Leukocyte-endothelial interactions in antineutrophil cytoplasmic antibody-associated systemic vasculitis.
ABSTRACT The etiology of ANCA-associated vasculitis is unknown. Currently, it is believed that disease may be triggered by infection with the release of proinflammatory cytokines in genetically susceptible individuals. Priming of PMNs and endothelial cells by these cytokines allows ANCAs to activate PMNs, with damage localized to the endothelium, resulting in early lesions. Damage and activation of endothelial cells produces proinflammatory chemokines and cytokines with influxes of monocytes and T cells that intensify endothelial damage. In the kidney, these changes eventually lead to crescent formation. Antigen-specific memory T cells persist after disease remission with the potential of reactivation and disease relapse. Although our understanding of the pathophysiologic mechanisms of ANCA-associated vasculitis is far greater now than when ANCAs were first identified in 1982, more experimental work in combination with clinical observations is required to further elucidate these mechanisms.
- Annals of the rheumatic diseases 06/2008; 67(5):723-4. · 8.11 Impact Factor
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ABSTRACT: To explore the effect of granisetron, a 5-HT3 antagonist, on fatigue and functional impairment in patients with chronic fatigue syndrome (CFS). Five female patients were eligible to receive oral granisetron for one month (1 mg a day for the first two weeks and 2 mg a day for the second two weeks). The patients had to be between 18 and 65 years of age and suffering from CFS according to the CDC criteria. The effect was assessed by pre- and post-testing, using validated instruments designed to assess the different dimensions of CFS. Treatment response was also evaluated by visual analogue scales (VAS) for fatigue. Analysis was based on intention to treat. Treatment with granisetron resulted in significant improvement in fatigue severity and functional impairment. Activity level showed no significant increase. The promising results of this study have encouraged us to perform a placebo-controlled, double-blind study to evaluate the efficacy of 5-HT3 receptor antagonists in the treatment of CFS.The Netherlands Journal of Medicine 10/2003; 61(9):285-9. · 2.38 Impact Factor
Article: The systemic vasculitides.[Show abstract] [Hide abstract]
ABSTRACT: Taken together, the systemic vasculitides constitute a small but significant component in the practice of many primary care physicians. Like most diseases with autoimmune aspects, the vasculitides increase in prevalence with age. Of paramount importance is careful differentiation, to provide early appropriate treatment and to monitor adverse effects.Hospital practice (Office ed.) 08/1992; 27(7):77-81, 85-6, 88.