Hungarian Immunology

[Malignancies in systemic autoimmune diseases and due to immunosuppressive therapy]

SZEKANECZ Éva, ANDRÁS Csilla, KISS Emese, TAMÁSI László, SZÁNTÓ János, SZEKANECZ Zoltán

JUNE 20, 2006

Hungarian Immunology - 2006;5(03)

[There is an increased risk for secondary tumor development in some, mostly systemic, rheumatic diseases. Among immunosuppressive agents used in antirheumatic therapy, there is enough data available to support that cyclophosphamide and azathioprine are oncogenic. However, the role of methotrexate, cyclosporine A and anti-TNF agents in tumorigenesis is rather controversial. Authors describe those systemic diseases and immunosuppressive drugs, which may increase the development of malignancies.]

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Hungarian Immunology

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Hungarian Immunology

[Detection of rare phospholipid/co-factor antibodies in lupus patients]

TARR Tünde, KISS Emese, BÓTYIK Balázs, TUMPEK Judit, SOLTÉSZ Pál, ZEHER Margit, SZEGEDI Gyula, LAKOS Gabriella

[OBJECTIVE - Was to detect the rare phospholipid/ co-factor autoantibodies in lupus patients. PATIENTS AND METHODS - In the present study, besides anti-cardiolipin and anti-β2-glycoprotein I, antibodies directed against phosphatidil-serine, protrombin and annexinV were measured by commercial ELISA kits in 85 randomly selected lupus patients, 14 of whom met the criteria of antiphospholipid syndrome. Corralations were determined between the presence and concentration of rare antiphospholipids and those included in the diagnostic criteria of antiphospholid syndrome, as well as with clinical thrombotic manifestations. RESULTS - Anti-cardiolipin IgG was positive in 14 patients, aCL IgM in eight, anti-β2GPI IgG in four and IgM in five patients. Lupus anticoagulant was detected in nine cases. Seven patients were positive for anti-phosphatidilserine IgG, nine for aPS IgM, anti-protrombin IgG was positive in nine cases. Antiprotrombin IgM and anti-annexinV were negative in all patients. Correlation was found between antiphosphatidilserine and anti-cardiolipin antibodies. The frequency and the concentration of rare antiphospholipid/ co-factor antibodies were higher in patients with secondray antiphospholipid syndrome. The presence of such rare antiphospholipid antibodies cumulated in patients with antiphospholipid syndrome. Their presence increased the frequency of thrombotic events in the entire study population, furthermore in those positive for lupus anticoagulant or anti-cardiolipin. CONCLUSIONS - The rare anti-phospholipid/cofactor antibodies were found in 12% of an unselected cohort of lupus patients. Their presence was more frequent in patients with secondary antiphospholipid syndrome, and further increased the risk of thrombotic complications.]

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[Launching the Hungarian Vasculitis Registry aimed to collect information about prevalence and outcome of our patients with ANCA-associated vasculitis, and treatment protocols of the disease. The on-line data collection has been developing dynamically since its initiation five years ago, presently 278 patients’ files are available. Patients’ mean age is 58.2±14.5 years, 62% are women; their disease is associated with c-ANCA positivity in 51% and p-ANCA in 49%. At diagnosis GFR was 24.6±21.6 ml/min/1,73 m2, that time 29%, during the total follow up 39% of the registered subjects needed dialysis. Renal replacement therapy could be discontinued in 23% of them. In cases with focal histological changes, also with upper respiratory tract and skin involvement dialysis was significantly less frequently necessary, which underlines the importance of early diagnosis. In induction therapy steroid was administered for 94% of the patients, 85% of them got cyclophosphamide, 59% was treated by plasmapheresis, 11% got rituximab. Maintenance treat ment contained steroid in 80%, per os cyclophosphamide in 23%, parenteral cyclophosphamide in 22%, furthermore 40% of the patients got azathioprin, 8 subjects got mycophenolate and 6 got methotrexate. Median follow up was 30 months (IQR 6-78), during which period 20% of the patients died, 5% got kidney transplantation, and 5% were lost to follow up. Median survival was 14.8 years, five years survival was 85%, and ten years survival was 70%. Long term survival in patients with c-ANCA vasculitis seemed better comparing to p-ANCA vasculitis, but when correcting by age this difference disappeared. Predictors of death were age and dialysis dependent renal failure. Relapses developed in 27% of patients, 28% of them presented in the first year, 21% suffered it after five years of care. Collected data by the Hungarian Vasculitis Registry shows our society’s successful professional activity. Our results are comparable to the published data in the literature, yet there are several areas in our care where further improvements are warranted in order to increase our patient’s survival and quality of life.]

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