RESUMO
Objective: Preclinical or latent RA is characterized by the presence of autoantibodies in the absence of clinical symptoms. The objective of this study was to identify the prevalence of preclinical RA in patients with Celiac disease in order to determine whether or not such individuals should be screened for RA based on the high-risk. Method: A cross-sectional study was carried out on patients with celiac disease in a tertiary care center in Rawalpindi, Pakistan. After initial assessment, RA-autoantibody levels (Rheumatoid factor and anti-CCP) were checked. Descriptive analysis was performed on the data gathered. Results: Sixteen patients with known celiac disease were identified to have positive rheumatoid factor and/or anti-CCP levels with an overall prevalence rate of 35%. This trend was significant for celiac patients having history of inflammatory arthritis and active celiac disease. No statistical significance was seen in baseline characteristics for categories of patients with positive rheumatoid factor versus with positive anti-CCP antibodies. Conclusion: Patients with CD can be considered as a high-risk group based on the high prevalence rate of rheumatoid factor/anti-CCP positivity observed in this study and should be considered for further RA screening/preventive studies. Abbreviations: RA = Rheumatoid arthritis; CD = Celiac disease; anti-CCP = anti-citrullinated cyclic peptide) antibodies; RF = Rheumatoid factor; GFD = Gluten-free diet.
RESUMO
Drugs are responsible for 3%-5% of acute pancreatitis cases. There are a lot of medications that are known to cause acute pancreatitis, however only one case has been reported so far on Etanercept. This is a case about 62-year old female with history of Rheumatoid arthritis (RA) was started on Etanercept to control her severe RA symptoms. Three weeks later, she presented with abdominal pain, nausea, vomiting and found to have acute pancreatitis based on clinical symptoms and elevated pancreatic enzymes. A thorough workup for the cause of pancreatitis was done and all were unrevealing. There was no history of alcohol use, abdominal trauma or any gastroenterology procedures. Ultrasound and CT abdomen ruled out hepatobiliary abnormalities. Lipid profile and electrolytes including calcium were also found to be normal. As all the workup was unremarkable, it was thought that drug-induced acute pancreatitis was likely the case. Etanercept was the only medication that was started recently, which made it the likely culprit and therefore it was stopped. Patient continued to improve and was discharged after medical stabilization. Her rheumatologist started her on Abatacept and she has remained symptom-free since then. Our case is interesting as it is the second case of etanercept induced acute pancreatitis. Furthermore, recent animal trials have demonstrated that etanercept potentially has a protective and/or therapeutic role in acute pancreatitis. However, no human studies regarding this topic have been performed. Due to limited data, a clear explanation behind these paradoxical actions of etanercept is still lacking.
RESUMO
BACKGROUND: Chronic rhinosinusitis (CRS) is a commonly observed sequela after radiation therapy to the paranasal sinuses. The histopathologic features of radiation-induced CRS have yet to be determined and may have major implications in disease management. METHODS: A structured histopathology report was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Histopathology variables, Lund-Mackay score (LMS), and 22-item Sino-Nasal Outcome Test (SNOT-22) scores were compared among patients with radiation-induced CRS (CRSr), CRS without nasal polyps (CRSsNP), and CRS with nasal polyps (CRSwNP). RESULTS: Fifteen CRSr, 43 CRSsNP, and 56 CRSwNP patients who underwent FESS were analyzed. Compared with CRSsNP, CRSr cases had increased squamous metaplasia (40.0% vs 9.3%, p < 0.013) and subepithelial edema (53.3% vs. 2.3%, p < 0.001). Compared with CRSwNP, CRSr cases had fewer eosinophils per high-power field (20.0% vs 50.0%, p < 0.034), less basement membrane thickening (33.3% vs 76.8%, p < 0.002), and fewer eosinophil aggregates (0.0% vs 30.4%, p < 0.009). CRSr had significantly greater mean LMS (13.47 ± 5.13 vs 7.07 ± 4.79, p < 0.001) compared with CRSsNP. CONCLUSION: Radiation-induced CRS patients exhibited greater squamous metaplasia and subepithelial edema when compared with a cohort of patients with CRSsNP, and decreased eosinophilia and basement membrane thickening compared with a cohort of CRSwNP patients. CRSr cases demonstrated no difference in eosinophilia or neutrophilia compared with CRSsNP, and decreased eosinophilia compared with CRSwNP, lending further credence to the unique nature of radiation in the development of CRS in this patient group. These findings may have major implications with regard to extent of surgical intervention and medical management.
