Immobilization involving Antibodies simply by Genetic Blend to a Fungus SelfAssembling Adhesive Protein

OBJECTIVE Enthesitis-related arthritis (ERA) represents a subgroup of juvenile idiopathic arthritis (JIA) which is regularly accompanied by anterior uveitis. This study describes the prevalence and characteristics of ERA-related uveitis. METHODS Cross-sectional data from the National Pediatric Rheumatological Database (NPRD) were used to characterize ERA-related uveitis (ERA-U). In addition to sociodemographic parameters, we documented the occurrence of uveitis and course of disease - including symptoms, visual acuity, and complications - as well as JIA characteristics such as disease activity (cJADAS10), functional ability (CHAQ score), laboratory parameters, and treatment. RESULTS In the years from 2002 to 2014, 3,778 (15.2%) of a total of 24,841 JIA patients recorded in the NPRD had ERA, and 280 (7.4%) of them had developed uveitis. Detailed ophthalmological documentation by an uveitis add-on module was available for 22.9% of these patients. Uveitis onset was acutely symptomatic in 63% of patients. Patients with uveitis were more frequently male, HLA-B27 positive, and younger at ERA onset, and they had higher ESR values at first uveitis documentation than those without uveitis. Uveitis was diagnosed at a mean age of 11.5 (± 3.9) years (50% within two years after ERA onset). Systemic treatment with corticosteroids and synthetic and biologic disease-modifying antirheumatic drugs was associated with a (not significantly) lower risk of developing uveitis. CONCLUSION The course of disease in ERA-U patients is frequently similar to HLAB27-associated uveitis in adults; however, a subgroup of patients presents with asymptomatic uveitis.OBJECTIVE To address the hypothesis that very early patients with systemic sclerosis (SSc) are a heterogeneous group of patients with mild or early disease, we analyzed the extent of heterogeneity in clinical, epidemiological and immunological characteristics of these patients. METHODS We performed an analysis of very early SSc patients from the Zurich cohort, who fulfilled neither the 2013 ACR/EULAR nor the 1980 ACR classification criteria, but had a clinical expert diagnosis of SSc with Raynaud's phenomenon and additional features of SSc (puffy fingers, SSc-specific antibodies, SSc pattern on nailfold-capillaroscopy or any organ involvement characteristic for SSc). Disease duration was defined from first Raynaud`s symptom. RESULTS One-hundred and two patients fulfilled the inclusion criteria and were analyzed. Their clinical presentation was heterogeneous with the large majority presenting with Raynaud's phenomenon, ANA antibodies, and nailfold capillaroscopy changes, but with varying presentations of other features like SSc-specific antibodies and early signs of organ involvement. While 54.1% (52/96) patients had a disease duration of less than 5 years, as many as 29.1% (28/96) patients had a disease duration of > 10 years, indicating long-standing mild disease. Patients with very early, potentially progressive disease did not differ from patients with long-standing, mild disease in terms of their clinical features at first presentation. CONCLUSION This study showed that patients with very early SSc are a mixture of patients with mild or early disease. This needs to be considered in clinical practice for risk stratification and for the study design of patients considered as early SSc.OBJECTIVE Anti-synthetase syndrome (ASyS)-related interstitial lung disease (ILD) has a poor prognosis. Intravenous cyclophosphamide (CYC) and rituximab (RTX) are the main treatments currently used for moderate to severe ILD. We compare the efficacy of CYC followed by standard immunosuppressive treatment (IST) vs. RTX in ASyS-related ILD. METHODS This observational retrospective study was conducted between 2003 and 2016 in three tertiary care centers. All patients with ASyS-related ILD and treated with CYC or RTX with at least six months of follow-up were included. Pulmonary progression-free survival (PFS) - defined according to the American Thoracic Society guidelines - was assessed at 6 months and 2 years. All severe adverse events were recorded. RESULTS Sixty-two patients were included. Thirty-four received 2-12 monthly intravenous CYC pulse, followed by standard IST in 30 cases (88%). RTX-group included 28 patients. Following initial day 1-day 15 infusions, RTX was repeated every 6 months in 26 cases (93%) and 15 patients (54%) received concomitantly another IST. Median steroid dose was similar between both groups. Although RTX and CYC demonstrated similar PFS at 6 months (92% vs. 81%, respectively), RTX was superior at 2-years (Hazard Ratio = 0,263 [0,094 - 0,732], p=0.011). Interestingly, lower DLCO at baseline was independently predictive of poor 2-year PFS (0.965 [0.936-0.995], p=0.023). FVC and DLCO improved in both groups without significant difference. Serious adverse events were similar in both groups. CONCLUSION Despite similar PFS at 6 months, RTX was associated with a better 2-year PFS compared to CYC in patients with ASyS-related ILD.OBJECTIVE To evaluate what concepts about gout and its treatment are reflected in images in online educational resources about gout. see more METHODS A Google search was performed to identify English-language patient resources from medical and health organisations and health education websites in seven countries Australia, Canada, Ireland, New Zealand, South Africa, UK and USA. Two raters independently coded the images in the resources into five main categories clinical presentations of gout, monosodium urate (MSU) crystals/urate, medicines, food/healthy lifestyle, and other advice for people with gout. RESULTS One hundred and three resources were identified; 28 resources without images were excluded. Seventy-one educational resources with a total of 310 images were included in the study sample. Of the 310 images, clinical presentations of gout were depicted in 92 images (30%), food/healthy lifestyle in 73 images (24%), urate/MSU crystals in 50 (16%), medicines in 14 (5%). Urate-lowering medication was shown only in one image (0.3%) and just six images (2%) depicted a serum urate target. Ninety-one images (29%) did not convey specific information about gout. CONCLUSION Key concepts about gout and treatment are under-represented in the images used in educational resources for patients. A large proportion of the images do not convey useful information about gout or its management.