD45+)/B cells/plasmablasts, and increase in IgM+ B cells. Stress also enhanced intestinal permeability. Sphk2 knockout mice presented a cytokine-expression profile towards a boosted Th17 response, lower expression of claudin 3,4,7,8, and structural abnormalities in the colon. Intestinal pathophysiology should consider stress and S1P as modulators of the immune response. S1P-based drugs, including Sphk2 potentiation, represent a promising approach to treat IBD.

The epigenome: key to understanding and predicting gout flares

Gout is a form of arthritis, resulting from an inflammatory reaction to the deposition of monosodium urate (MSU) crystals in the synovial fluid of the joint space. It is characterised by periods of acute inflammation in the affected joint, or joints (known as gout flares), separated by asymptomatic periods. There seems to be substantial overlap between environmental triggers of gout flares and common environmental modifiers (diet, pharmaceuticals, and stress) of epigenetic markers (DNA methylation, histone modifications, and ncRNA). Very few studies have looked at whether environment is influencing gout through epigenetic mechanisms. The pathogenesis of gouty inflammation is well understood but understanding the variation of response to hyperuricaemia in terms of gout flare initiation is less well known. In this review, we will examine the potential of epigenomics in understanding how gout flares may occur, both in terms of development of hyperuricaemia and the inflammatory response. Looking at the epigenome and its intersection with lifestyle could help identify new targets and strategies for effective management of gout flares.

Design of optical system of photoelectric detection sensor and flare signal processing with array lens

AbstractBecause the flare signal formed by projectile explosion is affected by the external environment, it is difficult for multi‐acoustic sensor array to obtain accurate synchronization signal. In order to solve this problem, this paper proposes a design method of ultra‐wide‐angle photoelectric detection sensor by using circular curved surface array lens, analyze the detection ability of photoelectric detection sensor with array lens, and establish the output signal function calculation model. According to the output signal of flare detection circuit, the feature points detection algorithm of modulus maxima based on wavelet transform is studied. Based on this algorithm, the signal is processed on the hardware processor to output the actual flare trigger control signal. The processing and recognition algorithm of signal mainly uses the relationship among wavelet modulus maxima, scale, Lipschitz index, and signal singularity to select the appropriate wavelet basis to process the flare signal formed by projectile explosion. Thus, the feature points of the flare signal singularity can be obtained. When the detection conditions of the feature points of the signal singularity are satisfied, the hardware outputs pulse signals to control the acoustic sensor array. The experimental results show that the designed detection algorithm of wavelet filtering and modulus maxima feature points can effectively detect the flare signal.

P117 Patient perceptions about causes of flare in IBD: results from the baseline dataset of the PREdiCCt study

Abstract Background Patient reported outcomes are important endpoints in IBD management, but patient perceptions of the causes of disease flare are unknown and thus may reveal novel areas for future study. Methods The PREdiCCt study (https://www.predicct.co.uk) is the largest prospective study of the causes of IBD flare. 2629 patients in clinical remission were recruited from 48 UK sites and followed for 2 years with detailed assessment of environmental and dietary factors via monthly questionnaires. 1946 (74%) patients completed the baseline questionnaires. We present here the results of the baseline questionnaire analysis of patient perceptions of disease flare, derived from a list of 17 putative causes from the literature and their own experience via free text input. Results In total 1,946 IBD patients [male=852, CD=1000; UC/IBDU=946, age 45.8±15.5 (mean±SD in years)] gave their opinion about factors initiating a flare. The commonest causes reported were stress (n=1359, 69.8%), dietary changes (n=911, 46.8%), alcohol use (n=385, 19.8%), sleep disturbances (n=331, 17%) and that their medication stopped working (n=308, 15.8%) (Figure 1). CD participants were more likely to identify dietary changes (50% vs 43%, p<0.001) and menstruation (16% vs 10% of female patients, p<0.001) as flare triggers than UC/IBDU participants, while UC/IBDU participants more frequently reported loss of response to medication as a trigger for flare (9% vs 5% for CD participants, p<0.001). CD patients with small bowel involvement were more likely to name dietary changes (61% vs 42%, p<0.001), travel (14% vs 9%, p=0.016) and smoking (4% vs 1%, p=0.04) as flare triggers. When compared by gender, the ranking of causes was identical but female participants were more likely to identify stress (77% vs 65%, p<0.001) and antibiotic use (12% vs 6%, p<0.001) as reasons for disease relapse compared to male participants. Conclusion Stress, dietary changes and alcohol use were identified as the main causes of flare by patients with dietary changes more frequently reported in CD (especially those with small bowel involvement). The impact of environmental and dietary factors in the development of flare is being further investigated with ongoing longitudinal data collection in the PREdiCCt Study.

