Does remission of renal disease associated with antihypertensive treatment exist?

In diabetic and nondiabetic chronic nephropathies, high blood pressure and urinary loss of proteins represent major determinants of progressive renal function decline. Reducing blood pressure with drugs that inhibit the renin-angiotensin system also lowers glomerular hypertension and ameliorates glomerular sieving properties, thus reducing proteinuria. Reducing urinary protein levels with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor antagonists (ARA) limits renal function decline to the point that remission of disease and regression of renal lesions have been observed in experimental animals and in humans. This therapy, however, may not be effective in all patients. For patients who do not achieve complete remission of proteinuria, renoprotective treatment should include intensified blood pressure control (and metabolic control in diabetes) and amelioration of dyslipidemia. Early intervention, before progressive glomerulosclerosis and scarring is initiated by increased protein traffic, may be important to maximize reno-and cardioprotection, especially in diabetes.     

How adherent to treatment with azathioprine are patients with Crohn's disease in long-term remission?

BACKGROUND: Patients with longstanding quiescent Crohn's disease on azathioprine usually maintain an excellent quality of life but are also concerned about long-term safety. This may affect adherence to treatment. The aim of the present study was to assess the adherence to azathioprine in a cohort of patients with Crohn's disease in long-term remission. METHODS: Thirty patients with Crohn's disease in remission on azathioprine for > or =48 months were enrolled in the study. All were asked to record the number of azathioprine tablets they consumed daily. Notes were kept every other month for 6 months. Adherence was defined as consumption of > or =80% of medication. RESULTS: Most patients (18/28, 74.3%) were not adherent to treatment. The mean (+/-SD) daily dose of azathioprine in adherent and nonadherent patients was 145 +/- 45 mg and 102 +/- 20 mg, respectively. However, there were no significant differences between the 2 groups in the mean IBDQ score and mean Crohn's Disease Activity Index (CDAI) score, both throughout the entire study and at each time point of the study. Male gender, single status, and consumption of >5 concomitant medications were associated with nonadherence. CONCLUSIONS: Most patients with Crohn's disease in longstanding remission had low self-reported adherence to azathioprine. Both male gender and single status were associated with nonadherence to azathioprine, whereas disease factors were not related to self-reported adherence. Patients considered nonadherent to treatment maintained disease remission and a quality of life similar to patients who were adherent to treatment.     

Complete remission of nephrotic syndrome with methylprednisolone pulses in an adult with Schönlein-Henoch purpura

Henoch-Sch?nlein purpura is a systemic vasculitis that occurs most frequently in childhood. Massive proteinuria, renal impairement at onset and histologic severity in renal biopsy are considered the main risk factors for deterioration of renal function at long-term. We report a 24 years-old woman with Henoch-Sch?nlein purpura who developped a severe nephrotic syndrome with microhematuria and normal renal function. Renal biopsy showed a diffuse endocapillary proliferative glomerulonephritis with less than 50% crescents (type IIIB of ISKDC classification). As their potential bad prognosis we decided to treat with methyl-prednisolone pulses (3 x 500 mg in months 0, 3 and 5) accompanied by maintenance treatment with prednisone (0,5 mg/kg/every other day) for 9 months. We observed with this protocol complete remission of nephritis with preservation of renal function.     

Perianal disease is associated with psychiatric co-morbidity in Crohn’s disease in remission

Background and aim

Crohn’s disease is a life-long inflammatory disease which can impair quality of life, in particular in patients with psychiatric co-morbidities such as depression and anxiety. The aim of this prospective cohort study was to assess the prevalence of depression and anxiety and related risk factors in patients with quiescent Crohn’s disease.

Methods

A consecutive series of adult patients with confirmed diagnosis of Crohn’s disease, in clinical remission, were included and investigated during ambulatory visits using a standard questionnaire assessing demographic and clinical features of the disease. Within 1 month after the ambulatory visit, all patients were interviewed by phone to assess the presence of psychiatric disorders using standardized questionnaires. The questionnaire assessed the development of psychiatric disorders after the diagnosis of Crohn’s disease, the use of antidepressant or antianxiety therapy and current anxiety or depression by means of the Hospital Anxiety and Depression Scale.

