Angelo Nigro

Infliximab for the treatment of Neuro-Behçet's disease: A case series and review of the literature

Introduction Behçet’s disease (BD) is a vasculitis in which the hallmark lesions are oral and often genital ulcers. Involvement of parenchymal central nervous system (neuro-Behçet’s) is a serious complication commonly characterized by brainstem and/or basal ganglia lesions. To date, treatment of neuro-Behçet’s remains largely empirical, and may not adequately control the disease (1). Serum tumor necrosis factor (TNF ) levels are increased in active BD (2), suggesting a role for TNF in disease pathogenesis. Clinically, significant improvement of various BD manifestations has been reported with TNF blockade (3). However, evidence for the efficacy of TNF blockers in the treatment of neuro-Behçet’s is scant. We present 8 patients with neuro-Behçet’s who responded favorably to infliximab therapy and review the relevant literature.

Sensitivity of the classification of psoriatic arthritis criteria in early psoriatic arthritis.

Objective. To determine the sensitivity of the CASPAR criteria in patients with early psoriatic arthritis (PsA). Methods. Consecutive patients with a clinical diagnosis of PsA and a disease duration < 12 months were enrolled for study. The proportion of patients meeting the criteria (i.e., the sensitivity) was determined. Results. Forty-four patients with early PsA (23 women, 21 men; mean age 51 yrs, range 16–90) were enrolled. Mean disease duration (± SD) was 15.8 ± 14.3 weeks (range 0.1–50.9 wks). Thirty-four patients satisfied the criteria at the first visit (sensitivity 77.3%). Most patients met the skin and laboratory criterion, i.e., they were rheumatoid factor-negative, while only 2 satisfied the radiologic criterion. Conclusion. Our findings suggest a less satisfactory performance of the CASPAR criteria when applied in early PsA. Lower sensitivity could mainly depend on the small proportion of patients fulfilling the radiologic criterion.

Can we reduce the dosage of biologics in spondyloarthritis

TNF blockers have revolutionized the management of spondyloarthritis (SpA). To date, four anti-TNFα agents (etanercept, infliximab, adalimumab, golimumab) have been approved for the management of ankylosing spondylitis (AS) and psoriatic arthritis (PsA). The first objective in the management of AS and PsA with TNF inhibitors is to reduce disease activity to clinical remission or low disease activity. After remission has been achieved, this state should be maintained as long as possible. However, the financial burden associated with the cost of anti-TNF agents as well as concerns about their long-term safety suggest reducing the dosage of the drug or discontinuing the therapy in the hopes of drug-free remission. The aim of this review is to examine what has, till now, been published on this topic in axial SpA, which includes AS and non-radiographic axial SpA (nr-axSpA), peripheral SpA and PsA. Discontinuation of therapy in axial SpA is not possible in the majority of patients, while on the contrary, reducing the dosage often is. In some patients with peripheral SpA and PsA it is also possible to discontinue therapy and to achieve drug-free remission.

The “Macaroni Sign” of Takayasu’s Arteritis

Takayasu’s arteritis is a large-vessel vasculitis occurring mainly in adolescent girls and young women. Ultrasound of the carotid and subclavian arteries can aid in early diagnosis of the disease. A 19-year-old woman presented with a 4-month history of fatigue, weight loss, and thrombocytosis. Examination showed a difference of 40 mm Hg in systolic blood pressure between the 2 arms, together with a decreased pulse in the left. Noteworthy laboratory results included erythrocyte sedimentation rate …

Anti-TNF agents for the treatment of active non-radiographic axial spondyloarthritis

The spondyloarthritis (SpA) complex includes ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, arthritis related to inflammatory bowel disease and forms that do not meet established criteria for these definite categories which are designated as undifferentiated SpA. In the early 1990s, two sets of classification criteria were suggested with the purpose to cover the whole clinical spectrum of SpA: the Amor criteria and the European Spondylarthropathy Study Group (ESSG) criteria...