Angela Pakozdi

• MD PhD
• Consultant at Barts Health NHS Trust

Background/Aims Varying rates of non-adherence to medication have been previously reported in lupus studies. The purpose of this evaluation was to assess adherence, and the factors associated with non-adherence in our multi-ethnic lupus cohort. Methods Data were collected from consecutive patients in a tertiary lupus outpatient centre between Nove...

Background Systemic lupus erythematous is a chronic autoimmune disease of unknown etiology. It predominantly presents in women of child-bearing age. The limited research available suggests that men with lupus are diagnosed at an older age compared to women, have a greater burden of end organ disease and a higher mortality. Objectives To examine th...

Background/Aims Systemic lupus erythematous (SLE) is a chronic autoimmune (AI) disease of unknown etiology. It predominantly presents in women and only 1 in 10 of sufferers are men. We sought to examine the clinical pattern in male lupus patients in a tertiary multi-ethnic lupus centre in East London, UK. Methods Male lupus patients were identifie...

Objective Patients with systemic lupus erythematosus (SLE) on immunosuppression have increased risk of human papillomavirus virus (HPV) infection, which causes premalignant cervical changes and cervical cancer. In the UK, females are invited from the age of 25 for cervical screening (CS).¹ HPV vaccination has been recommended with a 3-dose schedule...

Objectives Low health literacy (HL) is associated with worse clinical outcomes. ?In systemic lupus erythematosus (SLE) this has not been extensively studied, particularly in the United Kingdom. We sought to evaluate the health literacy in patients with lupus nephritis (LN) in a deprived area of East London. Methods Health literacy in patients with...

Objective The risk of progression to end stage kidney disease (ESKD) following identification of Lupus nephritis (LN) is 10–30 %, this risk has remained unchanged for decades. The landmark BLISS-LN trial led to belimumab being the first FDA approved drug for patients with active LN. We present our case series of LN patients treated with belimumab a...

Objective To examine the clinical pattern in male lupus patients in a tertiary multi-ethnic lupus centre in East London, UK. Methods Male lupus patients were identified through review of a pre-existing database of lupus patients and clinic lists at Barts Trust. All patients’ electronic notes were reviewed prior to a telephone interview. All the pa...

Background/Aims The immune response to SARS-CoV-2 is known to be reduced in the immunocompromised. However, extent to which immunity is affected by immunosuppression in specific disease cohorts remains poorly characterised. Furthermore, implications of the ongoing vaccination booster programme require further study. Individuals with lupus nephritis...

Background We aimed to evaluate the use of baricitinib, a Janus kinase (JAK) 1–2 inhibitor, for the treatment of patients admitted to hospital with COVID-19. Methods This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple possible treatments in patients hospitalised with...

Background Casirivimab and imdevimab are non-competing monoclonal antibodies that bind to two different sites on the receptor binding domain of the SARS-CoV-2 spike glycoprotein, blocking viral entry into host cells. We aimed to evaluate the efficacy and safety of casirivimab and imdevimab administered in combination in patients admitted to hospit...

Background Aspirin has been proposed as a treatment for COVID-19 on the basis of its anti-thrombotic properties. We aimed to evaluate the efficacy and safety of aspirin in patients admitted to hospital with COVID-19. Methods In this randomised, controlled, open-label, platform trial, several possible treatments were compared with usual care in pa...

Background Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVER...

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients ho...

Background/Aims Neutropaenia occurs in 20-40% of patients with systemic lupus erythematosus (SLE) and is attributed to a combination of autoimmune and complement-mediated destruction of white cells, increased neutrophil apoptosis and medication side-effects. Commonly when patients become neutropaenic (<2x10^9/L), immunosuppressant doses are reduce...

Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECO...

Background Modern biologic therapies have demonstrated encouraging results in the treatment of axial spondylarthropathy (AxSpA). The benefits of interleukin-17 inhibitors (IL-17i), as first and second line therapies, are well established [1, 2]. A systematic literature review by Navarro-Compán has shown some benefit of second line therapies using b...

Background Systemic lupus erythematous (SLE) is a multi-system autoimmune disease which has a relapsing and remitting course. Patients with lupus nephritis (LN) are at risk of relapse and hence long term follow up and disease monitoring are of particular importance. Anti-C1q antibodies (C1Q Ab) are observed in 30-60% of patients with SLE. It has be...

