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Biomedical subjects

E Toubi

Publications and source records attributed to E Toubi.

46 records · Page 3Linked to original sources
PubMed1995

Association of antiphospholipid antibodies with central nervous system disease in systemic lupus erythematosus.

OBJECTIVE: To determine the prevalence and characteristics of central nervous system disease in systemic lupus erythematosus (CNS/SLE) with particular reference to disease activity and to the presence of antiphospholipid (aPL) antibodies. PATIENTS AND METHODS: From 340 unselected SLE patients attending our lupus clinic, we found 96 (28%) to have definite CNS manifestations not attributed to any cause other than SLE. Patients with mild migraine or cognitive disorders were excluded. The control group consisted of 100 SLE patients without CNS or thromboembolic manifestations. RESULTS: Fifty-six of our CNS patients had transient ischemic attacks or strokes, 24 had epilepsy, and 12 had psychiatric disorders; the other 4 did not fulfill SLE criteria. In all, 55% of patients (53) were found to be positive for aPL antibodies, whereas only 20% of the SLE control group were positive (P < 0.001). Based on a physicians' global clinical assessment tool together with laboratory analysis, only 42 (44%) patients were found to be active at the onset of CNS manifestations, and the other 54 (56%) were nonactive. A finding of aPL antibodies was associated strongly with the inactive CNS/SLE group (P = 0.001). Of the 53 patients who underwent magnetic resonance imaging (MRI) study, 33 showed small high-density lesions suggestive of vasculopathy. Twenty-six (79%) of them were positive for aPL antibodies; whereas of the 20 patients with normal MRIs, only 8 (40%) were positive for aPL antibodies (P < 0.01). CONCLUSION: We confirm that CNS disease in SLE is significantly associated with the presence of aPL antibodies. The CNS manifestations can occur in about half of SLE patients without any other evidence of lupus activity. Abnormal MRIs highly correlate with positive aPL antibodies.

Antibodies, Antiphospholipid↗
PubMed1995

Increased thromboembolic incidence in anti-cardiolipin-positive patients with malignancy.

This study was undertaken to determine the prevalence of anti-cardiolipin antibodies (ACLAs) in patients with malignancy and to investigate a possible association of ACLAs with thromboembolic events in such patients. The study included 216 patients with solid and non-solid malignancies and an age-matched control group of 88 healthy subjects. ACLA levels were measured and related to thromboembolic phenomena (diagnosed by imaging methods) that occurred within 12 months of the diagnosis of cancer. Forty-seven patients (approximately 22%) with cancer were ACLA positive as compared with only three subjects (approximately 3%) in the control group (P < 0.0001). The ACLA-positive cancer patients had a significantly higher rate of thromboembolic events than ACLA-negative cancer patients: 13 of 47 (28%) vs 24 of 169 (14%), respectively (P < 0.05). High titres of either IgG-ACLA or IgM-ACLA were found in 10 out of 13 ACLA-positive cancer patients with thrombotic complications, but in only 2 out of 34 cancer ACLA-positive patients without thromboembolic events (P < 0.0001). In four cancer patients in whom ACLA levels were followed ACLA decreased after successful surgery/chemotherapy treatment and remained negative and thromboembolic free for 12 months of follow-up. Patients with malignancies show an increased prevalence of ACLA. Furthermore, ACLA-positive patients, mainly those with high titres, are much more prone to thromboembolic events.

Adult↗
PubMed1993

Whole saliva in systemic lupus erythematosus patients.

Whole saliva composition and flow rate were examined in 22 patients with systemic lupus erythematosus and compared with matched healthy controls. Significantly lowered salivary flow rate was observed in patients with systemic lupus erythematosus unrelated to the subjective complaint of xerostomia. Salivary sodium, calcium, and magnesium concentrations were significantly higher in the SLE patients with systemic lupus erythematosus, whereas potassium and total protein concentrations and amylase activity did not differ significantly from the controls. Salivary IgA and IgM levels were significantly higher in the patients than in controls. IgA, IgG, IgM, C3, C4, antinuclear antibody, and anti-DNA antibody levels were measured in serum of the patients with systemic lupus erythematosus and correlated with salivary immunoglobulins. The only significant correlation between saliva and serum was found between levels of salivary IgG and serum anti-DNA antibody. The altered salivary composition might indicate a subclinical involvement of salivary glands in the patients.

Adult↗
PubMed1990

Classification of patients with common variable immunodeficiency by B cell secretion of IgM and IgG in response to anti-IgM and interleukin-2.

We have classified patients with common variable immunodeficiency (CVI) on the basis of the ability of their B cells to respond to anti-IgM and interleukin (IL)-2 in vitro. Group A had cells unable to secrete IgM or IgG, Group B secreted IgM alone, and Group C secreted both IgM and IgG. A separate small group of patients lacked peripheral B cells. Where Ig secretion was present with anti-IgM and IL-2, EBV increased it, but where it was absent, EBV only induced IgM secretion in two out of eight Group A patients and IgG in one out of five Group B patients. These classifications are related to the sex of the patient and may represent different loci of the block in B-cell differentiation in CVI.

Antibodies, Anti-Idiotypic↗
PubMedDate not supplied

Hepatitis C virus-related arthritis: characteristics and response to therapy with interferon alpha.

