Monday

Think psoriasis is just a rash? Think again.

Psoriasis is a chronic inflammatory disease characterized by patches of abnormal skin, that affects between 2 percent and 3 percent of the world’s population. But psoriasis is more than skin deep. It is associated with many diseases and the disease associations just keep growing.

Psoriasis and its associations to systemic diseases of a chronic inflammatory nature

Psoriasis and just some of its associations to systemic diseases of a chronic inflammatory nature


Bruce Jancin writing in Rheumatology News reported on information presented at the European Academy of Dermatology and Venereology. Published studies have linked psoriasis with significant increases in chronic obstructive pulmonary disease, multiple sclerosis, migraines, uveitis, pancreatitis, and abdominal aortic aneurysm.

Chronic Obstructive Pulmonary Disease (COPD) refers to a group of diseases that impair the flow of air to the lungs, making it more difficult to breathe.  A 2015 review concluded that people with psoriasis had an approximately two-fold greater risk of developing COPD, compared with the general population. The risk was higher in people with severe psoriasis. 

Multiple sclerosis is an inflammatory, autoimmune disease of the central nervous system that disrupts communications between the brain and other parts of the body. A meta-analysis of 43,643 patients with multiple sclerosis shows that these patients have an increased incidence and prevalence of psoriasis. Association of Multiple Sclerosis with Psoriasis: A Systematic Review and Meta-Analysis of Observational Studies.

Migraines are a common neurological disorder, characterised by moderate to severe headache and nausea. Psoriasis was found to be associated with an almost 4-fold increase in risk for migraine in US research at the New York University School of Medicine in 2019. Psoriasis and the risk of migraines in the United States.

Uveitis is inflammation in the eye which affects the middle layer of tissue in the eye wall. The results of a 2020 study revealed significantly increased risk of both prevalent and incident uveitis among patients with psoriasis. Psoriasis and Risk of Uveitis: A Systematic Review and Meta-Analysis

Pancreatitis is the inflammation of the pancreas, an organ that sits near the stomach and liver. A 2016 study demonstrated that patients with psoriasis are at a significantly elevated risk of CP and the risk increased with severity of psoriasis. The Risk of Chronic Pancreatitis in Patients with Psoriasis: A Population-Based Cohort Study. 

Abdominal aortic aneurysm is a localized enlargement of the abdominal aorta. Psoriasis was found to be an independent risk factor for abdominal aortic aneurysms (AAA), according to a 2016 Danish study, published in Arteriosclerosis, Thrombosis, and Vascular Biology: Nationwide Study on the Risk of Abdominal Aortic Aneurysms in Patients With Psoriasis.

Here is a list from the National Psoriasis Foundation/USA of Related Conditions of Psoriasis which also includes Cardiovascular Disease, Metabolic Syndrome, Obesity, Hypertension, Dyslipidemia, Diabetes, Anxiety and Depression, Inflammatory Bowel Disease, Cancer, Kidney Disease, Sleep Apnea and Hepatic (liver) Disease.


Video Comment by Dr Nathan Wei of the Arthritis Treatment Center : A more serious condition than we thought.

Nathan Wei, MD FACP FACR was a rheumatologist and Director of the Arthritis Center of Maryland. He was a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine at the time of creating this video.

Think psoriasis is just a rash? conditions associated with psoriasis

Sunday

Long-standing Link Between ankylosing spondylitis and HLA-B27 Explained

Results could explain how immune system mistakenly targets health tissue in ankylosing spondylitis (AS).

ankylosing spondylitis

Ankylosing spondylitis (AS) is a type of arthritis that mainly affects the joints of the spine. 

Ankylosing spondylitis is an inflammatory condition that involves the spine and skeleton of the head and trunk. The disorder causes inflammation and pain in joints in the spine, pelvis and other parts of the skeleton. In addition, parts of the spine, the hips or the sacroiliac joints where the hips join the lower back, may fuse, or grow, together.

UCSF Health 
ankylosing spondylitis

 Long-standing Link Between AS and HLA-B27 Explained 

 Writer: Steve Bryson PhD | 

“Our findings that T cells at the sites of pathology recognize HLA-B*27 bound to both self and microbial antigens adds a very important layer of understanding to these complex conditions that also feature strong inflammatory signatures,” Gillespie said. “Our hope is that this work will one day pave the way for more targeted therapies, not only for these conditions but ultimately, for other autoimmune diseases.”

