Onycho-pachydermatit with extensive bone marrow edema predominant in the metacarpals: a "forme fruste" of POPP?

Psoriatic onycho-pachydermo-osteo/periostitis (POPP) syndrome is a rare form of psoriatic arthritis with a combination of (i) psoriatic onychodystrophy, (ii) connective tissue thickening, and (iii) periostitis of the distal phalanges. The treatment of the condition has generally been reported to be unsatisfactory with the traditional regimes. Here, we describe a case whom we believe is one presentation of POPP with extensive bone marrow edema of metacarpal bones without distinctive periostitis.

A neuro-Behçet's case complicated with intracranial hypertension successfully treated by a lumboperitoneal shunt.

A 21-year-old man had been diagnosed as having thrombosis of the dural sinus secondary to Behçet's disease. Despite treatment with acetozolamide, azathioprine and methylprednisolone over the ensuing 6 months, he had little improvement in his symptoms of intracranial hypertension and required frequent lumbar CFS drainage. The patient then underwent lumboperitoneal shunt operation, which resulted in rapid resolution of papilledema and gradual improvement in the visual field. In conclusion, we suggest that in BD patients with dural sinus thrombosis, in whom the intracranial hypertension developed but failed to normalize after treatment with immunosuppressive agents, lumboperitoneal shunting should be considered as an effective therapeutic tool.

Anterior spinal cord syndrome in a patient with Behçet's disease.

Although neurological involvement in Behçet's disease is not so uncommon, isolated spinal cord disease is quite rare and reported to be observed in about 2% of all cases with neurological involvement. Here we report a Behçet's patient with spinal cord disease presented with anterior spinal cord syndrome. This rare syndrome is caused by hypoperfusion of the anterior spinal artery and to our knowledge has not been previously reported in patients with Behçet's disease. This report defines the characteristic clinical features of this entity and emphasizes the importance of early immunosuppressive treatment and initiation of rehabilitation.

TNF inhibitors for rheumatoid arthritis - a year in review.

The identification of tumor necrosis factor-alpha (TNF-a) as an important mediator in the pathogenesis of rheumatoid arthritis (RA) led to the development of TNF inhibitors (TN- FIs), which has ushered in a revolution not only in therapies for RA, but other rheumatic diseases as well. Treatment strategies for RA will continue to evolve as new agents are developed and as new data become available. This article provides a summary of clinical studies with TNFIs conducted in RA patients and reported over the previous 18 months based on a PubMed search using the terms TNFIs (with their individual generic names) and RA.

TNF inhibitors - new and old agents for rheumatoid arthritis.

The development of tumor necrosis factor (TNF) inhibitor therapy has revolutionized the treatment of rheumatoid arthritis (RA). Unfortunately, no one single agent is fully effective in every patient; different patients respond to different therapies in different ways, even to those agents with the same mechanism of action. In this regard, newer TNF inhibitor agents, such as golimumab and certolizumab pegol, are a welcome addition to the treatment armamentarium of RA. This article addresses some of the recent advances in TNF inhibitor therapy for RA, including therapy involving these two newer agents and recent recommendations about well established TNF inhibitors (infiximab, etanercept, adalimumab) that may affect various aspects of RA treatment strategies.