Background Patients with lupus nephritis (LN) are at risk of relapse and hence long term disease monitoring is required. Here we undertook a prospective follow up of patients after having Anti-C1q antibodies (C1Q Ab) measurement to determine whether the result predicted a flare of LN. Methods SLE patients attending an Inner-City Lupus Center, were...

Introduction A 32-year-old man presented to rheumatology clinic with a 2-year history of progressively worsening right temporal headache, a painful hard lump on his right temple and pre-auricular tenderness not responding to conventional analgesics. Patient denied any jaw and tongue claudication. His vision was not compromised and patient denied we...

Background Genetic studies have identified a single UBE2L3 risk haplotype which is associated with SLE and multiple autoimmune diseases, and leads to increased expression of UBE2L3 in eQTL studies. The E2 ubiquitin-conjugating enzyme UBE2L3 regulates NF-κB activation through regulation of the Linear Ubiquitination Chain Assembly Complex (LUBAC). Th...

Background A number of studies have implicated psychological stress as a trigger for autoimmune diseases. In a questionnaire study involving 120 lupus patients emotional stress was selected in over 75% cases as a trigger for their disease¹. The role of stress as a trigger in lupus however is controversial. Here we study whether there is an associat...

Background Biologic therapies have improved the physical well-being of patients with Inflammatory arthritis. However, there remains a lack of emphasis on addressing patients’ psycho-social needs in routine rheumatology practice. Objectives The aim of this study was to explore the unmet psychological, emotional and social needs of inflammatory arth...

Background Chronic hepatitis B virus (HBV) infection remains a significant global health problem. In high endemic areas like African and Asian countries, most infections occur from vertical transmission, whilst in western countries HBV is primarily acquired in adulthood. Either way, HBV can persist in infected hepatocytes lifelong, even if undetect...

Background A number of studies have implicated psychological stress as a trigger for autoimmune diseases. In a questionnaire study involving 120 lupus patients emotional stress was selected in over 75% cases as a trigger for their disease.¹ The role of stress as a trigger in lupus however is controversial. Here we study whether there is an associat...

Background Over the last decade the rise in social media use has been almost exponential. There are numerous online platforms where patients can interact for support and information gathering. A study presented at the ACR in 2013 showed lupus patients were willing to participate in Facebook chats for the purposes of disease education.¹ We sought to...

Introduction Randomized controlled trials (RCTs) are considered the gold standard for assessing treatment efficacy. However, sampling bias can affect the generalization of results to routine clinical practice. Here we assessed whether patients with lupus nephritis (LN) seen in routine clinical practice would have satisfied entry criteria to the maj...

Background.: The role of repeat renal biopsy in lupus nephritis (LN) to guide treatment or predict prognosis has been controversial. We assessed glomerular and tubulointerstitial histological characteristics of serial renal biopsies, correlations with clinical variables and the impact on subsequent management. Methods.: Out of a large single-cen...

Objective: To assess treatment responses and long-term outcomes in a multiethnic lupus cohort with proliferative lupus nephritis (LN) from a single United Kingdom (UK) center. Methods: 86 lupus patients were diagnosed with active proliferative LN between 1995 and 2015 at Barts Health, a large inner city hospital in London, UK. They were grouped by...

Tumour necrosis factor (TNF) inhibitors have been shown to possess a wide range of beneficial effects other than reducing inflammation. Most of those have been recognised indirectly during observational and clinical trials that studied the anti-inflammatory effects of the drugs. Patients appreciate greatly when fatigue and depression improve once t...

Background and objectives Lupus nephritis (LN) is the major cause of morbidity and mortality in patients with systemic lupus erythematosus. The role of repeat kidney biopsies (RB) to guide treatment or to predict outcome and prognosis has been controversial. In this retrospective study we focused on histological characteristics of RBs and aimed to...

Background Although bone and joint manifestations are common in children with cystic fibrosis (CF), they have received little attention in adults. CF-related arthropathy (CFA) is a relatively infrequent complication previously reported to be present in 2-8.5% of the CF population. It usually affects the large joints with recurrent episodes of swell...

To determine the prevalence of systemic sclerosis (SSc) overlap syndrome and autoantibody profile in a large single-center cohort. SSc diagnoses, subsets, and autoantibody profiles were obtained from clinical records of patients attending the Centre for Rheumatology, Royal Free Hospital, between September 1999 and February 2007. In total, 332 (20%)...