Co-first author Michael Paley, MD, PhD, of Washington University, added, “For ankylosing spondylitis, the average time between initial symptoms and actual diagnosis is seven to eight years. Shortening that time with improved diagnostics could make a dramatic impact on patients’ lives, because treatment could be initiated earlier.

“As for therapeutics, if we could target these disease-causing T cells for elimination, we could potentially cure a patient or maybe even prevent the disease in people with the high-risk genetic variant. There’s a lot of potential for clinical benefit here.”

 Read full article at Ankylosing Spondylitis News 

HLA-B27 Testing

The HLA-B27 test checks for a protein on your white blood cells. HLA-B27 causes the immune system to attack healthy cells. Up to 95 percent of people who do have ankylosing spondylitis are HLA-B27 positive.

The test is a simple blood draw. Your doctor may order the test if he or she suspects your symptoms are caused by an autoimmune or autoinflammatory condition. Your doctor should also help you interpret your test results, but you can find the basics below.

  • What does HLA-B27 negative mean?
    • If you are HLA-B27 negative, it means you don’t have HLA-B27 on your white blood cells.
  • Can you be HLA-B27 negative and still have ankylosing spondylitis?
    • You can be negative for HLA-B27 and still have ankylosing spondylitis. 
  • What does HLA-B27 positive mean?
    • If you are HLA-B27 positive, it means you do have some HLA-B27 on your white blood cells. You inherited the HLA-B27 gene from your parents.
  • Can you be HLA-B27 positive and not have ankylosing spondylitis?
    • Not everyone who tests positive for HLA-B27 in the blood has an immune or inflammatory disorder.
    • If you are HLA-B27 positive, you have a 10 percent chance (or less) of developing a spondyloarthritis condition.
    • If you do not have ankylosing spondylitis, you may have a different condition. The presence of HLA-B27 in you blood means you are at greater risk of developing such a disease. SOURCE


VIDEO: Ankylosing Spondylitis: Visual Explanation for Students

autoimmune disease ankylosing spondylitis


Saturday

Anti Nuclear Antibody Test (ANA)

An antinuclear antibody test can help determine the existence of particular types of antibodies in the body.

Anti Nuclear Antibody Test



Antibodies are essentially proteins that the immune system generates to fight bacteria, viruses, and other dangerous foreign bodies. They are made by the white blood cells (B cells). If an antibody finds proteins of a foreign infectious organism, it employs other cells to help keep the infection at bay. This process is called inflammation.

Sometimes, however, the immune system can misconstrue agents within the body as external attacks. It then produces specific antibodies known as “autoantibodies,” which invade the body’s cells and tissues, wreaking havoc on the joints, skin, and muscles.

Antibodies that aim for “normal” proteins contained in a cell’s nucleus are called antinuclear antibodies (ANA). The high amount of ANAs is characteristic of autoimmune diseases such as lupus, Hashimoto’s thyroiditis, scleroderma, polymyositis, Sjögren’s syndrome, mixed connective tissue disease, drug-induced lupus, inflammatory bowel disease, and autoimmune hepatitis.

FIND OUT MORE including Results of an ANA Test at Metropolis Pathology

VIDEO: 5 Things You Need To Know About Your Positive ANA by rheumatologist Dr. Elizabeth Ortiz

Anti Nuclear Antibody Test

Monday

Manganese benefits for autoimmune disease

Manganese is a mineral that is considered an essential nutrient because the body requires it to function properly. 

Manganese benefits for autoimmune disease

It is a strong antioxidant that helps to reduce inflammation in the body. It also aids metabolism, helps regulate blood sugar, helps heal bones and connective tissues, and can help reduce premenstrual cramps. 

Low dietary manganese intake or low levels of manganese in blood or tissue have been associated with Osteoporosis and Diabetes mellitus.

Rich sources of manganese include whole grains, especially oatmeal and brown rice and wheat germ, legumes, tofu, nuts such as pecans, peanuts and almonds, and leafy vegetables such as spinach. The good news is that we get adequate dietary manganese from eating these foods and rarely need to supplement our diet. If you’re considering a supplement, talk to your doctor first as excessive levels of manganese are toxic and supplements should be approached with care.

TOFU RECIPE. 

