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Островский, В. В., and Э. Ф. Сами. "Особенности современного течения ревматизма." Thesis, Издательство СумГУ, 1997. http://essuir.sumdu.edu.ua/handle/123456789/25083.
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Kwong, Wai-ip Eric. "Development of an in-house anti-Ro52 ELISA and a study of the clinical applications of anti-Ro52 in rheumatic diseases." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42925009.
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Kwong, Wai-ip Eric, and 鄺偉業. "Development of an in-house anti-Ro52 ELISA and a study of the clinicalapplications of anti-Ro52 in rheumatic diseases." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42925009.
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O'Gorman, Aisling M. "The rheological analysis of human pathological synovial fluids." Thesis, Queen's University Belfast, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.282292.
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HAGO, ALMUGADAM Shawgi Yousif. "LEISHMANIA: METABOLOMICS, BIOCHEMICAL AND CLINICAL STUDIES." Doctoral thesis, Università degli studi di Ferrara, 2017. http://hdl.handle.net/11392/2487968.
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Visceral Leishmaniasis (VL) is a major health problem worldwide and both, drugs have toxic effects and parasites developed resistance therefore new compounds and drug targets are sought. In this thesis Leishmania (L) and leishmaniasis were probed both in biochemical and clinical studies. The 6-aminonicotinamide effect was analysed on L parasite growth and metabolism by metabolomics technology. The rational was pentose phosphate pathway (PPP), a major antioxidants provider, has been reported as a 6-AN target and L PPP enzymes have significant differences versus those of the mammals, thus PPP might represent a good target. The other biochemical study was conducted to characterize L transglutaminase (TGase), catalyzing irreversible protein crosslinking; if fundamental for L parasites, these enzymes could represent another promising drug target. In the thesis clinical part, subclinical L infections were evaluated in autoimmune rheumatic patients treated with immunosuppressive drugs at Ferrara Hospital in Italy.
L. mexicana and L. infantum promastigotes were treated with 7.8 mM 6-AN for 24 hours and small metabolites were extracted and analysed by pHILIC-LC-MS. TGase was tested in vivo in canine L. infantum promastigotes as well as in vitro in parasite extracts using fluorescein-cadaverine. Transamidation in AS precipitated fractions was measured in microwell plates. Western blot of human L. infantum lysate and canine L. infantum extract and precipitated fractions as well as immunocytochemical analysis of canine L. infantum were performed using human TGase 2 polyclonal antibodies. L PCR and real-time PCR were performed on DNA extracted from PBMCs from 50 autoimmune rheumatic patients and 50 healthy subjects. Plasma cytokines were also measured.
In both L. mexicana and L. infantum, 6-AN caused significant depletion of phosphoribosylpyrophosphate (PRPP) and nicotinate and as a result purine and pyrimidine nucleotides were reduced and their nucleobases accumulated. Glutathione, ribose-5-phosphate, 6-phosphogluconate levels and downstream PPP intermediates were similar to controls. In mammals 6-AN is converted to abnormal 6-ANAD/P by NAD+ glycohydrolase, however, in L its toxicity is only seen in mM range, in which 6-AN depletes the cellular PRPP content probably in the Preiss-Handler NAD+ salvage pathway, resulting in depletion of nucleotides required for nucleic acid biosynthesis. L NAD+ glycohydrolase might decompose NAD+ but not catalyze exchange reactions as found in other microrganisms, however, combined 13C-glucose labeling and flux analysis might be useful to ascertain the fate and action mechanism of 6-AN in L. TGase was detected and confirmed in vivo and/or in vitro in human and canine L. infantum promastigotes. The activity in the canine strain was found Ca2+-dependent and inhibited by 10mM GTP. Immunocytochemistry showed fluorescent protein and blots revealed a band of 74.6 KDa for the canine strain and two bands of 55.34 KDa and 65.87 KDa for the human strain, thus the TGase pAbs (orb2986) could permit purification of this L enzyme.
Eighteen autoimmune rheumatic patients were positive for L DNA by PCR and/or quantitative PCR. No statistical difference observed in relation to ownership of a dog or the type of biological drug used. Pro-inflammatory IL-1, IL-6, IL-12(p70), IL-7, IL-15, IFN-γ and TNF-α; anti-inflammatory IL-4, IL-13; and regulatory IL-10 cytokines were markedly elevated in patients with additional increase those positive for L DNA.
The high L parasitaemia detected suggests that biologic treatment can lead to cryptic VL or L infection in a latent phase which may progress to full VL in the setting of immunosuppression. Molecular screening for L using PBMC fractions and cytokine analysis should be performed before treating autoimmune rheumatic patients with biologic drugs.La leishmaniosi viscerale (VL) è un problema sanitario mondiale e i farmaci possono dare tossicità nonché generare resistenza, perciò è importante la ricerca di nuovi composti e nuovi “drug target”. In questa tesi la Leishmania (L) è stata studiata sia dal punto di vista biochimico che clinico. Ho analizzato gli effetti antiproliferativi e metabolici della 6-aminonicotinamide. Essendo riportato come bersaglio principale della 6-AN la via dei pentosi fosfato (PPP), necessaria al sistema di difesa antiossidante della cellula e i cui enzimi in questi parassiti presentano differenze significative con quelli di mammifero, PPP potrebbe rappresentare un buon ”drug target”. Inoltre, poiché un secondo bersaglio potrebbe essere la transglutaminasi (TGasi) riportata essere importante per il parassita, si è cercato di caratterizzarla in L. infantum. Nello studio clinico, si è valutata la prevalenza di parassitosi da L, asintomatiche/subcliniche in pazienti dell’ospedale di Ferrara, affetti da patologie reumatiche autoimmuni, trattati con farmaci immunosoppressori. Promastigoti di L. mexicana e L. infantum sono stati trattati per 24 ore con 6-AN 7,8 mM e dopo estrazione i metaboliti più piccoli sono stati analizzati mediante pHILIC-LC-MS. La TGasi è stata saggiata in vivo in promastigoti di L. infantum e in vitro in lisato cellulare dopo incubazione con fluoresceina-cadaverina. L’attività è stata anche saggiata in micropiastra pure dopo frazionamento con AS. Anticorpi policlonali contro TGasi 2 umana sono stati usati nell’immunocitochimica e in Western Blot di lisati di L. infantum umana e canina e frazioni precipitate. Su DNA estratti da PBMC di 50 pazienti e 50 soggetti sani si sono effettuate PCR qualitativa e real-time. Inoltre si sono quantificate le citochine seriche. Sia in L. mexicana che L. infantum, 6-AN ha causato una diminuzione significativa di fosforibosil-pirofosfato (PRPP) e nicotinato e come conseguenza di nucleotidi mentre le nucleobasi sono aumentate. I livelli di glutatione, ribosio-5-fosfato, 6-fosfogluconato e intermedi PPP a valle erano simili ai controlli. Nei mammiferi la 6-AN è metabolizzata a 6-ANAD/P da una NAD+ glicoidrolasi, ma in L la tossicità solo in concentrazione mM, con deplezione di PRPP e conseguente calo di nucleotidi, indica che 6-AN potrebbe entrare nella via Preiss-Handler di sintesi del NAD+. In L la NAD+ glicoidrolasi potrebbe idrolizzare il NAD+ ma non catalizzare lo scambio tra nicotinamide e 6-AN, come riportato in altri microrganismi. Analisi ulteriori di flusso dopo marcatura con 13C-glucosio potrebbero chiarire il meccanismo d’azione del 6-AN in L. Si è confermata in vivo and in vitro, la presenza in L di una TGasi attiva, in promastigoti canini Ca2+-dipendente e inibita da GTP. Con l’immunocitochimica si è rivelata fluorescenza e nei blot bande di 74.6 KDa per il ceppo canino e di 55.34 e 65.87 KDa per quello umano, suggerendo che gli anticorpi usati potrebbero essere utili nella purificazione dell’enzima. In 18 pazienti si è riscontrata positività ma non evidenziate differenze significative tra possessori o meno di cani e in riferimento al tipo di farmaco somministrato. In tutti i pazienti in trattamento con farmaci biologici, erano significativamente elevate le citochine pro-infiammatorie IL-1, IL-6, IL-12(p70), IL-7, IL-15, IFN-γ e TNF-α, quelle anti- infiammatorie IL-4 e IL-13 e la regolatoria IL-10, ma un aumento maggiore era presente nei pazienti positivi per la presenza di DNA di L. L’alta parassitemia trovata suggerisce che il trattamento possa portare a VL criptica o infezione latente, con possibilità di progressione a VL conclamata in caso di evoluzione a uno stato di immunocompromissione. Si potrebbero quindi introdurre uno screening molecolare su frazioni PBMC e l’analisi di citochine prima di prescrivere questo tipo di farmaci a pazienti con patologie autoimmuni.
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Kivi, Pertti. "Käden ja kyynärvarren rasitussairaudet olkaluun epikondyliitin sekä käden ja kyynärvarren tenosynoviitin ja peritendiniitin kliininen ja työlääketieteellinen tutkimus /." Tampere : Tampereen yliopisto, 1986. http://catalog.hathitrust.org/api/volumes/oclc/15507116.html.
