Emese Kiss - Academia.edu (original) (raw)

Papers by Emese Kiss

Biomedicines, Aug 31, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Biomedicines, Feb 13, 2022

Autoimmunity Reviews, Jun 1, 2007

Antiphospholipid syndrome (APS) is a systemic autoimmune disease associated with arterial and ven... more Antiphospholipid syndrome (APS) is a systemic autoimmune disease associated with arterial and venous thrombotic events and recurrent fetal loss. Cardiac manifestations in APS primarily include accelerated atherosclerosis leading to cardiovascular disease. There is increased cardiovascular mortality in APS. Cardiovascular risk is even higher in secondary APS in lupus patients. Several traditional and disease-related, autoimmune-inflammatory risk factors are involved in APS-associated atherosclerosis and its clinical manifestations. Antiphospholipid antibodies (APA), lupus anticoagulant, anti-oxLDL and other antibodies have been implicated in vascular events underlying APS. The primary and secondary prevention of atherosclerosis and CAD in these diseases includes drug treatment, such as the use of statins and aspirin, as well as lifestyle modifications. Apart from atherosclerosis and CVD, other cardiac manifestations may also be present in these patients. Among these conditions, valvular disease including thickening and vegetations is the most common. APA are involved in the pathogenesis of Libman-Sacks endocarditis usually associated with SLE. In addition, ventricular dysfunction, intracardiac thrombi and myxomas, pulmonary hypertension may also exist in APS patients. Early diagnosis of APS, thorough examination of the heart, control of traditional risk factors by lifestyle modifications and pharmacotherapy, probably anti-inflammatory treatment close follow-up of APS patients may help to minimize cardiovascular risk in these individuals.

Annals of the Rheumatic Diseases, Jun 13, 2022

Introduction Commercial assays measuring antibodies to citrullinated protein/peptide (ACPA) show ... more Introduction Commercial assays measuring antibodies to citrullinated protein/peptide (ACPA) show poor quantitative agreement. The diagnostic industry has never adopted the International Union of Immunological Societies-Centers for Disease Control and Prevention (IUIS-CDC) ACPA reference standard. Recently, the National Institute for Biological Standards and Control (NIBSC) prepared a new candidate ACPA standard (18/204). We evaluated both reference materials using different commercially available ACPA assays. Materials and methods This is an international study in which the NIBSC candidate ACPA standard and the IUIS-CDC ACPA reference material were analysed together with 398 diagnostic samples from individuals with rheumatoid arthritis (RA) and in 1073 individuals who did not have RA using nine commercial ACPA assays. Results For both reference materials and samples from individuals with RA and individuals who did not have RA, there were large differences in quantitative ACPA results between assays. For most assays, values for the IUIS-CDC standard were lower than values for NIBSC 18/204 and the IUIS-CDC/NIBSC ratio was comparable for several, but not all assays. When NIBSC 18/204 was used as a calibrator, an improvement in alignment of ACPA results across several of the evaluated assays was obtained. Moreover, NIBSC 18/204 could align clinical interpretation for some but not all assays. Conclusion Adoption of an international standard for ACPA determination is highly desirable. The candidate NIBSC 18/204 standard improved the standardisation and alignment of most ACPA assays and might therefore be recommended to be used as reference in commercial assays. HOW MIGHT THIS IMPACT ON CLINICAL PRACTICE? ⇒ Alignment of ACPA assays would be particularly important in the context of the American College of Rheumatology/European Alliance of Associations for Rheumatology 2010 rheumatoid arthritis (RA) classification criteria, where ACPA concentration has a high impact on rRA classification.

LAM (Lege Artis Medicinæ), 2011

Rheumatology, Oct 1, 1999

Objective. Most information available about the disease course of patients with systemic lupus er... more Objective. Most information available about the disease course of patients with systemic lupus erythematosus (SLE) is restricted to the first 5 yr after disease onset. Data about the disease course 10 yr after disease onset are rare. The aim of this multicentre study was to describe the outcome of SLE patients with a disease duration of >10 yr. Methods. Outcome parameters were the SLE Disease Activity Index (SLEDAI), the European Consensus Lupus Activity Measure (ECLAM),

