RESUMEN
OBJECTIVE: To explore changes in the phenotypic features of Sjögren's syndrome (SS), and in SS status among participants in the Sjögren's International Collaborative Clinical Alliance (SICCA) registry over a 2-3-year interval. METHODS: All participants in the SICCA registry who were found to have any objective measures of salivary hypofunction, dry eye, focal lymphocytic sialadenitis in minor salivary gland biopsy, or anti-SSA/SSB antibodies were recalled over a window of 2 to 3 years after their baseline examinations to repeat all clinical examinations and specimen collections to determine whether there was any change in phenotypic features and in SS status. RESULTS: As of September 15, 2013, a total of 3,514 participants had enrolled in SICCA, and among 3,310 eligible, 771 presented for a followup visit. Among participants found to have SS using the 2012 American College of Rheumatology (ACR) classification criteria, 93% again met the criteria after 2 to 3 years, and this proportion was 89% when using the 2016 ACR/European League Against Rheumatism (EULAR) criteria. Among those who did not meet ACR or ACR/EULAR criteria at baseline, 9% and 8%, respectively, had progressed and met them at followup. Those with hypergammaglobulinemia and hypocomplementemia at study entry were, respectively, 4 and 6 times more likely to progress to SS by ACR criteria than those without these characteristics (95% confidence interval 1.5-10.1 and 1.8-20.4, respectively). CONCLUSION: While there was stability over a 2-3-year period of both individual phenotypic features of SS and of SS status, hypergammaglobulinemia and hypocomplementemia at study entry were predictive of progression to SS.
Asunto(s)
Síndrome de Sjögren/diagnóstico , Adulto , Argentina/epidemiología , Asia/epidemiología , Autoinmunidad , Biomarcadores/sangre , Proteínas del Sistema Complemento/deficiencia , Proteínas del Sistema Complemento/inmunología , Dinamarca/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Hipergammaglobulinemia/diagnóstico , Hipergammaglobulinemia/epidemiología , Hipergammaglobulinemia/inmunología , Masculino , Persona de Mediana Edad , Fenotipo , Valor Predictivo de las Pruebas , Pronóstico , Sistema de Registros , Factores de Riesgo , Síndrome de Sjögren/epidemiología , Síndrome de Sjögren/inmunología , Síndrome de Sjögren/fisiopatología , Factores de Tiempo , Estados Unidos/epidemiologíaRESUMEN
Background: In patients with advanced human immunodeficiency virus (HIV) infection, aphthous ulceration of the mouth and oropharynx can become extensive and debilitating. Preliminary reports suggest that thalidomide may promote the healing of oral aphthous ulcers. Methods: We performed a double-blind, randomized, placebo-controlled study of thalidomide as therapy for oral aphthous ulcers in HIV-infected patients. The patients received a four-week course of either 200 mg of thalidomide or placebo orally once per day. They were evaluated weekly for the condition of the ulcers, their quality of life, and evidence of toxicity. Assays were perfomed for plasma tumor necrosis factor alpha (TNF-alpha) soluble TNF-alpha receptors, and HIV RNA. Results: Sixteen of 29 patients in the thelidomide group (55 percent) had complete healing of thier aphthous ulcers after four weeks, as compared with only 2 of 28 patients in the placebo group (7 percent; odds ratio, 15; 95 percent confidence interval after adjusted P<0.001). Pain diminished and the ability to eat improved with thalidomide included somnolence and rash (7 patients each), and 6 of the 29 patients discontinued treatment because of toxicity. Thalidomide treatment increased HIV RNA levels (median increase, 0.42 log10 copies per milliliter; increased with placebo, 0.05; P=0.04). With thalidomide treatment there were unexpected increases in the plasma concentrations of TNF-alpha and soluble TNF-alpha receptors. Conclusions: Thalidomide is an effective treatment for aphthous ulceration of the mouth and oropharynx in patients with HIV infection
Asunto(s)
Humanos , Estomatitis Aftosa/complicaciones , Estomatitis Aftosa/diagnóstico , Estomatitis Aftosa/terapia , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/inmunología , Síndrome de Inmunodeficiencia Adquirida/microbiología , Talidomida/administración & dosificación , Talidomida/uso terapéutico , Esófago/lesiones , Esófago/microbiología , Faringe/lesiones , Faringe/microbiologíaRESUMEN
To explore the nature and importance of mononuclear cells of different phenotypes in oral premalignant lesions and oral cancer, we studied biopsy specimens from 21 oral red and/or white lesions (6 hyperkeratosis, 3 mild dysplasia, 4 severe dysplasia and 8 squamous cell carcinoma), using monoclonal antibodies and avidin-biotin-peroxidase complex staining. Peripheral blood samples (PB) from 4 normal subjects and 5 reactive lymph nodes (LN) were used as controls for the technique. T11-positive cells were the predominant phenotype (74-78 por cento) in all cases examined. The T4/T8 ratio in severe dysplasia was significantly lower than that in mild dysplasia (p ó 0.05). These observations support the hypothesis of a role for cellular immune responses in oral premalignant lesions and oral cancer. The predominance of T cells may represent the local expression of immunity against antigens (viral or other). The decreased T4/T8 ratio observed in severe dysplasia may represent a transitory stage of local immunosuppression, which may be of critical importance for the progression into carcinoma. Phenotypic variations in mononuclear cell infiltrates in these conditions could be of diagnostic value