Tachon's syndrome (suracute back and/or thoracic pain following local injections of corticosteroids). A report of 318 French cases.

OBJECTIVES: To assess the frequency, features, and outcome of excruciating lumbar, dorsal, and/or thoracic pain following injections of local corticosteroids in rare instances. METHODS: A questionnaire mailed to 500 French rheumatologists. RESULTS: Three hundred and eighteen cases were reported by 92 rheumatologists (one event per 8000 injections or 6.5 years of practice), following injections into lumbar epidural space (39%), an upper limb (30%), a lower limb (mostly the heel) (24%), or other locations (7%), of cortivazol (67%), hydrocortisone (25%), betamethasone (7%), or paramethasone (1%). Symptoms occurred 1-5 min (78%) or less than 1 min (22%) after injection, and highly acute axial pain usually lasted for less than 5 min (34%) or 5-15 min (51%). In addition to pain in lumbar (84%) and/or dorsal regions (25%) [often preceded or associated with thoracic pain (36%)], other signs were: anxiety (87%), shortness of breath (64%), facial flushing (64%), diffuse sweating (41%), agitation (29%), transient cough (23%), abdominal pain (20%), transient hypertension (15%), paleness (10%), hypotension (8%), diarrhoea (3%) and headache (3%). None of these patients was known to be allergic, and urticaria developed in only 2%. Outcome was favourable in all cases (even though 4/318 patients were transiently hospitalised) with an overall duration of 25 +/- 71 min. Another injection was performed later in 146/318 cases (46%), but Tachon's syndrome recurred in only 20 of these 146 patients (14%). CONCLUSION: The outcome of this impressive syndrome seems excellent. Tachon's syndrome might be the venous counterpart of Nicolau's syndrome (injection of corticosteroids in an artery).

High intraindividual week-to-week variability in BASDAI and BASFI values: are several evaluations needed before starting or stopping TNFalpha antagonist therapy for spondyloarthropathies?

OBJECTIVE: To evaluate intraindividual variability of the BASDAI, BASFI, and HAQ in patients with spondyloarthropathies. METHODS: The three variables were collected prospectively in 24 patients, once a week for 30 weeks. They were also collected retrospectively in 31 patients on stable infliximab regimens with a mean of 11.5+/-4 injections, starting at the fourth infusion. RESULTS: The BASDAI and BASFI showed high intraindividual variability from week to week; SDs greater than 1 were found for the BASDAI in 14/24 patients and for the BASFI in 10/24 patients, and ranges greater than 4/10 occurred for the BASDAI in 13/24 patients and for the BASFI in 10/24 patients. Although the mean BASDAI was greater than 4 in only 6/24 patients, values greater than 4 occurred on one or more occasions in 19 (79%) patients. The retrospective study of infliximab-treated patients from the fourth infusion onward also showed high variability of BASDAI and BASFI values, with SDs greater than 1 in 18/31 patients and ranges greater than 4 in 14/31 patients and greater than 2 in 22/31 patients. CONCLUSION: Repeated determination of the BASDAI and BASFI by the patients (using paper forms or personal digital assessments) may help to identify candidates for treatment intensification, to optimize infliximab injection regimens in good responders, and to avoid unnecessary switching from one TNFalpha antagonist to another.

25 mg etanercept once weekly in rheumatoid arthritis and spondylarthropathy.

OBJECTIVE: To assess the clinical results at 6 months of etanercept 25 mg once weekly (half-dose), and etanercept 25 mg twice weekly (full-dose), in patients with rheumatoid arthritis or spondylarthropathy. METHODS: Case records of all patients treated by etanercept for at least 6 months in the same rheumatology unit were retrospectively studied, to assess the mean values of DAS-28 and BASDAI, just before (J0), and after 6 months (M6) of treatment, in patients with rheumatoid arthritis or spondylarthropathy treated with etanercept 25 mg given either once or twice weekly. RESULTS: 112 patients had been treated for at least 6 months (44 at half-dose, and 68 at full-dose). Values of DAS-28 or BASDAI both at J0 and M6 were available in 92 patients. DAS-28 dramatically improved both in the half-dose group (from 5.2+/-0.8 to 3.5+/-0.8) and in the full-dose group (from 5.5+/-1.0 to 4.1+/-1.0). BASDAI also strikingly improved both in the half-dose group (from 60+/-13 to 25+/-18), and in the full-dose group (from 58+/-15 to 37+/-23). CONCLUSION: Although this was not a double-blind, prospective, randomised study, the strong improvement noticed in the half-dose group suggests that etanercept 25 mg once a week can induce major clinical and biological relief in some patients with RA or spondylarthropathy.