Skin and Connective Tissue Diseases Commons^™

Basal Cell Carcinoma—A Preventable Disease, Jamie Weaver

Nursing Student Class Projects (Formerly MSN)

Basal cell carcinoma (BCC) is a nonmelanoma skin cancer. According to the Skin Cancer Foundation, “BCC is the most frequently occurring form of all skin cancers. More than one out of every three new cancers is a skin cancer, and the vast majority are BCC’s” (www.skincancer.org). Exposure to ultraviolet (UV) rays is one of the main risk factors in developing a BCC. People with a lighter skin tone are at a higher risk of developing a BCC than those with a darker skin tone.

Gout, Lorrie Listebarger

Nursing Student Class Projects (Formerly MSN)

Gout is a syndrome caused by an inflammatory response creating an over production of uric acid increasing uric acid levels in the blood and body fluids. Gout is defined as a disorder resulting from tissue deposition of MSU crystals (in joints, bursae, bone, and certain other soft tissues, such as ligaments, tendons and occasionally, skin) and/or crystallization of uric acid within the renal collecting system (tubules and renal pelvis) that typically occurs in acid urine” (Terkeltaub & Edwards, 2013, p. 20). Gout is among the oldest diseases affecting approximately 3.9% of adults in America (Terkeltaub & Edwards, 2013, p. xv). …

Dermatitis Herpetiformis, Rachel Wolf

Nursing Student Class Projects (Formerly MSN)

The main sign that accompanies DH is the eruption of intensely pruritic papulovesical lesions that typically present bilaterally on the elbows, knees, buttocks, neck, and scalp (Criado et al., 2012). They may appear on the upper back, abdomen, groin, and face as well. The lesions are small blisters that resemble those that are caused by the herpes simplex virus. By the time a patient seeks evaluation by a care provider, the lesions have often been scratched so much as to cause erosions, excoriation, and or crusted papules (Junkins-Hopkins, 2010). The surrounding area may have erythema and or urticarial plaques. Patients …

Functional Analysis Of The Molluscum Contagiosum Virus Mc160 Death Effector Domain-Containing Protein Rxdl Motif, Sarah Weber

Seton Hall University Dissertations and Theses (ETDs)

The Molluscum contagiosum virus (MCV) is a member of the Poxviridae family that causes benign skin lesions. MCV lesions persist on average for 8-12 months in otherwise healthy individuals. MCV lesions are characterized by reduced inflammation. The persistence and reduction of inflammation at the site of MCV lesions have been attributed to MCV immune evasion genes. MCV encodes two death effector domain (DED) containing proteins, MC159 and MC160. DEDs are found in cellular proteins such as FADD and procaspase-8. These cellular proteins are involved in several innate immune responses such as apoptosis and activation of interferon (IFN). Presumably, MC159 and …

Detection Of Igg4-Specific Autoantibodies In Rheumatoid Arthritis Serum Samples, Azra Borogovac, Youmna Lahoud, Janice Weaver, Sheldon M. Cooper, Mercedes Rincon, Jonathan Kay, Ellen M. Gravallese

Ellen M. Gravallese

Background: Rheumatoid arthritis (RA) is a chronic multi-system autoimmune disease characterized by inflammatory synovitis. Autoantibodies such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) have been implicated in the pathogenesis of RA, and are currently important criteria for diagnosis within the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria.1 Yet, many patients diagnosed with RA do not have measurable circulating ACPA or RF which may result in delayed diagnosis and treatment. After IgG1, IgG4 is the second most predominant isotype among ACPA and RF; however it is not detected in currently available diagnostic assays. Recent …

Detection Of Igg4-Specific Autoantibodies In Rheumatoid Arthritis Serum Samples, Azra Borogovac, Youmna Lahoud, Janice Weaver, Sheldon M. Cooper, Mercedes Rincon, Jonathan Kay, Ellen M. Gravallese

Jonathan Kay

Background: Rheumatoid arthritis (RA) is a chronic multi-system autoimmune disease characterized by inflammatory synovitis. Autoantibodies such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) have been implicated in the pathogenesis of RA, and are currently important criteria for diagnosis within the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria.1 Yet, many patients diagnosed with RA do not have measurable circulating ACPA or RF which may result in delayed diagnosis and treatment. After IgG1, IgG4 is the second most predominant isotype among ACPA and RF; however it is not detected in currently available diagnostic assays. Recent …

