Paediatric multiple sclerosis: a case report of missed and dismissed diagnosis

Multiple Sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system (CNS). Up to 10 % of MS patients have onset in paediatric age group. Although the clinical profile of MS appears similar to that seen in adults, several features may differ and specific issues arise in children. Here, we reported a 12-year old girl who presented with 3-year history of episodes of seizures and facial nerve palsy and finally fatigue and cognitive impairment were noted and interfered with her academic performance. Because of the presumed atypical clinical presentations, the diagnosis was missed then dismissed despite neuroimaging features and CSF immunological findings that were highly suggestive of MS. Later, evolution of the disease by neuroimaging helped confirming the diagnosis and directed toward the delayed therapy.

The Clinicopathological Study of Lichen Planus

Introduction: Lichen planus is an unknown origin subacute or chronic inflammatory, autoimmune disease occurring mainly in the epidermal parts of the body such as skin. Apart from commonly arising on cutaneous surfaces, it was also shown affect the oral mucosa, genital mucosa, scalp, or nails. and significantly affect the life styles of the humans. Lichen planus lesions can be explained the six P's -planar [flat-topped], purple, polygonal, pruritic, papules, and plaques. Lichen planus is said to have no cure and only the symptoms can be relieved or healed. Since there are different types of Lichens planus, it is important to study the types in detail for proper treatment. Objective: The present study is aimed to explore the spectrum of lesions in Lichen Planus and its prevalence on the patients. Methodology: Out of 100 cases analyzed in our study, 84 cases were clinically analyzed as Lichen planus of which 80 cases were diagnosed to be Lichen planus both clinically and histopathologically and 4 cases were diagnosed as Lichenoid dermatitis (HPE). Results: The correlation of clinical and histopathological types of Lichen Planus Sex incidence is higher in females (55%), having the ratio of 1:1.2 with a male to the female. Duration of the disease ranged from 10 days to 8 years. Majority of the cases (73%) showed less than 3 months’ duration of the disease. Conclusion: Our study revealed that the successes of the therapeutic regimes are purely dependent on the types of the lichens and an urgent need to take severe action against it.

Rethink about the role of rheumatoid factor and anti-citrullinated protein antibody in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by joint inflammation and extra-articular manifestations. Many questions in the pathogenesis, clinical manifestation, and disease spectrum are answered after the discovery of the first autoantibody namely rheumatoid factor (RF). The finding of the second autoantibody named anti-citrullinated protein antibody (ACPA), which unearths the importance of protein citrullination process. It further provides the insight how immune cells and complement interact to perpetuate the inflammatory response. These two autoantibodies pave the way for our better understanding of RA. This review article focuses on the history, pathophysiology, and clinical association of these two autoantibodies in RA.

Vaccination of Patients with Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that affects various organs. SLE patients have an increased risk of infection compared to the general population. Immunosuppressive agents commonly used in SLE increase the risk of infection. Vaccination is a good way to reduce the risk of infection. However, some SLE patients are concerned that vaccination may worsen lupus disease activity or cause side effects. The latest SLE patient vaccination data were reviewed in this study, which focused on the safety, immunogenicity, and efficacy of influenza, pneumococcal, tetanus, hepatitis A, herpes zoster, and human papillomavirus vaccines. Korean immunization recommendations were also compared to those of other countries.

Multiple sclerosis: making the invisibles visible

Multiple sclerosis (MS), a chronic inflammatory autoimmune disease with its protean manifestations commonly present as motor weakness, diplopia, visual loss, sensory symptoms in limbs or face or even bladder and bowel dysfunction. Underneath the umbrella of these common symptoms many invisible, unpredictable and erratic symptoms persists which complicates both the clinical presentation and the treatment. As majority of these symptoms are subjective so their true assessment on objective ground is difficult. It is important to consider that patients with MS and their care-takers should have reasonable knowledge about these symptoms because if these symptoms go unidentified or untreated then they may lead to a difficult diagnostic dilemma hence complicates further management. The frequency and severity of these unusual symptoms at times raise a suspicion of other neurological diseases. The occurrence of any of these symptoms at times may be a sign of active disease.

Rare case of bilateral wrist and foot drop from SLE-related vasculitic polyneuropathy

Systemic lupus erythematosus (SLE) is a heterogeneous, chronic, inflammatory, autoimmune disease characterised by multiorgan involvement and the production of multiple autoantibodies. Neurological manifestations in SLE patients are frequently reported—the prevalence is 37%–90%. We present a unique case where the patient presented with bilateral wrist and foot drop for 4 days, which later led to the diagnosis of SLE-related vasculitic polyneuropathy. During the course of treatment, the patient received prednisone, rituximab and hydroxychloroquine. At 6-month follow-up, patient had reported significant improvement in her weakness with increased mobility in upper and lower extremities. Prompt diagnosis and treatment are necessary in these cases to prevent disease progression and morbidity.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. It is characterised by symmetrical joint involvement and extra-articular manifestations. Joint and periarticular tissue destruction occurs as a result of inflammation of the synovial joints, leading to functional impairment. Early diagnosis and treatment are the key to minimising the significant daily challenges experienced by patients and underpin more successful outcomes. This article will explore the recognition and management of RA in primary care, drawing on recently updated National Institute for Health and Care Excellence guidelines.

Long Non-Coding RNAs Target Pathogenetically Relevant Genes and Pathways in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease driven by genetic, environmental and epigenetic factors. Long non-coding RNAs (LncRNAs) are a key component of the epigenetic mechanisms and are known to be involved in the development of autoimmune diseases. In this work we aimed to identify significantly differentially expressed LncRNAs (DE-LncRNAs) that are functionally connected to modulated genes strictly associated with RA. In total, 542,500 transcripts have been profiled in peripheral blood mononuclear cells (PBMCs) from four patients with early onset RA prior any treatment and four healthy donors using Clariom D arrays. Results were confirmed by real-time PCR in 20 patients and 20 controls. Six DE-LncRNAs target experimentally validated miRNAs able to regulate differentially expressed genes (DEGs) in RA; among them, only FTX, HNRNPU-AS1 and RP11-498C9.15 targeted a large number of DEGs. Most importantly, RP11-498C9.15 targeted the largest number of signalling pathways that were found to be enriched by the global amount of RA-DEGs and that have already been associated with RA and RA–synoviocytes. Moreover, RP11-498C9.15 targeted the most highly connected genes in the RA interactome, thus suggesting its involvement in crucial gene regulation. These results indicate that, by modulating both microRNAs and gene expression, RP11-498C9.15 may play a pivotal role in RA pathogenesis.