Elisabeth Aberer

Medical University of Graz, Gratz, Styria, Austria

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Publications (117)408.29 Total impact

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    ABSTRACT: Background To improve detection and follow-up of patients with systemic sclerosis, the German Network for Systemic Scleroderma (DNSS) was founded 2003 and comprise rheumatologists, dermatologists, pulmonologists and nephrologists from more than 40 medical centers. Renal crisis is rare but still a medical emergency in patients with SSc. Objectives Up to date, more than 3000 patients have been grouped into four descriptive disease subsets, i.e. limited cutaneous disease (lcSSc), diffuse cutaneous disease (dcSSc), overlap-syndrome and undifferentiated connective tissue disease (UCTD) with scleroderma features. Methods In this analysis, we have focused on renal crisis within the three main subsets, e.g. lcSSc, dcSSc and overlap-syndromes to identify baseline aspects, which are predictive for future SSc associated renal crisis. Results Recent analyses of up to now 3180 patients revealed that 56% of patients suffer from limited SSc (lcSSc), 34% from diffuse SSc (dcSSc) and 11% of patients were diagnosed with an overlap-syndrome. Eighteen patients developed a renal crisis (1.4%, 18/3180), while 10% (315/3180) were classified with kidney involvement and 8% (257/3180) with proteinuria. Of these, 66.7% (12/18) were diagnosed with the diffuse form of SSc, while just 27.8% (5/18) were diagnosed with lcSSc and 5.6% (1/18) with SSc-overlap syndromes. Predictive factors for renal crisis in our patient cohort included the diffuse form of SSc (odds ratio (OR) 4.6, p=0.005, 95%>confidence interval (CI) 1.6-13.5), a modified Rodnan skin score (mRSS) of more than 15 (OR 4.7; p=0.002, 95%>CI 1.7-13), positive anti-RNA polymerase (RNAP) autoantibodies (OR 24.6, p<0.0001, 95%>CI 6.1-99.5), tendon friction rubs (OR 5.4, p=0.004, 95%>CI 1.7-16.9), hypertension (OR 6.1, p<0.0001, 95%>CI 2.3-16.5), proteinuria (OR 11.8, p<0.0001, 95%>CI 4.3-32.1) and elevated CK-levels (OR 5.1, p=0.01, 95%>CI 1.4-18.9). Interestingly, positive anti-topoisomerase autoantibodies did not predict a higher risk for renal crisis. Patients diagnosed with renal crisis were significantly more frequent on ACE-inhibitors (61.1%, 11/18, p=0.001). Of these, 5 patients also suffered from proteinuria and 7 patients from hypertension. Patients on systemic glucocorticoids had also an increased risk to develop a renal crisis (OR 5.1, p=0.002, 95%>CI 1.8-14.3), independent of the dosage (> or <7.5mg/day). Conclusions Renal crisis has become a rare complication in SSc. The highest risk was associated with the detection of RNAP antibodies, followed by proteinuria, hypertension, tendon friction rubs, elevated CK-levels and a modified Rodnan skin Score above 15. Close monitoring of patients at high risk for SSc associated renal crisis is mandatory. Disclosure of Interest None declared
    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):819.2-819. DOI:10.1136/annrheumdis-2015-eular.4669 · 10.38 Impact Factor
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    ABSTRACT: Background and Objectives: Religious/spiritual (R-S) wellbeing is associated with higher vitality and lower depression scores. In this study we investigated strategies for disease coping and the role of religiosity/spirituality for well-being. Patients and methods: 149 patients (107 female), 44 of these with systemic sclerosis (SSc), 48 with lupus erythematosus (LE) and 57 with malignant melanoma stage I-II (MM) were interviewed by a self-developed questionnaire addressing concomitant circumstances and the multidimensional inventory for religious-spiritual well-being” (MI-RSWB). Results: Disease burden at the time of diagnosis is higher in LE-patients than in patients with SKL and MM. Acceptance of disease can be attained only after years in SKL and LE patients. The score of R-S wellbeing is significantly lower in LE patients compared to healthy controls. In LE, photosensitivity and joint pains are negatively associated with the ability to forgive. SSc patients with alterations of their face and lung involvement have increased religiosity. MM-patients show significantly higher values for transcendental hope. Conclusions: Lectures about disease and psychological assistance are the most important needs of patients. Despite the magnitude of disease burden, R-S coping does currently not play a significant role, but could be an important resource that should be addressed in future (Full paper in German Language).