Influenza infection as a trigger for systemic lupus erythematosus flares resulting in hospitalization

In patients with systemic lupus erythematosus (SLE), there are concerns that infections may increase the risk of flares. We evaluated the association between influenza infection and SLE flares resulting in hospitalization. SLE flares resulting in hospitalization and influenza cases were ascertained from the Korean national healthcare insurance database (2014–2018). We used a self-controlled case series design. We defined the risk interval as the first 7 days after the influenza index date and the control interval was defined as all other times during the observation period of each year. We estimated the incidence rates of SLE flares resulting in hospitalization during the risk interval and control interval and compared them using a Poisson regression model. We identified 1624 influenza infections among the 1455 patients with SLE. Among those, there were 98 flares in 79 patients with SLE. The incidence ratio (IR) for flares during the risk interval as compared with the control interval was 25.75 (95% confidence interval 17.63–37.59). This significantly increased the IRs for flares during the risk interval in both women (IR 27.65) and men (IR 15.30), all age groups (IR 17.00–37.84), with and without immunosuppressive agent (IR 24.29 and 28.45, respectively), and with and without prior respiratory diseases (IR 21.86 and 26.82, respectively). We found significant association between influenza infection and SLE flares resulting in hospitalization. Influenza infection has to be considered as a risk factor for flares in all SLE patients regardless of age, sex, medications, and comorbidities.

A Potential Role for Stress-Induced Microbial Alterations in IgA-Associated Irritable Bowel Syndrome with Diarrhea

SummaryStress is a known trigger for flares of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS); however, this process is not well understood. Here, we find that restraint stress in mice leads to signs of diarrhea, fecal dysbiosis, and a barrier defect via the opening of goblet-cell associated passages. Notably, stress increases host immunity to gut bacteria as assessed by immunoglobulin A (IgA)-bound gut bacteria. Stress-induced microbial changes are necessary and sufficient to elicit these effects. Moreover, similar to mice, many diarrhea-predominant IBS (IBS-D) patients from two cohorts display increased antibacterial immunity as assessed by IgA-bound fecal bacteria. This antibacterial IgA response in IBS-D correlates with somatic symptom severity and was distinct from healthy controls or IBD patients. These findings suggest that stress may play an important role in patients with IgA-associated IBS-D by disrupting the intestinal microbial community that alters gastrointestinal function and host immunity to commensal bacteria.

The Effects of Oscillations and Collisions of Emerging Bipolar Regions on the Triggering of Solar Flares

Abstract The ability to predict the occurrence of solar flares in advance is important to humankind due to the potential damage they can cause to Earth’s environment and infrastructure. It has been shown in Kusano et al. that a small-scale bipolar region (BR), with its flux reversed relative to the potential component of the overlying field, appearing near the polarity inversion line (PIL) is sufficient to effectively trigger a solar flare. In this study we perform further 3D magnetohydrodynamic simulations to study the effect that the motion of these small-scale BRs has on the effectiveness of flare triggering. The effect of two small-scale BRs colliding is also simulated. The results indicate that the strength of the triggered flare is dependent on how much of the overlying field is disrupted by the BR. Simulations of linear oscillations of the BR showed that oscillations along the PIL increase the flare strength while oscillations across the PIL detract from the flare strength. The flare strength is affected more by larger amplitude oscillations but is relatively insensitive to the frequency of oscillations. In the most extreme case the peak kinetic energy of the flare increased more than threefold compared to a non-oscillating BR. Simulations of torsional oscillations of the BR showed a very small effect on the flare strength. Finally, simulations of colliding BRs showed the generation of much stronger flares as the flares triggered by each individual BR coalesce. These results show that significantly stronger flares can result from motion of the BR along the PIL of a sheared field or from the presence of multiple BRs in the same region.

