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Y Shoenfeld

Publications and source records attributed to Y Shoenfeld.

At least 937 records · Page 52Linked to original sources
PubMedDate not supplied

Effect of Avemar--a fermented wheat germ extract--on rheumatoid arthritis. Preliminary data.

OBJECTIVE: To investigate the effect of the fermented wheat germ extract (Avemar)in patients with severe rheumatoid arthritis (RA). METHODS: Fifteen female RA (Steinbrocker II-III) patients, who had unsuccessfully tried two different DMARD treatments, were enrolled in an open-label, 1-year long, pilot clinical study. DMARD and steroid therapies were recorded and continued. All patients received Avemar as additional therapy. For measurement of efficacy the Ritchie Index, the Health Assessment Questionnaire (HAQ) and the assessment of morning stiffness were applied. Patients were evaluated at baseline, 6 and 12 months. For statistical analyses the Wilcoxon test was used. RESULTS: At both 6 and 12 months, Ritchie index, HAQ and morning stiffness showed significant improvements compared with the baseline values. Dosages of steroids could be reduced in about half of the patients. No side effects of Avemar were observed. CONCLUSION: Supplementation of standard therapies with a continuous administration of Avemar is beneficial for RA patients.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Outcome of patients with scleroderma admitted to intensive care unit. A report of nine cases.

OBJECTIVE: Patients with systemic rheumatic disease constitute a small percentage of admissions to the medical intensive care units (ICUs). Systemic sclerosis (SSc) is one of the rheumatic diseases that together with secondary complications may lead to a critical illness requiring hospitalization in the ICU. We present the features, clinical course and outcome of critically ill patients with scleroderma that were admitted to the ICU. METHODS: The medical records of nine patients with diagnosis of scleroderma (8 female, 1 male), admitted to the intensive care unit of Sheba Medical Center during the 11-year interval between 1991 and 2002, were reviewed. RESULTS: The mean age of the patients at the time of admission to the ICU was 48 +/- 13 [SD] years. The mean duration of SSc from diagnosis to the ICU admission was 8 +/- 8 years. Six patients had diffuse SSc, two patients had limited SSc and one patient had juvenile diffuse morphea. The main reasons for admission to the ICU were: infection/ septic syndrome (n = 4), scleroderma renal crisis (SRC) with pulmonary congestion (n = 2), acute renal failure associated with diffuse alveolar hemorrhage namely scleroderma- pulmonary - renal syndrome (SPRS) (n = 1), iatrogenic pericardial tamponade (n = 1), mesenteric ischemia (n = 1). The patients had high severity illness score (mean APACHE II 25 +/- 3). Eight out of nine patients (89%) that were admitted to the ICU died during the hospitalization, six (66.6%) of them died in the ICU. Septic complications as the main cause of death were determined in five patients (62.5%), while four of them had pneumonia and acute respiratory failure along with underlying severe pulmonary fibrosis. Lungs and kidneys were the most common severely affected organs by SSc in our patients. CONCLUSION: The outcome of scleroderma patients admitted to the ICU was extremely poor. Infectious complication was the most common cause of death in our patients. Although infections are treatable, the high mortality rate for this group of patients was dependent on the severity of the underlying visceral organ involvement, particularly severe pulmonary fibrosis. The severity of this involvement is a poor outcome predictor. An early diagnosis and an appropriate treatment of such complications may help to reduce the mortality in scleroderma patients.

Adult↗
PubMedDate not supplied

Restricted specificity of anti-ribosomal P antibodies to SLE patients in Israel.