    Journal der Deutschen Dermatologischen Gesellschaft 06/2015; · 2.05 Impact Factor
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    ABSTRACT: Patients with elevated basal tryptase (sBT) >15μg/L and anaphylaxis may have an underlying mastocytosis. A monoclonal mast cell activation syndrome (MMAS) with aberrant mast cells (MC) at extracutaneous sites has been described in patients with severe hypotension or anaphylaxis. Since MC in patients with elevated sBT might be altered in the skin as well, we studied MCs in normal neck skin in anaphylaxis and urticaria patients with elevated sBT. A mean of 93.1 (SD 19.1) MC/mm² was counted in normal neck skin in 14 patients with anaphylaxis, 84.0 (SD 13.6) in 7 patients with urticaria, 142.0 (SD 24.0) in 2 patients with eczema, 124.4 (SD 43.2) in 5 patients with systemic mastocytosis (SM) in comparison to autopsy skin (39.1 MC/mm², SD 12.4). In 5/14 (35.7%) of the anaphylaxis and 3/5 (60%) SM patients more than 25% of MCs were spindle shaped and expressed CD 25 antigen. We could show for the first time that the normal skin can harbour clonal MC in anaphylaxis patients. Analogous to the criteria for mastocytosis, we suggest a skin score criteria including an elevated number of MC, spindle shape, CD 25 expression, c-Kit mutation and sBT values >20μg/L. In patients with anaphylaxis and elevated sBT skin should be biopsied and, as with the approach for mastocytosis diagnosis in the bone marrow, MC should be analysed for their number, clonality and c-Kit mutation. This approach should be confirmed in further studies. Patients with aberrant skin MC should be handled as mastocytosis patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Allergy 04/2015; 70(7). DOI:10.1111/all.12634 · 6.03 Impact Factor
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    ABSTRACT: Purpose: To compare Borrelia-specific intrathecal antibodies by two different ELISAs, an immunoblot (IB) and CXCL13. Methods: Twenty-seven adults and 23 children with clinical symptoms compatible with NB were tested for Borrelia-specific intrathecal antibodies by flagellum ELISA-AI (flELISA), a recombinant ELISA-AI (rELISA) and by IB. Patients were classified according to the European Federation of Neurological Societies (EFNS) criteria as definite NB, possible NB, or non-NB. CSF CXCL13 levels were measured by ELISA. Results: Among 50 patients, definite NB was diagnosed with the rELISA-AI in 29 (58%) patients, confirmed by IB in 19/29 patients, with flELISA-AI in 17 (34%) patients, confirmed by IB in 15/17 patients, and with IB in 20 (40%) patients. CXCL13 was positive in 22 (44%) patients. In 4 of 8 patients with negative AI, IB showed many detectable bands both in the CSF and serum. Conclusions: The diagnosis of NB strongly relies on the used test method. The rELISA-AI test appears to be the most sensitive while the flELISA-AI is the least sensitive. However when the ELISA-AIs were confirmed by IB, different patients were identified as NB, while only 26% were identified by all performed test methods. There is a demand for standardized test methods with well-defined sensitivity and specificity to establish validated diagnostic criteria for NB including the use of the IB assay and CXCL13 as an additional non-Borrelia specific determinant in early NB.
    Journal of the Neurological Sciences 09/2014; 347(1-2). DOI:10.1016/j.jns.2014.09.027 · 2.47 Impact Factor
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    ABSTRACT: Background Systemic sclerosis (SSc) is a rare and potentially life threatening autoimmune disorder. The burden of disease compared to other dermatoses is unknown. The purpose of this study was to assess both the quality of life in patients with SSc and the variables that are associated with poor quality of life. Forty-one patients with systemic sclerosis (29 limited, 2 diffuse, 10 undifferentiated forms) were assessed with respect to their health status and compared to published data for the normal population, SSc patients from other studies, and patients with chronic skin diseases. Results For the most part, our SSc patients had better outcomes in all 8 dimensions of the SF-36 than SSc patients from other studies, and poorer scores than the healthy population and those with occupational contact dermatitis, ichthyosis, non-melanoma skin cancer, contact dermatitis, atopic eczema, chronic nail disease, vitiligo, health care workers with work-related disease, and those with other chronic skin diseases, but significantly better scores for mental health than those with nail disease, vitiligo, and health-care workers. Patients with atopic dermatitis, psoriasis and pemphigus had significantly poorer mean scores in social function and mental health than SSc patients. Patients with pemphigus were also significantly impaired in their physical and emotional roles. Patients with systemic lupus erythematosus (SLE) had the significantly poorest mean scores for QoL in all 8 domains except bodily pain and emotional role. Conclusion Besides SLE, SSc is one of the most severe chronic dermatologic diseases in terms of reduced QoL. Since SSc cannot be cured, treatment strategies should include therapeutic interventions such as psychotherapy, social support, physiotherapy, and spiritual care. Their beneficial effects could be studied in future.