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Voyi, Kuku Vinolia Vuyelwa. "Development of an antirheumatic drug." Doctoral thesis, University of Cape Town, 1988. http://hdl.handle.net/11427/17187.
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Includes bibliographical references.The diamino-diamide ligands have been investigated in an attempt to develop an antirheumatic drug. The ligands N,N'-di-(2-dimethylamino)ethyloxamide and N,N'di-(2-diethylamino)ethyloxamide, were synthesised and characterised using the physical techniques, NMR, mass- and infrared spectrometry. The stability constants of the complexes of Mg, Ca, Zn and several first transition metal-ions with the ligands were determined potentiometrically. The solution conformation of the CuII complexes were determined using visible spectrophotometry. Finally the physico-chemical studies were carried out. Firstly by studying the interaction of the copper complex with albumin at the physiological pH 7.4 using visible spectrophotometry. Secondly by determining the superoxide dismutase activity of the ligand by reduction of nitrobluetetrazolium using visible spectrophotometry. Lastly the ligands and the carr, CuII, MgII and ZnII metalions were monitored in vitro using the computer blood plasma model.
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Левченко, А. В., and А. Д. Башкирова. "Основные направления в лечении острой ревматической лихорадки." Thesis, Сумский государственный университет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/47740.
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Острая ревматическая лихорадка – постинфекционное осложнение тонзиллита или фарингита, вызванных b-гемолитическим стрептококком группы А, в виде системного воспалительного заболевания соединительной ткани с преимущественной локализацией в сердечно–сосудистой системе, суставах, мозге и коже, развивающееся главным образом у лиц молодого возраста (7–15 лет). Данное заболевание склонное к рецидивированию и формированию пороков сердца. Таким образом, лечение ревматизма является чрезвычайно актуальной проблемой.
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Young, Man-chi, and 楊敏智. "Determinants of resilience in patients with rheumatic disorders." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B47869653.
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Introduction
Rheumatic disease is an autoimmune disorder with an unpredictable course of
exacerbation and remission. There is no known cure for the disease at the moment.
The patients’ conditions may progressively deteriorate despite intensive therapies, and
runs an erratic course with the possibility of disfiguration and alteration in body
image. Pain, disabilities and psychological distress are common. Rheumatic patients
may respond differently to the same level of pain and physical symptoms. The
understanding of the needs of rheumatic patients and how they successfully manage
the disease and optimize psychological adjustment can help develop effective
psychosocial interventions.
Aims
The aims of the study are (1) to identify the needs of rheumatic patients and
perceptions of their disease, (2) to develop a conceptual framework for psychological
adjustment, and (3) to identify factors associated with resilience in rheumatic patients.
Methods
The present study consisted of two phases. The first phase was a focus group
interview, aiming to understand the patients’ feelings and to design a questionnaire.
The second phase was a prospective questionnaire survey that includes a baseline
study and a six-month follow-up study. Patients were recruited from support groups in
Hong Kong. The baseline questionnaire was self-administrated, and the follow-up
questionnaire was administrated by telephone interview. The self-regulation model
was chosen as the basis for the conceptual framework for psychological adjustment.
The questionnaire included demographics, illness representation, coping efforts,
appraisal of coping efforts, sense of coherence, quality of care, functional disability,
and health-related quality of life. The outcome measures were functional and
psychological health, change in adjustment, and positive and negative resilience.
Results
Having a good and caring doctor, more information on the disease, and public
understanding of the disease were the needs of rheumatic patients. The patients
perceived that the disease was chronic, cyclical, and had poor consequences. They
perceived that the disease caused great pain, stress, depression and anxiety, and
affected their daily activities, appearance, and relationship with family and friends.
Poor adjustment was associated with chronic and cyclical timeline, and poor
perception of personal and treatment control. The analysis of resilience shows that
positive perception of treatment control and disease consequence, correct
understanding of disease causes, and high sense of own value and importance to the
society, were protective. While those who lacked family support and blamed
themselves or their families to be the cause of disease, were vulnerable.
Discussion and conclusions
The present study lends support to the validity of self-regulation model in
psychological adjustment to disease, but coping efforts could only partially mediate
the relationship of illness representation to appraisal of coping efforts, implying that
the coping style might not sufficiently capture the underlying differences in individual
coping styles. An effective psychosocial intervention can be developed based on the
factors associated with better adjustment and resilience, and targeted at non-working
older patients with rheumatoid arthritis. Last but not least, support from the
community, and public understanding of the disease are important for rheumatic
patients.published_or_final_version
Psychiatry
Doctoral
Doctor of Philosophy
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Binder, Allan Ivan. "Painful stiff shoulder (frozen shoulder) and soft tissue rheumatism in the upper limb." Doctoral thesis, University of Cape Town, 1985. http://hdl.handle.net/11427/25848.
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莊松輝. "痹症的古文獻整理." HKBU Institutional Repository, 2006. http://repository.hkbu.edu.hk/etd_ra/743.
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Wahlsten, Daniel. "Betydelsen av socialt stöd för anpassning till kronisk reumatisk sjukdom." Thesis, Mälardalen University, Department of Social Sciences, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-411.
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Vilka psykologiska processer som gör att vissa individer klarar sig bättre än andra i påfrestande situationer har väckt allt större intresse hos forskarna. Syftet med den här studien var att undersöka vilken betydelse socialt stöd har för anpassningen till kronisk reumatisk sjukdom. Studien utfördes i form av tolv halvstrukturerade intervjuer. Analys av materialet som helhet antydde att intervjupersonerna ansåg att socialt stöd från omgivningen hade hjälpt dem att anpassa sig till sjukdomen. Vården, i form av bland annat läkare, framstod som ett särskilt viktigt socialt stöd. Även stödet från andra individer med liknande sjukdom lyftes fram som betydelsefull. Den största anpassningen till sjukdomen verkar ske de första åren, men tycks också därefter pågå fortlöpande.
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Falsarella, Glaucia Regina 1980. "Prevalência e fatores associados às doenças reumáticas e aos sintomas articulares crônicos em idosos." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308432.
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Orientador: Arlete Maria Valente CoimbraDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-16T18:16:14Z (GMT). No. of bitstreams: 1 Falsarella_GlauciaRegina_M.pdf: 1971232 bytes, checksum: d2166302be1edbdaaa70b45429e1b7e5 (MD5) Previous issue date: 2010
Resumo: As doenças reumáticas representam condição multifatorial, responsável pela limitação funcional, pelo alto custo para o paciente e sociedade, o que compromete a Qualidade de Vida Relacionada à Saúde (QVRS), tendo, portanto, grande relevância para a saúde pública. O presente estudo, na área da saúde e qualidade de vida na velhice, tem em sua composição dois artigos, que apresentam como objetivo determinar a prevalência e os fatores associados às doenças reumáticas e aos sintomas articulares crônicos, bem como suas repercussões sobre a QVRS. Este estudo transversal, com caráter epidemiológico envolveu 2209 idosos (?60 anos) do município de Amparo-SP. Foram avaliados os dados sociodemográficos, as doenças reumáticas, os sintomas articulares, as condições de saúde, os sintomas depressivos pela GDS-15 e a qualidade de vida pelo SF-36. Para investigar a associação entre doenças reumáticas/sintomas articulares e fatores de risco foram utilizadas a regressão logística univariada e a multivariada. Para determinar a relação entre as condições reumáticas e a QVRS empregou-se tanto a Análise de Variância Multivariada (MANOVA) como a Análise de Variância Univariada (ANOVA). As doenças reumáticas atingiram 22.7% dos idosos e associaram-se significativamente com: sexo feminino (Odds Ratio - OR 1.91), renda familiar 3-9.9 salários mínimos (SM) (OR 1.29), ?10 SM (OR 2.34), doença cardiovascular (OR 1.42), catarata (OR 1.39), glicocorticóides (OR 5.24), outros anti-inflamatórios (OR 2.24), dor (OR 0.983). Após ajuste para glicocorticóides e diabetes identificou-se OR=1.42 para catarata. Os sintomas articulares acometeram 45.6% da amostra e apresentaram a seguinte relação: mulheres (OR 1.40), Índice de Massa Corporal (IMC) 18.5-24.9 kg/m² (OR 2.29), 25.0-29.9 kg/m² (OR 2.55), ?30.0 kg/m² (OR 3.31), capacidade funcional (OR 0.990), estado geral de saúde (OR 0.993) e dor (OR 0.981). Após ajuste para glicocorticóides e diabetes identificou-se OR=1.30 para catarata. Ao investigar o impacto das doenças reumáticas sobre a QVRS verificou-se o comprometimento relativo da: capacidade funcional (F=10.9) e dor (F=34.77). Os sintomas articulares repercutiram: capacidade funcional (F=10.9); aspectos físicos (F=72.61); dor (F=164.29); estado geral de saúde (F=71.95); vitalidade (F=55.78); aspectos sociais (F=73.14); aspectos emocionais (F=49.09); saúde mental (F=44.72). A identificação destas características possibilita determinar o impacto das alterações osteoarticulares nos diversos domínios da saúde, maior entendimento dos processos fisiopatológicos, além de auxiliar nas medidas preventivas precoces e eficientes.
