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Witte T.,Klinik fur Immunologie und Rheumatologie
Zeitschrift fur Rheumatologie

Sjögren's syndrome is a common autoimmune disorder. Several genetic risk factors such as STAT-4, ILT6 and the haplotype HLAB8/DR3 have been identified. In addition, there are environmental risk factors, possibly chronic viral infections. In the pathophysiology of Sjögren's syndrome T and B cells infiltrate the salivary and lacrimal glands. As a consequence of the destruction of glandular cells by cytotoxic T cells, production of cytokines and autoantibodies inhibiting glandular fu nction, the production of saliva and tears is decreased. The feeling of dry eyes and mouth is frequently not noticed by the patients. Therefore, Sjögren's syndrome should also be considered when extraglandular manifes-tations such as vasculitis, polyneuropathy or arthritis occur, even when the patients do not complain of dry eyes and mouth. Establishing the diagnosis of Sjögren's syndrome requires verification of reduced glandular function, for example using Schirmer's test and the Saxon test. The confirmation of Sjögren's syndrome as a cause of sicca syndrome is subsequently performed by the detection of autoantibodies against Ro (SS-A) and La (SS-B) and/or by a salivary gland biopsy. © Springer-Verlag 2009. Source

Behrens G.M.N.,Klinik fur Immunologie und Rheumatologie

HIV therapy is able to achieve complete viral suppression in up to 90% of patients. Thus, most patients will benefit from long-term effective and tolerable therapy combinations. Antiretroviral therapy, however, can still lead to side effects, is costly, and its success is dependent on sufficient health system resources and access to different drug combinations. Established tools in prevention and novel approaches to avoid spread of HIV infection are crucial to combat the epidemic. Recent advances in research about how drug regimens stop viral transmission (treatment as prevention), how the immune system defends against HIV (natural killer cells, broad neutralizing antibodies), and how cellular factors restrict viral replication are import milestones on the long way to stopping the global epidemic and to fostering vaccine development. © 2012 Springer-Verlag. Source

Witte T.,Klinik fur Immunologie und Rheumatologie
Zeitschrift fur Rheumatologie

Sjögren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of the tear and salivary glands leading to dryness of the mouth and eyes. The awareness that extraglandular manifestations, such as polyneuropathy, arthritis or recurrent airway infections may indicate Sjögren's syndrome is important. In the diagnostic procedure, the tear and saliva production and antibodies against Sjögren's syndrome A (SS-A) and SS-B should be measured. A salivary gland biopsy should be performed when the diagnosis is not still clear. The therapy of oral and ocular dryness is mainly symptomatic whereas the treatment of extraglandular manifestations is based on experience with treatment of these manifestations in systemic lupus erythematosus (SLE). © 2014 Springer-Verlag. Source

Witte T.,Klinik fur Immunologie und Rheumatologie | Schulze-Koops H.,Ludwig Maximilians University of Munich
Arthritis Research and Therapy

IgG4-related disease is rare, but a frequent differential diagnosis for malignant and for autoimmune diseases. Li and colleagues report the largest cohort of patients with IgG4-related sialadenitis. The observations reveal that the most important diagnostic step is obtaining biopsies. In addition, the IgG4 serum concentration may be a biomarker for the disease progression. © 2015 Witte and Schulze-Koops. Source

Background: The prognosis of rheumatoid arthritis has been substantially improved by the treatment with biologics; however, it is still unclear which combination of biological and conventional disease-modifying antirheumatic drugs (DMARDs) is optimal to achieve remission as in clinical trials biologics were mainly studied in combination with methotrexate or as monotherapy. There are, however data that the efficacy of tumor necrosis factor (TNF) inhibitors is better in combination with methotrexate, whereas the efficacy of tocilizumab is optimal even as a monotherapy. In this article the differing dependence of TNF inhibitors and of tocilizumab on the combination with methotrexate is explained from the viewpoint of an immunologist. Methods: A selective search and evaluation of the literature were carried out in relation to the mechanism of action of TNF inhibitors, tocilizumab and methotrexate in rheumatoid arthritis. Results and conclusions: Methotrexate mainly targets the activation of T and B lymphocytes and TNF inhibitors suppress monocytes and myeloid dendritic cells. Tocilizumab corrects the errant activation and differentiation of T and B lymphocytes and in addition inhibits monocytes, dendritic cells and neutrophils. Therefore, TNF inhibitors and methotrexate act optimally only in combination to exert an effect on all components of the cellular immune system in rheumatoid arthritis. In contrast, tocilizumab has a broad mode of action even in monotherapy. © 2013 Springer-Verlag Berlin Heidelberg. Source

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