OBJECTIVE: To characterize hepatitis C virus (HCV)-related arthropathy and to evaluate the response to treatment with interferon-alpha (INF-alpha). METHODS: We studied 28 HCV-infected patients with arthritis. All patients underwent complete clinical, laboratory and radiological evaluation, including assessment and follow-up by a rheumatologist. Twenty-five patients were treated with INF-alpha for a median period of 12 months. RESULTS: All patients were HCV-RNA positive (genotype 1b in 65%). The mean duration of arthropathy-related symptoms prior to the diagnosis of HCV infection was 12 months. 19 patients (68%) had symmetric polyarthritis and 19 (68%) had morning stiffness > or = 60 min. None of the patients had erosive disease or subcutaneous nodules. 12 (43%) had detectable cryoglobulin (mean cryocrit: 3.6 +/- 3.5%), 17 (61%) had rheumatoid factor (RF) (median titer: 1:80), and only 15 (54%) had elevated ESR. 14 patients (50%) had > or = 4 ACR (American College of Rheumatology) criteria for the diagnosis of rheumatoid arthritis (RA), 9 of whom were mistakenly diagnosed and previously treated as RA patients. Only 3 patients had a satisfactory response to previous treatment with anti-inflammatory or disease modifying drugs. Complete or partial response of arthritis-related symptoms in INF-alpha treated patients was observed in 44% and 32%, respectively. Cryoglobulin became undetectable in 9 of 12 patients. However, a complete biochemical and virological end-of-treatment response was achieved in only 8 (36%) and 5 patients (20%), respectively. CONCLUSION: HCV arthropathy should be considered in the differential diagnosis of any patient with arthritis, even in the absence of liver disease. Treatment with interferon-alpha may lead to substantial clinical improvement of HCV-related arthritis even without a complete biochemical or virological response.

Adult↗
PubMedDate not supplied

The association of serum matrix metalloproteinases and their tissue inhibitor levels with scleroderma disease severity.

OBJECTIVE: Matrix metalloproteinase 3 (MMP-3) is reported to play an important role in the pathogenesis of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Studies have also investigated the association of different tissue inhibitors of MMPs (TIMPs) with fibrosis in scleroderma (SSc). The aim of this study was to evaluate the correlation of serum MMP-1, 3 and TIMP-1 with severity and disease specific markers of SSc and RA. METHODS: Serum MMP-1,3 and TIMP-1 were measured in 42 SSc patients (age range 28-68 yr mean 47 yr) and compared to 29 RA and 30 healthy age- and sex-matched individuals. Elevated values of MMPs and TIMP-1 were defined as those greater than 2 SD above the normal mean. All SSc and RA patients were scored for disease severity. RESULTS: Serum MMP-1 was significantly elevated in 8/42 (19%) SSc patients (p = 0.01) but only in 2/29 (7%) RA patients (p = 0.2). Whereas MMP-3 levels were elevated in 10/29 (34%) RA patients (p = 0.002), it was elevated in only 5/42 (12%) SSc patients (p = 0.03). TIMP-1 was found elevated in 17/42 (40%) SSc patients (p = 0.001) and in only 4/29 RA patients (with a strong trend towards significance, p = 0.052). We found a significant association between the elevation of both MMPs and TIMP-1 levels, with the severity of SSc. Those who had an increase of more than one MMP and/or TIMP, demonstrated life-threatening major organ involvement such as end stage lung fibrosis, GI aperislasis, and severe cardiacfailure. Contrary to that in SSc, the severity of RA showed some trend of association with MMP-3 only. CONCLUSION: We confirm previous observations that MMPs and TIMPs may play an important role in various rheumatic diseases. Whereas serum increase of MMP-3 correlated with RA severity, SSc severity was more characterized by the increase of both MMP-1 and TIMP-1. This suggests that the MMPs and TIMPs involved in SSc are different than those playing a role in RA, which may indicate that in SSc they are produced in different locations than in RA.

Adult↗
PubMedDate not supplied

Livedo reticularis is a marker for predicting multi-system thrombosis in antiphospholipid syndrome.

OBJECTIVE: Livedo reticularis (LR) is a skin vasculopathy that has been frequently described in patients with anti-phospholipid syndrome (APS) and reported to be present in association with valvular heart pathology and strokes (i.e. Sneddon's syndrome). METHODS: In a cohort of APS patients we investigated the possible association of LR with various clinical aspects of APS such as pregnancy morbidity, central nervous system (CNS) and cardiac manifestations. RESULTS: Livedo reticularis was found in 50/308 (16%) of APS patients, and there was a significant association with cerebrovascular accidents (CVA), migraines and epilepsy (p = 0.01, 0.002, and 0.02 respectively). A similar association was also detected between LR, and the presence of cardiac valve thickening and vegetations (p = 0.001). No association with venous thrombosis, recurrent fetal loss, IUGR or toxemia was found. CONCLUSION: Livedo reticularis is a frequent cutaneous manifestation in patients with APS. Its high association with cardiac and CNS thrombosis may suggest that LR-APS patients compose a subset at higher risk for thrombosis, and thus may require a closer follow-up and a more aggressive anticoagulation.

Adult↗