Abstract: Rheumatic diseases represent a multifactorial condition responsible for functional limitations and high cost to the patient and society, undermining health-related quality of life (HRQOL). The present study considered two articles on health and quality of life in old age, aiming to determine prevalence and risk factors associated with rheumatic diseases and chronic joint symptoms, as well as their impact on HRQOL. The following questionnaires were applied in this cross-sectional study comprising 2,209 elderly (?60 years): self-reported medical diagnosis of rheumatism and chronic joint symptoms, sociodemographic, health status, ADL, IAVD, GDS-15 and SF-36. Univariate and multivariate analyses were used to investigate association between rheumatic diseases/chronic arthritis symptoms and selected factors. To determine the relationship between rheumatism conditions and HRQOL was employed MANOVA e ANOVA, with p?0.05. The prevalence of arthritis was 22.7%. Multivariate analysis showed significant arthritis: female sex (OR 1.91); family income ?10 minimum wages (mw) (OR 2.34); cardiovascular disease (OR 1.42); cataract (OR 1:39); glucocorticoids (OR 5.24); pain (OR 0.983). A significant association between cataract and arthritis was detected even after adjusting for use of glucocorticoids and diabetes (OR 1.42). The prevalence of chronic joint symptoms was 45.6%. Multivariate regression results for joint symptoms included: female gender (OR 1.40); BMI ?30.0 kg/m² (OR 3.31); functional capacity (OR 0.990); general health (OR 0.993) and pain (OR 0.981). A significant association between cataract and joint pain was detected after adjusting for the use of glucocorticoids and diabetes (OR 1.42). It was found impairment when investigating the impact of rheumatic diseases on HRQOL: physical functioning (F = 10.9) and pain (F = 34.77). The joint symptoms caused the following problems: functional (F=10.9), physical problems (F=72.61), pain (F=164.29), general health (F=71.95), vitality (F=55.78), social (F=73.14), emotional (F= 49.09), mental health (F= 44.72). The identification of these characteristics will allow determining the impact of osteoarticular changes on the various health fields, providing a better understanding of pathophysiological processes, as well as contributing to early and effective preventive measures.
Mestrado
Gerontologia
Mestre em Gerontologia
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Zhuang, Songhui. "Bi zheng de gu wen xian zheng li /." click here to view the abstract and table of contents, 2006. http://net3.hkbu.edu.hk/~libres/cgi-bin/thesisab.pl?pdf=b1998702xa.pdf.
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Wyeth, Emma Hana, and n/a. "Hauhaketia to wahia i mua i te takurua : Maori and genetic health research : a case study." University of Otago. Department of Biochemistry, 2008. http://adt.otago.ac.nz./public/adt-NZDU20080319.114119.
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This project was carried out under a broad theme of Maori health and investigates the genetics of rheumatoid arthritis (RA) and gout within two Maori case-control cohorts. In addition, it reports on the developmental stages of a whanau project focussing on the compilation of our whakapapa and collation of information relating to type 2 diabetes within the Parata whanau, which I whakapapa to. My conducting this research in light of me being Maori is also considered: much of the prevailing literature on Maori and science describes science as the handmaid of colonisation, and singles out genetic research as being "neo-colonial". I reject those that would label me a "sell-out" and show how my research is shaped by, and consistent with, the history of my immediate tipuna, and my iwi more generally, since European contact.
RA is an autoimmune disease of the joints and affects approximately 1% of the general population. There is currently very little data available on its prevalence in New Zealand although it is thought that it is similar to those of the rest of the world. Gout is the most common form of inflammatory arthritis in Caucasian males and recent data suggests a worldwide increase in prevalence in many populations. Gout is characterised by the deposition of monosodium urate or uric acid crystals in the joints, which produces an inflammatory response. In New Zealand, the prevalence of gout is estimated to be 3% in Caucasians and twice this in Maori. Both RA and gout are complex arthritic diseases and are influenced by a combination of genetic and environmental factors. It is likely that numerous genetic susceptibility loci are responsible for the genetic components of these diseases.
This project tests various genetic regions for susceptibility to or protection against both RA and gout in two separate Maori case cohorts and a common control cohort. To do this, the confounding factor of population stratification, resulting from population admixture, was overcome via developing a method specific for these Maori cohorts. This tool utilised genotype data from a set of unlinked genome-wide markers and the structure and STRAT software packages, allowing valid case-control studies to be carried out in the presence of population stratification. These data showed that four sub-populations exist in the Maori RA case-control cohort and three in the Maori gout case-control cohort.
A number of studies have confirmed the HLA region as the major genetic determinant of autoimmunity and recently, PTPN22 and CTLA-4 variants have been shown to be common to the onset of a number of autoimmune phenotypes. The IDDM6 region on chromosome 18 has also been implicated in type 1 diabetes, RA and autoimmune thyroiditis and contains a number of candidate genes for a role in RA, many of which were investigated in this thesis. Polymorphisms within the PTPN22, CTLA-4, BCL2, SMAD4, DCC, TNFRSF11A, PADI4, CCR5 and CCL3L1 genes were tested for association with RA in the Maori cohort (98 cases and 109 controls) with some significant association results obtained. The HLA-DRB1*02 and HLA-DRB1*08 loci were associated with the protection against and susceptibility for RA, respectively (P = 0.004 and 0.017). The deviation of CCL3L1 copy-number from the cohort mean (two copies) was also associated with the RA development. Copy-number <2 indicated association with protection against RA (P = 0.012) and copy-number >2 indicated association with susceptibility to RA (P = 0.002). However, it must be stressed that these results were obtained without accounting for the presence of population stratification.
The organic anion transporter (OAT) and the urate transporter 1 (URAT1) genes, involved in the regulation of blood urate levels, are members of the solute carrier transporter (SLC) family and provide good candidates for a role in gout. A number of polymorphisms within the OAT, URAT1 and the SLC5A8 genes were tested for association with gout in the Maori cohort (72 cases and 109 controls) with some success. The SLC5A8 rs1709189 SNP was significantly associated with gout in this cohort (P = 0.004). Polymorphisms within two alcohol dehydrogenase (ADH) genes were also tested for association due to their role in alcohol metabolism and the association between alcohol consumption and gout. The ADH2 rs1229984 SNP was also significantly associated with gout in this cohort (P = 0.012). These significant results were obtained after population stratification was taken into account.
The data presented in this thesis confirm the presence of population stratification in the two Maori case-control cohorts and demonstrate some association of the HLA-DRB1 region and CCL3L1 with RA and the SLC5A8 and ADH2 genes with gout. An extensive whakapapa of our whanau has also been compiled and associated type 2 diabetes information collected. However, this is by no means a completed task and work will continue on this project under the guidance of the Parata whanau.
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Humphreys, Jennifer. "Validation of the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis with special emphasis on the role of autoantibodies." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/validation-of-the-2010-american-college-of-rheumatology-european-league-against-rheumatism-classification-criteria-for-rheumatoid-arthritis-with-special-emphasis-on-the-role-of-autoantibodies(189200f1-4daa-4c99-8019-9b600c03ee0c).html.
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Aim: The aim of this thesis was to validate the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis (RA), in particular with respect to its construct validity and the role of autoantibodies within the criteria. Methods: This thesis used data from the Norfolk Arthritis Register, a longitudinal inception cohort of adults (16 years and over) with inflammatory polyarthritis (IP), defined as at least 2 swollen joint for at least 4 weeks. The 2010 criteria were used to define RA, firstly in a re-estimation of the incidence rates (IR) with comparisons made to incidence defined by the previous criteria set; and secondly in a study comparing mortality rates in patients with RA to those of the general population, and how these rates changed over time. Analyses were performed testing the ability of the 2010 criteria to identify those patients with IP at increased risk of mortality, disability, disease severity and radiographic damage. The levels and number of autoantibodies present were investigated as predictors of mortality in patients with IP. The association between anti-carbamylated protein (anti-CarP) antibodies and long term disease outcomes were investigated. Results: The incidence of RA was 40 per 100 000 population; baseline IRs were similar to the cumulative IRs using the previous criteria set over 5 years. Patients who were seronegative were less likely to be classified as RA by the 2010 criteria. Mortality rates in patients with RA were higher compared to the general population (standardised mortality ratio 1.16, 95 percent confidence interval (CI) 1.04-1.29) and declined over the study period at the same rate as the general population. Patients with IP who fulfilled the 2010 criteria had increased risk of early death (hazard ratio (HR) 1.35, 95 percent CI 1.13-1.64), as well as increased levels of disability (beta 0.38, 95 percent CI 0.33-0.43), disease severity (beta 1.63, 95 percent CI 1.54-1.73) and radiographic damage (beta 0.33, 95 percent CI 0.20-0.47) throughout follow up. Patients with two autoantibodies had an increased risk of early death (HR 1.35, 95 percent CI 1.09-1.68), but there was no association with early death and the levels of these antibodies. Anti-CarP antibody positivity was independently associated with worse disability (beta 0.12, 95 percent CI 0.02-0.21) and disease severity (beta 0.23, 95 percent CI 0.07-0.39) throughout follow up. Conclusions: The 2010 ACR/EULAR classification criteria for RA identify patients with IP early in their disease course and recognise those at increased risk of mortality and poor outcomes. The 2010 criteria may miss a subgroup of seronegative patients who nevertheless have a poor prognosis. Novel autoantibodies may be useful to identify this subgroup.
