Jan Willem Cohen Tervaert, Canada
University of Alberta MedicineModerator of 1 Session
Presenter of 3 Presentations
AUTOINFLAMMATORY/AUTOIMMUNITY SYNDROME INDUCED BY ADJUVANTS (SHOENFELD’S SYNDROME) DUE TO HYSTEROSCOPIC ESSURE STERILIZATION
Abstract
Background and Aims
Autoinflammatory/autoimmunity Syndrome induced by Adjuvants (ASIA) can be induced by implantation of foreign bodies such as vaginal mesh and silicone breast implants. Sterilization using the Essure device has been associated with various safety issues. The aim of the present study was to determine whether these patients may suffer from a foreign-body type of ASIA.
Methods
A case report is presented. In addition, patient files of 34 consecutive patients who underwent surgical removal of their Essure device were studied for symptoms compatible with ASIA
Results
A 38 year old female patient known for 10 years with Granulomatosis and Polyangiitis developed symptoms compatible with ASIA (severe fatigue, myalgias, arthralgias, cognitive impairment and irritable bowel syndrome (IBS)) after Essure sterilization in 2014. Directly after removal of the device (July 2016), all complaints disappeared. Out of 34 evaluated patients that underwent Essure removal in Yorkville, IL, USA, because of pelvic pain, 14 of 34 patients spontaneously reported prior to Essure removal severe fatigue, 21 of 34 reported myalgias/arthralgias, and 11 of 34 reported cognitive impairment. In addition, after Essure placement 17 of 34 developed IBS, 10 of 34 developed hair loss, whereas 2 patients had a new diagnosis of inflammatory bowel disease. Post-operative recovery was good with disappearance of nearly all symptoms.
Conclusions
Essure device implementation may cause symptoms as has been found in other forms of foreign body induced ASIA. We postulate that Polyethylene Teraphalate (PET) fibers and Nickel/Titanium alloy coil (both present in the Essure device) may be responsible for this effect.
INTERNATIONAL CONSENSUS ON ANCA TESTING BEYOND SYSTEMIC VASCULITIS
Abstract
Background and Aims
ANCA positivity is a distinctive laboratory feature of ANCA-associated vasculitis. However, ANCA can be detected by antigen-specific immunoassays or indirect immunofluorescence (IIF) in patients with other autoimmune, inflammatory, infectious or neoplastic diseases. The aim was to issue a Consensus Statement on ANCA testing and interpretation beyond systemic vasculitis.
Methods
This Consensus Statement was prepared by a group of experts, including specialists in internal medicine, rheumatologists, nephrologists, gastroenterologists, hepatologists, pulmonologists, and clinical laboratory immunologists, based on the results of a comprehensive search in PubMed for disorders that can be associated with positive ANCA test results.
Results
Evidence suggests that ANCA may have diagnostic, clinical, and/or diagnostic relevance beyond systemic vasculitis. Testing for proteinase-3 ANCA and myeloperoxidase-ANCA should be performed in any patient with clinical features suggesting ANCA-associated vasculitis and in patients with anti-GBM disease, idiopathic interstitial pneumonia, and infective endocarditis complicated by nephritis, whereas routine ANCA testing is not recommended in connective tissue diseases, autoimmune liver diseases, inflammatory bowel diseases, infections, and/or various forms of malignancy. ANCA testing may be justified in patients with suspected autoimmune hepatitis type 1, who do not have conventional disease-related autoantibodies, or in patients with inflammatory bowel diseases in case of diagnostic uncertainty to discriminate ulcerative colitis from Crohn’s disease. In these cases, ANCA should be tested by IIF since target antigens are not yet well characterized
Conclusions
ANCA testing is clinically relevant not only in patients with manifestations suggesting systemic vasculitis, but also in patients with certain other disorders, particularly in patients with anti-GBM disease or idiopathic interstitial pneumonia.
FATIGUE IN AUTOINFLAMMATORY/AUTOIMMUNITY SYNDROME INDUCED BY ADJUVANTS (SHOENFELD’S SYNDROME) DUE TO FOREIGN BODY IMPLANTATION: A COMPARISON WITH FATIGUE IN FIBROMYALGIA
Abstract
Background and Aims
Fatigue is a disabling problem in patients with ASIA but its etiology is still poorly understood. Our objective was to identify the determinants of fatigue in patients with ASIA due to foreign body implantation when compared to determinants of fatigue in patients with fibromyalgia.
Methods
38 consecutive patients with ASIA due to silicone breast implant and/or mesh implant and 21 sex and age-matched patients with fibromyalgia (FM) were included in the study. All patients completed validated questionnaires to assess chronic fatigue, anxiety, depression, sleep and cognitive failure. Statistical analysis was carried out using Fischer’s exact test.
Results
30 of 38 (79%) ASIA patients and 17 of 21 (81%) FM patients fulfilled the IOM criteria for chronic fatigue syndrome (p=1.0). In ASIA patients with fatigue, more sleep disturbances (p=0.01) and cognitive failure (p=0.01) were evident compared to ASIA patients without fatigue. No statistical difference was seen in anxiety or depression between ASIA patients presenting with or without fatigue (p>0.05). C-reactive protein levels were not associated with chronic fatigue. When comparing sleep disturbances, anxiety, depression and/or cognitive failure between patients with ASIA and FM, no statistical differences were observed (p>0.05), suggesting that these conditions may present with similar symptomology.
Conclusions
Chronic fatigue, sleep disturbances and cognitive failure frequently occur in patients with ASIA due to foreign body implantation. Although the profile of symptoms is analogous to that in FM patients, we suggest that it is important to differentiate between these two conditions since explantation of the implant may cause amelioration of symptoms in patients with ASIA.