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Lumps and lesions
Published in Manu Shah, Ariyaratne de Silva, The Male Genitalia, 2018
Manu Shah, Ariyaratne de Silva
Molluscum contagiosum is a viral infection that may present on the genitals. As with scabies, most cases are spread by non-sexual contact. However, when lesions arise on the genitals alone, the probability is that they are sexually transmitted. The virus is the molluscum contagiosum virus (MCV) which is a large DNA virus belonging to the molluscipox genus. Giant lesions may occur in patients with HIV and the presence of lesions may reflect immune deficiency (see Chapter 10, page 107). No accurate data exists on incidence of sexually acquired molluscum contagiosum.
Station 2: History Taking
Published in Saira Ghafur, Parminder K Judge, Richard Kitchen, Samuel Blows, Fiona Moss, The MRCP PACES Handbook, 2017
Saira Ghafur, Parminder K Judge, Richard Kitchen, Samuel Blows, Fiona Moss
Blood tests: Full blood count (FBC) (including mean cell volume [MCV]), urea and electrolytes (U&Es), liver function tests (LFTs) (including gamma-glutamyl transpeptidase [GGT]), vitamin B12 and folate, glucose, thyroid function tests (TFTs), autoimmune screen and immunoglobulins, hepatitis screen, HIV screen, Lyme serology, syphilis serology
Practice Paper 3: Questions
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
A 55-year-old woman with a long history of rheumatoid arthritis is shown to have an Hb concentration of 10.5 g/dL, an MCV of 80 fL and a raised ferritin level. Her arthritis is treated only symptomatically with paracetamol.
Objective and noninvasive biochemical markers in rheumatoid arthritis: where are we and where are we going?
Published in Expert Review of Proteomics, 2021
Anne C. Bay-Jensen, Anne Sofie Siebuhr, Dres Damgaard, Patryk Drobinski, Christian Thudium, Joachim Mortensen, Claus H Nielsen
In recent years, an increasing body of evidence has revealed that post–translational protein modifications (PTMs), including citrullination, carbamylation and acetylation, may trigger autoimmunity in RA [21-23]. Citrullination is the best described PTM in the field and the one most specific to ACPAs, with a prevalence of 70% in RA patients [24]. The anti-CCP-2 antibody test identified RA patients with 66–74% sensitivity and 95–100% specificity [16,25]. Autoantibodies that recognize citrullinated vimentin (anti-Sa) and mutated citrullinated vimentin (anti-MCV) have also demonstrated relatively high diagnostic potential [16,25]. Anti-Sa antibodies show low sensitivity (37%) but high specificity (97%), while anti-MCV antibodies show high sensitivity (61%) and 100% specificity. Citrullinated keratin has been shown to be a potent autoantigen in RA, leading to the generation of anti-keratin antibodies (AKAs) that can identify RA patients with a sensitivity of 48–68% and a specificity of up to 98% [26,27]. Likewise, the detection of anti-citrullinated fibrinogen antibodies (ACFAs) has also demonstrated high diagnostic capacity [28]. In a recent meta-analysis. Dai et al. found that ACPA detection has a mean sensitivity and specificity of 61% and 98%, respectively, for the identification of RA patients [29]. Antibodies directed against citrullinated telopeptides of type I and II collagen may also have predictive value for the development of seropositive RA with a sensitivity of 41–47% and a specificity of 94–96% [30,31].
British Journal of Biomedical Science in 2020. What have we learned?
Published in British Journal of Biomedical Science, 2020
More traditional biomarkers have also been investigated. In issue 1 the involvement of autoantibodies in RA. This is a chronic systemic autoimmune disease with a global prevalence of 0.51%. It is characterised by inflammatory lesions in synovial tissue which develop quickly (75% of cases within 2 years) leading to joint destruction and function with ensuing disability [66]. The pathogenesis of the disorder has yet to be defined; however various cytokines and inflammatory mediators have been implicated [67]. Early diagnosis of the disease is complicated by the diverse nature of the disorder and a lack of a good early serological marker, but is clearly important. Huang and colleagues [68] investigated a series of markers known to be raised in RA, namely high-mobility group box-1 (a DNA chaperone that acts as a proinflammatory cytokine), anticitrullinated peptide antibodies (anti-CCP) which are the most specific for RA and predict joint damage, rheumatoid factor (RF, widely used in clinical practice), anti-mutated citrullinated vimentin antibodies (anti-MCV) and a new marker serum 14-3-3η which is highly specific and related to the severity of the disease. Despite this battery of markers there has been little comparison of their diagnostic use. This study comparing patients with RA, those with other connective tissue disorders and controls showed 14-3-3η followed by RF, whereas the combination of anti-CCP and anti-MCV was the most specific and sensitive for diagnosis of RA.
Predicting factors for disappearance of anti-mutated citrullinated vimentin antibodies in sera of patients with rheumatoid arthritis
Published in Modern Rheumatology, 2020
Nozomi Ishigooka, Takao Fujii, Hiroyasu Abe, Kosaku Murakami, Ran Nakashima, Motomu Hashimoto, Hajime Yoshifuji, Masao Tanaka, Hiromu Ito, Koichiro Ohmura, Satoshi Morita, Tsuneyo Mimori
Kastbom et al. reported that anti-(non-mutated) citrullinated vimentin Ab may most frequently disappear among ACPAs, including anti-CCP, anti-citrullinated fibrinogen, and α-enolase Abs, after intensive RA treatment in the Swedish Farmacotherapy (SWEFOT) trial [12]. In addition, anti-(non-mutated) citrullinated vimentin Ab is statistically associated with better radiographic outcome [12]. In our cohort, however, there appeared to be no correlations of anti-MCV titers with disease activity and radiographic progression. These results suggested that anti-MCV titer is not always associated with RA disease activity change in our cohort. This discrepancy may be caused by the difference in the observation period as the radiographic evaluation in the SWEFOT trial was performed for 2 years, which is longer than our study (1 year). The enrolled patients were also different; the majority of the SWEFOT trial included early RA patients, while our study included established patients. Additionally, non-mutated citrullinated vimentin was used in the SWEFOT trial, but ‘mutated’ citrullinated vimentin is used in our study. Serum Abs in RA patients react more actively with ‘mutated citrullinated vimentin’ than with non-mutated citrullinated vimentin [7].