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Systemic lupus erythematosus has always been a research hotspot in the field of autoimmune diseases in China and other countries. In 2022, Chinese and international researchers have made a lot of new progress in epidemiology, pathogenesis, diagnosis and evaluation, and treatment of systemic lupus erythematosus. This review mainly summarizes major representative advances.
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Objective:To investigate clinical efficacy and safety of dupilumab in the treatment of atopic dermatitis (AD) .Methods:An ambispective study was conducted on 123 AD patients treated with dupilumab in Department of Dermatology, the Second Xiangya Hospital of Central South University from July 2020 to March 2022, clinical data were collected, and efficacy and safety of dupilumab were evaluated. Primary outcomes included scores of eczema area and severity index (EASI) , patient-oriented eczema measure (POEM) , peak pruritus numerical rating scale (NRS) and dermatology life quality index (DLQI) before and after 4-, 8-, 12- and 16-week treatment, and adverse reactions and events were recorded. Comparison of scores before and after treatment was performed using paired t test or repeated measures analysis of variance, Mann-Whitney U test was used for the comparison of efficacy among patients with different types of skin lesions or different IgE levels, and multiple regression model based on robust standard errors was used to analyze factors influencing the efficacy. Results:Among the 123 AD patients, 107 were enolled into the efficacy analysis, and 85 (79.44%) completed at least 4 weeks of treatment, including 6 (7.06%) achieving EASI75 and 23 (27.06%) achieving EASI50, and the EASI, NRS, POEM, DLQI scores (10.41 ± 6.72, 4.12 ± 1.74, 8.60 ± 4.29, 7.81 ± 4.38, respectively) significantly decreased compared with those before treatment (18.08 ± 10.69, 7.21 ± 2.01, 16.88 ± 5.74, 12.95 ± 5.95, respectively; all P < 0.001) in the 85 patients. Among the 107 patients, 47 (43.93%) completed at least 16 weeks of treatment. Among the 47 patients, 23 (82.14%) of 28 adults and 17 (89.47%) of 19 adolescents and children achieved 75% or greater improvement in EASI score; the EASI, NRS, POEM and DLQI scores before the treatment all significantly differred from those 4, 8, 12, 16 weeks after the treatment (all P < 0.001) , and all the scores were significantly lower at weeks 4, 8, 12 and 16 than at the previous adjacent time points (all P < 0.05) . At week 4 during the treatment, the EASI improvement rate was significantly lower in the AD patients with prurigo nodularis than in those without ( U = 151.00, P = 0.006) , while there was no significant difference in the EASI improvement rate between the AD patients with xeroderma and those without ( P > 0.05) ; at week 16 during the treatment, there was no significant difference in the EASI improvement rate between patients with prurigo nodularis or xeroderma and those without (both P > 0.05) . Multiple regression analysis based on robust standard errors at week 16 showed that the improvement degree in the EASI score was not correlated with the type of skin lesions ( β = 3.20, P = 0.075) , but correlated with age ( β = -0.22, P = 0.030) , whether patients were in adulthood ( β = 9.54, P = 0.049) , immediate family history ( β = 7.46, P = 0.017) ; the improvement degree in the NRS score was correlated with the type of skin lesions ( β = 0.55, P = 0.032) , age ( β = -0.04, P = 0.033) , weight ( β = -0.05, P = 0.020) , whether patients were in adulthood ( β = 2.06, P = 0.003) and whether patients received combined treatment with antihistamines ( β = -1.91, P = 0.001) . Adverse reactions: among the 123 patients, 6 (4.88%) developed conjunctivitis, and 2 (1.63%) developed facial erythema. Adverse events: vitiligo-like changes occurred on the right forehead of 1 patient, and 3 patients discontinued the treatment with dupilumab due to Henoch-Sch?nlein purpura, distal axonal damage in peripheral nerves in both upper limbs, and epilepsy, respectively. The causal relationship between these adverse events and dupilumab was unclear. Conclusion:Dupilumab is effective in the treatment of AD with high overall safety, and can serve as a new treatment option for AD patients with an unsatisfactory response to traditional treatment.
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In 2021, Chinese and international researchers have made a lot of new progress in pathogenesis, diagnosis and evaluation, and treatment of systemic lupus erythematosus. This review summarizes major representative advances.
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Androgenetic alopecia is a distinctive condition associated with genetic factors and effect of androgens, usually adversely affects the appearance and mental health of patients. This review summarizes research progress in the pathogenesis, diagnosis, evaluation and clinical treatment of androgenetic alopecia in 2020.
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A 24-year-old female patient presented with recurrent itchy annular erythema and scales on the trunk and extremities for 9 years. Histopathological study revealed hyperkeratosis with focal parakeratosis, neutrophil aggregation in the stratum corneum, blisters below the stratum corneum, and perivascular infiltration with lymphocytes, a small number of eosinophils and neutrophils in the superficial and middle dermis. Direct immunofluorescence assay showed negative staining for IgG, IgM, IgA and C3. Whole-exome sequencing of the SPINK5 gene showed a missense mutation c.2423C>T (p.T808I) in exon 25, and a splicing site mutation c.2965-1G>A in exon 31. The compound heterozygosity for the two mutations may be the cause of Netherton syndrome in the patient. Based on the clinical manifestations and genetic testing results, the patient was diagnosed with Netherton syndrome.
