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Biomedical subjects

M Abu-Shakra

Publications and source records attributed to M Abu-Shakra.

At least 37 records · Page 2Linked to original sources
PubMed2000

Influenza virus vaccination of patients with systemic lupus erythematosus: effects on disease activity.

OBJECTIVE: To determine whether vaccination of patients with systemic lupus erythematosus (SLE) with influenza virus vaccine is associated with exacerbation of SLE. METHODS: The study population comprised 24 patients with SLE who received influenza vaccine (cases group) and 24 other SLE patients who did not receive the vaccine (controls group). The primary outcome measure was the SLE Disease Activity Index (SLEDAI) scores 6 weeks and 12 weeks after vaccination. Secondary outcome measures included: number of SLE flares, defined as any increase in the SLEDAI > or = 3 points, and activity of renal disease. Repeated measurements MANOVA was used to compare the SLEDAI scores of the cases and controls. RESULTS: All patients were women. The mean age at enrollment into the study was 46.1 and 40.6 years for the cases and controls, respectively. The mean disease duration was 9.1 for the cases and 9.3 years for the controls. SLEDAI scores for the cases and controls were 6.6 and 8.9 at vaccination, 4.9 and 6.8 at Week 6, and 5.1 and 6.7 at Week 12, respectively. The SLEDAI scores of the cases and controls at the 3 different assessments were not statistically different (p = 0.28). However, within each group the decrease in the SLEDAI over time was statistically significant (p = 0.02). Three and 6 flares were observed in the cases and controls, respectively, (p = 0.27) during the 12 weeks of followup. Improvement in the renal disease was observed in the cases and controls. CONCLUSION: Influenza virus vaccine is safe for patients with SLE. Patients with SLE should be encouraged to receive the vaccine according to the recommendation given by the Immunization Practices Advisory Committee.

Adult↗
PubMed1999

Molecular mimicry between host and pathogen: examples from parasites and implication.

The studies summarized in this paper suggest that parasites may trigger activation of autoimmune mechanisms. The association between parasites and autoimmunity could by manifested by the development of pathogenic anti-parasitic antibodies and cytotoxic T cells that attack and damage self tissues as a result of molecular mimicry between host and parasites. On the other hand, the homology between self and parasitic antigens may enable parasites to protect themselves from the immune system and to induce a state of immunosuppression. Although classic autoimmune diseases have not been shown to be more common amongst patients with chronic parasitic infections than in the general population, it is clear that autoimmune activity does occur in patients with chronic parasitic infections. It is possible that infection with parasites and other microbial agents may be followed by the activation of the immune system and, in genetically predisposed individuals, by loss of functional tolerance to self, activation of autoreactive cell that leads to progression to an overt autoimmune disease.

Animals↗
PubMed1999

Frontiers of SLE: review of the 5th International Congress of Systemic Lupus Erythematosus, Cancun, Mexico, April 20-25, 1998.

OBJECTIVE: To review the recent advances in clinical and experimental research in systemic lupus erythematosus (SLE). METHODS: Review of the 5th International Congress of SLE that took place in Cancun, Mexico, on April 20-25, 1998. RESULTS: The main topics presented at the conference are summarized. These include new findings about the genetics of SLE due to fine mapping of the patients' genes and lupus mouse models, the nucleosome as a major autoantigen in SLE, serving as an immunogen for pathogenic T helper and B cells and contributing to the development of lupus nephritis, abnormalities of apoptosis as a cause of SLE, and apoptotic mechanisms as a cause of autoimmunization. Other topics included the pathophysiologic role of anti-endothelial cell antibodies in lupus with central nervous system involvement, vasculitis, the thrombotic diathesis associated with the antiphospholipid syndrome, induction of endothelial cell apoptosis and its regulation by the idiotypic network, the penetration of antinuclear antibodies to the cytoplasm and nucleus and the subsequent interaction with cellular organelles, and new aspects in the antiphospholipid syndrome, including animal models of the disease and the importance of antibodies to beta-2-glycoprotein-I and prothrombin. Advances in the clinical aspects of SLE included clinical manifestations, diagnosis, pregnancy and neonatal SLE, infections, hormones, and treatment. Additionally, four "Lectures of A Lifetime," entitled (1) What causes lupus? (2) From natural autoimmunity to autoimmune disease; (3) The idiotypic network and SLE; and (4) Late-stage morbidity and mortality in SLE-the role of accelerated atherosclerosis were presented. CONCLUSIONS: Recent advances provide new insights into the pathogenesis of SLE, as well as hope for novel therapeutic modalities and diagnostic measures. These offer the possibility of improving life quality and decreasing mortality from the disease and its complications.

Animals↗
PubMed1999

The role of spa therapy in various rheumatic diseases.