Osteopontin: A Bridge Between Bone And The Immune System, Ellen M. Gravallese

Ellen M. Gravallese

The molecular mechanisms underlying the putative role of osteopontin in the chronic inflammatory disease rheumatoid arthritis are unclear. A study in a murine model of arthritis now demonstrates that a specific antibody directed against the exposed osteopontin epitope SLAYGLR is capable of preventing inflammatory cell infiltration in arthritic joints.

The Role Played By Cell-Substrate Interactions In The Pathogenesis Of Osteoclast-Mediated Peri-Implant Osteolysis, Zhenxin Shen, Tania N. Crotti, Kevin P. Mchugh, Kenichiro Matsuzaki, Ellen M. Gravallese, Benjamin E. Bierbaum, Steven R. Goldring

Ellen M. Gravallese

Prosthetic wear debris-induced peri-implant osteolysis is a major cause of aseptic loosening after total joint replacement. In this condition, wear particles released from the implant components induce a granulomatous inflammatory reaction at the interface between implant and adjacent bone, leading to progressive bone resorption and loss of fixation. The present study was undertaken to characterize definitively the phenotype of osteoclast-like cells associated with regions of peri-implant focal bone resorption and to compare the phenotypic features of these cells with those of mononucleated and multinucleated cells associated with polyethylene wear particles. Peri-implant tissues were obtained from patients undergoing hip revision surgery …

The Role Of Tnf-Receptor Family Members And Other Traf-Dependent Receptors In Bone Resorption, Ellen M. Gravallese, Deborah L. Galson, Steven R. Goldring, Philip E. Auron

Ellen M. Gravallese

The contribution of osteoclasts to the process of bone loss in inflammatory arthritis has recently been demonstrated. Studies in osteoclast biology have led to the identification of factors responsible for the differentiation and activation of osteoclasts, the most important of which is the receptor activator of NF-kappa B ligand/osteoclast differentiation factor (RANKL/ODF), a tumor necrosis factor (TNF)-like protein. The RANKL/ODF receptor, receptor activator of NF-kappa B (RANK), is a TNF-receptor family member present on both osteoclast precursors and mature osteoclasts. Like other TNF-family receptors and the IL-1 receptor, RANK mediates its signal transduction via TNF receptor-associated factor (TRAF) proteins, suggesting …

Critical Roles For Interleukin 1 And Tumor Necrosis Factor Alpha In Antibody-Induced Arthritis, Hong Ji, Allison Pettit, Koichiro Ohmura, Adriana Ortiz-Lopez, Veronique Duchatelle, Claude Degott, Ellen M. Gravallese, Diane Mathis, Christophe Benoist

Ellen M. Gravallese

In spontaneous inflammatory arthritis of K/BxN T cell receptor transgenic mice, the effector phase of the disease is provoked by binding of immunoglobulins (Igs) to joint surfaces. Inflammatory cytokines are known to be involved in human inflammatory arthritis, in particular rheumatoid arthritis, although, overall, the pathogenetic mechanisms of the human affliction remain unclear. To explore the analogy between the K/BxN model and human patients, we assessed the role and relative importance of inflammatory cytokines in K/BxN joint inflammation by transferring arthritogenic serum into a panel of genetically deficient recipients. Interleukin (IL)-1 proved absolutely necessary. Tumor necrosis factor (TNF)-alpha was also …

Mechanisms Of Bone Loss In Inflammatory Arthritis: Diagnosis And Therapeutic Implications, Steven R. Goldring, Ellen M. Gravallese

Ellen M. Gravallese

Rheumatoid arthritis represents an excellent model in which to gain insights into the local and systemic effects of joint inflammation on skeletal tissues. Three forms of bone disease have been described in rheumatoid arthritis. These include: focal bone loss affecting the immediate subchondral bone and bone at the joint margins; periarticular osteopenia adjacent to inflamed joints; and generalized osteoporosis involving the axial and appendicular skeleton. Although these three forms of bone loss have several features in common, careful histomorphometric and histopathological analysis of bone tissues from different skeletal sites, as well as the use of urinary and serum biochemical markers …

