Autoimmune DiseasesPub Date : 2020-11-28eCollection Date: 2020-01-01DOI: 10.1155/2020/8364502
Autoimmune Diseases
{"title":"Retracted: Galectin-1, -4, and -7 Were Associated with High Activity of Disease in Patients with Rheumatoid Arthritis.","authors":"Autoimmune Diseases","doi":"10.1155/2020/8364502","DOIUrl":"https://doi.org/10.1155/2020/8364502","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.1155/2019/3081621.].</p>","PeriodicalId":46314,"journal":{"name":"Autoimmune Diseases","volume":"2020 ","pages":"8364502"},"PeriodicalIF":4.0,"publicationDate":"2020-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/8364502","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38708520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autoimmune DiseasesPub Date : 2020-07-31eCollection Date: 2020-01-01DOI: 10.1155/2020/3484659
Ivana Nieto-Aristizábal, Álvaro J Vivas, Pablo Ruiz-Montaño, Cristian C Aragón, Iván Posso-Osorio, Jairo Quiñones, Julián Alejandro Rivillas, Gabriel J Tobón
{"title":"Therapeutic Plasma Exchange as a Treatment for Autoimmune Neurological Disease.","authors":"Ivana Nieto-Aristizábal, Álvaro J Vivas, Pablo Ruiz-Montaño, Cristian C Aragón, Iván Posso-Osorio, Jairo Quiñones, Julián Alejandro Rivillas, Gabriel J Tobón","doi":"10.1155/2020/3484659","DOIUrl":"https://doi.org/10.1155/2020/3484659","url":null,"abstract":"<p><strong>Introduction: </strong>Therapeutic plasma exchange (TPE) is commonly used as treatment of certain autoimmune neurological diseases (ANDs), and its main objective is the removal of pathogenic autoantibodies. Our aim was to describe the clinical profile and the experience with the usage of TPE in patients with ANDs at our institution.</p><p><strong>Methods: </strong>This is an observational retrospective study, including medical records of patients with diagnosis of ANDs who received TPE, between 2011 and 2018. Characteristics of TPE, such as number of cycles, type of replacement solution, and adverse effects, were evaluated. The modified Rankin Scale (mRS) was applied to measure the clinical response after the therapy.</p><p><strong>Results: </strong>187 patients were included with the following diagnoses: myasthenia gravis (MG), <i>n</i> = 70 (37%); Guillain-Barré syndrome (GBS), <i>n</i> = 53 (28.3%), neuromyelitis optica spectrum disorders (NMOSD), <i>n</i> = 35 (18.7%); chronic inflammatory demyelinating polyneuropathy (CIDP), <i>n</i> = 23 (12.2%); and autoimmune encephalitis (AE), <i>n</i> = 6 (3.2%). The most used types of replacement solution were albumin (<i>n</i> = 131, 70%) and succinylated gelatin (<i>n</i> = 45, 24%). All patients received a median of five cycles (IQR 5-5). Hypotension and hydroelectrolytic disorders were the main complications. After TPE, 99 patients (52.9%) showed improvement in the mRS scores and a statistical significance (<i>p</i> < 0.05) was seen between the admission score and after TPE for every diagnosis except for CIDP.</p><p><strong>Conclusion: </strong>TPE has an adequate safety profile, and improvement in functionality in treated patients reflects its effectiveness.</p>","PeriodicalId":46314,"journal":{"name":"Autoimmune Diseases","volume":"2020 ","pages":"3484659"},"PeriodicalIF":4.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/3484659","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38271529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autoimmune DiseasesPub Date : 2020-06-25eCollection Date: 2020-01-01DOI: 10.1155/2020/5793817
Mohammad Javad Tavassolifar, Mohammad Vodjgani, Zahra Salehi, Maryam Izad
{"title":"The Influence of Reactive Oxygen Species in the Immune System and Pathogenesis of Multiple Sclerosis.","authors":"Mohammad Javad Tavassolifar, Mohammad Vodjgani, Zahra Salehi, Maryam Izad","doi":"10.1155/2020/5793817","DOIUrl":"https://doi.org/10.1155/2020/5793817","url":null,"abstract":"<p><p>Multiple roles have been indicated for reactive oxygen species (ROS) in the immune system in recent years. ROS have been extensively studied due to their ability to damage DNA and other subcellular structures. Noticeably, they have been identified as a pivotal second messenger for T-cell receptor signaling and T-cell activation and participate in antigen cross-presentation and chemotaxis. As an agent with direct toxic