OBJECTIVE: Anti-ribosomal P antibodies (aRib-P Ab) are highly specific for systemic lupus erythematosus (SLE), but their correlatation with disease activity and manifestations including renal, hepatic and central nervous system (CNS) involvement is still controversial. The aim of our study was to evaluate the prevalence of aRib-P Ab and their correlation with clinical manifestations and anti-dsDNA antibodies in SLE patients from Israel. METHODS: Elevated titers of aRib-P Ab utilizing the ELISA method were analyzed in 141 sera samples from 44 SLE patients, 20 Familial Mediterranean Fever (FMF) patients, 22 primary antiphospholipid syndrome (PAPS) patients, 12 patients with infections, and 43 healthy individuals. The SLEDAI score was utilized for assessing SLE disease activity. RESULTS: Elevated titers of aRib-P Ab were present in 11% of SLE patients (n = 6). The mean SLEDAI was 7 (range: 3-10). No statistically significant association was observed between the presence of aRib-P Ab and disease manifestations present in the SLEDAI. The 6 SLE patients had renal disease (n = 1), leucopenia (n = 1), rash (n = 3), and CNS involvement manifested as psychosis (n = 1) or depression (n = 1). Elevated titers of anti-dsDNA antibodies were found in 50% of patients with elevated titers of aRib- P Ab. Patients with PAPS, FMF, infections or healthy controls did not harbor elevated titers of aRib-P Ab. CONCLUSION: Elevated titers of aRib-P Ab were restricted to SLE patients. We confirm previously reported associations of aRib-P Ab reactivity with disease activity and elevated anti-dsDNA Ab titers. No significant correlation with a specific manifestation described on the SLEDAI score was established in this small cohort of patients.

Adolescent↗
PubMedDate not supplied

Toxoplasmosis and systemic lupus erythematosus. Comparative serological studies.

There are still controversial views as to the relation between SLE and toxoplasmosis. Therefore, we looked for serological markers in both diseases. In patients with SLE (17), toxoplasmosis (28), and in normal controls (28) anti-Toxoplasma gondii antibodies, anti-nuclear antibodies of different specificities, anti-histone and anti-cardiolipine antibodies, as well as antibodies against most common public idiotypes were measured. Significant increases in antinuclear antibodies and other SLE-related antigens were observed in patients with SLE. On the contrary, low levels of these antibodies were found in toxoplasmosis patients and in controls. The same was true for 16/6 anti-DNA idiotype antibodies. The incidence of anti-Toxoplasma antibodies in SLE sera did not differ in comparison with that in the normal population. Our data suggest that subacute and chronic toxoplasmosis do not play essential roles in generating the antibodies that are important to the pathogenetic mechanism operating in SLE.

Adult↗
PubMedDate not supplied

Successful surgical treatment of polycystic liver disease.

A patient with multiple liver cysts, erroneously diagnosed as suffering from echinococcal infection, was treated with mebendazole for four months. When fever appeared, she was treated with antibiotics, but her condition further deteriorated. On laparotomy polycystic liver disease was diagnosed and four liters of pus (due to peptostreptococcal infection) was evacuated from one of the cysts, which was also deroofed. The other cysts were excised and the patient recovered. These unusual events are discussed in the light of the pertinent literature.

Cysts↗
PubMedDate not supplied

Anti-histone antibodies in SLE and other autoimmune diseases.

The frequency of IgG and IgM anti-total histones and anti-histone subfractions were studied in 63 patients with SLE and 257 patients with other autoimmune conditions employing the ELISA. IgG anti-histone antibodies were found in 17 of 63 (25%) sera of lupus patients and in only 16 of 257 (6%) sera of patients with other autoimmune conditions. The latter incidence did not differ statistically from that of 115 healthy control subjects. Furthermore, the concomitant appearance of both IgG and IgM anti-histone antibodies was observed only in SLE patients. Anti-histone subfraction (H1, H2A, H2B, H3, H4) activity was determined in sera containing anti-total histone antibodies. There was a higher preponderance for antibodies to H1, H2A, H2B in SLE. We conclude that anti-histone antibodies seem to be a marker for lupus and its variants (e.g. drug induced lupus) and should be routinely looked for in SLE patients.

Antibodies↗
PubMedDate not supplied

Antinuclear autoantibodies in uveitis.

We have studied 44 sera of patients with uveitis, and controls for the presence of ANF and other antinuclear antibodies (ss-DNA, ds-DNA, Poly (I), Poly (G), RNP, Sm, histones) and for the presence of a common anti-DNA idiotype (16/6 Id) employing the ELISA method. Various incidences of antinuclear antibodies were found in sera of patients with uveitis. The uveitis specimens were found to have high titers of autoantibodies to ss-DNA, ds-DNA, Poly (I), histones and Poly (G). High titers of anti-Sm antibodies were detected only in 9% of the uveitis patients, which is markedly lower than the reported percentage of anti-Sm antibodies in SLE. No significant differences were found in the incidence of antinuclear antibodies between sera of patients with localized uveitis and uveitis concomitant with a systemic disorder. Similarly, no relationship was found between location of uveitis (anterior versus posterior) and autoantibody profile. Our results imply that despite considering uveitis as a specific organ malady, it should be regarded serologically as an autoimmune condition.