Methotrexate And Cardiovascular Events, Alpesh Shah

Electronic Thesis and Dissertation Repository

We conducted a systematic review and meta-analysis to assess the association of MTX with cardiovascular morbidity, cardiovascular mortality and all-cause mortality in patients with autoimmune disease. Our primary outcome was incident cardiovascular events. After screening 13,479 citations, we identified a total of 30 eligible studies. We synthesized adjusted risk estimates using a random effects model. MTX was significantly associated with a 25% reduction in cardiovascular events (pooled RR: 0.75, 95% CI: 0.65, 0.86, I²: 11%), a 55% reduction in cardiovascular mortality (0.45, 95% CI: 0.26, 0.80, I²: 33%) and a 40% reduction in all-cause mortality (0.60, …

Clinical Disease Activity And Acute Phase Reactant Levels Are Discordant Among Patients With Active Rheumatoid Arthritis: Acute Phase Reactant Levels Contribute Separately To Predicting Outcome At One Year, Jonathan Kay, Olga Morgacheva, Susan P. Messing, Joel M. Kremer, Jeffrey D. Greenberg, George W. Reed, Ellen M. Gravallese, Daniel E. Furst

Jonathan Kay

INTRODUCTION: Clinical trials of new treatments for rheumatoid arthritis (RA) typically require subjects to have an elevated acute phase reactant (APR), in addition to tender and swollen joints. However, despite the elevation of individual components of the Clinical Disease Activity Index (CDAI) (tender and swollen joint counts and patient and physician global assessment), some patients with active RA may have normal erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels and thus fail to meet entry criteria for clinical trials. We assessed the relationship between CDAI and APRs in the Consortium of Rheumatology Researchers of North America (CORRONA) registry by …

Is Prophylactic Oxybutynin Safe And Effective In Reducing The Severity Of Palmar Hyperhidrosis In Adults?, Kristin K. Amicone

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine “Is prophylactic oxybutynin safe and effective in reducing the severity of palmar hyperhidrosis in adults?”

STUDY DESIGN: This review is based on two randomized controlled trials (RCTs) and one non-randomized crossover study published in 2008, 2011, and 2012. The studies compared the safety and efficacy of oxybutynin in reducing the severity of palmar hyperhidrosis.

DATA SOURCES: All articles used were published in English, in peer-reviewed journals, and found using PubMed, Ebscohost, and Cochrane Review databases.

OUTCOMES MEASURED: For all studies, the safety and effectiveness of oxybutynin on palmer hyperhidrosis …

Is Benzoyl Peroxide And Clindamycin Effective Combination Treatment For Progressive Macular Hypomelanosis In Adults?, Samantha Colosi

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not there is efficacy with combination treatment benzoyl peroxide and clindamycin for progressive macular hypomelanosis in adults.

Study Design: A review of three English language studies. One published in 2006 and two in 2011. Includes two RCT’s and one randomized left-right comparison study.

Data Sources: Researched articles via PubMed and Cochrane database. All articles were published in peer-reviewed journals. Two randomized, controlled trials and one randomized left-right comparison study were used.

Outcomes Measured: The outcomes measured by: subjective patient ratings based on photographs before and after treatment …

Is A Once Daily Topical Application Of Fixed-Dose Combination Gel Containing Adapalene 0.1%-Benzoyl Peroxide (Bpo) 2.5%(Adapalene-Bpo) Effective At Treating Mild To Moderate Acne?, Kelly A. Weitzel

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not a once daily topical application of fixed-dose combination gel containing adapalene 0.1%-benzoyl peroxide (BPO) 2.5% (adapalene-BPO) is effective at treating mild to moderate acne.

STUDY DESIGN: Three multi-center double blind randomized control studies published in the English language between 2007-2013.

STUDY SOURCES: Three peer-reviewed RCTS were found using Pubmed. These studies compared the same fixed-dose combination gel adapalene-BPO against placebo vehicles. Two studies also compared to additional groups receiving monotherapies.

OUTCOMES MEASURED: Outcomes measured were improvement of participant’s acne according to the Investigator’s Global Assessment of …