Eating Increases and Exercise Decreases Disease Activity in Patients With Symptomatic Dermographism.

BACKGROUND: Eating can increase disease activity in patients with symptomatic dermographism , the most common subtype of chronic inducible urticaria, but it is unclear how common this is. The effects of exercising on symptomatic dermographism disease activity have also not yet been determined. OBJECTIVE: To assess the impact of exercise and nonspecific carbohydrate-rich food intake on the severity and intensity of symptomatic dermographism after exercise and nonspecific carbohydrate-rich food intake. METHODS: We assessed disease activity by FricTest provocation testing in 75 symptomatic dermographism patients before and after eating, exercising, or both. We determined the rates of food-dependent (FD) symptomatic dermographism and food-exacerbated (FE) symptomatic dermographism. By comparing post- and pre-exercise FricTest scores, we identified complete responders: that is, patients with a negative FricTest response after exercising and partial responders. Finally, we evaluated whether exercise protects patients with FD-symptomatic dermographism or FE-symptomatic dermographism from eating-induced worsening of symptomatic dermographism. RESULTS: Of 64 symptomatic dermographism patients, eight had FD-symptomatic dermographism (13%), 42 had FE-symptomatic dermographism (66%), and 14 patients showed no negative impact of eating on disease activity (21%). Physical exercise reduced FricTest skin provocation test responses in 83% of 58 patients. Exercising protected patients with FD/FE-symptomatic dermographism from worsening of symptomatic dermographism owing to eating in half of cases, with higher rates for exercise after eating (67%) compared with exercise before eating (35%). CONCLUSIONS: Our study shows that eating often worsen symptomatic dermographism symptoms, and exercise often improves it. Our findings might aid patients in controlling symptoms better.

Fatigue Is Common and Predicted by Female Gender and Sleep Disturbance in Patients with Chronic Spontaneous Urticaria.

BACKGROUND: Fatigue is a common and disabling symptom in chronic inflammatory diseases. To the best of our knowledge, there are no studies evaluating fatigue thoroughly in patients with chronic spontaneous urticaria (CSU). OBJECTIVES: To evaluate fatigue and its drivers in patients with CSU, and to compare patients with healthy controls in terms of fatigue. METHODS: One hundred and three patients with CSU and 35 age- and gender-matched healthy control subjects were evaluated for fatigue with the Fatigue Severity Scale (FSS) and visual analog scale-fatigue. Patients were also assessed for their duration, activity, and control of disease, as well as anxiety, depression, and quality of life (QoL). RESULTS: There were no significant associations between disease activity, disease control scores, and FSS (P > .05). Although there were no significant differences in terms of antinuclear antibody positivity and IgE levels between fatigued and nonfatigued patients with CSU, C-reactive protein levels were higher in fatigued patients (P = .009). A significant correlation was noted between total FSS score and both Chronic Urticaria-QoL (r = 0.246, P = .013) and Dermatology Life Quality Index (r = 0.302, P = .002) in patients with CSU. In regression analyses, female gender and the presence of disturbed sleep were found to be significant predictors of fatigue in patients with CSU (P = .008; odds ratio [OR]: 9.02, and P = .001; OR: 8.35). CONCLUSION: Fatigue is a common and important symptom in patients with CSU and adversely affects QoL. While evaluating patients with CSU, it is important to assess fatigue, especially in female gender patients and in those having sleep disturbance.

Successful treatment of tubulointerstitial nephritis in immunoglobulin G4-related disease with rituximab: A case report.

BACKGROUND: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated condition that consisted of disorders that share particular clinical, serologic and pathologic properties. The common presentation of disease includes tumor-like swelling of involved organs and the histopathological findings are a lymphoplasmacytic infiltrate enriched with IgG4-positive plasma cells, and a variable degree of fibrosis that has a characteristic "storiform" pattern in biopsy specimens of tumor-like masses. Major presentations of this disease, which often affects more than one organ, include autoimmune pancreatitis, salivary gland disease (sialadenitis), orbital disease and retroperitoneal fibrosis. The steroid treatment is essential for the treatment of the disease however, other immunosuppressive drugs including cyclophosphamide or rituximab could be an option in resistant cases. CASE SUMMARY: Herein, we reported a 34-year-old woman whom previously had diagnosed with asthma, rheumatoid arthritis and Sjögren's syndrome (SS) referred our nephrology department due to acute kidney failure development at the last rheumatology visit. After kidney biopsy she has been diagnosed with IgG4-RD and tubuluointerstitial nephritis. She had been accepted resistant to steroid, mycophenolate mofetil, methotrexate and azathioprine therapies due to receiving in last two years. She refused to receive cyclophosphamide due to potential gonadotoxicity of the drug. Thus, rituximab therapy was considered. She received 1000 mg infusion, 15 d apart and 6 mo later it has been administered same protocol. After one year from the last rituximab dose serum creatinine decreased from 4.4 mg/dL to 1.6 mg/dL, erythrocyte sedimentation rate decreased from 109 mm/h to 13 mm/h [reference range (RR) 0-20], and C-reactive protein decreased from 55.6 mg/L to 5 mg/L (RR 0-6). All pathologic lymph nodes and masses were also disappeared. CONCLUSION: Patients with IgG4-RD usually misdiagnosed with rheumatologic diseases including systemic lupus erythematous or SS and also they were screened for the presence of malignancy. Rituximab could be an important treatment option in cases with steroid resistant tubulointerstitial nephritis in IgG4-RD.

Androgenetic alopecia as an indicator of metabolic syndrome and cardiovascular risk.

Numerous studies have investigated a probable association between androgenetic alopecia (AGA) and cardiovascular disease (CVD) by researching limited and dispersed parameters. We aimed to evaluate both traditional and non-traditional cardiovascular risk factors in male patients with early-onset AGA. This case-control study included 68 participants: 51 male patients with early-onset AGA and 17 healthy male controls. Patients with AGA were classified into three groups according to the Hamilton-Norwood scale and the presence of vertex hair loss. Traditional and non-traditional cardiovascular risk factors were examined in all study subjects. Metabolic syndrome was diagnosed in 25 patients with AGA and in two control subjects (p < 0.05). The carotid intima-media thickness values were found to be significantly higher in patients with vertex pattern AGA than in patients without vertex baldness and controls (p < 0.05). The pulse-wave velocity values were also found to be significantly higher in patients (p < 0.001). A limitation of this study was the small study population. In conclusion, vertex pattern AGA appears to be a marker for early atherosclerosis. This finding supports the hypothesis that early-onset AGA alone could be an independent risk factor for CVD and metabolic syndrome.