Clinical outcomes and safety of rituximab treatment for patients with systemic lupus erythematosus (SLE) - results from a nationwide cohort in Germany (GRAID).

OBJECTIVE: The objective of this article is to evaluate the safety and clinical outcome of rituximab treatment in systemic lupus erythematosus (SLE) patients refractory to standard of care therapy in a real-life setting in Germany. METHODS: The GRAID registry included patients with different autoimmune diseases who were given off-label treatment with rituximab. Data on safety and clinical response were collected retrospectively. In SLE patients, clinical parameters included tender and swollen joint counts, fatigue, myalgia, general wellbeing, Raynaud's and the SLEDAI index. Laboratory tests included dsDNA antibody titres, complement factors, hematologic parameters and proteinuria. Finally, the investigators rated their patients as non-, partial or complete responders based on clinical grounds. RESULTS: Data from 85 SLE patients were collected, 69 female and 16 male, with a mean disease duration of 9.8 years. The mean follow-up period was 9.6 ± 7.4 months, resulting in 66.8 patient years of observation. A complete response was reported in 37 patients (46.8%), partial response in 27 (34.2%), no response in 15 (19.0%). On average, major clinical as well as laboratory efficacy parameters improved substantially, with the SLEDAI decreasing significantly from 12.2 to 3.3 points. Concerning safety, one infusion reaction leading to discontinuation of treatment occurred. Infections were reported with a rate of 19.5 (including six severe infections) per 100 patient years. CONCLUSION: With the restrictions of a retrospective data collection, the results of this study confirm data of other registries, which suggest a favourable benefit-risk ratio of rituximab in patients with treatment-refractory SLE.

Fish, flesh and a good red herring: a case of ascending upper limb infection in a renal transplant patient.

While newly developed potent immunosuppressive agents have dramatically reduced the incidence of rejection of transplanted organs, they have increased the patients' susceptibility to opportunistic infections and cancer. Here we report a rare skin infection caused by atypical mycobacterium marinum in a 50-year-old female renal transplant recipient. The patient presented with localized skin lesion on the dorsum of her hand, which was misdiagnosed as gout. Only after the lesions spread in a sporotrichoid pattern, a cutaneous infection with atypical mycobacteria was suspected. The diagnosis was based on histopathological analysis as well as mycobacterial culture, both showing infection with atypical mycobacterium. Three months of antimycobacterial treatment led to a marked regression of the lesions. Sporotrichoid lesions in renal transplant patients are rare and a diagnostic challenge for the physician. A thorough history and a low threshold for skin biopsies could prevent painful and unnecessary surgical interventions.

Kinetics of the alizarine red S surface redox reaction.

Kinetics of the surface redox reaction of alizarine red S adsorbed on mercury is measured by square-wave voltammetry. In 1 mol/l KNO(3) buffered to pH 9.22, the standard reaction rate constant of the redox couple anthraquinone/anthrahydroquinone in the adsorbed alizarine red S molecule is k(s)=100 +/-10 s(-1) and the cathodic transfer coefficient is alpha=0.4. At pH 2 in this medium k(s) is greater than 500 s(-1).

A Prussian blue-based reactive electrode (reactrode) for the determination of thallium ions.

A reactive electrode (reactrode) made of Prussian blue (PB), graphite and paraffin can be used for a selective determination of thallium ions down to a concentration of 2. 10(-8) mol 1(-1). The working principle of the reactrode is that thallium ions can be pumped into Prussian blue during alternating oxidation-reduction cycles. After a preconcentration of thallium ions in PB, the voltammetric determination follows as usually in anodic stripping voltammetry, i.e. the thallium ions are reduced to thallium metal which is subsequently oxidized to give the anodic stripping signal. The peculiarity of the Prussian blue-thallium system is that the thallium ions are situated in the holes of the PB matrix. When reduced to metallic thallium, they are substituted by potassium ions. Cd(2+), Fe(3+), Zn(2+), Cu(2+) and Ni(2+) do not interfere up to a hundredfold excess, NH(4)(+) does not interfere up to a thousandfold - and Bi(3+) up to tenfold excess. The interference by Pb(2+) can be suppressed with EDTA.

Measurement of the kinetics of adsorbed cinnoline by square-wave voltammetry.

The standard redox reaction rate constant of cinnoline (1,2-benzodiazine) adsorbed to the mercury electrode in 0.9 mol L(-1) KNO(3) buffered to pH 7, 9.2, and 4.65 are k(s)=455+/-110 s(-1), 65+/-25 s(-1), and 300+/-75 s(-1), respectively.