Rheumatoid Meningitis a Rare Extra-Articular Manifestation of Rheumatoid Arthritis: Report of 6 Cases and Literature Review.

Objectives: Central neurological manifestations of rheumatoid arthritis (RA) like rheumatoid meningitis (RM) are rare, little known and have a high rate of morbi-mortality.

Methods: We described six cases of RM that were directly related to RA activity after exhaustive assessment.

Results: They were mainly women, aged of 50 to 69.

[Rheumatoid arthritis : cardiovascular and pulmonary manifestations].

Rheumatoid arthritis (RA) often affects extra-articular structures. Treatments used for arthritis are often also effective on the extra-articular manifestations, but exceptions are numerous, particularly for cardiovascular and pulmonary problems. Cardiovascular disorders mainly include complications related to atherosclerosis : they are probably the main contributor to the increased mortality observed in RA, must be specifically taken into account and largely determine the choice of treatments used to treat RA.

[Risk factors and prophylaxis of Pneumocystis jirovecii pneumonia in HIV-negative patients].

Pneumocystis jirovecii (formely carinii) pneumonia (PcP) affects immunosuppressed patients. Cotrimoxazole prophylaxis has proven to be effective and its indications in HIV patients are well established. In non-HIV patients, the prognosis is poorer and diagnostic tests are of lower sensitivity.

A 64-Year-Old Woman with Chest Pain, Limb Weakness, and Endometrial Cancer.

Necrotizing autoimmune myopathy (NAM) is a rare subgroup of idiopathic inflammatory myopathies (IIM). This pathology usually affects proximal limb muscles and in some cases the myocardium. Patients usually display proximal limb weakness.

Low pre-treatment B-cell counts are not a risk factor of infection in patients treated with rituximab for autoimmune diseases: An observational study.

Objectives: Rituximab (RTX) is increasingly used in patients with refractory rheumatoid arthritis (RA) and other severe autoimmune diseases (AID). In practice, many clinicians are reluctant to prescribe RTX in patients with low B-cell counts because of the presumed risk of infection. The aim of this study was therefore to investigate whether B-cell counts before treatment or retreatment with RTX predict the occurrence of infections.

Methotrexate in chronic-recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized crossover trial.

Introduction: Calcium pyrophosphate deposition (CPPD) may cause severe arthropathy, major joint destruction and treatment options are limited. The aim of this study was to test the therapeutic efficacy of methotrexate (MTX) in chronic or recurrent CPPD arthropathy.

Methods: Patients with CPPD arthropathy were randomized to receive either weekly subcutaneous injections of 15 mg/week of MTX or placebo (PBO) for three months, in a double-blind, crossover randomized controlled trial.

Classification, diagnosis, and management of idiopathic inflammatory myopathies.

The detection and characterization of a large array of autoantibodies, including at least 8 different antisynthetase, anti-SRP, -200/100 (HMGCR), -Mi-2, -CADM-140 (MDA5), -SAE, -p155, -MJ (NXP-2), and -PMS1, frequently associated with distinct and well-defined clinicopathological features, allowed for significant improvement in the definition and diagnosis of idiopathic inflammatory myopathies (IIM). Classification remains difficult, with lingering divergence between the different specialties involved in IIM care, but several categories clearly stand out, including dermatomyositis (DM), overlap myositis (OM), polymyositis, necrotizing myositis, and sporadic inclusion body myositis (s-IBM). Biopsy and histological analysis remain crucial, particularly in the absence of autoantibodies, to accurately specify the diagnosis and rule out mimics such as muscular dystrophies and metabolic myopathies.

Rheumatoid meningitis occurring during adalimumab and methotrexate treatment.

Rheumatoid arthritis is well known for multiple extra-articular manifestations. Here, we present a case of chronic rheumatoid meningitis occurring during treatment with methotrexate and the tumour necrosis factor (TNF) alpha antibody adalimumab. Nine and seven months, respectively, into the course of these two treatments, a 59-year-old Caucasian lady with mild, early, seropositive rheumatoid arthritis developed headaches and psychomotor retardation followed by seizures.

