[Clinical case of the month. A rare case of arthritis and fever]. / Un cas rare d'arthrite fébrile.

We present the case report ofa 28 year old male presenting with recurrent fever episodes and arthralgia. Based on the presence of an inflammatory syndrome, a hyperferritinemia, a salmon-pink rash and recurrent fever episodes, the diagnosis of an adult onset Still's disease (AOSD) was made. A treatment with corticosteroids was started. During the following years, the corticosteroids could not be tapered. Eventually, a treatment with anakinra, an interleukin 1 (IL-1) receptor antagonist was started, allowing tapering of the corticosteroids. This case report supports the possible role of IL-1 in the pathogenesis ofAOSD, possibly through the inflammasome.

Comparative Study of Real-Life Management Strategies in Gout: Data From Two Protocolized Gout Clinics.

OBJECTIVE: To compare outcomes of 2 gout clinics that implemented different treatment strategies. METHODS: Patients newly diagnosed with gout and a follow-up of 9-15 months were included. Co-primary outcomes were the proportion of patients reaching a serum uric acid (UA) ≤0.36 mmoles/liter and free of flares. Secondary outcomes were the proportion of patients requiring treatment intensification and experiencing adverse events. One clinic adopted a strict serum UA (≤0.30 mmoles/liter target) strategy, with early addition of a uricosuric to allopurinol, and the other clinic adopted a patient-centered (PC) strategy emphasizing a shared decision based on serum UA and patient satisfaction with gout control. Independent t-tests or chi-square tests were used to test differences in outcomes, and logistic regressions were used to adjust the effect of the treatment center on outcomes for confounders. RESULTS: In total, 126 and 86 patients had a follow-up mean ± SD of 11.3 ± 1.8 versus 11.1 ± 1.9 months. In the UA strategy, 105 of 126 patients (83%) compared to 63 of 86 (74%) in the PC strategy (P = 0.10) reached the threshold of ≤0.36 mmoles/liter; and 58 of 126 (46%) versus 31 of 86 (36%) were free of flares (P = 0.15). In the UA strategy, 76 of 126 patients (60%) were on allopurinol monotherapy compared to 63 of 86 (73%) in the PC strategy (P = 0.05), yet the number of adverse events was not different (n = 25 [20%] versus n = 20 [23%]; P = 0.55). Adjusting for confounders did not substantially change these associations. CONCLUSION: A strict UA strategy resulted in a nonsignificantly higher proportion of patients reaching a serum UA ≤0.36 mmoles/liter and being free of flares. This result was accomplished with significantly more therapy intensification. The small sample size plays a role in the significance of results.

Two rare complications of glioblastoma multiforme: persistent hiccup and acquired haemophilia A.

A 69-year-old man was admitted to the hospital with persistent hiccups. Computed tomography and magnetic resonance imaging of the brain were performed and revealed a glioblastoma multiforme localised in the right temporal lobe. After resection, the hiccups disappeared, suggesting that temporal areas are involved in control mechanisms of hiccups. A month later, the patient was readmitted because of skin, mucosal and soft tissue bleedings. Laboratory findings showed a prolonged aPTT, a low factor VIII activity and a factor VIII inhibitor, leading to the diagnosis of acquired haemophilia A. Acquired haemophilia A is a potentially life-threatening haemorrhagic disorder resulting from the presence of antibodies against factor VIII. We believe that this disorder developed due to exposure of factor VIII(-like) tumour antigens to the immune system. This case illustrates two yet unknown complications of a glioblastoma multiforme: persistent hiccups and acquired haemophilia A.