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Castellanos, Moreira Raúl Antonio. "Anticuerpos frente a péptidos carbamilados en la artritis reumatoide: Papel en el reumatismo palindrómico, la enfermedad pulmonar intersticial y la respuesta terapéutica." Doctoral thesis, Universitat de Barcelona, 2021. http://hdl.handle.net/10803/671742.
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INTRODUCCIÓN:
La artritis reumatoide (AR) es una de las enfermedades autoinmunes más frecuentes y la forma de artritis inflamatoria más común afectando en torno al 1% de la población mundial. Además, es una enfermedad sistémica de naturaleza autoinmune, que se caracteriza por inflamación articular y la presencia de autoanticuerpos, como los anticuerpos contra péptidos citrulinadas (ACPA). Los ACPA constituyen un biomarcador de mal pronóstico. La AR es un síndrome heterogéneo, con diferentes mecanismos patogénicos involucrados entre individuos con el mismo diagnóstico. De hecho, aunque los autoanticuerpos son una característica importante de la AR, hasta en un 30% de individuos no se detectan autoanticuerpos. Los anticuerpos contra proteínas carbamiladas (anti-CarP), son una nueva familia de anticuerpos, presentes en el 50% aproximadamente de pacientes con AR, incluso en aquellos negativos para otros anticuerpos. También, los anti-CarP se relacionan con un peores desenlaces de la enfermedad.
Es probable que existan factores pronósticos relacionados con los anti-CarP aún no establecidos que podrían tener relevancia para la población con AR. En esta tesis doctoral hipotetizamos que los anti- CarP se detectan en formas tempranas de AR, como en el reumatismo palindrómico (RP), que su presencia en la AR establecida puede condicionar a complicaciones tales como la enfermedad pulmonar intersticial (EPI), y que podría ser un biomarcador de buena respuesta para agentes como el Abatacept (ABA).
OBJETIVOS:
Los objetivos de esta tesis son: 1) Analizar la prevalencia de anti-CarP en pacientes con RP y comparar su respuesta inmune contra a proteínas carbamiladas frente a la de la AR establecida; 2) Analizar la relación entre los anti-CarP y la enfermedad pulmonar intersticial en pacientes con A; 3) Determinar el papel de los anti-CarP como biomarcador de respuesta terapéutica a ABA en pacientes con AR.
METODOLOGÍA Y RESULTADOS:
Para responder todos estos objetivos, se diseñaron 4 estudios. En el primer trabajo realizamos un estudio transversal para determinar la presencia de anti-CarP en una cohorte de pacientes con RP. En esta cohorte, los anti-CarP fueron positivos en el 24% los pacientes con RP. Al comparar con la AR, observamos que todas las proporciones de isotipos anti-CarP fueron significativamente más bajas en RP. En cuanto a la distribución de los isotipos, la respuesta de IgG anti-CarP fue similar en ambos grupos (100% en RP vs 79% en AR), pero la respuesta de isotipos fue significativamente menor en la IgA (31% vs 53%) e IgM (31% vs 56%) en pacientes con RP. En el segundo trabajo, analizamos la presencia de RP preexistente en una cohorte de AR establecida, y analizamos si existe un perfil de anticuerpos distintivos en estos pacientes. Encontramos que el 18% de los pacientes con AR presentaban una historia compatible de RP previo al debut de su enfermedad. Al analizar el perfil serológico, la positividad de anticuerpos fue numéricamente más alta para los pacientes con RP preexistente, incluido los Anti-CarP (52% vs 45%) aunque las diferencias no fueron estadísticamente significativas. En el tercer trabajo, realizamos en un estudio transversal sobre una cohorte de paciente con AR con y sin EPI, además de una serie de replicación de otro centro hospitalario. Observamos que todas la especificidades de anti-CarP medidas eran frecuentes en el grupo EPI-AR (Anti-FCS 70% vs.43%; Anti-Fib 73% vs.51%; Anti-CFFHP 38% vs.19%; Anti-CarP- IgA 51% vs.20%, p <0.05). El análisis de regresión logística multivariante demostró que todas las especificidades de anti-CarP mostraron un efecto robusto para aumentar las probabilidades de EPI tanto en la cohorte principal como en la serie de replicación. Para el cuarto trabajo, realizamos un estudio prospectivo, sobre una cohorte multicéntrica de paciente con AR tratados con ABA. Entre los 65 pacientes que fueron analizados, 43% de ellos eran anti-CarP positivos. A los tres meses de seguimiento, observamos que los pacientes positivos para los anti-CarP mostraron una reducción significativa en la actividad de la enfermedad, medida por δ-DAS28 (-
1,904 vs -0,212) en comparación con los anti-CarP negativos. Además, aquellos pacientes catalogados como respondedores presentaban niveles de anti-CarP basales más altos, y se observó una reducción significativa de dichos anticuerpos tras 3 meses de tratamiento.
CONCLUSION:
Con estos estudios hemos logrado avanzar un poco en el conocimiento del papel de los anti-CarP en el RP, EPI relacionada a la AR y en la respuesta terapéutica del ABA.INTRODUCTION: Rheumatoid arthritis (RA) is one of the most common autoimmune diseases, characterized by joint inflammation and the presence of autoantibodies, such as antibodies against citrullinated peptides (ACPA). ACPAs are a poor prognostic biomarker. RA is a heterogeneous syndrome, with different pathogenic mechanisms involved between individuals with the same diagnosis. Antibodies against carbamylated proteins (anti-CarP) are a new family of antibodies, present in approximately 50% of patients. OBJECTIVES: 1) To analyze the prevalence of anti-CarP in patients with palindromic rheumatism (PR) and to compare their immune response against that of established RA; 2) To analyze the relationship between anti-CarP and interstitial lung disease(ILD); 3) To determine the role of anti-CarP as a biomarker of therapeutic response to abatacept (ABA). METHODOLOGY AND RESULTS: To answer these objectives, 4 studies were designed. In the first, a cross-sectional study to determine the presence of anti-CarP in a cohort of patients with PR. Anti-CarP were positive in 24% of PR patients. When comparing with RA, all the proportions of Anti-CarP isotypes were significantly lower in PR. Regarding the isotypes distribution, IgG anti-CarP was similar in both groups (100% vs 79%) but was significantly lower in IgA (31% vs 53% ) and IgM (31% vs 56%) in patients with RP. In the second study, we analyzed the presence of pre-existing RP in an established RA cohort, and whether they had a distinctive antibody profile. 18% of patients had a compatible history of PR prior to RA diagnosis. Antibody positivity was numerically higher for patients with pre-existing PR, including Anti-CarP (52% vs 45%). In the third study, we conducted a cross-sectional study on two cohorts of patients with RA with and without ILD. All Anti-CarP specificities were more frequent in the ILD-RA group (Anti-FCS 70% vs. 43%; Anti- Fib 73% vs. 51%; Anti-CFFHP 38% vs. 19%; Anti -CarP-IgA 51% vs. 20%, p <0.05). Multivariate analysis demonstrated that all Anti-CarP had a robust effect towards increasing the odds of ILD. For the fourth work, was a prospective study of RA patients treated with ABA. 43% of them were Anti-CarP positive. After 3 months of follow-up, patients positive for anti-CarP showed a significant reduction in disease activity compared to negative anti-CarP. Also, those patients classified as responders had higher baseline anti-CarP levels, and a significant reduction in these antibodies was observed after 3 months of treatment.
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Zakout, Samy. "Understanding polymyalgia rheumatica." Thesis, University of Bristol, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.683730.
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Polymyalgia rheumatica (PMR) is the commonest rheumatological disease of the elderly white population that is treated with glucocorticoids. Patients suffer with debilitating morning stiffness and pain involving the shoulder girdle and less commonly the pelvic girdle. It has a profound inflammatory response including increased plasma interleukin 6 (IL-6). Our PMR rapid access clinic, established as part of this work, provided material to the 3 studies included in the thesis: The differential diagnosis of PMR is wide, with no consensus amongst clinicians on the use of diagnostic criteria in a clinical context. The diagnosis is made on clinical grounds, reinforced by a positive response to glucocorticoids. By identifying {uncomplicated' PMR patients in our rapid access clinic, I analysed the performance of published diagnostic criteria on our cohort of patients and suggested a new model. Glucocorticoids regimens currently in use vary significantly. There are broadly two regimens: one using a rapid reduction thought to cause less adverse effects with a subsequent greater frequency of disease relapse, and an alternative approach using slow reductions. I measured the relapse rate in the slow reduction regimen we use in our department and found it to be less prevalent than that reported in the literature for rapid reduction. By undertaking 24-hour blood sampling studies in 10 PMR patients, I showed that plasma IL- 6 followed a circadian rhythm in untreated PMR, peaking in the early hours of the morning and correlating with the reported morning stiffness. I performed a small-randomised controlled trial, comparing two treatment arms: morning standard prednisolone (7mg) compared to night timed-release tablet (TRT) prednisone (7mg). The treatment lasted two weeks and was compared to responses after a further 2-week morning prednisolone (15mg). IL-6 and morning stiffness were reduced by all 3 treatments but TRT prednisone was substantially more effective than standard prednisolone, raising the possibility of treating PMR with lower doses of glucocorticoids in the future.
