[Pancreatic panniculitis with polyarthritis: PPP syndrome].

Background: Diseases of the pancreas may present with extrapancreatic symptoms, such as (poly)arthritis or necrosis of subcutaneous fat. A combination of pancreatitis, panniculitis and (poly)arthritis is referred to as the PPP syndrome, which is associated with acute and chronic pancreatitis, as well as pancreatic malignancies.

Case Description: This article describes a patient which was admitted to our hospital with severe polyarthritis and panniculitis.

Initiating tocilizumab, with or without methotrexate, compared with starting methotrexate with prednisone within step-up treatment strategies in early rheumatoid arthritis: an indirect comparison of effectiveness and safety of the U-Act-Early and CAMERA-II treat-to-target trials.

Objectives: Methotrexate (MTX), often combined with low moderately dosed prednisone, is still the cornerstone of initial treatment for early rheumatoid arthritis (RA). It is not known how this strategy compares with initial treatment with a biological. We therefore compared the effectiveness of tocilizumab (TCZ), or TCZ plus MTX (TCZ+MTX) with MTX plus 10 mg prednisone (MTX+pred), all initiated within a treat-to-target treatment strategy in early RA.

Validation of quantitative salivary gland scintigraphy in relation to the American-European concensus criteria for Sjögren's syndrome.

Purpose: The aim of this retrospective study was to evaluate the diagnostic value of semiquantitative parameters in salivary gland scintigraphy (SGS) in the diagnostic work-up of primary Sjögren's Syndrome (SS) using the American-European consensus criteria (AECC) as the gold standard.

Patients And Methods: 99mTc-pertechnetate-SGS was performed in 110 patients with suspected primary SS. Uptake ratios (URs) and excretion fractions (EFs) for all parotid and submandibular salivary glands were calculated.

Ascending Aortic Aneurysm Secondary to Isolated Noninfectious Ascending Aortitis.

Isolated noninfectious ascending aortitis (I-NIAA) is increasingly diagnosed at histopathologic review after resection of an ascending aortic aneurysm. PubMed was searched using the term aortitis; publications addressing the issue were reviewed, and reference lists of selected articles were also reviewed. Eleven major studies investigated the causes of an ascending aortic aneurysm or dissection requiring surgical repair: the prevalence of noninfectious aortitis ranged from 2% to 12%.

Rheumatoid factor isotype and Ro epitope distribution in primary Sjögren syndrome and rheumatoid arthritis with keratoconjunctivitis sicca.

Primary Sjögren syndrome (pS) is associated with autoantibodies such as rheumatoid factor (RF) and anti-nuclear antibodies such as anti-Ro (SS-A) and/or La (SS-B). Recent developments within autoimmune diagnostics allow quantitation of RF subclasses and anti-Ro epitopes. Will this refinement by autoimmune diagnostics help predicting development of extraglandular manifestations (EGM) in pS patients? A cohort of pS and rheumatoid arthritis (RA) patients with keratoconjunctivitis sicca (n = 35 and 16, resp) was included.

Is extra-glandular organ damage in primary Sjögren's syndrome related to the presence of systemic auto-antibodies and/or hypergammaglobulinemia? A long-term cohort study with 110 patients from the Netherlands.

Aim: To test the hypothesis that systemic auto-antibodies or hypergammaglobulinemia are related to the prevalence of extra-glandular tissue organ damage (EGOD) in primary Sjögren's syndrome (SS).

Methods: A real practice-based investigation of a relatively large (n = 110) Dutch cohort of primary SS patients systematically followed up in a large non-academic hospital.

Results: After a follow up of mean 8.

Necessity of TNF-alpha inhibitor discontinuation in rheumatoid arthritis is predicted by smoking and number of previously used biological DMARDs.

Objectives: Despite the success of TNF-alpha inhibitor (TNFi) treatment in rheumatoid arthritis (RA), a substantial number of patients necessitate discontinuation. Prediction thereof would be clinically relevant and guide the decision whether to start TNFi treatment.

Methods: Data were used from the observational BiOCURA cohort, in which patients initiating biological treatment were enrolled and followed up for one year.

Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): a multicentre, randomised, double-blind, double-dummy, strategy trial.

Background: For patients with newly diagnosed rheumatoid arthritis, treatment aim is early, rapid, and sustained remission. We compared the efficacy and safety of strategies initiating the interleukin-6 receptor-blocking monoclonal antibody tocilizumab with or without methotrexate (a conventional synthetic disease-modifying antirheumatic drug [DMARD]), versus initiation of methotrexate monotherapy in line with international guidelines.

Methods: We did a 2-year, multicentre, randomised, double-blind, double-dummy, strategy study at 21 rheumatology outpatient departments in the Netherlands.

[A woman with a swelling of the right elbow].

A 74-year-old woman with longlasting rheumatoid arthritis came to our clinic because of a swollen bursa olecrani. Aspiration of the swelling yielded a yellow fluid; polarized light microscopy showed cholesterol crystals.

[A man with a red ear].

A 80-year-old man had a red and painful ear with an repeating interval of 1 week. He had a history of COPD, an aortic valve and mitral valve replacement with a bioprosthesis and anterior uveitis. Histological examination of the ear showed relapsing polychondritis.

[Painful, swollen hand after carpal tunnel surgery].

A 45-year-old man presented at the rheumatology outpatient department with a painful swollen hand after carpal tunnel surgery. This is a complication in approximately 2% of all patients due to complex regional pain syndrome.

Look beyond the disease activity score of 28 joints (DAS28): tender points influence the DAS28 in patients with rheumatoid arthritis.

Objective: To explore the influence of tender points (TP) on the Disease Activity Score assessing 28 joints (DAS28) in patients with rheumatoid arthritis (RA).

Methods: In 200 consecutive patients with RA from the outpatient clinic, DAS28 and its components, tender and swollen joint counts (TJC, SJC, respectively), visual analog scale (VAS) for patient's general health (GH), and erythrocyte sedimentation rate (ESR), along with a tender point count (TPC) were assessed. Patients were categorized according to 4 TPC classes: zero, 1-5, 6-10, and ≥ 11 TP.

[A man with calcifications in his legs].

A 70-year-old man had ulcers on his right lower leg for a year; he also had pitting oedema. On X-ray of his legs soft tissue calcifications were seen. These were caused by venous insufficiency.

Relation of systemic autoantibodies to the number of extraglandular manifestations in primary Sjögren's Syndrome: a retrospective analysis of 65 patients in the Netherlands.

Objectives: Extraglandular manifestations (EGM) are often seen in patients with primary Sjögren's syndrome and are probably due to a (more) disturbed immune system. Their relation to systemic autoantibodies remains controversial. We hypothesized that positive serology as reflected by the presence of 1 of more systemic autoantibodies is related to the number of EGM.

Five-year followup of rheumatoid arthritis patients after early treatment with disease-modifying antirheumatic drugs versus treatment according to the pyramid approach in the first year.

Objective: To evaluate whether the clinical advantages observed after 1 year in a randomized controlled clinical trial, in which 2 treatment strategies were compared (the early disease-modifying antirheumatic drug [DMARD] approach versus the pyramid approach), persist after 5 years.

Methods: In this study, 238 patients with recently diagnosed rheumatoid arthritis (RA) were randomized to either the pyramid group (n = 56) or the early DMARD group (n = 182). Patients assigned to the pyramid group received nonsteroidal antiinflammatory drugs for at least 1 year after inclusion (the mean +/- SD lag time until first prescription of a DMARD was 14 +/- 9 months).