    BMC Research Notes 09/2014; 7(1):594. DOI:10.1186/1756-0500-7-594
  • 41st Annual Meeting of the Arbeitsgemeinschaft-Dermatologische-Forschung; 03/2014
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    ABSTRACT: Background In the last years, it has been controversially discussed in the literature if smoking is associated with the activity of cutaneous lupus erythematosus (CLE) and the efficacy of antimalarial agents.Objectives To investigate the influence of smoking on disease severity and antimalarial treatment in patients with CLE using the Core Set Questionnaire of the European Society of Cutaneous Lupus Erythematosus (EUSCLE).MethodsA total of 1002 patients (768 female, 234 male) with different CLE subtypes were included in this cross-sectional study, which was performed in 14 different countries. Smoking behaviour was assessed by the EUSCLE Core Set Questionnaire and statistically analysed using an SPSS database. The results were correlated with the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the efficacy of antimalarial treatment.ResultsA high percentage (87.2%) of the 499 CLE patients, who have ever smoked, had already smoked by the date of their first diagnosis. Patients with intermittent CLE smoked significantly more often than patients with subacute CLE (p<0.05) and chronic CLE (p<0.05). The total CLASI activity and damage score of CLE patients was 6.6 ± 7.1 and 2.6 ± 4.3, respectively, and was higher in patients who have ever smoked than in non-smokers. Antimalarial treatment was successful in 84.3% of cases, with a significantly higher efficacy in non-smokers than in patients who have ever smoked (p<0.05). The total CLASI activity score was lower in CLE patients treated with antimalarials at the time point of the evaluation compared to untreated patients.Conclusion This multicentre analysis of 1002 CLE patients assessed by the EUSCLE Core Set Questionnaire statistically confirms that smoking influences CLE disease severity and the efficacy of antimalarial treatment.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 03/2014; DOI:10.1111/bjd.13006 · 4.28 Impact Factor
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    ABSTRACT: Elevated serum tryptase levels can be a sign of mastocytosis, which is a rare disease associated with systemic and/or skin manifestations. To investigate patients with elevated tryptase levels in regard to their underlying diseases, and to determine whether increased tryptase can be used as a diagnostic marker for underlying mastocytosis. In a retrospective study the data of 96 patients with serum tryptase levels higher than 15 μg/L were systematically analysed. In 48 patients control investigations for baseline tryptase were performed. Fifty-three of the 96 patients had tryptase levels ≥20 μg/L. A mere 16% of the 96 patients suffered from mastocytosis and had the highest tryptase levels (P < 0.001). The remaining patients had anaphylaxis (36%), urticaria and angioedema (26%), local reactions to insect bites (4%), drug reactions (3%), or miscellaneous diagnoses (15%). Only 16 of these had acute symptoms at tryptase investigation. In all, 48 patients had a follow up; in 7/48 patients with acute symptoms normal tryptase levels were seen at control investigations, but 41/48 (85%) patients showed continuously elevated tryptase levels >15 μg/L and in 30 patients (62%) even values >20 μg/L; 11 of these patients had anaphylaxis, five urticaria, five other diagnoses and nine patients mastocytosis. More than 50% of patients with non-mastocytosis such as urticaria and angioedema, drug or anaphylactic reactions repeatedly had tryptase levels higher than 20 μg/L. Since baseline tryptase >20 μg/L is a minor criterion for mastocytosis, these patients should be inspected for skin lesions of mastocytosis and receive a diagnostic body work-up for systemic mastocytosis including a bone marrow biopsy.
