Alfacalcidol treatment restores derailed immune-regulation in patients with undifferentiated connective tissue disease

Abstract

Avascular or aseptic necrosis is a well-defined entity leading to the degradation of cellular elements of the bone. The pathogenesis of osteonecrosis (ON) is still unknown. There are two main types of ON: traumatic or nontraumatic. Several clinical entities could associate with ON, systemic diseases, environmental factors, pregnancy, systemic autoimmune or rheumatic diseases, thrombophilia, corticosteroid therapy, cytotoxic dugs, infections, metabolic and hematologic diseases, etc. Corticosteroids (CS) are still the most frequently used therapeutic options in the early phase and during flares of these diseases. Inflammatory cytokines and antibodies have been described to participate in the pathogenesis of ON. The infiltrative disorders of the bone marrow could also contribute to the development of ON. Hereby, we describe a female patient with NHL followed by SLE in whom ON has developed at least in two localisations. Lupus flare, long-term CS therapy, lymphoma relapse or the presence of antiphospholipid antibodies were excluded. Although the bi-localised ON could be contributed to immunologic factors or trauma, the exact aetiology in this case could not be elucidated.Keywords Antiphospholipid antibodies . Aseptic necrosis . Corticosteroid . NHL . SLE Avascular or aseptic necrosis is a well-defined entity leading to the degradation of cellular elements of the bone. The pathogenesis of osteonecrosis (ON) is still unknown. There are two main types of ON: traumatic or non-traumatic. Several clinical entities could associate with ON, systemic diseases, environmental factors, pregnancy, systemic autoimmune or rheumatic diseases, thrombophilia, corticosteroid therapy, cytotoxic dugs, infections, metabolic and hematologic diseases, etc. There are some systemic autoimmune diseases, such as systemic lupus erythaematosus (SLE), antiphospholipid syndrome (APS) and vasculitis which may associate more frequently with ON than others (1). Corticosteroids (CS) are still the most frequently used therapeutic options in the early phase and during flares of these diseases (2). Inflammatory cytokines and antibodies have been described to participate in the pathogenesis of ON. The infiltrative disorders of the bone marrow could also contribute to the development of ON; however, in non-Hodgkin's lymphomas (NHL), no clear association with ON have been shown previously (1). Hereby, we describe a female patient with NHL followed by SLE in whom ON has developed at least in two localisations. Lupus flare, long-term CS therapy, lymphoma relapse or the presence of antiphospholipid antibodies were excluded. Although the bi-localised ON could be contributed to immunologic factors or trauma, the exact aetiology in this case could not be elucidated.We report a case of a 32-year-old Caucasian woman with large B cell mediastinal NHL treated with radiotherapy and autologous bone marrow transplantation. Following the therapy, she got in remission. Later, at the age of 40, she complained for fever and polyarthritis. The relapse of the NHL was...

Relationship Between Serum 25 Hydroxy Vitamin D Levels and Disease Activity in Patients with Rheumatoid Arthritis

“…[15] tarafından yapılan bir derlemede de, ankilozan spondilit hastalarında serum D vitamini düzeylerini inceleyen çalışmaların önemli bir kısmında hastalık aktivitesi ile serum D vitamini seviyeleri arasında ters yönde anlamlı ilişki saptanmıştır. Romatoid artritli hastalarda eklem hasarı progresyonunun mevsimsel değişiklikler gösterdiği ve alfa-kalsidiol replasmanının proinflamatuvar hücrelerin proliferasyonunu ve bu hücrelerin sitokin üretimini azalttığı gösterilmiştir [20] . D vitamini analogları ile yapılan tedavilerin romatoid artrit hastalarında hastalık aktivitesini azalttığı başka çalışmalarda da göste-rilmiştir [21] .…”

T helper cell subsets in arthritis and the benefits of immunomodulation by 1,25(OH)2 vitamin D

“…A recent study of the potential beneWt of alfacalcidol in undiVerentiated connective tissue disorders also conWrmed beneWt [63]. This suggests that vitamin D treatment may be useful in other autoimmune conditions.…”

Állásfoglalás

“…Humán autoimmun kórképek között debreceni kutatók elsőként vizsgálták a Dvitamin im munregulatorikus hatását. A poliszisztémás autoim mun kórképek előfázisában, a nem differenciált colla genosisban három különböző dózisban (0,5 µg/nap, 1 µg/nap, 1,5 µg/nap) alkalmazott alfakalcidolke zelés közül az 1 µg/nap alfakalcidol adása bizonyult a leghatásosabnak, ami csökkentette a CD4+ Tsejtek IFNγexpresszióját és az IL17 citokin szintjét [105,106].…”