Antibodies, Antinuclear↗
PubMedDate not supplied

Anti-Rnp antibodies in chronic liver diseases.

Antinuclear antibodies are commonly observed in chronic liver disorders. Sera from 87 patients with various chronic liver diseases were tested for the presence of antibodies against two extractable nuclear antigens (ENA) - RNP and Sm. Using an enzyme-linked immunosorbent assay (ELISA) anti-RNP antibodies were detected in 13 patients (15%) most of whom had cryptogenic or primary biliary cirrhosis. When the sera were further tested by ELISA for the presence of anti-Sm antibodies no antibody binding could be detected. These findings support the notion that anti-RNP (but not anti-Sm) antibodies are included among the autoantibodies shared by systemic lupus erythematosus and chronic liver diseases.

Autoantibodies↗
PubMedDate not supplied

Surgery in patients with circulating lupus anticoagulant.

Twelve surgical procedures were performed in eight patients with circulating lupus anticoagulant. Bleeding complications were noted intra and postoperatively in three patients, either with an associated hypoprothrombinemia and/or thrombocytopenia. Five patients in whom only circulating lupus anticoagulant was found had an uneventful intra and postoperative course. It is concluded that the presence of lupus anticoagulant, when unassociated with other hemostatic defects, is not a contraindication for surgery.

Adult↗
PubMedDate not supplied

Major surgery in leukemic patients.

During the last ten years, 15 major operations have been performed in our ward on 14 patients with leukemia. Nine had an uncomplicated postoperative course, two succumbed to overwhelming postoperative infections, another two died from cardiovascular complications and one from carcinomatous spread. There were no wound-related complications and no granulocyte or platelet transfusions were necessary. It is concluded that major surgery should not be avoided in patients solely because of the presence of a leukemic process.

Aged↗
PubMedDate not supplied

Surgery in patients with hepatitis.

The results of thirteen major operations performed in twelve patients with various forms of hepatitis are reviewed. five patients succumbed shortly after surgery, four of them with acute yellow atrophy of liver and one following septic shock. In the patients with acute viral hepatitis, associated malignancy is assumed to have contributed to death. One patient with chronic active hepatitis treated by corticosteroids had an uneventful recovery, while two patients with the same disease, to whom corticosteroids were not administered, succumbed to hepatic failure.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Impaired binding capacity of asialyl and agalactosyl IgG to Fc gamma receptors.

OBJECTIVE: Autoimmunity in rheumatoid arthritis has been associated with deficient glycosylation of serum and synovial IgG which could potentially be mediated through the binding of the Fc portion of the molecule to its cognate receptor. METHODS: Normal IgG1 and IgG3 were affinity-purified, and sialic acid and galactose were clipped off using neuraminidase and beta-galactosidase, respectively. The binding of these sugar-depleted IgG to the Fc gamma receptors (Fc gamma R)IIIb on polymorphonuclear leukocytes (PMN) was assessed by flow cytometry. RESULTS: The binding of both asialyl and agactosyl IgG1 and IgG3 to PMN was significantly lower than that of the native IgG1 and IgG3. CONCLUSION: These data indicate that agalactosyl and, to a lesser degree, asialyl IgG, do not bind as efficiently as native IgG to Fc gamma R. Such a reduction in the perspective of the heterogeneity of the PMN Fc gamma RIIIb.

Arthritis, Rheumatoid↗
PubMedDate not supplied

D-penicillamine-induced autoantibodies in a mouse model.