    Australasian Journal of Dermatology 02/2014; 56(1). DOI:10.1111/ajd.12146 · 1.11 Impact Factor
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    ABSTRACT: Systemic sclerosis (SSc)-overlap syndromes are a very heterogeneous and remarkable subgroup of SSc-patients, who present at least two connective tissue diseases (CTD) at the same time, usually with a specific autoantibody status. To determine whether patients, classified as overlap syndromes, show a disease course different from patients with limited SSc (lcSSc) or diffuse cutaneous SSc (dcSSc). The data of 3240 prospectively included patients, registered in the database of the German Network for Systemic Scleroderma and followed between 2003 and 2013, were analysed. Among 3240 registered patients, 10% were diagnosed as SSc-overlap syndrome. Of these, 82.5% were female. SSc-overlap patients had a mean age of 48±1.2 years and carried significantly more often 'other antibodies' (68.0%; p<0.0001), including anti-U1RNP, -PmScl, -Ro, -La, as well as anti-Jo-1 and -Ku antibodies.These patients developed musculoskeletal involvement earlier and more frequently (62.5%) than patients diagnosed as lcSSc (32.2%) or dcSSc (43.3%) (p<0.0001). The onset of lung fibrosis and heart involvement in SSc-overlap patients was significantly earlier than in patients with lcSSc and occurred later than in patients with dcSSc. Oesophagus, kidney and PH progression was similar to lcSSc patients, whereas dcSSc patients had a significantly earlier onset. These data support the concept that SSc-overlap syndromes should be regarded as a separate SSc subset, distinct from lcSSc and dcSSc, due to a different progression of the disease, different proportional distribution of specific autoantibodies, and of different organ involvement.
    Annals of the rheumatic diseases 01/2014; 74(4). DOI:10.1136/annrheumdis-2013-204487 · 10.38 Impact Factor
  • M Wiednig · C Beham-Schmid · B Kranzelbinder · Elisabeth Aberer
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    ABSTRACT: Background: Hypereosinophilic syndrome (HES) is defined as a high eosinophilic granulocyte count in peripheral blood and other tissues. It can be associated with clonal and non-clonal haematological neoplastic diseases. Methods: Here we present a patient with a 27-year history of pruritus, urticarial lesions, recurrent diarrhoea, depression and a monoclonal gammopathy in the setting of HES. Results: The patient presented with erythemas, disseminated plaques, papules and scaling. Eosinophils continuously increased from 14% in 2002 to 65% in 2011. Tryptase levels were >20 µg/l. Skin biopsies were unspecific. In the bone marrow biopsy 30% of eosinophilic differentiated precursors and 10% plasma cells were noticed. Skin and bone marrow initially not indicative for mast cell proliferation were investigated for clonal mast cell proliferation. By immunostaining, single tryptase-, CD117c- and CD25-positive mast cells were detected not only in bone marrow, but also in the skin. Molecular investigations revealed a D816V exon 17 mutation of the c-KIT gene in bone marrow and skin biopsies. Conclusion: In this patient HES was associated with high tryptase levels with 2 underlying clonal cell populations - IgGκ-positive plasma cells and single clonal mast cells with a high percentage of eosinophils in the bone marrow with symptoms of a clonal mast cell activation syndrome. Because of 3 minor criteria the patient finally fulfilled the criteria for systemic mastocytosis (according to the WHO). Patients with high tryptase levels and symptoms of mast cell activation syndrome should be investigated for clonal mast cell disease even in the absence of increased mast cells in the skin and bone marrow.
    Dermatology 08/2013; 227(1). DOI:10.1159/000351807 · 1.57 Impact Factor
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    ABSTRACT: Mastocytosis is a group of rare diseases characterized by abnormal expansion and accumulation of tissue mast cells in various organ systems. The disease can be divided into cutaneous and systemic variants. Although considered a rare pathologic condition, more and more patients are currently diagnosed as suffering from mastocytosis. The increasing incidence is best explained by enhanced awareness and improved diagnostics in the Western world. This has in turn created a need to establish optimal facilities for the diagnosis, management, and therapy of patients with mastocytosis. In 2002, the European Competence Network on Mastocytosis (ECNM) was established, with the aim to provide all available information to doctors and patients, and to improve management and therapy of mastocytosis in Europe. Within the ECNM, Centers of Excellence and Reference Centers have been defined and inaugurated. In addition, several countries established a local network of competence within the ECNM. In 2011, the Austrian Competence Network on Mastocytosis (AUCNM) was inaugurated. The AUCNM serves as an integral part and essential partner of the ECNM. In the current article, the structure, aims, achievements, and ongoing projects of the AUCNM are presented.