Electric Current Evolution at the Footpoints of Solar Eruptions

Abstract Electric currents play a critical role in the triggering of solar flares and their evolution. The aim of the present paper is to test whether the surface electric current has a surface or subsurface fixed source as predicted by the circuit approach of flare physics, or is the response of the surface magnetic field to the evolution of the coronal magnetic field as the MHD approach proposes? Out of all 19 X-class flares observed by SDO from 2011 to 2016 near the disk center, we analyzed the only nine eruptive flares for which clear ribbon hooks were identifiable. Flare ribbons with hooks are considered to be the footprints of eruptive flux ropes in MHD flare models. For the first time, fine measurements of the time evolution of electric currents inside the hooks in the observations as well as in the OHM 3D MHD simulation are performed. Our analysis shows a decrease of the electric current in the area surrounded by the ribbon hooks during and after the eruption. We interpret the decrease of the electric currents as due to the expansion of the flux rope in the corona during the eruption. Our analysis brings a new contribution to the standard flare model in 3D.

Ultraviolet solar flare signatures in the framework of complex network.

Studying natural phenomena via the complex network approach makes it possible to quantify the time-evolving structures with too many elements and achieve a deeper understanding of interactions among the components of a system. In this sense, solar flare as a complex system with the chaotic behavior could be better characterized by the network parameters. Here, we employed an unsupervised network-based method to recognize the position and occurrence time of the solar flares by using the ultraviolet emission (1600 Å) recorded by the Atmospheric Imaging Assembly on board Solar Dynamics Observatory. Three different regions, the flaring active regions, the non-flaring active regions, and the quiet-Sun regions, were considered to study the variations of the network parameters in the presence and absence of flaring phases in various datasets over time intervals of several hours. The whole parts of the selected datasets were partitioned into sub-windows to construct networks based on computing the Pearson correlation between time series of the region of interest and intensities. Analyzing the network parameters such as the clustering coefficient, degree centrality, characteristic length, and PageRank verified that flare triggering has an influence on the network parameters around the flare occurrence time and close to the location of flaring. It was found that the values of the clustering coefficient and characteristic length approach those obtained for the corresponding random network in the flaring phase. These findings could be used for detecting the occurrence times and locations of the region at ultraviolet images.

Locating Hot Plasma in Small Flares using Spectroscopic Overlappogram Data from the Hinode EUV Imaging Spectrometer

One of the key processes associated with the "standard" flare model is chromospheric evaporation, a process where plasma heated to high temperatures by energy deposition at the flare footpoints is driven upwards into the corona. Despite several decades of study, a number of open questions remain, including the relationship between plasma produced during this process and observations of earlier "superhot" plasma. Hinode/EIS has a wide slot often used as a flare trigger in the He II emission line band. Once the intensity passes a threshold level, the study switches to one focussed on the flaring region. However, when the intensity is not high enough to reach the flare trigger threshold, these datasets are available during the entire flare period and provide high-cadence spectroscopic observations over a large field of view. We use one-minute cadence data from two such studies of a C4.7 flare and a C1.6 flare to probe the relationship between hot Fe XXIV plasma and plasmas observed by RHESSI and XRT to track where the emission comes from, and when it begins. Although the spatial and spectral information are merged in the wide-slot data, it is still possible to extract when the hot plasma appears using the Fe XXIV spectral image. It is also possible to derive spectrally pure Fe XXIV light curves from the EIS data, and compare them with those derived from hard X-rays, enabling a full exploration of the evolution of hot emission. The Fe XXIV emission peaks just after the peak in the hard X-ray lightcurve; consistent with an origin in the evaporation of heated plasma following the transfer of energy to the lower atmosphere. A peak was also found for the C4.7 flare in the RHESSI peak temperature, which occurred before the hard X-rays peaked. This suggests that the first peak in hot-plasma emission is likely directly related to the energy-release process.

Continuum Enhancements, Line Profiles, and Magnetic Field Evolution during Consecutive Flares

Abstract During solar flares, magnetic energy can be converted into electromagnetic radiation from radio waves to γ-rays. Enhancements in the continuum at visible wavelengths, as well as continuum enhancements in the FUV and NUV passbands, give rise to white-light flares. In addition, the strong energy release in these events can lead to the rearrangement of the magnetic field at the photospheric level, causing morphological changes in large and stable magnetic structures like sunspots. In this context, we describe observations acquired by satellite instruments (Interface Region Imaging Spectrograph (IRIS), Solar Dynamics Observatory/Helioseismic and Magnetic Imager, Hinode/Solar Optical Telescope) and ground-based telescopes (Rapid Oscillations in the Solar Atmosphere (ROSA)/Dunn Solar Telescope) during two consecutive C7.0 and X1.6 flares that occurred in active region NOAA 12205 on 2014 November 7. The flare was accompanied by an eruption. The results of the analysis show the presence of continuum enhancements during the evolution of the events, observed both in ROSA images and in IRIS spectra. In the latter, a prominent blueshifted component is observed at the onset of the eruption. We investigate the role played by the evolution of the δ sunspots of the active region in the flare triggering, and finally we discuss the changes in the penumbrae surrounding these sunspots as a further consequence of these flares.

