Frequent Use Of Corticosteroids Research Articles

Risk of Fracture in Patients with Myasthenia Gravis: A Nationwide Cohort Study in Korea.

Myasthenia gravis (MG) is an autoimmune disorder that affects the neuromuscular junctions, resulting in muscle weakness and fatigue. Muscle weakness, restricted mobility, and frequent use of corticosteroids in patients with MG may predispose them to a higher risk of fractures. However, studies on the impact of MG on bone health and the associated fracture risk are scarce. Utilizing claim database of the Korean National Health Insurance Service collected between 2002 and 2020, we compared the risk of major osteoporotic fracture between 23 118 patients with MG and 115 590 individuals as an age- and sex-matched control group using multivariable Cox proportional hazard models. Over a median follow-up duration of 5.58years, the MG group (mean age 53.7years; 55% women) had higher risk of major osteoporotic fracture compared to controls (incidence rate 13.59 versus 9.74 per 10 000 person-years), which remained independent of age, sex, comorbidities, drug use including anti-osteoporotic agents, and previous fracture history (adjusted hazard ratio [aHR] 1.19, p < 0.001; subdistributed HR 1.14, p < 0.001 adjusted for mortality as competing risk). Subgroup analyses showed a greater association between MG and major osteoporotic fracture risk in younger (age 50 or younger) than older individuals (aHR 1.34 vs. 1.17) and in men compared to women (aHR 1.32 vs. 1.15; p for interaction <0.05 for all). An imminent divergence of the fracture risk curve between MG and controls was observed for vertebral fracture while there was time delay for non-vertebral sites, showing site-specific association. Factors associated with higher fracture risk in patients with MG were older age, female gender, high dose glucocorticoid use (> 7.5mg/day), immunosuppressant use, and previous history of fracture. In summary, patients with MG had higher risk of major osteoporotic fracture compared to controls, which calls further preventive actions in this patient group.

Strongyloidiasis - diagnostic and therapeutic dilemmas in hyperinfection patients: a case series.

The helminth infection caused by Strongyloides stercoralis is widespread in tropical regions, but rare in European countries. Unfamiliarity with the disease and diagnostic obstacles could contribute to its lethal outcome. Frequent use of corticosteroids during the COVID-19 pandemic could increase its significance. The aim of this retrospective descriptive study was to explore disease patterns and discuss clinical dilemmas in patients with S. stercoralis hyperinfection treated at the University Hospital for Infectious Diseases 'Dr. Fran Mihaljević' in Zagreb, Croatia, between 2010 and 2021. Five out of 22 (22.7%) immunosuppressed patients treated due to strongyloidiasis developed hyperinfection. All patients were male, median 64 years; four were immunosuppressed by corticosteroids (although ileum resection could have been the trigger in one) and one by rituximab. The diagnosis was established after a median of 1.5 months of symptom duration, accidentally in all patients, by visualizing the parasite in the gastric/duodenal mucosa in four cases, and bronchial aspirate in one. All patients were cachectic, four out of five had severe hypoalbuminemia and all suffered secondary bacterial/fungal infection. Despite combined antibiotic, antifungal and antihelmintic therapy, three out of five of the patients died, after failing to clear living parasites from stool samples. We can conclude that significant delays in diagnosis and lack of clinical suspicion were observed among our patients with the most severe clinical presentations of strongyloidiasis. Although being beyond diagnostic recommendations for strongyloidiasis, an early upper gastrointestinal endoscopy with mucosal sample analysis could expedite diagnosis in severe, immunosuppressed patients. The persistence of viable parasites in the stool despite antihelmintic therapy should be further investigated.

Multi-joint steroid-induced avascular necrosis in a malignant brain tumor patient

Avascular necrosis (AVN) is a rare but serious adverse event associated with the use of corticosteroids for long durations or at high doses. This case report describes a 47-year-old female patient with low-grade astrocytoma who was initiated on low-dose dexamethasone for symptom management. The patient developed joint pain 1 year after steroid exposure, then was found to have AVN of the hip followed by multiple other joints. This case report highlights the extent to which AVN can occur in patients with brain tumors following a short course of low-dose corticosteroids. Careful evaluation of and monitoring for the development of AVN should occur frequently in patients with brain tumors given the frequent use of corticosteroids for symptom management in this population.