OBJECTIVE: We have previously shown that the administration of D-penicillamine (D-PEN) to patients with rheumatoid arthritis induces circulating insulin autoantibodies (INSAAB). In order to gain further insight into such immune responses, we measured a battery of circulating autoantibodies in 4 strains of mice receiving D-PEN: C57BL/KsJ, BALB/c, C3H/HeJ, and C57BL/6. These rodents groups differ in their degree of susceptibility to streptozotocin (STZ)-induced immune diabetes (SIMD), which is high in the first 2 strains, and mild and nil in the third and fourth, respectively. METHODS: Randomly assigned animals from each group were given a weekly subcutaneous (SC) injection of either D-PEN 1 mg, D-PEN 3 mg, or solvent (PBS) for a period of 4 weeks. Serum levels of antibodies to insulin, single stranded DNA (ssDNA), thyroglobulin, and cardiolipin were measured weekly. RESULTS: Only the C57BL/KsJ and C3H/HeJ mice reacted to D-PEN administration. When compared to the pre-treated and solvent-treated mice, D-PEN 1 mg, and to a lesser degree D-PEN 3 mg, induced elevation of antibodies to insulin and to ssDNA in C57/KsJ mice (p < 0.001), while only ssDNA antibodies were detected in the C3H/HeJ mice (p < 0.0001 for D-PEN 1 mg; p < 0.05 for D-PEN 3 mg). D-PEN had no effect on the level of antibodies to cardiolipin or to thyroglobulin in any of the mice. CONCLUSIONS: This study showed that D-PEN induces an antigen(s)-specific humoral response only in mice already inherently prone to autoimmunity. This model suggests that the activation of autoimmunity by environmental factors is probably facilitated by genetic background, and might partly explain the diversity of autoimmune manifestations in D-PEN-treated patients.

Animals↗
PubMedDate not supplied

Primary Sjögren's syndrome and primary biliary cirrhosis: differences and similarities in the autoantibody profile.

Sera from 61 patients with primary biliary cirrhosis (PBC) and 23 patients with primary Sjögren's syndrome (pSS) were tested for the presence of autoantibodies to 15 different antigens (PDH, RNP, SS-A, SS-B, Sm, Scl-70, H2AH2B, Jo-1, collagen-type I, GBM, GM <--> 1, Sulf, GD1b, MPO, PR3). Patients with pSS had significantly (p < 0.01) higher frequencies of antibodies to SS-A, SS-B and RNP (78%, 52%, 22% vs 29%, 20%, 5%, respectively) when compared to patients with PBC. On the other hand, patients with PBC had significantly (p < 0.01) higher frequencies of antibodies to PDH, Sm, Jo-1, collagen and MPO (80%, 34%, 26%, 52%, 67% vs 13%, 9%, 13%, 13%, 9%, respectively) as compared with patients with pSS. For all the other autoantibodies, no significant differences were found between PBS and pSS patients. These data on the similarities in autoimmunity between two diseases with different clinical presentations shed more light on the mosaic of autoimmunity.

Adult↗
PubMedDate not supplied

Idiotypic induction of autoimmunity: do we need an autoantigen?

Autoimmune diseases may be classified into two groups: autoantibody-mediated and cellular-mediated. In many autoimmune conditions the autoantigen is well-defined, immunogenic and, upon immunization of the naive animal, will lead to the production of autoantibodies and, eventually, to the induction of the respective autoimmune disease. However, in certain autoimmune diseases the autoantigen is either ill-defined, or is not immunogenic, or is intracellular. In many of these situations it is difficult to explain the emerging clinical findings by the mere binding of the autoantibody to the autoantigen. We herewith propose an additional mechanism for autoimmune disease induction, employing active idiotypic immunization. The induction of the disease is exemplified by three clinical models-SLE, APS, and Wegener's granulomatosis. The implications for human disease are discussed.

Animals↗
PubMedDate not supplied

IgA in Sjögren's syndrome.

Patients with Sjögren's syndrome (SS) display two sets of immunological abnormalities. B cells are oligoclonally activated, resulting in hypergammaglobulinaemia, elevated levels of circulating immune complexes (CIC) and non-organ specific autoantibodies. The cellular arm of the immune response is also involved, as shown by the predominance of activated T cells within the exocrine gland infiltrate. IgA could well bridge the gap between activated B cells and defective T cells and by doing so, play a pivotal role in the pathogenesis of SS. This interpretation is supported by the high proportion of IgA in immunoglobulin(Igl) production at the mucosal level. Additionally, IgA is the Igl class most dependent on T cell help. A number of studies over the past 15 years have reported high levels of serum and secretory IgA, IgA-rheumatoid factor and IgA-containing CIC. A correlation between disease activity and the latter abnormalities has recently been shown. There is, however, a need for longitudinal assessment of total IgA and IgA autoantibodies in order to further evaluate their role in the pathogenesis of the disease.

Antigen-Antibody Complex↗