The Schnitzler syndrome: chronic urticaria and monoclonal gammopathy--an autoinflammatory syndrome?

Schnitzler syndrome describes the simultaneous occurrence of monoclonal gammopathy and chronic urticaria with at least two additional minor symptoms (arthralgia, bone pain, fever of uncertain origin, hepato- or splenomegaly, lymphadenopathy, increased erythrocyte sedimentation rate, leukocytosis/thrombocytosis or increased bone density). Schnitzler syndrome is not wellknown and very likely under-recognized. Comprehensive diagnostic examinations are necessary to rule out other diseases, especially those of hematologic origin. Close interdisciplinary collaboration is mandatory. The etiology of Schnitzler syndrome is unclear, but the rapid response to the interleukin-1 receptor inhibitor anakinra underlines the pivotal role which the proinflammatory cytokine interleukin-1 may play in the pathophysiology of this potentially autoinflammatory disorder.

Schnitzler syndrome: treatment failure to rituximab but response to anakinra.

Schnitzler syndrome is a rare disease characterized by a chronic urticarial rash and a monoclonal gammopathy. The exact pathogenesis is still uncertain and treatment remains a challenge. Here, we report a patient who was only recently given the diagnosis of Schnitzler syndrome although the typical symptoms had been present for about 6 years. Administration of the B-cell antibody rituximab did not exert any beneficial effect despite effective elimination of B cells and a reduction of the paraprotein. In contrast, injection of the interleukin-1-receptor antagonist anakinra caused a complete remission within a few days.

A controlled prospective case control study of a prevention training program in female team handball players: the German experience.

BACKGROUND: Few authors have investigated the effectiveness of preventive intervention in European team handball. PURPOSE: The aim of the present study was to evaluate the effects of a prevention program on the incidence of injuries in female European team handball players. STUDY DESIGN: Prospective controlled study. METHODS: Ten female handball teams (134 players) took part in the prevention program (1. Information about injury mechanism, 2. Balance-board exercises, 3. Jump training) while 10 other teams (142 players) were instructed to train as usual. Over one season all injuries were documented weekly. RESULTS: Ankle sprain was the most frequent diagnosis in both groups with 11 ankle sprains in the control group and 7 ankle sprains in the intervention group (Odds ratio: 0.55, 95% confidence interval: 0.22-1.43). The knee was the second frequent injury site. In the control group 5 of all knee injuries were anterior cruciate ligament (ACL) ruptures (incidence: 0.21 per 1000 h) in comparison with one in the intervention group (incidence: 0.04 per 1000 h). Odds ratio was 0.17 with 95% confidence interval of 0.02-1.5. CONCLUSIONS: This study confirms that proprioceptive and neuromuscular training is appropriate for the prevention of knee and ankle injuries among female European team handball players.