Pure extra-thoracic sarcoidosis: about 24 cases.

Introduction. Pure extra-thoracic sarcoidosis is rare and poorly characterized in the literature. Herein we present features of pure extra-thoracic sarcoidosis, in comparison with sarcoidosis with intra-thoracic involvement, in a population from the south of Tunisia. Methods. Retrospective, descriptive and comparative study of the patients presenting systemic sarcoidosis and attending the Department of Internal Medicine at the Hedi Chaker University Hospital, Sfax, Tunisia, for 21 years, from January 1996 to December 2016. Results. Twenty-four patients presented pure extra-thoracic sarcoidosis (30% of the cases of systemic sarcoidosis). There was a female predominance (79%). The mean age was 50 years. The main features were polyadenopathies (10 patients: 41.7%), cutaneous involvement (10 patients: 41.6%), inflammatory polyarthralgia (8 cases: 33.3%), general symptoms (6 patients: 25%), uveitis (6 cases: 25%), cholestasis (3 cases) and kidney involvement (2 cases). Lymphopenia, hypercalcemia, and hypercalciuria were observed each one in 12.5% of the cases, and high angiotensin converting enzyme (ACE) level in 38.5% of the cases. The histological proof was required in all the patients. Statistically significant associations identified were mainly hepatic involvement with general symptoms (p=0.035), peripheral lymphadenopathies (p=0.035) and kidney damage (p=0.022), and cutaneous involvement with articular manifestations (p=0.032). Systemic corticosteroids were used in half of the cases, with a good outcome in 21 cases, and recurrence in two cases. One patient was lost to follow up. The comparison to the form with mediastino-pulmonary involvement showed less lymphadenopathies (p=0.001), less lymphopenia (p=0.006), and less frequent use of corticosteroids (p=0.044). Conclusion. Our series was characterized by the frequency of the pure extra-thoracic form and the diversity of the systemic manifestations.

Frequency of diabetes and other comorbidities in chronic inflammatory demyelinating polyradiculoneuropathy and their impact on clinical presentation and response to therapy

ObjectivesTo determine the prevalence of different comorbidities in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and their impact on outcome, treatment choice and response.MethodsUsing a structured questionnaire, we collected information on comorbidities...

Rheumatoid artrhitis treatment in Brazil: data from a large real-life multicenter study

BackgroundLast decades witnessed great technological advances in rheumatoid arthritis (RA) management, but their implementation in clinical practice might prove difficult. Despite the efficacy demonstrated in controlled trials this information needs to be confirmed by real life data. This study assessed real-life treatment among RA patients.MethodsREAL study included Brazilian RA patients from eleven centers. Interview and medical records were performed. Continuous variables were compared using Student’s t or Mann-Whitney and categorical variables were assessed with chi-square or Fisher’s exact tests.Results1115 patients were included, women 89.5%. Median age 56.6 years, disease duration 152.5 months; 78.7% were rheumatoid fator positive; 55.2% had erosive disease; DAS28 (disease activity index-28 joints) = 3.5, HAQ (health assessment questionnaire) =0.875. The median duration of symptoms until the start of first DMARD was 12 months. A total of 529 (47.2%) patients used corticosteroids; 1022 (90.8%) were on conventional synthetic (cs) DMARDs and 406 (36.1%) on biological (b) DMARDs. Methotrexate (MTX) was the most frequent csDMARD: 748 (66.5%) patients, followed by leflunomide (LFN), used by 381 (33.9%) of patients. MTX was associated to LFN in 142 (12.6%) patients. Only five (0.4%) patients used triple therapy (MTX + hydroxychloroquine + sulfasalazine) or sulfasalazine in monotherapy.ConclusionsDespite advances in therapeutic resources, roughly half RA patients failed achieve T2T goals and 55.2% developed erosive disease. The frequent use of corticosteroids and delay in initiating DMARDs were demonstrated. Issues concerning timely access to medical care are crucial for effective management.