Spa therapy seems to have a role in the treatment of a broad range of joint diseases. It cannot substitute for conventional therapy but can complement it. The improvement reported in some of the studies is of short duration, lasting for months. It should be considered for patients suffering from various types of inflammatory arthritides or noninflammatory arthritides who are symptomatic, despite accepted medical therapy and conservative physiotherapy, if they can afford the expense. The patients should be told that the effectiveness and success of this therapy cannot be predicted in advance. Because we have no way to date, of curing most rheumatic diseases, clinical trials of alternative therapeutic methods are justified. These methods may alleviate patient suffering and are almost totally devoid of serious adverse effects. No studies have been reported that evaluate their cost-effectiveness.

Balneology↗
PubMed1999

Balneotherapy at the Dead Sea area for knee osteoarthritis.

BACKGROUND: Balneotherapy at the Dead Sea area has been applied in various inflammatory rheumatic diseases such as rheumatoid arthritis and psoriatic arthritis. The efficacy of balneotherapy at the Dead Sea area for the treatment of degenerative rheumatic diseases has not yet been formally evaluated. OBJECTIVE: To evaluate the efficacy of balneotherapy at the Dead Sea area in patients suffering from osteoarthritis of the knees. METHODS: Forty patients were randomly allocated into four groups of 10 patients. Group I was treated by bathing in a sulphur pool, group 2 by bathing in the Dead Sea, group 3 by a combination of sulphur pool and bathing in the Dead Sea, and group 4 served as the control group receiving no balneotherapy. The duration of balneotherapy was 2 weeks. RESULTS: Significant improvement as measured by the Lequesne index of severity of osteoarthritis was observed in all three treatment groups, but not in the control group. This improvement lasted up to 3 months of follow-up in patients in all three treatment groups. CONCLUSION: Balneotherapy at the Dead Sea area has a beneficial effect on patients with osteoarthritis of the knees, an effect that lastas at least 3 months.

Aged↗
PubMed1999

Quality of life in systemic lupus erythematosus: a controlled study.

OBJECTIVE: To assess the quality of life (QOL) of patients with systemic lupus erythematosus (SLE) and to compare it with that of healthy women and patients with primary fibromyalgia (FM). METHODS: QOL was evaluated using the QOL scale, which includes 16 items, each scored on a 7 point scale. Healthy controls were chosen from hospital personnel. RESULTS: The study population comprised 75 female patients with SLE, 50 healthy women, and 30 women with primary FM. Compared to controls, patients with SLE had significantly lower scores for the health, work, active recreation, and independence items. The QOL scores were not associated with disease activity. Patients with SLE and FM had significantly lower scores for the health related items compared with patients with SLE without FM. CONCLUSION: The QOL of patients with SLE was found to be impaired compared with controls. FM adversely affects the QOL of patients with SLE.

Adult↗
PubMed1998

Clinical and radiographic outcomes of rheumatoid arthritis patients not treated with disease-modifying drugs.

OBJECTIVE: To compare the radiographic and clinical features of rheumatoid arthritis (RA) patients who were not given disease-modifying antirheumatic drugs (DMARDs) with those of RA patients who were followed up and treated with DMARDs at a rheumatology clinic. METHODS: The population of this case-control study includes a series of RA patients who immigrated to Israel from the previous Union of Soviet Socialist Republics and who were treated only with nonsteroidal antiinflammatory drugs. Control patients who were followed up and treated with DMARDs at our rheumatology clinic were matched by sex, disease duration, number of actively inflamed joints, and the presence of serum rheumatoid factor. The outcome measures were the number of deformed and radiographically damaged joints. Radiographic damage was evaluated by the methods of Steinbrocker and Sharp. RESULTS: The study population consisted of 22 RA patients (15 women, 7 men) who were not treated with DMARDs and 22 patients (15 women, 7 men) who were treated with DMARDs. The mean disease duration was 16.2 years for the study patients and 14.3 years for the controls. Compared with the matched controls, RA patients who were not treated with DMARDs were found to have a significantly higher mean number of deformed joints (13.8 versus 7.2), a higher mean number of damaged joints (24.4 versus 15.5), and a higher overall damage score by the Sharp criteria (146.1 versus 65.7). CONCLUSION: RA patients who were not given DMARDs had a 1.57-fold increased number of radiographically damaged joints and a 2.22-fold increased overall Sharp damage score compared with patients who were treated with second-line agents.

Adult↗
PubMed1998

Normal melatonin levels in patients with fibromyalgia syndrome.

OBJECTIVE: To assess urine levels of melatonin measured by 6-sulphatoxymelatonin (aMT6s) in patients with fibromyalgia (FM). METHODS: Nocturnal aMT6s urine levels were measured by ELISA, in a sample of urine collected from 10 PM to 7 AM from 39 female patients with FM and 39 age matched healthy female controls. All subjects were interviewed and assessed for nonarticular tenderness, FM symptoms, quality of life, and physical functioning. RESULTS: Nocturnal aMT6s levels of patients with FM were not statistically different from those of controls: 16.7+/-9.2 vs 16.0+/-11.3 microg, respectively. No association was observed between aMT6s levels of patients with FM and disease duration, reproductive status, sleep and mood disturbances. CONCLUSION: Nocturnal urine aMT6s levels were similar in patients with FM and controls. Studies are needed to elucidate the possible role of melatonin in FM and should include larger samples of newly diagnosed untreated patients with FM.

