pulmicort and Autoimmune-Diseases

Topics: Adrenal Cortex Hormones; Animals; Antibodies, Antineutrophil Cytoplasmic; Autoantigens; Autoimmune Diseases; Budesonide; Complement C5a; DNA Methylation; Drug Delivery Systems; Glomerulonephritis, IGA; HLA Antigens; Humans; Kidney Diseases

Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by biliary destruction, progressive cholestasis, and potentially liver cirrhosis. Patients develop a well-orchestrated immune reaction, both innate and adaptive, against mitochondrial antigens that specifically targets intrahepatic biliary cells. A puzzling feature of PBC is that the immune attack is predominantly organ specific, although the mitochondrial autoantigens are found in all nucleated cells. The disease results from a combination of genetic and environmental risk factors; however, the exact pathogenesis remains unclear. Serologically, PBC is characterized by presence of antimitochondrial antibodies, which are present in 90-95 % of patients and are often detectable years before clinical signs appear. Like other complex disorders, PBC is heterogeneous in its presentation, symptomatology, disease progression, and response to therapy. A significant number of patients develop end-stage liver disease and eventually require liver transplantation. Recent studies from large international cohorts have better identified prognostic factors, suggesting a change in patient management based on risk stratification. Therapeutic options are changing. In this review we discuss data on the autoimmune responses and treatment of the disease.

Topics: Anti-Inflammatory Agents; Autoimmune Diseases; Biopsy; Budesonide; Chenodeoxycholic Acid; Cholagogues and Choleretics; Cholangitis; Fibric Acids; Humans; Immunosuppressive Agents; Liver; Prognosis; Ursodeoxycholic Acid

Primary biliary cirrhosis (PBC) is a chronic autoimmune liver disease mostly seen in middle-aged women characterized by progressive nonsuppurative destruction of small bile ducts resulting in intrahepatic cholestasis, parenchymal injury and ultimately end-stage liver disease. Despite major breakthroughs in our understanding of PBC, there remains only one FDA-approved agent for treatment: ursodeoxycholic acid (UDCA) to which one-third of patients are unresponsive.. Biochemical response to treatment with UDCA is associated with excellent survival rates in PBC patients. However, there is a need for alternative treatments for nonresponders. Results from human epidemiological and genetic studies as well as preclinical studies in PBC animal models have provided a strong impetus for the development of new therapeutic agents. In this review, we discuss the recent advances in translational research in PBC focusing on promising therapeutic approaches, namely immune-based targeted therapies and agents targeting the synthesis and circulation of bile acids.. We are in a new era for the development of novel therapies for PBC. Data on fibrates, budesonide and obeticholic acid offer encouragement for nonresponders to UDCA.

Topics: Autoimmune Diseases; Bile Acids and Salts; Budesonide; Chenodeoxycholic Acid; End Stage Liver Disease; Female; Fibric Acids; Humans; Liver; Liver Cirrhosis, Biliary; Receptors, Cytoplasmic and Nuclear; Signal Transduction; Treatment Failure; Ursodeoxycholic Acid

Collagenous colitis belongs to the group of microscopic colitis. The aetiology and pathogenesis are unknown but different pathogenic hypothesis, autoimmune, infectious, alimentary and medicinal being are advanced, the last one being the most frequent aetiology. The collagenous gastritis is a rare entity and its association with collagenous colitis was exceptionally reported, only six cases being published. We report the seventh case of collagenous gastritis, ileitis and colitis in a 75-year-old woman with chronic diarrhea and important weight loss. This thickened subepithelial collagen band was appeared in an autoimmune injury context with antecedent of Hashimoto's thyroiditis and probably chronic atrophic Biermer's gastritis. The clinical and histological evolution was favourable with budesonide.

Topics: Aged; Anti-Inflammatory Agents; Autoimmune Diseases; Budesonide; Colitis, Collagenous; Collagen; Female; Gastric Mucosa; Gastritis; Hashimoto Disease; Humans; Ileitis

Topics: Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents; Autoimmune Diseases; Azathioprine; Budesonide; Cyclosporins; Diagnosis, Differential; Drug Therapy, Combination; Female; Hepatitis; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Prednisolone; Pregnenediones; Prognosis; Tacrolimus; Time Factors