Conditions of vulnerability to the inadequate treatment of bronchiolitis.

To analyze clinical and demographic variables possibly associated with the prescriptions of non-recommended but routinely used therapies for infants with acute viral bronchiolitis. A cross-sectional study included hospitalized infants with bronchiolitis caused by the respiratory syncytial virus. Those with other associated infections and/or morbidities were excluded. The data were collected from medical records. Among 120 cases, 90% used inhaled beta-agonists, 72.5% corticosteroids, 40% antibiotics, and 66.7% inhaled hypertonic saline solution. The use of bronchodilators did not present an independent association with another variable. More frequent use of corticosteroids was associated with low oximetry, longer hospitalization time, and age>3 months. Antibiotic therapy was associated with the presence of fever, longer hospitalization, and age>3 months. Inhaled hypertonic saline solution was associated with longer hospitalization time. Non-recommended prescriptions were frequent. Corticosteroid and antibiotic therapy were associated with signs of severity, as expected, but interestingly, they were more frequently used in infants above 3m, which suggested less safety in the diagnosis of viral bronchiolitis in these patients. The use of bronchodilators was even more worrying since they were indiscriminately used, without association with another variable related to the severity or characteristics of the host. The use of the inhaled hypertonic solution, although not associated with severity, seems to have implied a longer hospitalization time. The identification of these conditions of greater vulnerability to the prescription of inappropriate therapies contributes to the implantation of protocols for the bronchiolitis treatment, for continuing education and for analysis of the effectiveness of the strategies employed.

P026 The association between corticosteroid exposure and long-term clinical and economic outcomes among patients diagnosed with ulcerative colitis

BACKGROUND: Despite their long-term risks, corticosteroids are often used in the management of ulcerative colitis (UC) to help patients achieve and maintain disease remission. The aim of this study was to describe the frequency of high-level corticosteroid exposure and the association between this exposure and both clinical and economic outcomes. METHODS: This retrospective analysis used the IQVIA Real-World Data Adjudicated Claims—US database from January 1, 2006 to June 30, 2017. Patients aged ≥18 years with ≥2 medical claims for UC (ICD9:556.* or ICD10 K51.*) who initiated their first UC therapy (considered the “index” date) between July 1, 2006 and June 30, 2013 and had continuous enrollment 6 months prior to (pre-index) and 4 years after (post-index) this therapy were included. The first 3 years of the post-index window was the corticosteroid exposure observation period; the fourth (and last) year was the outcomes assessment period. Patients were categorized into one of 2 corticosteroid use cohorts: “frequent” (&gt;30 days of continuous corticosteroid exposure in at least 2 of the 3 observation years) versus “infrequent” (all others). Cohorts were compared with respect to the incidence of clinical outcomes (known disease and corticosteroid-related sequelae including infections, osteoporosis etc.), healthcare resource utilization, and costs in the outcomes assessment period. Analyses included chi-square tests and 2-sample t tests. RESULTS: A total of 22,841 patients with UC were included (53.1% female; mean age = 45.2 years [SD = 11.5]). Among them, 4,098 (17.9%) patients met criteria for frequent corticosteroid use. Compared with patients in the infrequent cohort, patients in the frequent cohort were significantly more likely to be younger (28.0% vs 22.7% were 18–39 years), male (48.9% vs 46.5%), and had greater total pre-index costs ($17,294 vs $8,257) (all P &lt; 0.05). Patients in the frequent cohort were significantly more likely to develop gastrointestinal conditions (e.g., ulcers, gastrointestinal bleeding; 87.5% vs 74.0%), infections (e.g., herpes zoster; 53.5% vs 44.3%), musculoskeletal conditions (e.g., osteoporosis; 59.7% vs 51.5%), and dermatologic conditions (e.g., acne, abdominal striae; 34.9% vs 29.8%) (all P &lt; 0.05) during the subsequent outcomes assessment period compared with patients in the infrequent cohort. Patients in the frequent cohort were also more likely to experience a future emergency room visit (24.8% vs 17.9%), an inpatient hospitalization (16.9% vs 8.2%), longer average length of hospital stays (5.9 vs 5.4 days), and higher costs (pharmacy: $17,243 vs $7,939; outpatient: $9,998 vs $6,363; inpatient: $7,299 vs $2,769) compared with patients in the infrequent cohort (all P &lt; 0.05). CONCLUSION(S): Frequent corticosteroid exposure was common among patients with UC and subsequently associated with an increased likelihood of adverse clinical outcomes and greater healthcare resource utilization, and costs.

