João Rovisco

A case of infliximab-induced lupus in a patient with ankylosing spondylitis: is it safe switch to another anti-TNF-α agent?

Anti-TNF-α therapies are the latest class of medications found to be associated with drug-induced lupus, a distinctive entity known as anti-TNF-α-induced lupus (ATIL) (Williams et al., Rheumatology (Oxford) 48:716–20, 2009; De Rycke et al., Lupus 14:931–7, 2005; De Bandt et al., Clin Rheumatol 22:56–61, 2003). With the widespread use of these agents, it is likely that the incidence of ATIL will increase. The onset of ATIL in patients with rheumatoid arthritis and Crohns disease has been described, but the literature regarding the occurrence of this entity in patients with ankylosing spondylitis (AS) is scarce (De Bandt et al., Clin Rheumatol 22:56–61, 2003; Ramos-Casals et al., Autoimmun Rev 9:188–93, 2010; Perez-Garcia et al., Rheumatology 45:114–116, 2006). To our knowledge, few reports of switching anti-TNF-α therapy after ATIL in AS have been reported (Akgül et al., Rheumatol Int, 2012). Therefore, it is not clear whether the development of ATIL should prohibit switch to another therapy, since patients may respond to another anti-TNF-α agent (Akgül et al., Rheumatol Int, 2012; Bodur et al., Rheumatol Int 29:451–454, 2009; Mounach et al., Clin Exp Rheumatol 26:1116–8, 2008; Williams and Cohen, Int J Dermatol 50:619–625, 2011; Ye et al., J Rheumatol 38:1216, 2011; Wetter and Davis, Mayo Clin Proc 84:979–984, 2009; Cush, Clin Exp Rheumatol 22:S141–147, 2004; Kocharla and Mongey, Lupus 18:169–7, 2009). A lack of published experience of successful anti-TNF-α switching is a cause of concern for rheumatologists faced with this challenging clinical scenario. We report the case of a 69-year-old woman with AS who developed infliximab-induced lupus, which did not recur despite the subsequent institution of etanercept. The authors review and discuss ATIL and the possible implications for subsequent treatment with alternative anti-TNF-α agents.

Coexisting primary Sjögren’s syndrome and sarcoidosis: coincidence, mutually exclusive conditions or syndrome?

Herein, we describe a 44-year-old female diagnosed with histologically proven coexistence of primary Sjögren’s syndrome and sarcoidosis with pulmonary and muscular involvement. The differential diagnosis may be difficult, but this is not an exceptional case, which highlights the need to critically revise the consideration of sarcoidosis as an exclusion for primary Sjögren’s syndrome, as established in current classification criteria.

Erratum to: Hidden musculoskeletal involvement in inflammatory bowel disease: a multicenter ultrasound study

Author details Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof Mota Pinto, Coimbra 3000-075, Portugal. Rheumatology Unit, L. Sacco University Hospital, Milan, Italy. Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy. Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Division of Musculoskeletal and Rheumatic diseases, National Institute of Rehabilitation, Mexico city, Mexico.

AB0631 Efficacy and safety of urine alkalinization for patients with uric acid nephrolithiasis with or without gout arthritis:. a systematic review

Background Gout is a complex metabolic and inflammatory disease with varying clinical presentations including gouty arthritis, uric acid nephrolithiasis and renal impairment. Urine alkalinization may be a useful adjunct in the management of gout. As part of the 3e initiative for generating recommendations for the diagnosis and management of gout, we performed a systematic review using Cochrane methods to determine the efficacy and safety of urine alkalinization in patients with uric acid nephrolithiasis with or without gouty arthritis. Objectives Determine the efficacy and safety of urine alkalinization in patients with uric acid nephrolithiasis with or without gouty arthritis. Methods We searched Medline, EMBASE and Cochrane databases to March 2012, and 2010-11 ACR/EULAR abstracts to identify all randomized controlled trials (RCTs) and quasi-RCTs that compared urine alkalinization to placebo or another therapy in people with uric acid nephrolithiasis with or without gouty arthritis. Primary outcomes were uric acid stone regression and withdrawals due to adverse effects. Two review authors independently selected studies for inclusion, assessed risk of bias (RoB) and extracted data using Cochrane methods. Results A total of 7103 articles were identified, of which 76 articles were selected for detailed review and two fulfilled inclusion criteria. One trial (60 participants) was judged to be at low risk of bias (RoB) and compared potassium citrate to phytotherapy. At 12 weeks, 14/30 (47%) people who received potassium citrate achieved uric acid stone remission compared to 9/30 (30%) in the phytotherapy group (P=0.05). The other trial (191 participants) was judged to be at unclear RoB and compared four treatment arms: potassium citrate and tamsulosin versus placebo or potassium citrate or tamsulosin. At 4 weeks, 27/46 (59%) who received potassium citrate achieved stone remission compared to 12/46 (26%) in the placebo group (P=0.003). There were no withdrawals in either trial due to adverse events. Conclusions There is limited evidence from two trials (1 at low RoB and 1 at unclear RoB) that urine alkalinization may be an efficacious and safe treatment for patients with uric acid nephrolithiasis with or without gouty arthritis. Disclosure of Interest None Declared