Effectiveness and safety of adalimumab compared with leflunomide in patients with Takayasu arteritis: a retrospective cohort study.

OBJECTIVE: This study aims to evaluate the effectiveness and safety of adalimumab (ADA) compared with leflunomide (LEF) in patients with Takayasu arteritis (TAK). METHOD: A retrospective cohort study was performed with the following inclusion criteria: the fulfilment of the 2022 American College Classification/European Alliance of Associations for Rheumatology criteria for TAK, age ≥18 years, and written informed consent. Forty-four patients were treated with LEF (n=28) or ADA (n=16) therapy due to relapsing/refractory disease or toxicity from previous therapy. Patients were evaluated at baseline (T0), at a median of 7.0 months (T1) and at 15.0 months of follow-up (T2). Data regarding disease activity, daily dose of prednisone, side effects and angiographic progression were analysed. RESULTS: LEF and ADA groups had similar features on the baseline visit. However, intravenous methylprednisolone was more frequently prescribed for the ADA group (p=0.019). On T1 and T2 visits, complete response rates were similar for ADA and LEF groups (75.0% and 88.5%; p=0.397 and 62.5% vs 78.3%; p=0.307), respectively. The differences remained non-significant after adjusting for baseline variables by propensity score matching. Although the ADA group had a higher median daily prednisone on visit T1 (p=0.004), it was similar on visit T2 (p=0.595). Similar rates of angiographic progression were observed in ADA and LEF groups (40% vs 25%; p=0.467). Mild-to-moderate adverse events were observed only in the LEF group (17.9%). CONCLUSION: LEF and ADA had comparable outcomes after a median of 15.0 months of follow-up. However, withdrawal from therapy and mild-to-moderate adverse events were only observed in the LEF group.

Musculoskeletal ultrasound findings in paracoccidioidomycosis.

Paracoccidioidomycosis is a fungal infection endemic to South America. The infection is usually asymptomatic and mostly affects the upper and lower respiratory tracts with clinical-radiological dissociation. Joint involvement is rare with no specific pattern or radiological injury. We report a case of paracoccidioidomycosis in which the patient's initial symptoms were hoarseness and arthritis. After an ultrasound examination, we performed the differential diagnosis of other noninfectious arthropathies and analysis of the material collected, which revealed infection with the fungus Paracoccidioides brasiliensis.

Achados ultrassonográficos osteomusculares na paracoccidioidomicose / Musculoskeletal ultrasound findings in paracoccidioidomycosis

Resumo A paracoccidioidomicose é uma infecção fúngica endêmica na América do Sul. A infecção geralmente é assintomática e afeta principalmente os tratos respiratórios superior e inferior, com dissociação clínico-radiológica. O envolvimento articular é raro, sem um padrão ou lesão radiológica específica. Apresenta-se um relato de caso de paracoccidioidomicose em que os sintomas iniciais do paciente foram rouquidão e artrite. Depois de um exame de ultrassonografia, foram feitos o diagnóstico diferencial de outras artropatias não infecciosas e a análise do material coletado, que revelou infecção pelo fungo Paracoccidioides brasiliensis.

Abstract Paracoccidioidomycosis is a fungal infection endemic to South America. The infection is usually asymptomatic and mostly affects the upper and lower respiratory tracts with clinical–radiological dissociation. Joint involvement is rare with no specific pattern or radiological injury. We report a case of paracoccidioidomycosis in which the patient's initial symptoms were hoarseness and arthritis. After an ultrasound examination, we performed the differential diagnosis of other noninfectious arthropathies and analysis of the material collected, which revealed infection with the fungus Paracoccidioides brasiliensis.