Tofu is made from soybeans and is soft and bland and can easily be incorporated in stir-fries as a great source of easy to chew protein. It easily absorbs other flavors so works well with asian sauces such as soya, oyster, or chili sauce. but if you are like me and can no longer tolerate these spicy sauces due to burning mouth syndrome you may like the following idea. 

Use firm or extra firm tofu and drain excess water off the tofu.

Slice the tofu into 1-inch thick pieces and place in a dish to use in the oven.

Mix all the sauce ingredients together and pour over tofu and bake for 20 minutes: 

  • Peanut butter
  • Golden syrup or coconut sugar or other sugar
  • Sesame oil
  • Salt or soya sauce
  • a splash of lime juice
Enjoy with rice and vegetables.

I track my food, exercise and other health metrics with cronometer. It encourages me to focus on nutrition as a whole rather than counting calories and even tracks foods like miso and soy butter.

Manganese benefits for autoimmune disease


Saturday

Updated rheumatoid arthritis treatment recommendations

EULAR – The European Alliance of Rheumatology Associations – has updated its recommendations on disease-modifying treatment for people with rheumatoid arthritis (RA) to take into account developments and new evidence in the field.

Updated rheumatoid arthritis treatment recommendations

Three small changes and one major change have been implemented, the major change involving Janus kinase inhibitors.

The updated recommendations were developed by a multidisciplinary task force of rheumatologists, other health professionals, and patient research partners. 

The information is based on evidence collected from three systematic reviews across efficacy and safety of both DMARDs and glucocorticoids.

WHAT IS EULAR?
EULAR is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with rheumatic and musculoskeletal diseases (RMDs). EULAR stands for The European Alliance of Rheumatology Associations.

You can view the full update in pdf form here

SOURCES:

UPDATED Rheumatoid Arthritis #RA TREATMENT RECOMMENDATIONS 2022 update published in the Annals of the Rheumatic Diseases https://www.eular.org/sysModules/obxContent/files/www.eular.2015/1_4229

ORIGINAL EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update

https://ard.bmj.com/content/early/2022/11/10/ard-2022-223356


Updated rheumatoid arthritis RA treatment recommendations


Wednesday

Genetic Liability to Autoimmune Diseases May Affect Alzheimer Disease Risk

Multiple sclerosis and Sjogren syndrome show more associations with Alzheimer disease compared with other autoimmune diseases.

Autoimmune Diseases May Affect Alzheimer Disease Risk

Genetic liability to multiple sclerosis and Sjogren's syndrome may be related to the risk of developing Alzheimer disease, according to a study published in the Journal of Psychiatric Research.

Some evidence was found for liability to multiple sclerosis being associated with higher risk and liability to Sjogren's syndrome with lower risk of Alzheimer's disease. The researchers concluded:

Liability to multiple sclerosis and Sjogren's syndrome could be associated with Alzheimer's disease. The underlying mechanisms, such as the role of myelin and neuroinflammation, should be further investigated.

Yeung CHC, Yeung SLA, Schooling CM. Association of autoimmune diseases with Alzheimer’s disease: A mendelian randomization studyJ Psychiatr Res. 2022;155:550-558. doi:10.1016/j.jpsychires.2022.09.052

VIDEO: What is Alzheimer’s Disease?

Autoimmune Diseases May Affect Alzheimer Disease Risk



Salmon Cakes with yoghurt dressing

You may call them salmon rissole, patties, burgers or cakes depending on where you come from. No matter what you call them they are one of our go-to meals that is gluten-free and would be on an anti-inflammatory diet like MIND or the Mediterranean diet. Of course with all recipes you may need to swap some ingredients to what you are able to eat.

Salmon Cakes with yoghurt dressing

Salmon Cakes with yoghurt dressing

Serves 4

  • 1 (6-oz.) can salmon 
  • 2 tbsp. diced shallots (green onions)
  • 2 tbsp. chopped parsley
  • 2 tbsp. chopped chives
  • ¼ cup finely chopped gluten-free rolled oats or oat flour or cooked rice
  • 1 large egg, lightly beaten
  • ½ tsp. salt
  • 1 tbsp. rice bran oil
  • Butter to lightly grease baking tray or any oil you prefer.
  • Lettuce to serve it on 
  • If spices are tolerated add ¼ tsp. of ground cumin or ½ tsp. tumeric or curry powder.

