CT-P13 subcutaneous infliximab in gastroenterology and rheumatology.

The drug infliximab has been a key milestone in the treatment of inflammatory conditions such as Crohn's disease, ulcerative colitis, rheumatoid arthritis and the seronegative spondyloarthritides. Biosimilar drugs followed the originator, further improving access and diversity of therapy choice. Subcutaneous infliximab (CT-P13) holds potential for greater patient flexibility by self administration, reducing travel and hospital attendance for infusion, particularly relevant at a time of pandemic. We highlight the pharmacodynamic and pharmacokinetic basis of the subcutaneous device, clinical trials in rheumatology and gastroenterology and consider the safety and cost implications. Real-world switching data is required to confirm the efficacy data from clinical trials given the reduction in dosing flexibility compared with intravenous therapy.

Raynaud's of the Tongue.

We describe a 40-year-old lady who presents with a painful white tongue on exposure to the cold. The differential diagnosis and investigations are outlined with a discussion about this unusual presentation of a common problem. LEARNING POINTS: Raynaud's can affect areas of the body besides the digits.Lingual Raynaud's should be considered in patients with transient tongue pain.Alternative diagnoses should be sought if ulceration or permanent symptoms develop.

Neurosyphilis Presenting with Papillitis.

Syphilis is one of the oldest described infectious diseases in the world and is caused by the spirochete bacterium Treponema pallidum [1]. Although now a rare disease, incidence is increasing with the number of diagnoses of the disease rising in England from 1688 to 2713 between 2003 and 2012 (a 61% increase)[2]. Major outbreaks of syphilis have been documented in London, Manchester, Dublin, and Brighton particularly among men who have sex with men (MSM)[3]. Diagnosis remains difficult on account of multi-system symptoms, duration of the condition, and social stigma. LEARNING POINTS: Normal CSF pressure with indistinct optic disc margins suggests papillitis, not papilloedemaNeurosyphilis can cause various ocular symptoms and is a cause of unexplained high ESRWhen treating with penicillin, the physician should be aware of a potential Jarish-Herzheimer reaction.