Annals of the Rheumatic Diseases, Feb 13, 2015

Introduction TNF-α plays an important role in host defense against various infections and in the ... more Introduction TNF-α plays an important role in host defense against various infections and in the pathogenesis of chronic inflammatory diseases. Therapeutic blockade of TNF-α could be an effective treatment in such cases. However, anti-TNF-α therapy increases the risk of reactivation of serious infections, including tuberculosis (TB). Thus, screening for TB became mandatory, prior to the initiation of TNF-α inhibitor therapy. Aim of the study To assess the performance and characteristics of the Quantiferon TB Gold test (QFT) by screening for TB in three different populations in Hungary: patients with inflammatory rheumatic diseases (RD), health-care workers who serve homeless people (HW) and homeless clients (HL). Methods Between April 2011 and March 2014, samples of 1430 consecutive RD patients, who required or already underwent TNF-a blocking therapy, were screened for latent TB. Two untreated groups, (i) 120 HL and (ii) 46 HW, both considered to be at high risk for TB, were also tested. The QFT was performed according to the manufacturer instructions. The amount of released IFN-g was measured by ELISA in samples stimulated by TB Antigen, saline (NIL) and phytohemagglutinin A (PHA). Results In the RD group, the QFT was negative in 87%, positive in 11%, and indeterminate in 2%. Of the 265 patients, 36 (13.6%) showed inconsistent results on repeat testing. In the HW group, the QFT was negative in 63% and positive in 37%. In the HL group, the QFT was negative in 50.8%, positive in 46.7% and indeterminate in 2.5%. In the RD group, low mitogen response (caused mainly by low lymphocyte count and/or improper specimen handling) and positive results close to the cut-off value of 0.35 IU/mL account for 86% of inconsistent results, while true reversions or conversions only for 14%. Conclusions Based on our results, for better differentiation of non-specific variations, we suggest that a grey zone close to the cut-off value of 0.35 IU/mL (0.35–0.800 IU/mL) should be defined. As for the mitogen response, results higher than 0.5 IU/mL (cut-off), but lower than 2 IU/mL should be interpreted carefully. Repeat testing in such cases could prevent misinterpretations caused by technical errors.

International Journal of Clinical Rheumatology, Dec 1, 2015

A szerzők közleményükben a lupus nephritis kezelésének legújabb irányelvei mellett bemutatják saj... more A szerzők közleményükben a lupus nephritis kezelésének legújabb irányelvei mellett bemutatják saját mycofenolat mofetillel szerzett tapasztalataikat a betegség kezelésében. A lupus nephritis és főleg a proliferatív formája olyan gyakori és komoly manifesztációja a szisztémás lupus erythematosusnak, amely végstádiumú veseelégtelenséghez vagy akár halálhoz is vezethet. Az elmúlt évtizedekben a lupus nephritis kezelése sokat fejlődött, ma már a kedvezőbb mellékhatás-profilú mycofenolat mofetil a cyclophosphamid alternatívájává vált a III-as és IV-es osztályú glomerulonephritis indukciós és fenntartó kezelésében. Lupus nephritis diagnózissal eddig 25 betegüknek kértek egyedi méltányosság alapján támogatást mycofenolat mofetil adására. Szövettanilag legtöbben a WHO III (A/C) és IV (A) szövettani osztályába tartoztak (30-30%), beszűkült vesefunkció csak 16%-ukban volt jelen. Glükokortikoid és cyclophosphamid indukciós kezelés után adott mycofenolatterápia mellett az átlagos napi proteinuria 3,18 g/napról 1,06 g/napra csökkent. A betegek 24%-ánál jött létre komplett, 48%-ánál részleges remisszió. Ezek alapján a mycofenolat mofetil hatékony kezelésnek tartható a proliferatív lupus nephritis kezelésében.

Frontiers in Pharmacology, Dec 22, 2021

A subset of interstitial lung diseases (ILDs) with autoimmune traits-including connective tissue ... more A subset of interstitial lung diseases (ILDs) with autoimmune traits-including connective tissue disease-associated ILD (CTD-ILD) and interstitial pneumonia with autoimmune features (IPAF)-develops progressive fibrosing (PF)-ILD. The aim of our study was to evaluate the clinical characteristics and predictors of longitudinal lung function (LF) changes in autoimmune PF-ILD patients in a real-world setting. All ILD cases with confirmed or suspected autoimmunity discussed by a multidisciplinary team (MDT) between January 2017 and June 2019 (n 511) were reviewed, including 63 CTD-ILD and 44 IPAF patients. Detailed medical history, LF test, diffusing capacity of the lung for carbon monoxide (DLCO), 6-min walk test (6MWT), blood gas analysis (BGA), and high-resolution computer tomography (HRCT) were performed. Longitudinal follow-up for functional parameters was at least 2 years. Women were overrepresented (70.1%), and the age of the IPAF group was significantly higher as compared to the CTD-ILD group (p < 0.001). Dyspnea, crackles, and weight loss were significantly more common in the IPAF group as compared to the CTD-ILD group (84.1% vs. 58.7%, p 0.006; 72.7% vs. 49.2%, p 0.017; 29.6% vs. 4.8%, p 0.001). Forced vital capacity (FVC) yearly decline was more pronounced in IPAF (53.1 ± 0.3 vs. 16.7 ± 0.2 ml; p 0.294), while the majority of patients (IPAF: 68% and CTD-ILD 82%) did not deteriorate. Factors influencing progression included malignancy as a comorbidity, anti-SS-A antibodies, and post-exercise pulse increase at 6MWT. Antifibrotic therapy was administered significantly more often in IPAF as compared to CTD-ILD patients (n 13, 29.5% vs. n 5, 7.9%; p 0.007), and importantly, this treatment reduced lung function decline when compared to nontreated patients. Majority of patients improved or were stable regarding lung function, and autoimmune-associated PF-ILD was more common in patients having IPAF. Functional decline predictors were anti-SS-A antibodies and marked post-exercise pulse increase at 6MWT. Antifibrotic treatments reduced progression in progressive fibrosing CTD-ILD and IPAF, emphasizing the need for guidelines including optimal treatment start and combination therapies in this special patient group.

