Caveats and truths in genetic, clinical, autoimmune and autoinflammatory issues in Blau syndrome and early onset sarcoidosis

Donato Rigante, Francesco Caso, Luisa Costa, Antonio Vitale, Rolando Cimaz, Orso Maria Lucherini, Paolo Sfriso, Sofia Tognon, Vittoria Bascherini, Mauro Galeazzi, Leonardo Punzi, Luca Cantarini

Risultato della ricerca: Contributo in rivistaArticolo in rivista

56 Citazioni (Scopus)

Abstract

Blau syndrome (BS) and early onset sarcoidosis (EOS) are, respectively, the familial and sporadic forms of the pediatric granulomatous autoinflammatory disease, which belong to the group of monogenic autoinflammatory syndromes. Both of these conditions are caused by mutations in the NOD2 gene, which encodes the cytosolic NOD2 protein, one of the pivotal molecules in the regulation of innate immunity, primarily expressed in the antigen-presenting cells. Clinical onset of BS and EOS is usually in the first years of life with noncaseating epithelioid granulomas mainly affecting joints, skin, and uveal tract, variably associated with heterogeneous systemic features. The dividing line between autoinflammatory and autoimmune mechanisms is probably not so clear-cut, and the relationship existing between BS or EOS and autoimmune phenomena remains unclear. There is no established therapy for the management of BS and EOS, and the main treatment aim is to prevent ocular manifestations entailing the risk of potential blindness and to avoid joint deformities. Nonsteroidal anti-inflammatory drugs, corticosteroids and immunosuppressive drugs, such as methotrexate or azathioprine, may be helpful; when patients are unresponsive to the combination of corticosteroids and immunosuppressant agents, the tumor necrosis factor-α inhibitor infliximab should be considered. Data on anti-interleukin-1 inhibition with anakinra and canakinumab is still limited and further corroboration is required. The aim of this paper is to describe BS and EOS, focusing on their genetic, clinical, and therapeutic issues, with the ultimate goal of increasing clinicians' awareness of both of these rare but serious disorders.
Lingua originaleEnglish
pagine (da-a)1220-1229
Numero di pagine10
RivistaAUTOIMMUNITY REVIEWS
Volume2014; 13(12)
DOI
Stato di pubblicazionePubblicato - 2014

Keywords

  • Blau syndrome
  • Early onset sarcoidosis

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