Oral and inhaled corticosteroid use and risk of recurrent pulmonary embolism

IntroductionChronic inflammatory diseases predispose for development of a first pulmonary embolism (PE). Previous studies showed that corticosteroids, which are the mainstay of treatment for inflammatory diseases, enhance the risk of a first venous thromboembolism. Yet, it is unknown whether corticosteroids also predispose for recurrent events. Therefore, we investigated the association between oral and/or inhaled corticosteroid use and the risk of recurrent PE. MethodsWe performed a nested case-control study using the PHARMO Database. Adult patients who had suffered from a first PE for which vitamin K antagonists were prescribed, were eligible. Of these, 384 patients with recurrent PE were matched to 1030 patients without recurrent PE. ResultsWe showed that oral or inhaled corticosteroids was ever used by 22.7% and 20.6% of patients with recurrent PE, and 23.5% and 21.5% of the patients without recurrent PE. There was an overall association between oral corticosteroid use and the risk of recurrent PE (p=0.02). Current use of oral corticosteroids increased the risk of recurrent PE (OR 3.74; 95% CI 2.04–6.87), whereas past use reduced the risk (OR 0.46; 95% CI 0.28–0.74). A similar pattern was observed for inhaled corticosteroids, although less strong (p=0.10). ConclusionsCurrent use of oral corticosteroids is associated with increased risk of recurrent PE. Whether this increased risk is caused by oral corticosteroids themselves, or by the underlying disease, or both, needs further investigation. Nevertheless, given the frequent use of corticosteroids in clinical practice, clinicians should be aware of this risk.

Osteoarthritis in horses - Part 2: a review of the intra-articular use of corticosteroids as a method of treatment

The problem considered in this review is related to the frequent use of corticosteroids (COs) (i.e. steroids) in the practice of equine medicine and surgery as a therapeutic strategy in the treatment of degenerative joint disease, commonly known as osteoarthritis (OA). This disease is one of the most common among the equine musculoskeletal diseases, and is clinically characterized by pain, lameness, joint effusion at the initial stage, which usually reduces with the progression of the disease, and reduced physical performance. Although steroids are considered excellent drugs in the control of clinical signs resulting from osteoarthritis, they also influence cellular activity through activation of various signaling mechanisms. However, they can cause adverse effects when administered intra-articularly, since they are immunosuppressive drugs of many cell types. They are also incriminated as suppressors of the chondrocyte matrix synthetic activities, which may contribute to 'arthropathy by corticosteroids', which can also be associated with cumulative injury resulting from improper use (dose and frequency of application) of already damaged joints. The objective of this article is to review information about the advantages and disadvantages of intra-articular COs for treatment of the disease in horses. In addition, some important information of other species is also presented.