effects on cells, ROS lead to the initiation of the autoimmune response. Moreover, ROS levels are regulated by antioxidant systems, which include enzymatic and nonenzymatic antioxidants. Enzymatic antioxidants include superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase. Nonenzymatic antioxidants contain vitamins C, A, and E, glutathione, and thioredoxin. Particularly, cellular antioxidant systems have important functions in maintaining the redox system homeostasis. This review will discuss the significant roles of ROS generation and antioxidant systems under normal conditions, in the immune system, and pathogenesis of multiple sclerosis.</p>","PeriodicalId":46314,"journal":{"name":"Autoimmune Diseases","volume":"2020 ","pages":"5793817"},"PeriodicalIF":4.0,"publicationDate":"2020-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5793817","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38267329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autoimmune DiseasesPub Date : 2020-06-01eCollection Date: 2020-01-01DOI: 10.1155/2020/6876920
Ashraya Jagadeesh, Leonard E Maroun, Lisa M Van Es, Richard M Millis
{"title":"Autoimmune Mechanisms of Interferon Hypersensitivity and Neurodegenerative Diseases: Down Syndrome.","authors":"Ashraya Jagadeesh, Leonard E Maroun, Lisa M Van Es, Richard M Millis","doi":"10.1155/2020/6876920","DOIUrl":"https://doi.org/10.1155/2020/6876920","url":null,"abstract":"<p><p>Down syndrome (DS), also known as trisomy 21 (T21), is associated with interferon (IFN) hypersensitivity, as well as predilections for Alzheimer's dementia (AD) and various autoimmune diseases. IFN-<i>α</i> and IFN-<i>γ</i> receptors are encoded on chromosome 21 (Ch21). It remains unclear how other Ch21 genes contribute to the neuropathological features of DS/T21. This study tests the hypothesis that identifying IFN-stimulated response element (ISRE) control sites on Ch21 will mark novel candidate genes for DS/T21-related IFN hypersensitivity and neuropathology not previously reported to be associated with IFN functions. We performed whole chromosome searches of online databases. The general ISRE consensus and gamma interferon activation consensus sequences (GAS) were used for identifying IFN-stimulated response elements. Candidate genes were defined as those possessing two or more ISRE and/or GAS control sites within and/or upstream of the transcription start site. A literature search of gene functions was used to select the candidate genes most likely to explain neuropathology associated with IFN hypersensitivity. <i>DOPEY2</i>, <i>TMEM50B</i>, <i>PCBP3, RCAN1</i>, and <i>SIM2</i> were found to meet the aforementioned gene search and functional criteria. These findings suggest that <i>DOPEY2</i>, <i>TMEM50B</i>, <i>PCBP3, RCAN1</i>, and <i>SIM2</i> are genes which may be dysregulated in DS/T21 and may therefore serve as novel targets for treatments aimed at ameliorating the neuropathological features of DS/T21. Future studies should determine whether these genes are dysregulated in patients with DS, DS-related AD, and autoimmune diseases.</p>","PeriodicalId":46314,"journal":{"name":"Autoimmune Diseases","volume":"2020 ","pages":"6876920"},"PeriodicalIF":4.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/6876920","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38072545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autoimmune DiseasesPub Date : 2020-05-18eCollection Date: 2020-01-01DOI: 10.1155/2020/8719284
Genny Margarita Chaia-Semerena, María Eugenia Vargas-Camaño, Cesar Daniel Alonso-Bello, Jorge Javier Guillén-Toledo, Ricardo Leopoldo Guido-Bayardo, Fernando Lozano-Patiño, Mariano Daniel Temix-Delfín, María Isabel Castrejón-Vázquez