Results

One hundred and ninety-five patients were included. Seventy-two (36.9 %) patients showed anxiety and/or depression symptoms, 46 (23.6 %) patients showed anxiety symptoms, 6 (3.1 %) patients showed depression symptoms and 20 (10.3 %) patients showed both symptoms. Forty-eight of these patients (58 %) were without any antidepressive or antianxiety treatment. Anxiety with or without depression was significantly correlated with female sex (p?=?0.017), history of perianal disease (p?=?0.003) and perianal surgery (p?=?0.042).

Conclusion

Anxiety is a frequent, often untreated, condition in patient affected by Crohn’s disease in clinical remission. Female sex, history of perianal disease and perianal surgery are major risk factors for anxiety.     

Molecular and cytogenetic remission in a case of subtype M4E acute myelogenous leukemia with minimal monochemotherapy: high sensitivity or spontaneous remission?

Complete remission was observed in an adult patient with acute myelogenous leukemia after minimal monochemotherapy. Remission occurred after a severe febrile pneumonia and was accompanied by cytogenetic and molecular remission. The hypothesis of spontaneous remission was raised, even if a high sensitivity to low-dose cytostatics cannot be excluded. Such spontaneous complete remissions, often associated with bacterial infections and blood transfusions, are extremely rare, and are usually of short duration. Previous cases are summarized, and the role of etiologic factors is discussed.     

Do patients with juvenile idiopathic arthritis in remission exhibit active synovitis on joint ultrasound?

The aim of the study was to assess the presence and characteristics of subclinical synovitis using power Doppler (PD) ultrasonography on patients with juvenile idiopathic arthritis (JIA) in clinical remission and compare the findings with those of healthy children. A cross-sectional study was carried out involving the clinical (physical exam, functional capacity and laboratory tests) and ultrasonography evaluation of 34 joints (synovial fluid/hypertrophy, PD signal and bone erosion). Subclinical synovitis was defined as the presence of synovial hypertrophy/joint effusion with or without any PD signal. Thirty-six patients (11.5 ± 3.74 years) and 36 controls (sex and age matched) were evaluated (2,448 joints). Twenty-seven patients were in remission on medication (mean duration: 1.8 ± 2.2 years). Subclinical synovitis was detected in 41.7 % patients and 11.1 % controls (p = 0.003). Erosion was detected in three patients (8.3 %). Subclinical synovitis was found in 38/1,224 (3.1 %) joints in the patients (most affected: radiocarpal wrist, anterior elbow and tibiotalar ankle) and 8/1,224 (0.6 %) joints in the controls (most affected: radiocarpal wrist). Differences in subclinical synovitis between patients and controls were found in the elbows (p = 0.033) and ankles (p = 0.006). A greater frequency of subclinical synovitis was found in patients with the extended oligoarticular or polyarticular subtypes (p = 0.013), those at an older age at disease onset (p = 0.007) and using methotrexate (p = 0.049). Patients with JIA in remission exhibit subclinical synovitis more frequently than controls. Subclinical synovitis was more frequent in patients with the polyarticular involvement and those at an older age at disease onset.     

Maintenance of remission with infliximab in inflammatory bowel disease： Efficacy and safety long-term follow-up

AIM To evaluate the safety and efficacy of a longterm therapy with infliximab in Crohn's disease (CD) and ulcerative colitis (UC) patients retrospectively.METHODS The medical charts of 50 patients (40 CD and 10 UC), who received after a loading dose of 3 infliximab infusions scheduled re-treatments every 8 wk as a maintenance protocol, were reviewed.RESULTS Median (range) duration of treatment was 27 (4-64) mo in CD patients and 24.5 (6-46) mo in UC patients. Overall, 32 (80%) CD and 9 (90%) UC patients showed a sustained clinical response or remission throughout the maintenance period. Three CD patients shortened the interval between infusions. Eight (20%) CD patients and 1 UC patient underwent surgery for flare up of disease. Nine out of 29 CD and 4 out of 9 UC patients, who discontinued infliximab scheduled treatment, are still relapse-free after a median of 16 (5-30) and 6.5 (4-16) mo following the last infusion,respectively. Ten CD patients (25%) and 1 UC patient required concomitant steroid therapy during maintenance period, compared to 30 (75%) and 9 (90%) patients at enrolment. Of the 50 patients, 16 (32%) experienced at least 1 adverse event and 3 patients (6%) were diagnosed with cancer during maintenance treatment.CONCLUSION Scheduled infliximab strategy is effective in maintaining long-term clinical remission both in CD and UC and determines a marked steroid sparing effect.Long-lasting remission was observed following infliximab withdrawal.     