Yogurt sauce:

  • ½ cup plain Greek yogurt
  • 2 tbsp. chopped fresh chives
  • 1 tsp. lemon zest
  • 1 tbsp. rice bran oil
  • ¼ tsp. salt

Drain fish.

Stir together fish, shallots, parsley, chives, oats, egg, salt, in large bowl until all ingredients are thoroughly combined.

Using your hands, form mixture into cakes, and place them on plate. Cover and refrigerate for 30 minutes or longer. 

Combine dressing ingredients in a small bowl.

When cakes have finished chilling place in a butter greased oven tray and bake in the heated oven at 180 degrees until brown (around 12 to 15 minutes). 

Divide lettuce evenly among plates, place fish cake on lettuce, and yogurt sauce on the side.

Substitutes:

Some people may not tolerate salmon but may be able to eat canned mackerel of fresh white fish. 

You may be interested in these articles on diet:

Whats in an Anti inflammatory Diet?




Salmon Cakes with yoghurt dressing


Thursday

Researchers identify important factors for regulating the body’s immune response

INDIANAPOLIS—Researchers at Indiana University School of Medicine are learning more about how special regulatory T cells can impact the immune system’s response and how those cells could be manipulated for potential treatments for food allergies and autoimmune diseases.

regulating the body’s immune response

In a study recently published in Science Immunology, researchers focused on regulatory T cells, or Treg cells, that regulate immune responses in the body and keep the immune system in order while fighting pathogens. In some cases, the immune system becomes overly responsive, leading to autoimmune diseases, such as Type 1 diabetes or lupus, food allergies or other issues. Researchers were able to identify the differences in isoforms that control Treg cells and how that affects the body’s immune function.

“There is a particular gene that controls this regulatory group of T cells, which controls immune response,” said Baohua Zhou, PhD, lead author of the study and associate professor of pediatrics for IU School of Medicine Department of Pediatrics. “Treg cells can help maintain the right balance to help the immune system not respond too strongly or too weakly.”

SEE FULL ARTICLE

Wednesday

Autoimmune Disorders Care Through Research and Results: The Mayo Clinic Way

Here is a summary of the 3-M Approach which is the Mayo Clinic Way of supporting people with Autoimmune disorders. As the name suggests there are three parts to their treatment approach.

The 3-M Approach 
On top of the research being conducted, the neuroimmunology laboratory has adopted a new model of care Pittock calls the “Mayo Clinic 3-M” approach. 

Sean J. Pittock, MD, is the director of the Mayo Clinic Center for MS (Multiple Sclerosis) and Autoimmune Neurology.

The first M stands for “Maximize reversibility.” Here, patients are given large doses of immunotherapy over a short period of time, with maximum reversibility measured through phenotype-specific evaluations. Pittock gave several examples of patients, saying, “If you come in with epilepsy, we count your seizures, or we do epilepsy monitoring. We give you your therapy, we measure, and then we get a sense of that big treatment trial." 

The second M is "Maintaining maximum reversibility." Once a patient has reached a point where they have shown progress with their treatment regimen, it becomes a question of maintenance because patients cannot be given steroids in perpetuity, Pittock explained. The next step is to select an immunotherapy that spares agents such like steroids and other choices like intravenous immunoglobulin, and use other drugs including rituximab, methotrexate, and in other cases, other drugs, such as IL-6 inhibitors like satralizumab. 
 
The third M is "Minimum dose of immunotherapy" to lower risk of adverse effects while maintaining the maximum reversibility. Patients on immunotherapy may experience a range of these, from flu-like symptoms such as fever, chills, weakness, nausea or vomiting, fatigue, headache, or trouble breathing, to other adverse effects including swelling and weight gain, heart palpitations, diarrhea, organ inflammation, and infection. 

 "What do we still need to work on? We discussed biomarkers and the immunopathology, but we still need to work on the treatment part," Zekeridou said. "The NMO example is a perfect example, but the thing the NMO trials has taught us is that we cannot do it alone. These trials were multicentered around the world. We’re dealing with rare diseases, so we need this kind of collaboration. We also need to do a better job of advocating for our patients until we have FDA-approved drugs. This is something we see in our clinic every day, where patients will not get insurance for specific treatments, even though they do have autoimmune encephalitis."


Autoimmune Care Through Research and Results


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