{"title":"The Effects of Alternate-Day Corticosteroids in Autoimmune Disease Patients.","authors":"Genny Margarita Chaia-Semerena, María Eugenia Vargas-Camaño, Cesar Daniel Alonso-Bello, Jorge Javier Guillén-Toledo, Ricardo Leopoldo Guido-Bayardo, Fernando Lozano-Patiño, Mariano Daniel Temix-Delfín, María Isabel Castrejón-Vázquez","doi":"10.1155/2020/8719284","DOIUrl":"https://doi.org/10.1155/2020/8719284","url":null,"abstract":"<p><strong>Introduction: </strong>Several studiesdemonstrated that the use of alternate-day corticosteroid therapy maintains control of autoimmune diseases due to the prolongation of their therapeutic effect beyond their metabolic effect, with a significant decrease in side effects in patients. For this reason, the current recommendation for the use of these medications is in a short cycle to avoid adverse effects when used frequently and for prolonged periods of time.</p><p><strong>Objectives: </strong>To learn variations in serum levels of autoantibodies in autoimmune diseases treated with steroids on alternate days, as well as whether there are differences in the response to them depending on the type of disease. <i>Study Design</i>. A descriptive, retrospective, and cross-sectional study was conducted in which serum autoantibody levels were compared at the time of diagnosis and three months after alternate-day corticosteroid therapy.</p><p><strong>Results: </strong>We included 106 patients from three autoimmune connective tissue diseases (systemic lupus erythematosus, Sjögren syndrome, and Hashimoto's thyroiditis) and observed a statistically significant decrease in serum autoantibody levels both in patients with lupus and those with Hashimoto's thyroiditis, regardless of the sex of the patients, as well as the type of steroids used.</p><p><strong>Conclusions: </strong>Treatment with alternate-day corticosteroids achieved a statistically significant decrease in serum autoantibody levels in patients with systemic lupus erythematosus and Hashimoto's thyroiditis.</p>","PeriodicalId":46314,"journal":{"name":"Autoimmune Diseases","volume":"2020 ","pages":"8719284"},"PeriodicalIF":4.0,"publicationDate":"2020-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/8719284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38019523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autoimmune DiseasesPub Date : 2020-01-19eCollection Date: 2020-01-01DOI: 10.1155/2020/8718736
Cady Rodney, Sherriann Rodney, Richard M Millis
{"title":"Vitamin D and Demyelinating Diseases: Neuromyelitis Optica (NMO) and Multiple Sclerosis (MS).","authors":"Cady Rodney, Sherriann Rodney, Richard M Millis","doi":"10.1155/2020/8718736","DOIUrl":"https://doi.org/10.1155/2020/8718736","url":null,"abstract":"<p><p>Vitamin D deficiency is prevalent in all ages regardless of climate or geographical location and evidence is emerging that the incidence of autoimmune diseases is increasing worldwide. Women make up a large proportion of autoimmune disease diagnoses, underscoring the importance of fully elucidating the complex synergistic relationships between estrogens and vitamin D. Vitamin D receptor-activating drugs appear to enhance remyelination in patients diagnosed with multiple sclerosis (MS) and other demyelinating diseases such as neuromyelitis optica (NMO). This review is intended to update health practitioners about the potential role of vitamin D deficiency demyelination and to motivate future research on dietary recommendations for vitamin D in preventing and treating demyel1nating diseases.</p>","PeriodicalId":46314,"journal":{"name":"Autoimmune Diseases","volume":"2020 ","pages":"8718736"},"PeriodicalIF":4.0,"publicationDate":"2020-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/8718736","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37905294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thushani Siriwardhane, K. Krishna, Vinodh Ranganathan, V. Jayaraman, Tianhao Wang, K. Bei, S. Ashman, Karenah E. Rajasekaran, J. Rajasekaran, H. Krishnamurthy
{"title":"Significance of Anti-TPO as an Early Predictive Marker in Thyroid Disease","authors":"Thushani Siriwardhane, K. Krishna, Vinodh Ranganathan, V. Jayaraman, Tianhao Wang, K. Bei, S. Ashman, Karenah E. Rajasekaran, J. Rajasekaran, H. Krishnamurthy","doi":"10.1155/2019/1684074","DOIUrl":"https://doi.org/10.1155/2019/1684074","url":null,"abstract":"Even though most thyroid subjects are undiagnosed due to nonspecific symptoms, universal screening for thyroid disease is not recommended for the general population. In this study, our motive is to showcase the early appearance of thyroid autoantibody, anti-TPO, prior to the onset of thyroid hormone disruption; hence the addition of anti-TPO in conjunction with traditional thyroid markers TSH and FT4 would aid to reduce the long-term morbidity and associated health