Mycophenolate mofetil for induction and maintenance of remission in naïve patients with granulomatosis with polyangiitis without renal involvement

Antineutrophil cytoplasmic antibodies (ANCA) associated vasculitides include granulomatosis with polyangiitis (GPA, previously called Wegener's), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA), previously called Churg-Strauss). In this report we used mycophenolate mofetil (MMF) and steroids to induce and maintain remission in two newly diagnosed cases with c-ANCA associated GPA. The two patients’ maintained remission with no disease relapses during one year follow-up.     

Cystic fibrosis and Crohn’s disease:Successful treatment and long term remission with infliximab

The association of cystic fibrosis and Crohn‘s disease (CD) is well known, but to date, there are very few cas-es in the literature of patients suffering from mucovisci-dosis who have required treatment with infliximab. We report the case of a 23-year-old patient suffering from cystic fibrosis and severe CD treated successfully with infliximab without any infective complications or wors-ening of the pulmonary disease and with a long term (2 years) complete remission.     

Prediction of DAS28-CRP remission in patients with rheumatoid arthritis treated with tacrolimus at 6?months by baseline variables

We attempted to determine what baseline variables are responsible for the efficacy of tacrolimus at 6 months in Japanese patients with rheumatoid arthritis (RA). One hundred and six RA patients treated with tacrolimus for 6 months were entered in this study. The outcome was set as the achievement of Disease Activity Score 28 C-reactive protein (DAS28-CRP) remission at 6 months. We examined the association of gender, DAS28-CRP at baseline, concomitant use of methotrexate (MTX), and concomitant use of prednisolone with the achievement of DAS28-CRP remission at 6 months by logistic regression analysis. Twenty-three of 106 patients (21.7%) achieved DAS28-CRP remission at 6 months. There was concomitant use of MTX by 20 patients (18.9%), prednisolone by 93 (87.7%), and prednisolone >5 mg/day by 43 (40.6%) at baseline. Logistic regression analysis showed that male gender (first) and moderate disease activity at baseline (second) are independent predictors toward achieving DAS28-CRP remission at 6 months. Maximum tacrolimus dosage administrated for patients over a 6-month period appeared not to be predictive for the DAS28-CRP remission at 6 months. In conclusion, we revealed for the first time that good outcome in RA patients treated with tacrolimus can be predictive by some baseline variables. That is clinically valuable for daily practice in the choice of disease-modifying antirheumatic drugs (DMARDs), especially tacrolimus.     

Durable remission of HIV-negative, Kaposi’s sarcoma herpes virus-associated multicentric Castleman disease in patient with rheumatoid arthritis treated with methotrexate

Multicentric Castleman disease (MCD) is a nonneoplastic lymphoproliferative disorder that has a poor prognosis. Optimal treatment is unknown. There are a few reported cases of MCD and rheumatoid arthritis. In this study, we report a patient with rheumatoid arthritis diagnosed with Kaposi’s sarcoma herpesvirus-(KSHV, human herpesvirus-8) associated MCD that showed expression of viral IL-6. Treatment with methotrexate (MTX) resulted in a complete remission of her disease lasting for 54+ months. Multiple studies have suggested that MCD and rheumatoid arthritis are associated with overexpression of the growth-promoting cytokine interleukin-6 (IL-6), and that MTX downregulates the production of this cytokine in vivo. As such, we suggest that the dramatic improvement in this patient’s disease is due to the immunomodulatory properties of MTX.