To use or not to use corticosteroids for pneumonia? A clinician’s perspective

The use of corticosteroids in the management of pneumonia is still a controversial issue. The physicians in daily clinical practice often use corticosteroids in patients with pneumonia for different reasons all over the world. As an example of real life is the frequent use of corticosteroids to treat patients with pneumonia due to H1N1 pandemic influenza in spite of WHO' statements that clearly discouraged this therapy. In fact, the literature up to august 2012 reported a total of 6,650 patients with pneumonia due to H1N1 virus infection (of whom 2,515 were ICU patients): corticosteroids were used with various dose regimen in 2404 patients (37.8%). The attitude of international guidelines on pneumonia in using steroids do not help the clinician to clearly choice when and how to treat pneumonia with steroids. However, stress doses of corticosteroids are suggested by some major guidelines on community-acquired pneumonia in case of severe episodes with sepsis. To date, there are 10 randomised controlled trials assessing the effectiveness of corticosteroids for community-acquired pneumonia globally involving 1090 participants. Most of the trials adopted stress doses of glucorticoids for 4-7 days. The evidence from these trials taken separately is weak due to limitations of the studies themselves, but a Cochrane review and a systematic review found benefit using prolonged low doses of glucocorticoids in severe community-acquired pneumonia. Moreover, such a strategy decreases vasopressor dependency and appears to be safe. Nevertheless, larger trials with more patients and clinically important end-points were claimed to provide robust evidence. Finally, infection surveillance is critical in patients treated with corticosteroids, and to prevent the rebound phenomenon, the drug should be weaned slowly.

Canakinumab for the Patient With Difficult-to-Treat Gouty Arthritis: Review of the Clinical Evidence

Many patients with gouty arthritis experience frequent flares and have comorbidities that may limit their anti-inflammatory treatment options for acute flare management. For patients with contraindications to both NSAIDs and/or colchicine, treatment options are particularly limited, and there is an unmet medical need in this subgroup of patients. Two phase 3 studies and their extensions have demonstrated that a single dose of canakinumab during an acute flare provided rapid and effective pain relief and prolonged suppression of flares and inflammation in patients with a history of frequent flares and contraindicated for, intolerant of, or unresponsive to NSAIDs and/or colchicine. Canakinumab was consistently superior to the active comparator triamcinolone acetonide and was generally well tolerated in this patient population with a high prevalence of multiple medical comorbidities. Canakinumab should therefore be considered as a treatment option in a target population of patients with frequent gouty arthritis attacks who are unable to use NSAIDs and colchicine and in whom frequent use of corticosteroids is not considered appropriate.

Vitamin D’s role in the pathogenesis and treatment of IBD

Vitamin D (VD) is a fat-soluble vitamin that exists in two major forms, ergocalciferol (VD2) and cholecalciferol (VD3). 1,2 The classiceffects of VD involve calcium and phosphorus homeostasis and regulation of bone mineralization. More recently, it has been recognized thatVD has a host of other intra-organ autocrine, paracrine, and intracrine actions that may result in significant immunomodulatory effects. 1 As aresult, there is greater interest in the possible role of VD defficiency in the development of chronic in ammatory conditions such as in ammatorybowel disease (IBD). 1–3 This chronic, incurable, immune-mediated in ammatory disorder of the gastrointestinal tract consists of twosubtypes, Crohn disease (CD) and ulcerative colitis. 4

A nationwide 2010-2012 analysis of U.S. health care utilization in inflammatory bowel diseases.

Implementation of the 2010 Affordable Care Act (ACA) calls for a collaborative effort to transform the U.S. health care system toward patient-centered and value-based care. To identify how specialty care can be improved, we mapped current U.S. health care utilization in patients with inflammatory bowel diseases (IBD) using a national insurance claims database. We performed a cross-sectional study analyzing U.S. health care utilization in 964,633 patients with IBD between 2010 and 2012 using insurance claims data, including pharmacy and medical claims. Frequency of IBD-related care utilization (medication, tests, and treatments) and their charges were evaluated. Subsequently, outcomes were put into the framework of current U.S. guidelines to identify areas of improvement. A disproportionate usage of aminosalicylates in Crohn's disease (42%), frequent corticosteroid use (46%, with 9% long-term users), and low rates of corticosteroid-sparing drugs (thiopurines 15%; methotrexate 2.7%) were observed. Markers for inflammatory activity, such as C-reactive protein or fecal calprotectin were not commonly used (8.8% and 0.13%, respectively). Although infrequently used (11%), anti-TNF antibody therapy represents a major part of observed IBD charges. This analysis shows 2010-2012 utilization and medication patterns of IBD health care in the United States and suggests that improvement can be obtained through enhanced guidelines adherence.