Impact of synthetic and biologic disease-modifying antirheumatic drugs on antibody responses to the AS03-adjuvanted pandemic influenza vaccine: a prospective, open-label, parallel-cohort, single-center study.

Objective: To identify the determinants of antibody responses to adjuvanted split influenza A (H1N1) vaccines in patients with inflammatory rheumatic diseases.

Methods: One hundred seventy-three patients (82 with rheumatoid arthritis, 45 with spondylarthritis, and 46 with other inflammatory rheumatic diseases) and 138 control subjects were enrolled in this prospective single-center study. Controls received 1 dose of adjuvanted influenza A/09/H1N1 vaccine, and patients received 2 doses of the vaccine.

Anti-apolipoprotein A-1 IgG predicts major cardiovascular events in patients with rheumatoid arthritis.

Objective: To determine whether anti-apolipoprotein A-1 (anti-Apo A-1) IgG are associated with major cardiovascular events in patients with rheumatoid arthritis (RA).

Methods: We determined anti-Apo A-1 IgG levels and the concentrations of cytokines, oxidized low-density lipoprotein (LDL), and matrix metalloproteinase 1 (MMP-1) MMP-2, MMP-3, and MMP-9 in sera from 133 patients with RA who did not have cardiovascular disease at baseline, all of whom were longitudinally followed up over a median period of 9 years. A major cardiovascular event was defined as a fatal or nonfatal stroke or acute coronary syndrome.

[Chondrocalcinosis and calcium pyrophosphate (CPP) crystal deposition disease in 2010].

Chondrocalcinosis may be asymptomatic or take three classical forms (acute recurrent inflammatory, chronic inflammatory, with osteoarthritis). Apart form that, CPP crystal arthropathies can mimic several rheumatic diseases, including polymyalgia, septic arthritis and spondylodiscitis. Several conditions can predispose to chondrocalcinosis, including hemochromatosis, hyperparathyroidism, familial hypocalciuric hypercalcemia, hypomagnesemia and treatment with tacrolimus or diuretics.

Influence of cytokine inhibitors on concentration and activity of MMP-1 and MMP-3 in disc herniation.

Introduction: Spontaneous resorption of disc herniation (DH) after sciatica is well documented. The matrix metalloproteinases (MMP)-1 and MMP-3 are enzymes potentially involved in this process. Glucocorticoid injections are commonly used for treatment, and other anti-inflammatory molecules like tumor necrosis factor (TNF) inhibitors are under clinical investigation.

Magnetically retainable microparticles for drug delivery to the joint: efficacy studies in an antigen-induced arthritis model in mice.

Introduction: Conventional corticosteroid suspensions for the intra-articular treatment of arthritis suffer from limitations such as crystal formation or rapid clearance from the joint. The purpose of this study was to investigate an innovative alternative consisting of corticosteroid encapsulation into magnetically retainable microparticles.

Methods: Microparticles (1 or 10 microm) containing both superparamagnetic iron oxide nanoparticles (SPIONs) and dexamethasone 21-acetate (DXM) were prepared.

Anakinra is a possible alternative in the treatment and prevention of acute attacks of pseudogout in end-stage renal failure.

We describe the case of a 71-year-old man with recurrent pseudogout attacks affecting multiple joints. He had end-stage renal failure that contra-indicated the use of non-steroidal anti-inflammatory drugs and was resistant to therapy with glucocorticoids. Based on the recent findings that interleukin (IL)-1beta is involved in crystal-induced inflammation, the patient received anakinra, a specific IL-1 inhibitor, in order to treat an acute attack of pseudogout.

Clinical experience with mycophenolate mofetil in systemic autoimmune conditions refractory to common immunosuppressive therapies.

Objectives: Standard therapies against inflammatory rheumatic diseases consist of immunosuppressive drugs with high toxicities and many side effects. Except in the treatment of systemic lupus erythematosus with renal involvement, controlled studies with mycophenolate mofetil (MMF) are lacking in other autoimmune and inflammatory systemic diseases. Here we describe our clinical experience with MMF in several unusual indications.