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Shinebaum, R. "Faecal flora and rheumatic diseases." Thesis, University of Leeds, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.355708.
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Mohamed, Kotit Susy Natalia. "Rheumatic heart disease in Egypt." Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/9752.
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Rheumatic Heart Disease remains one of the most neglected cardiac conditions in children and young adults around the world. The pathogenesis is complex and remains elusive, and the clinical characteristics vary around the world. This thesis concentrates on different aspects of the disease in Egypt, where it is known to have a high incidence. The methodology included epidemiological studies in school children in Aswan and investigation of RHD in a population with history of RF, using newly developed echocardiographic criteria. Concomitantly, the pattern of immune response in RF and RHD was determined in serum and excised valves. In this series RF presents in children and young adults, as well as adults, (0.2-44 years, 10.69 ± 6.24) with polyarthritis being the most common clinical presentation (87.9%) and recurrences of RF being very common (98.2%). RHD affected 23 in 1000 school children in Aswan with over 90% of the cases being subclinical and developed in up to 69.2% of the individuals with history of RF, predominantly as mitral regurgitation. Risk factors for the development and severity of RHD were shown to be low disease awareness, non-compliance to penicillin prophylaxis or a regimen of longer than 15-days. Resistance to antibiotic regimens, including Penicillin and Vancomicin seems to lead to development and recurrences of RF in Egypt. This series showed the presence of immune activation and ongoing immunological reaction in an apparently quiescent phase of the disease with distortion of normal valvular architecture, histology and composition. This work has served to define the epidemiology, pattern of disease, immune reponse and predisposing factors in a population with no previous data, also contributing to the improvement of the echocardiographic diagnostic criteria. Standardization of the criteria will allow comparison of prevalence in different areas and improve case detection.
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Pandey, Sanjib Raj. "Temporal logic-based fuzzy decision support system for diagnosis of rheumatic fever and rheumatic heart disease." Thesis, University of Greenwich, 2016. http://gala.gre.ac.uk/18088/.
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This is a collaboration project between the Nepal Heart Foundation (NHF) and the University of Greenwich (UoG), United Kingdom (UK). Our mutual aim, agreed at the outset, has been to analyse, design and develop a cost effective Clinical Decision Support System (CDSS) for diagnosis and recognition of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) at an early stage by developing/adopting UK’s and NHF’s treatment practices and procedures that would be appropriate for the Nepalese environment and lifestyle. The Application we developed was designed for use by community health workers and doctors in the rural areas of Nepal where laboratory facilities, expert services and technology are often deficient. The research undertaken investigated three problems that previously had not been addressed in the Artificial Intelligence (AI) community. These are: 1) ARF in Nepal has created a lot of confusion in diagnosis and treatment, due to the lack of standard procedures; 2) the adoption of foreign guidelines is often not effective and does not suit the Nepali environment and lifestyle and 3) the value of combining (our proposed) Hybrid Approach (Knowledge-based System (KBS), Temporal Theory (TT) and Fuzzy Logic (FL)) to design and develop an application to diagnose ARF cases at an early stage in English and Nepali. This research presents, validates and evaluates a proposed Hybrid Approach to diagnose ARF at three different stages: 1) Detected; 2) Suspected and 3) Not-detected and also to identify the severity level of detected ARF in the forms of Severe Case, Moderate Case or Mild Case. The Hybrid Approach is a combination of the KBS/Boolean Rule Model, Temporal Model and Fuzzy Model. The KBS/Boolean Rule Model has four components for design and implementation of KBS. These are: identifying the ARF stage in a case; Rule Pattern Matching; New Rule Formation and Rule Selection Mechanism. The Temporal Model has four components namely: Descriptive Explanation of ARF symptoms; Temporal Lookup-Table/Rules and Temporal Reasoning which produce a Temporal Template for demonstrating the relationship between the signs and ARF. The Fuzzification, Fuzzy Inferences and Defuzzification components are applied to design and implement a Fuzzy Model. The research undertaken divided the overall ARF diagnosis problem, in effect its requirements, into several sub-problems and each model of the Hybrid Approach addressed particular sub-problems for example, Identify the stage of the ARF component of the KBS/Boolean Rule Model used to solve the question of identifying the stage of ARF based on the symptoms presented. Each problem was therefore handled using a particular model’s components. This significantly helped to improve maintainability, reliability and the overall quality of our final ARF Diagnosis Application. The developed ARF Diagnosis Application was experimentally tested and evaluated by NHF’s experts and users through applying NHF’s data sets consisting of 676 real patients’ records. The ARF Diagnosis Application was found to match 99% of the cases derived from NHF’s datasets. The overall ARF diagnostics performance and accuracy was 99.36%. Therefore, the experiments and evaluations of our ARF Diagnosis Application proved that it was logically and technically feasible to employ the Hybrid Approach for developing a new and practical ARF Diagnosis Application. The Application was ultimately developed and succeeded in embracing NHF’s requirements and guidelines thereby matching the Nepalese setting and making it suitable for use in Nepal having fully by met the exigencies of the Nepalese environment and lifestyle. Application of a new ARF diagnosis system (ours) proved that the Hybrid Approach, applied methods of diagnosis of ARF, medication and treatment plan, including help and supporting information which were identified and defined, were shown to be appropriate to support effectively community health workers and doctors who actively care for ARF and RHD cases in rural Nepal.
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Iwobi, Mabel Uzoamaka. "Salivary autoantigens in human rheumatic diseases." Thesis, University of Sussex, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.260048.
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Yaseen, Hafiz Muhammad. "Modélisation de l'infection par le chikungunya(CHIK), de son impact, et des facteurs pronostiques de chronicité et de qualité de vie post-CHIK." Thesis, Aix-Marseille, 2013. http://www.theses.fr/2013AIXM5008.
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Afin de modéliser l'évolution de l’infection par le chikungunya (CHIK), son impact, et les facteurs pronostiques de chronicité, nous avons travaillé en trois parties. L'impact à long terme de l’épidémie de CHIK en 2005-2006 à la Réunion a été estimé en calculant la proportion de patients en phase chronique au cours du temps et la charge globale de morbidité du CHIK par la méthode des années de vie ajustées sur l'invalidité (méthode DALY de l’OMS, qui prend en compte les années de vie perdues en raison de la mortalité prématurée et des années de vie vécues avec une incapacité). Ainsi entre 51,2 et 65,3% des patients étaient estimés symptomatiques après 1 an et 0% à15,2% après 5 ans. Le total d’années de vie en bonne santé perdues à la Réunion a été estimé à 65-73/1000 personnes, 55,5% des pertes concernant la population active (les 20 à 60 ans), et 86% étant dues à la persistance de rhumatismes post-CHIK (phase chronique). Les facteurs pronostiques de la persistance de rhumatismes et de l’altération de la qualité de vie (QdV) à long terme (30 mois) ont été étudiés dans une cohorte des gendarmes dont 25% étaient infectés (CHIK+). Etre CHIK+, avoir des comorbidités et un moral déprimé pendant la phase aiguë étaient prédictifs de la persistance d’arthrite comme d’arthralgies. De plus, la présence d’arthralgies ou arthrite à six mois était très prédictive de la persistance des mêmes rhumatismes à 30 moisTo model the evolution of chikungunya virus (CHIK) infection, its impact and the prognostic factors of post-CHIK rheumatism and quality of life, we worked in three parts. The long-term impact of the 2005-2006 CHIK outbreaks in Reunion Island was estimated by calculating the proportion of chronic patients over time and the global burden of CHIK using the Disability Adjusted Life Years (DALY) method. This method sums the years of life lost due to premature mortality and the years lived with disability. Between 51.2 and 65.3% of patients were estimated chronic after 1 year and 0%-15.2% after 5 years. The global disease burden of CHIK was estimated 65-73 DALYs/1000 persons, 55.5% concerning the active population (20-60 years old), and 86% due to persistence of post-CHIK rheumatisms. Prognostic factors of the long-term (30 months) rheumatisms and impaired quality of life (QoL) were studied in a cohort of French army policemen (25% CHIK infected: CHIK+). Being CHIK+, suffering of comorbidity and having depressed mood during the acute stage were predictive for both persistent arthritis and arthralgias at 30 months. In addition, suffering of either arthralgias or arthritis at six months was predictive of the same symptoms at 30 months. Determinants of impaired QoL were CHIK infection and comorbidity, in addition to older age, work-stoppage during the acute infection and arthritis at 6 months for the QoL physical component, and depressed mood at 6 months for the mental health component.Association between the severity of initial CHIK-stages and recovery were studied using multiple correspondence analysis (MCA)
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Mohanty, Subhasis. "Role of pathogenic antibodies in rheumatic diseases." [S.l.] : [s.n.], 2003. http://deposit.ddb.de/cgi-bin/dokserv?idn=967642760.
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Bakker, Carla Heleen. "Patient-oriented outcome assessment in rheumatic diseases." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Maastricht University [Host], 1995. http://arno.unimaas.nl/show.cgi?fid=7915.