Epidemiology of sarcoidosis in Afro-Caribbean people: a 7-year retrospective study in Guadeloupe.

There are no reliable epidemiological data on sarcoidosis in the French West Indies, although this disease is known to be more frequent and more severe in Black African-Americans and West Indians. This retrospective study aimed to assess the incidence and prevalence of sarcoidosis in Guadeloupe over a 7-year period and to determine its epidemiological, clinical, and evolutionary characteristics. Patients were identified through the computerized databases of the three pathology laboratories and two hospitals on the islands of Guadeloupe. Histologically proven cases of sarcoidosis were selected. All patients were recalled at a single study time-point. A total of 75 patients were identified. These included 44 women and 31 men (sex ratio: 1.4), with a mean±standard deviation (SD) age of 47±14years and Fitzpatrick skin types IV-VI. The average incidence was 2.28 per 100,000 inhabitants per year (95% confidence interval [CI] 1.69-3.02). The prevalence of sarcoidosis in 2009 was 21.09 per 100,000 inhabitants (95% CI 16.00-26.18). Most patients (61/71, 85.9%) exhibited multiple organ involvement; the mean±SD number of organs involved was 2.6±1.1. The initiation of systemic therapy was required in 75.7% of cases. Several lines of treatment were necessary in 41.5% of affected patients. At the study time-point, seven patients were found to have died. Four of these deaths were directly attributable to sarcoidosis (mortality rate: 5.3%). This epidemiological study on sarcoidosis in Guadeloupe reveals a low incidence of the disease and a high degree of severity as evidenced by the average number of affected organs, the high frequency of extrathoracic organ involvement, the frequent use of corticosteroids, and a mortality rate of 5.3%.

Cataractes liées à l’application prolongée de dermocorticoïdes : étude de 8 cas à Abidjan

Cataract induced by corticosteroids is an entity, which has been well described for a relatively long time, but this eventuality caused by the cutaneous application of corticosteroids remains inadequately reported. The purpose of this study was to describe cataract as one of the complications of the misuse of cutaneous application of corticosteroids. In eight patients seen for visual loss, bilateral cataract was discovered. The only probable etiology in these cases appeared to be the cutaneous application of corticosteroids. Indeed, the work-up and careful history performed did not uncover any other etiology. Eight patients, six women and two men, exhibited cataracts related to the application of topical corticosteroids. The age of the patients ranged between 39 and 45 years. The cataracts were bilateral and posterior subcapsular alone or combined. The period of use of corticosteroids ranged from 5 to 10 years. The products used consisted of a variety of chemicals including corticosteroids mainly in the form of traditionally manufactured soap, but also as ointment or other types of mixtures. Topical corticosteroids induce posterior subcapsular cataract. The mechanism of action is direct access to the eye without any hepatic-first pass effect on the corticosteroid in question. The increasingly frequent use of corticosteroids in African blacks for skin lightening raises concern regarding the risk of epidemic cataracts in young women attempting to lighten their skin to be beautiful. Increased public awareness should be undertaken to prevent this growing and harmful phenomenon.

THU0071 Hospitalization and risk of hospitalized infection in patients with rheumatoid arthritis based on iorra cohort

BackgroundThere has been rapid progress in the treatment of rheumatoid arthritis (RA) in the last decade and it has become more important to manage various complications, such as infection, in...

PTU-107 Nafld in Patients with Severe Asthma

IntroductionNAFLD is a spectrum of liver disease that encompasses Nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). The pathophysiology is not fully understood, but is believed to be a combination...