BACKGROUND There is a recognized association between inflammatory bowel disease (IBD) and hepatobiliary autoimmune disease, particularly primary sclerosing cholangitis (PSC). There have been fewer reported cases of IBD and primary biliary cholangitis (PBC), which is treated with ursodeoxycholic acid (UDCA). This report presents the case of a 60-year-old woman with PBC who was diagnosed with Crohn's ileitis after suspension of UDCA treatment. CASE REPORT A 66-year-old female patient with PBC was admitted to our department for irrepressible chronic diarrhea and recurrent abdominal pain. PBC was diagnosed on the basis of serological data: chronic (>6 months) increase in alkaline phosphatase (ALP) associated with positivity for specific anti-nuclear antibodies (sp100 and gp210), without requiring a liver biopsy and a magnetic resonance cholangiopancreatography to rule out PSC. Given the intolerance and non-responsiveness according to the Toronto criteria (ALP <1.67 times the normal limit after 2 years) to UDCA at 15 mg/kg/day, an oral monotherapy treatment using obeticholic acid at 5 mg/day was prescribed. The patient complained of abdominal pain and upper gastrointestinal symptoms. The endoscopic/histologic and radiologic examinations supported the diagnosis of Crohn's ileitis. Given the potential benefits to PBC patients of what is described as off-label therapy, budesonide at a dosage of 9 mg/day p.o. was also administered. One month after discharge, an improvement was observed both in the cholestasis indices and in gastrointestinal symptoms. CONCLUSIONS This report presents a case of PBC in which the patient was diagnosed with Crohn's ileitis after cessation of treatment with UDCA, and highlights the importance of recognizing the association between autoimmune hepatobiliary disease and IBD.

Topics: Abdominal Pain; Aged; Alkaline Phosphatase; Autoimmune Diseases; Budesonide; Crohn Disease; Female; Humans; Ileitis; Inflammatory Bowel Diseases; Liver Cirrhosis, Biliary; Middle Aged; Ursodeoxycholic Acid

Topics: Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Autoimmune Diseases; Budesonide; Chemical and Drug Induced Liver Injury; Female; Glucocorticoids; Humans; Liver Function Tests; Melanoma; Nivolumab; Treatment Outcome

Autoimmune disorders (AID) have been shown to be associated with chronic antibiotic-refractory pouchitis (CARP). The role of anti-microsomal antibodies in ileal pouch disorders has not been investigated. The aims of the study were to investigate the prevalence of positive anti-microsomal antibody in symptomatic patients with ileal pouches and to investigate its clinical implications.. A total of 118 consecutive symptomatic patients with ileal pouches were included between January and October 2010. Anti-microsomal antibodies were measured at the time of presentation. Demographic, clinical, and laboratory characteristics were compared between patients with positive and negative anti-microsomal antibody.. There were 14 patients (11.9%) with positive serum anti-microsomal antibody. The mean age of patients in the antibody positive and negative groups were 41.8 ± 14.4 and 42.0 ± 14.0 years, respectively (p = 0.189). All 14 patients in the antibody positive group (100%) had some form of AID, as compared to 20 patients (19.2%) in the antibody negative group (p < 0.001). Four (28.6%) patients in the antibody positive group had at least one AID in addition to Hashimoto's thyroiditis in contrast to four (3.8%) in the antibody negative group (p = 0.003). In addition, five (35.7%) patients had associated primary sclerosing cholangitis (PSC) in the antibody positive group compared to nine (8.7%) in the antibody negative group (p = 0.012). Eleven patients (78.6%) in the antibody positive group required steroids for treatment of pouch related symptoms in contrast to 26/104 (25%) patients in the antibody negative group (p = 0.002).. Anti-microsomal antibodies were common in pouch patients presenting with symptoms. Patients with positive anti-microsomal antibodies were much more likely to have concurrent AID and PSC. These patients were more likely to require therapy with steroids.

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Autoantibodies; Autoimmune Diseases; Budesonide; Cholangitis, Sclerosing; Crohn Disease; Drug Resistance, Bacterial; Female; Hashimoto Disease; Humans; Male; Middle Aged; Pouchitis

Topics: Aged; Antiviral Agents; Autoimmune Diseases; Budesonide; Diarrhea; Endoscopy, Gastrointestinal; Glucocorticoids; Hepatitis C, Chronic; Humans; Interferon-alpha; Male; Prednisone

Topics: Anti-Inflammatory Agents; Autoimmune Diseases; Budesonide; Cholagogues and Choleretics; Cholangitis, Sclerosing; Cholestasis, Intrahepatic; Disease-Free Survival; Drug Therapy, Combination; Humans; Liver Cirrhosis, Biliary; Liver Function Tests; Liver Transplantation; Syndrome; Ursodeoxycholic Acid

Topics: Anti-Inflammatory Agents; Autoimmune Diseases; Budesonide; Humans; Liver Cirrhosis, Biliary; Randomized Controlled Trials as Topic; Ursodeoxycholic Acid