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Hauser, Barbara. "Mechanism of bone loss in rheumatic diseases." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/22823.
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Osteoporosis and fragility fractures are recognized complications of inflammatory rheumatic diseases. This is thought to result from the effects of chronic inflammation, relative immobility and corticosteroid use. A rare syndrome of osteoporosis in a patient with coeliac disease has been described which results from production of neutralizing antibodies to the bone protective protein osteoprotegerin (OPG). The aim of my thesis is to evaluate prevalence and clinical predictors of osteoporosis in a contemporary cohort of patients with rheumatoid arthritis (RA) and to investigate the role of OPG autoantibodies in the pathogenesis of osteoporosis in rheumatic diseases. In a retrospective cohort study, I found that the overall prevalence of osteoporosis in patients with RA was 29.9% which is in keeping with older reports that recorded a prevalence rate between 17% and 36%. In our contemporary cohort osteoporosis was significantly more common than in a gender and age matched control cohort (17.4%). Further analysis showed that only age and BMI were independent predictors of osteoporosis in RA. A predictive tool based on age and BMI was developed which had 91.4% sensitivity for the detection of osteoporosis in an independent RA population. I went on to screen for the presence of autoantibodies to OPG in patients with various rheumatic diseases. In a study of 75 patients with rheumatoid arthritis and 199 healthy controls OPG autoantibodies were detected in two controls (1%) compared with seven patients with RA (9.3%). The RA patients with detectable OPG antibodies had a longer disease duration, higher DAS28 scores and higher levels of the bone resorption marker CTX than RA patients who did not have autoantibodies. Purified IgG from patients with high levels of OPG antibodies blocked the ability of recombinant OPG to inhibit RANKL induced NFκB activation in a HEK293 cell based assay indicating that they were functional. In a further study of 134 patients with ankylosing spondylitis (AS), 16 patients (11.9%) had detectable OPG antibodies. The presence of OPG-Ab was independently associated with reduced hip bone mineral density and an increased risk of fractures in this population. In patients with a longer disease duration we have also observed that there was a higher discrepancy between spinal and hip BMD in OPG-Ab positive patients compared with OPG ab negative patients (p=0.003). In order to investigate if OPG antibodies affected measurement of serum RANKL concentrations as detected by ELISA using OPG as the capture reagent, I measured OPG ab and free RANKL concentrations in 55 rheumatic disease patients. Surprisingly there was a significant positive correlation between free RANKL and OPG Ab concentrations (r=0.430, p=0.001) which was the opposite to what I had expected. These findings reject the hypothesis that OPG ab block binding of synthetic OPG to RANKL in the ELISA. In conclusion, I have shown that osteoporosis is a common complication in RA and I have developed a new risk prediction tool for the use in clinical practice. I have also found that OPG antibodies are produced more commonly in patients with RA and AS than in healthy controls and that antibody levels correlate with bone resorption markers in RA and bone mineral density in AS patients. In vitro studies have shown that some OPG antibodies have functional effects on RANKL signalling. These findings raise the possibility that OPG antibodies may contribute to the pathogenesis of local and systemic bone loss in rheumatic diseases and signal the need to study the relationship between these antibodies and bone disease in large-scale longitudinal studies.
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Sprenger, Kenneth John. "Circulating immune complexes in acute rheumatic carditis." Doctoral thesis, University of Cape Town, 1995. http://hdl.handle.net/11427/27055.
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The group A beta-haemolytic streptococcus is known to be the aetiologic agent in acute rheumatic fever, but the exact pathogenesis remains obscure. A review of the histopathology of the Aschoff body suggests that the cardiac pathology is a granulomatous hypersensitivity reaction. However the streptococcus has not been found in the lesions, and the agent responsible for the granuloma has not yet been identified. Circulating immune complexes have previously been measured in some children with acute rheumatic fever. The normal or raised complement components measured by some workers in acute rheumatic fever suggests that the immune complexes may not be complement fixing. Considering that the usual assays for measuring immune complexes depend on complement fixation, the failure of the immune complexes to fix complement might produce false negative results. A physical, non-complement fixing assay (polyethylene glycol precipitation - PEG), was therefore used to measure circulating immune complexes. Results were expressed as total IgG precipitated (g/L), or as a percentage of serum IgG. Immune complexes were also measured by two complement dependent assays, a Clq binding assay (ClqBA), and conglutinin binding assay (CBA). Complexes were assayed in 15 children with acute rheumatic carditis (ARC), 11 with non-active, chronic rheumatic heart disease (CRHD), 13 with acute poststreptococcal glomerulonephritis (APSGN), and 15 normal children and adults (NORMAL). Total haemolytic complement, complement components as well as the complement breakdown product C3d, were measured.
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Eichbaum, Quentin Gavin. "Antigenic mimicry and autoantibodies in rheumatic fever." Doctoral thesis, University of Cape Town, 1990. http://hdl.handle.net/11427/26296.
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Springer, David Brian. "Mobile phone-based rheumatic heart disease detection." Thesis, University of Oxford, 2015. https://ora.ox.ac.uk/objects/uuid:5ec8c818-dafb-4571-8198-97607f8d0451.
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Rheumatic heart disease (RHD), the permanent damage of the heart valves caused by an untreated 'strep throat' infection, is the leading cause of cardiovascular mortality and morbidity in children and young adults worldwide. Simple penicillin treatment after the early diagnosis of RHD can stop recurring bouts of the condition, which lead to the most severe valvulopathy, and ultimately, heart failure. However, RHD is an under-diagnosed condition in the developing world, as such a diagnosis requires, at a minimum, a trained clinician to perform auscultation to detect pathological heart sounds. Trained medical personnel are scarce in the countries where RHD is most prevalent. A low-cost, mobile phone-based automatic diagnostic tool offers a potential solution, allowing a non-medically trained individual to screen for RHD in those countries. An essential feature of such a device is feedback on the signal quality of heart sound recordings. The first major contribution of this thesis is the investigation of features and algorithms for the automatic signal quality assessment of heart sound recordings. These algorithms are able to differentiate between good- and poor-quality recordings in over 80% of cases when using both a low-cost mobile phone-based stethoscope and an electronic stethoscope. Once the quality of recordings is ensured, the positions of the first and second heart sounds need to be located in a process called segmentation. This thesis extends the state-of-the art hidden semi-Markov models by: investigating additional features; extending the Viterbi algorithm; incorporating logistic regression into the model to form a hybrid generative-discriminative model; and investigating a discriminative duration-dependent probabilistic model - a conditional random field. These extensions are found to outperform the state-of-the-art method. Lastly, the period between the first and second heart sounds can be analysed for the presence of a pathological murmur. This thesis presents automated systolic murmur classification algorithms based on wavelet and mel-frequency cepstral coefficient-based features along with denoising via cycle averaging. These algorithms outperform three methods from the literature when detecting valvulopathy, while also outperforming a cardiologist and commercial software when detecting RHD in mobile phone-based heart sound recordings.
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Ba-Saddik, Iman Ali Mahmoud. "Rheumatic fever and rheumatic heart disease : prevalence among Yemeni school children and studies of the immunopathogenesis of the disease." Thesis, University of Liverpool, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.569117.