concerns. Here, a total of 4581 subjects were tested multiple times for TSH, FT4, anti-TPO, and anti-Tg and followed up for 2 years. We streamlined our subjects into two groups, A1 (euthyroid at first visit, but converted to subclinical/overt hypothyroidism in follow-up visits) and A2 (euthyroid at first visit, but converted to hyperthyroidism in follow-up visits). According to our results, 73% of hypothyroid subjects (from group A1) and 68.6% of hyperthyroid subjects (from group A2) had anti-TPO 252 (±33) and 277 (±151) days prior to the onset of the thyroid dysfunction, respectively. Both subclinical/overt hypothyroidism and hyperthyroidism showed a significantly higher percentage of subjects who had anti-TPO prior to the onset of thyroid dysfunction compared to the combined control group. However, there was no significant difference in the subjects who had anti-Tg earlier than the control group. Further assessment showed that only anti-TPO could be used as a standalone marker but not anti-Tg. Our results showcase that anti-TPO appear prior to the onset of thyroid hormone dysfunction; hence testing anti-TPO in conjunction with TSH would greatly aid to identify potentially risk individuals and prevent long-term morbidity.","PeriodicalId":46314,"journal":{"name":"Autoimmune Diseases","volume":"32 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2019-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83189696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. M. Vilar, M. Pereira, A. Dantas, M. Rêgo, I. Pitta, C. Marques, R. Gonçalves, Laurindo Ferreira da Rocha Júnior, A. Duarte, M. Pitta
{"title":"Galectin-1, -4, and -7 Were Associated with High Activity of Disease in Patients with Rheumatoid Arthritis","authors":"K. M. Vilar, M. Pereira, A. Dantas, M. Rêgo, I. Pitta, C. Marques, R. Gonçalves, Laurindo Ferreira da Rocha Júnior, A. Duarte, M. Pitta","doi":"10.1155/2019/3081621","DOIUrl":"https://doi.org/10.1155/2019/3081621","url":null,"abstract":"Background Due to the variety of functions that galectins (Gal) possess, it is clear that they participate in the pathogenesis of rheumatoid arthritis (RA). Although some studies demonstrate their functions, there is still no correlation with the clinical data of the disease, having the physiological meaning still unknown. Objectives To compare serum levels of Gal-1, -4, and -7 in patients with RA and healthy controls and to correlate them with clinical parameters. Methods Serum samples were collected from patients with RA and healthy donors to determine the serum levels of Gal-1, -4, and -7. Results Serum levels of Gal-1, -4, and -7 were significantly higher in RA patients compared to controls. We evaluated disease activity (CDAI) with serum levels of galectins and found that patients who were high in disease activity had high levels of galectin compared to the moderate activity group. Galectin-4 had higher levels in patients who were in high activity when compared to the group in remission or low activity. Evaluating the activity of the individual disease (DAS28), patients in high individual activity had high levels of Gal-4 when compared to the group in remission or low activity. We also found an association between positive rheumatoid factor and Gal-1 and Gal-4 levels. Conclusion Our results show for the first time the relationship between serum levels of galectin and the clinical parameters of patients with RA. Demonstrating their role in pathogenesis, new studies with galectins are needed to assess how they function as a biomarker in RA.","PeriodicalId":46314,"journal":{"name":"Autoimmune Diseases","volume":"1 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2019-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89663917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autoimmune DiseasesPub Date : 2019-07-09eCollection Date: 2019-01-01DOI: 10.1155/2019/2135423
Borros M Arneth
