Valee Harisdangkul

Leflunomide for the Treatment of Rheumatoid Arthritis and Autoimmunity

&NA; Leflunomide, a new oral immunomodulatory agent, is effective for the treatment of rheumatoid arthritis. Its mechanism of action in suppressing inflammation is based in its inhibition of dihydroorotate dehydrogenase, an enzyme responsible for de novo synthesis of pyrimidine containing ribonucleotides. It is the first disease‐modifying antirheumatic drug approved for treatment of rheumatoid arthritis with an indication for retardation of joint damage by radiography. Side effects are generally mild and include diarrhea, rashes, reversible alopecia, and elevation of hepatic transaminases. Despite the concern about hepatotoxicity, combination use with methotrexate in treating patients with rheumatoid arthritis has been shown to be safe. Other autoimmune diseases in which leflunomide has been used successfully include Felty syndrome, vasculitis, Sjogren syndrome, Wegener granulomatosis, and bullous pemphigoid.

Systemic lupus erythematosus presenting with recurrent acute demyelinating polyneuropathy

We report a patient who in the course of 3 years developed 3 distinct episodes of an acute demyelinating neuropathy, each fulfilling the criteria set up by an ad hoc committee of the National Institute of Neurological and Communicative Disorders and Stroke for acute Guillain-Barré syndrome. Each episode was associated with strong serological evidence for lupus erythematosus. The episodes were separated by 1-2 years and each was followed by near complete clinical recovery. The only systemic feature was a pleural effusion during the last 2 episodes.

Myasthenia gravis and systemic lupus erythematosus: truly associated or coincidental—two case reports and review of the literature

Systemic lupus erythematosus (SLE) andmyasthenia gravis (MG) are autoimmune disorders that have been reported to coexist [1–3]. These two diseases share many pathogenetic and epidemiological features. Several genetic, immunological, and environmental factors said to play a role in causation of these diseases are also common to both [2]. Despite these similarities, they are two distinct clinical syndromes [2]. The coexistence of SLE and MG is well documented, but there have been no controlled epidemiological studies to prove that a real association exists [2]. Here we report two cases of MG in patients with underlying SLE and review current literature.

Mycophenolate mofetil: selective T cell inhibition.

&NA; Mycphenolate mofetil is a suppressor of T cell proliferation and adhesion. Its primary mode of action is inhibition of inosine monophosphate dehydrogenase, a purine salvage pathway required by T lymphocytes. Although the role of T cells in rheumatoid arthritis (RA) has been controversial, a preliminary report of mycophenolate mofetil’s successful use in RA patients clearly suggests that its efficacious properties need further investigation. Its favorable risk/benefit ratio, a broad clinical experience in kidney transplantation, and its recent extension to other rheumatic diseases suggests that this new antirheumatic agent has significant therapeutic potential for suppression of synovial inflammation.

Malignant tumor with chest wall pain mimicking Tietze's syndrome.

Abstract Chest pain is commonly caused by musculoskeletal chest wall disorders. Tietze’s syndrome is a relatively rare cause of chest wall pain characterised by non-suppurative, painful swelling of the upper costal cartilages. The diagnosis should be based on these classic clinical features after excluding other potential causes of pain. A patient who was diagnosed with Tietze’s syndrome but was found to have squamous cell carcinoma of the mediastinum with unknown primary site invading the sternum and anterior chest wall is presented for discussion.