    memo - Magazine of European Medical Oncology 06/2013; 6(2). DOI:10.1007/s12254-013-0083-y
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    ABSTRACT: Systemic mastocytosis (SM) is a hematopoietic neoplasm characterized by pathologic expansion of tissue mast cells in one or more extracutaneous organs. In most children and most adult patients, skin involvement is found. Childhood patients frequently suffer from cutaneous mastocytosis without systemic involvement, whereas most adult patients are diagnosed as suffering from SM. In a smaller subset of patients, SM without skin lesions develops which is a diagnostic challenge. In the current article, a diagnostic algorithm for patients with suspected SM is proposed. In adult patients with skin lesions and histologically confirmed mastocytosis in the skin (MIS), a bone marrow biopsy is recommended regardless of the serum tryptase level. In adult patients without skin lesions who are suffering from typical mediator-related symptoms, the basal serum tryptase level is an important diagnostic parameter. In those with slightly elevated tryptase (15-30 ng/ml), additional non-invasive investigations, including a KIT mutation analysis of peripheral blood cells and sonographic analysis, is performed. In adult patients in whom i) KIT D816V is detected or/and ii) the basal serum tryptase level is clearly elevated (> 30 ng/ml) or/and iii) other clinical or laboratory features are suggesting the presence of occult mastocytosis, a bone marrow biopsy should be performed. In the absence of KIT D816V and other indications of mastocytosis, no bone marrow investigation is required, but the patient's course and the serum tryptase levels are examined in the follow-up.
    American Journal of Blood Research 05/2013; 3(2):174-180.
  • N Wutte · G Kovacs · A Berghold · H Reiter · W Aberer · E Aberer
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    ABSTRACT: B-cell derived molecules are involved in the pathogenesis of systemic sclerosis (SSc).(1) Recently, the B-cell activating factor BAFF was found to be increased in the skin and serum of SSc patients, correlating with disease activity, interleukin-6 (IL-6) and lung fibrosis in clinical trials.(2,3,4) CXCL13, another B-cell marker, responsible for the migration of B-cells to the site of inflammation(5,6) attracted by activated endothelial cells after endothelial cell damage, has not yet been investigated in systemic sclerosis. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 05/2013; 169(3). DOI:10.1111/bjd.12411 · 4.28 Impact Factor
  • Milana Surtov-Pudar · Elisabeth Aberer
    Journal der Deutschen Dermatologischen Gesellschaft 04/2013; 11(4):354-5. DOI:10.1111/ddg.12018_suppl · 2.05 Impact Factor
  • Milana Surtov-Pudar · Elisabeth Aberer
    Journal der Deutschen Dermatologischen Gesellschaft 01/2013; 11(4). DOI:10.1111/ddg.12018 · 2.05 Impact Factor
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    ABSTRACT: The aim of this prospective, cross-sectional, multicentre study performed by the European Society of Cutaneous Lupus Erythematosus (EUSCLE) was to investigate different therapeutic strategies and their efficacies in cutaneous lupus erythematosus (CLE) throughout Europe. Using the EUSCLE Core Set Questionnaire, topical and systemic treatment options were analysed in a total of 1002 patients (768 female and 234 male) with different CLE subtypes. The data were correlated with the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the criteria of the American College of Rheumatology for the classification of systemic lupus erythematosus. Sunscreens were applied by 84.0% of the study cohort and showed a high efficacy in preventing skin lesions in all disease subtypes, correlating with a lower CLASI activity score. Topical steroids were used in 81.5% of the patients, with an efficacy of 88.4%, whereas calcineurin inhibitors were only applied in 16.4% of the study population and showed an efficacy of 61.7%. Systemic agents including antimalarials and several immunomodulating drugs, such as systemic steroids and methotrexate, were used in 84.4% of the 1002 patients, particularly in cases of acute CLE. The CLASI activity and damage score was higher in treated CLE patients as compared to untreated patients, regardless of therapy with topical or systemic agents. In summary, preventive and therapeutic strategies of 1002 patients with different subtypes of CLE were analysed in this prospective, multicentre, Europe-wide study. Sunscreens were confirmed to be successful as preventive agents, and topical steroids showed a high efficacy, whereas antimalarials were used as first-line systemic treatment.