{"title":"Neuronal Antibodies and Associated Syndromes.","authors":"Borros M Arneth","doi":"10.1155/2019/2135423","DOIUrl":"https://doi.org/10.1155/2019/2135423","url":null,"abstract":"Introduction Multiple well-recognized conditions, such as Lambert–Eaton myasthenic syndrome (LEMS) and myasthenia gravis (MG), have been associated with neuronal antibodies. Materials and Methods A search was performed using Embase, PubMed, and CINAHL. An initial search of each database was conducted using keywords and terms related to the aim of the current review. Additional articles were obtained by examining the reference lists and citations in the selected records. Results The studies identified through the search process used different designs and methods to explore neuronal antibodies and associated syndromes. Previous studies have shown that neurological and psychiatric disorders can be mediated and influenced by various antibodies. The identification of autoantibodies can help with the accurate diagnosis of conditions and commencement of early treatment. Discussion A review of selected studies identified in the literature implicated that classic anti-neuronal antibodies, such as anti-Ri and anti-Hu, play a role in the development of neurological diseases. More recent studies have indicated that other novel antibodies act on neuronal cell surface antigens to contribute to the development of neurological disorders. Conclusion Existing research provides evidence revealing a spectrum of antibodies linked to the development and progression of neurological diseases. However, further antibody testing and studies should be performed to validate the relationship between conditions and antibodies.","PeriodicalId":46314,"journal":{"name":"Autoimmune Diseases","volume":"2019 ","pages":"2135423"},"PeriodicalIF":4.0,"publicationDate":"2019-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/2135423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James C Di Palma-Grisi, K. Vijayagopal, Muhammad A Muslimani
{"title":"Case Reports of DRESS Syndrome and Symptoms Consistent with DRESS Syndrome Following Treatment with Recently Marketed Monoclonal Antibodies","authors":"James C Di Palma-Grisi, K. Vijayagopal, Muhammad A Muslimani","doi":"10.1155/2019/7595706","DOIUrl":"https://doi.org/10.1155/2019/7595706","url":null,"abstract":"Background Monoclonal antibodies constitute a potent and broadly tolerable drug class, representing for some conditions the first newly approved treatment in years. As such, many are afforded “fast-track” or “breakthrough therapy” designations by the U.S. Food and Drug Administration, leading to provisional approval before Phase III clinical trials are reported. Although these drugs are usually safe, some patients experience life-threatening complications—myositis and encephalitis have led to permanent or temporary recalls. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a hypersensitivity condition easily missed due to its long incubation period and nonspecific presentation. This minireview is primarily intended as an abbreviated guide for practitioners who may be using these powerful treatments. Methodology We searched PubMed using a string of symptoms consistent with DRESS syndrome and monoclonal antibodies approved by the FDA since 2015. Then, we excluded studies reporting dermatological complications of reactivation of nonherpetic infection, immunodeficiency-related infection, or reactions to the injection site or infusion. We searched for and accessed prior reviews and background studies via PubMed, Mendeley, and Google Scholar. Results Two cases of DRESS syndrome were identified in the literature, both the result of treatment with daclizumab. There was one additional case of encephalitis without cutaneous symptoms caused by daclizumab. Drug-induced hypersensitivity dermatitis was reported following treatment with nivolumab and two cases of combination treatment with ipilimumab and either nivolumab or durvalumab produced maculopapular rash and bullae in the first patient and lichenoid dermatitis and blisters in the second patient. Conclusions Daclizumab was the only recently approved monoclonal antibody associated with DRESS syndrome as such. Limitations in the diagnostic reliability of DRESS syndrome as a clinical entity and the lack of negative clinical trial reporting suggest enhanced vigilance on the part of clinicians and regulators may be warranted.","PeriodicalId":46314,"journal":{"name":"Autoimmune Diseases","volume":"23 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2019-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81685210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}