P612 Dietary practices and beliefs of British South Asians with inflammatory bowel disease: A prospective UK study

Abstract Background The increasing incidence of inflammatory bowel disease (IBD) in newly industrialised countries and immigrant populations appears to outpace that which genetic influences alone could instigate. Environmental factors, in particular, the western diet, are therefore implicated in its aetiopathogenesis. Limited data exist on the dietary practices of the migrant South Asian population with IBD. We aim to describe the dietary practices of British South Asian IBD patients and information resources utilised to guide these beliefs. Methods A prospective, cross-sectional, questionnaire-based study is being conducted across hospitals in the UK. Two-hundred South Asian patients with IBD are being recruited to complete a questionnaire regarding demographics and dietary practices. Results Data from 118 patients are available to date. Mean patient age is 43 years (51% female). Sixty-five per cent have ulcerative colitis (UC) and 33% Crohn’s disease (CD). Fifty-one per cent are of Indian ethnicity, 37% Pakistani and 10% Bangladeshi. Forty-nine per cent of patients were born in the UK to parents who were born outside of the UK and 51% of patients were born outside the UK. Mean disease duration is 10.5 years. Forty-six per cent considered diet to be an initiating factor in their IBD, based on their own experience (85%) as well as information from internet resources (31%) and other patients with IBD (19%). Fifty-nine per cent of patients felt that diet had triggered a relapse of their disease. Most commonly reported foods were spicy (69%) and fatty foods (47%), milk products (44%) and red meat (37%). Eighty-six per cent of patients avoided certain foods in an attempt to prevent an IBD ‘flare’. Most frequently avoided foods were spicy foods (76%), fatty foods (69%), red meat (60%), coffee (55%), carbonated drinks (54%) and milk products (53%). One in four patients had tried a specific exclusionary diet, with 13% having tried a gluten-free diet in the absence of coeliac disease, to manage their symptoms. Just over a half of patients reported being able to find specific dietary advice for IBD, most commonly via the internet. Over half of patients avoided eating the same meal as their family or eating out to prevent relapse of their IBD. 1 in 3 consumed certain foodstuffs or nutritional supplements to prevent a relapse of IBD, most commonly turmeric in 25% of these patients. Conclusion Dietary restriction may be highly prevalent amongst the British South Asian IBD community with a high proportion reporting diet as an initiating factor and trigger for disease flares. Studies on immigrant populations may hold valuable clues regarding the influence of migration, environmental influences and drift from traditional cultural practices on IBD aetiopathogenesis and related symptoms. A larger dataset will be presented at conference proceedings.

Infections as triggers of flares in systemic autoimmune diseases: novel innate immunity mechanisms

The innate immune response (IIR) has to be immediate facing pathogens, and effective to induce a long-lasting adaptive immunity and immune memory. In genetically susceptible individuals, beyond a first defense, a chronically activated by infections IIR may represent a trigger for the onset or flares in systemic autoimmune diseases. This article reviews the recent scientific literature in this regard and highlights the key issues needing investigation. Thanks to its high specificity mediated by pattern recognition receptors, the IIR is not called unspecific anymore. The discovery of these increasingly accurate recognizing molecular mechanisms has also evidenced their involvement in breaking self-immune tolerance and to maintain chronic inflammation in autoimmune responses. Neutrophil extracellular traps (NETS) as the main source of antinuclear antibodies; the 'neutrophils-pDC activation loop' theory; and the Th1/Th2/Th17 misbalances induced by microbial products because of chronically activated innate immune cells, are some of the recent uncovered IIR origins involved in infectious-induced systemic autoimmune diseases. A deeper understanding of the genetic predisposition and the pathogen-derived factors responsible to exacerbate the IIR might potentially provide therapeutic targets to counteract flares in systemic autoimmune diseases. VIDEO ABSTRACT.