Obstructive Sleep Apnea and Autoimmune Disease: A Two-Way Process

Free AccessObstructive Sleep ApneaObstructive Sleep Apnea and Autoimmune Disease: A Two-Way Process Aibek E. Mirrakhimov, M.D., Erkin M. Mirrakhimov, M.D., Ph.D. Aibek E. Mirrakhimov, M.D. Address correspondence to: Aibek E. Mirrakhimov, Saint Joseph Hospital, Department of Internal Medicine, 2900 N. Lake Shore, Chicago, IL 60657(773) 665-3022(773) 665-3384 E-mail Address: [email protected] Saint Joseph Hospital, Department of Internal Medicine, Chicago, IL Search for more papers by this author , Erkin M. Mirrakhimov, M.D., Ph.D. Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan Search for more papers by this author Published Online:April 15, 2013https://doi.org/10.5664/jcsm.2604SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONWe read with a keen interest the article published by Walsh et al.1 These researchers analyzed 63 subjects with ankylosing spondylitis (SpA) and found that patients using TNF-inhibitors were less likely to have obstructive sleep apnea (OSA). Moreover, a non-statistically significant trend toward an improvement of OSA severity was found. The authors speculated regarding potential mechanisms responsible for this clinical observation such as more frequent corticosteroid use, cervical spine abnormalities and systemic inflammation. We are grateful to authors for studying this important problem. Nevertheless, we believe that some aspects merit attention.Loubaki et al. showed that upper airways (UA) of patients with OSA have a greater expression of TNF-α, which may lead to UA inflammation and greater collapsibility.2 Walsh et al.1 discussed that both OSA and SpA share systemic inflammation as a pathophysiologic feature. On the other hand, a research group from Taiwan showed that OSA increases the risk for the incidence of autoimmune diseases in a prospective epidemiological studies.3,4 It is interesting to speculate that OSA related increase in TNF-α may initiate the disease in susceptible individuals. Therefore, OSA may be not only the consequence of autoimmune rheumatic disease, but also as a risk factor for their occurrence. Future studies should address whether OSA treatment would have an impact on reduction of rheumatic disease incidenceDISCLOSURE STATEMENTThe authors have indicated no financial conflicts of interest.CITATIONMirrakhimov AE; Mirrakhimov EM. Obstructive sleep apnea and autoimmune disease: a two-way process. J Clin Sleep Med 2013;9(4):409.REFERENCES1 Walsh JA, Duffi n KC, Crim Jet al.Lower frequency of obstructive sleep apnea in spondyloarthritis patients taking TNF-inhibitors. J Clin Sleep Med; 2012;8:643-8, 23243397. LinkGoogle Scholar2 Loubaki L, Jacques E, Semlali Aet al.Tumor necrosis factor-alpha expression in uvular tissues differs between snorers and apneic patients. Chest; 2008;134:911-8, 18689593. CrossrefGoogle Scholar3 Kang JH, Lin HCObstructive sleep apnea and the risk of autoimmune diseases: a longitudinal population-based study. Sleep Med; 2012;13:583-8, 22521311. CrossrefGoogle Scholar4 Yang YW, Kang JH, Lin HCIncreased risk of psoriasis following obstructive sleep apnea: a longitudinal population-based study. Sleep Med; 2012;13:285-9, 22285106. CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 09 • Issue 04 • April 15, 2013ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationJanuary 1, 2013Accepted for publicationJanuary 1, 2013Published onlineApril 15, 2013 Information© 2013 American Academy of Sleep MedicinePDF download

Autoantibodies in patients with asthma: is there a link between asthma and autoimmunity?

The objective of this study was to measure autoantibodies and the mean individual immune reactivity (IR) in children with asthma. The study group consisted of ten children with asthma and the control group of ten age-matched healthy subjects. In all patients IR and 24 autoantibodies (aAb) type G were measured by ELISA (Immunculus, Russia). The IR in asthmatics was 42% and was statistically significantly higher than this of control group 9% (p < 0.005). The level of aAbs (LuM, LuS, CoM and dsDNA) was also raised in the asthmatics. Anti-Adr aAbs was higher in one patient who required intense treatment for asthma with frequent use of corticosteroids. Anti-HMMP, insulin and IR aAbs were significantly lower in comparison to the control group (p < 0.05). This study confirms the high level of immunological activation in patients with asthma. The presence of autoantibodies implies that autoimmunity might have a role in the pathogenesis of asthma.