Lupus, Aug 4, 2010

Antiphospholipid syndrome (APS) is a distinct clinical entity characterized by arterial and venou... more Antiphospholipid syndrome (APS) is a distinct clinical entity characterized by arterial and venous thromboembolic events, recurrent fetal loss and the presence of antiphospholipid antibodies in the patients' sera. In primary APS, there is no detectable underlying disease, while overlap APS is associated with clinical syndromes including systemic autoimmune diseases, infections, or malignancies. We carried out a retrospective analysis of serological and clinical manifestations as well as assessed outcome-measures in 165 patients with primary APS. Thrombotic manifestations and possible signs of autoimmune diseases were determined at the time of the diagnosis, followed by the analysis of recurrent thrombotic events and effects of therapy during the follow-up period. Among the 165 patients with primary APS at onset, 105 patients (63%) remained primary APS after a mean 5.2 years of follow-up. In 14% of the patients, subsequently APS became associated with various characteristics of undifferentiated connective tissue disease. Finally 23% of patients evolved into a definitive systemic autoimmune disease during a mean 9.75 years of follow-up. Recurrent thrombotic events were registered in 24% of patients. Our results suggest that primary APS may be considered as a potential early phase of a dynamic transition towards a well-defined systemic autoimmune disease.

Clinical Chemistry and Laboratory Medicine (CCLM)

Objectives Rheumatoid factor (RF) is a well-established marker for the diagnosis and classificati... more Objectives Rheumatoid factor (RF) is a well-established marker for the diagnosis and classification of rheumatoid arthritis (RA). Most studies evaluated IgM RF or isotype-nonspecific total RF assays. We evaluated the added value of IgA RF in this context. Methods An international sample cohort consisting of samples from 398 RA patients and 1073 controls was tested for IgA RF with 3 commercial assays. For all RA patients and 100 controls essential clinical and serological data for ACR/EULAR classification were available. Results The sensitivity of IgA RF for diagnosing RA was lower than the sensitivity of IgM RF. Differences in numerical values between IgA RF assays were observed. With all assays, the highest IgA RF values were found in patients with primary Sjögren’s syndrome. Double positivity for IgM RF and IgA RF had a higher specificity for RA than either IgM RF or IgA RF. The sensitivity of double positivity was lower than the sensitivity of either IgA RF or IgM RF. Single posi...

Oral Diseases

ObjectiveOne‐third of the Hungarian population suffers from xerostomia. Since there is no evidenc... more ObjectiveOne‐third of the Hungarian population suffers from xerostomia. Since there is no evidence of the actual prevalence of Sjögren's syndrome (SS) in Hungary, this study aimed to evaluate the same.Materials and MethodsData were collected from the Faculty of Dentistry, Semmelweis University from 2008 to 2015. A diagnosis of SS was established based on the American College of Rheumatology and European League Against Rheumatism criteria.ResultsOf the 1076 patients examined with sicca symptoms, 188 patients had confirmed SS. Primary SS (pSS) was diagnosed in 135 patients and secondary SS (sSS) was confirmed in 53 patients. According to the available statistical records of the public health service of Hungary, there were an average of 16 (0.0014%, 5–26) newly diagnosed SS cases in the entire population and 141 SS patient‐practitioner consultations (49–232) per 100,000 inhabitants in the country over the past 10 years (based on the past 10 years: 2011–2020).ConclusionResults revea...

Annals of the Rheumatic Diseases, 2020

Background: Osseous hydatid cyst is an uncommon disease with weak response to treatment.hydatid d... more Background: Osseous hydatid cyst is an uncommon disease with weak response to treatment.hydatid disease should be included in the differential diagnosis of cystic lesions of bone in endemic regions. Bone cysts account for only 0.5 to 2.5% of all hydatid cysts in humans. Objectives: To report a case of osseous hydatid disease extended on hip and femur Methods: We report a case of osseous hydatid disease Results: A 49 YEAR OLD BRICKLAYER, with no past-medical history and no animal contact, was admitted to our department for a left hip pain. the patient was apyretic and in a good general health condition. He had a very painful walk. the mobilility of the left hip joint was very painful and restricted. The pelvis X-rays showed osteolytic lesions in the ischiopubic branch and in the left femur and proximal extremity of the tibia. The C-Reactive protein value, the protein electrophoresis were normal. tumor markers test was negative. An ultrasound of the hip showed a low abondance intra-ar...