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Background: The epidemiological, genetic and host immunogenetic association between Group A P haemolytic Streptococcal (GAS) pharyngotonsillitis and the subsequent development of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) is an area of major interest. RHD still remains an important contributor to cardiovascular disease in children and adults in Yemen. Aims: The purpose of this study was to determine: (i) the prevalence ofRHD among primary school children in Aden City, Yemen, (ii) the prevalence of GAS and Non Group A β haemolytic Streptococcal (SNA) pharyngotonsillitis among patients attending primary health care centres, (iii) the distribution of emm genotypes and selected superantigen prophage exotoxin anasofgenes among GAS and SNA , (iv) the antimicrobial susceptibility pattern of GAS and SNA in patients with a history of ARF and RHD, (v) comparision of a profile of selected cytokines and chemokines between ARF and recurrent rheumatic fever (RRF) patients. Methods: A cross-sectional case-finding survey of RHD was conducted in 6000 school children aged 5 - 16 years in Aden City to determine the prevalence of RHD. A cross- sectional descriptive survey was undertaken in 730 children aged 1- 16 years with acute pharyngotonsillitis to determine the prevalence of GAS and SNA infections. Thirty four throat culture isolates from patients with GAS and SNA pharyngotonsillitis with history of ARF and echo-proven cases of RHD were analyzed by a multiplex PCR method to determine the emm genotypes, presence of superantigen prophage-associated virulence genes and so! genes. Antibiotic sensitivity tests were conducted on 24 GAS and SNA throat culture isolates using the BSAC disc diffusison method. Fourteen serum cytokine and chemokine concentrations including interleukin-Iβ (IL-lβ), interleukin-6 (IL-6), interleukin-7 (IL-7), interleukin-8 (IL-8), interleukin-9 (IL-9), interleukin-10 0 (IL-I0), interleukin-12p70 (IL-12p70), tumor necrosis factor (TNF-α), interferon gamma (IFN- γ), chemokines monocyte chemotactic protein-I (MCP-1), macrophage inflammatory protein-I a (MIP-1 a), macrophage inflammatory protein-I P (MIP-I P), human interferon inducable protein-I 0 (IP-IO) and regulated upon activation, normal T-cell expressed and secreted (RANTES) protein levels from children with ARF and RRF were analyzed by the BD F ACS Array Bioanalyzer using FCAP Array Software. Results: The prevalence of RHD was 36.5/1000 school children which is one of the highest reported among school echo cardiography surveys in the world. RHD had a high preponderance in 10-16 years old students. 49.8% had mitral regurgitation (MR) lesions, 26.6% had MR with mitral valve prolapse (MVP) and 17.8% with combined MR and aortic regurgitation (AR) lesions. RI--ID was diagnosed in more than one family member in 53 (24.2%) of the children. A high prevalence of GAS pharyngotonsillitis (41.5%) was noticed in children of 11 - 15 years of age. A red erythematous uvula and petechie on the soft palate were observed significantly more commoinlyin GAS pharyngotonsillitis. Group B (GBS), Group C (GCS) and Group Gβ haemolytic streptococci (GGS) were isolated from pharyngotonsillitis in 4.3% patients with history of ARF/RHD. The most frequent GAS isolates among ARF and RI-ID patients with pharyngotonsillitis were emm87, emm12, emm28 and emm5. This is the first report of emm87 and emm28 genotypes to be potentially rheumatogenic. The 11 emm87 GAS isolates shared a common PFGE pattern and profile of five exotoxin prophage genes spec, spdl, sdn, sUC and silD with the sof 87 sequence. emm12 and emm28 GAS strains were positive for gene sof , spec and spd1. This is the first report to describe the pattern of exotoxin prophage genes of spec, spd1, sdn, silC and silD among emm87,-emm12, emm28 and emm5 GAS and SNA (GBS, GCS and GGS) isolates with history of ARF and RHD. The genotypic characteristics of GBS, GCS and GGS isolates confirmed seven new emm sequence types first detected among children with acute pharyngotonsillitis. GAS and SNA isolates were susceptible to the β-lactam antimicrobials, penicillin and amoxicillin. Erythromycin resistance was detected in so! positive emm 12 and emm28 in 50% and 33% of isolates respectively. Chemokine MCP-l was significantly correlated with cytokines, IL-lβ, IL-6, IL-l0, IL- 12p70, TNF-α, IFN-γ and RANTES in patients with RRF. This suggests that MCP-l could serve as a potential inflammatorybiomarker for patients with RRF having underlying RHD. MIP-1~ had significant correlations with IL-8, IL-lO, IL-12p70, IP- 10, TNF-α and IFN-γ in patients with ARF. MIP-l~ may serve as a potential inflammatory biomarker in patients with ARF without RHD. Conclusions: The high prevalence of RHD is an alarming public health problem in Yemen. Urgent screening surveys and a preventive RHD prophylactic program with appropriate management of GAS pharyngotonsillitis are required. Future studies are needed to confirm the rheumatogenic GAS and SNA strains with their exotoxin prohage genes and the role of the chemokines and cytokines as biomarkers for ARF within the complex network of auto immune reactions in RF/RHD. This study hopes to provide a further small step in elucidating the pathogenesis of this complex immunological disease.
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Allen, John Bowen. "Genetic Basis for Elevated Rheumatic Heart Disease Susceptibility in Samoa." BYU ScholarsArchive, 2018. https://scholarsarchive.byu.edu/etd/7006.
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Rheumatic heart disease is an inflammatory heart disease that affects millions of people around the world. Especially high rates of the disease can be found in Oceania, including the island nation of Samoa. Genetic studies of immune response genes have provided insight into a possible genetic link to increased susceptibility to rheumatic heart disease, including the genes that code for the toll-like receptor (TLR) protein family. One of the functions of TLR proteins is to recognize the presence of bacteria via identification of bacterial flagella. My evaluation of a Samoan family identified a variant in the TLR-5 gene that would inhibit this ability. However, further study showed this variant to not be statistically significant in relation to rheumatic heart disease susceptibility. My contribution to a regional genome-wide association study of Oceania resulted in the discovery of a variant in the IGHV4-61 gene affecting the ability of antibodies to properly bind to bacterial antigens. This variant was associated with a 1.4-fold increased risk of rheumatic heart disease development. The success of this study warrants further investigation of the IGHV4-61 variant in other populations and illustrates the benefits of utilizing a genome-wide association study to study rheumatic heart disease.
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Lund, Christian. "Immunsuppression beim rheumatischen Hornhautulcus Mycophenolat Mofetil im Vergleich mit anderen Immunsuppressiva." Saarbrücken VDM Verlag Dr. Müller, 2005. http://d-nb.info/99145202X/04.
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Shabani, Fariba. "Regulation of matrix metalloproteinases, their inhibitors and IL-8 in inflammatory rheumatic diseases : effects of cytokines and anti-rheumatic agents /." Title page and contents only, 1997. http://web4.library.adelaide.edu.au/theses/09PH/09phs524.pdf.
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Tungulboriboon, Sutthiluck. "Creating health through self-care : an explanatory study of teenagers with rheumatic fever and rheumatic heart disease in Northeast Thailand." Thesis, Robert Gordon University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.289086.
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Cao, Duojia. "CD25+CD4+ regulatory T cells in rheumatic disease /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-178-4/.
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Zühlke, Liesl Joanna. "Outcomes of asymptomatic and symptomatic rheumatic heart disease." Doctoral thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16785.
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Includes bibliographical referencesRheumatic Heart Disease (RHD) is a leading cause of heart disease in children and young adults in the developing world, with significant associated morbidity and mortality. Early secondary prophylaxis may retard the deleterious progression from its antecedent, acute rheumatic fever to permanent heart valve damage, and thus several echocardiographic screening programmes to detect asymptomatic RHD and institute early prophylaxis have been conducted. While effective interventions are available for ameliorating the effects of RHD, research on their use in different settings is scant. Key questions remain regarding the natural history of asymptomatic RHD and the optimal method for early detection. In addition, there is a lack of contemporary estimates of mortality and morbidity among the symptomatic population in the developing world. The primary purpose of the thesis was to determine the outcomes of asymptomatic and symptomatic RHD. More specifically, I sought to quantify the incidence, prevalence and outcomes of RHD in South Africa over the past two decades, determine the natural history of asymptomatic RHD and validate a focused protocol for screening in schoolchildren from Cape Town. In addition, I determined the baseline characteristics, prevalent sequelae and gaps in evidence-based implementation in children and adults from14 developing countries. Finally, I investigated the independent predictors for mortality and morbidity of RHD over a two-year period in patients from Cape Town, South Africa. My thesis has five key findings. Firstly, a systematic review of the literature showed that the incidence and prevalence of RHD over the past two decades in South Africa remains high, although there is evidence of falling cause-specific mortality at a population level. Secondly, asymptomatic RHD has a variable natural history that ranges from regression to a normal state, to persistence of disease, and progression to symptomatic RHD. Thirdly, a focused hand-held echocardiography protocol shows promising levels of sensitivity and specificity for detecting subclinical RHD. Fourthly, the baseline data from the global rheumatic heart disease registry demonstrates significant gaps in the implementation of medical and surgical interventions of proven effectiveness in low- and middle-income countries. Finally, the annual mortality rate for children and adults with RHD in Cape Town over a two-year period is 4.1%with cardiovascular events occurring at a rate of 0.18 events per patient per year. The findings encapsulated in this thesis have important implications for policy, practice and research related to the management of asymptomatic and symptomatic RHD in the world.
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Krugten, Michiel Volkert van. "Tumor necrosis factor gene polymorphisms and rheumatic diseases /." Leiden, 2003. http://catalogue.bnf.fr/ark:/12148/cb40223074h.
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Yates, Max. "The epidemiology of polymyalgia rheumatica and giant cell arteritis." Thesis, University of East Anglia, 2017. https://ueaeprints.uea.ac.uk/66860/.
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Introduction: The epidemiology of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) is poorly characterised, with little known about the aetiological factors involved in disease onset and progression. This project aimed to determine the incidence and prevalence of PMR and GCA, including their related morbidity, and to investigate aetiological hypotheses for disease onset and progression using community-based populations and contemporary classification criteria. Methods: Three large phenotypically informative datasets were constructed: GCANS (n = 4,728), EPIC-Norfolk (n = 25,660) and DCVAS (n = 712) to establish the descriptive epidemiology and investigate aetiological hypotheses centred on cardiovascular risk factors in cross-sectional and longitudinal study designs. The EPIC cohort included unique data from retinal photographs, allowing the application of vasculometric analysis. Results: The prevalence ranged from 0.91% to 1.62% for PMR and 0.25% to 0.47% for GCA. Age and traditional cardiovascular risk factors were important for both disease onset with associations between hypertension and LDL with PMR. Visual impairment developed in 8% of GCA cases with six months of onset; risk factors for blindness in GCA included peripheral vascular disease. Inflammatory arthritis developed in 10% of PMR cases at 10 years with greatest risk in smokers. Analysis of retinal photographs showed an association between venular width and PMR, but no other characteristic morphological features were identified. Conclusions: These are the first estimates of PMR and GCA incidence and prevalence for the UK to apply current classification criteria. This is the first study to use a prospective design to show traditional cardiovascular risk factors to be important for disease onset and progression; their presence may point towards a need for more careful monitoring. The novel vasculometric data from retinal photographs provides insight into aetiological hypotheses of disease, particularly those with underlying vascular dysregulation mechanisms, and may be of potential value in screening.