Treating difficult crystal pyrophosphate dihydrate deposition disease.

Calcium pyrophosphate dihydrate deposition disease is a common and potentially severe metabolic arthropathy. Early disease (in patients View Article and Find Full Text PDF

Methotrexate as an alternative therapy for chronic calcium pyrophosphate deposition disease: an exploratory analysis.

Objective: To evaluate the effectiveness of methotrexate (MTX), which works not only as an immunosuppressant, but also as a potent antiinflammatory agent, as an alternative therapeutic option for patients with severe calcium pyrophosphate deposition disease (CPDD) who fail to respond to standard therapy with nonsteroidal antiinflammatory drugs and/or glucocorticoids.

Methods: We analyzed, in 2 university hospitals in Switzerland, consecutive patients with CPDD that was resistant to classic treatment and were subsequently treated with MTX. Before and after initiation of MTX therapy, we quantified the frequency of pseudogout attacks, pain intensity, the number of swollen and tender joints, and inflammatory biomarkers.

The new IL-1 family member IL-1F8 stimulates production of inflammatory mediators by synovial fibroblasts and articular chondrocytes.

Six novel members of the IL-1 family of cytokines were recently identified, primarily through the use of DNA database searches for IL-1 homologues, and were named IL-1F5 to IL-1F10. In the present study, we investigated the effect of IL-1F8 on primary human joint cells, and examined the expression of the new IL-1 family members in human and mouse joints. Human synovial fibroblasts (hSFs) and human articular chondrocytes (hACs) expressed the IL-1F8 receptor (IL-1Rrp2) and produced pro-inflammatory mediators in response to recombinant IL-1F8.

Proteasome blockade exerts an antifibrotic activity by coordinately down-regulating type I collagen and tissue inhibitor of metalloproteinase-1 and up-regulating metalloproteinase-1 production in human dermal fibroblasts.

Tissue fibrosis results when dysregulation of extracellular matrix (ECM) turnover favors deposition of collagen and other ECM proteins over degradation. Fibrosis may then lead to organ dysfunction and pathology as observed in systemic sclerosis (SSc). In the present study, we investigated the antifibrotic properties of proteasome blockade.

The effectiveness of anti-tumor necrosis factor therapy in preventing progressive radiographic joint damage in rheumatoid arthritis: a population-based study.

Objective: To compare the effectiveness of 3 therapeutic strategies in preventing progressive joint damage, in a population-based cohort. The 3 strategies were infliximab with concomitant disease-modifying antirheumatic drugs (DMARDs), etanercept with concomitant DMARDs, and etanercept alone.

Methods: We used sequential radiographs to assess all patients who were treated with infliximab or etanercept for >10 months.

[Review of the protective effects of tumor necrosis factor inhibitors in rheumatoid arthritis].

Rheumatoid arthritis (RA) is a chronic in-flammatory disease with progressive joint damage, generally considered irreversible. A more aggressive therapeutic approach is promoted. Progression of joint damage, gradual functional disability and rate of mortality are lowered by disease modifying antirheumatic drugs (DMARD).

[Efficacy of tumor necrosis factor-alpha blockade for severe sciatica?].

The domain of sciatica is at the edge of a mini revolution. For ten years evidence have been accumulating in favour of a local inflammation rather than a pathology resulling only from a nerve compression. This hypothesis has first been strengthened by the discovery of inflammatory mediators in human herniated discs and then by animal models.

The active metabolite of leflunomide, A77 1726, increases the production of IL-1 receptor antagonist in human synovial fibroblasts and articular chondrocytes.

Leflunomide is an immunomodulatory agent used for the treatment of rheumatoid arthritis. In this study, we investigated the effect of A77 1726 - the active metabolite of leflunomide - on the production of IL-1 receptor antagonist (IL-1Ra) by human synovial fibroblasts and articular chondrocytes. Cells were incubated with A77 1726 alone or in combination with proinflammatory cytokines.