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The etiology of systemic lupus erythematosus is still unclear, and its pathogenesis is complicated. In 2020, Chinese and international researchers made a lot of new progress in the pathogenesis, diagnosis and evaluation, and treatment of systemic lupus erythematosus. This review summarizes major representative advances.
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Systemic lupus erythematosus (SLE) is an autoimmune disease that mainly affects young and middle-aged women. It can involve multiple organ systems, with complex and diverse clinical manifestations. The research on the etiology, diagnosis and treatment of SLE has always been a hot spot in this field. In 2019, a lot of new progress was made in the pathogenesis, diagnosis and evaluation, and treatment of SLE in China and other countries, and this review summarizes main representative advances.
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Adult-onset Still′s disease (AOSD) is a type of systemic inflammatory disease of unknown etiology, with diverse clinical manifestations, and there are some difficulties in its diagnosis and treatment. In recent years, it has been found that some new markers, such as heme oxygenase 1, calreticulin, inflammatory cytokines and advanced glycation end products, can be used for a comprehensive assessment of the activity and severity of AOSD. Moreover, new biological agents, such as tumor necrosis factor inhibitors, interleukin-1 (IL-1) inhibitors, IL-6 inhibitors and recombinant IL-18 binding proteins, bring new hope for the treatment of AOSD. This review mainly summarizes progress in the diagnosis and treatment of AOSD.
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Systemic lupus erythematosus (SLE) is a chronic and autoimmunity-mediated diffuse connective tissue disease. The mainstay of treatments for SLE mainly relies on corticosteroids and immunosuppressants, which have a series of unavoidable side effects. Therefore, it is of fundamental importance to search novel therapeutic targets for better treatment with favorable efficacy and minor side effects. Recent studies shed light on potential therapeutic targets for SLE, mainly covering the followings: B-cell/plasmocyte-related targets [B cell activating factor (BAFF), a proliferation-inducing ligand (APRIL), CD20, CD22, CD19/FcγRIIb, Bruton tyrosine kinase (Btk), and proteasome], T cell-related targets [calcineurin, mammalian target of rapamycin (mTOR), regulatory factor X1 (RFX1), and Rho kinase], macrophage-related targets (macrophage migration inhibitory factor), intracellular signaling molecules, cytokines (cereblon, histone deacetylase 6, Janus activated kinase/signal transducer and activator of transcription), co-stimulating factors (CD28/B7, CD40/CD154), IgE autoantibody, and gut microbiome. Among them, belimumab (a humanized monoclonal antibody against B-lymphocyte stimulator) and telitacicept (a recombinant human B-lymphocyte stimulator receptor-antibody fusion protein) have been sequentially approved for the clinical treatment of SLE in China. A variety of new targeted-therapy drugs are in the Phase 2 or Phase 3 clinical trials,among which anifrolumab (a human monoclonal antibody against type I interferon receptor subunit 1) has completed a Phase 3 clinical trial with good responses achieved, although its incidence of herpes zoster is higher than that in the control group. The research progress in both molecular mechanisms and new drug development for different therapeutic targets have greatly promoted our better and in-depth understanding of the pathogenesis of SLE, and have also reflected the complexity and heterogeneity of the disease. Successful development and clinical application of more novel therapies would no doubt usher in a new era of individualized treatment for SLE in the future.
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Humans , Antibodies, Monoclonal/therapeutic use , B-Lymphocytes , Graft vs Host Disease , Immunosuppressive Agents , Lupus Erythematosus, Systemic/drug therapyABSTRACT
Objective:To explore the clinical features of Sweet′s syndrome and analyze its histopathological features and treatment.Methods:The general data, clinical manifestations, laboratory examination, histopathological examination and treatment of 36 patients with Sweet′s syndrome who admitted our hospital from 2013 to 2019 were retrospectively analyzed.Results:The male to female ratio is 1∶1, with the highest incidence in the 50-60 years old range (27.8%). Skin lesions were more common in head and neck (30.6%), limbs (27.8%), upper limbs (19.4%) and whole body (22.2%). Accompanying symptoms were observed in 20 patients (55.6%) and most common are fever (47.2%) and joint pain (19.4%). Malignant tumors were associated with 5 patients (13.9%), chronic inflammation or infection with 17 patients (47.2%), diabetes mellitus with 4 patients (11.1%) and pregnancy with 3 patients (8.3%). It is most easily misdiagnosed as erythema polyforms (11.1%) and allergic dermatitis dermatitis (11.1%). Histopathologic features ware dermal papillary edema, dermal neutrophilic infiltration and nuclear dust. All patients relieved after glucocorticoid therapy.Conclusions:The proportion of male and female in Sweet syndrome is close to the same. Chronic infection and malignant tumor are the most common causes, which are easy to be misdiagnosed in clinic. Comprehensive evaluation of patients′ systemic diseases and accurate histopathological analysis are helpful for early identification and diagnosis of Sweet syndrome.
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Systemic lupus erythematosus (SLE) is a complex autoimmune disease mainly involving young and middle-aged women, with various clinical manifestations and complicated pathogenesis. SLE has always been a hot spot in the field of autoimmune diseases. This review summarizes new achievements and advances in genomics and clinical studies in SLE in 2018.