High prevalence of Behçet's disease in southern Italy.

OBJECTIVES: This paper aims to estimate the prevalence of Behçet's disease (BD) in the city of Potenza, the regional capital of Basilicata (or Lucania) Region, in southern Italy. METHODS: Patients with BD living in Potenza for at least 12 months prior to diagnosis were identified through the following sources: general practitioners, community-based specialists, San Carlo Hospital specialists, the Basilicata centralised index and the Basilicata database for rare diseases. All identified patients were contacted by phone and were recalled to our outpatient clinic for re-evaluation. Patients were classified as having complete BD if they met the International Study Group (ISG) criteria for BD. RESULTS: By surveying a population of 69.060 subjects, 13 patients with a diagnosis of BD were identified. All were white and Italian by descendent. Eleven out of these satisfied the ISG criteria and allowed us to obtain a prevalence rate of 15.9 per 100.000 (95%CI 8.9-28.5), which is the highest ever found value in Europe. CONCLUSIONS: This cross-sectional population-based study suggests that BD is more frequent in the southern part than in the northern part of Italy and confirms that the prevalence of the disease increases in a north-to-south manner within the European continent.

Efficacy of adalimumab in patients with Behçet's disease unsuccessfully treated with infliximab.

OBJECTIVES: To evaluate the clinical response after switching from infliximab to adalimumab in patients with Behçet's disease (BD). METHODS: In this ongoing, prospective, longitudinal and observational study, data were collected on efficacy and safety of every patient with BD beginning anti-TNF therapy in the last 8 years. The present analysis was restricted to patients who were switched to adalimumab after failing or not tolerating infliximab. RESULTS: A total of 69 patients with BD have been treated with infliximab so far. Seventeen of these (25%) have been switched to adalimumab for lack or loss of efficacy or infusion reactions. In 10 out of these 17, the main manifestations requiring switching were the mucocutaneous lesions, in 4 retinal vasculitis and in 3 the neurological involvement. Of the 17 treated patients, 9 showed sustained remission of the disease and 3 a good response. No side effects were observed in any patient. CONCLUSIONS: The results of our study suggest that patients with BD showing a scarce response or adverse events to infliximab may successfully be treated with adalimumab, regardless of the reason for switching.

[Etanercept in the treatment of rheumatoid arthritis. A case report]. / Artrite reumatoide in trattamento con etanercept. A proposito di un caso.

Authors present a case of a patient affected by rheumatoid arthritis, non responder to the different DMARDs treatment; besides some of these treatments have even provoked relevant side effects. It has been attempted the use of biological therapy, using etanercept. After some months of this treatment with a high performance of the therapy and great subsidence of the disease, the appearance of a severe infection has compelled the interruption of the therapy, causing very slow recovery. Authors underline the relevant importance of a careful and constant observation of the patients under biological therapy, since it could be always possible the appearance of serious infections.

Can we reduce the dosage of biologics in spondyloarthritis?

TNF blockers have revolutionized the management of spondyloarthritis (SpA). To date, four anti-TNFα agents (etanercept, infliximab, adalimumab, golimumab) have been approved for the management of ankylosing spondylitis (AS) and psoriatic arthritis (PsA). The first objective in the management of AS and PsA with TNF inhibitors is to reduce disease activity to clinical remission or low disease activity. After remission has been achieved, this state should be maintained as long as possible. However, the financial burden associated with the cost of anti-TNF agents as well as concerns about their long-term safety suggest reducing the dosage of the drug or discontinuing the therapy in the hopes of drug-free remission. The aim of this review is to examine what has, till now, been published on this topic in axial SpA, which includes AS and non-radiographic axial SpA (nr-axSpA), peripheral SpA and PsA. Discontinuation of therapy in axial SpA is not possible in the majority of patients, while on the contrary, reducing the dosage often is. In some patients with peripheral SpA and PsA it is also possible to discontinue therapy and to achieve drug-free remission.

Sensitivity of the classification of psoriatic arthritis criteria in early psoriatic arthritis.

OBJECTIVE: To determine the sensitivity of the CASPAR criteria in patients with early psoriatic arthritis (PsA). METHODS: Consecutive patients with a clinical diagnosis of PsA and a disease duration < 12 months were enrolled for study. The proportion of patients meeting the criteria (i.e., the sensitivity) was determined. RESULTS: Forty-four patients with early PsA (23 women, 21 men; mean age 51 yrs, range 16-90) were enrolled. Mean disease duration (+/- SD) was 15.8 +/- 14.3 weeks (range 0.1-50.9 wks). Thirty-four patients satisfied the criteria at the first visit (sensitivity 77.3%). Most patients met the skin and laboratory criterion, i.e., they were rheumatoid factor-negative, while only 2 satisfied the radiologic criterion. CONCLUSION: Our findings suggest a less satisfactory performance of the CASPAR criteria when applied in early PsA. Lower sensitivity could mainly depend on the small proportion of patients fulfilling the radiologic criterion.