Adult↗
PubMed1998

HCV antibodies in saliva and urine.

Infection with hepatitis C virus (HCV) is usually established by detection of serum antibodies (anti-HCV). This study was conducted in order to evaluate whether saliva and urine may substitute serum for anti-HCV detection. Serum, saliva, and urine were obtained simultaneously from 141 patients with a variety of liver diseases and from 52 patients with autoimmune diseases (systemic lupus erythematosus n = 27 and rheumatoid arthritis n = 25). The cell free fraction of saliva and urine samples was tested for anti-HCV using a modification of a serum anti-HCV kit. Western blot analysis was used as a confirmation method. Of the patients with liver diseases, 73 were anti-HCV-seropositive. Salivary and urinary anti-HCV could be detected in 66 (90%) and 36 (49%) of the anti-HCV-seropositive patients, respectively. The presence of anti-HCV in saliva or urine was not related to the severity of liver disease. All the anti-HCV-seronegative liver patients were negative for salivary anti-HCV and 22 (32%) had urinary anti-HCV. The patients with autoimmune diseases were all anti-HCV-seronegative. None had detectable salivary anti-HCV while 33 (63%) were positive for urinary anti-HCV. Western Blot analysis confirmed the presence of anti-HCV in all serum and saliva samples tested but only in 2/12 urine samples. The results suggest that saliva, but not urine, may serve as a substitute for serum for the determination of anti-HCV positivity.

Blotting, Western↗
PubMed1997

Hepatitis B and C viruses serology in patients with SLE.

Sera of 95 patients with SLE were tested for the presence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibodies. The results show that HBsAg was not detected in the sera of all of the SLE patients. Only one patient was confirmed to have anti-HCV antibodies, suggesting that chronic infection with hepatitis B and C is not increased in patients with SLE compared with the general population.

Adolescent↗
PubMed1997

Mortality studies in systemic lupus erythematosus. Results from a single center. III. Improved survival over 24 years.

OBJECTIVE: Prognosis studies have indicated that survival of patients with systemic lupus erythematosus (SLE) has improved significantly. We investigate whether the apparent improvement in the survival of patients with SLE is associated with a reduction in the risk of death compared with the general population, or with changes over time in the distribution of various prognostic factors. METHODS: The University of Toronto cohort of 720 patients with SLE followed between 1970 and 1994 was divided into 3 groups based on year of entry into study: Group A 1970-77, Group B 1978-85, Group C 1986-1994. Standardized mortality ratios (SMR) were calculated for each cohort. Prognostic factors for death occurring in the first 8 yr period after entry into the study were examined in each of the 3 cohorts. Analysis involved chi-squared tests for categorical values and unpaired t tests for continuous variables. RESULTS: Group A comprised 183 patients, Group B 332 patients, and Group C 205 patients. An examination of the first 8 years of evaluation for each group revealed that the SMR decrease over time ranged from 10.1-fold greater than the general population in Group A, to 4.8-fold in Group B, to 3.3-fold in Group C. Prognostic factors for death varied over time, with vasculitis decreasing and hyperlipidemia increasing. CONCLUSION: Survival in SLE has improved over 24 yrs in the University of Toronto cohort more than the health of the general population has improved. This improved survival was not related to changing demographics, severity of lupus at presentation, major change in disease patterns, or new modalities of treatment.

Adolescent↗
PubMed1997

Strategies for assessing pain and pain exaggeration: controlled studies.

OBJECTIVE: To compare structured with intuitive methods of detecting exaggerated pain, in 2 randomized studies, with masked observers, and to compare properties of measures of relative tenderness, as surrogates for measures of pain. METHODS: Pairs of experienced rheumatologists assessed tenderness and behavior in subjects who were either giving honest responses (Not Acting) or exaggerating their tenderness while hiding the deception (Acting). In Study 1 (20 subjects) the assessments of behavior were descriptive only; for Study 2 (25 subjects) a prestructured format was developed. The challenge to the examiners was to detect Acting. The challenge to the analyst was to develop, from the recorded data, an algorithm that described or bettered the examiners' performance. RESULTS: By exaggerating, nontender patients could meet formal ACR criteria for fibromyalgia. The addition of a prestructured pain behavior assessment in Study 2 was associated with improvement in the observers' ability to detect Acting, with improvement of sensitivity from 60 to 90% (p = 0.0003, Study 2 compared with Study 1). False positive diagnoses of Acting by the observers were uniformly uncommon, with specificity of 85 and 86% in the 2 studies. CONCLUSION: Formal numerical techniques are required and feasible for separately assessing the structural and psychogenic components of chronic pain.

Adult↗
PubMed1997

Balneotherapy in autoimmune disease.

The mechanisms of action of balneotherapy in the treatment of autoimmune disease are not sufficiently clear. Although this therapy does not replace but rather complements conventional drug therapy, it is certainly beneficial in suitable cases. Additional controlled studies are needed to delineate the mechanisms of actions and the effectiveness of balneotherapy in autoimmune disease.

Arthritis, Psoriatic↗