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Gourley, Ian Scott. "A study of familial Lupus in Ireland." Thesis, Queen's University Belfast, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261928.
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Frazer, Hilary Elizabeth. "Autoantigens in connective tissue disease." Thesis, Queen's University Belfast, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.328058.
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Lundström, Emeli. "Genetic studies of the HLA locus in rheumatic diseases." Stockholm, 2010. http://diss.kib.ki.se/2010/978-91-7409-852-5/.
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Neumann, Vera. "The relationship between bowel flora and the rheumatic diseases." Thesis, Imperial College London, 1990. http://hdl.handle.net/10044/1/46469.
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Aviña-Zubieta, Juan Antonio. "The long-term effectiveness of antimalarials in rheumatic diseases." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq21151.pdf.
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Miltinienė, Dalia. "The prevalence of inflammatory rheumatic diseases in Vilnius, Lithuania." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2009. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2009~D_20090611_130605-72009.
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Objective: to assess the prevalence of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and spondyloarthropathy (SpA) in Vilnius, Lithuania. Methods: 3 prevalence studies were conducted: 1. Registry-based study of the prevalence of RA and SLE; 2. Population-based study of the prevalence of RA and SLE (interview conducted by mail); 3. Poulation-based study of the prevalence of RA and SpA (interview conducted by telephone). Results: according to the Vilnius RA and SLE registry, the prevalence of RA in Vilnius at the end of year 2004 was 0,14% (95% CI 0,13-0,15), and the prevalence of SLE was 0,0174% or 17,4/100 000 (95% CI 0,0137-0,0218). The population-based study, conducted by mail, revealed 15 RA and 2 SLE cases, accounting for a prevalence rate of RA of 0,37% (95% CI 0,21-0,62), and a prevalence of SLE rate of 0,0498% (95% CI 0,006-0,180). The standardized prevalence rate according to age and sex in the Vilnius population showed an RA prevalence of 0,32% (95% CI 0,18-0,57). The population-based study, conducted be telephone, detected 16 RA and 13 SpA cases, resulting in a crude prevalence of 0,76% (95% CI 0,44-1,24) for RA and 0,62% (95% CI 0,33-1,06) for SpA. The standardized prevalence rate according to age and sex in the Vilnius population showed an RA prevalence of 0,51% (95% CI 0,29-0,96) and a SpA prevalence of – 0,75% (95% CI 0,38-1,40).Darbo tikslas: nustatyti reumatoidinio artrito (RA), seronegatyvių spondiloartropatijų (SpA) bei sisteminės raudonosios vilkligės (SRV) paplitimą Vilniaus mieste. Darbo metodika: Buvo atlikti 3 tyrimai: 1. RA ir SRV paplitimo Vilniaus mieste apskaičiavimas, remiantis Vilniaus miesto RA ir SRV sergančių asmenų duomenų baze; 2. RA ir SRV paplitimo Vilniaus mieste populiacinis tyrimas, apklausiant Vilniaus miesto gyventojus paštu; 3. RA ir SpA paplitimo Vilniaus mieste populiacinis tyrimas, apklausiant Vilniaus miesto gyventojus telefonu. Rezultatai: remiantis Vilniaus miesto RA ir SRV sergančiųjų duomenų baze, RA paplitimas Vilniaus mieste 2004m. pabaigoje buvo 0,14% (95% PI 0,13-0,15). Apskaičiuotas SRV paplitimas Vilniuje 2004m. pabaigoje buvo 0,0174% arba 17,4/100 000 gyventojų (95% PI 0,0137-0,0218). Atlikus RA ir SRV paplitimo tyrimą (apklausą paštu), nustatyta, kad RA paplitimas Vilniuje yra 0,37% (95% PI 0,21-0,62), o SRV paplitimas – 0,0498% (95% PI 0,006-0,180). RA paplitimas buvo standartizuotas pagal amžių ir lytį, remiantis 2004m. pradžios Vilniaus miesto populiacija, apskaičiuotas standartizuotas RA paplitimas yra 0,32% (95% PI 0,18-0,57). Atlikus RA ir SpA paplitimo tyrimą (apklausą telefonu), apskaičiuotas RA paplitimas buvo 0,76% (95% PI 0,44-1,24), o SpA paplitimas - 0,62% (95% PI 0,33-1,06). RA ir SpA paplitimas buvo standartizuotas pagal amžių ir lytį, remiantis 2004m. pradžios Lietuvos populiacija, apskaičiuotas standartizuotas RA paplitimas yra 0,51% (95%... [toliau žr. visą tekstą]
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Kidd, Bruce Lindsay. "The classification of HLA B27 positive inflammatory rheumatic disease." Thesis, University of Southampton, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.241605.
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Pal, B. "A clinical, laboratory and serological study of 219 patients with Sjogren's syndrome in North East England." Thesis, University of Newcastle Upon Tyne, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.384013.
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Teh, Lee-Suan. "Neuropsychiatric systemic lupus erythematosus." Thesis, University of Aberdeen, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.240703.
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Neuropsychiatric (NP) symptoms are relatively common in patients with SLE. The diverse and dramatic clinical presentations, the unclear pathogenesis, the lack of diagnostic test/s and uncertainties about the optimal management are some problems facing a clinician. When serum anti P antibodies were claimed to be highly correlated to lupus psychosis, this needed confirmation. An ELISA for measuring anti P antibodies was developed and validated. The prevalence of anti P antibodies was determined in different patient groups in a large retrospective study. Although anti P antibodies were highly specific for SLE, there was no correlation between the presence of these antibodies and lupus psychosis or other NP symptoms. Two prospective studies were carried out to eliminate any bias in our retrospective study. In one, none of the patients developed psychosis and these antibodies were not found to be specific for lupus depression or anxiety. In the other, anti P antibodies were measured in Malaysian Chinese SLE patients. No correlation was found between these antibodies and NP-SLE but a high prevalence of these antibodies was demonstrated in this group. Genetic studies showed that there was an increase in HLA-Dr2w16X subtype allele in anti P-positive patients but this did not reach significance. The usefulness of measuring antineuronal antibodies in helping to diagnose NP-SLE was examined but these antibodies were not better indicators of NP-SLE. Although the clinical correlations of anti P antibodies remain controversial, anti P antibodies were found to selectively bind to neuroblastoma cell surfaces in vitro but the nature of the surface antigen was not determined. Finally, sera from patients with lupus psychosis were found to significantly influence the response of neuroblastoma cells to agonist-induced stimulation and if confirmed, would offer an explanation for the reversible changes in cell function associated with psychiatric lupus.
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Walters, M. T. "A clinical and immunohistological study of the effects of therapy on the rheumatoid synovium." Thesis, University of Southampton, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.233739.
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Åhlin, Erik. "Functional Role of Immune Complexes in Rheumatic and Parasitic Diseases." Doctoral thesis, Uppsala universitet, Klinisk immunologi, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-139529.
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Immune complexes (IC) have key pathological roles in both autoimmune and infectious diseases. In this thesis functional mechanisms behind IC-driven inflammation in rheumatic diseases and tropical infections have been studied, with special focus on the contribution of autoantibodies and cytokine-inducing properties of IC. In the autoimmune disease SLE, increased levels of IC-induced cytokines were associated with both increased classical complement activation and the occurrence of the autoantibodies anti-SSA and anti-SSB, both directed against RNA-associated antigens. In addition, complement activation and anti-SSA synergistically predisposed to higher levels of IC in sera. In the following study it was demonstrated that also other autoantibodies against RNA-associated autoantigens were more enriched than anti-dsDNA in SLE IC. Sudanese Visceral Leishmaniasis (VL) patients had elevated IC levels, and precipitated IC induced higher levels of GM-CSF, IL10, IL6 and IL1RA than control IC. Levels of IC were especially prominent in severely ill patients receiving antimony treatment, and a parallel association with IC induction of GM-CSF was demonstrated. Leishmania-infected patients were often rheumatoid factor (RF) positive and a substantial number displayed reactivity towards cyclic citrullinated peptide (CCP) antigens. Contrary to what was seen in Sudanese RA sera, the CCP reactivity was not restricted to citrulline but reacted equally well with arginine-containing control peptides. Levels of anti-CCP among VL patients were not due to cross-reactions with, or CCP-reactivity bound to IC. I have demonstrated that IC are associated with the presence of autoantibodies in both SLE and in Leishmania infection. In SLE, autoantibodies against RNA-associated antigens were more prone to form circulating IC than anti-dsDNA. In Leishmania infection false reactivity against the CCP-autoantigen correlated to IC levels although the IC themselves did not contain such reactivity. In both diseases higher IC levels were associated with a more active disease, and purified IC induced key cytokines in disease pathogeneses.
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Mathsson, Linda. "Immune Complex Regulated Cytokine Production in Rheumatic and Lymphoproliferative Diseases." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7446.
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