Vasculogenesis is the generation of vessels from endothelial progenitor cells (EPCs). Attenuated numbers and function of EPCs associated with defective vasculogenesis are present in rheumatoid arthritis (RA), scleroderma and other autoimmune-inflammatory diseases, which have significant relevance for increased cardio-and cerebrovascular morbidity a...

In rheumatoid arthritis, chemokines mediate the migration of inflammatory leukocytes into the synovium. Among the four known chemokine families, CXC, CC chemokines and fractalkine seem to be of outstanding importance in this process. Angiogenesis, the formation of new vessels, is also important during the perpetuation of inflammation underlying rhe...

Regulation of IL-6 transsignaling by the administration of soluble gp130 (sgp130) receptor to capture the IL-6/soluble IL-6R complex has shown promise for the treatment of rheumatoid arthritis (RA). However, enhancing endogenous sgp130 via alternative splicing of the gp130 gene has not yet been tested. We found that epigallocatechin-3-gallate (EGCG...

Leukocyte infiltration into the rheumatoid arthritis (RA) synovium is a multistep process in which leukocytes leave the bloodstream and invade the synovial tissue (ST). Leukocyte transendothelial migration and adhesion to RA ST requires adhesion molecules on the surface of endothelial cells and RA ST fibroblasts. This study was undertaken to invest...

Monocyte recruitment by proinflammatory cytokines is a hallmark of rheumatoid arthritis (RA). Lewis(y-6) and H (Le(y)/H) are blood group antigens up-regulated on RA synovial endothelium. We have previously shown that both soluble Le(y)/H and a glucose analog of H, H-2g, are angiogenic and mediateleukocyte-endothelial adhesion via induction of inter...

Survival analysis of a series of 366 consecutive patients with systemic sclerosis (SSc). Clinical and laboratory data were evaluated from 1983 until 2005 using a standard protocol. The female/male ratio was 315/51. The mean (SD) age of the patients was 56.8 (12.2) years. The duration of disease was 12 (5-19) years with a median follow-up of 6 (3-12...

Interleukin-13 (IL-13) is a pleiotropic cytokine that can affect vessel formation, an important component of the rheumatoid arthritis (RA) synovial tissue pannus. The purpose of this study was to use a gene therapy approach to investigate the role of IL-13 in angiogenesis in vivo, using a rat adjuvant-induced arthritis model of RA. Ankle joints of...

Interleukin-18 (IL-18) is a proinflammatory cytokine implicated in the pathogenesis of rheumatoid arthritis (RA). This study was undertaken to examine the role of IL-18 in up-regulating secretion of the angiogenic factors stromal cell-derived factor 1alpha (SDF-1alpha)/CXCL12, monocyte chemoattractant protein 1 (MCP-1)/CCL2, and vascular endothelia...

Rheumatoid arthritis (RA) is commonly associated with decreased bone mineral density (BMD) due to numerous factors. BsmI polymorphism of the vitamin D receptor (VDR) gene has been implicated in the pathogenesis of osteoporosis. Vitamin D has several immunomodulatory effects and thus may play a role in the course of arthritis. However, little data i...

To evaluate the efficacy of epigallocatechin-3-gallate (EGCG), a potent antiinflammatory molecule, in regulating interleukin-1beta (IL-1beta)-induced production of the chemokines RANTES (CCL5), monocyte chemoattractant protein 1 (MCP-1/CCL2), epithelial neutrophil-activating peptide 78 (ENA-78/CXCL5), growth-regulated oncogene alpha (GROalpha/CXCL1...

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by destruction of bone and cartilage, which is mediated, in part, by synovial fibroblasts. Matrix metalloproteinases (MMPs) are a large family of proteolytic enzymes responsible for matrix degradation. Macrophage migration inhibitory factor (MIF) is a cytokine that induces th...

The authors describe a case of an 38-year-old woman suffering from a parasitical infection which is rare in Hungary. It was diagnosed in connection with a surgical liver segment resection. Visceral larval migrans is an infection caused by migration of the roundworm Toxocara larvae to organs and tissues. The authors describe the pathophysiology of t...

Background Genetic polymorphisms, such as the polymorphisms of vitamin D receptor (VDR) and oestrogen receptor (ER) genes play an important role in bone metabolism and the pathogenesis of osteoporosis. Little is known about the role of VDR and ER gene polymorphisms in rheumatoid arthritis (RA), although hormonal factors are highly involved in the e...