    Autoimmunity reviews 12/2012; DOI:10.1016/j.autrev.2012.10.005 · 7.93 Impact Factor
  • Article: Reply.
    Nadine Reiter · Elisabeth Aberer
    Journal of the American Academy of Dermatology 06/2012; 66(6):1005. DOI:10.1016/j.jaad.2012.02.028 · 4.45 Impact Factor
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    ABSTRACT: Borderline pulmonary arterial hypertension (PAH), characterized by a marked exercise-induced increase in pulmonary artery pressure (PAP) with normal resting values, may precede overt PAH in systemic sclerosis (SSc). We undertook the present study to investigate whether PAH treatment is safe in these patients and might attenuate hemodynamic progression. SSc patients with borderline PAH underwent right heart catheterization at baseline, after a 12-month observation period, and subsequently after 6 months of bosentan therapy. Changes in mean PAP at 50W during the observation period versus during therapy were compared. Ten patients completed the study. Mean PAP at rest, at 50W, and during maximal exercise increased significantly during the observation period (mean ± SD increases of 2.5 ± 3.0 mm Hg [P = 0.03], 4.0 ± 2.9 mm Hg [P = 0.002], and 6.8 ± 4.1 mm Hg [P = 0.0005], respectively) and tended to decrease during the treatment period (decreases of 2.5 ± 3.9 mm Hg [P = 0.07], 1.5 ± 4.5 mm Hg [P = 0.32], and 1.8 ± 7.0 mm Hg [P = 0.43], respectively). The changes during the observation period versus the therapy period were significantly different (P = 0.03 at rest, P = 0.01 at 50W [primary end point], and P = 0.02 during maximal exercise). The changes in resting pulmonary vascular resistance were also significantly different during the observation period (increase of 8 ± 25 dynes · seconds · cm(-5) ) versus during the therapy period (decrease of 45 ± 22 dynes · seconds · cm(-5) ) (P < 0.0005). Changes in resting pulmonary arterial wedge pressure were not significantly different between the observation period and the treatment period, despite the significant increase during the observation period (2.6 ± 2.5 mm Hg [P = 0.01]). No relevant adverse effects were reported. In SSc patients with borderline abnormal pulmonary hemodynamics, resting and exercise PAP may increase significantly within 1 year of observation. Bosentan might be safe and effective to attenuate these changes. Randomized controlled trials are warranted to confirm the exploratory findings of this hypothesis-generating pilot study.
    Arthritis & Rheumatology 04/2012; 64(4):1257-62. DOI:10.1002/art.33460 · 7.76 Impact Factor
  • R Mofarrah · W Aberer · E Aberer
    Journal of the European Academy of Dermatology and Venereology 02/2012; 27(2). DOI:10.1111/j.1468-3083.2012.04480.x · 2.83 Impact Factor
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    Elisabeth Aberer · Gerold Schwantzer
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    ABSTRACT: The early immune response (IR) in European Lyme borreliosis patients has not yet been studied in detail. The aim of the study was to analyse retrospectively the antibody development in 61 erythema migrans (EMs) patients depending on the duration of infection from tick bite by using a whole-cell lysate B. garinii immunoblot. The evolution of antibodies proved to be undulatory in untreated patients with two peaks for IgM at weeks 5 and 9 and for IgG at weeks 4 and 8. The analysis of IR courses after therapy identified patients constantly seropositive or seronegative and patients with repeated seroconversions with a switch, disappearance, or reappearance of anti-23 kD or anti-39 kD antibodies during the one-year period. We suggest that the antibody production in EM patients may be missed due to an undulatory IR. This phenomenon might be an as yet insufficiently researched aspect in Lyme borreliosis.
    01/2012; 2012. DOI:10.5402/2012/719821

Publication Stats

2k Citations
408.29 Total Impact Points


  • 2001–2015
    • Medical University of Graz
      • • Universitätsklinik für Dermatologie und Venerologie
      • • Clinical Institute of Medical and Chemical Laboratory Diagnostics
      Gratz, Styria, Austria
  • 1997–2008
    • Karl-Franzens-Universität Graz
      Gratz, Styria, Austria
  • 2000
    • Vienna General Hospital
      Wien, Vienna, Austria
  • 1985–1999
    • University of Vienna
      • Hygiene Institute
      Wien, Vienna, Austria
  • 1989
    • University of Texas at San Antonio
      San Antonio, Texas, United States